To define the analytic frame and analytic boundaries is also to characterize the optimal psychoanalytic situation. Moreover, considerations of frame and boundary facilitate the emergence of the analytic object, a crucial but largely unexamined development in analytic discourse.
The analytic frame is an envelope within which the treatment takes place. Although the term conjures up images of a picture frame, the concept is not nearly so rigid. Rather, it is a dynamic and flexible set of conditions that reflects the analysts ongoing efforts to respond to the patient while establishing an optimal ambience for analytic work.
In 1977 Robert Langs divided the frame into two sets of components. One set involves the details of the contractual understanding about the setting of analysis. These are relative constants that include such items as an absence of physical contact, confidentiality, the location of meetings in the analyst's office, the position of the analysand on the couch and the analyst in the chair behind the couch, the payment of a set fee, and an agreed-upon length and frequency of sessions. The second set comprises the human elements that define the interaction, including the nonjudgmental acceptance of the patient by the analyst; an attempt to understand the meaning of communications and behaviors; the relative anonymity of the analyst while the patient agrees to say whatever comes to mind; the analyst's abstinence from inappropriate gratifications while offering concern and efforts to understand; interpretation of unconscious conflicts as they become apparent; and, particularly, a focus on understanding the interaction between analyst and analysand.
Six years later Vann Spruiell, in “The Rules and Frames of the Psychoanalytic Situation,” wrote about the analytic frame from a somewhat different perspective. He stressed that his use of the term relates to “frame theory” and refers to views of social interaction developed in other disciplines and applied to the psychoanalytic setting. Specifically, Spruiell emphasizes the rules by which certain types of interaction are “framed,” meaning how they are defined and delimited from other types of interaction between people. He defines the frame of the analytic situation as referring to “unchanging basic elements or principles of organization defining a specific social event and distinguishing it from other events” (p. 9).
Much of Spruiell's emphasis is on the deliberately unbalanced nature of the analytic dyad. To a large extent the analytic frame is constructed and defined by the skewed nature of the interaction between the two participants. While the patient lies on a couch and attempts to say whatever comes to mind, the analyst listens silently much of the time, not concentrating too intently but not drifting off to sleep either. The evenly suspended attunement of the analyst hovers above the process in such a way that attention shifts back and forth between the analyst's own internal processes and the analysand's associations. The analyst must participate in the relationship while at the same time maintaining a dual state of consciousness in which the relationship and the participation are observed from a distance.
The analytic frame creates, among other things, an atmosphere of safety. Powerful affects can be mobilized without fear of impingement or humiliating criticism from the analyst. The patient is given “space” to regress and to allow unacceptable unconscious wishes and feelings to emerge. It is precisely because the rules of the game are different from all other social interactions that patients are free to experience themselves in a new light.
The concept of analytic or professional boundaries, what might be termed the architecture of the frame, is sometimes misconstrued to mean simply an arbitrary set of rules by which ethics committees and licensing boards determine whether disciplinary measures are needed. Talk of boundaries is also misunderstood at times as endorsing an attitude in the analyst that is rigid, robotic, and remote. When boundaries are caricatured, they can indeed lead to a countertransference posture that is inflexible and cold. The intent, however, is exactly the opposite. Boundaries define the parameters of the analytic relationship so both patient and analyst can be safe while being spontaneous.
An analogy may be useful here. Visitors to the Grand Canyon note that they are protected from falling into the chasm by a guardrail placed strategically at its rim. This safety measure allows children (and adults) to play and enjoy themselves while being at minimal risk for catastrophe. Although analytic boundaries are in general more flexible than a guardrail, they are in some areas, sexual contact for instance, equally unyielding.
Analytic boundaries are of course more than a guardrail, more than a mere restraint. To a large extent the analytic frame can be regarded as an extension of the analyst's outer ego boundaries. Analysts are continuously attending to the difference between what is going on inside the patient and what is going on inside themselves. The analytic boundaries assist in this function by representing a type of interpersonal boundary. Similarly, just as healthy ego boundaries must be flexible enough to open at times and close at others, so must analytic boundaries be sufficiently flexible that accommodations can be made, depending on the needs of the analytic process.
One of the central paradoxes of the analytic situation is that professional boundaries must be maintained so that both participants have the freedom to cross them psychologically. In other words, processes such as empathy and projective identification oscillate across the semipermeable membrane constructed by the analytic dyad. The analyst expects a therapeutic regression to occur in both parties so that more primitive states of fusion and exchange will be possible.
Analytic boundaries ensure that the analyst can contain and process communications without acting inappropriately on them. Hence, analytic boundaries may be the built-in structures within the frame that check, control, and eventually “upgrade” primitive affects communicated through projective identification into a verbal, symbolic realm that stems from a developmental phase characterized by more mature object relations. Analytic boundaries need to be reasonably firm to permit these primitive communications to go from analyst to patient, as well as from patient to analyst.
The developmental process of repeated fusions and defusions in self- and object representations, described by Edith Jacobson in The Self and the Object World , is often recapitulated in the analytic situation, and it is incumbent upon the analyst to recognize these regressive experiences and use them therapeutically. The optimal analytic approach to these externalizations of internalized object relations involves a particular analytic attitude that can best be characterized as simultaneously participating and observing, a state that Richard Sterba described as dissociation within the ego and that Harry Stack Sullivan termed participant observation. Analysts must allow themselves to participate in these temporary disruptions of the barrier between self and object, while carefully noting the determinants and meanings of such disruptions.
This discussion of the analyst's response leads directly into a consideration of what is known as the professional, or analytic, role. The structural characteristics of the frame — the office setting, the fee, the duration of the session, the
abstention from physical contact, the avoidance of gift giving, the position of the patient on the couch and the analyst behind it — are important in themselves, but together they define the specificity of the analytic role. As Richard Almond has recently suggested, this role allows the analyst to be subjectively, or personally, involved, while maintaining some level of objectivity as a participant in a professional relationship. Patrick Casement has stressed that the analyst's role is not to gratify libidinal demands (such as the wish to be loved, sexually satisfied, or taken care of in the way a parent takes care of a child), but rather to respond to the patients growth needs (such as the need for empathic understanding, caring, and concern) and to try continually to make sense of the patient's experience. These elements are often invoked to describe Winnicott's notion of the holding environment. This distinction can be conceptualized as the difference between environmental provisions and instinctual gratifications.
Stephen Mitchell, in Hope and Dread in Psychoanalysis , has likened the distinction made by Winnicott and Casement to the difference between wishes and needs. Mitchell cautions, however, that determining which is which is often a highly complex undertaking that inevitably entails some trial and error. He shares our view that the analytic frame must be flexible, and he has stressed that the appropriate frame may vary from patient to patient. Even the basic elements of the frame can have entirely different meanings to different analysands. He cites an example of a female patient for whom lying on the couch was reminiscent of a masochistic submission to a domineering mother who insisted that her daughter be absolutely silent and immobile after going to bed so as not to disturb her. For this patient, getting up from the couch and moving around the office became a necessary part of the analytic frame.
According to Mitchell, the attitude of the analyst toward the patient's demands or requests is much more crucial than the literal content of the analyst's response. Mitchell also pointed out that the analytic frame is constructed by analyst and patient conjointly, and each party may view the dimensions of flexibility versus rigidity in entirely different ways: “While the analyst thinks she is standing firm, the patient may feel he is being brutalized in a very familiar fashion. Many patients are lost because they feel utterly abandoned or betrayed by analysts who think they are maintaining the purity of the analytic frame. The frame is preserved; the operation is a success; but the patient leaves, climbing off the operating table in the middle of the procedure” (p. 194).
The issue of how much gratification is optimal within the analytic boundaries and frame is a thorny one that defies simple guidelines. For one thing, the concept of gratification in some ways implies an unambivalent wish on the part of the patient. Does the patient with sexual longings for the analyst really want those wishes concretely gratified? Maybe yes, maybe no, but the vast majority of analysands would be highly ambivalent about such gratification. If the patient is a victim of childhood incest and is unconsciously resurrecting the childhood situation in the analytic setting, it is difficult to imagine how consummating a sexual relationship could be construed as gratifying. Most of us would question whether an incestuous father is gratifying his daughter's sexual longings even as we acknowledge that little girls have erotic desires for their fathers.
The analytic situation has been aptly described by Leo Stone as one of deprivation-in-intimacy. The intimacy is one in which there is an inherent gratification — that is, the highest priority is the therapeutic obligation to the patient. Yet the setting also symbolizes a basic experience of separateness. Stone has argued that one of the basic differences between an analyst and a traditional physician is that the former represents the mother-of-separation as opposed to the mother involved with intimate bodily care. Stone also stressed, however, that such principles as abstinence must be implemented with a certain latitude and flexibility lest they defeat the very purpose of the psychoanalytic enterprise.
Certainly the analytic process entails a good deal of frustration, and both parties know that all the patient's desires will not be satisfied. To establish an engagement that is lively and spontaneous, the analyst will inevitably vary the frame from day to day and from patient to patient. Mitchell suggests that “what is most crucial is neither gratification nor frustration, but the process of negotiation itself, in which the analyst finds his own particular way to confirm and participate in the patient's subjective experience yet, over time, establishes his own presence and perspective in a way that the patient can find enriching rather than demolishing” (p. 196). The understanding of what transpires between analyst and analysand is, of course, the essence of the process. The key here is that the analyst must strive to act in the patient's best interests, even though those interests may be difficult to ascertain from moment to moment.
Mitchell's comments on how analysts find their own particular way to participate in the negotiation process with the patient reflect a growing awareness in the field that the analyst's participation is a variable that shifts from analyst to analyst and, for one particular analyst, across patients. In an article published last year in Psychoanalytic Quarterly, Jay Greenberg observed that there is an interactive matrix that serves to define the precise nature of the frame and the “rules” in each analytic dyad. In this regard, we must acknowledge that the varying levels of elasticity of the frame are a reflection not simply of the patient's specific needs, but also of the analyst's subjectivity.
One patient agreed to an analytic process four times a week but insisted on sitting in a chair rather than using the couch. Her analyst explored the request with her, and the patient spoke at some length about how her mother had “disappeared” into mental hospitals several times when the patient was a child. To lie on the couch was experienced as a repetition of this trauma because the analyst “disappeared” from view. The analyst explained that she found it much more difficult to achieve the optimal state of attentiveness when a patient was looking directly at her. With a few sessions of discussion, they finally negotiated a compromise whereby the patient would begin the analysis on the couch but could sit up when she felt particularly vulnerable to “losing” her analyst. This negotiated frame took into account both the patient's needs and the analysts subjectivity.
The analytic role is in part defined by the analyst's dedication to the patient. Roy Schafer has elaborated this further in his definition of the analyst's role as involving a group of characteristics that define the analytic attitude. Included in these characteristics are forthrightness, the avoidance of either-or thinking, an emphasis on analyzing rather than reacting, a courteous and respectful effort to be helpful, an avoidance of acting on selfish motivations, and neutrality.
A recent major shift in psychoanalytic thinking is the widespread recognition that the participation and personal presence of the analyst are always influencing the process, often in ways that are largely unconscious. For example, the analyst may espouse a nonjudgmental neutrality as part of the analytic frame but nevertheless unwittingly convey to her patient that she disapproves of the patient's current romantic object choice. She may be surprised to hear her patient say, “I can tell you don't like him” Recognizing that she was unconsciously communicating something of her feelings to the patient, the analyst would then explore the patient's perception further to see how the experience was recapitulating experiences of disapproval. At the same time she would look within herself to identify her own contribution (from her past) to the present enactment.
Self-disclosure is generally regarded as a breach of an analytic boundary, but as this vignette illustrates, some self-disclosure is inevitable. Irwin Z. Hoffman has suggested that there are times when more deliberate self-disclosure may enhance the process. When a patient asks the analyst a direct question, for example, it may be useful to reveal aspects of the analyst's experience as well as the analyst's conflict over whether to answer the question. Yet self-disclosure of personal problems or difficulties from childhood is rarely useful and should signal to the analyst that something is awry. Most helpful disclosures involve some version of clinical honesty in the here-and-now experience of the patient. We would, however, draw a clear line at the self-disclosure of sexual feelings for the patient. Disclosure of erotic countertransference usually has a different meaning for the patient than do other admissions by the analyst. It may overwhelm and confuse the patient; it may threaten the patient with the inherent link between sexual feelings and action; and it frequently leads to a
collapse of the analytic space because the concrete has replaced the symbolic.
Consideration of the analytic role serves as a convenient segue to an examination of the analytic object. Freud recognized the uniqueness of the analytic relationship when he noted in “Observations on Transference-Love” that analysis represents a type of relationship “for which there is no model in real life.” Indeed, the analytic object is created by careful attention to the analytic frame and to analytic boundaries. Both facilitate the emergence of a specific type of object that is constructed by the interaction of patient and analyst and contains the interpretive material generated during analysis. There is increasing consensus within the psychoanalytic literature that the mutative process of psychoanalysis involves both the internalization of the relationship with the analyst and the achievement of insight through interpretation. From this consensus it follows that the analyst must be both a transference object, subject to interpretive work, and a new object, subject to internalization. As Greenberg noted in a 1986 article, “If the analyst cannot be experienced as a new object, analysis never gets under way; if he cannot be experienced as an old one, it never ends.” Follow-up studies show that the analyst remains mentally represented for the patient as both an old and a new object; this bimodal representation is an achievement of analytic work that persists.
The analytic frame and analytic boundaries together provide an atmosphere that facilitates the emergence of the analyst as a transference object. The relative anonymity and at least partial abstinence in the analytic role serve as fertile soil for the displacement of past objects in the patient's life into the present relationship with the analyst. Ron Baker has argued that the new object will not emerge until the transference object is extensively analyzed and interpreted. Baker's point is important because of the frequent confusion between the analyst as an idealized transference object and the analyst as a new object.
Particularly in the analysis of patients who have experienced childhood trauma, the analyst may be regarded as an idealized rescuer who will make up for the bad experiences of the patient's past. As Mitchell has observed, however, the desires of adult patients should not be viewed simply as replacements or compensations for the deprivations of childhood (as the patients themselves often view them). Childhood trauma goes through various adult transformations and becomes angry revenge or overvalued suffering. Hence, the gratification of these desires is not likely to bring about the result the patient hopes for. Much of the confusion arises from a tradition within the analytic literature that equates the analyst's role with that of a parent. Hans Loewald compares the analytic process to one that involves reparenting. Although there are certainly elements of the analyst-patient relationship that recapitulate and parallel the parent-child relationship, the analogy can be misused to justify a folie a deux in which the patient desperately wants the analyst to become the “good parent” to make up for the “bad parent” of the past, and the analyst colludes with this wish by attempting to become an idealized figure who will compensate the patient for past traumas.
Spruiell shares our concern: “Even within the frame we do not act like parents; we do not succor, ignore, reward, spank, cajole, argue with, instruct, bathe, forbid, etc. Nor do we act like lovers, enemies, friends, siblings, or the patient himself or some part of him. We act like analysts, a fact sometimes forgotten in the literature, where one finds assertions that within the alliance the analyst is really being a better parent than the patient ever had. It is as disastrous for analysts to actually treat their patients like children as it is for analysts to treat their own children as patients” (1983, p. 12). Casement argues that taking the patient's transference wishes literally and attempting to gratify them blurs the distinction between symbolic holding and literal holding. The patient needs to experience past trauma and the old object relationship as it was originally, as well as have the experience of analyzing this transference wish with the analyst. Only then can old trauma be worked through.
Systematic analysis of the transference within the analytic frame ultimately provides the patient a new object experience. Morris Eagle has suggested that the safety of the analytic setting, along with the analyst's survival of the patient's attacks, sends a powerful message to the patient. He goes so far as to compare it to an unspoken interpretation that helps the patient understand that the analyst is a new object, different from the original traumatic object, and that the analysis itself is not the original traumatic situation.
The analytic object, then, is in one sense an amalgam of the transference object and the new object. In that regard it is a joint creation of the interpenetrating subjectivities of the two participants. In Subjects of Analysis Thomas Ogden argues that the core of the analytic process is the dialectical movement of subjectivity and intersubjectivity between analyst and patient: “There is no such thing as an analysand apart from the relationship with the analyst, and no such thing as an analyst apart from the relationship with the analysand” (p. 63).
In this homage to the Winnicottian view of mother and child, Ogden is suggesting that transference and countertransference reflect a dialectic between the analyst as a separate entity and the analyst as a joint creation of the intersubjectivity of the analytic process. Ongoing projective identification between the two participants creates an interpersonally decentered subject that Ogden refers to as the analytic third. The analysis itself takes shape in the interpretive space between analyst and analysand.
One implication of Ogden's view is that three subjectivities can be identified in psychoanalytic work: that of the analyst, that of the patient, and that of the analytic third. Projective identification simultaneously negates and reappropriates both subjectivities to create a new “subject” From the patient's perspective, this subject is also the analytic object. In this sense, the object is indeed a new creation of the setting. It is jointly constructed by analyst and analysand (and their internal objects) through the long repetitions of the analytic process within well-prescribed frames and rituals.
In conclusion, each analytic dyad creates its own analytic object. To accomplish this task, an analytic frame with a unique set of analytic boundaries is forged in the crucible of the analytic interaction. Despite the individual differences in these elements, certain overriding characteristics define the analyst's role as specifically psychoanalytic. These include relative restraint; an avoidance of excessive self-disclosure; a regularity and predictability of sessions; a devotion to understanding the patient; a generally nonjudgmental attitude; an acknowledgment of complexity in motives, wishes, and needs; a sense of courtesy and respect for the patient; and a willingness to put one's own desires aside in the service of a greater understanding of the patient.
Portions of this article appear in Boundaries and Boundary Violations in Psychoanalysis, by Glen Gabbard and Eva Lester, New York, Basic Books, 1995. Reprinted here with permission from Basic Books.