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V. SETTING AND PARAMETER
In this entry, the standard setting necessary to achieve a psychoanalytic process is described. However, there is some controversy that also involves other elements of the setting. In general, such parameters are regarded as justified when it comes to patients with severe psychopathology, who may not tolerate the standard conditions. Eissler (1953, p.110) first defined the term parameter in psychoanalysis as follows: “the deviation, both quantitative and qualitative, from the basic model technique, which requires interpretation as the exclusive tool.” This modification should be temporal and will disappear, returning to standard technique as soon as possible. Although Eissler refers mainly to making use of other interventions instead of interpretation, the term parameter can be considered in a broader sense (other terms have been used, such as variation of technique , Loewenstein, 1982). This means any modification of elements of the psychoanalytic method, which in the standard setting involves frequency of sessions, the use of the couch and therapy duration (of the session and the whole process). Some analysts consider that it is necessary to introduce some kind of variations in the setting when treating patients with severe pathology, such as borderline and psychotic patients. This is the case of Kernberg, who states that “borderline personalities do not tolerate the regression within a psychoanalytic treatment” (Kernberg 1968, p. 601); however, he does not claim that his technique should be considered as psychoanalysis, but as psychoanalytic psychotherapy. Other analysts, on the contrary, do not modify the standard conditions for similar patients; for them the standard method is both necessary and possible (H. Rosenfeld, 1978). This difference of approach reflects different theoretical views about the psychopathology and in some instances refers to different kinds of this psychopathology. Other psychoanalysts such as Krejci (2009) and in their theory of mentalization, Bateman & Fonagy, (2013) also propose that severe borderline patients who act out in extreme ways require modifications to the setting in order for treatment to be established.
VI. FURTHER DEVELOPMENTS OF THE CONCEPT OF THE SETTING
Some writers have differentiated the “frame” from the “setting”; the former being the setting provided by the analyst within which an analytic process can unfold, rather like the frame of a painting (Milner 1952a) whilst the setting refers to the process itself. Milner regarded the frame as essential in marking off what is inside from what is outside; the frame shows “that what is inside has to be perceived, interpreted in a different way from what is outside”. The frame “marks off an area within which what is perceived has to be taken as
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