What is the frame in psychotherapy and why do we need to keep it from breaking? This week I discuss the importance of boundaries and guidelines set forth by Robert Langs, MD regarding how to know when your relationship with your therapist is healthy – and when it is not. I also talk about the concepts of transference and countertransference in psychotherapy.
Notes From This Episode
Download a Word doc on Lang’s guidelines for psychotherapy.
Go to the webpage for the European Society for Communicative Psychotherapy where you can learn more about Robert Langs’ work.
Here’s a good site, called Good Therapy for locating a psychotherapist
Guidelines for Psychotherapy
From the book: Rating your Psychotherapist
Author: Robert Langs, M.D.
1) Ideal conditions which constitute the "frame"
- A single, set fee
- A single, set location
- A set time and length of the session
- A soundproof office (or noise machine)
- Relative anonymity of the therapist (no self-revelations or opinions, focus should be on the patient)
- Total privacy
- Total confidentiality
2) Referrals
Good:
- Local Medical Society, Mental Health Association, or other professional organization
- Recommendation from a friend who is a psychiatrist, psychologist or social worker or other mental health worker
- Employer, principal or lawyer recommendation
Bad:
- A co-worker, social acquaintance, or relative sees or used to see him/her and says he/she is good
- Therapist is the wife/husband of one of your friends
- Therapist is a friend or used to be a friend of the family
3) Your first interaction with the therapist
Good:
- He/she was concerned and listening
- Said nothing of a personal nature
- No physical contact except for an initial or concluding handshake
- At the end of the meeting the therapist set the ground rules for treatment
Bad:
- He was very physically demonstrative, that is, hugging or holding your hand
- He/she came on to you sexually
- Was unprofessional and self revealing
- Talked more than you did
4) The fee and Schedule:
Good:
- Set a single, reasonable, fixed fee
- Won't let you build up debt
- Won't accept gifts or other forms of compensation beyond the fee
- Arranged a definite schedule for therapy (day, time, length and frequency) and these have not changed throughout the course of therapy (except when necessitated by work or life circumstances)
Bad:
- He/she is willing to falsify a fee to an insurance company
- He/she negotiated a barter arrangement
- There are repeated changes in time/location/day, length of sessions
- Sessions start late because other patients stayed late
- He/she lets you stay longer than the scheduled time
5) Treatment:
Good:
- Treatment types vary a great deal (cognitive, behavioral, humanistic, etc.): but in all cases: Does it make sense to you?
- Does it feel okay?
- It should always remain a professional relationship
- In general, the therapist should let you do most of the talking
Bad:
- Therapist keeps directing you to talk about particular issues (your marriage, your sex life, etc.
- He/she frequently tells you what they think you should be doing with your life ("If I were you I would…)
- The therapist is hostile, makes you feel guilty, or is seductive
6) Termination:
Good:
- You felt like a sense of new insight and understanding had been reached and your symptoms had largely (though probably not completely) been resolved
- It seemed like the right time to end therapy
- A specific date was set and adhered to (didn't happen in an unplanned way)
- All the ground rules mentioned previously had been maintained up until the end
- Once therapy was over you had no further contact with the therapist
Bad:
- You decide impulsively to stop therapy and your therapist accepts this without encouraging you to consider your decision
- Therapist badgers you to continue despite your feeling that it is time to stop. He/she insists that you still need help
Resources for this episode
Read Robert Lang’s book on psychotherapy on Amazon.
