DBT for Family Members of BPD Sufferers

This article was originally published as “DBT for BPD” at

Borderline Personality Disorder (BPD) is a disorder that is uniquely characterized by intense emotional dysregulation and a slow return to baseline calm. When diagnosing BPD, doctors look for nine different characteristic traits, including the frantic attempt to escape real or imagined abandonment, a pattern of intense, unstable interpersonal relationships, profound and chronic emptiness, impulsivity and risk-taking.

Given the number of traits, the varying degrees of intensity, and the subsequent number of possible trait combinations, BPD does not always manifest itself in the same way. However, the underlying sense of emptiness and the toxic self-loathing will be clear to a trained clinician.  Even if your loved one does not meet five of the nine necessary criteria for BPD, intense emotional dysregulation combined with a number of the aforementioned traits can make life difficult both for you and your loved one.

Recognizing the strain put on family members of people living with BPD, the National Educational Alliance for Borderline Personality Disorder (NEA.BPD) created the Family Connections (FC) program. This is a free program in which trained family members help participating family members, by sharing their knowledge, wisdom, and experience. This program is now offered in Israel under the auspices of the Israeli NEABPD:

The twelve-session Family Connections program was developed by Dr. Perry Hoffman and Dr. Alan Fruzzetti. During this program participants learn about the disorder and various treatment options, hear the stories of others going through the same lonely and difficult experience, and most crucially learn and practice Dialectical Behavior Therapy (DBT) skills.

This program has revolutionized the lives of many family members throughout the world by helping family members understand the challenges they face and by providing them with tools that make it easier to live with them. Several scientific studies have shown that by providing the participants with effective means of dealing with their situations their rates of grief, burden and depression have decreased and their sense of empowerment or mastery has increased.

Why DBT?

Why does the NEA.BPD Family Connections course teach DBT skills in particular? To put it bluntly, DBT skills work. Just as the skills when employed and taught by an experienced therapist can help our loved ones, they can also help us with the emotional dysregulation that dealing with a sufferer of BPD can bring.

Dialectical Behavior Therapy was first developed by Marsha Linehan, a trained psychologist and a BPD sufferer. Perhaps, no one could have understood the pain our loved ones (and anyone with extreme emotional dysregulation) go through more than she could. She predicated her therapy on the (dialectical) movement between Acceptance and Change. In a nutshell, this allows sufferers to feel truly understood and accepted before they are asked to strive for a life worth living by changing. This dialectical movement from acceptance to change also helps family members accept the reality of their situation and empowers them to change so that they can deal with their difficult reality more effectively.

The DBT Toolkit

So, how does the DBT toolkit help healthy family members? Many of the DBT skills make common sense. They are tools that many people might employ to make their lives more effective and more meaningful. However, recognizing the importance of these tools, fine-tuning them, and knowing exactly how and when to apply them is not such a simple task.

Prominent among these DBT practices are “taking the middle path”—moving between acceptance and change—and “validation,” the practice of successfully granting legitimacy to both one’s own and others’ valid thoughts, actions and behaviors.

Another component of the DBT toolkit—relationship and family environment skills—helps us to structure emotionally charged interactions, so that everyone’s needs (including our own) can be clearly communicated, recognized, and perhaps even met. Recognizing that during a crisis it is hard to remember how to use the skills, DBT demands that we practice them throughout our daily lives (at the supermarket, in the synagogue, at the gym) and provides easy-to-remember acronyms so that when things become heated, we don’t lose our heads and worsen the situation. This is no small achievement when everyone is on edge!

Less intuitive but crucial are the DBT practices of Radical Acceptance and Mindfulness, which allow us to accept and cope with our own emotional dysregulation and pain in situations that oftentimes seem unsolvable.

The various components of the DBT toolkit allow family members to alter their relationship to the problem and live more fulfilling and more effective lives.  Learning these Dialectical Behavior Therapy skills re-empowered my wife and myself as parents, giving us the ability to stand up for our rights, to care for ourselves and our non-BPD children, and for our child suffering from BPD. Taking the Family Connections course allowed us to learn the necessary skills in a supportive environment, together with other people who understood and validated our suffering.