Dynamic Deconstructive Psychotherapy

Dynamic Deconstructive Psychotherapy (DDP) is a 12-month treatment for young adults with borderline personality disorder and other complex behavior problems, such as alcohol or drug dependence, self-harm, eating disorders, and recurrent suicide attempts. There is evidence that complex behavior problems are maladaptive ways coping with negative life experiences, and are often accompanied by identity disturbance, low self-esteem, depression, anxiety, moodiness, impulsivity and an inability to sustain fulfilling relationships. Neuroscience research suggests that individuals having complex behavior problems process emotionally-charged experiences in aberrant ways; there is a relative deactivation of medial prefrontal and posterior brain regions responsible for attaining a sense of self and self-other differentiation. On the other hand, there is hyper-activation of limbic regions, including the amygdala and ventral striatum, which contribute to hyperarousal and impulsivity.

DDP combines elements of translational neuroscience, object relations theory, and deconstruction philosophy. Therapists provide weekly one-hour individual sessions helping patients activate those areas of the brain responsible for adaptive and integrative processing. Sessions involve discussing recent emotionally-charged experiences and integrating different ways of making meaning of those experiences. In addition, therapists provide novel experiences in the patient-therapist relationship that support individuation and challenge patients’ basic assumptions about themselves and others.

A 12-month randomized controlled trial with 30-month follow-up compared the efficacy of DDP to high intensity treatment in the community for individuals with borderline personality disorder and co-occurring alcohol misuse. DDP resulted in significant improvements in suicide attempts, self-harm, heavy drinking, drug use, and multiple measures of psychopathology, including depression, dissociation, impulsivity, mood instability, and perceived social support. Moreover, the adherence of therapists to DDP techniques was highly correlated with outcome, suggesting that specific treatment effects were responsible for patient improvement.

Training Opportunities in DDP

  • Individual clinical supervision provided to PGY-III psychiatry residents
  • Elective course in DDP is available for senior residents and psychology interns, which includes didactic instruction and cllinical consultation
  • Half-day and full-day workshops
  • An interactive multimedia training module and a training manual are freely available.

Resources

Faculty

References

Gregory, R. J. (2004). Thematic stages of recovery in the treatment of borderline personality disorder. American Journal of Psychotherapy, 58, 335-348.

Gregory, R. J. (2005). The deconstructive experience. American Journal of Psychotherapy, 59, 295-305.

Gregory, R. J. (2007). Borderline attributions. American Journal of Psychotherapy, 61, 131-147.

Gregory, R. J., Chlebowski, S., Kang, D., Remen, A. L., Soderberg, M. G., Stepkovitch, J., Virk, S. (2008).A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy: Theory, Research, Practice, Training, 45, 28-41.

Gregory, R. J., Remen, A. L. (2008). A manual-based psychodynamic therapy for treatment-resistant borderline personality disorder. Psychotherapy: Theory, Research, Practice, Training, 45, 15-27.

Goldman, G. A., Gregory, R. J. (2009)Preliminary relationships between adherence and outcome in dynamic deconstructive psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 46, 480-485.

Gregory, R. J., Delucia-Deranja, E., & Mogle, J. A. (2010). Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder co-occurring with alcohol use disorders: 30-month follow-up. Journal of Nervous and Mental Disease, 198, 292-298.