Becoming diplomats with boundaries - a thematic analysis of relatives' experiences with group-based psychoeducation about bipolar disorder.

Background: Group-based psychoeducation for relatives of patients with bipolar disorder (BD) is offered at the Copenhagen Affective Disorder Clinic, Denmark. This qualitative study explores relatives' experiences with the program, how it influenced them, and key factors shaping these effects.

Methods: We interviewed 10 relatives (5 parents and 5 partners) who had recently completed the psychoeducation program. We included only parents and partners, as they make up 90% of attendees at the clinic's psychoeducation. The interviews were individual, semi-structured, audio-recorded, transcribed, and analyzed using reflexive thematic analysis. Through a concurrent parallel RCT study involving 206 relatives, we obtained 70 written commentaries from an evaluation questionnaire about the education.

Results: Through the analysis, we developed five themes: A: Relating through shared experiences, B: Understanding the land of Bipolar Disorder, C: Trusting the Treatment Means Sharing the Burden, D: Setting boundaries to protect yourself, and E: Becoming a diplomat. Participants valued recognizing themselves in others, but meaningful recognition required similarity in relation (partner or parent) and BD type I or II (theme A). Understanding BD and its treatment was crucial for participants (B & C), with some participants reporting significant knowledge gains while others were already familiar. Some participants found great relief in meeting the clinicians and learning to trust the treatment, as they had previously been concerned about its quality and felt a self-imposed responsibility (theme C). Many, especially partners, found setting boundaries challenging and wanted more focus on this subject in the education (D). In theme E, we explore how relatives reflected on their ability to cope in difficult situations by being diplomatic and strategic and drawing on the insights described in themes A-D.

Conclusions: Group-based psychoeducation for relatives of patients with BD was feasible and addressed core support needs, but adjustments could enhance its impact. In a large-group setting, participants could be divided into smaller discussion groups based on their relationship to the patient and/or the patient's BD type. Additionally, we propose incorporating 'diplomats with boundaries' as a positive caregiving model, conceptualized through our analysis.

Trial Registration: The investigation was conducted as part of the R-Bipolar study registered at ClinicalTrials.gov, ID NCT06176001, 19/12/2023. Submission for ethical approval was not required (Journal-nr.: 21063013).