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

Questionable:

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

Questionable:

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)

Questionable:

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

Questionable:

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

Questionable:

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.



