Brief Supportive Psychotherapy: A Treatment Manual and Clinical Approach PDF
Preview Brief Supportive Psychotherapy: A Treatment Manual and Clinical Approach
i Brief Supportive Psychotherapy ii iii Brief Supportive Psychotherapy A Treatment Manual and Clinical Approach JOHN C. MARKOWITZ iv Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2022 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Names: Markowitz, John C., 1954– author. Title: Brief supportive psychotherapy : a treatment manual and clinical approach / John C. Markowitz, M.D. Description: New York, NY : Oxford University Press, [2022] | Includes bibliographical references and index. | Identifiers: LCCN 2022012631 (print) | LCCN 2022012632 (ebook) | ISBN 9780197635803 (paperback) | ISBN 9780197635827 (epub) | ISBN 9780197635834 (ebook) Subjects: LCSH: Supportive psychotherapy—Handbooks, manuals, etc. Classification: LCC RC489. S86 M37 2022 (print) | LCC RC489. S86 (ebook) | DDC 616.89/14—dc23/eng/20220610 LC record available at https://lccn.loc.gov/2022012631 LC ebook record available at https://lccn.loc.gov/2022012632 DOI: 10.1093/ med- psych/ 9780197635803.001.0001 9 8 7 6 5 4 3 2 1 Printed by Lakeside Book Company, United States of America v Emotions can be powerful but they’re not dangerous. Markowitz, 2016 vi vii CONTENTS 1. Introduction 1 2. What Is Supportive Psychotherapy? 6 3. The Common Factors of Psychotherapy 11 4. Affect Focus 22 5. Formulation: Developing an Emotional Conceptualization of the Patient 40 6. The Structure of Brief Supportive Psychotherapy 48 7. Supportive Evidence: Research on a Treatment That Works 72 8. Adjusting Brief Supportive Psychotherapy to Different Disorders 85 9. Case Examples 88 10. Brief Supportive Psychotherapy Training and Supervision 130 Acknowledgments 135 References 137 Index 145 viii 1 1 Introduction What is supportive psychotherapy? Is it important? Is it any good? The term has been widely used and misused, variously and often poorly defined. “Supportive” has frequently served as a pejorative or disparaging rubric for weak therapy. Yet properly defined and employed, supportive psychotherapy is a potent interven- tion whose elements emphasize the core of all good psychotherapy (Markowitz, 2014; Markowitz & Milrod, 2021; Markowitz, 2022a, 2022b). I conduct psychotherapy outcome research. One of the problems that the field faces is what to compare psychotherapies to, as there is no psychotherapy equiv- alent to an inert pill placebo in a medication trial. Some psychotherapy research studies have used a waiting list as a comparison. That is, patients enter the study seeking treatment, hear that they might receive a treatment, and then are told, “There’s no treatment; just come back after 12 weeks and we’ll rate your symptoms again.” A waiting list is not only disappointing and unfair to suffering patients and likely unethical for patients who have treatable disorders. It’s also very weak com- petition, inasmuch as the measure of the robustness of an active treatment always depends on the comparator: A treatment can only be better than what you com- pare it to. So “compared to what?” is a key question in research trials. A treatment that’s better than an inert or even harmful condition (a “nocebo,” which a waiting list may be) hasn’t made much of a case for itself. A treatment that beats an active control condition— in other words, exceeds a treatment that does something— now, that’s an accomplishment. More than thirty years ago, when I was a junior faculty member at Cornell University Medical College interested in psychotherapy research, we needed a com- parison condition for a psychotherapy study to treat an extremely vulnerable pa- tient population. I worked with a senior Cornell psychoanalyst, Dr. Michael Sacks, and got help from Drs. Allen Frances and Larry Jacobsberg as well. We wanted to develop a treatment that was not an empty condition, that might help the patients who received it. We wanted it to have generalizability: that is, to have some con- nection to psychotherapy as it might be practiced in the community. We grounded it in the basics of psychotherapy: building a treatment alliance, encouraging toler- ance and expression of one’s feelings, and utilizing the other so-c alled “common factors” inherent in all good psychotherapies (Rogers, 1951; Frank, 1971; Frank & Frank, 1993). We hoped it would be an elemental, effective intervention.
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