Self psychology, object relations theory and supportive psychotherapy.

A clinical theory of supportive psychotherapy that provides an explanatory model for its mode of therapeutic action can be developed through an examination of the work of Heinz Kohut and object relations theorists such as Ronald Fairbairn and D.W. Winnicott. Central to Kohut's theory of therapy is the premise that in the treatment situation a "good object" is provided for the patient in the form of a therapist who will be internalized, and thus mitigate or repair deficits in the self-structure resulting from inadequate early parenting. The object relations theorist Ronald Fairbairn also emphasizes the importance of the "satisfactory transference situation" to therapeutic change consistent with the author's view that fostering and maintaining the positive transference is a critical technical component in at least the earlier phases of supportive psychotherapy. D.W. Winnicott's conception of the "holding environment" is particularly relevant to the "frame" of supportive psychotherapy through such elements as ensuring the "safety" of the therapeutic situation, and the therapist not allowing anxiety and other affects to mount to intolerable and disorganizing levels. Central to the therapeutic posture of these clinicians is the adoption of an intensely emphatic introspective stance vis-a-vis the patient, which is seen was a critical component of supportive psychotherapy. The effective use of empathy aids the maintenance of the positive transference and facilitates the internalization by the patient of aspects of the interactive process in supportive psychotherapy, thus effecting therapeutic change.