7 LP Jiwa Menur Sby
7 LP Jiwa Menur Sby
7 LP Jiwa Menur Sby
psychotherapy, according to
rather than what it is. He defines these actions chotherapy outcome studies have thus far not
as 1) reducing behavioral dysfunctions, 2) demonstrated that one therapy is better than
reducing subjective mental distress, 3) sup- another for most patients,9 although it has
porting and enhancing the patient’s been consistently observed that therapy is better than
strengths, coping skills, and capacity to use no therapy.’#{176}
environmental supports, 4) maximizing
treatment autonomy, and 5) facilitating max- MODELOF SUPPORTIVE
imum possible independence from psychiat- T H E R A P Y
ented therapy. In everyday practice, most psy- the therapeutic alliance; 2) using direct mea-
chotherapy involves a blend of approaches, sures to relieve symptoms and to minimize
aptly characterized by Luborsky8 as being on development of anxiety within the therapy;
a continuum from expressive to supportive, 3) focusing on seW-esteem, adaptive skills,
with midpositions of expressive-supportive and psychological (or ego) functions (mea-
and supportive-expressive. To meet the sures may include reassurance, encourage-
patient’s needs, elements of pure expressive ment, praise, advice, reframing, clarification,
treatment are withheld or supportive ele- confrontation, education); 4) attention to
ments are added. However, the conceptual negative aspects of the patient-therapist rela-
framework of individual dynamic therapy is tionship when present, but not to positive
intertwined with a model of treatment, such transference; and 5) minimal interpretation
113
as the expressive model, that often has lasting of unconscious
impact in that the psychoanalytic techniques Table 1 compares the two models. Be-
of abstinence and nongratification are cause the model of supportive psychotherapy
adopted as the habitual stance of the thera- does not specify that analysis of transference
pist. If a body of evidence had demonstrated must be the basis for change, the therapist is
that exploratory therapy is more effective “real” to the patient. When psychotherapy is
than supportive therapy for most patients, based on the assumptions, premises, and
this would be justifiable. If evidence demon- techniques of expressive therapy (the expres-
strated that exploratory therapy is consis- sive model), the therapist gives up only as
tently best for a specific group of patients, much neutrality as necessary.’4 With the sup-
that would be reason to recommend it, at portive therapy model, the therapist is no
least for that group. However, controlled psy- more neutral than necessary. It is important
to note that this 180-degree shift does not can appropriately guide psychotherapy for a
imply that supportive therapy is undisci- wide range of clinical problems. The differ-
plined or that the relationship should ever be ential application of strategies developed for
anything but professional. Transferential is- treatment of low-functioning patients thus
sues are examined only if they threaten to defines a psychotherapeutic model also
disrupt the treatment. Because the model broad enough to serve the needs of higher
does not specify that the unconscious must be functioning patients.
made conscious, techniques developed to en-
courage the free flow of unconscious material P R o P o sA L
Supportive Expressive
is
Conversational style: patient is encouraged Flow of material important: patient is encouraged
Clarification and confrontation are employed. Clarification, confrontation, and interpretation are
employed.
Negative transference is examined; positive Analysis of transference is a major focus.
transference is not discussed.
There are a number of potential advan- knowledge that therapeutic activity is coher-ent
tages to the use of the supportive psychother- and purposeful.
apy model. It may be more palatable for
many patients than an abstinent psychoana- MoDELs AND DEPARTURES
the use of supportive therapy to patients with supportive therapy. It is not the therapy by
whom expressive techniques are not ex-pected to unskilled counselors that was often recom-mended
obtain good results. We suggest that in the 1960s and ‘70s, but instead
these conventional views may deprive many should be a supportive therapy based on thor-
patients of the benefits of an effective form ough knowledge of personality development
of psychotherapy that is more comfortable, and psychopathology, carried out by practi-
more palatable, and, for many patients, more tioners who have had specific training and
effective than treatment in which the supervision in this modality.
therapist’s style is based on the psychoana-
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