Christopher Bollas (1), an English Psychoanalyst, has made the thought-provoking statement that the ”psychoanalyst’s practice is a form of countertransference.”  He is not referring to the specific reactions of a therapist to a client, but to the heart felt structure of the psychoanalytic situation, the frame, the conditions of practice and the ground rules of engagement with clients.   Historically the frame (2) has been conceptualized as a necessary and salutary boundary established by therapists in order to create the conditions of safety for the client.  In contradistinction, Bollas states that Freud created the psychoanalytic situation out of his unmet and unanalyzed needs.  “What Freud could not analyze in himself – his relation to his own mother – he represented through his creation of the psychoanalytic space and process.”

Bollas’ essay prompts therapists to examine the countertransference significance of the frame or risk acting out their countertransference in their maintenance of the frame.  If the classical frame expresses the analyst’s unconscious needs along side conscious practical considerations, the frame becomes a psychological construction that blends contradictions and inconsistencies with procedures.  One can look at the classical frame as one would examine a dream. The patient, the analyst, and the rules governing their interaction represent different aspects of the analyst.  The patient is expected to free associate while the analyst acts in accordance with the principles of abstinence, anonymity, and neutrality.  One can see how the analyst/patient amalgam embodies a paradoxically scintillating tension between the wish to be known intimately and the fear of being known.

This paradoxical tension persists in contemporary psychoanalytic and psychotherapy practices. The therapist’s wish for intimacy and the countervailing fear create cross currents layered into the psychotherapeutic frame.  Clients walk into an office.  They accommodate to a structure that combines personal and impersonal elements in the most tantalizing ways. They are clients or patients, not friends, but they are privileged to an intimacy that few friends enjoy. They experience an unparalleled though limited exclusivity: they are listened to, encouraged to be intimate for 45 or 50 minutes once or multiple times a week.  They pay for this privilege and then leave.  This is indeed a strange configuration that conjoins intimacy with the formality of a business relationship.

While there has been much focus on the co-construction of therapeutic meaning, the frame is the unilateral creation of the therapist. The length of session, flexibility over ending session, fees, personal disclosure, gift giving and receiving, and extra-therapeutic contact have been set up by convention with the needs of the therapist in mind.  Historically, therapists viewed the frame as inviolable (2). Therapists have too uncritically accepted the conditions that structure clinical practice as necessary givens, without examining either its psychological significance or its impact on the client. Therapists consciously maintain these conditions, and only under duress and with great reluctance modify them. Client’s counter reactions to the frame have been interpreted as acting out.

Often the settings of the frame sift out those clients who accommodate from those who don’t within the first few sessions. It is not surprising that most clients who remain in treatment accept the frame, though some grudgingly.  I have had clients politely joke about paying to have somebody listen to them.   I’ve had one client; however, whose articulate protest of the frame provides a client’s perspective on the frame.   She was a therapist in training who came for counseling to fulfil her graduate school requirement. She was never comfortable in her role as client. She made this clear in the first session when she told me that she didn’t like the idea of therapists telling clients what to do.  I was never comfortable in my role as not therapist. There was often anxiety mysteriously floating in the office creating a background of suspense and discomfit that could not be addressed. I believed that her unarticulated anxiety associated with fears of dependency prompted her to avoid the role of patient.  This triggered in me an anxious uncertainty about my role, and an insistence on acting more like the therapist. The more I acted like a therapist, the more she resisted acting like a client.  We became locked in an impasse. Efforts to talk about the impasse only deepened it. We sustained a tense and uncomfortable relationship for 11 sessions, until she decided to find another therapist.

One can look at our brief therapy as a struggle over the frame. She was articulate and insightful.  She felt that the frame was established and maintained for the comfort of the therapist at the expense of the client. It was a mechanism for therapists to titrate the needs of the client. She claimed that the therapist’s narcissistic insistence on maintaining the frame encouraged the client’s accommodation, and accentuated the compliance of the false self. She felt that the needs of the true self, especially the regressive needs, cried out against the rigidity of the frame, particularly the compulsive commitment to ending sessions on time. While the client is invited to open her heart, she must abruptly stop at the end of the hour.  This rigid adherence to the frame posed a grave threat to the client who might need more flexibility in order to grow.  My client felt this rigidity to be harsh, insensitive and potentially re-traumatizing for the client.

In thinking about this case years later, I realized that I failed to be the therapist that she needed. I was unwilling to understand and accept her wish not to be a client. She was pleasant, neither demanding nor argumentative.  She would casually minimize the value therapy, frequently remind me of ways in which she obtained therapy from friends, alternative healers, while complain that she wasn’t getting anything out of the therapy. She would articulately highlight the artificial impersonal aspects of the frame.   She made her co-payment at the start of each session with a certain ambiguous acknowledgement that left me feeling unmistakably paid. I viewed her statements about the inequality of the frame as defensive. While she never explicitly asked or demanded me to modify my approach, her Being insisted on what I unthinkingly felt to be a massive demand. I thought about her personality inconsistencies as evidence of underlying problems of dependence and trust.  I believed that she didn’t want to be in therapy. I did not consider that she did not want to be in with me.  I did not think about my need to end sessions on time and the subtle or not too subtle ways in which I began to disengage as the clock approached the end of the hour. I did not consider my focus on her defensiveness as counter defensive.  In the end, she felt that I didn’t get her resistance to therapy and told me so. I was wounded, but relieved.

As I thought about the issues of this case, the following images emerged.  I imagined swimming in the ocean toward a raft located not too far from shore. I recalled childhood memories of arduously swimming toward a raft and the relief I felt when I had arrived.  I thought about how my feelings in a therapy session resemble the feelings I had swimming. Will the ocean become too rough? Can I make it?   Am I going too far?  Will I be able to get back?  Not being a strong swimmer, these feelings were always present when I swam away from shore.  Another image entered my mind. Years ago I participated in a one day process-oriented group therapy training.  At the end of the group, after we addressed termination, the facilitator left.  As he opened the door to leave, it creaked.  The sound stirred the still air. In the silence I felt the creepy image of a lid shutting on a coffin.
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(1) Bollas, Christopher  (1987) The Shadow of the Object: Psychoanalysis of the Unthought  Known   New York, Columbia University Press.

(2) Robert Langs (1973 The Technique of Psychoanalytic Psychotherapy,
(1976) The Therapeutic Interaction