Dynamic Deconstructive Psychotherapy Web-Based Training Program

Introduction to the Web-Based Training Program

This interactive program was developed to supplement training in dynamic deconstructive psychotherapy or DDP. DDP is an empirically supported and manual-based treatment initially developed for borderline personality disorder (BPD), but now applied across a broad range of chronic mental disorders, such as chronic depression and anxiety, early-onset PTSD, eating disorders, and addictions.  See DDP Training Manual.

This program includes video clips of psychotherapy sessions that illustrate principles and methods of DDP. Each vignette is an almost verbatim portrayal of an actual prerecorded patient-therapist interaction.  In making the film, we used 20 patient-therapist encounters, encompassing 9 different patients and 5 different therapists.  Even though the patients have given explicit consent for the use of the recordings, I have taken the precaution of having actors play the patient roles in order to help protect their identity.  So, you will see the same actor or actress playing the part of different patients in different vignettes.  Also, in each vignette, Dr. Georgian Mustata or I play the part of the therapist, regardless of whether or not we were the actual therapists for the patient.  As a further precaution, identifying information has been edited out.  So, in summary, each vignette represents a balance or compromise that provides as close approximation as possible to a previous, actual patient-therapist interaction, while also protecting confidentiality.

Treatment with DDP involves individual weekly sessions over 12 months and follows a manual-based protocol.  Before beginning DDP, I suggest reading all chapters in the treatment manual, receiving weekly case consultation, and reviewing the vignettes in this series.  

DDP targets two areas for remediation: 1) Deficits in the emotion processing system and 2) An embedded sense of badness.  According to DDP theory, these two etiologies cause difficulties in specific neuroaffective capacities, called Association, Attribution, and Alterity.  Treatment with DDP targets each of these neuroaffective capacities utilizing three sets of related techniques, i.e. Association, Attribution and Alterity techniques.  See the first two chapters of the manual for a more comprehensive introduction.

Treatment begins with an evaluation, a formulation of difficulties and treatment goals, and explicit written commitments to recovery (see Chapter 3, Establishing the Frame).  The goal is to foster a sense of ownership and autonomous motivation within patients for their own treatment and recovery.  Clear boundaries, roles, and expectations are also established early on.  After the first few sessions, the principal focus is to foster verbalization of recent specific emotion-laden experiences, including identifying and labeling underlying emotions and sequencing interactions into simple narratives (Association techniques).  The therapist also tries to help the patient open up the meanings of these narratives by bringing in new perspectives for the patient to consider, while remaining generally non-directive and non-judgmental (Attribution techniques).  In addition, there is a strong experiential component to the treatment whereby emotion-laden interactions between the patient and therapist can either enact and reify the patient’s pathological schema, or can support self-other differentiation, repair ruptures in the alliance, and foster individuated relatedness (Alterity techniques).  Treatment progresses over four distinct stages, each characterized by specific therapy tasks and patterns of relatedness. 

Problematic behaviors, such as alcohol misuse or self-harm, are viewed as compensatory, maladaptive efforts to self-soothe in the absence of verbal/symbolic and relational capacities.  The therapist encourages verbalization of recent episodes of problematic behaviors, including antecedents, consequences, and associated emotions (see section on Managing Self-Destructive and Maladaptive Behaviors in Chapter 8, Specific Techniques). 

I am hoping the video vignettes will bring to life some of the text in the treatment manual.  The sequence of vignettes follows the same organization as employed in Chapter 8, Specific Techniques, and as employed in the DDP Adherence Scale in the Appendix.  That is, we will begin with a group of vignettes illustrating Association techniques, and then move to Attributions, Ideal Other, Alterity Real, and, finally, Enactments.  For more resources, see the main DDP Website.

 

Robert J. Gregory, M.D.

Director, Psychiatry High Risk Program

Director, Suicide Prevention Center

Professor of Psychiatry

Norton College of Medicine Upstate Medical University