Deconstructive Dynamic Psychotherapy: Characteristics and Uses

Personality disorders can be a real therapeutic challenge, in the face of which it is essential to display maximum professional skill and human sensitivity. Only from this confluence can a formula emerge that benefits the patient.

Deconstructive dynamic psychotherapy, formulated by Robert J. Gregory pursues the purpose of allowing the person to connect with their own emotional experiences and develop positive relationships with those who live with them.

It is based on classic psychoanalytic models, such as object relations (the idea that one’s own “self” exists only in relation to other objects) or the philosophy of deconstruction (reorganization of thoughts in the face of contradictions and logical fallacies that can condition or distort it).

Below we will see its basic characteristics with a brief theoretical delimitation of the proposal and a detailed analysis of its objectives.

Deconstructive dynamic psychotherapy

Deconstructive dynamic psychotherapy It is designed for the care approach of people who suffer from Borderline Personality Disorder (BPD), with a gloomy prognosis due to the concurrence of other clinically serious circumstances (drug abuse, interpersonal conflicts, etc.). It proposes a succession of therapeutic modules justified by the neurological disturbances found in these patients through neuroimaging studies (on the hippocampus, amygdala, anterior cingulate cortex and prefrontal areas).

These functional and structural alterations would generate a deleterious impact on processes such as memory, affective regulation and executive functions (especially decision making and attributional processes). Besides association, attribution and alterity would be compromised; three facets with a key role in emotional experiences and their integration. The treatment is aimed at modifying the neurocognitive mechanisms that are involved in each of them.

The program is made up of weekly sessions lasting 45-50 minutes, which last for a year or a year and a half, depending on the severity of the symptoms and the objectives that are achieved throughout the process. The focus is oriented towards the evocation of moments of interpersonal conflict that the patient has experienced in the preceding days, which will be explored by a therapist who adopts a progressively less directive position, emphasizing individual responsibility throughout.

Next we will see an analysis of all the areas that are contemplated in the application of the procedure, as well as the techniques to be deployed in each of the cases.

1. Association

One of the fundamental purposes of deconstructive dynamic psychotherapy is to enhance the person’s ability to translate their subjective experiences into words that give them greater objectivity. It is about transforming the symbol (or thought) into verbal content, which will be the raw material that will be worked with during the sessions. In more difficult cases, metaphors can be used, which imply a space that borders on both sides, on the limit of what is thought and what is narrated.

The model suggests that people with BPD have difficulty carrying out such a transformation process, perceiving that through encoding they lose some of the most notable nuances of what they wish to convey. Nevertheless, They can show their internal states with great ease by resorting to art in all its forms so this becomes a tool in the process of association between emotion and verbalization that can be used in the therapeutic act.

What the therapist does in these cases is to recall with the patient the most recent examples (from everyday life) in which some overwhelming or difficult experience could have arisen, with the aim of dissecting them into more discrete units and stringing them together in a coherent way with the logic of his own narrative. The underlying intention of all possible agents involved is analyzed, as well as the responses of oneself and those of the rest of the participants in the situation.

The objective is to link the emotions experienced with acts of reality, so that these are integrated into the context of the things that happen on a daily basis. This task aims to eliminate the ambiguity of the feeling and understand the situations through which to give meaning to the experience. That is, interpret them in an integrated way.

The authors place special emphasis on the fact that patients with BPD often show a disorganized attachment pattern, which arises as a result of experiences of abuse/maltreatment. In this case the person fights against the desire for closeness and the contradictory need for distancing, which coexist in the same space and which build the base from which the next step of the therapy depends: the polarization of emotions and bonds. with the rest.

2. Attribution

The constant swing of mood and polarization in the way others are valued It generates in the person with BPD a feeling of discontinuity in the life experience, as if it lacked foundations on which to stand or a predictable logic. This way of living and feeling can generate deep existential confusion, and is one of the reasons why the individual feels a deep emptiness when he looks inside.

The person would debate a constant ambivalence between seeking and avoiding, or between approaching and fleeing, which is rarely resolved adequately. The self-image would therefore be very unstable, to the point that it would be very difficult to find words with which to describe what one is. One of the most relevant aspects to be addressed in this phase of the intervention involves the secondary consequences of what has been outlined: excessive or very poor control of impulses, and inflexible projection of all responsibility on oneself or on others (without gray areas).

Throughout this stage it is important to raise in the person reflection processes that avoid judging the experience, so that you can place yourself on a plane that allows for a balanced analysis of what you feel. And people who suffer from BPD can make interpretations of their self that frame them as victims or executioners, which leads them to emotions of helplessness or self-rejection that do not fit at all with the objective parameters of the event that triggered them.

The model proposes, in short, that the perpetual lability of the mood (and the evaluations made of others) can lead to a painful dissolution of one’s identity Through the active search for balance, based on objectively described facts, it is possible for the person to define an adjusted image of themselves and the ties that unite them to others.

3. Otherness

The negative interpretation of any event depends on its result and the voluntariness attributed to the hand of the person who executes it. That is, to what extent it is considered that the undesirable consequences of some adverse event could have been avoided if the triggering agent had desired it, or to what extent the injury occurred deliberately and definitely maliciously.

The third phase aims strengthen the mentalization process, or the ability to subtract communicative elements (sender, message, receiver, etc.) to evaluate them objectively and from affective neutrality. From this, limits are drawn between negative acts and the identity of their author, creating distance between the meaning-signifier and thus contributing to identifying the presence or absence of some intentionality that connects them. If this is the case, the resulting emotions must be precisely addressed.

The adoption of a position of external observer of all internal processes is also sought, so that they are devoid of emotion and can be analyzed in a more objective way (discriminating what is real from what is not real at all). This process is very important for the assumption of fear of abandonment, since it arises without objective reasons for it and produces very deep discomfort.

Through the reinforcement of otherness The aim is for the person to differentiate himself from others, separating his own fears from the way he perceives others, and feeling like the agent of his existence. The therapist must avoid any paternalistic attitude, reaffirming the identity of the person with whom he is interacting, since at this point it is essential that he assumes an active role with respect to his conflicts and problems of a social nature.

Management of problematic behaviors

BPD is characterized by a concatenation of externalizing problems, beyond the complexities of the inner life of those who suffer from it. These are behaviors that cause harm to oneself or others, and that eventually pose some danger to one’s own life: unprotected sex, self-harm of various degrees, abuse of narcotic substances, irresponsible driving or other acts in which risks to physical or psychological integrity.

This model understands that these are behaviors associated with problems in the three aforementioned areas, which can be explained by a functional alteration of the different brain systems involved in the regulation of emotions and in the perception of identity as a coherent phenomenon (which were already described previously).

The deficit in the area of ​​association entails an unawareness of the way in which negative interactions alter emotion, such that discomfort is perceived in a vague and intangible way. This circumstance is linked to impulsive acts lacking an objective, since the coordinates for the causes and consequences of the affect that is being experienced at a given moment could not be located. The behavior that would be carried out to deal with stressors would be erratic or chaotic.

Attribution deficits would be related to a polarity of judgment that blocks the considered analysis of the nuances included in the situation, which would translate into enormous difficulty in making decisions (since the benefits and drawbacks are not considered simultaneously, but rather one or the other in isolation). There are also difficulties in inhibiting impulses, since extreme emotions usually precipitate acts loaded with uncontrollable intention.

The difficulties in otherness would hinder the effective separation of the real and the symbolic, generating spurious associations between acts and their consequences (“I cut myself to alleviate the suffering”, “I drink to drown the sorrows”, etc.). Commitment This area would also imply confusion in the processes of introspection (feeling of inner emptiness), and some of the cognitive biases that most frequently manifest during this disorder (arbitrary inference, generalization, etc.).