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Therapeutic Frame and Clinical Boundaries

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Therapeutic Frame and Clinical Boundaries

Overview

The therapeutic frame is a widely used concept in the clinical and medical fields.

Therapeutic frame refers to the fixed elements of the therapeutic association providing the

context of therapeutic work. It covers the "boundaries," relational and environmental conditions

for the therapeutic process. The fundamental concepts in the therapeutic frame are that it protects

the confidentiality of clients’ information from the first meeting with the therapists to the therapy

session and during the contact between the client and the therapist. It provides an avenue for

peaceful and free interaction before, during, and after the therapeutic work. In addition to the

therapeutic frame is the clinical boundary between the therapist and the client. Some rules and

regulations limit interaction during the therapeutic process. With COVID-19 confronting the

entire globe, Video therapy is an emerging trend in counseling; however, a therapist has to apply

the therapeutic frame and clinical boundaries to maintain maximal respect, power, trust, and

closeness to their clients.

Medium -video therapy

Video therapy is a very key player in the development of the therapeutic process. With a

global pandemic like COVID-19, counselors diversify how they work and discharge their services.

Video therapy is the widely used technology in therapy since March 2020, when COVID-19

disrupted the normal lifestyle of many families across the world. Depression and stress rise daily,

bringing the urgency for most affected families to be given emotional and mental therapy. Despite

the need for therapy, it is normally impossible to have face-to-face therapy but due to the fear of

contracting diseases and, in some cases, distance. Video therapy stands as the most efficient and

flexible means to attend to those in need of therapy.

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Frame & Boundaries

Regardless of the need for video therapy, therapeutic frame and boundaries are essential in

any form of counseling, bringing the need of a therapist to keep work ethics and do their therapeutic

work. Video therapy is widely through zoom meetings or video conferencing channels. They are

very reliable in connecting the therapist and the client irrespective of the distance or location since

what one needs is a steady internet connection. The essential thing in video therapy is the

confidentiality of client information and keeping the session professional (Bachkirova and Baker,

2018). The therapists should treat video therapy as any other normal session, like face-to-face.

Video conferencing or zoom platform acts as the clinic, giving the need for the counselor to allow

for rules and regulations in clinical boundaries to apply in such session. The therapist must treat the

client with the respect he/she deserves and ensure that there is no sexual harassment or nudity

during the session. Violation of the client's rights is chargeable in a court of law, meaning that the

client can also report any cases of mistreatment or unprofessionalism by the counselor.

In Video therapy, many factors are considered to ensure a professional relationship between

the therapists and the client. The therapist must operate within his scope, meaning that he must

understand his roles and responsibilities and translate to solving the client's problem without

violating the client's privacy. Secondly, the therapist must set out clear parameters in terms of the

duration of the session and what is required during the session. Giving the client professional

orientation makes her set her mind clear before the actual therapy. Thirdly the therapist must spell

out the platform to do the video therapy so that the client prepares adequately without

inconveniencing the therapists. The client has a right to know the therapy charges without the

therapist exploiting him by overcharging therapy sessions. Fees for the therapy should be fair

according to the set standards guarding the health sectors globally.

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In line with the clinical code of conduct, gifts and favors should be to the client's

willingness. The therapists should not ask for any favor unless it is a professional favor contributing

to the client's health. The dress code should be professional during the therapeutic process that it

cannot make either of the parties uncomfortable. The counselor should dress to respect his

profession and the client to clear an ample environment for peaceful interaction. Language should

be professional devoid of uncomfortable terms and jokes. The client and the doctor attending to him

should also use their correct name but avoid calling each other names to create commotion during

the session. The therapists should use the correct name, collection of words, and fair tone to open up

during the sessions. Video therapy, using uncomfortable name may upset the client making him/her

end the session inflicting more problems on already existing pains that the therapist ought to help

her overcome.

Frame and Boundaries, pt 2

In cyber-service (video therapy), there are serious considerations about the client and

therapist relationship. Unlike the normal sessions, the therapists must make sure that he works with

the client and guide him through the therapeutic process. The client has expectations of how he feels

the therapist should operate; the therapist should embrace the client expectations and work with him

closely to formulate a solution during the session (House, 2018). In Video therapy, the therapist

should evaluate critically the expectations of the client; focus on building therapeutic relationship

and apply professional guidance to meet such expectations. In getting to understand what client’s

needs are, therapists must operate within their scope.

There are many limitations in Video therapy and restrictions that guard the boundaries and

therapeutic frame between the therapists and the clients. The therapist must avoid asking for

unnecessary favors from the client. The data he gets from the client during and after the session
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should be confidential. The therapist should only use the data for the case of attending to the client.

The counselor and the client should formulate an agreed structure (the therapeutic frame) for the

therapy session. It should be guided by the fundamental principle of the therapeutic process where

the client informs the therapist of his problem; the therapist then prepares the possible solution

avenues (Sloshower, 2020). They then suggest how to solve the problem, and then recommend what

is needed for the therapy and what it takes to have a session in the orientation stage. After that, the

therapist guides the client on the possible solution through an agreed platform for Video therapy.

Time is a crucial resource in any activity; video therapy is not an exception. The session

must have a clear schedule, whether it happens through video conferencing or zoom platforms. The

counselor must stipulate how much time the process will last so that the client can set his mind to

adhere to the duration set. During the therapeutic process, both the client and the counselor have

their rights and responsibilities to avoid conflicts. The client has a right to be heard, respected, and

confidentiality and integrity of his data kept; the counselor has the right to guide and inform the

client according to his professional understanding of the underlying problem. The counselor also

has the responsibility of listening to the clients’ expectations and applying his knowledge to solve

the problem accordingly.

Video therapy is also applicable in social media platforms; a therapy can organize a session

with a client(s) using Facebook messenger or Instagram platforms and restrict those joining the

session to only his/her clients. Since social media is prone to public exposure, he can use a live

session to reach the client(s) by alerting them when they attend the session, giving them proper

orientation, and then the actual session. In social medial therapy sessions, the therapist must ensure

the confidentiality of the client's input.

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Record keeping is a very useful aspect of the therapeutic process. The counselor must ensure

that the information of each client is safe. Mixing up several users' data might compromise the

confidentiality of the data hence derailing the integrity and availability of the data when needed.

Therefore, the therapists' responsibility is to ensure that the records are safe for every session he

goes with either one or more clients. Data confidentiality is protected to avoid exposure of the data

to a third party. The therapy session should have a given goal to achieve; therefore, it should be

geared towards a certain objective to realize the patient's intention to choose a therapy. After the

therapeutic process, the counselor should evaluate his work to see if he has achieved the therapeutic

goals.

Violation of laws, rule, and regulations that guides the therapeutic process is a criminal

offense. When a client decides to seek counseling over an issue, he has exhausted all avenues, and

things do not work his way; therefore, the counselor needs to help him build confidence that his

issue is settled. However, in some cases, the counselors violate the privacy of the session with their

client either by exposing data to a third party or verbal information to third parties. In the case of

stigmatization of the client or breaking confidentiality of his data, the client has a right to sue the

therapist in a competent court of justice for violating his privacy.

Personal Challenges

Despite the rules that guide boundaries and frames in Video therapy, it is sometimes

challenging to handle issues without breaking some rules during the session. The choice of medium

for doing the therapy can be challenging when dealing with client with little knowledge in

technology. Clothing is a major factor in Video therapy since the client at the comfort of his bed

may decide to put on night dress undermining the integrity of the session; in such cases the therapist

must use a friendly language to remind the customer of the appropriate code without making her
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feel disrespected (House, 2020). Name and language are also underlying issues to therapists.

Sometimes, you may need to breach the rule to make the client understand the session that may

make you use inappropriate language or name. In video therapy the therapist may use fair tone and

friendly language to create peace in the client’s heart and bring about therapeutic relationship

making the client let go the memories.

Transference / Countertransference

During therapeutic relationship, there are two scenarios which may be insightful and

problematic at the same time; transference and Countertransference. Transference occurs when the

client redirects feeling of other people to the therapist; a skilled therapist often uses such a feeling to

insightfully view how the client may interact with strangers hence creating a therapeutic

relationship with the client (Little, 2020). The transference helps the therapist guide the client how

to work on emotions with the therapist during the therapeutic process. Every counselor must make

the session lively but with the same magnitude exhibits professionalism to avoid such incidences.

However, in some cases the therapist exhibits the countertransference.

Countertransference is the concept where the therapist reacts to the client’s feeling of

transference. It occurs in therapeutic process where the therapist projects her feelings onto the

client. A therapist may react to a client positively reminding him of a colleague or friend,

therefore; the counselor may use such a feeling to recognize and use them to understand how the

client feels about other people close to him. According to Little, the countertransference is a

good tool to develop therapeutic relationship which the therapist may use insightfully to bond

with the client and understand the client’s life (2020). It is important that the therapist understand

when and how to apply transference and countertransference to bring about the therapeutic

relationship at the same time maintain the clinical boundaries and therapeutic frame.
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How does video therapy differ from Face to Face therapy?

Different scholars have a divergent view of Video therapy and how it differs from face-to-

face therapy; I believe that there is no much difference apart from the physical presence of the

therapist. Unlike face-to-face, Video therapy is convenient to any client despite the client's

geographical location; anybody can receive therapy services at the comfort of his/her home without

necessarily going to the therapist physically. Video therapy has a setback or delay in

communication. The therapist has to consult before giving feedback in contrast with face-to-face

where the feedback is instant. Accessing Video therapy requires one to have enough technical

know-how, more so when using complex technologies in accessing the therapeutic session.

Regardless of all the demerits of Video therapy, I believe it is better than face-to-face, more so

during this time of global pandemic and the technology era.

Conclusion

In a nutshell, for any therapeutic process, be it Video therapy or face-to-face therapy,

communication and orientation are key to keeping boundaries and therapeutic frames. It is the

fundamental duty of the health expert to prepare the client spelling out how the process is bound to

happen and the activities that are to take place. The therapist must keep clinical boundaries to

ensure that he earn the client’s trust; he must also treat the customer with respect and utmost civility

without trespass. Most importantly, the therapist should ensure confidentiality of the information

from the client without stigmatization.

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References

Alan Eppel, M. B., Jordon Charlebois, M. D., & Blaire McKim, M. D. OUT OF THE FRAME:

BOUNDARIES in ONLINE PSYCHOTHERAPY.

Bachkirova, T., & Baker, S. (2018). Revisiting the issue of boundaries between coaching and

counselling (pp. 487-499). Routledge.

House, R. (2018). Deconstructing profession-centred therapeutic practice: I. Resistance,

boundaries and" frame", holding," material" generation. In Therapy Beyond

Modernity (pp. 49-68). Routledge.

House, R. (2020). The culture of general practice and the therapeutic frame. In Clinical

counselling in primary care (pp. 19-42). Routledge.

Little, R. (2020). Boundary Applications and Violations: Clinical Interpretations in a

Transference-Countertransference-Focused Psychotherapy. Transactional Analysis

Journal, 50(3), 221-235.

Sloshower, J., Guss, J., Krause, R., Wallace, R. M., Williams, M. T., Reed, S., & Skinta, M. D.

(2020). Psilocybin-assisted therapy of major depressive disorder using Acceptance and

Commitment Therapy as a therapeutic frame. Journal of Contextual Behavioral

Science, 15, 12-19.