Dynamic deconstructive psychotherapy

Dynamic Deconstructive Psychotherapy (DDP) is a manual-based treatment for borderline personality disorder. It has been developed by Robert Gregory for severe and treatment-refractory clients, especially those with co-occurring substance use disorders. It is a time-limited treatment that involves weekly individual sessions over 12 months, and combines elements of neuroscience research, object relations theory, and deconstruction philosophy. DDP postulates that individuals suffering from borderline personality disorder need to remediate a neurocognitive deficit in the ability to process emotionally charged experiences, as well as to overcome an embedded sense of badness.

The goals of DDP are: (1) connecting with one’s own emotional experiences in order to develop an integrated sense of self and (2) connecting with others in more authentic ways, so as to improve the quality of relationships.

The primary focus of treatment is on recent social interactions. Three sets of techniques are employed: Association, Attribution, and Alterity. With Association techniques, the therapist helps the client to develop a narrative sequence of a given interaction and to identify emotions that the client may have experienced. With Attribution techniques, the therapist helps the client to examine alternative ways to interpret the interaction, thereby deconstructing rigid, polarized attributions towards self and other, and opening up new and more complex perspectives. With Alterity techniques, the therapist provides deconstructive experiences within the therapist-client relationship that support individuation and help to experientially deconstruct rigid, polarized attributions.

DDP is offered on a weekly basis in 45-50 minute sessions. Between sessions, clients are encouraged to work on connecting to their emotional experiences using Daily Connection Sheets, and to attempt to develop more authentic and individuated relationships outside of treatment.

DDP is a time-limited treatment proceeding through four sequential stages with the duration pre-determined to be 12 months. The expectation is not that the client will be cured within 12 months, but that the client will be sufficiently recovered to move out of intensive mental health treatment. For patients who are not ready for this step at the end of 12 months, monthly maintenance sessions or 6-month blocks of weekly booster sessions are made available.

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