The Frame

This thread invites the curious to read about the therapeutic frame in a series of articles by Michael Karson, Ph.D., J.D. Dr. Karson's views on "implicit rules" and their application had me thinking about my own therapy. The incidence of coincidence between Dr. Karson's implicit rules and those of my therapists differ from a rather close correlation to quite divergent.

Here are the articles:

The Therapeutic Frame Part 1 | Psychology Today
A Simple Test of Therapy | Psychology Today
The Therapeutic Frame Part 2 | Psychology Today
The Frame, Part 3 | Psychology Today
The Frame, Part 4 (Privacy) | Psychology Today

Dr. Karson reenforces my belief that therapy achieves a better result if the client is open and forthright.

The same consideration applies to more normal troubles, like anxiety and depression. These problems are easy to divulge to a therapist, and your therapist prompts you for good examples. You report truthfully that you often experience intense anxiety when the phone rings. Now the therapist wants to know what goes through your mind when the phone starts ringing. You know perfectly well that the therapist’s question makes you think of your pregnant sister miscarrying, but you either think that this cannot be the problem—you love your sister—or you think that the therapist will be disgusted with you if you report this image. Instead, you make up something sensible but false about bad news you once got over the phone, wasting months of therapy on the wrong focus, but saving face. Again, the question is, what would the therapist and the therapy space have to be like to induce you to report what actually occurs to you?

The anomaly for me is having to rectify my belief with what I consider my poor results in therapy.

What i think i hear you saying is, i did all this stuff, i didnt "just" show up, i did it "right" - how come it didnt work?

I am guessing, from the formal tone of this post and others of yours, that you did not form a close relationship with your t. How do you feel about that?

I do not have a feeling. I did have several good connections. One psychologist said we were simpatico.

Yeah, ya gotta do the FEEEEEEEEEEELINGS and relationship thing, is how it appears to me. By whatever means you can justify that to yourself. Like hitting bottom, as they say in AA. And "leap and the net will appear" as they say in acting. I love that one, i admit.

I have had twenty-plus professionals treat me. Not one said I had to have feelings for them. I know about feelings. I can connect with people without getting emotional.

Can you verbalize what you feel hasn't been accomplished in your therapy or is it more vague - like you just don't feel right? And I agree that for certain types of therapies/issues you don't need to have a relationship per se with a therapist for the therapy to work. I think you do need to have trust, but in terms of warm feelings and all, I don't think everyone needs that.

I was told I had a treatment resistant illness, a personality not conducive to therapy and the medications I was prescribed were not doing much. This lead to being told I might have to accept I will not get better.

I have diagnosed as treatment resistant as well and I know some providers not experienced with it might get frustrated. I don't know if your illness is depression/anxiety but that's what mine is. I don't think it's as hopeless as it's been made to sound to you, however.

Lot's of people don't have personalities that are conducive to therapy. My daughter has Asperger's and I know she is not a person who will do well in therapy. She told me therapy is stupid and when she went last stood up and walked out of the therapist's office as soon as he mentioned the word anxiety. She is only 11 so this attitude might change, but I doubt it - unless it's for something specific (like a phobia) that she chooses to address.

Maybe meds will be of most help to you. If your current ones aren't helping can your psychiatrist explore other options?

I have tried maybe thirty different medications. My first trip to a professional was in 1969.

There is more that I could say, but this is about Dr. Karson's excellent discussion of how best to conduct therapy.

This doesnt scan. It sounds like what Lt Cmdr Data would say about feelings before he got his emotion chip.

So what is your quest? I totally sympathize with the many years, many practitioners, no results - that's how i felt before my current go-round. Then google became my friend. And amazon. Are you looking to connect with people who have overcome a similar hurdle? Cuz you are kind of hinting maybe - passive aggressive doesnt solve things, ya know. So i switched to straight on aggression much better!

Eta - sorry, my screen just updated - i will go read dr karsons stuff.

I was just looking up my favorite for quoting on another site, the Grateful Dead drummer, Mickey Hart's, "Adventures don't begin until you get into the forest."

For me, the frame was containment. My T once asked me to free associate and then we stopped me when we realized we were both lost after less than 30 seconds/2 sentences That both my T and I showed up every week for 9 years, that she did not allow idle chat (I never knew the weather when I was seeing her except in winter when I'd stay awake praying that it wouldn't snow badly enough to cancel therapy the next day), I had to talk to her, she did not take to reading and she wouldn't tell me stories (I still can't believe I asked her to and then took it personally that she wouldn't when she was just being literal that she didn't know any/know how to tell stories) and she ignored body language because she had enough trying to understand what we were talking about, etc. all that added up and gradually made me feel safe enough to sit down and do the work with her in that space in the way she recommended -- therapist as frame.

I was interested when told about the two types of frames, the containment type like a fence or boundaries, etc. and the interior type like one's spine, allowing one to move about, a veritable Baba Yaga house.