Supportive Psychotherapy
No clear and simple definition exists of supportive psychotherapy. However, this therapeutic approach is generally considered to be an intervention, utilized intermittently or continuously, which seeks to help patients to deal with distressing emotions, reinforce their pre-existing strengths and promote adaptive coping with the illness. Supportive psychotherapy is a patient-centered but highly flexible approach that should be modified on each occasion for each patient. In other words, the core requirement for this approach is flexibility, and therefore this approach is difficult to be followed by having strict guidelines and manuals to assure treatment fidelity. Generally, supportive psychotherapy includes developing a relationship of trust with the patient so that the patient can talk freely. It focuses on addressing the patient’s concerns, listening, understanding, accepting and empathizing with the patient’s distress. The crisis intervention model is sometimes used additionally, which attempts to relieve symptoms and stabilize the crisis by reviewing recent events, allowing a catharsis and manipulating the environment. Supportive psychotherapy also often involves a sensitive approach to the patient in denial. Denial is a psychological defense that often helps advanced cancer patients to manage their anxiety and depression. It allows such patients to continue living while facing the painfulness of their inevitable death. In this situation, therapists note the patient’s denial. Simply acknowledging the denial can in itself be supportive for the patient. When providing supportive psychotherapy to advanced cancer patients, the therapist should help them to achieve a ‘good death’. A Japanese study identified 18 important domains of a good death: (i) physical and psychological comfort, (ii) dying in a favorite place, a good relationship with medical staff, (iv) maintaining hope and pleasure, (v) not being a burden to others, (vi) a good relationship with family, (vii) physical and cognitive control, (viii) environmental comfort, (ix) being respected as an individual, (x) life completion, (xi) a natural death, (xii) preparation for death, (xiii) role accomplishment and contribution to others, (xiv) unawareness of death, (xv) fighting against cancer, (xvi) pride and beauty, (xvii) control over the future and (xviii) religious and spiritual comfort. Patients’ preferences and needs can differ, and therefore flexible and individually tailored psychological support to achieve a good death for the patient can be supportive in itself.
Ref: Tatsuo Akechi, Psychotherapy for Depression Among Patients with Advanced Cancer, Japanese Journal of Clinical Oncology, Volume 42, Issue 12, 1 December 2012, Pages 1113–1119