Supportive-expressive therapy (SE) is a type of psychodynamic psychotherapy that is effective in treating a mental health issues such as anxiety disorders. It draws from the psychodynamic orientation, which originated with Freud’s psychoanalytic theory. 

Proponents of SE believe that psychological problems originate in early childhood. Treatment of these problems occurs alongside issues associated with anxiety and involves becoming more aware of, working through and overcoming unhelpful patterns in relationships. 

SE focuses on anxiety within the context of the person and their relationships with others. It is a combination of two main components: 1) supportive techniques to help clients feel comfortable in discussing their personal experiences, and 2) expressive techniques to help clients identify and work through interpersonal relationship issues. 

The main techniques of SE include supportive techniques to bolster the therapeutic alliance and interpretations to help patients gain selfunderstanding. This is done by working on three main areas of focus: 1) the person’s emotional experience, for example, through the person identifying and labeling the emotions they have been experiencing, 2) the communication between the therapist and the person receiving treatment, and 3) interpretation of what is revealed in therapy sessions. 

The goal of SE is to help clients achieve mastery over their difficulties, gain self-understanding and practice self-control over problems. It’s based on the theory that the development of problematic behaviors—as with the development of personality—is influenced by formative life experiences. 

The therapist and client explore and gain insight into conflicts that developed within the client through early experiences, for example, with parents and caregivers, and how these are represented in current situations and relationships. 

A 2004 study examined the efficacy of SE with 26 patients (aged 22 to 64) diagnosed with generalized anxiety disorder. After treatment, patients revealed significant positive changes in anxiety, depression, worry, and interpersonal problems (Crits-Christoph, 1996). A similar study at the Menninger Clinic in Houston, Texas found SE to be effective in helping people with social anxiety disorder (SAD). 

A study of 70 women with anxiety over breast cancer risk had the women participate in 12 sessions of supportive-expressive group therapy that lasted 6 months. Before and after measures of psychosocial functioning, depression and anxiety were completed. Findings from the study indicated that the women had significant improvement with a lessening of anxiety, worry and depression (Esplen, 2004). Based on this research a type of group therapy was developed called mindfulness-based cancer recovery. 

Mindfulness in Supportive-Expressive Therapy 

Mindfulness-based cancer recovery (MBCR) is a 9-week program for cancer patients developed by psychologist Linda Carlson. It’s based on the mindfulness-based stress reduction (MBSR) program developed in the 1980s by Jon Kabat-Zinn. 

The development of MBCR led to research comparing it to supportiveexpressive group therapy (SET). A Canadian study  compared the effects of MBCR and SET in a randomized clinical trial with 271 distressed breast cancer survivors. The women were randomized into either MBCR, SET or a control group. The results indicated an improvement in levels of stress in both the MBCR and SET groups, but the SET groups had additional improvements in mood. The researchers contributed this to the social support that the women received in the SET group. 

MBCR is considered to be a mindfulness-based intervention (MBI). Based on the evidence in support of mindfulness as an underlying mechanism of MBIs, nonspecific therapeutic factors—such as the experience of social support—can contribute to the positive effects of MBIs.

Randi Fredricks, Ph.D.

References

Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, Speca M. (2013). Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer. J Clin Oncol, 31(25), 3119-3126.

Kabat-Zinn, J. (2013). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Bantam Dell.

Esplen MJ et al. (2004). A multicenter study of supportive-expressive group therapy for women with BRCA1/BRCA2 mutations. Cancer,101(10), 2327-2340.

Crits-Christoph P, Connolly MB, Azarian K et al, (1996). An open trial of brief supportive-expressive psychodynamic psychotherapy in the treatment of generalized anxiety disorder. Psychotherapy, 33, 418–430.

Crits-Christoph P, Crits-Christoph K, Wolf-Palacio D et al. (1995). Brief supportive-expressive psychodynamic therapy for generalized anxiety disorder. In: Dynamic Therapies for Psychiatric Disorders (Axis I), edited by Barber JP, Crits-Christoph P. New York, NY: Basic Books.

Connolly MB, Crits-Christoph P, Shappell S et al. (1998). Therapist interventions in early sessions of brief supportive-expressive psychotherapy for depression. Journal of Psychotherapy Practice and Research, 7, 290-300.

Misch DA. (2000). Basic strategies of dynamic supportive therapy. Journal of Psychotherapy Practice and Research, 9(4), 173-188.

Luborsky L, (1984). Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive Treatment. New York, NY, Basic Books.

Leichsenring F, Beutel M, and Leibing E. (2007). Psychodynamic psychotherapy for social phobia: A treatment manual based on supportive–expressive therapy. Bulletin of the Menninger Clinic, 71(1), 56-84.

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