Feeling Our Way

Turn in the direction of the skid.

The Therapeutic Frame Part 1

What are the implicit rules of therapy?

Every relationship has implicit ground rules that serve the participants’ goals, that further their agendas about what kind of relationship they want or expect. For example, marriages vary in the extent to which the partners keep each other up to date about the daily vagaries of work. If you want to know what kind of marriage a couple has (or that you have) on this score, you can get a lot more information by probing the implicit rule about uploading work details than you can by asking them what kind of marriage they want to have or think they have. If you try the latter, two very different couples might both tell you that they want a marriage that’s a true partnership that’s playful and vital, and that they keep spouses up to date about work. Instead, you will learn more about the couple if you can determine whether they tell each other about major conflicts at work, about puzzling problems with colleagues, or about whether the coffee room ran out of skim milk. This is an example of the more general directive in psychology to get examples.

Implicit and explicit rules define all sorts of relationships, including those between friends, colleagues, and even restaurant servers and diners. A list of rules shared in a geographic location is called a culture; a list of rules shared in a relationship is called a frame.

Find a Therapist

Search for a mental health professional near you.

An important rule in any interaction concerns the amount of information you are supposed to consider about other people. The classic example is not noticing a stutter. Another widespread social rule is that you don’t tell people what you are really thinking, not about the seasoning on the meals they prepare, not about the wild sexual and aggressive thoughts that go through your head, and not about the ugly secrets from your past. This rule facilitates most social interactions (that is, it fosters the goals in almost all relationships), but it leaves people hungry for intimacy if they don’t have any friends, lovers, or family members who really get them. (One reason widowers have so much the harder time of it than widows in our culture is because when the wife in a straight marriage dies, the widower has often lost his only intimate relationship.) The corollary of the rules against intimate disclosure and noticing things is that you are generally forbidden from commenting on the behavior of other adults if the comment identifies aspects of the self behind the social mask.

The set of rules that govern a relationship are like the frame of a painting or the stage in a theater; the frame of a painting tells you the kind of thing it is, the sort of attitude—aesthetic in the case of a painting—that you should adopt in relating to it, and what’s in the painting and what’s not. An artistic frame also facilitates engrossment, since the elements of what’s inside it are taken on their own terms; a weak frame is like seeing the backstage during a theater production. But a picture frame, as a friend of mine points out, is selected after the painting is complete, so a relational frame is more like the stretcher frame that a canvas is put on before the artist starts painting; its size and structure depend on what sort of painting the artist is undertaking in response to different artistic agendas and the needs of the patron or the audience. I don’t claim the frame should be the same for every therapy. Instead, I claim that changes in the frame should be managed thoughtfully, that tight frames enhance engrossment, and that the frame of every therapy will need to distinguish it from social and professional relationships that inhibit authenticity.

Many forms of individual therapy depend on access to thoughts, wishes, and memories normally kept behind the social mask. Good therapy also authorizes the therapist to comment on the patient’s behavior. The frame of therapy—its set of implicit rules—is designed solely to facilitate these two relational goals, disclosure and comment. Much is known about which rules lead to disclosure and comment and which inhibit them (which I will discuss in a future post). The social rules against disclosure and comment are so pervasive that the frame of therapy must set it apart from all other types of social relating. The rules around professional relationships (as opposed to a therapeutic relationship)—learned in relation to doctors—push the therapist into an expert role that inhibits the interpersonal process. The therapist wants to be neither social nor professional, and yet the therapist and the patient can easily be seen as two people trying to have a conversation (social) and the therapy is indeed a professional service. These are the Scylla and Charybdis of therapeutic relating, and maintaining a therapeutic frame requires an extraordinary effort, because it is so easy to drift into social or professional relating. Teaching therapists what a therapeutic relationship feels like is like teaching an only child how to act like a sibling, and therapists who have never experienced a therapeutic frame find it hard to believe that such a thing exists.

Michael Karson, Ph.D., is a professor of psychology at the University of Denver.

more...

Subscribe to Feeling Our Way

Current Issue

Let It Go!

It can take a radical reboot to get past old hurts and injustices.