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Dynamic Deconstructive Psychotherapy

Dynamic Deconstructive Psychotherapy (DDP) is an evidence-based model of psychotherapy that was originally developed for borderline personality disorder, but now is used for a wide array of other serious conditions, such as chronic depression and anxiety, suicidality, posttraumatic stress disorder, eating disorders, dissociation, and alcohol and drug dependence.  Research suggests that individuals having these diverse conditions have an impaired capacity to adaptively process emotionally laden experiences, attain a positive sense of self, and to develop authentic and fulfilling relationships. 

DDP combines elements of translational neuroscience, object relations theory, and deconstruction philosophy and involves weekly individual sessions for up to 12 months.  DDP differs fundamentally from most other therapies in that it is a recovery-based model, instead of a chronic illness-based model of care.  Instead of providing advice, problem-solving, or skills to deal with the symptoms and issues of chronic illnesses, DDP attempts to address the underlying vulnerabilities of these conditions in order to provide transformative healing leading to recovery. During weekly sessions, clients recount recent emotion-laden experiences, explore their emotions and reactions, reflect upon their experiences in increasingly integrative, complex, and realistic ways, learn how to develop close, authentic relationships, and work towards self-acceptance and self-compassion.

In numerous clinical trials, DDP has been shown to improve symptoms of borderline personality disorder, dissociation, and depression, to lessen complex behavioral problems, such as suicide attempts, self-harm, and substance misuse, to decrease institutional care, and to improve social and occupational functioning.  Because of these findings, the U.S. federal agency SAMHSA lists DDP as a treatment with evidence of effectiveness in its Suicide Prevention Resource Center (see www.sprc.org).

Training Opportunities in DDP

  • Individual clinical supervision provided to PGY-III psychiatry residents
  • Elective in DDP is available for senior residents and psychology interns, which includes didactic instruction, assigned readings, and clinical consultation
  • Fee-based workshops and individual or group consultation is available to individuals and agencies (see list of therapists with advanced competency in DDP)

Resources

Faculty

  • Robert Gregory
  • Ann Arezzo
  • Katherine Cerio
  • Danielle Davis
  • Glenn Forsythe
  • Rachael Kuch-Cecconi
  • Cynthia Malek
  • Abigail Riggall
  • Joseph Schmidt
  • Rebecca Shields
  • Scott Ulberg

References

Thomas, J. G., Sperry, S. D., Shields, R. J., Gregory, R. J. (2022).  A novel recovery-based suicide prevention program in upstate New York. Psychiatric Services 73, 701-704. 

Majdara, E., Rahimian-Boogar, I., Talepasand, S., Gregory, R. J. (2021).  Dynamic deconstructive psychotherapy in Iran: A randomized controlled trial with follow-up for borderline personality disorder. Psychoanalytic Psychology 38, 328-335.

Gregory, R.J. & Sachdeva, S. (2016). Naturalistic outcomes of evidence-based therapies for borderline personality disorder at a medical university clinic. American Journal of Psychotherapy 70, 167-184.

Chlebowski, S., & Gregory, R. J. (2012). Three cases of dissociative identity disorder co-occurring with borderline personality disorder treated with dynamic deconstructive psychotherapy. American Journal of Psychotherapy, 66, 165-180.

Deranja, E., Manring, J., & Gregory, R. J. (2012). A manual-based treatment approach for training psychiatry residents in psychodynamic psychotherapy. Journal of the American Psychoanalytic Association, 60, 591-598.

Goldman, G. A., & Gregory, R. J. (2010). Relationships between techniques and outcomes for borderline personality disorder. American Journal of Psychotherapy, 64, 359-371.

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.

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., 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.

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

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

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

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