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