Feeling Our Way

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The Frame, Part 3

The rules of therapy and parenting are not a cage but an embrace.

Fortunately, the very worst moment in my life lasted less than one second. I was observing the birth of my first child, his (at the time, I didn’t know he was a boy) head having crowned. Suddenly, there was his whole head, a deep dusky blue. I had gone to classes and read books, but I was utterly unprepared for his color. Later, I learned that it is quite common among healthy babies to come out blue and change color with the first breath, but at the time, my world went inside out, while panic in an abyss of loss consumed me. In less than a second, I noticed something remarkable that I think provides a valuable lesson for therapists, parents, and educators. I noticed that Dr. Sprong’s hands weren’t moving any faster than they had been. Quicker than words, I knew that this meant that all was okay, despite what I could see and all that I thought I knew. I instantly relaxed.

The frame of therapy, like a reliable bedtime, communicates to patients and children that whatever they are going through can be taken in stride. Whether a session ends in tears, laughter, reflection, or anger, it ends on time, communicating that all is equally welcome, and all equally merits attention. When a therapy is organized to keep the therapist as ambiguous as possible to facilitate the patient’s display of idiosyncratic expectations of relationships, we don’t indulge the patient’s thirst for personal information about us. Instead, we communicate that their curiosity need not upset the pace and content of what we are doing together. When the patient asks for our advice, we interpret the function of the request, often in the context of the patient’s frustration with the lack of results. This should lead us to reconsider whether the working alliance needs repair; but we don’t indulge the request with a tantalizing morsel of personal history to distract us both from the lack of progress or lack of agreement about what it is we are doing together.

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Many problems that patients bring to therapy have to do with difficulties reconciling themselves with reality. A vast number of mating concerns have to do with the fact that you can generally mate only with someone with about as much social capital as you have. This is a law of nature that many people find oppressive. Many weight-loss problems have to do with an implicit protest against the laws of thermodynamics (calories in and calories out). Many people live a life that challenges the proposition that they will get older and that there are only so many hours in a day, and their constant emotional bruising as they bump up against reality brings them to therapy. Flexibility in the frame of the therapy inadvertently communicates that they don’t need to adjust to reality after all; it communicates that reality will adjust to them.

In ballroom dancing, the frame is the shape maintained by the dancers’ bodies as they interact with each other. Dancers, like lovers, therapists, and parents, must not dominate each other or lean on each other. Instead, they must collaborate, each in his or her own role. It is the frame of the dance that allows them to maintain their autonomy and their interdependence simultaneously. This is what I mean by a therapeutic frame, an embrace rather than a cage.

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

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