If you listen to psychotherapists when they talk to one another, you will often hear them speak of something called the “therapeutic frame.” This term, coined by the psychoanalyst Marion Milner, refers to the set of conventions and ground rules that structure the therapeutic experience. Just as the frame of a painting defines the borders of a work of art, the therapeutic frame is the “container” in which the therapy takes place.
As an architect, I find myself curious about this frame. What are its dimensions? Where does it start and where does it end?
We begin, of course, with the recurring time and place of the therapy sessions, the agreed-upon fee, the consistency of the furniture and the predictable presence of the analyst. There is also the expectation of a safe and separate environment in which the patient can remember sad moments, experience shame and think about desire. The therapeutic frame creates the freedom that allows the patient to say all that comes to mind. It separates the therapy from the rest of life, for both the patient and the therapist.
But the frame, it seems to me, is wider than the confines of the consulting office; it is a zone containing so many little habits that we rarely notice.
My therapy frame starts with the coffee I pick up on my way from the subway. It extends to the friendly doormen at my therapist’s building and to the ongoing lobby renovation (I’m happy they have removed the front step, making the lobby wheelchair accessible). It also includes the waiting room, and the new noise machine that hasn’t yet decided if the waiting room is a rain forest or an ocean. And it contains Dr. A and Dr. B (as I will call them), who share the office suite with my therapist.
I see Dr. A and Dr. B fairly often. Dr. A always greets me with a warm hello when I see him taking his white fluffy dog for a walk or when he gets a cup of tea from the kitchenette. Dr. B usually arrives with me on Friday mornings. Busy making his way into the office, he never acknowledges that he recognizes me; perhaps this is his way to show his commitment to patient privacy.
Funny, I realize I know more about Dr. A and Dr. B than they know about me, the opposite of the usual relationship of patient and therapist. They don’t know my name or that I’m an architect or that I’ve been reading a lot about psychoanalysis in the last few years and have written about the intersection of architecture and psychoanalysis. I, on the other hand, have seen their offices (Dr. A has a few guitars). Once, while in the waiting room, I read a blog post by Dr. A that mentioned his divorce, and I have also Googled Dr. B, a respected psychiatrist, and found an interesting article in which he explains why he prefers to focus on his patients’ array of symptoms rather than to classify them under one medical diagnosis.
I notice that Dr. B is suffering from a disease which, having never spoken to him, I cannot label diagnostically, but I see some of its symptoms. A fragile-looking man, his body contorted and his voice high, Dr. B has been slowly and visibly deteriorating. A few years ago he still moved independently, though with difficulty, using a walker. Then came a wheelchair followed by a little maroon cart that he drives into his office. Recently, he was assisted by a very talkative male aide. I am impressed that Dr. B continues to maintain a rigorous schedule despite these difficulties.
Dr. B’s office door is always kept open between patients so that he need not get up to open it when he is ready for the next session. I remember once overhearing a painful phone conversation that he was having with a representative of his health insurance company, in which he begged for more assistance. On another occasion, I recall worrying about his safety — this vulnerable, partly paralyzed person — when a tall man entered his office yelling in rage.
I have seen many of Dr. B’s patients over the years. The most memorable was an elderly man. Unusually tall, with wavy gray hair down to his shoulders, he wore a luxurious fur coat and many rings. Perhaps he had been in theater? To me he looked like a 19th-century Russian count. He came accompanied by a lanky bald man (some sort of aristocratic aide?), who sat silently in the waiting room, typing on his laptop, while the count saw Dr. B.
On a recent Monday, after returning from vacation, I enter the waiting room and immediately notice that something is different. Dr. B’s door is in a strange midpoint position: not open as it typically is between sessions, but also not shut. The lights are off, save for a dim lamp. I peek in and see that the furniture is strangely gathered in the center of the room, a cardboard box placed on the couch. Maybe Dr. B is retiring, I think.
My therapist arrives and I enter his room. “What happened to Dr. B’s office?” I ask. It feels safer to talk about furniture and rooms than to ask about people. A short silence follows, and I hear my therapist say, “Dr. B died last week, during the Passover Seder.” We are both quiet for a long moment.
I am surprised by the depth of my sadness for a man I really did not know, and it lingers over me. The end of a life is both strange and natural. Life is fragile and fleeting.
Why am I sharing this small story? Perhaps because I love that psychoanalysis is a frame through which I have permission to pay close attention to peripheral vision, to things that are out of focus and not so conscious. Enigmatic dreams, childhood memories and mourning are all welcome, and they open me to my own feelings and to a wider range of human experiences.
As an architect, I try to notice the sequence of spaces that we move through as we enter and leave a building. My task is to create spaces for various functions, and I achieve this by designing the walls and facades that make these activities possible. By designing exteriors, we create interiors. Architecture is a meditation on entering and exiting: It articulates the frames that contain our lives.
Perhaps life itself is a bit like architecture, and a bit like the therapeutic frame: a zone of experiences between an unknown beginning and an unimaginable end.
On my way out of my therapist’s office, I see a folded sheet of paper taped to Dr. B’s door. Below the letterhead is a handwritten note addressed “to Dr. B’s patients.” I’m curious, but I leave the suite without opening the note, out of respect for the man who always respected my privacy.