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Learning Supportive PsychotherapyReview - Learning Supportive Psychotherapy
An Illustrated Guide
by Arnold Winston, Richard N. Rosenthal, and Henry Pinsker
American Psychiatric Publishing, 2011
Review by Sharon Packer, MD
Jan 15th 2013 (Volume 17, Issue 3)

When the clock strikes midnight on December 31, 2012, psychiatrists across America must use the same CPT codes as their medical colleagues have used all along. Many might prefer to turn into pumpkins, for these new demands are daunting. Like MDs everywhere, psychiatrists must collect and record data about vital signs, motor movements, integument (otherwise known as "skin"), and many other bodily functions, in addition to the mental states that are the typical purview of psychiatrists. If psychiatrists perform psychotherapy, they must record those notes separately.

"Psychotherapy" must be distinguished from mere "counseling," which is deemed to be a medical service rather than a specifically psychiatric technique, according to the powers-that-be. It's all very confusing, at least at this stage of the game.

So what exactly is therapy? Questions about the "true nature" of therapy will reverberate more than ever before and will be called into question more and more. As health care reforms come into being, cash-strapped Medicare and penny-pinching managed care will demand proof of both "efficacy" and "medical necessity." Before long, believing in the value of therapy in general, without being able to prove how a specific type of therapy helps a particular clinical condition, will be become outdated.  In many circles, that point of view is already outdated.

In the past, many members of the public (and a surprisingly high percentage of professionals) conflated "psychotherapy" with "psychoanalysis." Then CBT arrived in high style and stole center stage, and became the Johnny-come-lately cure-all of the early 21st century. (Forget about the fact that CBT had been delineated decades ago.) In recent years, CBT was tested in controlled settings, touted as an advance,  and recommended  as an adjunct to--or even as an alternative for-- psychopharmacology. Behavioral conditioning, a one-time favorite of experimental psychologists, was subsumed by CBT, as the "Cognitive" aspect of "Behavioral Conditioning" gained sway.

So little was said about supportive therapy. Supportive therapy, the stepchild of therapies, was swept to the side, Cinderella-style, as it was forced to do most of the work, without gaining respect or recognition.  I add this fairy tale analogy not simply to sound poetic, but because it is an apt analogy. Supportive therapy is the most commonly used therapy of the fives therapies that psychiatric residents must master before completing their training. Like the corps de ballet that dances indefatigably in the background as the audience applauds the prima ballerinas, supportive therapy never gained much recognition because it is not as dramatic as those therapies that take center stage.  

Winston, Rosenthal and Pinsker's book on Learning Supportive Therapy can rectify that situation. This slim volume, published by American Psychiatric Association's official press, APPI, is an eloquently written, easy-to-follow text that speaks directly to fledging psychiatrists (and other therapists) who are acquiring a new skill and are being educated about the value of that skill at the same time. This book could just as easily be called Re-Learning Supportive Therapy, since it includes information that will appeal to seasoned practitioners, many of whom are wondering how therapy became so splintered over time. Luckily, this book succinctly explains how therapeutic standards shifted over the decades, and so it will appeal to seasoned practitioners as well.    

Learning Supportive Therapy starts with Freud, but without overemphasizing analytic jargon. It demarcates "expressive" (psychodynamic) therapy from "supportive," both in its text, and in many user-friendly graphs and charts, and via live interviews recorded on CD. It acknowledges the role of fifties' films in sculpting our expectations about therapy and "the couch cure." It swiftly moves into the real world, where time and money constraints interact with clinical concerns, and where social changes have made Freudian preoccupations with the sexual etiology of neuroses nearly obsolete.

One of the most valuable aspects of this book is its ability to accept today's therapeutic reality as it is, without engaging in polemic or political diatribe, and without romanticizing the way things were or pontificating about the way things should be. Instead, this book weaves together valuable data from clinical studies, which show that even high-functioning patients derive as much benefit from supportive therapy as from more "expressive" or dynamic therapy. The text also reminds us that therapeutic approaches are rarely as orthodox as they are presented, and that syncretic approaches that blend elements of different therapies at different times are more the norm than the exception. 

The short clinical vignettes are also excellent teaching tools. They are short enough to hold the attention of the video game generation, but long enough to convey essential information. Some of the examples about transference and counter-transference are downright funny, even if they are true. One "LOL"-rated scenario about questions that a patient poses to his therapist, regarding the therapist's marital status and more, is guaranteed to make this serious book accessible to all ages. In addition, it also offers quick and simple solutions for thorny clinical problems that can arise, if not in the office, then at least in the imagination of the novice therapist. Its light-hearted anecdotes and conversational style are sure to dispel anxiety that accompanies one's first forays into the therapeutic labyrinth.

In summary, this book is essential for those learning supportive therapy, and it is equally recommended for anyone wanting a refresher course. It offers easy-to-understand explanations of changes that have occurred in therapeutic approaches over the decades. The recommendations are bolstered by hard outcomes data, plus basic facts about treatment trends. This dispassionate approach is most refreshing at a time when so many books and articles about psychiatric practice turn out to be one-sided diatribes that aim to argue rather than to educate.

 

© 2013 Sharon Packer

 

Sharon Packer, MD is a psychiatrist who is in private practice in Soho (NYC) and Woodstock, NY. She is an Asst. Clinical Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. Her books include Dreams in Myth, Medicine and Movies (Praeger, 2002), Movies and the Modern Psyche (Praeger, 2007) and Superheroes and Superegos: The Minds behind the Masks (Praeger/ABC-Clio, 2010). In press or in production are Sinister Psychiatrists in Cinema (McFarland, 2012) and Evil in American Pop Culture (ABC-Clio, 2013, co-edited with J. Pennington, PhD.) She can be contacted at drpacker@hotmail.com .


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