1. Family Connections: NEABPD Aust: Barb Mullen

2. Class values Respect Co-operation Acceptance
Family Connections is based upon a Dialectical therapy approach where BPD is seen as ‘emotional dysregulation’. There are other approaches (mentalisation, schema), but this way is tried and proven and easily accessible.
Family Connections: NEABPD Aust: Barb Mullen

3. Family Connections: NEABPD Aust: Barb Mullen
to Family Connections
BARB:
Welcome to our Family Connections Course – the first one in Australia!
Family Connections is a 12-week series for relatives of persons with difficulties managing their emotions.
I hope you enjoy your time with us, I know I will.
Family Connections: NEABPD Aust: Barb Mullen

4. Borderline Personality Disorder (BPD)
Your family member may have a diagnosis of BPD
Your family member may not have a diagnosis of BPD
Your family member may have a different diagnosis
If you believe your loved one has BPD,
you are welcome.
Family Connections is a 12-week series for relatives of persons with difficulties managing their emotions. Behaviours often present are mood
lability (ups and downs), difficulties with anger, relationship problems,
impulsivity, self-injury, and suicide attempts.
Often times these behaviours are diagnosed to be borderline personality
disorder (BPD). Or, another diagnosis may be given.
Regardless of what the diagnostic “label” is, you will learn more about the symptoms and behaviours.
While you will develop a better understanding about these symptoms and your relative, most importantly, you will learn skills for yourself and your own well-being.
BPD and its symptomatology are difficult to have and difficult to observe in a loved one. The symptoms and behaviours can create havoc for many. No one would disagree that the behaviours that go along with the symptoms can be hell for the sufferer and an equal hell for those that love them.
Family Connections: NEABPD Aust: Barb Mullen

5. Family Connections: NEABPD Aust: Barb Mullen
Living in a BPD family
The difficulties of living with a loved one with BPD are multi faceted and multi layered:
For the person with BPD
For those who love them
Carers of people with BPD may be mothers, fathers, husbands, wives, siblings, children, friends and more. They may live with their loved one, they may not.
While we believe that participation in this program may also be helpful to our relatives, that is not one of our direct goals in our time together. Our goal is to help ourselves. As parents and relatives, we suffer with our loved ones and then suffer also for ourselves.
Although the symptoms and behaviours can create havoc for many, it doesn’t mean that people don’t get better. Many do, but the road, at times, can be bumpy.
The disorder itself is viewed, in part, as an emotion dysregulation disorder. We need to know how to best manage ourselves in light of those difficulties and the behaviours that come with that, in addition to our own individual struggles.
Family Connections: NEABPD Aust: Barb Mullen

6. What is Family Connections?
In Family Connections we will learn the most up to date information on BPD
We will learn skills that focus on acceptance, which will make our lives easier
We will learn skills to manage our own change
We will learn skills to improve our relationship with our loved one
We will support each other
In our time together we will:
Hear the most current information on the disorder (education).
2. Learn skills that will focus on acceptance of what is (ourselves, our
loved ones, situations, etc.) in any given moment, making life a little less stressful, AND learn skills to manage (change) ourselves and our
relationships more effectively in any given moment or situation.
3. Support each other.
Family Connections: NEABPD Aust: Barb Mullen

7. Family Connections: NEABPD Aust: Barb Mullen
Connections Offers N (K)nowledge New research Empowerment Community Resources Tools for well-being Involvement Optimism Networking Skills training
Family Connections: NEABPD Aust: Barb Mullen

8. Family Connections: NEABPD Aust: Barb Mullen
Program Goals
To help understand the problems, suffering and behaviours associated with BPD and its related features;
To understand more how to manage our own emotional response to situations and our relationships, to reduce our suffering;
To develop a support network of family members with others with similar situations.
IAN:
Every year new information and research are made available. We will try to keep ourselves well informed and will have articles of interest to distribute.
If there is any topic of specific interest you would like to learn more about, let us know and the National Education Alliance for Borderline Personality Disorder (NEA- BPD), the umbrella under which this program exists, will obtain reading material for us.
We will also learn from each other how best to cope. As we accept things that perhaps we cannot change right now, while always mindful of our relationship with our family member and how important he/she is to us, we do believe that, in the long run, helping ourselves can be helpful to our relative.
Who we are
I also have relatives with this disorder, so I know firsthand how difficult it is to observe someone with the symptoms and we know firsthand how difficult it is to live with someone with the symptoms of BPD.
Brief Introductions
Please tell us who you are, about your situation and your relative, and what you hope to achieve here during our time together. We have a “Pass Rule,” which means it is OK at any time not to share if you do not want to. We do, however, encourage you to talk and share. Also, we observe a CONFIDENTIALITY rule within our class.
First, we, the leaders will start the discussion of our relatives. We will follow the protocol with our name, our relationship to our ill loved one, their age, diagnosis (if available), treatment history, and major symptoms. To facilitate timely wrap-up, we ask that we each then state/rate our own emotional coping states on a scale of 1 to 10 (1=good; 10=poor).
We also know the stress that BPD creates for those in the family. Part of having the stress comes directly from the very difficult behaviours that accompany BPD and its related symptoms.
However, we as family members need to learn how to manage the stress; otherwise, quite frankly, we can become non-functional at times. Those non-functional states are not helpful to anyone. Just as we are advised by the airlines to put on our own oxygen mask first, we too need to apply an oxygen mask strategy to be most effective if we want to help our relative.
Just like you, we have a unique expertise with BPD.
Family Connections: NEABPD Aust: Barb Mullen

9. Family Connections: NEABPD Aust: Barb Mullen
Weekly
Go around/review practice and exercises
Learn new material
Questions and discussion
Viv
We don’t profess to have all the answers, but we hope that together, with the skills we will be sharing and the discussions we will be having, we can decrease some of the stress and worry that comes with being the relative of a person with BPD or BPD-related symptoms. If anyone wants to present a situation for consultation/discussion, we will brainstorm it together as a group when there is time.
Please feel free to take notes during class about points you would like to discuss from the informational piece (course manual) and, especially, thoughts that arise during the week. We would also very much appreciate your input, for example, ideas and actions that have worked for you, or points you would like to see included in the curriculum. We have included pages in your binder to jot down thoughts/ideas, etc.
Program Design
Family Connections was designed by family members, a consumer, and two mental health professionals. The program integrates the real life experiences and needs of families of persons with BPD and related symptoms, and consumers, and the expertise of over 15 years of
professional work with families.
Family Connections is also an adaptation and synthesis of two family programs that have served hundreds of families over almost two decades, both programs under the leadership of Perry D. Hoffman, Ph.D., and Alan E. Fruzzetti, Ph.D. We have some articles for you on their work we will to you. In addition, the course manual has been enriched over the years by the addition of materials from experienced Family Connections leaders.
Family members, have been trained to lead this course. Family members were chosen to be the leaders because we are “experts” in the way that no professional can be. Also, we, in many instances, have our own personal motivation that is unstoppable.
Family Connections: NEABPD Aust: Barb Mullen

10. Family Connections: NEABPD Aust: Barb Mullen
Group Guidelines
Punctuality
Confidentiality
Assignments
Group Consultation
This is a no blame environment, we aim to be non judgemental.
Group Guidelines
1. Punctuality- Please be here on time as we will start punctually.
2. Confidentiality- What is said in the group, stays in the group.
3. Attendance - We ask that you make attendance a top priority since when group members
are absent the whole group is affected. Please call us if you are unable to attend so that we
don’t worry about what may have happened to you or your family member.
4. Practice assignments - We ask that you do the weekly assignments as they will help
maximize what you gain from our time together.
5. Group consultation/discussion- When time permits, we hope we can work together
helping each other with a current problem or issue.
Family Connections: NEABPD Aust: Barb Mullen

11. Family Connections: NEABPD Aust: Barb Mullen
Relative Rights
We need to have a “healthy selfishness” (balance);
We need to learn to say “no”;
We need to have our own emotional support network;
We need to accept that we cannot solve our relatives problems;
We need to accept we will lose our “cool” at times.
So, why are things so difficult at times?
Because this is an extremely complex and difficult disorder.
Family Connections: NEABPD Aust: Barb Mullen

12. Family Connections: NEABPD Aust: Barb Mullen
The Criteria (DSM-V)
One way of describing BPD is to say it is “severe emotion dys-regulation”. There are 9 different problem areas: 5 or more need to be present.
“Borderline” is an outmoded term. It describes a state on the border between neurosis and psychosis, however, many researchers and professionals today see BPD as a disorder of the emotion regulation system.
Discussions have gone on to change the name, but to date, it still stands. One suggested alternative is to change the name of the disorder to “emotional dysregulation disorder.”
Family Connections: NEABPD Aust: Barb Mullen

13. Family Connections: NEABPD Aust: Barb Mullen
Criteria 1
Fear of being abandoned: This may manifest itself as clingy, dependent behaviour. Midnight emergency phone calls, text messages throughout the day and night. It may manifest itself as total rejection by the person with BPD for their loved one: ‘I will reject you before you reject me’.
Family Connections: NEABPD Aust: Barb Mullen

14. Family Connections: NEABPD Aust: Barb Mullen
Criteria 2
Intense mood shifts: Shame Fear or anxiety Sadness Anger A person with BPD will be become deeply distressed within seconds it seems. These core emotions are the basis for much pain.
Family Connections: NEABPD Aust: Barb Mullen

15. Family Connections: NEABPD Aust: Barb Mullen
Criteria 3
Impulsivity: Promiscuity Fast driving Verbal outbursts
Family Connections: NEABPD Aust: Barb Mullen

16. Family Connections: NEABPD Aust: Barb Mullen
Criteria 4
Problems with Anger
Family Connections: NEABPD Aust: Barb Mullen

17. Family Connections: NEABPD Aust: Barb Mullen
Criteria 5
Recurrent suicidal behaviour or self mutilating behaviour
Family Connections: NEABPD Aust: Barb Mullen

18. Family Connections: NEABPD Aust: Barb Mullen
Criteria 6
Pattern of unstable and intense relationships Family members often bear the brunt of this criteria: for example, once a parent, always a parent – while a friend or work colleague can walk away. Where the person with BPD has children, the dynamic for loved ones changes completely.
Family Connections: NEABPD Aust: Barb Mullen

19. Family Connections: NEABPD Aust: Barb Mullen
Criteria 7
Chronic feelings of emptiness As if you are wearing a mask behind which there is nothing.
Family Connections: NEABPD Aust: Barb Mullen

20. Family Connections: NEABPD Aust: Barb Mullen
Criteria 8
Unstable sense of self, “chameleon-like”: A lack of stability about sense of self which leads to difficulties in making decisions; having a belief that feels solid one minute, but not the next; things are often seen in black and white.
Family Connections: NEABPD Aust: Barb Mullen

21. Family Connections: NEABPD Aust: Barb Mullen
Criteria 9
Stress related paranoia or dissociative symptoms (zoning out; a way of removing yourself from a painful experience) dissociation is defined as feelings of detachment from one’s own body or thinking. While dissociation is not uncommon, it is the degree and intensity in BPD that is problematic.
Family Connections: NEABPD Aust: Barb Mullen

22. Family Connections: NEABPD Aust: Barb Mullen
People who have less than 5 criteria may still have significant borderline features that severely impact their lives.
Family Connections: NEABPD Aust: Barb Mullen

23. Family Connections: NEABPD Aust: Barb Mullen
Dysregulation occurs when we are oriented to escape, to reduce negative arousal regardless of the long term consequences of our methods.
Family Connections: NEABPD Aust: Barb Mullen

24. 5 areas of dysregulation
Emotion dysregulation (core) – ie rage, anxiety, depression
Interpersonal dysregulation – chaotic relationships
Self dysregulation – unstable sense of self
Behavioural dysregulation – self injury
Cognitive dysregulation – paranoia
Linehan (1993) Cognitive Behaviour Treatment for Borderline Personality Disorder
Our Mutual Connection
The diagnosis of BPD includes a very wide spectrum of behaviours. People in this group have relatives whose levels of functioning may greatly differ. The level of functioning differs not only among sufferers, it differs at different times for the sufferer. It is for some of these reasons that the disorder is characterized, even by professionals, as “an elusive entity.”
However, there are many threads of common experiences that we all share. It is these common experiences that bring us together, and are also, unfortunately, often not understood by others.
Key Points
Irrespective of diagnosis, there are a multitude of emotions that occur when a loved one’s life is changed by mental illness: depression, anger, loss, grief, guilt. We often do not acknowledge these feelings, even to ourselves.
As we are all family members and understand the impact that this disorder has on the entire family, we hope we can feel free to talk about these feelings. Talking and education are major ingredients to managing such feelings more effectively.
What has this been like for you?
Family Connections: NEABPD Aust: Barb Mullen

25. Family Connections: NEABPD Aust: Barb Mullen
Basic Assumptions
People need to interpret things in the most benign way possible
There is no truth or absolute truth
Everyone is doing the best they can at the moment
Everyone needs to try harder
(See also Module 4, Family Environment Skills, page 19)
Different Perceptions: New Behaviours
As we have no control over how another person acts or behaves, we need rather to work to change the way we experience the world. We need to commit to changing ourselves.
We will learn how to step back, to be more mindful (less emotional, more focused, observing ourselves), to analyze what works, and to acquire new behaviours.
Family Connections: NEABPD Aust: Barb Mullen

26. Family Connections: NEABPD Aust: Barb Mullen
What’s the proof?
Research into the Family Connections Program show:
Decreased grief
Decreased burden
Decreased depression
Increased mastery,
empowerment
Family Connections: NEABPD Aust: Barb Mullen

27. Practice Exercises
(write one sentence on each question for next week’s discussion)
From your perspective, what are your relative’s predominant behaviours, emotions and cognitions?
Which ones interfere with his/her life the most?
Which ones are most problematic for you?
Practice Exercises
At the end of each Module, you will find exercises that are designed to reinforce what we have covered during the weekly session and, as skills are discussed, to provide a focus to practice behaviours of change. In Modules 3-6, the exercises are also included with the content.
People often say that even after they have finished the Family Connections course the exercises are very helpful as a means of remaining mindful when dealing with difficult situations. Some
post exercises that are particularly helpful to them in their family situation on the refrigerator!
Family Connections: NEABPD Aust: Barb Mullen