Beyond Diagnosis to Meaningful Patterns in Emotional Distress: The Power - Threat - Meaning framework and ‘Psychosis’ (half day)

Lucy Johnstone
Dr Lucy Johnstone, Consultant Clinical Psychologist and project leader

The workshop describes an ambitious Division of Clinical Psychology-funded project to outline the principles of a conceptual alternative to the diagnostic model of mental health difficulties and distress, with an anticipated launch date in late 2017. Project members, who represent a mixture of professional and survivor backgrounds, are Lucy Johnstone (project lead), Mary Boyle (deputy lead), John Cromby, Jacqui Dillon, David Harper, Peter Kinderman, Eleanor Longden, David Pilgrim, and John Read. The Framework builds on a number of other high-profile BPS and DCP documents, including ‘Understanding Psychosis’ (2014.) The project team has developed an alternative, evidence-based, non-medical approach to identifying patterns in distress, including those that are called ‘psychosis’. It synthesises the causal roles of power, threats, evolved threat responses, social discourses, and personal meanings and narratives, and is called the Power Threat Meaning Framework. The General Patterns that emerge from this broad-ranging integration are supported by a growing body of research from different fields and disciplines, and are intended to provide the basis for an ongoing series of developments in clinical practice with ‘psychosis’ and other presentations, as well as in service design and commissioning, professional training, research, and service user involvement. The Framework can serve as a knowledge resource for the construction of narratives of distress both within and across cultures. Most importantly, it restores the link between personal distress and wider contexts of inequality and social injustice, and is thus relevant to campaigning and change at multiple levels. 


  • Describe the key principles of the Framework.
  • Demonstrate how the Framework might work in practice, with examples and exercises.
  • Invite discussion and feedback about the Framework.