“Family Connections”, a DBT-Based Program for Relatives of People with Borderline Personality Disorder during the COVID-19 Pandemic: A Focus Group Study
Abstract
:1. Introduction
2. Methods
2.1. Participants and Recruitment
2.2. Description of “Family Connections”
2.3. Data Collect and Procedure
2.4. Ethical Considerations
2.5. Measures
Interview Protocol
2.6. Data Analysis
3. Results
3.1. Characteristics of the Relatives and Patients
3.1.1. Family 1
3.1.2. Family 2
3.1.3. Family 3
3.1.4. Family 4
3.2. Qualitative Results
3.2.1. Theme 1: The Impact of COVID-19 Confinement on People with BPD
Positive Experiences
“In general, we were afraid to be at home to see what could happen because we of course didn’t know how we would react, and they are much more sensitive […], so there has been a little bit of tension and nervousness in that area, like a punching bag… and I tell her, but Dad is taking it personally, she has a disorder, and when she’s up here she lashes out at the person closest to her, which is you, because you’re stuck with her 24 h a day. But she was fine with us, with everything that was happening. I believe she has acted very well, was strong, and helped me in everything; she has been incredibly positive.”
“We’ve been amazed. Wonderful, very surprising, we could not believe it. I had a hard time because my wife got the coronavirus. Then, the whole family was followed up with, and they did the diagnostic test, the serology on all of us, and the only one who had really gone through it is her, not us. One day she was overwhelmed, and she said to her brother “please, I want to rest, I am studying”. She was studying non-stop every day; she has signed up for a lot of online courses, and she has done everything. She is very happy. And there is more. Two weeks ago, suddenly she became independent”.
Neutral Experiences
Negative Experiences
“I don’t even feel like saying anything. Because everybody is good… and we are not. We had improved a lot just a few weeks ago, and we have gone backwards. During the confinement, it has been… uf. Sometimes, it’s hard for us to even know about allowing yourself to lose control because I don’t know if I allow myself to or if I lose it without permission because I’m tired; I’m very tired. You are more dependent than you were before the confinement. We have achieved something good because we also have to say something good, and that is that the social isolation she had is gone because now she stays with her friends”.
3.2.2. Theme 2: Learning and Knowing What Is Going on with Their Relatives
“I think that the most important thing we have learned is to know what our family member suffers. I think none of us knew because we could not understand why they behaved as they did. Learning about their problem and putting into practice all the methods to improve our coexistence with them has been positive because there came a time when we could not live with that person.”
“Look, one of the things we have learned is that I overprotected my daughter out of fear that a crisis would occur. But there came a moment, when I came here to the group, that I said, “this is as far as I go”. I was doing it for her sake, but then I realized that I was being very selfish, and I felt guilty, and I have learned all that here, not that I didn’t know it, but to say, “it’s not just me who is thinking it, it’s that they are telling me”. In short, I have now learned to say “No.”
“It is like the famous statement: “let’s take care of the caregiver”. If we don’t take care of the caregiver, they won’t be able to take care of you because you are sick, you can’t take care of them because you don’t know how.”
“It seems to me that here we all worry a lot, you with your mother, you with your wife, you with your daughter, and you are of course and another relative who is not here today. I think that we have come here because we are eager to learn and to know what is going on with our relative. We have taken in everything to learn.”
3.2.3. Theme 3: Validation and Radical Acceptance Were the Most Used and Useful DBT Skills during Confinement Due to COVID-19
Most Useful Skills
On the one hand, the partner in Family 1 said, “I think acceptance has been the most important thing because it helps you realize what you have and what you must accept, and that’s how it is. Not hitting the wall.”
On the other hand, the mother in Family 4 commented that “Validating her feelings, her sensations, and all that has seemed very important to me. Knowing how to say, “I understand that you are like this…”
Most Used Skills during the Confinement
3.2.4. Theme 4: Professionals, the Content of the Program, the Sincerity of All the Attendees, and Having a Safe Space
“To learn, learn how to handle the situation”(mother in Family 3); “To know how to act because we did not know how to act on many occasions”(father in Family 2); “We are in a situation that is a borderline situation, and I have to find a way to cope with it” (partner in Family 1); “I think that it’s a good thing that we all came here with an empty glass, with a blank slate, and that we all came here to fill it up” (father in Family 4); “We came here to learn”(mother in Family 3); and “Because we were lost” (mother in Family 2).
“Knowing that we are not the only ones and that, as you said before, we are not doing so badly… Because all of us here, I imagine, have been told so many diagnoses for our relative and so many strange things that now it turns out that there is a diagnosis that fits well “.
“…that we have seen that we share many things in common with others, and one very important thing I think is that they listen to you and help you and support you and each other and you listen to others”.
“It is common that we have someone very close to us who causes conflict. Knowing that he or she is not alone in the world relieves you of a lot of weight. It frees you from the burden, and then the capacity that each one has to transform it or to be able to contribute to that family member, that is already inside of you, but to be able to communicate and to be able to say it in public”. The mother in this family interacted with him, adding “It’s just, who do you tell your problems to? No one, you can’t,” and the father in Family 2 replied, “Because people don’t seem to understand you”.
“And another thing that I think is good, I don’t know if any of you have thought about it, but what I have thought about is the fact that here everyone belongs to different places and backgrounds and outside of here we don’t have any relationship, none, and that’s positive. Why? Because when you and I come here, I come to tell you about my daughter’s problems and my problems with her, but they stay here; they do not leave here. Therefore, I can see them around the city one day, and I will say hello to them. Moreover, for me that is fundamental, the fact that you come to a group of people that you do not know, and you are willing to come. I was in another city today, and you have to come from work and leave your work and come here. You share intimate things, and they stay here, in the sense that if I, for example, knew you from before, it would be more difficult. I would not be so open.”
“We’re going to leave with hope because when we came here, we didn’t have any, at least not us”.
3.2.5. Theme 5: Great Satisfaction with and Acceptance of the FC Group
“It has been very good for us because we were lost, and it has helped us to realize that it is something that affects many people, and that the reactions of our relatives are similar.”
“Then we come here, and we have something in common, we share. I also find it very enriching that we can talk to each other. A member of the group could have seen something that works that I may not have seen.”
“The first time I came here, I was a little reluctant because had to expose my problems and speak in public, but as the sessions went on, I thought “I’m looking forward to it, because I want to express this, and I want them to know it”.
“You feel sheltered.”
“This is like you go and say things that in other places we can’t. You open, you tell, and it is a good experience. It is therapy for the caregiver. It is learning how to take care of ourselves so that we can take care of them later.”
4. Discussion
5. Practical Implications
6. Strengths and Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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How was the confinement and what experiences did you have with your family member in this period? |
What of the skills that have been used in the program have you learned, and which have been most useful to you? |
What skills have you used the most during confinement? |
Why did you come to the FC group? |
What experiences have you had with the group? |
What do you think is essential for a group like this to work? |
What advantages have you found from attending this group compared to your usual treatment? |
Why do you think it is necessary for family members to adhere to this group? |
Participant | Characteristics | Mean (SD) |
---|---|---|
Caregiver | Age (years) | 53,43 (27 to 68) |
n (%) | ||
Sex | ||
Female | 5 (71,4) | |
Male | 2 (28,6) | |
Relationship with the patient | ||
Mother | 3 (42,9) | |
Father | 2 (28,6) | |
Husband | 1 (14,3) | |
Daughter | 1 (14,3) | |
Patient | Age (years) | 36 (22 to 57) |
n (%) | ||
Sex | ||
Female | 4 (100) | |
Mental disorder diagnosis | ||
BPD | 1 (25) | |
BPD and Major Depressive Disorder | 1 (25) | |
BPD and Bipolar Disorder | 1 (25) | |
BPD and Anorexia Nervosa Disorder | 1 (25) |
Family 1 | Family 2 | Family 3 | Family 4 | ||||
---|---|---|---|---|---|---|---|
Couple | Daughter | Mother | Father | Mother | Mother | Father | |
Knowledge about BPD | 8 | 9 | 8 | 7 | 8 | 9 | 8 |
Identification and management of emotions | 7 | 8 | 7 | 6 | 7 | 9 | 7 |
Awareness of your family member’s emotions | 8 | 8 | 7 | 8 | 6 | 9 | 7 |
Usefulness of Acceptance skills | 10 | 9 | 10 | 10 | 9 | 10 | 10 |
Usefulness of Validation skills | 9 | 9 | 10 | 10 | 8 | 10 | 9 |
Ability to validate your family member | 9 | 8 | 9 | 9 | 9 | 9 | 9 |
Usefulness of Management of problems | 9 | 10 | 10 | 10 | 9 | 10 | 9 |
Ability to manage problems with your family member | 7 | 8 | 9 | 8 | 7 | 8 | 9 |
Family 1 | Family 2 | Family 3 | Family 4 | ||||
---|---|---|---|---|---|---|---|
Couple | Daughter | Mother | Father | Mother | Mother | Father | |
Program is logical | 9 | 10 | 8 | 8 | 10 | 10 | 10 |
Satisfaction with the program | 10 | 10 | 9 | 9 | 9 | 10 | 9 |
You would recommend the program | 10 | 10 | 10 | 10 | 10 | 7 | 9 |
Usefulness of program and expectations | 9 | 9 | 9 | 9 | 10 | 10 | 10 |
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Fernández-Felipe, I.; Díaz-García, A.; Marco, J.H.; García-Palacios, A.; Guillén Botella, V. “Family Connections”, a DBT-Based Program for Relatives of People with Borderline Personality Disorder during the COVID-19 Pandemic: A Focus Group Study. Int. J. Environ. Res. Public Health 2022, 19, 79. https://doi.org/10.3390/ijerph19010079
Fernández-Felipe I, Díaz-García A, Marco JH, García-Palacios A, Guillén Botella V. “Family Connections”, a DBT-Based Program for Relatives of People with Borderline Personality Disorder during the COVID-19 Pandemic: A Focus Group Study. International Journal of Environmental Research and Public Health. 2022; 19(1):79. https://doi.org/10.3390/ijerph19010079
Chicago/Turabian StyleFernández-Felipe, Isabel, Amanda Díaz-García, José Heliodoro Marco, Azucena García-Palacios, and Verónica Guillén Botella. 2022. "“Family Connections”, a DBT-Based Program for Relatives of People with Borderline Personality Disorder during the COVID-19 Pandemic: A Focus Group Study" International Journal of Environmental Research and Public Health 19, no. 1: 79. https://doi.org/10.3390/ijerph19010079
APA StyleFernández-Felipe, I., Díaz-García, A., Marco, J. H., García-Palacios, A., & Guillén Botella, V. (2022). “Family Connections”, a DBT-Based Program for Relatives of People with Borderline Personality Disorder during the COVID-19 Pandemic: A Focus Group Study. International Journal of Environmental Research and Public Health, 19(1), 79. https://doi.org/10.3390/ijerph19010079