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Pearson-Hall, Phoebe (2024) How do young adults with Borderline Personality Disorder experience their relationship with their parents/carers whilst in treatment: an interpretative phenomenological analysis. Doctoral thesis, London Metropolitian University.
Background: There is an emerging theme within the literature of borderline personality disorder (BPD) that infers the relationship between parents/carers and their child could play an important role in the development and maintenance of symptoms associated with BPD. This is understood in the context of Linehan’s (1987) biosocial model which proposes BPD is primarily an illness of emotional dysregulation. Linehan (1987) explains symptoms of BPD emerge due to long standing transactions between an individual’s biological vulnerability to heightened emotional states and an invalidating environment in childhood. It is proposed that unless an individual can leave their invalidating environment or transactions within their environment change, then the cycle of emotional dysregulation will continue. Hence, DBT for adolescents (DBT-A) has a family skills group (FSG) which sets out to assist parents/carers in learning how to respond and support their young person to create new effective transactions which model emotional regulation. Despite the same theoretical model underpinning DBT-A and DBT, there is no FSG in DBT. This is particularly interesting and relevant to young adults (YA) who could be living in the same environment as they did in childhood. Moreover, YA are likely to be emotionally and financially dependent on their parents/carers and have similar developmental needs to adolescents (Sood & Linker, 2017). Hence, researchers have suggested YA with BPD may benefit from input from their parents/carers in treatment in the same way it is understood that adolescents do (Darrow et al., 2022). However, literature supporting this theory is scarce and little is known about YA experience of their relationship with their parents/carers whilst they are in treatment. Exploring this phenomenon through a qualitative lens could shed new light on this under researched area and contribute towards developing theory and treatment for YA with BPD.
Aims: The study aimed to gain a detailed understanding of how young adults with BPD experience their relationship with their parents/carers whilst in treatment. It aimed to offer individuals an opportunity to share their experience in a currently undocumented field of literature and provide insight for clinicians working with young adults who may still be living at home with their parents/carers.
Method: Six young adult females, who had a working diagnosis of BPD were recruited from a private psychiatric hospital. Six semi-structured interviews were carried out and transcribed verbatim. Each transcript was then analysed using an Interpretative Phenomenological Analysis (IPA).
Findings: Three general experiential themes (An enmeshed relationship; implementing therapy at home with parents/carers; paving a way forward), and eight personal experiential themes were constructed from the analysis.
Conclusions: The findings suggested that young adults experienced an enmeshed relationship with their parents/carers in which they felt the need to mask their true feelings and emotions and at times struggled to recognise their emotions independently from their parents/carers. Their relationship with their parents also presented itself in the context of implementing therapy at home. This arose in a variety of contexts in which the participants felt that starting therapy made them feel more isolated from their parents/carers and unable to fully immerse themselves into therapy. Finally, participants relayed their ideas and aspirations for the future, referencing increased emotional acceptance; knowledge of their BPD; acceptance that some aspects within the relationship will not change; and with that, finding inner peace. The current study provided a foundational knowledge of how young adults may experience their relationship with their parents/carers whilst in treatment, from a narrative perspective. Implications are discussed in terms of service provision and therapeutic approaches for counselling psychologists and other professionals working with young adults with BPD.
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