Alan E. Fruzzetti

Family interaction and the development of borderline personality disorder: A transactional model

Although no prospective epidemiological studies have evaluated the relationship between family interactions and the development of borderline personality disorder (BPD), there is considerable evidence for the central role of family interactions in the development of BPD. This paper describes the role of family interactions or processes, especially those that might be regarded as invalidating or conflictual, negative or critical, and the absence of more validating, positive, supportive, empathic interactions, in the development of BPD. Perhaps more importantly, the proposed model considers how these parental and family behaviors transact with the childs own behaviors and emotional vulnerabilities, resulting in a developmental model of BPD that is neither blaming of the family member with BPD nor of her or his parents and caregivers, and has important and specific implications for both prevention and intervention.

Dialectical behavior therapy for domestic violence: Rationale and procedures

Domestic violence is a significant social problem with significant psychological and medical consequences for its victims and their children. In part because treatments for domestic violence are often not effective, and in part because of the hypothesized similarities between the problems of chronically aggressive men and chronically suicidal women (e.g., emotion dysregulation), a rationale for applying Dialectical Behavior Therapy (DBT) to domestic violence is provided. This new application of DBT, designed to treat aggression and violence in families, is described. Aggression assessment procedures and conceptualization issues are presented, along with a case to illustrate treatment principles and intervention strategies. Typically targeting men who batter their partners, this new application includes the four essential functions of DBT, including attending to client motivation, skill acquisition, skill generalization, and team/therapist consultation. In addition, a number of new treatment developments are presented to target reducing and eliminating aggression: validation and empathy skill training; a focus on reconditioning anger responses to be more normative (including identifying alternative emotions and their associated effective coping responses); skills training on accurate interpersonal emotional expression; and understanding the functions of aggression and teaching skills in how formerly aggressive partners can get relationship and self-management needs met skillfully. A brief overview of the other strategies and components of DBT, and how they are applied to treating domestic violence, is also provided. Particular attention is devoted to therapists maintaining a nonjudgmental stance by utilizing mindfulness practice and team consultation.

Painfully reassuring? : The effects of validation on emotions and adherence in a pain test

Communicating reassurance to patients with musculoskeletal pain complaints, but no red flags, presents a dilemma of dampening worry while refraining from reinforcing undue pain behaviors. Previous research shows that reassurance does not decrease negative affect and may be perceived as not taking the symptoms seriously. Validation offers an alternative where the patients experiences and feelings are acknowledged and has demonstrated, for other problems, a decrease in arousal which may set the stage for behavioral change. The purpose of this study was to investigate experimentally whether validation, as compared to invalidation, impacts on emotions and adherence during repeated pain tests.

Understanding and engaging families: An Education, Skills and Support Program for relatives impacted by Borderline Personality Disorder

Background: Few methodologically sound studies have been conducted to facilitate the understanding of relationships in families with a member suffering from severe personality disorders. Because of severity, symptomatology, and high rates of co-occurring disorders, borderline personality disorder (BPD) particularly affects family members and others in their social environment. However, there are few interventions available to address the needs of these family members. Aim: To report on a replication and extension study of ©Family Connections (FC), a 12-week community-based BPD education program for family members. Method: FC participants (N = 55) were assessed pre, post and at 3-month post program follow-up on: (i) levels of change in family well-being outcomes: burden, grief and empowerment; and (ii) differences between male and female participants in these outcomes. Results: Findings from the original FC study were replicated and extended: Participants showed significant improvements on all well-being variables, including significant reductions in depression. Outcomes for male vs. female participants were comparable at program completion except for grief, on which women remained higher than men despite significant improvements for both. Conclusion: BPD family members experience significant distress but benefited from this semi-structured group program led by family members. Findings support the use of the FC program. Declaration of interest: None.

Parental Validating and Invalidating Responses and Adolescent Psychological Functioning An Observational Study

The current study assessed the extent to which parental validating and invalidating behaviors (a) could be reliably measured in parent–adolescent relationships, (b) differed significantly between clinic and nonclinic families, and (c) were associated with measures of adolescent emotion dysregulation, behavior problems, and parent–adolescent relationship satisfaction. Adolescents (N = 29; age range = 12–18; 62% female) and their parents completed a variety of self-report and parent-report measures of adolescent functioning. Ratings of parents’ validating and invalidating responses during video-recorded social support and problem-solving interactions were obtained. Results indicated that parental validating and invalidating behaviors (a) were measured with a high degree of reliability, (b) differed significantly between clinic and nonclinic families, and (c) were correlated, in expected directions, with adolescent emotion dysregulation, externalizing problem behaviors, and adolescent relationship satisfaction. The implications of these findings are discussed in terms of both research and potentially improved family interventions.

I see you're in pain - The effects of partner validation on emotions in people with chronic pain

Abstract Background and aims Chronic pain not only affects the person in pain, but can also have a negative impact on relationships with loved ones. Research shows that chronic pain is associated with difficulties in marital relationships, which in turn is related to a variety of negative outcomes such as psychological distress and conflict within the family. This suggests that couples where chronic physical pain is present also struggle with emotional pain and relationship problems, and thus targeting relationship skills and interpersonal functioning might be helpful for these couples. Although studies in this area are promising, their numbers are few. In the present study, validation as a way of communicating is suggested for handling emotional expression in interpersonal interactions. Validation communicates understanding and acceptance of the other person’s experience, and it has been shown to have a down-regulating effect on negative emotions. It has previously been demonstrated to be important for these couples. However, the feasibility and effects of increasing partner validation in these couples are unknown. Therefore, the aim of the present study was to investigate if a brief training session in validation for spouses would result in more validating and fewer invalidating responses towards their partners with pain, and to investigate if changes in these behavioural responses were associated with changes in emotion and pain level in the partner with pain. Methods Participants were 20 couples where at least one partner reported chronic pain. The study employed a within-groups design in which spouses of people with pain received validation training (without their partner’s knowledge), and their validating and invalidating responses were rated pre- and post-intervention using a reliable observational scale. Also, positive and negative affect and subjective pain level in the persons with pain were rated pre- and post-intervention. Results Results showed that the validation training was associated with increased validating and decreased invalidating responses in the partners. Their spouses with chronic pain reported a decrease in negative affect from pre- to post-training. Conclusions Our results indicate that the partner or closest family member, after brief validation training, increased validating responses and decreased invalidating responses towards the person with pain, which had an immediate positive impact on emotions in the other person. Implications This study suggests that using validation in interpersonal interactions is a promising tool for couples where chronic pain is present.

Fostering Validating Responses in Families

SUMMARY Families and family interactions can play a role in the development (vs. prevention), maintenance (or remediation), and treatment of borderline personality disorder (BPD); and, having a family member with BPD can have a significant impact on family functioning. This paper reviews a transactional model for the development and maintenance of BPD, with implications for treatment, particularly from the perspective of dialectical behavior therapy (DBT). The paper also describes a subset of DBT interventions specifically developed for work with couples and families to turn the destructive “inaccurate expression/invalidation cycle” into the constructive “accurate expression/validation cycle,” which is illustrated by a case example.

A hybrid emotion-focused exposure treatment for chronic pain: A feasibility study

Abstract Background and aims Exposure in vivo for patients with fear-related chronic pain has a strong theoretical base as well as empirical support. However, the treatment does not work for every patient and overall the effect size is only moderate, underscoring the need for improved treatments. One possible way forward might be to integrate an emotion regulation approach since emotions are potent during exposure and because distressing emotions may both interfere with exposure procedures and patient motivation to engage in exposure. To this end, we proposed to incorporate an emotion-regulation focus into the standard exposure in vivo procedure, and delivered in the framework of achieving relevant personal goals. The aim of this study then was to test the feasibility of the method as well as to describe its effects. Method We tested a hybrid treatment combining an emotion-regulation approach informed by Dialectical Behaviour Therapy (DBT) with a traditional exposure protocol in a controlled, single-subject design where each of the six participants served as its own control. In this design participants first make ratings to establish a baseline from which results during treatment and the five month follow-up may then be compared. To achieve comparisons, participants completed diary booklets containing a variety of standardized measures including pain catastrophizing, pain intensity, acceptance, and function. Results Compared to baseline, all subjects improved on key variables, including catastrophizing, acceptance, and negative affect, at both post treatment and follow up. For 5 of the 6 subjects considerable gains were also made for pain intensity and physical function. Criteria were established for each measure to help determine whether the improvements were clinically significant. Five of the six participants had consistent results showing clinically significant improvements across all the measures. The sixth participant had mixed results demonstrating improvements on several variables, but not on pain intensity or function. Conclusions This emotion-regulation hybrid exposure intervention resulted in considerable improvements for the participants. The results of this study underscore the potential utility of addressing emotions in the treatment of chronic pain. Further, they support the idea that targeting emotional stimuli and using emotion regulation skills in conjunction with usual exposure may be important for obtaining the best results. Finally, we found that this treatment is feasible to provide and may be an important addition to usual exposure. However, since we did not directly compare this hybrid treatment with other treatments, additional research is needed before firm conclusions can be made. Implications Addressing emotional distress in the treatment of patients suffering chronic pain appears to be quite relevant. Emotion regulation skills, employed together with exposure in vivo, hold the promise of being useful tools for achieving better results for patients suffering fear-related and emotionally distressing chronic pain.

Risk factors affecting children of mothers with borderline personality disorder: Comment on Stepp, Whalen, Pilkonis, Hipwell, and Levine (2011).

Comments on an article Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention by Stepp, Whalen, Pilkonis, Hipwell, and Levine (see record 2011-05873-001). Despite both a limited empirical literature and the muddy problem of borderline personality disorder (BPD) classification, the authors have significantly clarified the risk factors relevant to children of mothers with BPD and have outlined important and reasonable skill-based interventions likely to mitigate these risks. Not only have they sensibly connected the dots among the extant studies (which included very different samples, ages of children, criterion behaviors, etc.), they have identified the few key points of agreement across studies and translated these into a blueprint for early intervention. This commentary (a) further elaborates on some of the parameters of BPD that make risk assessment for children of mothers with BPD complicated, including both diagnostic heterogeneity and myriad other problems that reduce the specificity of BPD as a classification tool for these purposes and (b) identifies direct, indirect, and general mechanisms of transmission of difficulties from a mother (or parent or caregiver) with BPD to her child.

Improving peer supervisor ratings of therapist performance in dialectical behavior therapy: An Internet-based training system.

The present study involved the development of an Internet-based training system (ITS) to help train peer supervisors. The system, which was piloted with Dialectical Behavior Therapy (Linehan, 1993) using mock sessions, demonstrates how Internet-based technology can facilitate training protocols to support the ongoing training and supervision of therapists efficiently. Participant evaluation of the system was very positive, with over 90% of respondents reporting that they believed that the ITS was very useful or extremely useful for therapist training. Possible uses of the system include: (a) helping therapists to learn to discriminate more effective from less effective interventions to provide better feedback to supervisees and peers on their sessions, (b) helping therapists to improve their own ability to monitor and deliver a treatment effectively, and (c) helping to structure therapist training and supervision activities. The system could also be used to help with real-world supervision of therapists, assuming that legal and ethical issues associated with the use of the Internet for clinical supervision are addressed adequately. (PsycINFO Database Record (c) 2010 APA, all rights reserved).