The Frame-In Approach: A Neurobiological and Attachment-Based Model for Managing the Therapeutic Frame in Complex Trauma Treatment

This article proposes an updated conceptualization of the psychotherapeutic frame, emphasizing its adaptive functions, particularly in the treatment of patients with complex trauma histories or disrupted early attachment relationships. Although conventional views emphasizing the frame's static elements need to be considered, they are insufficient for managing complex relational dynamics, frame departures, impasses, and enactments that commonly arise in treatment with patients who have experienced significant trauma. Integrating insights from attachment theory and the neuroscience of memory systems, this article argues that the frame's interaction with implicit memory systems, especially procedural memory, underlies the frame's therapeutic significance. Departures from the frame are conceptualized primarily as activations of these procedural scripts, often reflecting attempts to navigate relational distress based on past experiences. A systematic, "frame-in" approach treatment is proposed, involving monitoring of six core frame constituents-roles, logistics, tasks/boundaries, goals, abstinence from maladaptive behaviors, and safety. This approach facilitates early detection and management of potentially disruptive enactments, protects the therapeutic alliance, helps regulate overwhelming affect, and promotes therapeutic implicit/procedural learning by modifying maladaptive relational patterns within a secure therapeutic framework. The frame-in approach is presented as a specific set of techniques for actively managing the therapeutic alliance, rather than viewing the alliance as a separate construct.