What is the difference between enabling therapy and supportive therapy

More regressed patients commonly have difficulties with affect regulation, which produces a state in which the patient cannot attend or think and which interferes with the capacity to self-reflect. In contrast to more psychodynamic-oriented therapies, one must be careful not to be incisive when practicing supportive therapy with more vulnerable or regressed patients.

These interventions are more appropriate for treating patients with neurotic defenses that are analyzed and examined and the conflicts underlying the defenses identified. Conscious problems are addressed, and defenses are questioned only when they are maladaptive. The patient is treated with honesty and respect.

Other important techniques used in supportive psychotherapy include behavior goal setting, encouragement, positive reinforcement, shaping behavior, and modeling. Children respond to the influence of their parents by imitating them and gradually by internalizing aspects of the parents by the process of identification.

They later identify with other important figures in their lives. Some key aspects of these identifications include the development of a stable sense of self; a capacity to modulate anxiety so that it does not lead to defensive distortions of reality; a benevolent conscience that allows for a reasonable pursuit of pleasure without unreasonable guilt; and a capacity to love without fearing a loss of the self in experiences of fusion, or of excessive anxiety in the face of separations.

It is important to take into account barriers to treatment such as economic, geographic, cultural, and stigma-related issues; distrust; and past persecutory experiences. Idioms of distress are the characteristic way in which members of different cultures describe what is wrong and which may differ from the expressions found in mainstream American culture. In some cases, the patient fears a repetition of these traumas, such as in the case of psychiatric hospitalization, which may elicit fears of oppression, abuse, and incarceration.

Its mission is to promote psychodynamic understanding when evaluating and treating patients in clinical practice, medical education, and residency training. Co-dependency is a term often heard in association with addiction, but what does co-dependency mean? Our residential addiction treatment programs could save your loved one as well as your family. Get started today by contacting us at After overcoming her own struggles with addiction, she began working in the treatment field in A part of the Banyan team since , Alyssa brings over 5 years of experience in the addiction treatment field.

Related posts. Get the help you need today at Banyan. Don't surrender your life to addiction, take control and get your life back today. Our drug and alcohol addiction treatment centers have helped thousands of people empower themselves to take back control of their lives. Transference issues are discussed only when they threaten to disrupt the treatment.

The therapist should be able to recognize manifestations of transference or countertransference, but conversation about these issues has little place in the supportive mode. Supportive approaches do not require adherence to psychodynamic theory Pinsker, , but they are compatible with it, as they are also compatible with cognitive-behavioral therapy and medical practice in general.

Addressing the topic of how to determine the balance between supportive and expressive techniques, Wachtel advised, "Be as supportive as you can be so that you can be as expressive [or exploratory] as you will need to be. When psychotherapy is based on the expressive model i. In the supportive therapy model, however, the therapist is no more neutral than necessary. My colleagues and I have proposed that instead of applying the expressive model to all but the most supportive end of the psychotherapy spectrum, the supportive model should be paramount in all but the most expressive treatment Hellerstein et al.

The supportive component of expressive-supportive treatment entails being alert for opportunities to offer praise and encouragement, solicit feedback and explicitly define the agenda. Efforts to minimize or prevent anxiety are appropriate with most patients. At the middle of the psychotherapy spectrum, the therapist must determine for each patient whether to utilize transferential aspects of the relationship, or to keep it to himself or herself.

As the patient's condition and goals change, the role of expressive elements may become greater. At all times, however, therapy should be coherent and consistent.

One does not make transference interpretations one day and not the next, or alternate between ignoring or challenging defenses. And although discovery of unconscious forces is not an objective when the supportive component is prominent, it is important that the therapist be aware of the ways that the unconscious process and transference can affect the patient, the therapist and the therapeutic relationship.

Unconscious forces do not cause all the mental disorders once attributed to them, but they often determine the outcome of treatment. Because psychotherapy research has generally failed to demonstrate that any one type of psychotherapy is more effective than another, it has been hypothesized that the effects of psychotherapy might be related to factors common to all therapies.

Lambert and Bergin listed 32 factors common across therapies that are associated with positive outcomes. They included: reassurance, structure, empathy, advice, cognitive learning, changing expectations for personal effectiveness, cognitive mastery, modeling and success experience.

Weinberger , Frank and Frank , and Winston and Muran all concluded that the therapeutic relationship is a major factor in determining outcome. If the therapeutic relationship and provision of support are, in fact, the active ingredients in psychotherapy, attention by all therapists to this aspect of their work would seem to be worthwhile. Treatment techniques have traditionally been presented to students as derivatives from theories about personality-development and symptom-formation.

Supportive psychotherapy has not been derived from theory; perhaps this is one of the reasons why supportive techniques are not usually part of the curriculum.

Education about supportive therapy ought to be part of residency training. Although most residents develop a repertoire of supportive skills, specific instruction about supportive therapy and supportive techniques would surely bene-fit patients treated by residents and other trainees in the early years of their careers. It may be comforting to think of dropout and noncompliance as expressions of a patient's psychopathology.

However, the practitioner who is skillful at establishing and maintaining relationships will have fewer dropouts and better compliance.

Because the ability to be supportive has been vaguely assumed to be a personality attribute of the therapist rather than as a skill to be learned, attention to the supportive component of therapy might have been seen as an admission of personal deficiency rather than the pursuit of technical prowess.

The supportive component of psychotherapy involves deliberate efforts to enhance the therapist-patient relationship, to minimize anxiety and to enhance the patient's self-esteem. When the patient is severely impaired, the supportive component is paramount.

With the patient who functions at a higher level and whose treatment is supportive-expressive or expressive-supportive, supportive measures may be most important for a successful outcome.

Psychotherapy research has generally not found that "pure" expressive therapy is more effective than other therapies. Enabling behaviors, on the other hand, keep someone from dealing with the negative consequences of their actions. Not dealing with these consequences gives the impression that their behavior is somehow acceptable. These people may feel as though they are being supportive, helpful, or accepting, but the reality is that they are causing the behaviors to worsen. Enablers will also often try to solve the problems for the people they are trying to help.

Solving their problems makes the enabler feel as though they are doing something good for the person they care about. The truth, however, is that they are hurting them. Enabling behavior that needs to change will also create a negative dynamic in the relationship. The person needing the help becomes unable to live their life in a healthy, independent and responsible manner, and therefore becomes dependent on others. The enabler then takes on responsibilities that are not truly theirs.

This can ultimately create resentment in the enabler and a very unhealthy and unbalanced relationship overall. If you are wondering whether you are being helpful or enabling, ask yourself the following questions.

If you have answered yes to any of these you may very well be enabling behaviors that need to change.