Family Interventions for
Borderline Personality Disorder
The current evidence
Kate Sloan
Nurse Practitioner in
Psychotherapy
Family Interventions – Mental
Health
Considerable research has demonstrated
the important role that families play in
recovery.
Evidence within Schizophrenia and this
has progressed within other mental health
diagnosis.
Although some advances have been
made working with families with BPD it is
well behind other disorders.
Expressed Emotions - relapse
Robust psychosocial predictor of relapse
– Schizophrenia
– Major depression
– Anorexia Nervosa
– Bi-polar
– Alcoholism
Stanbridge, et al, (2003) Onwumere et al, (2009)
Expressed Emotion - BPD
Criticism and hostility is not predictive of
outcome
Criticism and hostility did not predict rates
of hosptilisation
Higher expressed emotion is associated
with better outcome.
Hoffman and Perry, (1999)
Invalidating Environment – the
impact on the individual
1. Are not able to label emotional experience
2. Do not learn the skills of tolerating emotional
experiences
3. Do not learn how to trust their own emotional
responses
Linehan, (1993)
Impact of Knowledge
Schizophrenia – Knowledge decreased burden,
depression, distress and expressed emotion.
BPD – Knowledge increased burden, distress
and depression and there was greater hostility.
– Recommendations about the quality of the
information given.
Hoffman and Hooley, (2003)
Interventions for Families of People
with BPD
Three manualised Family psycho education
programs are described in the literature.
Gunderson/Mclean program
Hoffman – New York, hospital program
Fruzzetti – DBT with couples and families
Dissemination of these programs has been
modest.
Gunderson/ McLean program
Borrowed from psycho educational
approaches developed for schizophrenia
Families identified with three major
problem areas:
– Communication
– Anger
– Suicidality
Hoffman/New York Hospital
program
Family treatment approach based on DBT
– Educational
– Skills development
– Environmental change
Interruption of the invalidating cycle
Based on the concept of expressed
emotion
Group meets weekly for approximately 6
months
Fruzzetti - DBT with couples and
families
Developed as part of standard DBT outpatient treatment
Value of family / partners learning
complementary skills
Core skills from DBT are included
Invalidating Responses
Not necessarly - Cruel, abusive,
neglectful or uncaring.
But may lead to – wants and
emotions being missed criticised
or not tended to or Invalid
behaviors being legitimised.
Validating responses
Listening, paying attention
Acknowledging the other’s points
Working to understand; asking questions
Understanding his/her problems in context
Normalizing his/her responses when they are
normative (“of course”)
With actions that convey understanding
Vulnerability
History of invalidating
responses
Temperament
Event
Judgments
Heightened emotional
arousal
Inaccurate emotional
expression
Invalidating emotional response
Outcomes
Reduction in symptoms
Relationship satisfaction
Increase in validating responses
Positive impact on relationships with
children
What next?
Accessible programs.
A framework to inform working with BPD
families and carers.
Randomised control trials.