Elsevier

Current Opinion in Psychology

Volume 37, February 2021, Pages 44-48
Current Opinion in Psychology

What we know — and want to know — about Family Connections: a review from the perspective of lived experience

https://doi.org/10.1016/j.copsyc.2020.07.029Get rights and content

Highlights

  • Family Connections supports families of people with borderline personality disorder.

  • Lived experience perspective can provide meaningful direction for future research.

  • New studies should examine Family Connections when peer-led as intended.

  • Qualitative studies could illuminate additional Family Connections outcomes.

  • Research on the efficacy for other disorders could increase program availability.

Family Connections is a peer-led education, skills, and support program for family members of individuals with borderline personality disorder. Extant literature on Family Connections is limited but consistent in regard to methodology and outcomes, allowing for meaningful cross-study comparison. Despite evidence across studies regarding the program’s efficacy, a number of questions remain to be answered. Three possible future research directions were identified from the perspective of family members with lived experience who are also Family Connections peer leaders; examining Family Connections when led by peers, gathering qualitative data about family member’s experiences of Family Connections to illuminate additional program benefits, and studying the efficacy of Family Connections for family members of those with other mental health disorders.

Introduction

Borderline personality disorder (BPD) is a is a pernicious disorder, full of emotional suffering and high rates of suicidality [1, 2, 3]. Family members of individuals with BPD often suffer alongside their loved ones, frequently without access to much needed education and support [4, 5, 6, 7, 8]. A number of interventions have been developed for family members of individuals with BPD, but relatively few studies have been conducted to assess their efficacy [9]. According to the most recent systematic reviews of family member interventions [9,10], Family Connections (FC) is the program with the most evidence for its effectiveness. As a result, some researchers consider FC an essential component in the treatment for BPD [11••].

This paper will provide an overview of the evidence for FC by briefly describing the five studies published since the program’s inception in 2005, while paying particular attention to the two studies published since 2017. Future research directions will then be discussed based on the perspective of two authors with lived experience (L.C. & D.H.). These authors are in a unique position to provide meaningful insight, given their lived experience perspective as family members of individuals with BPD for whom FC was created who are also actively involved in coordinating FC groups Recent systematic reviews of family member interventions for BPD — including FC — have called for further and more diverse research [10,12,13]. Therefore, the lived experience perspective presented here could provide meaningful direction for future studies.

Section snippets

Family Connections & Sashbear

FC is a 12-week multi-family education, skills and support program designed to meet the needs of family members of individuals with BPD [14]. FC is modeled structurally after the National Alliance for the Mentally Ill’s highly valued Family-to-Family Program [15]. In FC, groups are led by trained family members. The content of the program — developed in consultation with several family members and individuals with BPD — was created by Dr. Alan Fruzzetti and Dr. Perry Hoffman, based on their

Evidence for FC

The inaugural study of FC by the creators of the program in 2005 [14], found that participation in FC significantly reduced family member burden and grief while increasing mastery. The observed changes were sustained three months post-FC, with burden continuing to decrease. Hoffman et al.’s replication and extension study in 2007 [16], confirmed initial findings regarding improvements in burden, grief, and mastery, but also reported a decrease in depression. At three-months post-FC, grief

Examining FC as a peer-led program

FC is described as a peer-led program. The efficacy of peer-led delivery models for family member interventions are well stated in the literature [21,22]. In FC, the peer-led delivery model is posited to allow family members to model non-judgment and to provide examples of skill application from their own experience [14]. However, only the two initial studies on FC by Hoffman et al. [14,16], utilized peers as the sole program leaders. In the study by Flynn et al. [17••], FC was led by a

Conclusion

There is limited but meaningful research regarding the efficacy of FC for family members of individuals with BPD, particularly in regard to improvements in family member burden, grief, mastery, depression, and overall mental wellbeing. It is clear from the research undertaken thus far, and from the perspective of two authors on this paper (L.C. & D.H.) with lived experience as family members and as FC leaders, that not enough is known about FC when delivered by peers as intended. Future studies

Conflict of interest statement

Nothing declared.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • • of special interest

  • •• of outstanding interest

CRediT authorship contribution statement

Lynn Courey: Conceptualization, Resources, Writing - original draft. Doreen Hyndman: Conceptualization, Resources, Writing - original draft. Clare Sheasgreen: Conceptualization, Investigation, Writing - original draft, Writing - review & editing, Project administration. Elizabeth McCay: Writing - review & editing.

References (34)

  • A.M. Chanen

    Borderline personality disorder in young people: are we there yet?

    J Clin Psychol

    (2015)
  • M. Linehan et al.

    The course and evolution of dialectical behavior therapy

    Am J Psychother

    (2015)
  • M. Linehan

    Cognitive-Behavioral Treatment of Borderline Personality Disorder

    (1993)
  • F.Y.Y. Ng et al.

    Recovery from borderline personality disorder: a systematic review of the perspectives of consumers, clinicians, family and carers

    PLoS ONE

    (2016)
  • F. Kulacaoglu et al.

    Borderline personality disorder (BPD): in the midst of vulnerability, chaos, and awe

    Brain Sci

    (2018)
  • C.M. Temes et al.

    Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up

    J Clin Psychiatry

    (2019)
  • M.L. Kay et al.

    Experiences of family members who have a relative diagnosed with borderline personality disorder

    Curationis

    (2018)
  • S. Ekdahl et al.

    A life tiptoeing: being a significant other to persons with borderline personality disorder

    Arch Psychiatr Nurs

    (2011)
  • S. Lawn et al.

    Experiences of family carers of people diagnosed with borderline personality disorder

    J Psychiatr Ment Health Nurs

    (2015)
  • E. Dunne et al.

    “It’s us that have to deal with it seven days a week”: carers and borderline personality disorder

    Community Ment Health J

    (2013)
  • R. Bauer et al.

    “Mad or bad?”: burden on caregivers of patients with personality disorders

    J Pers Disord

    (2012)
  • V. Guillen et al.

    Interventions for family members and carers of patients with borderline personality disorder: a systematic review

    Fam Process

    (2020)
  • R. Sutherland et al.

    Support, interventions and outcomes for families/carers of people with borderline personality disorder: a systematic review

    Pers Ment Health

    (2019)
  • S.I. Liljedahl et al.

    Family Connections in different settings and intensities for underserved and geographically isolated families: a non-randomised comparison study

    Borderline Pers Disord Emot Dysregulation

    (2019)
  • S. Fitzpatrick et al.

    Optimizing borderline personality disorder treatment by incorporating significant others: a review and synthesis

    Pers Disord

    (2019)
  • A. Fossati et al.

    Improving family functioning to (hopefully) improve treatment efficacy of borderline personality disorder: an opportunity not to dismiss

    Psychopathology

    (2018)
  • P.D. Hoffman et al.

    Family Connections: a program for relatives of persons with borderline personality disorder

    Fam Process

    (2005)
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