This post, “The Psychotherapeutic frame” was originally published in Washington DC Psychotherapist’s, Dr. Lynn Friedman’s, Johns Hopkins blog.

The psychotherapeutic frame?

The term, “psychotherapeutic frame” refers to the therapist’s effort to create a safe, therapeutic atmosphere in which rapport and trust can be established. In setting up a therapeutic frame, therapists are thoughtful about creating expectations. That is, we want to make the psychotherapy setting predictable so that patients can feel safe and so that they know that they can count on us.  So, as therapists we are thoughtful about: scheduling appointments, handling the beginning and ending of a psychotherapy (or psychoanalytic) sessions, establishing and collecting fees, dealing with lateness, addressing cancellations and, responding to “no shows”, dealing with insurance companies, obtaining consent before sharing patient information with anyone and related fare. In general, the term, “psychotherapeutic frame”, refers to the structural aspects of the session.

Decisions regarding the therapeutic frame have far reaching therapeutic implications. In setting policy, I feel that the clinician must consider every aspect of the frame with special care. We encourage patients to speak openly and without fear of reprisal. The session is for and about the patient and we do our very best to set aside our personal agenda and to listen in a non-judgmental fashion. The so called, “the therapeutic frame” is first and foremost about the clinical needs of the patient. However, the frame must also reflect the clinician’s needs. Clinicians are typically earning a living and therefore, expect to be paid, expect others to agree to and adhere to a schedule, etc. Thus, these aspects of practice are very important because they convey much to the patient about the therapist’s method of working. Deviations and departures from the therapeutic frame, whether by the patient or the clinician, warrant careful attention both in the clinical setting and in any consultation that the therapist may seek.

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