Last Friday saw the launch of the Power Threat Meaning framework. It’s a complex idea for a system of understanding distress which could replace the nosological diagnosis. I think I want to write two posts about it. Today is the first and concerns a guide for ‘supporting narratives’. The later post will be about how the document is written.
Now for the discussion below I am also using the Overview , as it describes the guide more clearly and succinctly. But before I do tell you what I think, I would like to offer a gripe. When I published an earlier post the question “What happened to you?” , I landed in hot water. Tweets that I don’t understand anything and misrepresent even more, were flying my way by the dozen, boiling down to telling that, obviously, the question was never meant to be asked in an interaction. And I am disappointed. I’m happy to take much stick for what I write, but I would like the arguments to be made in good faith. It turns out that the question can actually be asked.
Indeed, the authors of the Framework offer a ‘guide to support narratives’, the questions which I will discuss below are explicitly positioned (in both documents) as prompts in conversations, even though still in development and acknowledged in a tweet as not a diktat. So, the questions Framework psychologists are to ask are:
- ‘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?)
- ‘What are your strengths?’ (What access to Power resources do you have?)
- ‘What is your story?’ (How does all this fit together?)
I want to stress that in the Main document the last two questions are described as an addition to the initial four. The document says:
Translated into practice with an individual, family or group, two additional questions need to be asked
leaving no doubt, I think, that the six questions are meant to be used in conversations/interviews with patients (or clients, service users….).
A reservation. I am assuming that the questions in brackets are not to be asked in an interview. This is because I assume that experienced clinicians cannot possibly ask such questions in a conversation with a patient. If they are meant to be asked, however, I would be only too happy to shred them to pieces. I also doubt that your average psychologist is au fait with current (or not so current) thinking on power and I am not convinced s/he will simply take “How is Power operating in your life?” in their stride. I’m also not entirely certain why ‘power’ is capitalised, but I am nit-picking here. But why is it? End of reservation.
As I mentioned before, I have already written about “What has happened to you?”. My main argument was that the question doesn’t focus on the person, but on something outside the person, which, to my mind, is even more problematic now. One of the document’s main points is that so far patients’ lived experience has been rejected, so I would have thought that the Framework’s conversation guide would focus on ‘my experience’. That means, in my opinion, that I would be prompted for an I-narrative, not an it-narrative. Indeed, given that elsewhere in the document, the authors talk about the use of verbs, implying that people do things, I would imagine that this would be reflected in the conversation guide. Inexplicably then, none of the questions open an I-narrative. It is, in fact, quite ironic that the question about ‘my strengths’ is bewilderingly similar to a question about my symptoms. In other words, I still cannot say what I like, do, achieve, I must say what my bloody strengths are. Where is the sense in it, is beyond my ken really.
It’s also worth noting that apart from the second question, the rest start with ‘what’, which suggests that the questions ask about things (I know it’s more complex). Only the how-question explicitly asks for verbs, so to say. The others don’t.
This focus on things is so strong that even a question that, I think, is aimed to get me talking, “What is your story?”, still explicitly asks me to describe my story, rather than tell it. I do understand, of course, that the question is unlikely to be understood like that, still, the point is linguistically valid. And as the authors are doggedly pursuing some sort of psychological language purity, the point is important.
Moreover, I have no idea why the only question which seems to open narrative space, is asked at the end of the interview. This goes against any conversation guide in psychology or psychiatry that I am aware of. To my mind, it makes no sense at all. The only explanation for it I can think of is that the Framework’s conceptual/ideological agenda is so strong that a patient simply cannot be allowed to talk freely. S/he must conform to the conversational plan set up by the clinicians and say what has happened to her/him. A story starting with ‘I am sad.’ seems unwelcome and is linguistically discouraged. I find this completely incomprehensible.
Let me now offer a few other comments. I quite dislike the use of ‘it’ in the questions. Even assuming that I can answer the question about what has happened to me, I really dislike what is likely to be complex and fuzzy, to be transformed into an easy ‘it’ which now has been identified and is ready for the Frameworker’s inspection and intervention. I don’t want to venture into the realm of psychological stuff, still, I would suggest that there might not be this ‘it’ to be easily identified. But what do I know?
My final point about the questions is about
What did you have to do to survive?
I don’t understand it because this question takes away any possibility of ‘my strengths’. When you ask about what I had to do, you ask me about external forces that compelled me to do things (I do know it’s more complex). And I really don’t understand why, preserving the structure of the question, you can’t ask the patient
What did you do to survive?
That opens possibilities of me telling you what I had to do, but it doesn’t force my hand. Is it really so bloody important to shove this power thing down my throat that I cannot simply tell you that I did something? Like, I did. You know. Because I’m strong, cool, handsome or overweight. Give me a bloody chance, for pity’s sake!! Interestingly, I can only answer the question about ‘my strengths’ only after the previous one took care of them. Bloody hell, I will not catch a break, will I?
No, I am not going to comment on the verb ‘survive’. I just despair at this default dramatization of life. And I also cannot understand why not ask simply:
How did you respond/react/do?
You know, focusing on the verbs. I’m suggesting this because I sooo know that asking:
Tell me more about it.
is impossible. The Framework cannot possibly allow this, can it?
As is probably clear, I don’t like this part of the Framework. I think it imposes its agenda on me, the patient, it rams it into me, so I can’t breathe. There is nothing about ‘supporting narratives’ in it. If anything it elicits narratives which the Framework wants. And for a conceptual framework which is so keen to tell me how important language is, it should do much more soul-searching with regard to how it speaks to me. At the moment, I am not speaking back.