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 explore patient issues with confidence.
The states of the I from the Transactional Analysis
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 to understand how people communicate, relate to each other and develop their personality. Well then, a central concept in Transactional Analysis is the "I state". According to this theory, each individual has three possible ego states:
- The father: represents the attitudes, values and internalized behaviors of parental figures and authorities.
- The Adult: It is the state of the rational and objective self, which processes information logically and seeks practical solutions.
- The boy: It is the state of the emotional and experiential self, where emotions, memories and behavior patterns learned from childhood reside.
We can review all human interaction taking into account what state of self each one is in, and Framing is no exception. The therapeutic setting should not come from a Parent-Child dynamic. That would mean that the therapist puts himself in the place of a parent who sets the rules and the patient in the place of a child who is given rules.
It is important that the therapeutic setting is defined from an Adult-Adult type of interaction.. It is an agreement that the adult part of the patient and the adult part of the therapist accept as necessary to optimize the work together. In this way, the setting seeks to empower the patient, allowing him to direct his life in accordance with her values. In addition, if it is about two adults who make an agreement, this can be adapted and reconsidered throughout the therapy, adjusting to the needs and progress of the patient.
- Related article: "Therapeutic Alliance: what it is, how it influences therapy and how it is created"
Reasons why the therapeutic setting is key in Psychology
Some aspects that are usually part of the therapeutic framework include the value of the sessions, the forms and terms of payment, the duration of the sessions, the communication between patient and therapist outside of them, delays, how far in advance can an hour be canceled or changed without being charged, among others.
These are four fundamental aspects for which framing is necessary and important:
1. structure and clarity
Therapy is a process of exploring the inner world and self knowledge, where it is expected to encounter unresolved issues, unresolved experiences, traumas, painful memories and other issues with a high emotional charge. All this can sometimes be experienced as something chaotic. The therapeutic setting, for its part, establishes clear parameters, giving predictability. This acts as a counterbalance to the relatively unpredictable aspect of the emotional world. Having a stable structure can also reassure the patient and reduce anxiety levels associated with therapy.
2. mutual protection
The framing does not represent rigidity or distrust, but a way of protecting both the patient and the therapist. This agreement Provides perseverance and a safe space for the development of the therapeutic process.
Having explicit rules that define what can happen in the therapeutic relationship prevents actual or perceived exploitation of either party. If there is no clear therapeutic setting, and the patient feels the need to talk to his therapist every time he feels alone or when he is dealing with difficult emotions, the therapist may feel exploited, and limited in his personal life by calls from the patient.
It is a different case if the patient and therapist have an explicit agreement specifying ways of S.O.S type communication In this scenario, there is no exploitation, since you are playing within the rules agreed.
Another example: Imagine that the therapist decided that he was not feeling 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 not clear how long the session lasts. In addition to protecting the patient and the therapist, the setting protects the relationship, since situations are avoided. ambiguous that can damage the bond and trust, in which case the success of the therapy is little likely.
- You may be interested in: "What to expect and what not to expect from psychological therapy"
3. depth in therapy
Well-established boundaries allow 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 is about playing a game within the agreed rules. All this implies taking responsibility for one's own actions, which in many cases can be something new.
Let's take the case of a patient who acts disorganized in her life, and lacks her commitments. This is likely to be reflected in therapy, for example, forgetting that you had a session and consequently absenting yourself. If your therapy framing implies that sessions you miss without notice are paid for, paying for this session that you did not attend can work as a stimulus to be much more careful in a next one chance. This would not happen if the therapist were "understanding" 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 relationships interpersonal.
4. Corrective Regarding Limits
Framing can offer an instance of "healthy boundaries" in the context of the therapeutic relationship. that can be especially significant for those patients who have experienced personal histories of non-respected or non-existent boundaries.
In the same example cited above, the fact that a session that didn't take place is considered paid is not a punishment, but an edge, a limit to what is permissible within a relationship. When these borders are clearly defined and are respected in a kind and empathetic way, you get a model, a guideline, a reference about what it means to set and respect limits in the interpersonal relationships of the patient.
Conclusion
Ultimately, any violation of the setting is a useful clue, revealing important aspects of the therapist, the patient, or the relationship between them. Some examples of transgression may be that the sessions last several minutes more than the agreed time, that the patient tries to communicate with the therapist at times or by means other than those agreed, or to cancel appointments with less anticipation than is defined in the frame. These situations should be addressed in therapy, or under the supervision of the therapist, providing a path towards self-discovery, self-knowledge and taking responsibility.
