This is a brief attempt to introduce The Power Threat Meaning Framework to ISPS-UK members. It was published on January 12th in London and attracted much interest with over 400 attending the launch.
A group of senior psychologists (Lucy Johnstone, Mary Boyle, John Cromby, David Harper, Peter Kinderman, David Pilgrim and John Read) and high profile service user campaigners (Jacqui Dillon and Eleanor Longden) spent five years developing the Power Threat Meaning Framework as an alternative to more traditional models based on psychiatric diagnosis. They were supported by researcher Kate Allsopp, by a consultancy group of service users/carers, and by many people who supplied examples of good practice that is not based on diagnosis.
The Framework was funded as a project by the British Psychological Society’s Division of Clinical Psychology, although it is not an official DCP or BPS set of Guidelines (suggestions for good practice) or Standards (codes of practice which are mandatory for psychologists.) Like many documents published by the BPS every year, it is a scholarly work intended to promote discussion and debate, and thus in the long term to contribute to evolving best practice and not just for psychologists
The Power Threat Meaning Framework is a new perspective on why people sometimes experience a whole range of forms of distress, confusion, fear, despair, and troubled or troubling behaviour. It is an alternative to the more traditional models based on psychiatric diagnosis. The Framework summarises and integrates a great deal of evidence about the role of various kinds of power in people’s lives; the kinds of threat that misuses of power pose to us; and the ways we have learned as human beings to respond to threat. In traditional mental health practice, these threat responses are sometimes called ‘symptoms’. The Framework also looks at how we make sense of these difficult experiences, and how messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt.
The Power Threat Meaning Framework is thus an over-arching structure for identifying patterns in emotional distress, unusual experiences and troubling behaviour, as an alternative to psychiatric diagnosis and classification. The document sets out the conceptual and empirical basis of such a system and is intended as a foundational intellectual resource. It is important to note that it is not tied to a particular level of explanation (social, psychological or biological) or to a specific theoretical orientation such as cognitive, behavioural or systemic. Thus while it can be used as it stands, it can also be seen as a meta-framework within which many existing models and bodies of evidence can be accommodated, and which can be used to inform future projects translating the framework into practice.
To put it at its simplest, the PTM Framework replaces ‘What is wrong with you?’ with four key questions:
- ‘What has happened to you?’ (How is Power operating in your life?)
- ‘How did it affect you?’ (What kind of Threats does this pose?)
- ‘What sense did you make of it?’ (What is the Meaning of these situations and experiences to you?)
- ‘What did you have to do to survive?’ (What kinds of Threat Response are you using?)
Translated into practice with an individual, family or group, two additional questions need to be asked:
- ‘What are your strengths?’ (What access to Power resources do you have?)
- …and to integrate all the above: ‘What is your story?’
The PTM Framework offers a structure for restoring the links between meaning-based threats (such as betrayal, abandonment, physical danger) and meaning-based threat responses (such as hyper-vigilance, self-injury and carrying out rituals.) Placing all of these in the wider contexts of power and social/ideological meanings helps to identify some broad, probabilistic and overlapping General Patterns and regularities organised by meaning rather than (as with medical diagnosis) by biology.
The Framework offers a way of constructing a non-diagnostic, non-blaming, de-mystifying story about strength and survival, with the potential to re-integrate many behaviours and experiences which would currently be diagnosed as symptoms of mental disorder. The overall message is: ‘You are experiencing an understandable reaction to difficult circumstances. Anyone else who had been through the same events might well have ended up reacting in the same way. However, these survival strategies may no longer be needed or useful. With the right kind of support, you may be able to leave them behind.’
A main aim of the PTM Framework is to restore the aspects that are marginalised and obscured by current diagnostically-based practice: the operation of power, the links between threats and threat responses, the wider social, political and cultural contexts, and the meaning-making and agency of those who are struggling to survive within their embodied personal, social, socio-economic and material environments. Narratives in the broadest sense can offer, and in many settings and cultures already do offer, a rich and meaningful alternative to psychiatric diagnosis. The PTM Framework suggests ways of supporting, conceptually, empirically and practically, the construction and co-construction of narratives, both within and beyond service settings.
The Power Threat Meaning Framework can be used as a way of helping people to create more hopeful narratives or stories about their lives and the difficulties they have faced or are still facing, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’. It highlights and clarifies the links between wider social factors such as poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress, confusion, fear, despair or troubled/troubling behaviour. It also shows why those of us who do not have an obvious history of trauma or adversity can still struggle to find a sense of self-worth, meaning and identity.
As well as having implications for therapeutic or clinical work, the Framework suggests constructive alternatives in the areas of service design and commissioning, professional training, research, service user involvement, peer support and public information.
It is important to note that Power Threat Meaning is an over-arching framework which is not intended to replace all the ways we currently think about and work with distress. Instead, the aim is to support and strengthen the many examples of good practice which already exist, while also suggesting new ways forward. The ideas presented in this project are necessarily described mainly at a theoretical level, and much more work will be needed to translate the conceptual framework into practice. The project team welcomes feedback and suggestions for adaptation and improvement, acknowledging that at present the work is at an early stage of development. This is something that ISPS-UK members would be encouraged to do. The longer term aim is to make the PTM Framework into a publicly available resource, by developing accessible versions and materials to support professionals, carers, service user/survivors and anyone else who is experiencing/working with emotional distress. In the meantime, the Appendices in the Overview give some examples of how non-diagnostic alternatives are already operating, together with suggestions and resources for further implementation of these ideas and principles.
There has been much interest on social media about PTFM especially twitter and blogs.
There have been a number of blogs discussing it and an article in The Independent which are well worth looking at:
Among the comments are: ‘It allows people to create their own theories about their lives”.
It is “like a road map the PTFM offers a whole lot of routes but not necessarily the destination. We are going to have to work out where it takes us.” “How could it be applied to organisations that are seen as coercive?” There has been discussion about how to apply it within systems that are so diagnostically-driven, as well as often based upon a business model.
I would recommend all ISPS-UK members to read it and give it a try! The Framework attempts to give us an alternative way of working with MH problems, something that many of us have been wanting for a very long time.
The PTM Framework versions and resources:
The full version is quite long and detailed and consists of eight chapters.
- Chapter 1: Problems of medicalisation and diagnosis
- Chapter 2: Conceptual and philosophical issues
- Chapter 3: Meaning and narrative
- Chapter 4: The social context
- Chapter 5: The role of biology
- Chapter 6: The Power Threat Meaning Framework
- Chapter 7: Service user consultation
- Chapter 8: Ways forward
- Appendix 1: Evidence supporting the General Patterns
A shorter overview is available online as well and consists of Chapter 6 in the main document and is probably the best place to start to understand the Framework for ISPS members. It is available on request as a hard copy from firstname.lastname@example.org.
There is also an introduction on the BPS website as well as a guided discussion and slides from the launch. These give a quick introduction to the Framework.