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Tijdschrift voor Psychiatrie 46 (2004) 3, 157 - 166

Essay

The psychiatrist as supportive object

M. Hebbrecht

background In recent editions of the Tijdschrift voor Psychiatrie there have been discus-sions about the role of the psychiatrist. At the basis of the psychiatrist's professional identity as a medical specialist lies the psychiatrist's more fundamental and core identity as a supportive object. As psychiatrists we seem to be focusing increasingly on the practical guidelines for treating psy-chiatric disorders and are thereby in danger of losing sight of the importance of our therapeutic relationship with patients. More attention needs to be given in training courses and in scientific literature to the supportive aspects of our work.
aim To review the literature on supportive psychotherapy, and taking into account the psycho-therapeutic theories of Winnicott and Kohut, in order to formulate a personal view about various aspects of the psychiatrist's fundamental supportive role; thereafter to summarize the empirical evidence concerning the basic elements of the therapeutic relationship.
method Hand books and review articles relating to psychodynamic supportive psychother-apy published since 1980 were systematically reviewed. In addition, the work of Winnicott and Kohut was studied thoroughly.
conclusions Giving support means helping to underpin an illusion that has been created by the patient and helping the patient to overcome his gradual disillusionment. Support means the management of narcissistic transferences. It is a specific way of handling transference and countertransference. Being supportive implies gratifying the patient's pre-oedipal needs within the boundaries of the psychiatrist's professional role. The psychiatrist as a supportive object has a triple role: looking after the 'healthy child' element in the patient, encouraging and caring for the 'adult' element, while watching over the alliance and the realistic relationship, and surviving at-tacks from tyrannical elements by facing up to them and setting limits. These elements need to be emphasised in a psychiatrist's therapeutic training.

keywords physician-patient relationship, psychotherapy, psychoanalysis, evidence-based medicine