As an introduction to the topic of the therapeutic frame, and to illustrate the wide variety and contradictory opinions present across the field of therapy, in the following slides you can find a selection of relevant quotes.

1. THE THERAPEUTIC FRAME
The Therapeutic
Potential of Broken
Boundaries
© Michael Soth 2010

2. The Therapeutic Potential of
Broken Boundaries
As an introduction to the topic, and to
illustrate the wide variety and
contradictory opinions present
across the field of therapy, in the
following slides you can find a
selection of relevant quotes:
2

3. Frank Zappa:
“The most important thing in art is
The Frame.
For painting: literally;
for other arts: figuratively –
because without this humble appliance,
you can’t know where
The Art stops and The Real World begins.
You have to put a ‘box’ around it because
otherwise, what is that thing on the wall?”
3

4. Johnston and Farber (1996)
Summary of research:
“Patients make relatively few demands and
psychotherapists accommodate them most
of the time. This finding stands in
opposition to the generally accepted image
of the psychotherapist standing firm in the
face of persistent attempts by the patient to
challenge existing boundaries and suggests
a spirit of cooperation and good faith under-
emphasized in theoretical writings.”
4

5. Nick Totton:
Boundaries and boundlessness
“But the developing concept of appropriate
boundaries, and in particular its codification
in legal and quasi-legal structures,
increasingly forces all therapists and
counsellors into defensive practice – that is,
working in ways which are based not on
giving the client the therapeutic environment
best suited to them, but on avoiding
vulnerability to misconduct hearings.”
Published in Therapy Today Oct 2010
5

6. Tony Ingham: In defence of boundaries
The Frame is the Therapy
“ So as a rule of thumb, I say … stick resolutely
to the frame. Put the frame first. This does not
mean that there will not be occasions when a
spontaneous thought, feeling or gesture will
not join the therapy, but that we commit to
reflecting on it when it does. It is being able to
work to these principles that make us useful.”
Published in Therapy Today Nov 2010
6

7. Ken Wilber “No Boundary” - 1
“This book examines how we create a
persistent alienation from ourselves, from
others, and from the world by fracturing
our present experience into different
parts, separated by boundaries. We
artificially split our awareness into
compartments such as subject vs. object,
life vs. death, mind vs. body, inside vs.
outside, reason vs. instinct …”
7

8. Ken Wilber “No Boundary” - 2
“The result of such violence, although
known by many other names, is simply
unhappiness. Life becomes suffering, full
of battles. But all our battles in our
experience - our conflicts, anxieties,
sufferings, and despairs - are created by
the boundaries we misguidingly throw
around our experience.”
8

9. Ken Wilber “No Boundary” - 3
• “It is the boundary line, which creates a pair of
opposites, in short, to draw boundaries is to
manufacture opposites. … Now our habitual way
of trying to solve these problems is to attempt
to eradicate one of the opposites.”
• “That all opposites - such as mass and energy,
subject and object, life and death - are so much
each other that they are perfectly inseparable,
still strikes most of us as hard to believe.”
9

10. Gutheil and Gabbard (1993) – 1
The Concept of Boundaries in Clinical Practice:
Theoretical and Risk-Management Dimensions
“Like many concepts in psychotherapy, such as
‘therapy’, ‘transference’, and ‘alliance’, the term
[‘boundaries’] proves slippery on closer
observation. The literature tends to focus on
patient-therapist sexual misconduct as an
extreme violation and not on the wide variety of
lesser and more complex boundary crossings,
many of which are, at first glance, less obvious
but pose difficulties of their own for clinicians.”
10

11. Gutheil and Gabbard (1993) - 2
“Part of the difficulty encountered in defining
appropriate boundaries can be related to the
historical tradition that modern therapists have
inherited. The great figures in the field gave out
mixed messages on the issue.”
“Heightened awareness of the concepts of
boundaries, boundary crossings, and boundary
violations will both improve patient care and
contribute to effective risk management.”
11

12. Gutheil and Gabbard (1993) - 3
“Boundary crossings may be benign or
harmful, may take many forms, and may
pose problems related to both treatment and
potential liability. The differences in impact
may depend on whether clinical judgment
has been used to make the decision, whether
adequate discussion and exploration have
taken place, and whether documentation
adequately records the details.”
12

13. Gutheil and Gabbard (1993) - 4
“…we must acknowledge that considerable
personal variation exists in our field. The
relationships between therapist and patient
vary from one therapist to another, and
there are even variations across patients in
the practice of one therapist. … it is
ultimately impossible to codify or prescribe
a personal relationship between therapist
and patient in a precise manner. ”
13

14. The therapeutic potential of
broken boundaries – Michael Soth
14
Aims for tonight:
• understand the paradoxical dynamic necessarily
inherent in the therapeutic frame, by which
boundaries will systematically tend towards being
crossed and broken
• so we develop some experientially-relevant
contextual & situational principles for reflecting on
and evaluating boundary crossings (as therapeutic or
counter-therapeutic)
• by including non-verbal and spontaneous
communications in assessing the ongoing, dynamic
tension between working alliance and enactment

15. www.integra-cpd.co.uk