By way of introduction the concepts ‘helpful-supportive’ (in analytical psychotherapy) and ‘exclusive-supportive’ psychotherapy are defined. Then the indications and the patients’ characteristics (marked ego weakness, dependency wishes) concerning exclusive-supportive psychotherapy in psychosomatic medicine are outlined. After this we describe the three interview and treatment steps of supportive psychotherapy in psychosomatic patients which particularly include the patients’ motivation for conflict-enlightenment psychotherapy. Furthermore some effectiveness criteria are presented. Apart from this motivation work, there exists an indication for supportive long-term psychotherapy in psychosomatic patients. Exclusive-supportive psychotherapy in chronically medically ill patients is founded upon the instability of the psychic adaptation processes (particularly the labilized denial work) following the manifestation of chronic disease. The characteristic intervention techniques deal with the patient’s secondary frustration-aggression following, on the one hand, his idea ‘Why am I so ill and not the others’. On the other hand, supportive-psychotherapeutic handling of the patient’s acute or long-lasting conflict situations prevails. Additional systemic psychotherapeutic procedures are highly recommended in psychosomatic and chronically ill patients, for these procedures are well suited to promoting the effectiveness of individual supportive psychotherapy.