Power-Threat-Meaning Framework - you must read this!

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miriam
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Power-Threat-Meaning Framework - you must read this!

Post by miriam » Tue Jan 16, 2018 2:30 pm

Lucy Johnstone has asked me to draw attention to the publication of the Power Threat Meaning Framework, which is available online in a short version at http://www.bps.org.uk/PTM-Overview and in a longer version with a detailed review of the conceptual principles and evidence supporting it at http://www.bps.org.uk/PTM-Main. It is an ambitious attempt to outline a conceptual alternative to diagnosis, co-produced with service users/survivors and a range of other contributors. The core project team is Lucy Johnstone, Mary Boyle, John Cromby, Jacqui Dillon, Dave Harper, Peter Kinderman, Eleanor Longden, David Pilgrim and John Read.

The documents are fairly detailed, so the team has produced an easy-read summary which can be adapted for your own purposes if needed.

Appendix 1 of the Overview document consists of a guided discussion for reflecting on the possible application of the Framework to clients, friends, family or ourselves (since the Framework applies to all of us, not just those labelled 'mentally ill.') It is available separately and is free to use.

I think it is a useful reframing of presenting issues and behaviours that is less pathologising, and brings together current knowledge about attachment, trauma and neuroscience, with input from a variety of service users, academics and clinicians. It also contains interesting political/theoretical/philosophical debates about the psychiatric model, diagnosis, and to what degree experiences versus biology determine the way we present in the world - useful thinking for anyone aspiring to be a clinical psychologist, or those already working in the field. It is quite a complex read, even in the short form, but very interesting and provocative.

The appendix includes a useful formulation template, and a guide to using the PTM framework in practice, and is definitely worth taking a look at. In fact, I'd recommend everyone aspiring towards clinical psychology or currently working should see it as a professional development opportunity to use it to reformulate with a particular client in mind!

Lucy has said she would welcome comments and discussion. I have persuaded her to sign up, if anyone has any questions to ask her about the framework...
Miriam

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Re: Power-Threat-Meaning Framework - you must read this!

Post by LucyJohnstone » Tue Jan 16, 2018 5:35 pm

Yes, please do raise any questions or make any comments. As Miriam says, it is a fairly challenging read, even in the short version - necessarily so given our ambitious aim of outlining the principles of a completely new non-diagnostic framework - but both documents start with a summary, and I can send a 2 side version suitable for brief explanation purposes if people want to message me with their email address (and if I can work out how to access private messages...) Lucy

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Re: Power-Threat-Meaning Framework - you must read this!

Post by Spatch » Wed Jan 17, 2018 6:14 pm

Broadly I am in agreement with what is contained in the document, as I suspect most modern clinical psychologists will be. We are trained to advocate formulations over diagnosis, and consider more hollistic biospychosocial frameworks when it comes to understanding, so it all fits with that. The approach is well put together and it's something that I was thinking of adopting in a group setting for clients that other services have considered "treatment resistant".

However, there are some barriers and reasons why I am not hugely optimistic about how far it will spread beyond therapists, psychologists and those already buy into the model. For starters there is the existing medical hegemony and vested interests that rely on diagnostic categorisation and the current status quo. That includes healthcare management organisations, insurance companies, pharma, research, charities. The model also flies against a fairly reactionary undercurrent in British society that is positivist/materialist, seeks to apportion blame and isolate simple reductionistic causes (which is personally very frustrating).

I also think that the model isn't helped by issues the issues that crop up around reliability and validity, (as is diagnosis to some extent). If formulations/PTM are essentially subjective, transient and prone to the biases, that comes with it's own drawbacks. Is a good PTM formulation simply anything that just fits with the client? The system they operate within? That gets the best outcome? Do they technically constitute an application of psychological science to reduce distress, which is the typical remit of clinical psychology.

From a service perspective, I also think this approach requires a highly skilled workforce, with a substantial educational background. I think it would be hard to operationalise and roll out en masse in a way that is meaningful. Even the way the document is written requires a degree of sophistication in appreciating ideologies, application of power, superstructure and a range of sociological and psychological concepts. Highly motivated graduates struggle with Foucault, Marx, Durkheim and the other elements that are alluded to in this approach. I have no idea what the workforce for this would look like and I think it would be hard to protcolise or even operationalise much of this beyond a very small group. Maybe am being too pessimistic.

That said, I really liked it. I was thinking of running an "experimental" therapeutic group with such an approach and will try out this framework. I do hope it does well, but in order to spread the ideas I think it has to be palatable to a wide range of audiences and they can conceptualise how it can be applied easily and quickly.
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Re: Power-Threat-Meaning Framework - you must read this!

Post by miriam » Fri Jan 19, 2018 12:58 am

Yes, I think that in a way it isn't anything that new, although it is framed as more universal and presented as a challenge to the medical model in this document. I think the greatest strength and the greatest barrier is that the model itself is put within a political and philosophical context, which means that the documents and concepts are quite complex, whilst the ideas in practise are quite simple. Hence it is brilliant reading for most of our members, as it is great food for thought and orients you to a lot of current debates within the profession. But it will be interesting to see whether it actually makes impact in practice.

It seems to be the zeitgeist at the moment (and a very good thing, IMHO) to be deconstructing medical models in favour of recognising the impact of ACEs. It puts me in mind of Johann Hari's latest articles/book and older TED talk, and the Welsh multiple ACes model that Bluecat shared with me today, as well as Christine Courtois and Bessel van der Kolk's efforts in the adult and child spheres respectively to get the impact of complex and multiple traumas and damaged attachment relationships recognised as a better way to understand attachment disorder and personality disorder than a neurobiological disease model (and their challenges to the DSM). I also wrote about a lot of this stuff in my book, Attachment in Common Sense and Doodles, in 2013, recognising the themes that had been researched, written and spoken about by others before me. But it seems to be gaining traction and a wider audience, unless I'm just in more of a bubble these days!

I have always been drawn to work with children and families who have experienced adversity, and to me childhood relationships and experiences underpin everything that comes afterward (although issues are often further compounded by later experiences - that were made more likely because of the person's established templates from what came before). Thinking about adversity in both the person's childhood experiences and current context, not only gives us insight into the biggest variable in personality disorder, attachment disorder and other specific conditions. It also explains a lot of the risk factors for wider issues with physical and mental health, challenging behaviour, addiction, violence, crime, homelessness, harmful relationship patterns and helps determine our sense of self.

I'd go so far as to say that getting child protection and parenting right is the biggest task facing humanity, and the area where I believe we can make most difference for the future - hence dedicating my career to working with the kids who have experienced the most adversity and trying to improve their outcomes.
Miriam

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Re: Power-Threat-Meaning Framework - you must read this!

Post by BenJMan » Sun Apr 15, 2018 11:54 pm

They definitely could have picked a better overall title... if you are going to take on the word 'diagnosis', having something not easily and quickly learnable and recognisable to the general public was a poor choice ! :)

That odd issue aside, I agree that it isn't anything revolutionary for those already sold on deconstructing the medical model, but it is a nice succinct (ish) approach.
I think a hero is any person really intent on making this a better place for all people ~ Maya Angelou.

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