Cross-cutting · 2018
Power Threat Meaning Framework
Suffering is better understood by asking what power operated, what threat it produced, what meaning it held and what the person did in order to survive.
The Power Threat Meaning Framework is a non-diagnostic conceptual framework developed by Lucy Johnstone, Mary Boyle and a team of authors connected with the Division of Clinical Psychology of the British Psychological Society. Its aim is to offer an alternative to functional psychiatric classification by shifting the clinical question from what is wrong with the person towards a contextual formulation centred on power, threat, meaning and survival responses. The framework holds that many experiences called psychiatric symptoms can be understood as intelligible, protective and situated responses to relational, social, material, cultural, ideological and biological adversity. It works as a meta-framework for constructing personal, family, group or community narratives that connect events, life conditions, threats, resources, meanings and forms of coping. Its central contribution is to reorder psychological suffering away from a logic of individual pathology and towards a logic of situated survival: people do things in order to survive real or perceived threats in contexts shaped by relations of power. Reference: Johnstone & Boyle, with Cromby, Dillon, Harper, Kinderman, Longden, Pilgrim & Read (2018); Johnstone & Boyle (2019); Boyle & Johnstone (2020).
Theory of change
The person changes when they can turn their survival responses into a contextual story that reduces shame, restores agency and mobilises power resources.
Core ideas
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Suffering makes sense within a history of power and threat
The PTMF proposes that many difficult psychological experiences become intelligible once the threats the person has lived through, and the forms of power that made them possible or maintained them, are reconstructed. The clinical question moves away from whether the person fits a diagnostic category and towards how their responses made sense in a specific context. Reference: Johnstone & Boyle, with Cromby et al. (2018); Johnstone & Boyle (2019).
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Symptoms may be survival responses
The framework interprets anxiety, disconnection, hypervigilance, self-harm, isolation, submission, defensive aggression, substance use or unusual experiences as possible responses to threats that may have protected, regulated, communicated, prevented harm or maintained some form of control. This reading neither idealises the responses nor denies their costs, but makes it possible to understand their function before attempting to transform them. Reference: Johnstone & Boyle, with Cromby et al. (2018); Boyle & Johnstone (2020).
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Meaning organises the final common pathway of suffering
The PTMF holds that personal, social and cultural meaning organises how a threat is lived and which responses appear. The same adverse experience can have different impacts according to resources, relationships, social discourses, the body, history and possibilities for action, so the formulation must reconstruct how the person understood what happened and not only what happened. Reference: Johnstone & Boyle (2019); Boyle & Johnstone (2020).
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Formulation replaces the label as the principal explanation
The framework offers an alternative to diagnostic logic without proposing a new closed taxonomy. Its principal tool is narrative and contextual formulation, able to integrate biography, power, threat, meaning, body, culture, relationships and agency in order to produce a clinically useful and revisable explanation. Reference: Johnstone & Dallos (2013); Johnstone & Boyle (2019).
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Social context is part of the mechanism
The PTMF places inequality, poverty, discrimination, violence, exclusion, medicalisation, ideological discourses and material conditions within the understanding of suffering. These elements do not function as an external backdrop, but as conditions that shape threats, meanings, resources and responses. Reference: Johnstone & Boyle, with Cromby et al. (2018); Felitti et al. (1998).
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Agency exists within real constraints
The framework avoids reducing the person to a passive victim and equally avoids holding them individually responsible for conditions they do not control. Agency is understood as a situated capacity to act, choose and construct meaning within material, relational, bodily and social limits; recovery therefore includes changing resources and contexts, not only internal attitudes. Reference: Johnstone & Boyle (2019); Boyle & Johnstone (2020).
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Narratives can be individual, family, group or community
The PTMF is not limited to individual psychotherapy. It can be used to construct shared stories in families, groups, communities, services, peer support and public health initiatives, provided a collaborative attitude is maintained and no expert narrative is imposed on people's experience. Reference: Johnstone & Boyle, with Cromby et al. (2018); Boyle & Johnstone (2020).
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The patterns are provisional, not covert diagnoses
The Provisional General Patterns are open groupings of threat responses and serve to guide understanding, research, services and narratives. Their value depends on preserving their flexible character: they lose their spirit when used as new rigid labels or as direct substitutes for diagnostic categories. Reference: Johnstone & Boyle, with Cromby et al. (2018); Johnstone & Boyle (2019).
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Clinical language also exercises power
The PTMF stresses that the words used to name suffering can increase or reduce shame, agency, hope and recognition. Describing someone as defective, disordered or dangerous does not have the same effect as formulating their experiences as responses to contextualised threats; clinical language is therefore an ethical and therapeutic tool. Reference: Johnstone & Boyle (2019); Boyle & Johnstone (2020).
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Recovery involves increasing real power
Recovery is not reduced to diminishing symptoms; it includes widening safety, resources, voice, belonging, rights, relationships and possibilities for action. The framework holds that many responses of suffering diminish when the conditions sustaining threat change and when the person regains the capacity to narrate, decide and take part in their world. Reference: Johnstone & Boyle, with Cromby et al. (2018); Boyle & Johnstone (2020).
Influences
- Critique of functional psychiatric diagnosis
- Psychological formulation
- Critical clinical psychology
- Community psychology
- Critical psychiatry
- Trauma-informed approaches
- Narrative therapy
- Social constructionism
- Hearing Voices Network
- Research on adverse childhood experiences
- Contextual models of suffering
- Peer support practices
Key references
- Johnstone, L., & Boyle, M., with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D., & Read, J. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society.
- Johnstone, L., & Boyle, M., with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D., & Read, J. (2018). The Power Threat Meaning Framework: Overview. Leicester: British Psychological Society.
- Johnstone, L., & Boyle, M. (2019). El Marco de Poder, Amenaza y Significado: un sistema conceptual no diagnóstico alternativo. Revista de la Asociación Española de Neuropsiquiatría, 39(136), 155-173.
- Boyle, M., & Johnstone, L. (2020). A Straight Talking Introduction to the Power Threat Meaning Framework: An Alternative to Psychiatric Diagnosis. Monmouth: PCCS Books.
- Johnstone, L., & Dallos, R. (Eds.). (2013). Formulation in Psychology and Psychotherapy: Making Sense of People's Problems. London: Routledge.
- Johnstone, L. (2014). A Straight Talking Introduction to Psychiatric Diagnosis. Monmouth: PCCS Books.
- Read, J., Mosher, L. R., & Bentall, R. P. (Eds.). (2004). Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. Hove: Brunner-Routledge.
- Bentall, R. P. (2003). Madness Explained: Psychosis and Human Nature. London: Penguin.
- Romme, M., & Escher, S. (1993). Accepting Voices. London: Mind Publications.
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences Study. American Journal of Preventive Medicine, 14(4), 245-258.