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Short-Term Supportive vs. Dynamic Psychotherapy for Personality Disorders

Increasingly, clinical trials of psychotherapy have compared different psychotherapies "head to head." Most studies have compared manualized short-term behavioral, cognitive-behavioral, or interpersonal psychotherapies with no treatment or nonspecific supportive therapy as a control treatment. This study compared manual-based brief supportive psychotherapy with manual-based short-term dynamic psychotherapy in patients with Cluster C disorders, mostly obsessive-compulsive, avoidant, self-defeating, and dependent personality disorders.

Researchers randomized 49 patients to receive either 40 sessions of supportive or dynamic psychotherapy. Supportive psychotherapy emphasized building self-esteem, reducing anxiety, and enhancing coping mechanisms. In contrast, dynamic psychotherapy featured more confrontational activities. All sessions were videotaped.

Both treatments resulted in similar degrees of improvement at termination and at six months follow-up, as assessed by several symptom measures including a global symptom index and an instrument for assessing changes in each patient's own target complaints. Supportive, but not dynamic, psychotherapy also resulted in improved scores on an inventory of interpersonal problems. Both groups had high rates of patients who dropped out before completing 40 sessions (29% for supportive and 40% for dynamic therapy); most completed fewer than 30 sessions.

Comment: Studies that examine videotapes of manual-based supportive psychotherapy may lead to further discrimination between so-called nonspecific factors in psychotherapy and specific healing aspects of "support." Proficiently and systematically applied supportive psychotherapy may prove to be as effective as other manual-based therapies for some conditions. Research now has to delineate the types of conditions most likely to respond to each of a growing number of manual-based psychotherapies.

— J Yager

Published in Journal Watch Psychiatry November 1, 1998

Citation(s):

Hellerstein DJ et al. A randomized prospective study comparing supportive and dynamic therapies. J Psychother Pract Res 1998 Fall 7 261-271.

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