Theo. L. Dorpat, M.D.

The most difficult aspect of teaching candidates the clinical skills of psychoanalysis is helping them first to recognize and then to eliminate mistakes in creating and maintaining a psychoanalytic frame. The most common types of frame errors committed by candidates are the use of antianalytic methods and deviations: these include directives, advice giving, limit-setting, reassurance, educative techniques, and various types of interpersonal manipulations. Less frequent types of frame errors include: nonadherence to the analytic neutrality rules of abstinence and anonymity; breaks in confidentiality; failure to maintain set fee, hours, and length of sessions; and the failure to provide a “holding environment” (e.g., excessive inactivity, detachment, and lack of affective communication).

In a study of twenty-one control cases I supervised, the major causes of analytic failure were the errors made by the candidates in developing and maintaining a psychoanalytic frame (Dorpat, 1984). The lack of attention given to the conceptual and technical issues regarding the frame in psychiatric and psychoanalytic training programs partly accounts for the disturbing prevalence of repeated mistakes in managing the frame. Candidates in the study I reported had far more resistance to recognizing frame errors and their deleterious effects on the patients than they did to recognizing the significance and impact of the errors they made in interpretations to their patients.

One of the most difficult tasks for instructors is to teach candidates in seminars and in supervision to identify and rectify frame errors. Learning to do psychoanalytic work is for many candidates a matter of unlearning and of inhibiting previously learned antianalytic methods of psychotherapy and case management. In my investigation, I found that the repeated use of these deviations prevented the establishment of a secure psychoanalytic frame and the formation of a psychoanalytic process.

This need for discontinuing ant