Shirah Vollmer MD

The Musings of Dr. Vollmer

Breaking The Frame

Posted by Dr. Vollmer on August 24, 2012

The frame in psychotherapy, the play-space, is the parameters which create boundaries. The situation is mostly confidential (with the obvious exceptions of reporting child abuse and suicidal behaviors), the start time is established, as is the stopping time. Fees are discussed and payment is due at a certain time. Contact outside of sessions are negotiated. Sometimes, clinical intuition dictates breaking this frame. Laura, fifty-seven, just lost her dad. Should the frame change? Should appointments be longer. Should she get “extra time”? If so, could this damage the relationship down the line? Would this be confusing for her? The frame gives comfort. There is solace in predictability. There is anxiety in uncertainty. The individuality of this field makes it so that there are no clear answers. There is only the understanding that breaking the frame can be helpful and/or hurtful, and I need to be mindful of this at all times. Laura was grateful for the change in parameters. Giving her more time just seemed humane under the circumstances. Sometimes common sense has to apply.

4 Responses to “Breaking The Frame”

  1. jo said

    Interesting … I’ve thought a lot about this. My therapist seems to be rather loose with time issues. She will often go over 50 minutes. She’s given me extra minutes numerous times and I’m assuming she does the same with her other clients. I have also waited up to 20 minutes past my scheduled appointment time more than once, waiting for her to finish with another client. I can see how this could help or hinder, depending on the situation. I’m grateful for the style of care she gives, so I accept this about her as well … but it does cause confusion at times.

  2. Thanks, Jo. You bring up a good point. Being “nice” to one patient, may hurt another patient’s feelings. The narrow path of indulgence versus rigidity is a tough call. Thanks again for sharing your experience.

  3. Shelly said

    I think in your profession, considering it is based on emotions and not simply on physical manifestations of somatic diseases, one needs to be a touch flexible, because one can’t turn off one’s feelings to suit a 50 minute session. Emotions run rampant 24 hours a day and medication may be able to help, but nothing can quite keep things in check as easily as checking in with one’s therapist. The beauty of your profession is that you can decide whether to return the call or not. I’m sure your patients do not expect a return call 24/7 but that you will return their call only if it is an emergency?

    • Shirah said

      The complications of being “flexible” are the challenge. Your commnet rings true. Those who think that my job has “regular hours” always throws me for the reasons you articulated. The issue of an “emergency” is another complication. Emergencies are often subjective and as such, one has to be sensitive to one’s sense of emergency layered over the issue that life-threatening situations might be happening. The judgment involved in being “flexible” is the skill I am trying to hone. Thanks.

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