The therapeutic frame occupies the minds of all therapists, particularly those in training and anxious to know whether they have ‘got the technique right’. A book on this subject, designed for trainee psychotherapists, thus deserves serious consideration.
Writing on this subject is scattered, and there is little on which to base any evidence-based approach. What then may the therapeutic frame comprise? Basic elements include a setting, both physical and psychic, that allows therapy to occur. The aim of the particular kind of therapy will determine the contours of this frame.
The broad sweep of perspectives and work environments that this book embraces is both its strength and potential weakness. First, the strengths: we are exposed to psychoanalytic, existential, humanistic and Jungian thinkers in a wide range of settings, with illuminating clinical vignettes. There are two personal and moving chapters - one describing the frame as experienced by a patient, and a second revealing how a clinician managed the frame during a life-threatening illness. The chapters on work in general practice and acute general hospitals provide useful guidelines on maintaining some form of therapeutic frame in the hurly-burly of these medical settings - thus maintaining a frame within a frame. The objective of maintaining a psychic frame in the face of assaults on the physical frame is usefully discussed. These chapters also challenge the idea of a universal therapeutic frame.
Now the weakness. The book's broad sweep offers many different perspectives and a reader trained in a particular school of thought may find these difficult to assimilate. It would have been useful to have drawn together the various themes or to have emphasised in each chapter the therapeutic aims of the writers, so that their use of the therapeutic frame could be better appreciated.
Overall, this is a useful contribution to an essential subject. There is enough material for the reader to gain from generic issues, for example seeing patients in an unplanned way. Issues associated with particular settings are usefully addressed in specific chapters - for example, the chapter by Nick Zinovieff on therapy in general practice has valuable pointers for therapists based in doctors’ surgeries. What comes through repeatedly in the writing is the need for a thinking, rather than rigid, approach to the frame, an appreciation of the dialectic between the need for a disciplined, informed approach to it and the inevitable flexibility required in practice. This spirit is in keeping with Freud's opposition to any mechanisation of technique (Freud, 1911) and is in itself a useful mindset in which trainees might approach the therapeutic frame.
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