Exploring the boundaries of the therapeutic frame and the importance of relationality within the socio‐cultural context of Pakistan

Abstract This study explores the challenges in maintaining the therapeutic frame and attitude when working in a collectivist country like Pakistan, where boundary‐keeping can conflict with certain cultural expectations. Drawing on 4 years of experience in a mental health clinic in Pakistan, I interrogate the frame in relation to culturally‐specific expectations, focusing on examples where the frame risks being experienced as culturally incongruent and alienating. The analysis is informed by personal clinical observations and by reflective discussions with local psychodynamically oriented therapists. I will present a grounded account of how some of us navigate tensions between what we want to do, what we feel we should do and what we were taught to do, trying to maintain accountability without compromising the therapeutic frame or cultural sensitivity. I will argue that, in collectivistic contexts, flexibility and relationality are conducive to fostering a strong therapeutic alliance without compromising the analytic ethos. In writing this paper, I reflect on my own bias, having viewed the frame as a Eurocentric, rigid construct. I recognise my tendency to ‘other’ it, questioning whether it stemmed from colonial residues, patriotic ambivalence or a desire to culturally reinterpret and humanise analytic practice. I conclude that psychodynamically informed practitioners in Pakistan are pragmatically using the frame in a way that is congruent with the cultural context, but is also consistent with international critical discussions of the frame and the analytic attitude.