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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.

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family interventions for borderline personality disorder the current evidence

Family Interventions for Borderline Personality DisorderThe current evidence

Kate Sloan

Nurse Practitioner in Psychotherapy

family interventions mental health
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
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
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
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
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
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
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
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
Fruzzetti - DBT with couples and families
  • Developed as part of standard DBT out-patient treatment
  • Value of family / partners learning complementary skills
  • Core skills from DBT are included
invalidating responses
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
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
slide13

Vulnerability

Temperament

History of invalidating responses

Event

Judgments

Heightened emotional arousal

Inaccurate emotional expression

Invalidating emotional response

outcomes
Outcomes
  • Reduction in symptoms
  • Relationship satisfaction
  • Increase in validating responses
  • Positive impact on relationships with children
what next
What next?
  • Accessible programs.
  • A framework to inform working with BPD families and carers.
  • Randomised control trials.