Culturally Safe Integrative Systemic Therapy for First Nations Families Living with Borderline Personality Disorder

Abstract

This paper proposes a culturally safe integrative systemic model for supporting First Nations people with borderline personality disorder (BPD). Firstly, this paper examines BPD from a systemic perspective by observing its impact on family and therapeutic systems. An overview of the empirical evidence for integrative systemic therapy demonstrates its suitability for working with BPD, particularly when combining systemic, psychodynamic, and cognitive-behavioural paradigms. A case example illustrating a client's journey using the proposed model is presented to explain how elements of Bowen family systems therapy, narrative therapy, and dialectical behaviour therapy are blended with cultural components to form a culturally safe integrative systemic approach. An initial evaluation demonstrated positive preliminary therapeutic outcomes, with the main strengths being the cultural additions and the mitigation of power struggles in the treatment and family systems that are reported in the literature as detrimental to BPD interventions. Limitations concerning the practicality of replication in mainstream settings are noted, particularly where full cultural safety may be more difficult to achieve. The paper suggests that integrative systemic approaches combined with cultural elements may be effective when supporting First Nations families living with BPD. Finally, this is currently the only integrative culturally safe therapeutic approach proposed for this cohort, making it unique given the overall paucity of empirical evidence in the field.