10/10/2022

Psychotherapeutic
Frame and
Boundaries
By Dr Nikolaos Souvlakis

Objectives
• Identify best practice and being aware ethical
breaches
• Raise awareness of ethical and mistakes and poor
boundaries
• How to maintain good ethical practice
• Clinical responsibilities

1
 10/10/2022

What is the frame?

• Therapeutic frame is originated in psychodynamic

thinking and has certain assumptions
• Frame is containment of the process
• Takes different forms
• It creates a reality of the therapeutic process
• It allows the development of transference

•However we need to consider:

•To what extent we aim to offer a relatively stable

therapeutic frame or not?

Fixed points
of the frame

2
 10/10/2022

What frame offers

❖ Trust
❖ Reliability
❖ Therapeutic symbiosis
❖ True mirror
❖ Appropriate frustration and/or healthy
satisfaction
❖ Unconscious images and symbols to
introject
❖ Healthy narcissistic balance
❖ Clear interpersonal boundaries
❖ Unconscious support

What do you think is secure frame?

Secure frame

becomes now a lens through which we

are starting detecting unconscious
fantasies about the external realities
and the emotional facts of their internal
reality as well.

3
 10/10/2022

What are boundaries

• Are the rules that hold the framework

• They are identified by the governing
body that we are accredited with
In other words
They set the parameters in which we, as
therapists, operate
• They assist the development of:
1. A trustworthy practice
2. Build a therapeutic alliance
3. Foster an environment for growth

Importance of Boundaries
BPS BACP
Respect Trustworthy
Confidentiality Autonomy
Consent Beneficence
Self-determination Non-Maleficence
Competence Justice
Responsibility Self-respect
Integrity

4
 10/10/2022

What boundaries
shall include?
• Space (room design)
• Frequency
• Duration
• Disclosure (?)
• The elements of the therapeutic
relationship

Shaky Boundaries
• One of the question that you need to answer is:
Are you a rescuer or a fixer?
If the answer to that is ‘yes’ it would be important to
reflect further and understand the narcissistic wound
that you are trying to heal through the profession.

The answer ‘yes’ will be the underline conflict upon

which you will operate in your professional capacity
and blur the boundaries

10

5
 10/10/2022

Minimise risks

• As therapists you will need to identify

and make provisions to minimise risks:
• Set healthy boundaries
• Maintain the frame
• Consult peers regularly
• Have consistent supervision
• Keep clinical notes
• Know own limits
• Refer when necessary
• Avoid DUAL relationships

11

Be careful of
self-disclosures
• Avoid self disclosures unless necessary → self
disclosure can blur the boundaries and take away
the client from the process
• You become the centre of the attention
• Always evaluate the impact that the disclosure
will have in the process
• Before you disclose ask:
Does it serve the client or myself?

Untimed self-disclosure can damage the client and

the process

12

6
 10/10/2022

9 important questions about

boundaries
• Is it for my client’s best interest?
• Whose needs are being servicing?
• Will they influence the therapeutic relationship and how?
• Should I consult with a peer or my supervisor?
• How do I feel if I share the issue?
• Do my actions serve my ego?
• What does the client mean to me?
• Do I go against the ethical framework?
• Am I treating the client differently?

13

Deviant Frame
•Countertransference can get in the way if not worked through in
supervision by providing a different frame than what deemed to be
therapeutic.

•No matter how hard we try we/therapist bring a certain level of

countertransference in the room.

•If frame is not secure leads to deviant frame offering:

①Mistrust
②Unclear interpersonal boundaries → parasitic symbiosis
③Impairment on reality testing
④Insecure relatedness
⑤Dysfunctional adaptions
⑥Martyr
⑦Perverse gratification

14