On verbs, nouns and pronouns in psychology

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.



  1. Dariusz, I really don’t understand these questions or how the thing in the parenthesis is supposed to mean the same thing as the question.

    If you ask me what happened to me — even in the context that i’m talking to a psychologist which narrows it down somewhat– well it’s complicated and lots of things have happened to me because I am many thousands of days old and I usually have more than one thing going on in my life at a time so I might not know which one to talk about. but perhaps I am being prompted to talk about a trauma of some kind, or an illness or something.

    If you ask how power is operating in my life then maybe I can talk about discrimination but in either case I feel like I’m being asked two very different questions, so different that it’s hard to reconcile them.

    ‘How did it affect you?’ (What kind of Threats does this pose?

    How did something affect me- maybe I will talk about my feelings and how they shape my behaviour. What kind of threats does this pose maybe I will talk about what I am afraid will happen to me? What prevents me from doing things I want to do? Again it’s two completely different things.

    ‘What sense did you make of it?’ (What is the Meaning of these situations and experiences to you?)

    well these might be similar enough to each other but I still feel they’d prompt different responses from me. If I’m making sense of it then I’ve interpreted it somehow. If there’s just a meaning happening to/at me then I’m not really an agent in the finding of this meaning anymore.

    ‘What did you have to do to survive?’ (What kinds of Threat Response are you using?)

    Again completely different questions.Things I do to survive is very concrete very specific very moment to moment things. or maybe i will say i learnt to cook? if you ask what kinds of threat response is like fight/flight/freeze?

    ‘What are your strengths?’ (What access to Power resources do you have?)

    If you ask me what my strengths are, I’m not going to talk about power resources that I can access, maybe I’ll say that I’m kind to people or that I’m good at maths. If you ask about power resources I won’t be able to think of anything, I might talk about poverty and isolation instead? uh there’s a library in my town? is that what they mean? i have electricity in my home? yes i’m getting bogged down in the jargon but that’s part of the point i’m trying to make.

    ‘What is your story?’ (How does all this fit together?)

    What these two questions have in common is that I couldn’t answer either of them on the spot! I don’t have a single story, I have a bunch of different stories that are all true and all come to different conclusions.

    I’m trying to think about how these questions would be useful and I really don’t see it. It feels like it’s pushing me to put something into one coherent linear narrative that leaves out the messy real life bits, especially the last question but all of them? one single narrative about one single event all wrapped up tidily in a bow like on tv when someone breaks their leg and then they get a cast and then it comes off and then they’re better?

    1. Dariusz Galasinski

      Thank you very much for your comment. I do believe that regardless of what clinicians (let alone me) think about the questions they pose, they should first and foremost be useful. And while I accept that might be questions that need to be useful primarily for the clinicians, most should be useful to the patient/service user. If we believe that narrated experience is key to understanding whatever the issue is and offering help, then usefulness to the patient must be of paramount importance.

      And if you say that the questions offered by the Framework are not useful, there is really not much more to say. They should start revising their protocol (which, obviously, is not a protocol, it just looks like one). To be honest, I also don’t think the 6 questions would be useful to me. I would prefer to tell about my problem in the way that I choose.

  2. Hi Darius. We welcome feedback. Can I clarify that – as you will see once you’ve read it – that PTMF supports the development of ANY kind of narrative that is personally meaningful, through ANY means (art, poetry etc) and that the suggested guided discussion can and should use ANY form of wording that is acceptable to the person reading it (or else they may choose not to use this kind of guided Discussion at all.) I would be surprised and dismayed if anyone took its wording or structure as literally as you seem to have done – it would be constrary to the explanation or spirit of the Framework

    1. Dariusz Galasinski

      Lucy, thank you for your comment. To be honest, I really don’t understand it. Both the form of the questions and your account of them in both documents suggest they are meant to be used as they are. So, quite frankly, I am baffled by the repeated distancing from the text of the document, even though it is very clear calling the questions prompts. Perhaps the solution would be either not to write the questions or to explicitly say that these prompts are not really prompts. Moreover, if you stress so much that language matters, you can’t, to my mind, say that in the case of the questions you coined it doesn’t really matter that much.

      Now, even taking your explanation on board, I find it hard to accept that the PTMF framework supports any narrative. The order of the questions suggests that this is not the case. Especially your use of the story question as a summary, and not opening of narrative space, suggests that the framework is interested only in particular stories. Whether you ask the question ‘What happened to you?’ or its equivalent, you still ask for a narrative from a particular point of view. A point of view which is yours and might not be mine. So, while I am happy to accept that the ‘spirit of the framework’ is about supporting narrative, its letter suggests something very different. And, to press the point, if language matters, then please, make it matter.

      1. Hi perhaps the questions reflect what the therapist thinks internally converting/ framing the person’s problems into the PTM framework. They may perhaps be underpinning the gist of the interaction between therapist and client during the formulation.
        But of course the sixth question should come first!

      2. Dariusz Galasinski

        I agree, the sixth question should come first. I don’t think it should be asked in such a way, but however it is asked, it should come first. At least according to the current ‘state of the art’ in psych interviewing (so far as I know).

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