When it comes to mental health, some patients want more efficient help.
Brief supportive psychotherapy, a 12-week talk therapy designed by Columbia psychiatrist John Markowitz, MD, isn't for everyone. But it is a proven therapy for depression, and some studies suggest it's also useful for people with anxiety disorders.
"Brief supportive psychotherapy distills psychotherapy down to the basic building blocks that are part of all effective treatments and not much more," says Markowitz, who helped develop the therapy 30 years ago and recently published the first book on the treatment.
"Brief supportive psychotherapy distills psychotherapy down to the basic building blocks that are part of all effective treatments."
Until now, the therapy has only been used in research studies, but the success of the therapy in those studies has led to a growing interest among therapists in general practice. Markowitz hopes his book serves as a guide for those therapists and brings brief supportive psychotherapy to more patients.
"It's a bare bones therapy, but sometimes it is the basics that matter. Patients and therapists sometimes get carried away by bells and whistles."
We recently spoke to Markowitz about the treatment and how it works.
What is brief supportive psychotherapy?
Brief supportive psychotherapy is a time-limited talk therapy stripped down to the basics:
- Listen to the patient
- Explore the patient's feelings about people and situations in his or her life
- When possible, normalize those feelings as appropriate
Brief supportive psychotherapy focuses on affect or emotion. Many patients with depression or anxiety disorders fear having strong negative feelings like anger, anxiety, and sadness, and they push those feelings away. But feelings are meaningful signals about how life is proceeding and treating you. The intensity of feelings reflects the impact of life circumstances on the individual.
"Brief supportive therapy helps people recognize their feelings, which can help them act to get what they need to feel better."
If you're angry at someone, for example, it's usually because they're doing something that's bothering you. It's often helpful to be able to say, "Please stop doing that." Otherwise, they'll keep bothering you while you get more and more irritated. Brief supportive therapy helps people recognize their feelings, which can help them act to get what they need to feel better.
We add the word "supportive" because the therapist supports the patient's experience in dealing with his or her feelings.
How is brief supportive psychotherapy different from other therapy?
In a way, brief supportive psychotherapy is the core of all good psychotherapy. Every element of brief supportive therapy should be present in other treatments, including helping a patient feel understood, respected, not judged, with realistic optimism for improvement.
What's different is that other therapies have elements, like homework tasks in cognitive behavioral therapy, that brief supportive psychotherapy doesn't. So brief supportive psychotherapy is less structured than other therapies, with the therapist listening longer, probably speaking less, and allowing the patient to take the therapy wherever he or she would like.
What is the science behind brief supportive psychotherapy?
The treatment has its beginnings in psychotherapy research. I research the effectiveness of different types of psychotherapies, and my colleagues and I originally designed brief supportive psychotherapy 30 years ago as a "control" treatment for studies testing the effectiveness of other therapies.
Often in research studies, treatments are compared to no treatment or people who are put on a waiting list. But a treatment that's better than nothing, or even a harmful condition, hasn't made much of a case for itself. We wanted to develop a treatment that would provide an elemental intervention against which other therapies could be fairly judged.
It performed better than expected. In seven out of nine studies, brief supportive psychotherapy worked as well as the more elaborate therapy. And it worked almost as well in the other two studies. It helps people improve.
There are many other treatments called "supportive therapy," but most are poorly defined and untested. Brief supportive psychotherapy is both defined and has been tested in nine randomized clinical trials, with a 10th underway.
Given the option of longer versus brief therapy, does anyone choose longer?
"It's a bare bones therapy, but sometimes it is the basics that matter."
Time-limited therapy puts pressure on both patient and therapist to resolve issues quickly. Brief supportive psychotherapy isn't appropriate for all patients or all psychiatric disorders, but it does work for mood disorders (depression) and anxiety disorders (panic). It hasn't been studied for other psychiatric conditions. There are psychiatric disorders that lend themselves to longer treatments, where an ongoing clinical relationship may be more necessary.
Are all therapists trained in brief supportive psychotherapy?
Far from it. Brief supportive psychotherapy has mainly been a research treatment. My book introduces it to clinicians and teaches them how to use it. One reason for publishing the book is to provide the treatment manual to psychotherapy researchers. Another is to give the many therapists who practice an untested general form of supportive psychotherapy an opportunity to understand this specific version that has been shown to work. A third reason is to help any therapist, regardless of therapeutic approach, to focus on affect and psychotherapeutic "common factors" in order to hone their general therapeutic skills.
References
John Markowitz, MD, is a psychiatrist, professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons, and a research psychiatrist at New York State Psychiatric Institute.
