Online Zoom CPD Training - 19 April 2020 with Michael Soth
9.30 – 12.30 (free - donations to charity)
“The most important thing in art is The Frame. For painting: literally; for other arts: figuratively – because without this humble appliance, you can’t know where The Art stops and The Real World begins. You have to put a ‘box’ around it because otherwise, what is that thing on the wall?” Frank Zappa
One of the main points that has come out of recent discussions on the topic of working online is the following: transitioning from working face-to-face in therapy to working remotely online via meeting on screens throws up all kinds of boundary issues, as the therapeutic frame needs to be re-negotiated in order to do justice to the new format. With the therapist less in control of the working environment and unreliable technology mediating the communication, all kinds of traditional assumptions and working practices are no longer maintainable and enforceable. We have heard many recent examples where traditional boundaries are not straightforwardly applicable or get compromised and broken, creating dilemmas for the therapist.
Therapists who have long specialised in working online - and who have established themselves as experts for a whole new set of codifications and guidelines for this new format of therapy - can easily be found on the internet, along with dedicated CPD training. Much of the training that is available is trying to transfer the established ethical and working principles of our discipline and professional organisations to the online format. However, in their current form, much of those professional guidelines is based on questionable assumptions regarding the therapeutic relationship and especially the therapeutic frame, that do not fully take into account unconscious processes, ruptures in the working alliance, enactments and the deeper dilemmas of the ‘impossible profession’. Most of our trainings and professional organisations work on the unrealistic assumption that therapy is ‘possible’ and ‘doable’ in a linear way without any of these vicissitudes and can be arranged, negotiated and conducted within a ‘safe’, fixed professional therapeutic frame. When a therapist finds themselves falling short of these unrealistic assumptions, they typically feel additionally shamed and incapacitated.
The focus of the online workshop: established assumptions around the therapeutic frame and its inherent paradoxes
What I would like to offer in this free CPD session is a deeper consideration of the established assumptions around the therapeutic frame and its inherent paradoxes. Rather than attempting to provide a fixed set of guidelines that can be applied across the board to all your online clients, I will want to pay attention to the idiosyncratic features of each unique client-therapist relationship, and help you formulate some principles that you can use to work out an arrangement and therapeutic frame that fits and supports the particular work that needs and want to happen with each client.
More importantly, we may want to look at some principles to help you reflect on the therapeutic and counter-therapeutic aspects of your responses to boundary breaks if and when they do occur.
How 'meta' is meta-level communication?
One way of languaging negotiations around the therapeutic frame is to call them meta-level communication - it’s not the therapy interaction itself, but communication about the therapy. Most people - including therapists - easily assume that this kind of meta-level communication is - by definition - an adult-adult conversation and negotiation. However, under the guise of valid and important interactions about the frame, all kinds of unconscious dynamics manifest in these apparently rational interactions and pervade them. Rather than helping to contain the therapy, meta-level communication can become a distraction and avoidance which lends itself to all kinds of enactments, which manifest via parallel process the very dynamic which it is apparently seeking to frame and contain.
The practical upshot for the therapist is:
- how do I respond to necessary and legitimate needs and requests for frame and meta-level communications with the client - which arise abundantly in the transition form face-to-face to working online - without ignoring or being blind-sighted by the unconscious dynamics which manifest via meta-level communication?
- how much credence do I give in my response to the legitimate frame issues that do indeed need to be discussed, clarified and agreed, without losing sight of the enactments for which they are a vehicle and which compromise the therapeutic position and working alliance?
The dilemmas of meta-level communication
The dilemmas of meta-level communication are not particular to online work - they are always one of the most tricky and confusing aspects of therapy, partly because we usually try to approach them via our traditional assumptions which ignore these very dilemmas. I have been thinking about the paradoxes of holding and losing and re-gaining the therapeutic frame for many years. You may find the following slides helpful, which I put together for a 2010 presentation and workshop I gave for CONFER - please take into account that these are 10 years old now, and could do with updating and refining: The Therapeutic Potential of Broken Boundaries (CONFER 2011)
In this online workshop we can consider and clarify some of these ideas and explore how helpful they could be to your practice. We will probably also want to make them more immediately relevant to your practice, by one of the participants volunteering a client-therapist dilemma which we can explore in a supervision demonstration online.
As in therapy generally, many conundrums, frame difficulties and meta-level questions about the format of therapy are driven by underlying emotional and relational issues, in simple terms: suspicion and mistrust and misconceptions which present themselves as if they are about therapy, its frame and format. However, much of the suspicion and mistrust pre-exists in the background of the client’s emotional reality, and only comes to the fore at the prospect of opening themselves up to ‘help’ (whatever that means) and sharing themselves with some degree of vulnerability and transparency.
So a crucial question when confronted with meta-level concerns is always how we understand and access and engage and access with both levels: the apparent, explicit, superficial level of valid concern, and the deeper, habitual pre-existing dynamic for which the meta-level is only a specific instance, and to some extent a distraction and defence.
When shifting online, there are many opportunities for similar distractions regarding the technology, the format, the new boundaries, etc. Please give headlines for clinical examples that you have encountered that illustrate the issues and topics of the workshop.
The meeting was recorded on Zoom, will be edited for confidentiality and then the recording will be made available to subscribers.
As an introduction to the topic, and to illustrate the wide variety and contradictory opinions present across the field of therapy, in the following slides you can find a selection of relevant quotes: https://www.slideshare.net/MichaelSoth/soth2010-confer-the-therapeutic-potential-of-broken-boundaries-introductory-quotes
Underlying discussions around therapeutic boundaries are a diversity of assumptions as to how 'containable' the process is, or in other words: how strongly do both partners in the relationship become subsumed by the waters of 'unconscious processes'? https://www.slideshare.net/MichaelSoth/soth2010-confer-the-therapeutic-potential-of-broken-boundaries-water-images
You can find some of the notes, comments and graphics from the meeting here.