Thanks to Paul Hamburg and Jeffrey Gordon for forwarding Sophie's posting to
me.  I'm glad I requested it, because it sensitively conveys how "curiosities"
can be used by the therapist under the guise of "understanding" or maintaining
the integrity of this or that patient's treatment, while the patient may have
quite a different experience of the situation.  And so, I would agree that the
dichotomy between "vanity" and "restraint" is not nearly as straightforward as
we might wish to believe, and that  probably therapists often swim between
these two poles;  what seems most critical, however, is how the patient
experiences the therapist--what it means to them.

In my eight years of professional practice, I had never encountered a
situation quite like this.  I admittedly "straddled the fence" by expressing
curiosity to the patient about why she would not tell me about the referral
source while at the same time telling her explicitly that she needn't tell me
about the source;  through this, I wanted (consciously) to both "accept her
where she was at" while avoiding getting into a triangular situation with
someone else with whom we were both acquainted.  In retrospect, I think this
was a haphazard effort on my part to deal with the novel ambiguity of the
situation, which obviously made me anxious.  Had I been aware of my anxiety at
the the time (as opposed to how I first saw it as a "technical" ambiguity and
challenge), I might have instead come to the conclusion that since I was at
least as anxious as the patient, she'd be better off with a colleague, and I
could have unambiguously invoked my policy against seeing two friends.  Had I
not been as anxious by her presentation, I might have seen her without
questioning whatsoever (at least outwardly) her need to keep the "secret."

I think the adherence to "rules" about the frame and about "proper technique,"
is frequently a euphymism for the therapist's inability to deal differently
with his or her sense of helplessness and "unknowing,"  and to that extent
rules can reflect "symptoms" of the therapist, as much as they may be
aimed--at least on the surface-- at the "symptoms" of the patient.  So in
general, I eschew the notion of "rules" in treatment, and much prefer to think
of general "principles" or "guidelines."

What a delicate balance it is to develop and preserve the frame in order to
give the imagination of the dyad free reign, while not being so rule-bound so
as to subvert the very imaginal processes that are needed for therapy to
thrive!

Thanks for your insightful remarks Sophie!

David Mittelman