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Reading through the #PTMF approach to 'mental distress’ I’m struck by how much it shares with a pathology-based view of 'mental illness’, and how far both sometimes are from what I’d consider a truly therapeutic perspective. In short, both share an ‘it-happened-to-you’ frame. /1
The DSM (as it were) says ‘you fell ill’; the PTMF says ‘you got clobbered’. Both are clearly important lenses! But what’s also of value in true psychotherapy is its equal emphasis on responsibility that has been tacitly shirked, on moral emotions (guilt shame envy jealousy /2
hate) that have been denied, etc. The patient who wants to change wants to know ‘how can I take better responsibility; how am I failing in my duty to myself?’ Often this moral failure consists in their failing to offer themselves the kindness and humane understanding they’re /3
due as a human being. Sometimes it consists in not taking the kind of courage that’s necessary to make a life actually work, or in sinking into self pity. It's striking that there are only 5 mentions of guilt and 22 of shame in the main PTMF document, and all of them concern /4
only their pathological forms. None consider the guilt or shame that the patient needs help facing and dealing with (through reparation & self-development) & which will engender psychopathology / psychological immaturity so long as it remains ignored. The PTMF also seems to /5
consider social ills the source of all troubles. Again, these are v important! But there’s an unthinking leftism in this axiological location of problems outside the individual, and it risks stymying that moral growth which is the ego’s true development. Only a genuine /6
love-derived conscience that functions as a regulative accountability-insisting ideal can truly replace a toxic introject/fear-based superego. Sure, the patient needs to experience love (i.e. needs to experience someone wanting the best for them) - nothing’s more important. /7
Sure she needs to actually be offered clear moral exemplars, & the opportunity to develop trust in the ordinary reparative business of apologising & being apologised to. But in the PTMF it seems to me that the moral/personal understanding of genuinely therapeutic presence has /8
been replaced by the kind of merely psychological understanding contained in psychosocial formulation. https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20-%20Files/PTM%20Framework%20%28January%202018%29_0.pdf /9
