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The concept of supportive therapy has been a problematic one for psychoanalysis. Often it has been included in overviews of the spectrum of psychotherapeutic treatments, only to be ignored. Psychoanalysis itself, and its closely allied 'expressive', 'insight-oriented', or 'exploratory' psychotherapeutic variants have been defined and redefined, while the border between them has been carefully delineated. Meanwhile, the notion of supportive therapy has mostly been left until last in the discussion, not described in itself but posited as the alternative, and less satisfactory, way of meeting the needs of 'other' kinds of patients. It can be seen as the mid-twentieth century equivalent of mesmerism: that which psychoanalysis needs to keep itself differentiated from.
There are scientific and pedagogical problems in this kind of thinking. In residency training and psychology fellowships, the majority of the patients that the trainees encounter require treatments which fall into the devalued supportive category. If most of the 'psychodynamic teaching' is organized around the classical analytic paradigms and patients, there is a mismatch between patients' needs and trainees' wishes, and trainees may have difficulty coming to terms with their patients' needs as a result. It is my impression that a version of this problem can be found in psychoanalytic training as well.
In a preface to Rockland's book Supportive Therapy, Robert Wallerstein argues that more careful and respectful descriptions of the subject need to be written. He is in a position to tell us, having provided us with valuable clinical data on this question. In Forty-two Lives in Treatment he documented the inextricable mixing of supportive and more classically expressive techniques in the treatment of seriously disturbed patients (Wallerstein, 1986). The study reported there, which classified treatments along the supportive-expressive continuum, found that the analysts and therapists changed their appr