Good practice examples

Emerging Proud is a grassroots social movement aiming to reframe madness as a catalyst for positive change.

A day of group discussions was held in London, UK, on how the PTMF relates to those who perceive their experiences in transformative, spiritual or spiritual emergency terms and how the framework could be used to support them.

Read a report written about the day which outlines the outcomes from these discussions and highlights the commonalities and actions points raised.

The Green String Network (GSN) is a network of organizations working with communities and institutions in Somalia, Kenya, Ethiopia, and South Sudan.

They employ a strength-based approach to community healing, recognizing that communities have the resources and resilience to overcome challenges of violence, injustice, and indignity, and can identify and utilize their strengths to recover and rebuild.

They draw on the PTMF in their workshops and training materials, as an alternative to the diagnostic models imposed by colonialism.

• Green String Network Overview
• PTMF Presentation - Mama Sarah's Narrative

The Humane Clinic in Adelaide runs the Suicide Narratives project.

This offers Emotional CPR and Just Listening during times of acute distress. Members of the community, including those who have experienced this form of distress, offer support in one to one or group settings.

Read the Suicide Narratives document.

• Authors: Matt Ball, Rory Ritchie.
  Editing support of document: Berny Maywald, Bernard Guerin
  Acknowledgement of input to ideas: Stephanie Mitchell

Suicide Narratives initially engaged a small working group with international contributors. We are grateful to all those who have contributed.

Read more about The Humane Clinic.

The 'Just listening' project in Australia was set up to allow ordinary community members to offer each other free, mutual support.

It draws on the Power Threat Meaning Framework among other principles.

The Just Listening Community is a free space creating connection for a person in distress, crisis, suicidal or with an important story to share.

It is a safe, therapeutic environment for people in emotional crisis as a meaningful alternative to other services, where trained community members listen and connect to the experiences of any person who visits.

• It offers various mutual aid groups including Hearing Voices and Suicide Narratives. It draws from a number of ideas, including the Power Threat Meaning Framework.
  
  Read the Just Listening Community six month evaluation report

The 'Own my Life' project was set up by Natalie Collins for women who have been subjected to domestic abuse, and practitioners who work with them.

It draws upon the PTMF among other sources, and PTMF-informed videos have been well-received.

• Collins, N. (2019). The 'own my life' course: Building literacy with women about trauma through the PTMF. Clinical Psychology Forum 313, 38- 41.

The SHIFT recovery community studied the PTMF as a group, which helped group members to see themselves as experiencing understandable responses to abnormal situations.

• SHIFT Recovery Community, 2020. Using the Power Threat Meaning Framework in self-help groups of people with experience of mental and emotional distress. Journal of Constructivist Psychology

The programme empower women who are marginalised and misrepresented.

The workshops highlight the effects of power imbalances, giving participants the chance to gain self-awareness and become aware of their strengths and assets, helping people to connect with the power and importance of writing their own stories.

The programme is underpinned by the Power Threat Meaning Framework.

• Geraldine Esdaille describes the work of 'We are Black Gold CIC', a  social enterprise which runs workshops and focus groups with women and men born and bred in Manchester

Yor-Peer Support used the PTMF guided discussion and core questions to create personal narratives that offered hope and new perspectives.

• Griffiths, A., (2019). Reflections on using the Power Threat Meaning Framework in peer-led systems. Clinical Psychology Forum, 313, 9-14

The Mavam Group– including Mavam Supported Housing, YLOH – Your Life Our Help, and The Life Learning Academy.

The Mavam Group comprises a collection of services that are built on the aim of helping people to improve their lives, by seeing their strengths, and accepting their challenges and experiences and the ways these have impacted their lives. The Group believe that helping people is based on the fundamental principle that people are not defined by the labels that have been applied by others. Our services are available to help and support anyone.

Mavam Supported Housing work with people aged sixteen upwards and provide a range of supported housing options, based on who they are, what they want and what they need to live their lives. People are able to move through the different levels of help and support available, as they move to the level of independence that works for them.

YLOH – Your Life Our Help, have designed a way of working, inspired by the Power Threat Meaning Framework, called Creative Enabling. This includes the Getting To Know You work that people do with staff, which encourages them to tell their story, and describe who they are, how they came to be where they are now, and what their hopes and strengths are. YLOH currently have five services; Help in Cluttered Homes, Community Outreach, Supported Living, Student Support and Art For Wellbeing.

The newest part of the Mavam Group is The Life Learning Academy (LLA). The LLA ensures that all staff are trained to see emotional distress as part of being human, with distress most often being related to the things that have happened or are happening in our lives.

The LLA has designed external courses, starting with Emotional First Aid Training. This is underpinned by the PTMF and trains people in helping others through the utilisation of compassion, respect, honesty, acceptance and the acknowledgement of the reality of people's experiences.

• Emotional First Aid and the YLOH

• Trauma Informed Approach in Adult Mental Health - Presentation slides
• Trauma Informed Approach in Adult Mental Health - Poster
• Stabilisation materials developed at Northwick Park (free to use)
• The PTMF Team Formulation Quality Measure

The Jigsaw National Centre for Youth Mental Health is a registered charity which provides individual therapeutic supports to young people aged 12–25 years, support to the communities in which they live, and seeks to influence change at policy level.

They have given us permission to share these materials, which were co-produced with the young people they support.

• Jigsaw - PTMF Worksheet
• Jigsaw - PTMF Threat Responses
• Jigsaw - PTMF Threat Responses Worksheet
• Jigsaw - a guide for clinicians using the PTMF with young people

You may also wish to read:

• Aherne, C., Moloney, O. & O'Brien, G. (2019). Youth mental health  and the Power Threat Meaning Framework: Jigsaw's systems perspective. Clinical Psychology Forum, 313, 3-7.
   
• Jigsaw -  Start Making Sense (2022) - The Jigsaw conceptualisation of mental health

Three part interview series on the Power Threat Meaning Framework:

• Interview part 1
  Interview part 2
  Interview part 3

You may also want to listen to:

• An introduction to the Power Threat Meaning Framework with Dr. Cian Aherne and Dr. Emma Hickey
• A five part video series on Trauma Informed Practice

Description of the context where PTMF ideas have been applied and the role of those involved

I was part of a group of Educational Psychology colleagues in Sheffield Educational Psychology Service and Sheffield University who met to reflect on and consider ways to develop the notion of formulation in general and extend this into the PTMF.

An initial workbook was started with key questions looking at theory and practice. This has not been updated as a group, but there may be scope to do this. 

A half day CPD was held where EP colleagues and Sheffield University colleagues delivered training on the PTMF.  

Myself, the Principal and Assistant EP presented a case example using the traditional 5 Ps and then how we extended this into using the PTMF.  

I used the PTMF framework template from the Guided Discussion, and drawing on  team discussions and measures used in practice.

I populated it with key questions for use in practice at the individual level or Network level and shared these with the team. Examples of these templates are attached.

• Template example 1

As an EP I link with a locality of SENCOs, and we meet termly as a group.

We completed a 'Network' conversation using the template prompts on a case example, and I presented a short information document to explain the approach. 

Details of feedback, articles, evaluations outcomes

A brief initial evaluation was completed, with positive results (download the evaluation) and we have had requests to take this work further in schools. 

Future plans

Our future plans are to use prompt sheets further in work with pupils, in direct assessment and also network group meetings.

We will reflect on this process and rethink of materials as needed.

Joanne can be contacted at [email protected].

Educational psychologist Anna Doedens-Plant ([email protected]) uses the PTMF in statutory report work.

After describing the young person's strengths she adds:

There are several factors that are likely to impact on X's learning and development but, for the purpose of this report, I will comment on those that are, in my view, a priority at the current time.

The purpose of this section is to add some additional reflections on the psychological factors or interactions of the issues mentioned below, which benefit from some further consideration, and X's emotional needs are key in this.

In my view, it is helpful and important to take the Power-Threat-Meaning framework (Johnstone & Boyle, 2018) as a starting point for understanding X's experiences. Rather than ask 'what is wrong with X?', this framework encourages us to consider the following questions:

1. What has happened to X? (how has power operated in his life?)

2. How did this affect him? (what kinds of threats did this pose to him?)

3. What sense did he make of this? (what was the meaning he may have taken from this?)

4. What did he have to do to survive? (what kinds of threat responses is he using?)

5. What are his strengths? (What access to power resources does he have?)

6. What is his story? (How does it all fit together?)

X has experienced significant and extensive neglect and physical and emotional abuse which, in my view, has resulted in relational and developmental trauma.

She then explores each of these questions in turn in the psychological perspective. Although this is a very explicit example, there are also occasions where she might not do so directly, but it still informs her thinking.

She finds that the framework fits well with the interactionist perspective that she was trained to use as an Educational Psychologist. In the cases of trauma, it can really help to shift people's understanding and thinking, thereby informing more appropriate support. She says that the framework is becoming increasingly known and used within our team.

Framework Housing Association provides services for individual facing severe and multiple disadvantage, i.e. homelessness, substance misuse, offending and mental health difficulties.

In the context of a DClinPsy thesis, the ideas from the PTMF have been translated into a protocol to be used with individuals across the course of 6 - 8 one-to-one sessions to explore issues of power, threat, their meaning and responses, their strengths, and telling their story.

This translation was done in collaboration with a group of Expert Citizens with experience of multiple disadvantage and has been piloted with one service user.

For further information contact [email protected]

The traditional model of psychiatric assessment and diagnosis can be criticised as reductive.

Turri et al developed an innovative model for psychiatric assessment of adult patients referred to our adult mental health team, the Systemic Assessment Clinic, incorporating the principles and techniques of systemic family therapy and dialogical practice into standard psychiatric assessment.

Turri et al (2020) - Systemic Assessment Clinic, a Novel Method for Assessing Patients in General Adult Psychiatry - Presentation and Evaluation.

Dan Warrender is a mentalization based therapist who uses the PTMF to provide psychoeducation about the impact of powerlessness on mental distress.

For further information contact [email protected].

Warrender D. et al (2020) Perspectives of Crisis Intervention for people diagnosed with BPD.

Dr Jo Ramsden is a psychologist who draws on the PTMF in prison and probation settings.

Here she describes how the PTMF ideas can inform practice in forensic settings.

The PTMF was used in a national specialist service for those with a diagnosis of Autism or intellectual disability.

The PTMF is used to offer a broader contextual understanding of a persons experience. 

Flynn, A. & Polak, N. (2019). Incorporating the PTMF into an autism and learning disability team.  Clinical Psychology Forum, 313, January 2019.

The PTMF was used in a unit for offenders with labels of so called 'personality disorder' to allow individuals to explore their experiences of prison.

Reis. M., Dinelli, S., & Elias, L. (2019) Surviving Prison: Using the Power Threat Meaning Framework to explore the impact of long-term imprisonment.

Trauma-informed care for people seeking help with complex experiences of adversity and trauma needs to enable people to be genuinely heard, meaningfully understood, and offered attuned help.

We consider how the Power Threat Meaning framework (PTMF; Johnstone et al., 2018) can be applied to understand a person's history and current experience, and we describe how we are adapting pathways of care within mental health services in order that people are helped more effectively.

Read the full article on developing trauma-informed care and adapted pathways using the Power, Threat, Meaning framework (Part 1: Being heard and understood differently) Jan Bostock & Nicola Armstrong.

Trauma-informed care for people seeking help with complex experiences of adversity and trauma needs to enable people to be genuinely heard, meaningfully understood and offered attuned help.

We consider how the Power Threat Meaning framework (PTMF; Johnstone et al., 2018) can be applied to understand a person's history and current experience and we describe how we are adapting pathways of care within mental health services in order that people are helped more effectively.

Read the full article.

Dr Cath Lowther is an educational psychologist who draws on the PTMF in her work in a permanency team in children's social care, where she supports adults who work with traumatised children. She finds it useful to help them view behaviours as communications of trauma/survival and to explore their stories as a springboard for this. 

She has also referenced the framework in statutory reports for trauma-experienced young people, with recommendations such as:

'Xxx will need to access appropriately targeted talking therapies and medication as prescribed by appropriate professionals. Education and care staff should be made aware of the therapeutic approaches that are being used so that they can support Xxx to practise any self-support strategies developed/taught in sessions. It is recommended that the Power Threat Meaning Framework is adopted when supporting and speaking with Xxx about their mental health needs. This framework shifts attention away from 'what is wrong with you?' towards more helpful questions such as: '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?)'.

She has also briefly referenced the framework in a book about resilience, where she explicitly positions resilience as a contextual resource, rather than an individual one.

Dr Lowther can be contacted at [email protected]
 

• Using the PTMF for team formulation in a CMHT

The aim of this group is to come together as educational professionals to explore ways in which the Power Threat Meaning Framework (PTMF; Boyle & Johnstone, 2018; 2020) might be applied within education.

Find out more about the group here.

The PTMF is being used in a women and children's refuge in Australia to work with mothers in understanding the broader context of their experiences and their children's experiences, and thus their responses. These families have typically experienced domestic violence or a range of other adversities. Many mothers have complex trauma presentations and a major barrier to engagement is shame. Not all have experienced physical violence – many have been subject to the more sophisticated abuse of coercive control. Developing an understanding of the complexities of response to coercive control is fundamental. The University of Newcastle in partnership with a local women's refuge has implemented a post graduate clinical placement within the refuge as a first step. Provisionally registered postgraduate students are working under supervision to provide clinical services using a strength-based, depathologising approach offered by means of formulation using the PTMF. There is a focus on strengthening attachment relationships and building skills for reducing the impact of symptoms to foster better emotional and behavioural regulation skills for parent and child. The PTMF provides a lens for understanding the behaviours and emotions in context, and student clinicians advocate for a conservative approach to assessment which factors in the need for the system to stabilise and for safety to be restored prior to any diagnostic processes. It is hoped that this will reduce the impact of diagnostic labels being applied improperly, develop an ongoing discourse around the impact of trauma and give attention to the need for treatment of trauma where indicated, as opposed to common diagnoses of behavioural and neurodevelopmental disorders. Given that the early years are fundamental to the development of identity, and that parents are also foundational to the way children see themselves, we are interested in determining what role an understanding by mothers (regarding them and child) of the impact of trauma and its responses may have on sense of self as a survivor and promote development of an identity that does not include a sense of being damaged or broken, rather resourceful, resilient and powerful in survival.

Details of feedback, articles, evaluations, outcomes, if available

We are still in very early stages, however have been given positive feedback from clients and refuge staff regarding the PTMF formulation and will provide further evaluation of outcomes as they become available. Initial outcome measures are promising.

Future Plans

I am currently the clinical supervisor in the clinic and a PhD (Science-Psychology) candidate seeking to use the PTMF to develop and implement a group intervention program for children and mothers in emergency and medium-term accommodation who have experienced domestic violence. A stepped model of intervention is proposed, building on the framework in both accommodation settings. The goal is to develop a trauma-informed, strengths-based intervention that recognises response to trauma instead of pathology, destigmatising and empowering participants to integrate their experiences and foster growth and well-being of the children and their mothers

Contact details

Saskia can be contacted at [email protected].

The presentation describes the powerful impact of a Group Formulation Programme at St Patrick's Hospital in Dublin.

The participants echoed many of the themes in the PTMF.

View the presentation