Frame

In the Fall of 2011 TBIPS will offer to both first year and third year classes a practical course on helping the analyst negotiate with patients the analytic frame. We will ask what distinguishes psychoanalysis and psychoanalytic psychotherapy from what a good friend or a loving family member can provide. What makes psychoanalysis and psychoanalytically oriented psychotherapy so special a relationship? Does the psychoanalytic attitude [see Jan 3, 2011 post] really allow the patient a freedom of self unlike any other relationship? Can the relationship really allow for the safe exploration of automatic ways of being with another in the world?

Analyst and patient together negotiate the frame or rules on which the two will come to rely. The analyst is punctual [lest the patient unnecessarily be made to feel like ‘chopped liver’] and alert [lest the patient unnecessarily be made to feel unable to garner the attention of important others], ready to be interested and self-reflective. And when the analyst is not punctual or interested and alert, the analyst must open her/his failings to the patient for exploration. The frame will describe when and how often the sessions will occur, the analyst’s availability between sessions, the fees, times, etc. including how many weeks or months the analyst is out of the office (conferences, vacation, etc). The frame includes the psychoanalytic attitude with its asymmetrical focus on what is in the best interest of the patient and with the safety of the patient’s psyche foremost. Safety is fostered when analysts do not judge, when we do not question with implicit incredulity or veiled contempt [both which can inadvertently humiliate a patient]; when we are attentive to changes in the patient’s (and our) self states, tone or prosody of speech, autonomic responses, or other indications that we may need to ‘slow down’.

Safety is also facilitated by our reliability, punctuality, earnestness in the experience, by our listening, processing, and considering what we have seen, heard, felt, and experienced. Maintaining the frame will, at times, help communicate safety. At other times, the frame must be flexible enough to allow for negotiation, and for enactments [sometimes patients seek to break the frame, not as resistance but as an attempt to reach us]. Because psychoanalysis (or psychoanalytic psychotherapy) is a dialogue within a frame, and with a reciprocity of sorts, and because it includes the multiple unconsciouses of both participants, both patient and analyst will emerge changed in some way.