Inside the Frame: Where My Work Begins

In my early days as a therapist, I was obsessed with the 50-minute hour - What do I say? What do I ask? How do I use those precious minutes well? Only to realize that therapy work actually begins outside of those 50 minutes. It actually begins before I even meet my clients, in how I organize my time and space, and in how I build the logistical and emotional foundation for therapy. This foundation is known as the therapeutic frame - the container within which therapy unfolds. 

Building the Frame

My frame has four core walls: the length of a session, the frequency of sessions, the fee, and my stance and presence. These are not arbitrary; they are psychological anchors that support both the therapist and the patient in doing deep emotional work.

The intentional creation and management of this container is a clinical process called dynamic administration. At its core, it's about creating predictability and structure - a consistent rhythm of meeting that fosters containment. Containment is not built through words alone, but through reliable patterns: same time, same place, same attentive presence. For clients with histories of chaos or relational inconsistency, this regularity can be profoundly reparative. It communicates something simple yet powerful: I’m here. You can count on this.

Because therapy is uncertain, neither party knows what will emerge. Which is why framework becomes essential. Set session times, clear fees, and consistent boundaries free the client from needing to manage the environment. In many ways, the therapist creates the holding environment, so the client can let go. The client no longer needs to “keep it together” alone because someone else is helping carry the weight. When clients say, “Fifty minutes isn’t enough,” it often reflects a deeper yearning to be fully known, uninterrupted. But therapy does not respond with endless availability. Instead, it answers with something more powerful : consistency. The steady promise of I’ll see you next week.

As Nancy McWilliams (2004) reminds us, transformation arises not just from emotional breakthroughs, but from reflective, reliable return. Holding the frame also means allowing space for frustration and disappointment. The frame restricts as much as it contains. Sessions end, requests can’t always be accommodated, availability is finite. These boundaries mirror the outside world. Part of the work is learning to tolerate limits without collapse, and to engage relationally even when one doesn’t get what one wants.

The frame anchors the therapist as much as the patient. 

A structured process clarifies when something is out of sync and reduces the emotional and cognitive load of making ad hoc decisions. When the behind-the-scenes logistics - scheduling, fees, cancellations - are sound, the work in the room becomes freer and deeper. A therapist who is undercompensated, working outside of their availability, or continuously bending the frame, may begin to feel depleted. This depletion shows up in the room. They are no longer fully present with the client and their own needs and frustrations begin to intrude. The therapeutic relationship becomes subtly (or overtly) co-opted by the therapist’s unresolved experience. The frame, then, becomes a source of security and groundedness for the therapist. The frame protects both people. They are able to offer care that is boundaried, consistent, and sustainable.

When the Frame Says No

Yet these same boundaries can sometimes feel withholding to the client. They may stir old wounds of separation or unmet need. The therapist is not endlessly available. This can echoes early developmental experiences: the moment a child realizes care is not always available on demand. And just as in childhood, this can be an entry point into learning how to self-soothe, to tolerate loss, and to internalize care.

Therapists, ideally, hold both maternal and paternal functions - providing warmth and playfulness, but also limits and structure. Through this dual stance, the patient is supported in integrating frustration, navigating disappointment, and moving toward emotional maturity.

I once worked with a young woman who turned quickly to rage when she felt disappointed. We were exploring how anger helped her feel in control, especially when vulnerability felt too threatening. In our fourth session, she messaged two hours beforehand asking to reschedule due to some bank work. My calendar was full.

I felt conflicted. The alliance was still forming, and I worried a missed session might feel rejecting. Yet I also saw a meaningful moment, an opportunity to uphold the boundary with care. Our policy is clear - reschedules required 24 hours’ notice. “Looks like we’ll meet next week then.” I replied.

She hesitated, typing and deleting messages, before finally replying hours later: “Yes, okay.”

In our next session, I brought it up gently. She admitted she was angry. It hadn’t been her fault, she said. She had really needed that session. I acknowledged her disappointment and asked how she had managed her anger, especially since she couldn’t direct it at me the way she often did with others.

That opened a deeper conversation about how anger helped her feel strong when she felt powerless, how not “letting it out” had forced her to pause, and how that pause gave space for reflection. We explored how unmet expectations triggered intense reactions, and how beneath those reactions lived a profound fear of not being seen. The frame held, and in doing so, it allowed the deeper work to begin.

If I had made an exception, she might have experienced momentary relief, but we would have missed this moment of insight. A therapist who stretches endlessly risks becoming idealised, a fantasy of perfect care. This is neither sustainable nor helpful. Growth happens when the client can experience and express disappointment safely, and see that the relationship endures.

In quiet but powerful ways, the frame becomes something more - it becomes a lived experience of steadiness. Over time, clients begin to carry that steadiness within: pausing before reacting, feeling their feelings without falling apart, and knowing where they end and another begins. In the end, the frame doesn’t just hold the therapy, it is the therapy. Not a set of rules, but a felt sense of safety, presence, and responsibility. And in many cases, that’s where the deepest change begins.