Therapeutic Framing: What It Is And Why It Is Important
The therapeutic setting, or sometimes called the therapeutic contract, represents a mutual agreement between the patient and the therapist which establishes the bases and limits of joint work.
Here it is made explicit what is acceptable and what is not for both parties. This provides the stability and predictability needed to safely explore patient issues.
An approach from which we can look at the importance of the therapeutic setting is the so-called Transactional Analysis. It is a theoretical framework developed by Eric Berne in the 1950s, which offers a perspective for understanding how people communicate, relate, and develop their personalities. Well, a central concept in Transactional Analysis is the “Ego state.” According to this theory, each individual has three possible ego states:
We can review every human interaction taking into account what state of self each person is in, and Enframing is no exception. The therapeutic framework should not come from a Parent-Child dynamic. That would be for the therapist to put himself in the place of a parent who sets the rules and the patient in the place of a child for whom rules are set.
It is important that the therapeutic framework be defined from an Adult-Adult interaction. It is an agreement that the adult part of the patient and the adult part of the therapist accept as necessary to optimize their work together. In this way, the setting seeks to empower the patient, allowing him to direct his life in accordance with his values. Furthermore, if it is two adults who make an agreement, it can be adapted and reconsidered throughout the therapy, adjusting to the patient’s needs and progress.
Reasons why the therapeutic framework is key in Psychology
Some aspects that are usually part of the therapeutic framework include the value of the sessions, payment methods and terms, the duration of the sessions, communication between patient and therapist outside of them, delays, how far in advance a session can be canceled or changed. hour without being charged, among others.
These are four fundamental aspects why framing is necessary and important:
1. Structure and clarity
Therapy is a process of exploring the internal world and self-knowledge, where it is expected to encounter unresolved issues, unresolved experiences, traumas, painful memories and other topics with a high emotional charge. All of this can sometimes be experienced as something chaotic. The therapeutic framework, for its part, establishes clear parameters, providing predictability. This acts as a counterbalance to the relatively unpredictable aspect of the emotional world. Having a stable structure can also give the patient peace of mind and reduce anxiety levels associated with therapy.
2. Mutual protection
Framing does not represent rigidity or mistrust, but rather a way to protect both the patient and the therapist. This agreement provides consistency and a safe space for the development of the therapeutic process.
Having explicit rules that define what can happen in the therapeutic relationship prevents real or perceived exploitation of either party. If there is no clear therapeutic framework, and the patient feels the need to talk to his therapist whenever he feels alone or is dealing with difficult-to-manage emotions, the therapist could feel exploited, and limited in his personal life by the calls. of the patient.
It is a different case if the patient and the therapist have an explicit agreement that specifies SOS-type forms of communication. In this scenario, there is no exploitation, since it is being played within the agreed rules.
Another example: Imagine that the therapist decided that he was not in a good mood and therefore informed the patient that the session would only last half the time. In this case, the patient may feel exploited or not treated fairly, especially if it is unclear how long the session lasts. In addition to protecting the patient and therapist, the frame protects the relationship, as ambiguous situations are avoided that could damage the bond and trust, in which case the success of the therapy is unlikely.
3. Depth in therapy
Well-established boundaries allow for deeper and more meaningful therapeutic work, safeguarding the therapeutic relationship and providing greater freedom to the patient and the therapist. It can also be a mirror to see our blind spots. In this way, taking responsibility is encouraged. Framing can be a corrective experience. It’s about playing a game within the agreed upon rules. All of this means taking responsibility for one’s own actions, which in many cases can be something new.
Let’s take for example a patient who acts in a disorganized way in his life, and fails to keep his commitments. This is likely to be reflected in therapy, for example by forgetting that he had a session and consequently being absent. If the framework of your therapy implies that sessions you miss without notice are paid for, paying for this missed session can act as an encouragement to be much more careful on a next occasion. This would not happen if the therapist were “sympathetic” and turned a blind eye every time this happens, which would be counter-therapeutic, and would end up reinforcing and supporting in the patient a dysfunctional way of operating in interpersonal relationships.
Framing can offer an instance of “healthy boundaries,” in the context of the therapeutic relationship. That can be especially meaningful for those patients who have experienced personal stories of disrespected or nonexistent boundaries.
In the same example cited above, the fact that a session that did not take place is considered paid for is not a punishment, but rather a border, a limit to what is permissible within a relationship. When these boundaries are clearly defined and enforced in a kind and empathetic manner, a model, a guideline, a reference is obtained about what it means to set and respect limits in the patient’s own interpersonal relationships.
Conclusion
In short, any violation of the frame is a useful clue, revealing important aspects of the therapist, the patient, or the relationship between them. Some examples of violation may be that sessions extend several minutes longer than the agreed time, that the patient attempts to communicate with the therapist at times or by means other than those agreed upon, or that the patient cancels appointments with less notice than is defined in The framing. These situations should be addressed in therapy, or in the supervision of the therapist, providing a path towards self-discovery, self-knowledge and taking responsibility.
