The Expressive-Supportive Dichotomy Reconsidered

In the original conceptualization of PRP, predictions about projected therapeutic courses and outcomes were to be made against the indications for an array of psychotherapeutic modalities, conceived within the framework of psychoanalytic theory and in current use in the ongoing clinical operations of the Menninger Foundation. These were described in terms of definitional parameters and the usual indications for their use, along the conventional spectrum from the most supportive to the most quintessentially expressive, psychoanalysis, in the first publication from the project (Wallerstein & Robbins, 1956, pp. 252-257). They included the following:

1. Psychotherapeutic counseling. This was conceived of as a process of educational clarification within an emotionally interactive engagement focused on the life-situational difficulties of the patient, and appropriate in cases of situational maladjustment, occupational misplacement, some marital problems, and the like.

2. Supportive psychotherapy. This was conceived of as a process of “strengthening the defenses” in ways that would restore a disrupted equilibrium between drive and reality pressures and the defensive and adaptive capacities to cope with them, which under disequilibrating pressures had generated symptoms and disturbed behaviors. It was felt that this therapeutic approach would be appropriate with either (a) basically healthy individuals overwhelmed by an acute reactive state, such as some acute depressive reactions, some traumatic neuroses, combat fatigue states, or panic states; or (b) patients with chronic severe personality disturbances or major “ego defects” of several varieties, such as character disorders with severe alloplastic symptoms, many impulse neuroses (addictions and perversions), borderline states, or even some mild overt psychoses.

3. Expressive psychotherapy. This would be designed to analyze defenses and uncover conflicts a