The Therapeutic Frame: Is it Central to the Cure?
Saturday 14 December 2019 - London
With Dr Maria Luca, Prof Alistair Ross, Maktuno Suit and Nick Totton
The therapeutic frame has evolved over 130 years, from being a practical appointment system for a meeting between analyst and patient, to a key component of the practitioner’s skill. Traditionally, it has been seen as providing consistency, reliability, confidentiality; of preserving a screen of anonymity around the psychotherapist, which allows the patient or client the freedom to freely roam their transferences and projections onto that person. It offers a dependable structure for that relationship, one with a quality of safety and predictability – something that is of great importance to those who suffer from inner or outer chaos in their lives.READ MORE...
The frame creates safety and inhibits the danger of the therapist’s use of the client. It offers a set of limits which, in themselves, can engage the patient with creative boundary pushing which illuminates their unconscious desires and fears. Yet, if held too rigidly, these limits can be experienced as deeply persecutory; they can exclude moments of deeper connection. The email that arrives between sessions, the early arrival for a session, the probing personal question about the therapist’s life: these interruptions may contain great potential for a therapeutic breakthrough if allowed some breathing space.
So, in contemporary psychotherapy, where should the therapeutic frame be placed? Many practitioners are now experimenting with outdoor therapy, loosely timed sessions, calls between sessions and self-disclosure. Do these enhance or hinder the work? After all, Freud took his patients on long mountain walks. Is there a risk that the frame exists primarily to protect the therapist? Or is it a key therapeutic device? We invite our speakers to consider if new and more flexible approaches run the risk of overlooking a key to therapeutic success: containment.
Registration and coffee
Dr Maria Luca
The Flexible Frame
The frame first proposed by Milner in 1952 was concerned with distinguishing the therapeutic setting from other forms of personal encounter and ensuring the demarcation between the therapeutic space and the outer world. It was intended to provide security and lay the foundations for the process and create the facilitative conditions for the cure. Robert Langs (1997) was an advocate for what can be described as an intractable frame. In 2004 Maria’s book on the therapeutic frame proposed a flexible, elastic frame. She has not changed her view since then. Today’s global market and international travel have changed the conditions within which therapy operates. The new world climate demands flexibility in a psychotherapist’s approach. Skype sessions rather than paying for absence, offering alternative times to replace cancelled sessions, email and sms exchanges are common these days. Are these deviations from the frame? Not if the therapist is skilled in handling flexibility, while staying true to the contractual arrangements. We can have frames to show us the way, but each frame is pushed and pulled elastically by the participants.
Rewilding the frame
The traditional therapeutic frame exists primarily, though not entirely, for the benefit and protection of the therapist rather than the client. Working outdoors with clients brings this home to us in a very direct way: although some people try hard, it is virtually impossible to carry the traditional frame with us up hill and down dale, through mud, water and briars. We are forced to ask ourselves: what is really necessary here? I will be arguing against a rigid emphasis on boundaries, and in favour of cultivating boundlessness – coming from a place of abundance and generosity.
Frames of the future: Mobile, Hybrid and Immersive
As therapists many of us are realising the need to embrace technological changes and adapt to changing societal norms in terms of how we practice and relate to core psychoanalytic concepts – including the analytic frame. What are some of the opportunities and risks of taking our understanding of the analytic frame and adapting it for use with a modern audience?
Prof Alistair Ross
When the Unconscious Changes the Frame
All dynamic therapies build their theories and techniques on the idea of the unconscious. The techniques associated with the therapeutic fame are to help identify and contain aspects of both the clients and therapists unconscious and use these in a therapeutic way. But what happens when the unconscious changes the therapeutic frame? Alistair will illustrate this idea with a clinical example and explore the impact this had on the client and the therapist.
Please choose one group and register for that on arrival
1: Nick Totton
Carrying on from his talk, Nick will be offering a structure to explore bringing boundlessness to the therapeutic encounter, and trying to clarify when strict boundaries are genuinely valuable, and when they are damaging to the therapeutic relationship.
2: Dr Maria Luca
Exploring implications of a rigid frame in therapy
Maria will identify and discuss the permutations and implications of a flexible frame, explore vignettes where individualised psychological formulations call for flexibility, and discuss principles of appropriate handling of frame challenges.
3: Maktuno Suit
In this workshop we will explore three therapeutic examples that explore how the analytic frame has been reimagined in three different contexts. Within these, we will explore how their adapted use impacted patient outcomes and the therapist, and draw out wider principles and best practice.
Mobile Frame – conducting therapy whilst walking with an offender in East London.
Hybrid Frame – conducting therapy virtually and face-to-face with a creative in LA and the UK.
An Immersive Frame – conducting therapy whilst living with a client in a luxury inpatient setting.