Parenting with personality disorder intervention: a manual for health professionals

This manual is designed to assist mental health clinicians to work effectively with parents or caregivers with a personality disorder. The aim of this intervention program, in line with the relational approach of the Project Air Strategy for Personality Disorders (Project Air Strategy for Personality Disorders, 2015), is to assist mental health clinicians to reflect on parenting with people with personality disorder. The goal is to support parents, children and families to enhance protective factors and to identify and reduce risk factors. Given the daily difficulties parenting presents for caregivers with personality disorder, this approach is likely to enhance the working alliance between the clinician and the client in treatment. Addressing parenting with people with personality disorder will likely achieve better mental health outcomes for both parent and child. It is often the case that personality disorder and parenting are not talked about together, particularly when parents are seeking treatment individually in an adult mental health service. However, personality disorder can have a profound effect on the home environment, especially on children. Parents with personality disorder may engage in more problematic parenting behaviours than other parents, such as low sensitivity and responsivity, inconsistent discipline and role-reversal (see Crandell, Patrick, & Hobson, 2003; Gratz et al., 2014; Hobson, Patrick, Crandell, Garcia-Perez, & Lee, 2005; Johnson, Cohen, Kasen, Ehrensaft, & Crawford, 2006; Macfie & Swan, 2009; Newman, Stevenson, Bergman, & Boyce, 2007; Stepp, Whalen, Pilkonis, Hipwell, & Levine, 2012; Wilson & Durbin, 2012; Zalewski et al., 2014). The possibility of intergenerational transmission of mental health disorders has been well documented (Stepp, et al., 2012), and children of parents with personality disorder may be at risk of experiencing more emotional, behavioural, social and cognitive difficulties than their peers (see Barnow, Spitzer, Grabe, Kessler, & Freyberger, 2006; Crandell, et al., 2003; Dutton, Denny-Keys, & Sells, 2011; Herr, Hammen, & Brennan, 2008; Macfie & Swan, 2009; Newman, et al., 2007; Weiss et al., 1996).