What Is Supportive-Expressive Therapy?

What Is Supportive-Expressive Therapy?

Supportive-expressive therapy is an evidence-based, psychodynamic psychotherapy that has been found to be effective in treating certain substance use disorders.

The goal of supportive-expressive therapy is to help clients achieve mastery over their difficulties, gain self-understanding, and practice self-control over substance use problems. It is based on the theory that the development of problematic substance use, as with the development of personality, is influenced by formative life experiences.

Supportive-expressive therapy draws from the psychodynamic orientation that originated with Freud's psychoanalytic theory, which claimed that psychological problems originate in early childhood. The belief is that these psychological problems can occur alongside problems associated with substance use and can be treated by becoming more aware of, working through, and overcoming internal conflicts and unhelpful patterns in relationships.

Techniques

Supportive-expressive therapy is a manualized and time-limited intervention for individuals with more severe substance use disorders. It focuses on substance use within the context of the person and their relationships with other people. A typical course of therapy consists of 16 to 30 sessions, which last about an hour each.

Supportive-expressive therapy is a combination of two main components:

• Supportive techniques to help clients feel comfortable in discussing their personal experiences
• Expressive techniques to help clients identify and work through central relational patterns

This is done through working on three areas of focus:

• Emotional experience, for example, through the person identifying and labeling the emotions they have been experiencing
• Communication between the therapist and the person receiving treatment
• Interpretation of what comes up in therapy sessions

Through supportive-expressive therapy, the therapist and client explore and gain insight into conflicts that developed within the client through early experiences and how these are represented in current situations and relationships.

What Supportive-Expressive Therapy Can Help With 

Like other forms of therapy, supportive-expressive therapy can be used to treat a variety of mental health problems, including:

• Anxiety
• Depression
• Eating disorders
• Interpersonal problems
• Personality disorders
• Psychological distress
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder
• Substance use disorders

Benefits of Supportive-Expressive Therapy

Supportive-expressive therapy has been recognized by the National Institute on Drug Abuse (NIDA) as an evidence-based approach to treating substance use disorders. The best outcomes have been found by combining drug counseling and supportive-expressive therapy, especially for people with severe co-occurring psychiatric problems.

This approach to therapy also works to influence how people think, feel, and act, promoting better coping skills, self-reflection, insight, and emotional growth.

Effectiveness

Research has shown that supportive-expressive therapy is more effective in treating severe substance use disorders than drug counseling, and improvements have been found to continue to be present 12 months after completing treatment.

Supportive-expressive therapy may be particularly well suited to clients with severe substance use disorders and cocaine use disorder when someone is open to discussing and exploring their internal experience.

In methadone maintenance treatment, the benefits from supportive-expressive therapy included reductions in drug use and need for less methadone and maintenance of treatment gains. Improvements in employment, measured by the number of days worked and wages earned, have also been described.

Things to Consider

Although supportive-expressive psychotherapy has been studied for the use of substance use disorders and other mental health conditions, there is still little known about which strategies are most effective, or when it's best for therapists to use supportive versus expressive techniques.

However, supportive-expressive therapy is non-directive, which means that the client, not the therapist, decides what is important to focus on. While the therapist is the guiding hand, you must do the hard work, including being vulnerable, opening up, and committing to the therapy process.

With any type of addiction treatment, it's also important to remember that the reality of recovery includes dealing with urges, cravings, and even relapses, so you must be honest with your therapy.

How to Get Started

If you feel that you or someone you love might benefit from supportive-expressive therapy, consider the following steps:

• Ask for a referral. Your primary care doctor or addiction counselor can refer you to a mental health professional who is qualified to provide supportive-expressive therapy.
• Inquire about coverage. Contact your health insurance provider to see if supportive-expressive therapy is covered under your plan, or if not, ask your therapist if they offer sliding scale fees, or rates based on your ability to pay.
• Choose the right therapist. When selecting a therapist, consider their qualifications as well as your own comfort level.
• Consider "shopping" around. If you're not "clicking" with your therapist or feel like your sessions aren't helpful, consider trying another therapist until you find someone with whom you're comfortable.