THE ANALYTIC FRAME & BOUNDARIES

“In order to do psychoanalytic psychotherapy, one has to create a special space in which the past can
reappear in the here-and-now; a space within which past emotional conflicts are re-lived and
understood with clarity and within which new solutions to old problems are found.

Angela Molnos (1995)

 Psychodynamic psychotherapy provides a special kind of space or ‘frame’ that is established

and maintained by the ‘boundaries’: This frame separates the therapeutic relationship from
other types of everyday, social relationships: It provides a safe, reliable, constant,
predictable environment within which the patient’s internal world can emerge.

 The ‘boundaries’ are important in establishing this frame and so creating a secure base for
the therapeutic process to develop and for setting a baseline for observation and
interpretation:

Without clearly delineated and maintained boundaries it is doubtful whether meaningful

psychotherapeutic work can take place.

These boundaries include the following:

1. PLACE
The building; the room; the privacy; the furniture, room layout all remain constant, week
in and week out.

2. TIME
Having been agreed by both parties, sessions take place at the same time on the same
day(s) and start and end on time: As much notice as possible is given as to possible
breaks.

3. CONDUCT
Regularity, punctuality with ‘suspended action’ – this is a talking therapy only.

4. RELATIONSHIP

Confidentiality: The therapist attitude; which will include interest, consistency and
honesty without self-disclosure.

TEWV: Specialist Psychotherapy Service: Wessex House: February 2013

 ANALYTIC LISTENING
1. To the actual words – what is said, choices of expression, changes of words and the famous
Freudian slips – words which might have more than one meaning.

2. To the mood and feeling and underlying messages that are conveyed through the actual
words the patient chooses. This kind of listening is like listening to a piece of music;
listening with the ‘third ear’ with your attention hovering over the material and to your
reactions etc.

3. To the non-verbal cues associated with the patients telling of their story e.g.:

o Posture
o Gaze
o Eye-contact
o Tone of voice
o Facial expression etc

4. To your own thoughts and feelings which might be unconscious and/or especially fleeting or
apparently irrelevant ones which might prove to have more meaning than at first likely or
possible.

This includes your counter-transference to the patient i.e. what is communicated indirectly
to you about the patients’ difficulties etc via processes such as projection or projective
identification.

Jacobs (1988) summarises this well:

‘Listening in this careful way, with attention to what the client is actually saying and
probably implying, the therapist also seeks to remember as much as possible because it is not
possible to comment on everything that the client says. At times, a client will be in full-flow
and the therapist does not wish to interrupt, so, points that might have been taken up or
questions that might have been asked therefore have to held in abeyance and in memory.

Nor is it possible always to understand the meaning of some parts or phases in the client’s
story so the therapist has to hold those aspects in mind until the client later says something
(or the therapist overcomes their own resistance) that perhaps throws light on unclear areas.

By holding onto the client’s unfolding story and associations, the therapist looks for threads
that run through, from which he or she might then weave an overall response which…..(takes
up the main anxiety or theme which the patient has been expressing) (pg 29)

TEWV: Specialist Psychotherapy Service: Wessex House: February 2013

 ANALYTIC INTERPRETATIONS & LINKS
INTERPRETATIONS

In psychodynamic psychotherapy is about engaging the patient in a particular kind of task with the
aim of making ‘the unbearable and incomprehensible, bearable and comprehensible’.

This task, which is essentially a search for meaning, involves:

a. Active understanding: This involves exploring the origin and meaning of symptoms,
difficulties and problematic styles of relating and helping the patient reflect on the ways in
which these reveal themselves in the ‘here-and-now’ of the relationship with the therapist.
Uncovering and re-experiencing aspects of the self in relation to others, e.g. thoughts,
feelings, attitudes etc.

b. Gaining access to the unconscious: This happens through exploration of the transference
and counter-transference, through dreams, fantasies, observable behaviour etc.

c. Linking: A major part of the interpretative work is about making connections: these maybe
between past and present; the therapist and the patient; external relationships; what is
being said and what is not being said; between content and process etc.

The aim of the interpretation is to produce emotional as well intellectual understanding at an ‘in-
depth’ level and when insight is achieved this way, the interpretation is said to be mutative. Such
interpretations usually bring considerable relief and a reduction of anxiety though this may not be
immediately apparent.

It is important to note the patient’s response following an interpretation: If there is an increase in

the ‘therapeutic alliance’, a confirming narrative, insight accompanied by historical material and/or a
deepening of affect then the interpretation is likely to been along the right lines.

However, a denial of the interpretations value or validity does not necessarily mean that it was
wrong – it may have been mistimed or provoked initial resistance (and conversely acceptance does
not mean that it was ‘right’ - the patient maybe being compliant).

TEWV: Specialist Psychotherapy Service: Wessex House: February 2013

 ANALYTIC INTERPRETATIONS

There are a range of interventions one might make is psychodynamic psychotherapy

e.g.: questions, silences , clarification,sSupport and making links making links

o Interpretations

……………...but there is no easy or formulaic strategy for ‘how to make them’: However, the
following might provide some useful hints to bear in mind.

1. Make your interpretations tentative (e.g. “I wonder if…..”; “it sounds as if…..”; “perhaps it
could be that…..”: This way, the patient doesn’t feel as though something is being forced
onto or into them after all, the therapist does not have a monopoly on what is ‘reality’ –
internal or external.

2. Pay attention as to how you say your interpretations and the emotional tone conveyed in
your voice as this often has a greater impact on the patient than the content although
timing too, has a role to play.

3. Think about what is the leading anxiety about and how you can take this up even if this is
done through a series of steps throughout the session (i.e. ‘leapfrogging’: Malan 1979)

4. Keep your interpretation as specific as possible and link it to the triangle of conflict (anxiety,
defence before hidden feeling) and to appropriate people in the patient’s life e.g. past or
current figures and/or the therapist.

5. Transference and counter-transference interpretations are especially useful although

difficult make and should be thought through carefully in your mind carefully beforehand.
They can often have the greatest impact upon the client but it takes courage to make them
and to deal with your own as well as the patient’s internal resistances.

6. Always note the patient’s response (conscious & unconscious) to any interpretation or
comment that you make: Often, a deepening of material or rapport is a sign of an accurate
interpretation is sign of an appropriate interpretation: Never-the-less, an accurate
interpretation may be mistimed or said when the patient is unable to take it in and also how
do feel about the reaction to your interpretation e.g. attacked, guilty, ashamed, fearful etc?

7. Interpretations usually have to be repeated and said in various sways over several sessions
for them to become ‘worked-through’ as it is not often that a ‘one-shot interpretation’ leads
to change.

TEWV: Specialist Psychotherapy Service: Wessex House: February 2013