Reflections on the Therapy Frame

Most therapists are aware of the importance of the therapeutic frame; it is one of those fundamental aspects of therapy that form the basis of our training, whatever modality we work in.

As a trainee I wrangled with this concept, thinking through with every client what the frame was, where the boundaries were, or should be, and how best to hold them. Since qualifying I wonder if I have become more settled into my conceptualisation of the art therapy frame, perhaps even blasé?

So, as is so often the case in our therapeutic journey, it is time to revisit this concept and consider its purpose and function. Does my concept of the frame still fit the work? Is my frame too rigid, or too wobbly to contain and hold my clients' distress? Is the material still sturdy or is it full of worm-holes and in need of repair? Perhaps I need to throw this whole frame in the bin and start building some new ones.
In discussing this with my colleague at The Potting Shed, Bethan Baëz-Devine, we wondered, and wandered, in our thinking and as creative practitioners came to the conclusion we ought to offer other therapists a space to play and reflect around this concept. Bethan found this unattributed quote "It is difficult to see the picture when you are inside the frame". This led us to the concept of "Stepping Out of The Frame' to give ourselves the opportunity to reconnect with our work, our frame and to fully explore whether it is fit for purpose.

In one of my roles as an Art Psychotherapist I work in a hospice with patients with life-limiting illnesses and it was in my first work with a dying patient where I felt my frame start to falter; it just didn't seem to fit or serve the purpose for which it was intended. That idea of the Langian frame (Robert Langs' work highlighted the idea of the tight frame, in a controlled environment where the therapist gives nothing of themselves to contaminate the transference) felt too harsh and unforgiving when working with clients who were moving towards the end of life.
I remember many conversations with my supervisor during that time where I explored the purpose of my role and the frame that I found myself in....could and should boundaries soften as a client's life fades?

So how do I thinking about my current therapeutic frame/s? These 4 concepts keep coming to mind:

1. Containment....is your frame sturdy able to contain and hold the therapy work? Containing in the sense of holding the client's distress and the transference relationship, but also containing in the sense of keeping safe. A safe container, a safe space to thrash out feelings, a safe place for the therapeutic relationship to flourish. I find as a more experienced practitioner that there are times when I stretch and twist this frame - the young person on the autistic spectrum who sometimes needs to get out of the therapy room and go for a walk, the patient in the hospice who is in a shared bed-bay but in need of some emotional support - but my constant mantra is 'safety, safety, safety' - is this container holding?
2. Flexibility. Back to that twisted and stretched frame....without flexibility my frame would break and splinter rather than adapt. Particularly in my work with dying patients I have had to adapt and offer flexibility, accommodating sessions in different spaces, working through different phases of a client's illness and the impact on their abilities. Therapy has a times moved from something quite traditional working with a client by a table filled with art materials to then become a bedside conversation, a witnessing in the last few days of a client's life.
3. Can you see the frame if you are in it? Taking the time to 'step out' of that frame, to reassess my role as therapist, my modality, my reasoning and feeling in the space. Why do I do what I do? Would another way serve this relationship better? By trying to reflect from a new perspective I can better see what I am doing and change and develop as I do.
4. The wider frame - what holds you? The invaluable additional frames that we work with an in....management, organisations, supervision, peer support, my family and friends...without a containing, flexible and supportive set of frames around me I could not contain and hold this challenging work. These many and multiple frames are an aspect of self-care as well as good working practice.

What concepts do you hold in mind to construct your therapeutic frame? Can you give yourself the opportunity to step outside of that frame and see it from another perspective? We invite you to continue your reflections on the therapeutic frame and all it holds...