Unipolar depression in adults: Supportive psychotherapy
- Julie Lord, MD
Julie Lord, MD
- Assistant Residency Training Director,
- University of Washington Outpatient Psychiatry Clinic
- Kimberly D McLaren, MD
Kimberly D McLaren, MD
- Assistant Professor of Health Services and Psychiatric Epidemiology
- University of Washington Medical School
- Mitchell Levy, MD
Mitchell Levy, MD
- Assistant Professor of Health Services and Psychiatric Epidemiology
- University of Washington School of Medicine
Supportive psychotherapy is used to treat depression by improving self-esteem, psychological functioning, and adaptive skills . Therapy focuses upon current, problematic relationships and maladaptive patterns of behavior and emotional responses .
Supportive psychotherapy is used to treat a variety of psychiatric illnesses other than depression, including anxiety disorders, schizophrenia, substance use disorders, and personality disorders . A survey of psychiatrists in 1998 found that 36 percent of them used supportive psychotherapy, often in conjunction with pharmacotherapy .
This topic reviews supportive psychotherapy for treating depression in adults. The initial treatment of depression; treatment of resistant depression; treatment of late-life depression; and diagnosis, prognosis, epidemiology, pathogenesis, and neurobiology of depression are discussed separately.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hellerstein DJ, Rosenthal RN, Pinsker H, et al. A randomized prospective study comparing supportive and dynamic therapies. Outcome and alliance. J Psychother Pract Res 1998; 7:261.
- Winston, A. Supportive psychotherapy. In: The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition, Hales, RE, Yudofsky, SC, Gabbard, GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2008. p.1257.
- Buckley, PJ. Applications of individual supportive psychotherapy to psychiatric disorders. In: Textbook of Psychotherapeutic Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2009. p.447.
- Tanielian TL, Marcus SC, Suarez AP, Pincus HA. Datapoints: Trends in psychiatric practice, 1988-1998: II. Caseload and treatment characteristics. Psychiatr Serv 2001; 52:880.
- Winston, A, Rosenthal, RN, Pinsker, H. Introduction to supportive psychotherapy, 1st ed, American Psychiatric Pub., Washington, DC 2004.
- Hellerstein, DJ, Pinsker, H, Rosenthal, RN, Klee, S. Supportive Therapy as the Treatment Model of Choice. J Psychother Pract Res 1994; 3:300.
- Pinsker, H. A primer of supportive psychotherapy, Analytic Press, Hillsdale, NJ 1997.
- Dewald PA. Principles of supportive psychotherapy. Am J Psychother 1994; 48:505.
- Hellerstein, DJ. Combining supportive psychotherapy with medication. In: Textbook of Psychotherapeutic Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2009. p.465.
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, third edition. Am J Psychiatry 2010; 167 (supplement):1.
- Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition www.psych.org/guidelines/mdd2010.
- Depression: the treatment and management of depression in adults (update). www.NICE.org.UK/CG90 (Accessed on October 12, 2010).
- Parikh SV, Segal ZV, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication. J Affect Disord 2009; 117 Suppl 1:S15.
- Misch DA. Basic strategies of dynamic supportive therapy. J Psychother Pract Res 2000; 9:173.
- Douglas CJ. Teaching supportive psychotherapy to psychiatric residents. Am J Psychiatry 2008; 165:445.
- Winston, A, Goldstein, M. Theory of supportive psychotherapy. In: Textbook of Psychotherapeutic Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2009. p.393.
- Rosenthal, RN. Techniques of individual supportive psychotherapy. In: Textbook of Psychotherapeutic Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Inc., Washington, DC p.417.
- Gabbard, GO. Psychodynamic psychiatry in clinical practice, 4th ed, American Psychiatric Pub., Washington, DC 2005.
- Rockland, LH. Supportive therapy : a psychodynamic approach, Basic Books, New York 1989.
- Rockland LH. Psychoanalytically oriented supportive therapy: literature review and techniques. J Am Acad Psychoanal 1989; 17:451.
- Gabbard, GO. Techniques of psychodynamic psychotherapy. In: Textbook of Psychotherapeutic Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Washington, DC 2009. p.43.
- Cuijpers P, van Straten A, Andersson G, van Oppen P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol 2008; 76:909.
- Gabbard, GO. Long-Term Psychodynamic Psychotherapy: a Basic Text, 2nd, American Psychiatric Publishing, Arlington VA 2010.
- American Psychiatric Association Practice Guideline for the Psychiatric Evaluation of Adults, Second Edition, 2006 http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm (Accessed on November 26, 2010).
- Work Group on Psychiatric Evaluation, American Psychiatric Association Steering Committee on Practice Guidlines. Psychiatric evaluation of adults. Second edition. American Psychiatric Association. Am J Psychiatry 2006; 163:3.
- Winston A. Practical psychotherapy: integrated psychotherapy. Psychiatr Serv 2003; 54:152.
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606.
- Kroenke, K, Spitzer, RL. The PHQ-9: a new depression and diagnostic severity measure. Psychiatric Annals 2002; 32:509.
- Zimmerman M, Chelminski I, McGlinchey JB, Posternak MA. A clinically useful depression outcome scale. Compr Psychiatry 2008; 49:131.
- Zimmerman M, Posternak MA, Chelminski I. Using a self-report depression scale to identify remission in depressed outpatients. Am J Psychiatry 2004; 161:1911.
- Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 2003; 54:573.
- Trivedi MH, Rush AJ, Ibrahim HM, et al. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med 2004; 34:73.
- Pinsker H. The role of theory in teaching supportive psychotherapy. Am J Psychother 1994; 48:530.
- Gabbard, GO, American Psychiatric Publishing. Textbook of psychotherapeutic treatments, 1st ed, American Psychiatric Pub., Washington, DC 2009.
- Werman, DS. The practice of supportive psychotherapy, Brunner/Mazel, New York 1984.
- Winston, A, Goldstein, M. Theory of supportive psychotherapy. In: Textbook of Psychotherapeutic Treatments, Gabbard GO (Ed), American Psychiatric Publishing, Washington, DC 2009. p.393.
- Horvath, AO, Symonds, SB. Relation between working alliance and outcome in psychotherapy: A meta-analysis. J Couns Psychol 1991; 38:139.
- Dekker J, Molenaar PJ, Kool S, et al. Dose-effect relations in time-limited combined psycho-pharmacological treatment for depression. Psychol Med 2005; 35:47.
- Molenaar PJ, Boom Y, Peen J, et al. Is there a dose-effect relationship between the number of psychotherapy sessions and improvement of social functioning? Br J Clin Psychol 2011; 50:268.
- Herllerstein, DJ. Combining supportive psychotherapy with medication. In: Textbook of Psychotherapeutic Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2009. p.465.
- de Maat S, Dekker J, Schoevers R, et al. Short psychodynamic supportive psychotherapy, antidepressants, and their combination in the treatment of major depression: a mega-analysis based on three randomized clinical trials. Depress Anxiety 2008; 25:565.
- Ekers D, Richards D, Gilbody S. A meta-analysis of randomized trials of behavioural treatment of depression. Psychol Med 2008; 38:611.
- Rosso G, Martini B, Maina G. Brief dynamic therapy and depression severity: a single-blind, randomized study. J Affect Disord 2013; 147:101.
- Kocsis JH, Gelenberg AJ, Rothbaum BO, et al. Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry 2009; 66:1178.
- Cuijpers P, van Straten A, Bohlmeijer E, et al. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med 2010; 40:211.
- Cuijpers P, Smit F, Bohlmeijer E, et al. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychiatry 2010; 196:173.
- Driessen E, Hollon SD, Bockting CL, et al. Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded Trials. PLoS One 2015; 10:e0137864.
- Barber JP, Stratt R, Halperin G, Connolly MB. Supportive techniques: are they found in different therapies? J Psychother Pract Res 2001; 10:165.
- Wallerstein RS. The Psychotherapy Research Project of the Menninger Foundation: an overview. J Consult Clin Psychol 1989; 57:195.
- Driessen E, Cuijpers P, de Maat SC, et al. The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis. Clin Psychol Rev 2010; 30:25.
- Cuijpers P, Driessen E, Hollon SD, et al. The efficacy of non-directive supportive therapy for adult depression: a meta-analysis. Clin Psychol Rev 2012; 32:280.
- Budge S, Baardseth TP, Wampold BE, Flűckiger C. European Journal of Psychotherapy & Counselling 2010; 12:23.
- Kool S, Dekker J, Duijsens IJ, et al. Efficacy of combined therapy and pharmacotherapy for depressed patients with or without personality disorders. Harv Rev Psychiatry 2003; 11:133.
- Molenaar PJ, Dekker J, Van R, et al. Does adding psychotherapy to pharmacotherapy improve social functioning in the treatment of outpatient depression? Depress Anxiety 2007; 24:553.
- Markowitz JC, Kocsis JH, Fishman B, et al. Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry 1998; 55:452.
- THEORETICAL FOUNDATION
- Standardized, self-report rating scale
- General treatment principles
- Logistics and structure of treatment
- Therapeutic interventions
- - Self-esteem
- - Psychological functioning
- - Adaptive skills
- - Pharmacotherapy combined with supportive psychotherapy
- EVIDENCE OF EFFICACY
- Supportive psychotherapy
- - Compared with treatment as usual
- - Compared with other psychotherapies
- - Compared with pharmacotherapy
- Supportive psychotherapy combined with pharmacotherapy
- - Compared with pharmacotherapy alone
- - Compared with psychotherapy alone