How Supportive-Expressive Therapy Treats Addiction

This treatment is designed for severe substance use disorders

man talking to therapist in therapy
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Supportive-expressive therapy is an evidence-based, psychodynamic psychotherapy, that is effective in treating more severe substance use disorders.

Find out if this form of therapy is right for you with this review of the treatment, including its origins and techniques.

What Is Supportive-Expressive Therapy?

Supportive-expressive therapy draws from the psychodynamic orientation, which originated with Freud's psychoanalytic theory, which claimed that psychological problems originated in early childhood.

These psychological problems can occur alongside problems associated with substance use and can be treated by becoming more aware of, working through and overcoming unhelpful patterns in relationships.

How Supportive-Expressive Therapy Stands Out

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 her relationships with other people. Supportive-expressive therapy is a combination of two main components: supportive techniques to help clients feel comfortable in discussing their personal experiences and expressive techniques to help clients identify and work through interpersonal relationship issues.

This is done through working on three areas of focus: the person's emotional experience, for example, through the person identifying and labeling the emotions they have been experiencing; the communication between the therapist and the person receiving treatment; and interpretation of what comes up in therapy sessions.

The Goal of the Therapy

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.

The therapist and client explore and gain insight into conflicts that developed within the client through early experiences, for example, with parents and caregivers, and how these are represented in current situations and relationships during supportive-expressive therapy.

Supportive-expressive therapy is non-directive, which means that the client, not the therapist, decides what is important to focus on, and a typical course of therapy consists of 16 to 30 sessions, which last about an hour each.

Supportive-expressive therapy is particularly well suited to clients with severe substance use disorders, including opioid use disorder, which can develop in response to using a drug such as heroin and cocaine use disorder.

Why Supportive-Expressive Therapy Helps Severe Substance Use 

Supportive-expressive therapy has been shown by research studies to be 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.

In methadone maintenance treatment, the benefits from supportive-expressive therapy included reductions in drug use, 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. In addition, people who receive supportive expressive therapy show fewer and less severe problems than those receiving drug counseling. It is as effective as cognitive-behavioral therapy.

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


Diener, Marc J. Pierson, Meredith M. "Technique and therapeutic process from a supportive-expressive relational psychodynamic approach." Psychotherapy, Vol 50(3), Special issue: Clinical Process. pp. 424-427. Sep, 2013.

Leichsenring, F. & Leibing, E. "Supportive-Expressive (SE) Psychotherapy: An update." Current Psychiatry Reviews, 3, 57-64. 2007.

Leichsenring, F., Rabung, S., & Leibing, E. "The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: A meta-analysis." Archives of General Psychiatry, 61, 1208-1216. 2004.

Luborsky, L. Principles of psychoanalytic psychotherapy: A manual for supportive-expressive treatment. Basic Books. 1984.

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