Supportive Psychotherapy: Varieties of the Positive Dependent Transference

Within psychoanalytic theory, the modus operandi of the expressive psychotherapeutic approach (modeled as it is after the theory of therapy of psychoanalysis itself, as the quintessentially expressive, uncovering treatment mode) has always been conceptually much better delineated than that of the supportive psychotherapeutic approach. As has been clearly stated, its basic mechanism is interpretation directed toward full or partial analysis of defense and resistance, leading to the uncovering (making conscious) of unconscious conflict; as has been made evident in the preceding chapter, however, it does not (cannot?) exist in pure culture. Gill (1951) put this as follows: “While the two poles of either strengthening the defenses, or of analyzing them as first steps toward reintegrating the damaged ego, stand as the gross opposites of two theoretical modes of approach, the psychotherapy of any specific case will show intricate admixtures of both” (p. 65). Bibring (1954) developed the same idea differently: He outlined five major mechanisms that could, together, comprehensively characterize the technical and the curative operations of psychoanalysis and psychoanalytic psychotherapies. He called these “abreaction,” “suggestion,” “manipulation,” “clarification,” and “interpretation,” and he sought to distinguish the different psychotherapeutic modes in terms of the differential deployment and saliency of each of these mechanisms. Psychoanalysis itself, of course, was described as that therapy in which interpretation is given overall primacy, and all the other mechanisms are employed only in the service of furthering the fullest interpretive effort. Within the range of psychoanalytic psychotherapy, however, Bibring did not distinguish the expressive from the supportive mode as sharply and explicitly as Gill did.

In Gill's conceptualizing, the concept of “strengthening the defenses” provides the organizing framework for all the suppo