Shirah Vollmer MD

The Musings of Dr. Vollmer

The Analytic Frame

Posted by Dr. Vollmer on April 12, 2016

The “analytic frame” is a way of describing the notion that patient and therapist engage in a verbal contract in which the job of the patient is to show up and pay the bill, while the job of the therapist is to help guide an understanding of the inner workings of both the mind of the patient, and where relevant, the mind of the therapist as well. Breaking or expanding the frame is not taboo, but something which should be carefully considered. The invisible frame is a strong reminder that the therapist is there as a facilitator and as such, should not bring his/her needs into the therapy room. Of course, the therapist has unconscious needs from the patient, such as a need for appreciation, but these unconscious needs should be fodder for discussion, if the patient feels those needs are interfering with his/her treatment. The frame, like any boundary, allows for freedom within the limits, as a playground is fenced, but there is freedom within it. Respecting the frame, the boundaries of treatment, allows for the safety of the experience, the safety of knowing there is privacy and there are limits to how much the therapist will share his/her issues. Maintaining the analytic frame is the work of the therapist, and so in my class tomorrow, we will talk about how unconscious reluctance to maintaining that frame may cause the therapist to discourage patients from entering deeper treatment by colluding with the obvious issues of time and money. Lacey, fifty-four, comes to mind. With three little children, a full-time job and an underemployed husband, she is “certain” she cannot come more than once a week for treatment. The therapist agrees with her, as the therapist is also a mother of young children, and so imagines her time limitations. As time goes on, Lacey has a ski accident and hurts her knee. Suddenly, she is going to physical therapy three times a week and paying for it out-of-pocket. “I am glad you are going to physical therapy and taking care of your knee, but I am also aware that when it comes to your body, you find the time and the money, but when it comes to your mind, you are convinced that you have significant limitations.” Suddenly, Lacey is taken aback and agrees that she knows physical therapy will help her knee, but she is far less certain if increasing her psychotherapy will help her life. The therapist, upon hearing this, begins to reflect that her collusion with the lack of time and money was simply a projection, and that Lacey’s reluctance for deeper psychotherapy, was not about her limited time, but rather her hopelessness about the process. The therapist did not encourage creating an analytic frame for Lacey to feel a sense of hopefulness about this. It is possible that the therapist, thinking how busy she is in her own life, did not want to increase her time commitment and so conveniently fell into “there is no time and there is no money” way of thinking. The two-way street issue presents again and again. And so our class will delve into the challenge of creating this ‘analytic frame’.

2 Responses to “The Analytic Frame”

  1. Shelly said

    Wow, this is a really interesting post. I had never thought about this two way street thing. Except when all treatment is a part of an HMO (and the therapist is a busy, harried physician who wanted the patients in and out within 20 minutes and was happy when the patient cancelled and thought of it as more time for a coffee or bathroom break), I never considered that scheduling issues on the side of the therapist could be because they were simply too busy and it would interfere with their lives outside of the office. In addition, I was once told that “therapy is a gift one gives himself.” If that is the attitude, no wonder that Lacey could see fitting in physical therapy for her knee, but not increasing her meetings with the the therapist: one is a must, and one is a “me time.” She simply couldn’t get on with her daily routine without treating her knee, but she could skip the “little luxury” of healing her mind.

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