Have you ever heard of therapists who talk about themselves to their clients, give advice to their clients, and push their own beliefs and values onto their clients? Or therapists who do therapy outside of regular hours via phone or text? Or therapists who answer phone calls during sessions? Who do therapy in cafes and public parks?
I feel like I hear about these therapists all the time. I also keep hearing about websites like Betterhelp, which invite clients to “Do it at your own time and at your own pace. Communicate with your therapist as often as you want and whenever you feel it's needed.” (Betterhelp also promises that you can change therapists anytime you want, as many times as you want.)
All of this “flexibility” and “openness” and “genuineness” might sound good, but the truth is that this is not a good way to practice psychotherapy. Indeed, I’d venture to say that - whatever this stuff is - it isn’t psychotherapy. Doing therapy this way is, at best, probably not effective; at worst, it's malpractice.
I'm afraid that many younger therapists these days may be unaware of an old and very fundamental concept: the “therapeutic frame.” Basically, the frame is the container that makes therapy effective. An inconsistent frame - or no frame at all - can lead to therapy being ineffective, even damaging. More often than not, when therapy feels stuck or unproductive, it’s because the therapist hasn’t established or maintained a solid therapeutic frame.
What is the Therapeutic Frame?
Here are some elements of the therapeutic frame. If you’ve been in therapy, I hope that you’ll be able to recognize all of them:
Confidentiality. Everything about therapy needs to be confidential. Your therapist should not share any information about you with anyone, unless you specifically authorize them to do so. This includes your name, your diagnosis, even your appointment times. Even the fact that you are a client.
Regular scheduled sessions that start on time and end on time, every time
No therapy outside of these regular sessions (i.e., no after-hours text messaging or phone calls)
Clear and consistent policies about fees and cancellations
A regular, private “location” for your meetings, whether it’s a brick-and-mortar office or an online platform.
Neutrality. This doesn’t mean that your therapist is neutral about you or what happens to you. It means that your therapist should be careful to not take sides with any of the conflicting elements in your life, so that YOU can observe them and think about them and eventually navigate your way through them. The goal of therapy is not to teach you how to behave; it is to help you free yourself from your own conflicts, habits, fears, trauma, etc. If your therapist keeps instructing you on what to do, that’s not therapy. It’s… something else.
A steady, predictable therapeutic frame (where the rules are understood and agreed to by both you and your therapist) helps you feel secure enough to talk about difficult things. You can talk about fears, things you’re ashamed of, even fantasies, without having to worry about consequences or fallout. You can get angry at your therapist. You can express fears of judgment or abandonment. You tell your therapist that you’re in love with them (or that you think they’re a terrible therapist) BECAUSE you know that it is safe to do so. At the end of this session, you know you'll see each other again next week for ANOTHER session.
The frame makes the therapy relationship special. It's not just a conversation between two people. It's safe, it's focused, and it's meant to be helpful to you. It's more of a crucible than a conversation. It's serious and intense in a way that other relationships are not.
This kind of steady, consistent, predictable relationship is almost impossible to achieve if you and your therapist meet whenever you feel like it, or chat via text or telephone in between sessions. It won’t work if your therapist is like a friend who is always on your side, always reminding you how wonderful you are and how bad all those other people are treating you. It won’t work if your therapist tells you all about THEIR experiences or beliefs or values.
The more secure the boundaries are in a relationship, the more freedom there is within that relationship. Real psychotherapy isn’t a soothing spa visit. It’s hard work. It’s hard work for the therapist, who has to give you plenty of space and support to think about yourself without accidentally hindering you or interfering with you - or making you feel alone and unheard. And it’s hard work for you, as a client, to really learn about yourself, to take responsibility for yourself, and to change in ways that lead to more freedom and more happiness.
Bottom line: be wary of casual, friendly therapists and websites that promise a relaxed and flexible approach. It sounds nice, but it'll probably end up frustrating you. And this frustrates me, because you might end up believing that you tried psychotherapy but that it didn't work - when, in fact, what you were doing wasn't really psychotherapy at all.
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