A post at Ars Psychiatrica stirred thoughts about a pair of posts I wrote 3 years ago. Both follow in one ridiculously long post, but I didn't see a point to breaking it into 2 parts again since both parts are already written. Anyone who cares about this subject can surely handle 10 minutes of reading.
Part I of Priming, Frames, Psychotherapy & Horror Movies:
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.Part II
Manipulating The Protective Functions Of The Frame
Last week, Laura Freberg offered an interesting discussion of why some people like to watch horror movies. She cited the research done by Eduardo Andrade and Joel Cohen who ask “How can the hedonistic assumption (i.e., people’s willingness to pursue pleasure and avoid pain) be reconciled with people choosing to expose themselves to experiences known to elicit negative feelings?" Although the authors are not clinicians, their research is germane to appreciating that clinical framework management is required if the patient is to go forward with a thorough exploration of highly disturbing unconscious perceptions and meanings of his or her internal experience.
Andrade and Cohen argued that a growing body of evidence indicates that people can experience both positive and negative feelings simultaneously. To lay persons, this might seem like an assumption that should have never been in doubt, but many psychologists, biologists and economists have assumed that positive and negative feelings cannot coexist simultaneously. Moreover, it was long assumed by many that we always seek pleasurable experiences while avoiding painful ones.
To explain behaviors that appear to contradict the hedonistic hypothesis, its defenders often argued that when we accept painful experiences, we do so in a rational manner, deferring present reward for some greater future reward. For example, people might attend a horror movie because they so enjoy the relief subsequent to the fear. With a few exceptions outside of psychoanalysis, the idea that pain and pleasure, fear and exhilaration could simultaneously coexist as part of a more complex inner experience was not widely accepted by experts who assumed we operate as relatively rational hedonists.
In a series of studies involving viewers of horror movies, Andrade and Cohen found strong evidence that negative and positive feelings can be co-activated. They also note that some individuals are attracted to watching horror movies while others consistently avoid them. They argued that the latter group avoids horror movies because they are unable to co-activate positive and negative feelings within the context of viewing these movies.
To explain the difference between the two groups, Andrade and Cohen proposed that an internal “protective frame” makes co-activation of negative and positive feelings possible, leading some individuals to find the viewing of horror movies attractive:
Finally, we propose a moderator that may be necessary for co-occurrence to be a stable state and that is likely to affect repeated pursuit of “aversive pleasures” such as horror movies as well as truly dangerous activities. To this purpose we adopt the notion of a protective frame (Apter 1982, 1992) and directly manipulate this perceived frame of mind to show that individuals can learn how to experience positive feelings while still being absorbed by the fearfulness of the event.
In examining their results, Andrade and Cohen found some support for the notion that the “co-activation” of positive and negative feelings does require the presence of a protective frame – a modulating sense of safety that allows the film viewer to simultaneously experience conflicting negative and positive feelings. Andrade and Cohen were also able to manipulate the film viewing framework such that individuals who did not already possess an internal modulating frame could be provided this frame through external manipulation.
In psychotherapy, we can think of a similarly protective therapeutic framework as a backdrop that allows the patient to pursue negatively charged thoughts and fantasies rather than retreating from such an exploration. If the frame in the therapeutic space is, indeed, functionally similar to the frame in Andrade and Cohen’s research with horror movie viewers, then thoughtful management of a protective therapeutic frame would seem essential to the therapeutic exploration of those aspects of inner experience that are chronically avoided.