Best Practices in Family Intervention for Serious Mental Illness: Borderline Personality Disorder Program

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Borderline Personality Disorder: Psychoeducation Program

Manual Title	Multifamily Psychoeducational Treatment of Borderline Personality Disorder
Creator	John Gunderson, M.D. and Cynthia Berkowitz, M.D.
Reference	Reference: Gunderson, J.& Berkowitz, C. Psychoeducational multiple family groups for families of patients with borderline personality disorder: What you need to know about borderline personality disorder: A summary of current knowledge about diagnosis, origins, course, and treatment. Prepared with support from a grant from NIMH and the New England Personality Disorders Association. Available from Dr. Gunderson's office (see below). Berkowitz, C. B., & Gunderson, J. G. (2002).Multifamily psychoeducational treatment of borderline personality disorder (pp.268-290). In W. R. McFarlane (Ed)'s Multifamily group treatment for severe psychiatric disorders. New York: Guilford.
Price	free
Contact Information:	John Gunderson, M.D. McLean Hospital Dept of Psychiatry 115 Mill St. Belmont, MA 02478 Phone: 617-855-2293 Email: jgunderson@mclean.harvard.edu

Program Overview:

Note: This program is focused on parents of children (primarily daughters) who have borderline personality disorder.

Theoretical Orientation:
Program is based on the belief that individuals with borderline personality disorder (BPD) have 3 core deficits("handicaps" that are "not disabilities"), namely: affect and impulse dyscontrol; dichotomous thinking; and intolerance of aloneness.

The program is a proactive,future-oriented approach that avoids a focus on the analysis of cause. The personality disorder's etiology is viewed as multifaceted, including a possible role of the family (which is in contrast to most other psychoeducation programs which strive to alleviate any guilt on the family's part).

The psychoeducational component draws from previous work by Anderson, Hogarty, Falloon, Leff & McFarlane.

Treatment Goal:
To decrease the stress in the family environment (which will hopefully improve the course of patient's illness).The program is not presented as any form of "cure."

Stages of Treatment:

Joining
- 1-2 meetings held with a single family (patient is excluded)
- Sessions focus on developing a working alliance with the relatives; obtaining the history; and providing educational materials(readings and guidelines)
Psychoeducational Workshop (optional)
- 2-4 hour workshop of 20-40 relatives
- Three major elements:
  - Didactic presentations (diagnosis, course,etiology, treatment)
  - Encourage sense of community with others
  - De-stigmatization of the disorder
Multiple Family Groups (MFGs)
- Each group involves ~6 families
- Groups meet for 90 minutes every 2 weeks
- Group duration is 1 to 1.5 years
- Inclusion of the patient is variable (patients are invited - but they often refuse to attend)
- Participants cannot talk about family problems for 1^st 10 minutes; followed by go-around check-in; then group problem-solving
- 15 specific coping guidelines for families(focused on decreasing crises, developing stability & limit setting) anchor the discussions

Research:

Berkowitz & Gunderson (2002)

Methods: Pilot study of two multiple family groups (n = 8)
Results: 2/3 of parents report a decreased burden & improved ability to modulate feelings.

All parents said MFGs helped communication with patient AND their knowledge of BPD.

Preliminary data comparing number of self-destructive acts in the year before treatment and first year of treatment show a downward trend (not statistically significant due to small sample size).

Authors conclude that controlled trials are needed.

Notes: Dr. Gunderson and Maureen Smith, LICSW provide training on family intervention to psychology and social work trainees at McLean Hospital.

Above description reviewed and approved by Dr. Gunderson, 11-27-02

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