Therapists' perceptions of out of session frame deviations.

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.