I think this framework is very OT in the way that it looks at trauma and trauma-informed care. It really looks at the individuals and their context and what they’ve been through and how it’s affecting their lives and impacting their occupational performance rather than treating based on diagnostic codes. It’s a call to get away from diagnosis and look at the individual for what they are, an individual.
Traditionally, behaviors are typically seen as symptoms which lead to a diagnosis — but in this framework, they’re looked at as survival techniques that were once useful, but are not interfering with their occupational performance.
Full disclosure: the framework did not use OT language — any OT language you see is my brain translating this framework into the OTPF. It was published by the British Psychological Society, but it is so easily applied to our practice as OTs.
Let’s break it down a little bit…
there are four core aspects to this framework:
Power. everyone has power, and to me, it makes sense to think of power as what client factors or environmental factors empower someone. A few examples in the framework — biological power which is what you’re able to do physically, legal power which is one’s ability access to legal services, economic power is your socioeconomic status and your ability to access your basic needs.
Threat to Power. anything that is threatening someone’s sense of power or their power to impact the world or environment around them. Threat to Power is the term this framework uses for trauma. Someone can threaten your biological power by threatening your body — I think of this with physical abuse, sexual abuse, and any thing that is violating someone physically. A threat to environmental power can also occur and may look like an abusive, unsafe, or neglectful environment. An economic threat to power may be an individual who is at a poverty level where access to basic needs are not able to be met. Anything that threatens your power typically causes mental distress.
Meaning. what sense did the client make of the threat to power? Meanings are typically formed within social and cultural contexts — if their contexts believe the threat to power is a significant event or that traumatic events are normal and a part of everyday life, the individual will be influenced by these contextual beliefs. Some potential meanings (there are many more in the framework!) listed in the framework are feelings of being unsafe, invaded, trapped, meaninglessness, isolated, or contaminated.
Threat Response. once someone has been subjected to the trauma or the threat of power, they develop a meaning to these traumas, then threat responses are formed. Which we typically see threat responses as behaviors or adverse responses to different stimuli or triggers. Examples from the framework that stood out to me are flashbacks, the freeze response, decreased attention or concentration, self-injurious behavior, self-neglect, aggression, impulsivity, avoidance, and decreased sleep participation.
This is how I feel the framework applies to OT practice:
- I really think it gives us some insight on how to understand the behavior based on clients’ occupational profiles and histories.
- It encourages me to be more observant and gather adequate information about the contexts that they were in before they came to see us and then looking at the contexts that they are in currently to understand their prior and current threats to power. Just because a client is out of a context in which trauma was occurring, does not mean their power is not continuing to be threatened!
- Understanding behaviors or threat responses were once affective survival techniques! If we can reframe the language around behaviors, we can empower our clients and reframe how we interpret behaviors.
- I think this framework allows OT as a profession to be more trauma-informed. As a trauma-informed practitioner, we can more easily see behaviors for what they are — a reaction or response — rather than a diagnostic symptom.
The Big Takeaway
Understanding the breadth of types of power, and types of threats. I was not aware how many different ways someone could be threatened and experience trauma and a loss of power. This framework really opened up my mind to see how and from where people draw on their power and how they feel empowered within their context and client factors.
One thing I really liked is there’s actually an appendix (appendix 1) that breaks down how to apply it to your practice, and they listed a guided discussion or guided discussion questions — but for me, it was more so speaking to coaching and how we can use coaching with our clients.
Over all this framework is just one of the stops on my journey to becoming a trauma-informed therapist. I truly believe no matter the setting I am working in, being trauma-informed will allow me to satisfy the basic needs of my clients so they can focus on healing and gaining occupational independence.
If you have any additional resources, thoughts, questions, or you really just do not like this framework, tell me! Comment below or on my Instagram post. I would love to start a dialog about this framework and trauma-informed care. These concepts are fairly new to me, and I would love to hear your experience.
Find the whole framework here — it is a very large document, but focus on Chapter 6 to gain a general understanding.
feature photo acquired from: https://www.mindful.org/point-of-view-when-vulnerability-and-trauma-collide/
All concepts and summaries derived from: https://www.bps.org.uk/sites/bps.org.uk/files/Policy%20-%20Files/PTM%20Overview.pdf and https://www.bps.org.uk/sites/bps.org.uk/files/Policy%20-%20Files/PTM%20Main.pdf