Written by Laura Gair, Senior Lecturer in Forensic Psychology, Centre for Applied Psychological Science, Crime and Conflict Theme
Over recent years, psychiatric diagnoses have been criticised for failing to recognise individual differences (Allsopp et al., 2019) and for focusing on “what is wrong with you?” (Johnstone & Boyle, 2018). The Power Threat Meaning Framework (PTMF) was created as an alternative to the traditional medicalised approaches and is “an overarching structure for identifying patterns in emotional distress, unusual experiences and troubling behaviour, as an alternative to psychiatric diagnosis and classification.” (Johnstone & Boyle, 2018, p.5). It seeks to understand the origins and maintenance of distress from a trauma-informed approach, replacing the question ‘what is wrong with you?’ with the following:
- What has happened to you? (How has Power operated 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?)[1]
Whilst the framework’s origins are within clinical psychology, it has gained attention in the forensic field as a way of helping others understand why individuals engage in incomprehensible behaviours, as well as supporting the individuals themselves to better understand their own behaviours and construct a different narrative of their experiences.
Take, for example, the case of Matthew Robinson, recently covered on BBC2’s programme ‘Parole’[2]. Matthew is serving a life sentence with a minimum tariff of 14 years for the murder of a 19-year-old woman in 2008, whom he killed whilst robbing her of £20. Prior to the offence, Matthew had been drinking with a friend all day, who left him to go out with other friends. Matthew describes feeling “in a rage” and deciding to use drugs, as this has been his way of coping with difficult emotions throughout his life. We also learnt details of Matthew’s childhood, including him having had a difficult relationship with his mother, who was a heroin addict. He was placed into foster care and Matthew described suffering a lot of rejection after this, with his mother arranging to see him but then not turning up. He explained he felt let down and would use drugs as his “crutch”.
As a forensic psychologist, I try to understand the factors that have led to someone engaging in a certain type of behaviour and develop a theoretically-based explanation of this behaviour, known as a formulation. The PTMF is one framework that could be used to help with this (see Figure 1). Matthew’s experiences with his mother are particularly important and can help us hypothesise about the events that led to the offence. For example, his friend leaving him on the night of the offence may have retriggered feelings of abandonment, alongside resentment. Matthew coped through substance use and he decided the victim was an easy target to obtain money for drugs. When she unexpectedly fought back, Matthew may have experienced a loss of control and retaliated. He may also have transferred the unhelpful emotions triggered by his friend leaving (rage, anger) onto the victim, which could explain the level of violence used. Whilst this does not excuse Matthew’s behaviour, by viewing it through the PTMF lens we can start to see how the offence may be better understood as a response to his past experiences.
Power Threat Meaning Framework applied to the case of Matthew:
Power
- Neglected and abandonment from mother
- Abuse from step-father
- Early attachments disrupted
- Lack of relational security and opportunity to learn to regulate and manage emotions
Threat
- Relational
- Physical/ bodily
- Emotional
- Environmental
- Occurred during childhood
- Lack of support
- Range of threats
- Long-lasting
Meaning
- Feeling abandoned and rejected by his mother
- Isolated and lonely
- Unsafe
- Helpless
- Emotionally overwhelmed
- Masks more of the painful feelings with aggression and rage
- Believes the only person he can rely on is himself
- Has to protect himself
Threat response
- Using drugs and alcohol to manage and escape overwhelming emotions
- Preparing to fight/attack and using aggression and violence to protect himself from perceived/ actual physical threats and to exert control
- Anger/rage-situations can quickly trigger long-standing feelings, expressed through rage and violence and/or managed via substance use
In February 2023, I attended a conference hosted by the Division of Forensic Psychology titled ‘Using the Power Threat Meaning Framework to Structure Forensic Reports’. An interesting suggestion was that we could restructure forensic reports to start with the formulation, as opposed to the traditional approach of presenting the formulation after the risk assessment. This would help the reader understand the individual’s experiences and behaviours from the start of the report and frame the rest of the report from a PTMF perspective. A lot of information could then be moved to the appendices. However, I worry this might divert focus away from the risk factors discussed within the report, a concern echoed by other attendees at the conference.
The PTMF has utility as a framework for understanding offending behaviour and guiding how this can be presented and explained to others by forensic psychologists. However, we need to be careful to not lose focus on the evidence-based risk factors that help us identify and assess risk. Thus, striking a balance between compassion and understanding of the elements considered by the PTMF, alongside the vital consideration of public safety, is needed.
References
Allsopp, K., Read, J., Corcoran, R., & Kinderman, P. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research, 279, 15-22. https:/doi.org/10.1016/j.psychres.2019.07.005
Boyle, M., & Johnstone, L. (2020). A straight talking introduction to the Power Threat Meaning Framework: An alternative to psychiatric diagnosis. Monmouth, UK: PCCS Books.
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.
[1] Useful resources that provide further information about the PTMF include Johnstone and Boyle (2018), Boyle and Johnstone (2020), and the dedicated website hosted by the DCP: https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework [2] Series 1, Episode 2, available on BBC iPlayer.