This chapter presents some over-arching precepts regarding the management of the ground rules of psychotherapy and touch on some of the more pressing unresolved issues related to the critical aspect of treatment. Given the many and diverse components of the ground rules of psychotherapy and the central role that they play in organizing the deep unconscious experiences of both patients and therapists, sessions in which there is but a single active frame issue are exceedingly rare. The patient has modified the ideal frame both by making the telephone call and by asking for the change to the time of the session. A patient’s secured-frame anxieties tend to increase markedly with the shift to a private setting. The highly defensive, communication-limiting, frame-modifying mode of adaptation reinforced by clinic settings and clinic therapists suits patients’ pathological needs and protects them from secured- frame, death-related anxieties.