Are you a parent of an adolescent who experiences their extreme mood swings, addictive and self-destructive behaviours, intense and unstable relationships, and black and white thinking? Your child may be suffering from Borderline Personality Disorder (BPD). And BPD is scary, isn't it? One moment your child can't stand to be away from you; they think you are the most wonderful person in the world! A few hours later, they despise you and pummel you with hurtful words and possibly physical violence. Most of the time you feel as if you have to literally walk on eggshells around him or her, because you never know how he or she is going to react or what they might do next. A person suffering from BPD may appear completely "normal" and may often have the ability to act "as if" he or she has no problems. Although some may be tempted to abandon a BDP sufferer, you are their parent and cannot do that. The worst part is that you feel helpless. You want to help your child; you don't know how. There is recent research-based evidence of a treatment model that can address the fundamental and important need that parents are longing to satisfy: help for their child. Before we look at this new model, let us review what therapies have been used to date, and where they may fall short.
For BPD adolescents, up to now they have likely been in individual therapy with some skills-based Dialectical Behaviour Therapy (DBT), and perhaps group counselling. DBT is a therapy developed by Marsha Linehan in Washington State, and combines person-centred empathy and acceptance with cognitive behavioural problem-solving (CBT), social-skills training and Middle-Eastern philosophy. It helps BPD individuals to modulate and control their extreme emotionality and behaviours, tolerate their distress as “normal”, and trust their thoughts and emotions. Although these components are helpful, therapy needs to include family members and to address core family processes unique to BPD, as well as the complexities of an adolescent’s development. During this developmental stage in an adolescent’s life, there is substantial physical change along with hormonal development, there is development of key cognitive abilities as the brain grows, honing of social skills, and immense peer pressure to perform competently. While your child is experiencing this turmoil, they are interacting with family members as they develop their identity and seek support as they grow. A positive family role is particularly important in the life of a BPD adolescent, and this component would address the need for an effective, holistic and systemic treatment approach to adolescents with BPD and drug abuse.

If these approaches have been working for some time now, then what is missing, and how does this new model address the need? With Integrative Borderline Adolescent Family Therapy (I-BAFT), the researchers believe that they have created an approach that incorporates three necessary treatment components: structural family therapy (SFT), which assists families to restructure out of fragmentation and under organization to help with role definition and boundary setting; empirically-tested brief strategic family therapy (BSFT) to help with communication; and dialectical behaviour therapy (DBT) discussed above. The approach also includes that developmental focus which is more critical here than in adult BPD. This multi-component treatment model brings together varied activities for the adolescent and their family to combat this disorder, and to lift their burden. This includes weekly family therapy; individual therapy; and skills-building interventions. It is designed to be offered in 3-sessions per week over a 6-8 month period, and involves separate therapists and a psychosocial skills trainer. There are a number of specific issues which are a source of concern to parents and unhelpful to the adolescent, including: self harm; drug abuse; emotion dysregulation & impulsivity; failure to establish life goals & skills; unstable family relationships; and family interactions that maintain the behavioural problems. Although it isn’t cheap, this approach focuses on changing these factors. It also encompasses comprehensive strategies that are designed to target and alter behaviours which hinder the child’s ability to cope effectively with BPD. These include: no suicide-related behaviour; continued therapy during crisis; crises framed as opportunities; and working with family members to provide structure. Because parents are concerned whether their child is able to cope with BPD, the adolescent’s treatment goals are: increasing skills in regulating emotions and maintaining healthy relationships; setting life goals; increasing motivation to achieve goals; modifying suicidal & parasuicidal behaviour; eliminating drug abuse; reducing impulsive behaviours, and reducing severe emotional dysfunction. While parents will see their child’s learning grow, the family can also learn and grow. Therefore, family treatment goals are: increasing parental leadership, guidance and nurturance; fostering parent-adolescent attachment; promoting familial validation through communication; eliminating ongoing verbal, physical or sexual violence; reducing interactions that reward emotion dysregulation; and promoting parent-adolescent engagement. All these will create a healthy and supportive environment for your child.

But will this approach produce results? The researchers found that an adolescent population is difficult to engage, retain and treat, and that the therapy is intensive. Despite these difficult obstacles, through this effective and successful treatment, they were able to engage 70% of the adolescents and families that enrolled. High parent and adolescent satisfaction reflected a positive assessment of the three treatment components by both adolescents and their parents. This is especially significant as the adolescent clients were not self-referred nor were they originally interested in treatment. They also found that unhealthy family patterns may precede the BPD behaviours and help them to blossom, so treatment that deals with adapting these is positive for parents and children. A positive note was that adolescent BPD traits were less entrenched than those of an adult BPD sufferer, and so the outlook for parents is brighter. Key learnings during the conducting of this research were that there is a negative impact on the adolescent when parental figures are lacking, there are adult-adolescent attachment problems to be addressed, and generic family therapy alone is insufficient. The research convincingly emphasizes the importance of providing a developmental and growth approach during the adolescent’s developmental stage.

Parents will be pleased to note that this research contributes to the growing impetus for integrative, systemic and holistic approaches to mental health, which include a variety of treatments that had been offered separately before now. If you are a parent or family member of an adolescent diagnosed with BPD, don’t think that you have to battle this alone. Contact your local Child and Youth Mental Health branch to discuss these treatment options that will not only help your child, but also help the whole family to become more resilient and take a role in meeting the challenge of adolescent BPD. Admittedly BPD may be a struggle, yet the goal is to struggle well!

Author's Bio: 

Sean L.G. Latimer, B.Comm; CA(SA); MA; RCC is a Registered Clinical Counsellor in private practice in White Rock, BC, Canada. His areas of practice are: trauma therapy (EMDR and OEI), relationships (Gottman Marital Therapy), and worklife and career issues.