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.
Shirah Vollmer MD 