Dr Cian Aherne is a Clinical Psychologist and Clinical Manager of Jigsaw Limerick. Jigsaw, Ireland's National Centre for Youth Mental Health, is an early intervention mental health service for young people aged 12-25.

Following the success of an earlier interview, Thinkful returned to Cian to learn more about the Power Threat Meaning Framework. In part three of this three part series Cian shares a practical example of the framework in action. Part one and part two can be read here.

Emma Farrell: Do you find that the young people young work with believe there is something wrong with them? That their suffering is there fault?

Cian Aherne: The young people coming into our service every day have have those beliefs I would say. Like, if I was to ask that question 'what's happened to you?' in the first session, they would have no sense of how to answer it, because their answer is always 'I'm just doing life wrong'. 'I'm just not thinking positively enough'. 'I want to get back to being happy'. 'Can you give me the coping skills to get back to being happy?' They've no sense that anything has happened. Because you ask. Well, what kind of stuff has happened they say 'Oh, I've had a good life. Good parents. Get on fine in school. Nothing's happened untoward'.

So that's why I don't ask that question first session. You take two or three sessions to get to know someone, and so that there's enough information then to say, okay, we've talked about a few things there. Do you think any of the things that you've mentioned might have had an effect on how you've been feeling? So, you know, that's just another way of phrasing 'what's happened to you?'. And sometimes things have come closer to the surface, and they've been able to acknowledge, maybe, exam stress. Maybe bullying. Maybe a relationship. Maybe the way their parents talk to them. You know, sometimes there are things that are a bit more obvious. But sometimes it takes a deeper unpacking, then of 'Okay. So you're still not seeing anything that's had an effect. What's it like being in a school where you know there's a high emphasis on academic achievement? Or, what's it like when your parents let you know that they've been disappointed that you only got 70 instead of 80 in it in an exam? Or, you know, that you haven't got 100%? And then they start to access their feelings around that, and are able to sense that 'oh, maybe there is something more here actually'.

Its is a lot more complex than just being your fault.

And, you know, one of the biggest successes that you might see from session one to session four is session one you get a pie chart out of responsibility, and they're all saying 90 to 100% of this is my fault, It's all down to me. And then fourth session its like, well, okay, maybe 20% is the school the pressure that's put on. Maybe there's another 10, 20%, from my parents. Maybe there's a bit more pressure that comes from my peers that I hadn't recognised before. And it starts to tease it all out and see that that story is a lot more complex than just being your fault. Are you being disordered? Because, again, that's the dominant narrative. But that's what these questions allow to open up.

Approaching [distress] from a strictly CBT or a strictly diagnostic perspective just limits you. The focus gets narrowed, and it doesn't allow for those more complicated conversations.

Approaching this from a strictly CBT or a strictly diagnostic perspective just limits you. The focus gets narrowed, and it doesn't allow for those kind of more complicated conversations. It doesn't allow for an acknowledgment of the complexities of the world that we don't necessarily have control over and that restructuring our negative thinking isn't going to change. Or that putting a label on it and getting medication isn't going to necessarily change because then all of those things are still going to continue in the background and still impact on our emotions.

Emma Farrell: I think what you do is really interesting because you are a convert, in many ways. You've come from that perspective of 'I just need to fix this list of young people on my calendar for the week', which is completely understandable - of course we'd want to do that. We've all been conditioned to think that way. And isn't that what we want to do? Just release the suffering of people in the world? And yet you've embraced this approach that requires such a degree of vulnerability. Letting go of those ideas of fixing people.

What this framework does sometimes is unveil a side of the world that we either have been choosing to ignore or haven't been able to engage with before, and that can be really overwhelming.

Cian Aherne: You know we do all want to just relieve suffering and people's pain in the world. Unfortunately or or fortunately, whatever your perspective is on this, this framework doesn't necessarily decrease distress, you know. And, in lots of ways, maybe it increases our distress before we can get to a point of overcoming things, or or having a more more coherent understanding. Because what this framework does sometimes actually is, unveil a side of the world that we either have been choosing to ignore or haven't been able to engage with before, and that can be really overwhelming actually. To realise that there's so much here that's out of our control.

Actually, the world needs changing, not us.

Hopefully what this framework does is give us a voice and starts to enact change and makes us creatures of action for the system that we're in rather than you know us bullying ourselves all this time. Hopefully, it gives us the impetus to see that. Okay, actually, the world needs changing, not us. That idea that that some of this stuff is going to help us feel better, that's not always going to play out, either. So yeah, I think that because I think that's sometimes what the world is looking for. A framework or an understanding, or a pill that's going to make us all feel better, and I think it's important to say that that's not what the answer from this is going to be. The answer from this is going to be give us a map, you know, from where we need to go with this stuff and realise why we're all feeling shit and anxious at times.

Emma Farrell: But I think that that's really important, because I don't think we're willing to acknowledge that human suffering is not something necessarily to be gotten rid of. It's our body telling us, its our minds and souls telling us, there's something wrong in the world. And so, rather than trying to get rid of it. at least with something like the PTMF, and I know there's other ways and other approaches too, but it allows us to engage with it. It allows us to listen to our suffering and what it's trying to tell us, and it's only by listening to it, I think, anyway, that we can respond to it. That we can, you know, listen to this information and actually do something about it. But what I find most challenging about the Power Threat meaning framework is that you realise that the most effective response to a lot of human suffering is reducing inequity, you know, its economic policy. It's making sure that people have safe housing and access to opportunities, and that 1% of the world doesn't, you know, own as much as the lower 50% of the world. And, you know, that people aren't struggling to survive and compete, and perform as if we're all in a dystopian sci fi novel. But, and perhaps this is a good way to end, its better to know the things that are happening within us and respect them rather than trying to to get rid of them.

Cian Aherne: It's the matrix, the red pill, blue pill choice, you know.

This is the final part of a three part series on the Power Threat Meaning Framework. If you'd like to learn more about the framework visit https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework