Limit Setting and the Analyst's Working Through

The structure of the analytic situation makes it different from all other situations and makes psychoanalysis possible. The frequency of sessions, their length, the days and hours that are allotted to them, and the analytic setting, are among the components of the structural foundation which provide a baseline for analysis. The patient's movement from this line, in whatever direction, provides a direct means of seeing this particular person's ways of being in the world. The patient does with the analyst what he or she does with others. However, the analytic structure is a form that enables the analyst, and ultimately, the patient, to see just what that is and offers an opportunity to grasp what propels it, what it means, and where it comes from. The patient may veer from the analytic structure by missing sessions, by coming late or leaving the hour early, by phoning the analyst between sessions, by requesting extra hours, by asking for appointment changes, and so on. Sometimes these moves on the patient's part can be fruitfully interpreted. At other times the analyst sits with them while attempting to determine their meaning or waiting until the patient can hear what is being played out. In addition, there are circumstances where such actions and others can threaten the analysis. Then the analyst may have to set limits for the patient.

The analyst, too, may go outside the boundaries of the analytic situation on occasion, judiciously and constructively, in such ways as, when called for, allowing the hour to run overtime, seeing the patient early, offering additional hours, and granting extra telephone contact. When the analyst consciously uses measures such as these carefully to further the analysis, the patient may benefit. If the analyst is responding to internal neurotic pressures, the analysis and the patient may suffer.

When the patient needs to alter the analytic situation, the need may be reality-based. Or it may be that the patient is expressing something throu