Knowledge of the biological basis of BPD can help families reframe the behavior of their loved one in the light of current science and accept that evidence-based treatment works. Accurate information can dispel the stigma that colours attitudes toward people with BPD.
Understand that the person with BPD is doing the best they can and does not intend to harm others or himself (debatable, sometimes a person with BPD can also have other conditions such as depression.) Discourage viewing the person with BPD as “manipulative,” as the enemy, or as hopeless. Understanding can melt anger and cultivate compassion.
Accept that the person with BPD has a disability and has special needs. Help the family accept their loved one as someone with a chronic illness. They may continue to be financially and emotionally dependent on the family and be vocationally impaired. BPD is a deficit or handicap that can be overcome. Help families to reconcile to the long-term course of BPD and accept that progress will be slow. There are no short-term solutions.
Do not assume that every family is a “dysfunctional family.” Emotions are contagious. Living with someone with BPD can make any family dysfunctional. Family members have been recipients of rages as well as abusive and irrational behaviors. They live in perpetual fear and feel manipulated. They often react by either protecting and rescuing or rejecting and avoiding. Reframe their points of view with compassion. Families are doing the best they can. They need support and acceptance. “Bad parents” are usually uninformed, not malevolent. They did the wrong things for the right reasons (the “allergic to milk syndrome”). Anyone can have a disturbed child. Keep reminding the family of the neurobiological dysregulations of BPD, and of the pain their loved one is coping with each day.
Collaboration for change.
Accept that families can help, can learn effective skills and become therapeutic partners. They can reinforce treatment. The IQ of a family member is not reduced if a loved one has BPD. Do not patronize or fragelize family members. Family members are generally well-educated, intelligent people who are highly motivated to help. Respect their commitment. When you provide them with effective skills to help their loved one, they can become therapeutic parent or partners. You can help them.
Stay in the present.
Do not focus on past painful experiences when the person with BPD cannot cope with aversive feelings and has no distress tolerance skills. Avoid shame-inducing memories. If you induce arousal and the patient cannot cope with the arousal, therapy becomes unacceptable, giving her additional pressure and stress and undermining cognitive control. This is a sure-fire way to get her to drop out of therapy.
Respect that families are doing the best they can, in the moment, without any understanding of the underlying disorders or the ability to translate their loved one’s behaviors. Although they may have done the wrong thing in the past, it was probably for the right reasons. Their intention was not to hurt their loved one.
Try not to assume the worst, and corroborate allegations. Remember that your perception of an event or experience may be different from what actually happened.
Avoid boundaries, limits, contracts, and tough love.
These methods are not effective with people with BPD. Be sure that families understand that boundaries are generally viewed as punishment by the person with BPD. Be sure they understand how to change behavior by explaining reinforcement, punishment, shaping, and extinction so that they do not reinforce maladaptive behaviors.
Encourage family members to nurture individual relationships with the person with BPD, not the united front of “we.” Although both parents can have the same goals for their loved one, they must express these goals in their own style, in one-on-one relationships. Focus on developing individual relationships and trust, not solving individual problems. This will discourage “splitting.”