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Introducing the Power Threat Meaning Framework

01 February 2018

Our Division of Clinical Psychology has published a report offering a new perspective on why people experience mental distress.

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.

You can read the full Power Threat Meaning Framework or a shorter overview.

The Framework applies not just to people who have been in contact with the mental health or criminal justice systems, but to all of us. It 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 misuse of power pose to us and the ways we have learnt to respond to those threats.

In traditional mental health practice, threat responses are sometimes called ‘symptoms’. The Framework looks instead 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 approach of the Framework is summarised in four questions that can apply to individuals, families or social groups:

  • 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?)

Two further questions help us think about what skills and resources people might have and how they might pull all these ideas and responses together into a personal narrative or story:

  • What are your strengths? (What access to Power resources do you have?)
  • What is your story? (How does all this fit together?)

Dr Lucy Johnstone, Consultant Clinical Psychologist and along with Professor Mary Boyle, the lead authors of the Power Threat Meaning Framework, said:

“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 or troubled behaviour, whether it is confusion, fear, despair or troubled or 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. “

The Framework, say the authors, has implications for therapeutic or clinical work. It can also offer constructive alternatives in the areas of service design and commissioning, professional training, research, service user involvement, peer support and public information. There are also important implications for social policy and the wider role of equality and social justice.

Update: Frequently Asked Questions

What is the Framework?

The Power Threat Meaning Framework uses mainly psychological and sociological knowledge along with recent biological research to outline a conceptual alternative to traditional models of mental health and distress based on psychiatric diagnosis.

How was it funded?

The development of the Framework was funded as a project by the British Psychological Society’s Division of Clinical Psychology.

What is the Division of Clinical Psychology?

The Division of Clinical Psychology represents clinical psychologists within the BPS and in the outside world. It has administrative support within the BPS and has an elected Executive working on a very part time basis. It does not provide clinical services and does not have resources to help people with personal clinical issues.

Is the Framework an official Division of Clinical Psychology or British Psychological Society model?

The Framework is not an official DCP or BPS position or model. It is not a 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.

How was the Framework developed?

The project members were a group of senior psychologists (Lucy Johnstone, Mary Boyle, John Cromby, David Harper, Peter Kinderman, David Pilgrim and John Read) and service user campaigners (Jacqui Dillon and Eleanor Longden). They were supported by researcher Kate Allsopp, by a consultancy group of service users/carers, by a Critical Reader group with a particular remit to advise on diversity issues, and by a number of other people who contributed sections of the document and/or supplied examples of good practice that is not based on diagnosis.

Who is the Framework for?

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 the misuse of power pose to us and the ways we have learnt to respond to those threats. Because these processes can affect any of us, the Framework can apply to anyone, whether or not they have been in contact with mental health or criminal justice services.

How is this different from traditional models?

In traditional mental health practice, threat responses are sometimes called ‘symptoms’. The Framework looks instead 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 approach of the Framework is summarised in four questions that can apply to individuals, families or social groups. The questions suggest broad areas for discussion, and can be re-worded or adapted for particular settings or personal preferences. They are:

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?)

Two further questions help us think about what skills and resources people might have and how they might pull all these ideas and responses together into a personal narrative or story:

What are your strengths? (What access to Power resources do you have?)
What is your story? (How does all this fit together?)

What does the Framework hope to achieve?

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. There are also important implications for social policy and the wider role of equality and social justice.

Are there plans for implementing the Framework?

The Framework is a set of ideas, which have not currently been translated into practice anywhere. The authors are offering it as a conceptual resource, a way of thinking, which people may or may not wish to explore further. That decision will be up to them. However, it is hoped that a range of individuals, organisations, training bodies, researchers and practitioners will be interested in taking on board some of its ideas and principles and starting to use, teach or research them, or in other ways begin to translate them into practice. This can, of course, include individuals or groups of service users. We would expect, in keeping with the principles of the Framework itself, that any such plans would fully involve all relevant stakeholders. The project team will be interested to hear about such developments, although realistically the level of direct support they can offer will be limited.

How were service users/survivors involved in the project?

Two survivors, Jacqui Dillon and Eleanor Longden, were members of the core project team. In addition, as described in Chapter 7 of the main document, a consultancy group of 8 service users/carers was recruited in line with the relevant DCP guidance in order to offer feedback on the Framework as it developed. A number of other service users/survivors also contributed to the document, and the project itself draws extensively on service user/survivor testimony and literature.

What are the implications for me if I have a diagnosis of…….?

There are no implications for anyone who has, or who needs for various purposes to have, a particular diagnosis. The Framework summarises the large and widely-available literature on critiques of diagnostic theory and practice but purposely does not address specific diagnoses (except in some cases to exclude them from the main discussion – see ‘Scope of the PTM Framework’, pp. 11-12 in the Overview). Given the acknowledged problems with the current classification systems, the Framework takes the position that professionals should be open about these debates, rather than presenting diagnoses to service users as undisputed facts. This more nuanced position may be helpful for people who prefer non-diagnostic understandings of their difficulties but whose views and choices are largely unrepresented within current service provision.

What are the implications for people’s benefits or access to other forms of welfare support?

There are no implications for these areas. Clinical psychologists and other professionals will continue to support clients/service users to access their entitlements as before, if necessary by using diagnostic terms. However, as discussed in Chapter 8 of the main document, the Framework could support a universal rights-based system that applies to all citizens whether or not they have a diagnosis. As with the other ideas and principles explored hypothetically in the Framework, we believe these are important discussions to have and to continue to have. 

Will psychologists be changing their practice now that the Framework has been published?

The Framework has no direct implications for the way clinical psychologists or other professionals currently practise. Clinical psychologists will remain accountable to HCPC standards, as before. Any plans for further DCP-funded projects related to the Framework would be subject to the same processes of funding application, evaluation and ongoing monitoring as the original project.  

Where can I read more?

You can read the full Power Threat Meaning Framework or a shorter overview. You can also download a suggested Guided Discussion for thinking about the Framework in relation to your life or the work you may be doing with peers or clients. The slides from the launch can be used for teaching or training purposes if attributed to Lucy Johnstone and Mary Boyle. There is also a brief summary of the principles and aims of the Framework which can be adapted for local purposes. A video of the main talks at the launch will be available soon.

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