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 C. 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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