The power threat meaning framework 5 years on - A scoping review of the emergent empirical literature.

Since its release the Power Threat Meaning Framework (PTMF) has received considerable interest and uptake. However, there have not yet been any attempts to review the scope of this emergent literature. This scoping review aimed to identify and synthesize: (1) all empirical research which utilized the PTMF in their methodologies, (2) the characteristics of these studies, (3) the different ways in which these studies utilized the PTMF, and (4) the key findings of these studies. This review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scoping review extension (PRISMA-ScR). Following systematic searches of academic databases and grey literature, 17 studies meeting eligibility criteria were included. These papers were subject to critical appraisal, data charting, and narrative synthesis. This review identified four uses of the PTMF: (1) PTMF-informed data collection, (2) PTMF-informed data analysis, (3) Experiences of/views on the PTMF, and (4) PTMF-informed psychological practices. This evidence-base demonstrated the merits of utilizing the PTMF across a range of disciplines, settings, and populations. This heterogeneity also presents challenges for evidence synthesis. Implications for research (e.g. importance of the coherent and consistent approach to research) and practice/policy (e.g. professional training, collaboration, service-level barriers) are considered.

Trauma-Informed Care on mental health wards: the impact of Power Threat Meaning Framework Team Formulation and Psychological Stabilisation on self-harm and restrictive interventions.

Aim: The aim of this evaluation was to assess the impact of introducing a model of Trauma-Informed Care (TIC), comprising weekly Power Threat Meaning Framework (PTMF) Team Formulation and weekly Psychological Stabilisation staff training, to a National Health Service (NHS) adult acute inpatient mental health unit over a four-year period. Method: A retrospective service evaluation design was employed to assess for differences in the number of incidents of self-harm, seclusion and restraint in the four-year period following the introduction of TIC, when compared to the year prior. Results: Significant reductions were demonstrated in the monthly number of incidents of self-harm (p < 0.01; r = 0.42), seclusion (p < 0.05; r = 0.30) and restraint (p < 0.05; d = 0.55) following the introduction of TIC. Conclusion: Findings suggest that PTMF Team Formulation and Psychological Stabilisation training can contribute to significant reductions in self-harm and restrictive interventions (seclusion and restraint) on adult mental health wards. Qualitative interviews with staff and service users from the unit will support a better understanding of the mechanisms of this change. Further research, employing a randomised control trial design, could increase the validity and generalisability of findings. However, the ethical implications of withholding potentially beneficial practices from a control group would need to be considered.

“¿Entiendes ahora por qué estoy así?” Formulación psicológica de un caso desde el Marco de Amenaza, Poder y Significado / Do you understand why I am like this?” Psychological formulation from the Power Threat Meaning Framework: A case report

Este artículo analiza un caso clínico desde el recientemente aparecido Marco de Poder, Amenaza y Significado. Se presentan las conceptualizaciones básicas de este modelo y los factores de análisis que proponen: poder, amenaza, significado y respuesta a la amenaza. Por medio de estos se realiza un análisis retrospectivo del caso y se proponen nuevas líneas de conceptualización e intervención inexploradas hasta el momento, basadas en la comprensión de las respuestas a la amenaza como formas de supervivencia y realizando modificaciones en su narrativa hacia una que le permita entender y gestionar su sufrimiento, pasando de la desesperanza a la agencialidad.

This article analyzes one clinical case from the recently published Power, Threat and Meaning Freamwork. The basic conceptualizations of this model and the analysis factors that they propose are presented: power, threat, meaning and response to the threat. Through these, a retrospective analysis of the case is carried out and new lines of conceptua-lization and intervention unexplored until now are proposed, based on the understanding of the responses to the threat as forms of survival and making modifications in their narrative towards one that allows them to understand and manage their suffering, moving from hopelessness to agency.

The Impact of the COVID-19 Pandemic on Those Supported in the Community with Long-Term Mental Health Problems: A Qualitative Analysis of Power, Threat, Meaning and Survival.

Research suggests that the COVID-19 pandemic has had a significant impact on those already living with mental health problems, though there is also evidence of resilience. However, to date there has been limited in-depth qualitative investigation. We interviewed 15 people living with long-term mental health problems who, before the pandemic, were being supported by third sector organisations, to explore how they experienced lockdowns and accessing services remotely. Template analysis was informed by the Power Threat Meaning Framework and suggested that participants experienced significant threats to their mental wellbeing and recovery which were exacerbated by current or previous powerlessness and inequality. Although participants described positive coping strategies, several described a return of unhelpful behaviours that had contributed to the original difficulties. The findings illustrate the wider contributions of social and economic context to mental health problems and the importance of ensuring that people do not feel abandoned and are proactively supported.

From Mental Health Industry to Humane Care. Suggestions for an Alternative Systemic Approach to Distress.

The article proposes a rough outline of an alternative systemic approach to mental health issues and of a more humane mental health care system. It suggests focusing on understanding mental distress as stemming from problems in living, using medications as agents facilitating psychotherapy, or as a last resort and short-term help, according to the principles of harm reduction. It argues that understanding drugs as psychoactive substances and studying the subjective effects they produce could lead to better utilization of medications and improvements in terms of conceptualizing and assessing treatment effects. Qualitative research could be particularly useful in that regard. It also advocates a radical departure from current diagnostic systems and proposes a synthesis of already existing alternatives to be used for both research and clinical purposes. Accordingly, a general idea for an alternative mental health care system, based on a combination of Open Dialogue Approach, Soteria houses, individual and group psychotherapy, cautious prescribing, services helping with drug discontinuation, peer-led services and social support is presented. The proposition could be seen as a first step towards developing a systemic alternative that could replace the currently dominating approach instead of focusing on implementing partial solutions that can be co-opted by the current one.