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What is the frame in psychotherapy and why do we need to keep it from breaking? This week I discuss some guidelines set forth by Robert Langs, MD regarding how to know when your relationship with your therapist is healthy - and when it is not.

Listen to episode 12 on the importance of the frame in psychotherapy.

or use the player below.

Notes From This Episode

Download a Word doc on Lang’s guidelines for psychotherapy.

Go to the webpage for the European Society for Communicative Psychotherapy where you can learn more about Robert Langs’ work.

Guidelines for Psychotherapy

From the book: Rating your Psychotherapist
Author: Robert Langs, M.D.

1) Ideal conditions which constitute the "frame"

A single, set fee
A single, set location
A set time and length of the session
A soundproof office (or noise machine)
Relative anonymity of the therapist (no self-revelations or opinions, focus should be on the patient)
Total privacy
Total confidentiality

2) Referrals

Good:

Local Medical Society, Mental Health Association, or other professional organization
Recommendation from a friend who is a psychiatrist, psychologist or social worker or other mental health worker
Employer, principal or lawyer recommendation

Bad:

A co-worker, social acquaintance, or relative sees or used to see him/her and says he/she is good
Therapist is the wife/husband of one of your friends
Therapist is a friend or used to be a friend of the family

3) Your first interaction with the therapist

Good:

He/she was concerned and listening
Said nothing of a personal nature
No physical contact except for an initial or concluding handshake
At the end of the meeting the therapist set the ground rules for treatment

Bad:

He was very physically demonstrative, that is, hugging or holding your hand
He/she came on to you sexually
Was unprofessional and self revealing
Talked more than you did

4) The fee and Schedule:

Good:

Set a single, reasonable, fixed fee
Won't let you build up debt
Won't accept gifts or other forms of compensation beyond the fee
Arranged a definite schedule for therapy (day, time, length and frequency) and these have not changed throughout the course of therapy (except when necessitated by work or life circumstances)

Bad:

He/she is willing to falsify a fee to an insurance company
He/she negotiated a barter arrangement
There are repeated changes in time/location/day, length of sessions
Sessions start late because other patients stayed late
He/she lets you stay longer than the scheduled time

5) Treatment:

Good:

Treatment types vary a great deal (cognitive, behavioral, humanistic, etc.): but in all cases: Does it make sense to you?
Does it feel okay?
It should always remain a professional relationship
In general, the therapist should let you do most of the talking

Bad:

Therapist keeps directing you to talk about particular issues (your marriage, your sex life, etc.
He/she frequently tells you what they think you should be doing with your life ("If I were you I would…)
The therapist is hostile, makes you feel guilty, or is seductive

6) Termination:

Good:

You felt like a sense of new insight and understanding had been reached and your symptoms had largely (though probably not completely) been resolved
It seemed like the right time to end therapy
A specific date was set and adhered to (didn't happen in an unplanned way)
All the ground rules mentioned previously had been maintained up until the end
Once therapy was over you had no further contact with the therapist

Bad:

You decide impulsively to stop therapy and your therapist accepts this without encouraging you to consider your decision
Therapist badgers you to continue despite your feeling that it is time to stop. He/she insists that you still need help