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Setting the Frame and Establishing Boundaries
Abstract
Setting the frame is essential to any type of psychotherapy, it establishes boundaries and sets up a safe relationship in which patient and therapist can work. The frame of psychotherapy includes: role, time, setting, money, contact information, what to do in the event of an emergency, confidentiality and issues relating to traineeship. A role is a part or function that we play in a particular situation. To set up a psychotherapeutic situation, we set aside a specific, consistent period of time during which our attention is focused exclusively on the patient. There are three major reasons why patients might need to contact the therapist outside of session time: emergencies, the need to cancel or reschedule a session and to request medication refills. A boundary is defined as the edge of appropriate behavior. Boundary "crossing" is a benign deviation from the frame that may advance the treatment and does not harm the patient.
... Behaviour change to support this mediation at the population level requires careful design and one of the features of parkrun that supports this might be its 'framing'. Manuals for the delivery of effective psychotherapy emphasise the need for framing of any intervention in terms of its role, time, place and cost [38]. Parkrun addresses these as follows: its role is as a "community event where you can walk, jog, run, volunteer or spectate" [7]; it is at the same time every week (9am on a Saturday morning; 9.30am in Scotland and Northern Ireland); it is in the same place (a local park); and it is free. ...
An intervention suggested by the World Health Organisation that might increase life satisfaction is parkrun, a free, weekly, timed five kilometre run or walk. The issues with such interventions are (1) whether they impact on the life satisfaction of their participants, and (2) whether they are cost-effective. A study of 548 newly registered parkrunners were asked about their life satisfaction at baseline and six months later. A change of one life satisfaction point per year per participant was defined as one WELLBY (wellbeing adjusted life year), with a value of £13,000. Three approaches were used to estimate the additionality (added value) of parkrun: (1) by comparing a participant’s number of parkruns to total activity; (2) by accounting for the participant’s perceived impact of parkrun across 16 measures; and (3) combining these two methods equally. After six months, weighted, seasonally adjusted life satisfaction increased from a mean of 7.489 to 7.746, a change of 0.257. Both life satisfaction improvement and additionality were greatest for the least active. Assuming only half a year of benefit, the total value of the life satisfaction change for the 2019 parkrun population of 400,167 participants was estimated as £667.4m, with the least active accounting for almost half. Comparing to the cost of running parkrun in 2019 and using the activity, impact and combined methods for additionality, benefit-cost analysis ratios were found to be 16.7, 98.5 and 59.3 to 1, respectively. These were between 2.8 to 16.7 times that of other population-level physical activity interventions. Physical health was a mediator between activity and life satisfaction; mental health was only found as a mediator when combined with physical activity. Successful features of parkrun that might guide other interventions include its framing (role, time, place and cost) and ability to forge both strong and weak social ties.
Effective psychotherapy builds on a strong foundation developing as early as the first session. The aim of this review is to identify clinical research related to nonspecific (i.e., common factors) treatment effects and to expand upon those findings in developing techniques for applied clinical practice. Clinicians across treatment modalities can implement these techniques that are informed by empirical evidence in an effort to develop a collaborative treatment relationship with new patients. Three therapeutic principles identified in this review are: fostering positive expectancies, role preparation, and collaborative goal formation. Research related to these factors is reviewed as are suggestions for implementing them into applied clinical practice during early treatment interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In simple, jargon-free language, Herbert Schlesinger sets out to demystify technique, to show how it is based on basic principles that are applicable both to psychoanalysis and to the psychotherapies that derive from it. He has little need for conventional theory; rather, he reframes essential analytic notions - transference, resistance, interpretation, regression, empathy - as processes and assigns technique the goal of promoting the patient’s activity within the treatment situation. The aim of the analytic therapist is to restore to the patient active control of his own life.
The authors systematically examine the concept of boundaries and boundary violations in clinical practice, particularly as they relate to recent sexual misconduct litigation. They selectively review the literature on the subject and identify critical areas that require explication in terms of harmful versus nonharmful boundary issues short of sexual misconduct. These areas include role; time; place and space; money; gifts, services, and related matters; clothing; language; self-disclosure and related matters; and physical contact. While broad guidelines are helpful, the specific impact of a particular boundary crossing can only be assessed by careful attention to the clinical context. Heightened awareness of the concepts of boundaries, boundary crossings, and boundary violations will both improve patient care and contribute to effective risk management.
The author argues that the use of clinical material for educational purposes or for publication presents the analyst with a conflict of interest between the protection of the patient's privacy and the educational and scientific needs of the field, and also that it places analysts in the position of using confidential patient material in the service of their own professional advancement. The strategies of dealing with this dilemma can be classified as follows: (1) thick disguise, (2) patient consent, (3) the process approach, (4) the use of composites and (5) the use of a colleague as author. Some of these options may, of course, be used in combination with one another. All of these methods have a place, and the author argues against a uniform approach. Each of these strategies is discussed in terms of its advantages and disadvantages. While no choice is without various risks, some guidelines are offered to assist analysts who wish to present or write about clinical cases.
The September 11, 2001, terrorist attack on the World Trade Center profoundly affected the population of New York City, including analysts and analysands. To study the effect of this event on the technique of psychoanalysts conducting ongoing analysis during the weeks after 9/11, confidential questionnaires were sent to all candidates and faculty at the Columbia University Center for Psychoanalytic Training and Research. Respondents indicated that in the days and weeks following 9/11 they initiated phone calls to their analysands, asked about their analysands' families, gave advice when it was requested, offered reassurance, and answered personal questions. They did not initiate physical contact, discontinue use of the couch, or give unsolicited advice. These responses suggest that these analysts made decisions to alter their technique in certain ways in the wake of a catastrophic event shared by the community.
Becoming a Therapist
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