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Dynamic Deconstructive Psychotherapy

Dynamic deconstructive psychotherapy (DDP) is a manual-based psychodynamic therapy developed for particularly challenging cases of borderline personality disorder (BPD), such as those having co-occurring substance use disorders or antisocial personality disorder. The treatment model is based on the hypothesis that the identity disturbance of BPD and related manifestations reflect a core neurocognitive deficit of aberrant processing of emotional experiences. DDP remediates this deficit by facilitating elaboration and integration of affect-laden interpersonal experiences and related attributions of self and other, as well as providing novel experiences in the patient-therapist relationship that promote self-other differentiation and a positive therapeutic alliance. Treatment involves weekly individual sessions for a predetermined period of time and follows sequential stages.

In a 12-month randomized controlled trial and 30-month follow-up, treatment with DDP resulted in significant improvements in suicide-related behaviors, heavy drinking, drug use, and multiple measures of psychopathology, including depression, dissociation, perceived social support, and core symptoms of BPD, as compared to optimized community care.

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. Preliminary relationships between adherence and outcome in dynamic deconstructive psychotherapy. Psychotherapy: Theory, Research, Practice, Training, in press.