Framework of the Psychoanalytic Treatment
FRAMEWORK OF THE PSYCHOANALYTIC TREATMENT
The "frame of psychoanalytic treatment" refers to the formal and contractual means necessary for establishing the situation that characterizes psychoanalysis compared to other forms of psychotherapy. Although the frame has been at the heart of psychoanalytic practice ever since its origins, considerations of its structure and function are more recent, dating from the Second World War. One of the first to investigate this frame was José Bleger in an article entitled "Psychoanalysis of the Psychoanalytic Frame" (Bleger, 1967).
This frame was gradually developed by Freud for what were often circumstantial or personal reasons, but he eventually developed a set of uniform recommendations consistent with the theoretical and practical modalities of treatment. As early as 1904 he described his "psychotherapeutic method": "Without exerting any other kind of influence, he invites them to lie down in a comfortable attitude on a sofa, while he himself sits on a chair behind them outside their field of vision. He does not even ask them to close their eyes, and avoids touching them in any way, as well as any other procedure which might be reminiscent of hypnosis. The session thus proceeds like a conversation between two people equally awake, but one of whom is spared every muscular exertion and every distracting sensory impression which might divert his attention from his own mental activity" (1904a, p. 250). Nine years later he provided additional details such as frequency and duration of the sessions and method of payment—parameters that were as important for proper treatment as the mutual obligations of free association or the prohibition to act out on the part of the analysand and free-floating attention or the rule of abstinence on the part of the analyst (1913c).
The restrictions imposed by the treatment setting apply to both parties, even if its contractual nature is often overlooked in order to emphasize the pseudo-power attributed to the psychoanalyst by virtue of the patient's masochism. The frame appears to function as the representative of the incest prohibition in the analytic situation, a prohibition that in fact favors expression and analysis. The frame can be considered an "excluded middle" that hovers over the protagonists during the session, reminding them that every "dualistic" relationship is illusory, even during moments of the most intense regression.
Opinions vary regarding these interpretations since the elements that characterize the frame are rich with symbolization. José Bleger (1967) distinguishes the frame within the psychoanalytic situation as a "non-process" consisting of "constants within whose bounds the process takes place" (p. 511), and he locates its origin in the "most primitive fusion with the mother's body" (p. 518). He subdivides the frame into two elements: the frame proposed by the analyst and accepted by the patient, and the frame formed by projections of the patient's most primitive symbiotic associations. It is with this last point that the concepts of "container-contained," the analyst's alpha function (Wilfred Bion), and Donald Winnicott's "setting" are associated. For Winnicott, the analyst "expresses" his love for the patient by his reflected interest and his hatred by his observance of the rites of payment and scheduling (Winnicott, 1958). According to Jean-Luc Donnet, "the frame is both protection and threat, just as its symbolization is forced and liberating" (1973). Jean Laplanche, with his image of the psychoanalyst's "tub," describes a "double-wall setting" wherein the outside wall, "purely legalistic and formal" but contractual, is necessary to preserve the inner wall, which is subject to the uncertainties of the analytic process and is needed for sexual issues and the transference neurosis to manifest themselves (Laplanche, 1987).
The arrangement of the frame for psychotic patients or as a function of what Lacan and his students refer to as the temporal scansion of the session introduces the question of its relationship with the establishment and ongoing coherence of a psychoanalytic process. There are a number of parameters involved and each of them raises the question of its role and importance in managing the situation: the number and duration of sessions (four sessions of fifty minutes at a minimum according to official American guidelines, three of forty-five minutes for French members of the International Psychoanalytic Association, shorter for others, longer for Freud), distribution throughout the week (frequent sessions, sometimes several a day for patients who live far away), payment (cash or check), accepting third-party payment or not, problems associated with days off, with vacations, with changes to the ritual (moving, for example), the intrusion of the telephone, contact during, or outside, the session (Sándor Ferenczi's "active technique" or "mutual analysis," Michael Balint's or Donald Winnicott's physical holding), and so on.
Rigid attitudes on one side, transgressive relativism on the other, reference to the paternal prohibition against incest versus a conception of the frame as a womb implying a total return to a primal state, a setting for hypnosis or a condition for working-through—the conditions associated with the unique nature of psychoanalytic treatment possess a non-alienating value only because they are based on a contract that circumscribes them and that can at any moment be torn up by either of its cosignatories.
Alain de Mijolla
See also: Abstinence/rule of abstinence; Initial inter-view(s); Face-to-face situation; Free association; "Lines of Advance in Psycho-Analytic Therapy"; Money and psychoanalytic treatment; Neutrality, benevolent neutrality; Psychoanalytic treatment.
Bleger, José. (1967). Psychoanalysis of the psycho-analytic frame. International Journal of Psycho-Analysis, 48 (4), 511-519.
Donnet, Jean-Luc. (1973). Le divan bien tempéré. Nouvelle revue de psychanalyse, 8, 23-49.
Freud, Sigmund. (1904a). Freud's psycho-analytic procedure. SE, 7: 247-254.
——. (1913c). On beginning the treatment (Further recommendations on technique of psycho-analysis I). SE, 12: 121-144.
Laplanche, Jean. (1989). New foundations for psychoanalysis (David Macey, Trans.). Cambridge, MA: Basil Blackwell. (Original work published in 1987)
Winnicott, Donald W. (1958). Collected papers: Through paediatrics to psycho-analysis. London: Tavistock Publications.
Busch, Fred. (1995). Beginning analytic treatment: Establishing an analytic frame. Journal of the American Psychoanalytic Association, 43, 449-468.