Therapists' perceptions of out of session frame deviations.
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Date
2011-04-06
Authors
Mahomed, Faraaz
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Abstract
This study explores the complex and relatively under-researched topic of out of
session frame deviations. It considers the role of frame deviations in
psychodynamic psychotherapy and the various conceptualisations of the frame,
examining the debate between the ideas of a flexible and ‘elastic’ frame and a
more unchanging and ‘impenetrable’ frame. The study uses a qualitative design
to examine therapists’ understandings of out of session frame deviations as they
have experienced them in practice. Six psychodynamic psychotherapists were
interviewed and asked for their perceptions regarding out of session frame
deviations. What emerged from the analysis of the interview material were
diverse experiences of the types of frame deviations outside of the consulting
room, by both therapist and patient. In addition, therapists felt that out of session
frame deviations might have an impact on the therapeutic process, depending on
their unconscious roots and on particular factors that were unique to the
relationship. Therapists had strong countertransference reactions to out of
session frame deviations and their handling of the deviations was often informed
by these reactions. The handling of out of session frame deviations was also
seen as specific to the relationship and, therefore, unique in each instance.
Therapists’ perceptions of patient dynamics as they related to out of session
frame deviations illustrated the varied functions that the deviations may serve
and demonstrated that transference was sometimes prominent in the deviations.
Therapists also emphasised the flexibility of the psychotherapy frame itself. The
study illustrated that out of session frame deviations are important and relate
significantly to the process of psychodynamic psychotherapy. They produce
uncertainties and ambiguities for therapists in practice and should be examined
closely rather than being overlooked.