Strategies of Dynamic Supportive Psychotherapy
Misch D. A. (2000). Basic strategies of dynamic supportive therapy. The Journal of psychotherapy practice and research, 9(4), 173–189.
This article has always been one of my favorite publications. Despite being published in the year 2000, the words still carry a lot of weight and meaning. I often refer to this article when trying to treat and support patients, and I think it has a lot of merit to be helpful anyone in being able to support others, even if they aren’t a formal therapist. It also has beautiful narrative examples that encapsulate the therapy journey. It is also a useful article for patients, helping them identify what strategies they might find helpful or efficacious from others, be they therapists or support persons.
The authors begin by explaining the variety of therapy modalities being used, and how it can be confusing for patients and therapists alike. Therefore, the paper’s aim is to find the common underpinnings which are founded in many therapies and are key in supportive psychotherapy.
So, the basic strategies of dynamic supportive therapy are:
Formulate the case: This means knowing how and guessing why we are in the situation that presents for therapy.
Be a good parent: This means behaving like an adult, regardless of how the client is feeling.
Foster and protect the alliance: This means that despite disagreement, you should always respect and show kindness, maintaining compassion and commitment.
Manage the transference: This means understanding how your friend or patient sees you, so as not to take it personally. Correct any errors quickly and move on.
Hold and contain: This can involve allowing them to vent, express, feel, and reassure. It could also mean involving others, having safety in mind, and always ensuring autonomy.
Lend psychic structure: This can be tricky, but it refers to using your own logical thinking as a model for someone else. It could involve reality testing, conscience, encouraging relaxation or problem-solving. Importantly, it is a loan, not for keeps!
Maximize adaptive coping mechanisms: This is basically using better coping skills. Use them together and employ skills training.
Provide a role model: This means that the therapist can be a positive healthy person that the patient or client can identify with. This doesn’t mean pretending to be perfect, but rather having a good balance between success and tribulations, so that the client can learn.
Decrease alexithymia: This means helping patients to identify and name their emotions.
Make connections: This involves decreasing the mystery of how by recognizing what causes symptoms and connecting the dots.
Raise self-esteem: This can be through fostering mastery by helping someone get better at something, like a coach for a sport! Encouraging employment and normalizing thoughts and behaviors are other ways to improve self-esteem.
Ameliorate hopelessness: This means trying to find the silver lining, or practically improving their situation (support letters, help with transport).
Focus on the here and now: This involves setting an agenda and working in a stepwise fashion. Safety, therapy interference, future negative events, non-compliance and negative transference are the usual hierarchical issues, respectively.
Encourage patient activity: This means helping them “do” rather than “say”, with concrete achievable goals, while emphasizing patience.
Educate patient and family: This means going the extra mile to be the educator, especially for others, to improve the wellbeing of family units together.
Modify the environment: This means maximizing family support, involving other agencies, advocating and speaking to others on behalf of the patient.
Overall, these sixteen strategies are not exhaustive, nor are they mandatory. There may be a lot of one, and barely any of the other. It needs to be specific and targeted towards the patient and their own personal story. However, the article encourages reflection, what things we do and what other things we could try. For me, it also reminds me that there are actual words for what can come naturally or logically. Lastly, it addresses assumptions that patients “know” or already “do”, stressing that there are lots of ways to help one another.