Often considered as a kind of deteriorated form of common psychotherapy, support therapy is nervertheless the most common form used by psychologists and psychotherapists and has its own context of application. It is from this paradox that Schmitt attempted to conceptualize this modality of caregiving, in 2012.
First, support is a large concept. It can be initiated by every human who wants to help, console or prevent the torments of someone. In every support relationship, the care taker shows attitudes like listening, empathy, comprehension and lack of judgement, However, a support relationship between a caregiver and a patient does not imply the same modalities than two people in a friend relationship. According to the author, the clinician psychologist must have a clear conscious of the frame in which a supporting therapy can happen. As every kind of psychotherapy, it take its place in the frame of a request formulated by the patient himself. It turns on three dimensions : comprehension, guidance and backing. The support psychotherapies have an humanist aim : to prevent torments, to repair and to sooth. It can precede or follow up a more specific analytic or cognitive psychotherapy or even be a kind of psychotherapy itself.
As a general rule, the purpose of every kind of psychotherapy (psychoanalytical, humanist or cognitive) for a major part of clinician psychologists is to establish a self reflection, a greater knowledge to the patients of themselves and a personal development in a long period. In contrast, the support psychotherapy is proposed to the patient in the case of situations which lead individuals to a incapacity to reflect. For the author, it concerns the period of mourning (real or symbolic), but it can be applied to patients who present a major psychic damage (depression, a chronic anxiety, harsh period of schizophrenia etc). Indeed, for these patients, it can be very difficult to elaborate, to think, to feel or to describe their affects.
Though, it is that specific psychic work which is expected in the longer and more technique treatments. Consequently and first of all, the support psychotherapy is offered to allay conflicts, to reduce symptoms and anxiety or sadness the subject is going through. « We’re talking about patients who want quick solutions, who need reinsurance and who don’t want to reflect or to pour out one’s feelings to anybody » (Schmitt, 2012).
The support psychotherapy can also be applied when patients come with a more precise request, clear expectations, without the need or the will to engage himself in a longer therapy. Nevertheless, as in the other kinds of psychotherapies, the psychologist identifies the psychic conflicts, the defense mechanisms, the automatic or dysfunctional thoughts, the psychic structure and the patient’s link to the reality. From dialogue and reflection, these data allow to understand how the individual works and then the way to initiate changing. So, this kind of psychotherapy will be centered on the adaptability of the subject to his reality, and the mixing of empathetic verbal exchange and suggestion technics, including persuasion. It will happen in the form of a directive and pedagogic relationship, with advice and encouragement.
Most support consultations last about half an hour. The place of meetings and the care purposes depend on the situation : if it is a crisis period or a chronic situation. These points will be discussed with the patient. Ideally, a support psychotherapy has to be adapted to the needs and the will of the patient. For a lot of authors, the eclecticism is the main idea when we talk about support psychotherapies. Indeed, these are not linked to a theoretical framework, but are more a set of technics. Then, the psychologist has to be creative to choose the therapy and the technics the most adapted to the present situation dependently of the subject he meets. In reality, it is often guided by the current the psychologist is familiar to. According to Schmitt, the symptom reducing, the affective channelling, the self-esteem gain and the learning of new reactions ways is beyond the frame of a unique therapy. The creation of a therapeutic alliance would be the mainspring of this change, whatever the type of psychotherapy we talk about.
Finally, we can highlight four specific techniques for support psychotherapy : the interpretation, the encouragement to work out repressed emotions, the advice and the praise. Concerning these formers, the clinician psychologist will take care to the direction and the aim to which it tends. The purpose is not to upset the patient and not to reinforce some of his defense mechanisms. It will depend on the context of these interventions. The advice and the praise prompt the psychologist to go out of his neutrality, so they lead him to make a stand, to express an opinion and to adopt a more or less marked suggestive attitude.
In conclusion, it seems important to distinguish support psychotherapy from other kinds of psychotherapies. They can all rely on the same mechanisms, but support psychotherapry requires a specific frame and processes. The support psychotherapy answers to proper care objectives, to which classic psychotherapy couldn’t answer completely if not at all. It is intended to subjects going through a period of crisis or fragility and threatened by regression, desorganization or dependence , for whom the capacities of insight and consciousness-raising are weak. Then, the question will be to initiate a clearly defined period of treatment during which the conditions to transform suffering in a problem are settled. It means that the psychologist has to support and mobilize the patient’s resources to a narcisistic repairing, which would be the first step to problem identification , then to working out repressed emotions and more important to an integration. For Schmitt, the endeavours to conceptualize this kind of psychotherapy are not enough and have to be pursued in order to let it take a real place in the large field of psychotherapies.
Schmitt, L. (2012). La psychothérapie de soutien. Paris : Elsevier Masson.
Annabelle MERCIER, Sarah TEBOUL, Ophélie MASSICOT
