What is the therapy frame?
Psychological change is a fundamental aim of all therapy, without hoping for change in some way, why would patients seek help? The pathway towards change is often not linear, and challenges must be navigated along the way. Change can be defined as “removal of symptoms through the correction of their underlying pathology” (Leiper & Maltby, 2004), however, psychodynamic therapists argue change is much more than the reduction or removal of symptoms, and for long term change to occur, one must work iteratively and continuously to make an enduring structural change (Leiper & Maltby, 2004). This requires extensive commitment on behalf of both the patient and the therapist. Prior to beginning sessions with a patient, particular attention must be given by the therapist to the analytic frame (Milton, 1993) or therapy frame and is an imperative part of the establishment and maintenance of the therapeutic relationship.
By ensuring that clear and transparent therapy guidelines are provided at the beginning of treatment, a space of trust and safety is established for the patient to begin to explore their inner selves, gain insight and ultimately experience psychological change. The consistent therapy frame communicates to the patient that this relationship is different to other relationships the patient may have experienced in the past. Any subsequent deviations to the frame can be explored further within the confines of the therapeutic relationship, providing an opportunity to reflect on unconscious motivations and promote inner change. However, the responsibility for this change mechanism to be activated lies solely with the therapist. It is they who must construct and manage the analytic frame to enable therapeutic interaction and create a safe space for the patient to bring unconscious thoughts to the forefront and move towards creating meaningful change in their lives.
The therapeutic frame acts as a consistent and safe space in which the patient can return to time and time again. Experiences of being metaphorically held and understood by the therapist repeatedly contribute to self-understanding and gaining insight into unconscious thoughts (Eagle, 2017). Within the therapeutic space, the unconscious thoughts can be revealed by the patient and a reintegration of disowned aspects of the patient can occur. The therapist is contained and tolerant of all expressions of unconscious feelings of the patient, and enables the patient to feel understood (Eagle, 2017). Unconscious parts of self that have in the past have been unseen are now accepted, tolerated and contained in the therapeutic relationship, leading to acceptance and change in the patient.
Eagle, M. N. (2017). Attachment theory and research and clinical work. Psychoanalytic Inquiry, 37(5), 284–297. https://doi.org/10.1080/07351690.2017.1322420
Leiper, R., & Maltby, M. (2004). The psychodynamic approach to therapeutic change. SAGE Publishers.
Milton, M. J. (1993). The frame in psychotherapy: Langs and Casement compared. Counselling Psychology Quarterly, 6(2), 143–150.
https://doi.org/10.1080/09515079308254501