Why Does Therapy Have Rules? Understanding the Therapeutic Frame

Seems counterintuitive, right? One of the most relational, vulnerable professional relationships you’re likely to have. Surely it should be fluid, permeable, less structured?

Not quite.

The only reason it can be what it needs to be – a robust framework and healthy boundaries.

If you’re a therapist or a client – I want to first acknowledge that each practitioner will have their own ideas as to what constitutes a professional boundary (I’m not going to go into the ethics of that here) but for the most part, boundaries around the therapeutic framework include, but are not limited to:

Cancellation policies

Payments

Timekeeping

Contact between sessions

Helping professions are one of those odd places whereby niceness and kindness commonly get mixed up. Surely, surely if you’ve had to cancel last minute, your therapist will be super nice and let the cancellation fee slide? After all – they’re there to help people. And yet, the nice thing isn’t always the kindest thing. Being ‘nice’ tends to mean smoothing over discomfort, rescuing someone from something. Being kind means offering consistency, even when consistency is uncomfortable.

Therapists are also business owners. Time is the ‘product’. A dedicated, ring fenced time slot is not likely to be filled with just a few hours notice. Therapists need to pay for the room hire (which will also have a cancellation policy), the professional memberships, the ongoing professional training. And, they also need to eat. A cancellation fee also recognises that the therapeutic hour is not the only time your therapist is ‘working’ for you. Note taking, research, holding you in mind, discussing anything of significance in supervision…all invisible, but nonetheless of significant value. And needed, very much needed, to make the work sustainable.

Sustainability is not just about the therapist’s income. It protects the quality of the therapeutic relationship. A therapist who can consistently show up, think clearly, remain attuned and offer their full attention is able to do better work. It is also excellent role modelling – much like parenting, sometimes modelling boundary holding can be more effective than discussing it.

Boundaries in therapy are sometimes misunderstood as a yardstick of how much compassion or empathy a therapist has. The reality is that compassion and boundaries can coexist. A therapist can absolutely understand that someone has become unwell, or had an unexpected situation arise – while still maintaining the agreed terms of the work.

Personally, I do not make decisions about which circumstances ‘count’ and which do not. Simply because it would place me in an impossible position of deciding whose circumstances are more worthy of flexibility. For me, the frame remains consistent for everyone.

Which takes us to payment, in general. Some therapists prefer payment prior to a session, others have a more trust-based policy of a day or two following a session. Either way, it’s super important. Clients’ roles in therapy – turn up, reflect and do the work to the best of your ability (which will, of course, ebb and flow), and pay for the sessions. Therapists’ roles in therapy – hold the frame. Be consistent, reliable. Provide a safe space to explore what needs exploring. Consider therapeutic theory. Stay attuned and regulated. Possibly provide tailored ‘homework’ or other out-of-session ideas. Do additional training and research around client’s presenting issues. Take trickier stuff to clinical supervision. Both people have an active role in the process…the responsibilities are just different.

Speaking of reliability and consistency…this is a two sided coin. If you have agreed a time, a day, a frequency…both parties need to ensure they are maintaining that as much as is feasibly possible. It is a commitment. Not always an easy one, no. But things worth committing to rarely are.

The frame isn’t there to be punitive, or to punish. It’s not there to create distance or resentment. Its intention is actually the opposite. By making the boundaries clear, both parties are freed up to be able to focus on the work itself.

It’s also important to recognise that making exceptions for any of the above can have unintended consequences that might impact clients. For some, too much flexibility can reinforce ideas that needs only matter if they’re justified, or there’s a requirement to ‘prove’ how much they’re struggling, or that they’re responsible for managing the therapist’s feelings.

A consistent frame communicates that circumstances matter, feelings are valid and can be explored…and the agreement still exists.

Boundaries don’t always feel good. You may not like the boundary. You may feel frustrated, disappointed or even angry. But you know where you stand. There is no guessing.

The therapeutic frame is not what gets in the way of a relationship. It is what allows the relationship to exist. When the boundaries are clear, neither person has to spend energy negotiating the scaffolding – they can use that energy for the work.

If you’re curious about beginning your therapeutic journey, or if you’re a therapist who’d like some like minded professionals to connect with – please do reach out. We’d love to hear from you.