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

Abstract

Background Family Connections (FC) is a multi-family skills training program for relatives of individuals with borderline personality disorder (BPD) and related difficulties, typically offered once per week for 12–14 weeks. Families with loved ones receiving residential Dialectical Behaviour Therapy DBT (DBT-R) in a different community, or those with multiple caregiving demands may have difficulty participating in weekly standard FC (FC-S). The aims of this paper are to: 1) Evaluate the results of the FC-S approach compared with an intensified weekend FC model developed for family members whose relatives are in DBT-R (FC-R); 2) Evaluate outcomes of FC-R for families with loved ones returning home from DBT-R, as little is known about how this population fares. Methods Data were collected at pre-treatment (T1), post-treatment (T2), and at six-to-seven-month follow-up (T3) in this non-randomized comparison study. A total of 82 family members participated, 34 of whom completed the FC-S program and 48 of whom completed the FC-R program. The evaluation was based upon outcomes derived from a standard battery used in FC research, analyzed by time and treatment setting. A composite score to evaluate family distress was generated. Two-way mixed multivariate analyses of variance (MANOVA) were employed to evaluate time (pre-versus-post versus follow-up) and group (FC-S versus FC-R). Results Scores on measures of mental health difficulties (General Severity Index), sense of burden (Burden Assessment Scale), and Global Family Functioning showed improvement over time. Having a loved one return home from DBT-R was associated with worsening on the GSI and the BAS at post-test. Notably, this deterioration was not found at follow-up. Conclusions Little is known about families with loved ones receiving DBT-R other than the fact that their loved ones had not responded to previous services, which suggests greater complexity and chronicity. Because the family members receiving the weekend intensive FC-R version of FC demonstrated improvement, preliminary support exists for service providers to use the weekend intensive FC-R model as a time-and-cost efficient option whenever barriers exist to participating in weekly FC-S. Our findings also suggest that booster sessions may be indicated for families receiving loved ones home from DBT-R programs.

Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review

“…The most empirically supported study is Family Connections (FC; Hoffman et al, 2005), one of the first interventions designed for relatives of patients with BPD, applied by either clinicians or trained relatives. To test the efficacy of FC, five uncontrolled clinical trials were conducted, with pre–post treatment and follow‐up evaluations (Ekdahl, Idvall, & Perseius, 2014; Flynn et al, 2017; Hoffman et al, 2005, 2007; Liljedahl et al, 2019). In general, the results of the FC program were consistent in all replications.…”

“…The FC programme deserves to be highlighted because it is the most advanced so far, both in terms of content specifically designed for families and in terms of strategies designed to improve its dissemination, such as training family members to hold the therapy groups themselves. Furthermore, conducting these kinds of programmes in different settings may be a time-and cost-efficient implementation option (Liljedahl et al, 2019).…”

Efficacy of “Family Connections”, a program for relatives of people with borderline personality disorder, in the Spanish population: study protocol for a randomized controlled trial

“…The program can be carried out by clinicians or trained relatives. To date, five uncontrolled clinical trials have been performed with pre-and post-treatment and follow-up assessments [17,24,25,29,30]. In all the replications, the results of the FC program were consistent, showing significant decreases in burden, grief, anxiety, and depression, and significant increases in the participants' subjective experience of mastery, empowerment, well-being variables, and family functioning.…”

“…Flynn et al [24] found similar results in a non-randomized controlled study (pre-, post-, 3-, 12-, or 19-month follow-up) that compared FC with a psychoeducation group. Finally, in a non-randomized comparison study with pre-, post-, and 6-month followup assessments, participants who received FC reported fewer mental health difficulties, a lower perceived burden of caring, and higher overall family functioning [30].…”

“…Furthermore, these variations were maintained or improved at 3-or 6-month follow up. The good results for family functioning could be due to the fact that FC validates patients' skillful behaviors, decreases their psychological symptoms, improves interpersonal relationships between family members and patients, increases understanding of the problem, reduces perceived stigma, and enhances family empowerment [30].…”