Psychoanalyst Robert Langs accords the management of the therapeutic framework a place of prominent standing alongside the analyst’s interpretative activity. He has argued that the therapeutic framework exerts a profound influence on both the patient and the therapist.
In Langs’s conceptualization, the treatment frame refers to the entire context of the relationship between patient and therapist. It consists of the treatment ground rules, the physical office, schedule, fees, privacy of the treatment and matters such as the therapist’s relative anonymity, neutrality, abstinence, trustworthiness, steadiness, calm and healing attitudes, both conscious and unconscious. According to Langs, elements of the framework provoke significant unconscious meanings in both the patient and the therapist, the recognition of these being critically important to treatment progress.
In two recent posts (here and here), I referred to research evidence that “priming” with seemingly insignificant stimuli can exert significant unconscious influences on subsequent perceptions and behavior. Within the therapeutic relationship, it might be said that the entirety of the therapeutic frame functions to prime various unconscious perceptions and meanings in both the therapist and patient. Although he does not use the word priming, Langs argues that the therapist cannot decode these unconscious meanings independently from the priming framework in which they are embedded. Meanings are generated within contexts and they are only recognized contextually.
For example, if a therapist begins a session late, the patient may generate a narrative about someone else (not the therapist) who was late for a meeting or an appointment. The narrative might contain negative perceptions and feelings about such a person. To usefully interpret the narrative, the therapist would need to be cognizant of the generating (priming) context of the narrative — the therapist's lateness to the session.
While the patient might not express manifest irritation with the lateness, the narrative seen through the lens of the priming event might tell a different story about the patient's unconscious reactions to the therapist's lateness. Manifest indifference to the therapist's lateness might be seen as a defensive denial of underlying irritation derivatively expressed in the narrative account of someone else's lateness. Communication in this derivative form might strike some readers as the sort of thing that occurs only rarely, but it happens frequently enough if the therapist doesn't block this sort of communication by muddying the communicative water with a chaotic contextual framework (too many provocative primes) or an excessive focus on the manifest level of communication.
Langs also attributed potential healing qualities to the treatment framework. Although the framework can prime disturbing unconscious perceptions, it can also provide a backdrop of safety. When the framework functions as a safe holding and containing environment for the exploration of disturbing perceptions and meanings, not only can helpful exploration take place, but the patient also introjects (internalizes) the holding qualities of the framework thereby effecting more enduring growth in the patient’s capacity to manage potentially destabilizing inner experience.
Relative adherence to the abstinence ground rule, for instance, limits the therapist to interpretive activity. The therapist's abstinence means that the therapist will refrain from non-interpretive activities that are usually part of everyday relationships including ordinary conversation, physical contact or even exchanges of pleasantries. In the charged environment of therapy, abstinence can provide a measure of reassurance that the therapist will not permit destructive enactment of impulses within the treatment relationship. The experience of abstinence and an interpretive stance within the therapeutic setting can also enhance the patient’s capacity for abstinence under subsequent pressure from impulses, increasing the capacity for conscious verbal exploration as an alternative to impulsive, pathological enactment.
One controversial aspect of Langs’s work lies in his assertion that there are certain universal framework positions that provide a secure (safe) holding framework for every patient. Deviations from this secure framework, whether they occur at the request of the patient or solely at the initiative of the therapist, generate disturbing unconscious meanings in both the patient and the therapist, according to Langs.
Whether or not one agrees with the notion of a universal secure framework, it is helpful to remember that the framework is not limited to a fixed number of tangible variables; it is a living surround that constitutes the backdrop and hold for the therapeutic relationship. Just as research has shown that primes generate unconscious perceptions, the entire frame (for better or worse) generates an array of both conscious and unconscious reactions in both the therapist and the patient. Often these unconscious reactions are at odds with conscious perceptions. Without regular thoughtful attention to the priming function of the contextual framework, it becomes exceedingly difficult to interpret the unconscious aspects of reactions to those primes.
In Part II, I will continue the discussion of the therapeutic framework and protective frames with reference to research findings by Eduardo Andrade and Joel Cohen (also see Laura Freberg: Why Do People Like Horror Movies?)