When you think about core topics in consultation-liaison psychiatry, “supportive psychotherapy” probably isn’t the first thing that comes to mind. But maybe it should be.

In this episode, I sit down with Dr. John Markowitz, Columbia psychiatrist, researcher, and co-author of Supportive Psychotherapy: A Guide, to talk about the therapy that “gets no respect.” Dr. Markowitz explains how this deceptively simple approach, built on empathy, affect, and alliance, rivals more “sophisticated” treatments for depression.

We explore why the most powerful interventions often come down to being present, listening well, and helping patients feel understood. And we talk about the threat facing psychotherapy itself and what we stand to lose if psychiatrists give it up.

Takeaways:

Supportive psychotherapy works and evidence shows it can be just as effective as CBT or IPT for depression.

Common factors like alliance, empathy, affect focus, and ritual account for much of what makes any therapy succeed.

Following affect matters emotions are uncomfortable, but they’re not dangerous, and they guide the healing process.

Less is often more letting patients lead, listening actively, and resisting the urge to “fix” can create deeper insight.

Psychotherapy is under siege and preserving its human core may be psychiatry’s most important act of resistance.

Selected references:
⁠What is Supportive Psychotherapy? ⁠(Markowitz 2014)
⁠Brief Supportive Psychotherapy⁠ (2022)
⁠Psychiatrist Effects in the Psychopharmacological Treatment of Depression⁠ (McKay 2006)

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Chapters:
00:00 Introduction to Psychiatry Bootcamp
00:40 Challenges in Psychotherapeutic Approaches
01:11 Supportive Psychotherapy: An Overview
02:12 Interview with Dr. John Markowitz
03:28 The Evolution and Efficacy of Supportive Psychotherapy
10:09 Common Factors in Psychotherapy
21:20 The Role of Therapeutic Rituals
26:03 Promoting Patient Autonomy and Success
31:20 Interpersonal Psychotherapy Explained
31:58 Defining Life Crises in Therapy
33:17 Role of Time-Limited Treatment
34:12 Supportive Psychotherapy Techniques
35:20 Avoiding Common Pitfalls in Therapy
37:20 Training and Adherence in Psychotherapy
39:04 Challenges in Supportive Therapy
42:53 Emotional Processing in Therapy
45:54 Psychodynamic Perspectives in Therapy
55:40 The Future of Psychotherapy