The Power Threat Meaning framework

Conventional psychiatric approaches view distressing unusual beliefs (e.g., delusions, paranoia, etc.) as an un-understandable symptom of underlying disorders like psychosis or personality disorder, likely caused by a biological vulnerability. But a more humane approach sees them as responses to adverse events in a person’s life. In this chapter, we briefly critique mainstream psychiatric approaches and outline an alternative approach informed by the Power Threat Meaning Framework and drawing on a range of theoretical perspectives. We conclude with a brief review of interventions consistent with this approach.

The Power Threat Meaning Framework (PTMF), published by the British Psychological Society (BPS) in 2018, is an attempt to address the question of how we might understand problems in living other than by using psychiatric diagnostic systems. How might we best conceptualize emotional distress and behavior which might concern or trouble others? We describe the context within which the PTMF was developed and explain some of its key elements before giving an overview of the articles in this special issue.

Advocates of a biomedical approach have argued that: it provides an evidence-based approach to classifying and understanding the causes of problems; adopting a biomedical understanding will reduce stigma; and biomedical interventions are effective and evidence-based. This article reviews the literature and finds not only that there is little or no evidence for these assumptions but that, in fact, the research evidence points to the need for the kind of alternative approach proposed by the PTMF. Alternative causal models which recognize the role of psychosocial adversities are described and alternative approaches to diagnostic classification and destigmatisation programs are suggested and innovative attempts to redesign services in a manner consistent with the PTMF approach are described. The article concludes by discussing implications for policy-level change.

Introduction for a special issue of the Journal of Constructivist Psychology on the Power Threat Meaning Framework

This article describes how the narrative construct is used in the Power Threat Meaning Framework to refer to personal narratives, cultural narratives and as a meta-theoretical language, synthesizing a range of different theoretical perspectives. It identifies ways in which this approach to narrative may differ from its use in a number of therapeutic traditions. Focusing on medicalization and drawing on the concepts of ideological power, framing, filtering and gatekeeping, it discusses the processes which facilitate the dominance of a medical frame in the public conversation about mental health, proposing that such dominance is an example of hermeneutical injustice. The article concludes, firstly, by suggesting some practices which therapists and other professionals could use to broaden and contextualize therapy conversations and, secondly, by making some proposals for how the public conversation about mental health could be re-balanced.