The psychotherapy frame

June 30, 2019
The psychotherapy frame

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

“The psychotherapy frame” refers to the psychotherapist’s effort to create a safe, therapeutic atmosphere in which rapport and trust can be established. In setting up a therapeutic frame, psychotherapists 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 psychotherapists 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 phrase, “the psychotherapy frame”, refers to the structural aspects of the session.

Decisions regarding the psychotherapeutic frame have far reaching therapeutic implications. In setting policy, I feel that the clinician must consider the implication of every aspect of the psychotherapy 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. Therefore, the psychotherapy 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. We expect to provide valuable help and to be paid for it. We adhere to a schedule and we expect that the people who we see will be adhere to a schedule. ¬†These aspects of practice are very important because they convey much to the patient about the psychotherapist’s method of working. Deviations and departures from the psychotherapy 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.

There’s much more to be said about the psychotherapy and we will address this, more extensively, in class.
Those seeking psychodynamic psychotherapy, psychoanalysis or clinical supervision are welcome to call me: 301.656.9650.
 

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