Dynamic deconstructive psychotherapy: characteristics and uses

Let's see what is dynamic deconstructive psychotherapy, created to treat BPD.

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

The dynamic deconstructive psychotherapy, formulated by Robert J. GregoryThe purpose of deconstructive dynamic psychotherapy, formulated by Robert J. Gregory, is for the individual to connect with his or her own emotional experiences and develop positive relationships with those with whom he or she lives.

It is based on classical psychoanalytic models, such as object relations (the idea that the 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 may condition or distort them).

In the following we will see its basic characteristicsThe following is a brief theoretical delimitation of the proposal and a detailed analysis of its objectives.

Dynamic deconstructive psychotherapy

The deconstructive dynamic psychotherapy is designed for the assistance approach of the people who suffer from Borderline Personality Disorder (BPD)with a bleak prognosis due to the concurrence of other circumstances of clinical severity (drug abuse, interpersonal conflicts, etc.). It proposes a series 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). In addition association, attribution and alterity would also be compromisedthree facets with a key role in emotional experiences and their integration. The treatment is aimed at modifying the neurocognitive levers involved in each of them.

The program is composed of weekly sessions of 45-50 minutes duration.The focus is oriented towards evoking moments of interpersonal conflict that the patient has experienced in the preceding days, which will be explored by a therapist who takes a progressively less directive position, depending on the severity of the symptoms and the objectives reached during 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 takes a progressively less directive position, emphasizing individual responsibility throughout.

The following is 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 dynamic deconstructive psychotherapy is to enhance the person's ability to translate his or her subjective experiences into words that provide them with greater objectivity. It is a matter of transforming the symbol (or thought) into verbal content.These will be the raw material with which we will work during the sessions. In cases of greater difficulty, 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 in carrying out such a transformation process, perceiving that through coding some of the most notable nuances of what they wish to convey are lost. Nevertheless, they are able to show their inner states with great ease by resorting to art in all its forms.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 might have arisen, with the aim of dissecting them into more discrete units and weaving them coherently with the logic of his or her own narrative. The underlying intention of all possible agents involved is analyzed, as well as one's own responses and those of the other participants in the situation.

The objective is to link the emotions that are experienced with acts of reality, so that they are integrated into the narrative of the situation.The aim is to link the emotions experienced with acts of reality, so that they are integrated into the context of the things that happen in everyday life. This task aims to eliminate the ambiguity of feeling and to understand situations in order to make sense of the experience. That is, to interpret them in an integrated way.

The authors especially emphasize that BPD patients often show a disorganized attachment pattern, which arises as a result of abuse/maltreatment experiences. In this case the person struggles with the desire for closeness and the contradictory need for distancing, which coexist in the same space and which build the basis from which the next step of therapy hangs: the polarization of emotions and bonds with others.

2. Attribution

The constant oscillation of mood and the polarization in the way in which others are valued generates in the person with BPD a sense of discontinuity in the experience of life, as if it lacked a foundation on which to stand or a predictable logic. This way of living and feeling can generate a deep existential bewilderment, and is one of the reasons why the individual feels a deep emptiness when looking inward.

The person would struggle in a constant ambivalence a constant ambivalence between search and avoidance, or between approaching and fleeing, which is rarely resolved in a positive way.which is rarely adequately resolved. 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 deal with in this phase of the intervention involves the secondary consequences of the above: excessive or very poor impulse control, and inflexible projection of all responsibility on oneself or on others (no gray areas).

Throughout this stage, it is important to stimulate in the individual processes of reflection in which judgement of the experience is avoidedThis is because people suffering from BPD can make interpretations of their self that frame them as victims or executioners, which leads to emotions of helplessness or self-rejection that do not fit for them. People suffering 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 perpetual lability of mood (and of one's appraisals of others) can lead to a painful dissolution of one's own identity. Through the active search for balance, based on objectively described facts, it is possible for the person to define an adjusted image of himself and of the ties that bind him to others.

3. Alterity

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

The third phase aims to strengthen the mentalization processor the capacity to subtract communicative elements (sender, message, receiver, etc.) in order to evaluate them objectively and from an affective neutrality. From this, limits are drawn between the negative acts and the identity of their author, creating distance between the meaning-signifier and thus contributing to identify the presence or absence of some intentionality that connects them. In the event that this is the case, the derived 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 more objectively (discriminating what is real from what is not real at all). This process is very important for the assumption of the fear of abandonment, because it arises without objective reasons for it and produces a very deep discomfort.

Through the reinforcement of otherness it is sought that the person differentiates him/herself from the othersseparating his own fears from the way he perceives others, and feeling himself as the agent subject of his existence. The therapist should avoid any paternalistic attitude, reaffirming the identity of the person with whom he/she is interacting, since at this point it is essential that he/she assumes an active role with respect to his/her 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 the sufferer.It is characterized by a concatenation of externalizing problems, beyond the complexities of the sufferer's inner life. These are behaviors that generate harm to oneself or to others, and that eventually involve some danger to one's own life: unprotected sex, self-injury of various kinds, substance abuse, irresponsible driving or other acts in which risks are taken to physical or psychological integrity.

The present 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 emotion regulation. involved in the regulation of emotions and in the perception of identity as a coherent phenomenon (which have already been described above).

The deficit in the area of association leads to an unawareness of the way in which negative interactions alter emotion, so that the discomfort is perceived in a vague and intangible way. This circumstance is linked to impulsive and aimless acts, since the coordinates for the causes and consequences of the affect being experienced at a given moment could not be located. The behavior that would be carried out to cope 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 involved in the situationThis would translate into enormous difficulty in making decisions (because benefits and drawbacks are not considered simultaneously, but one or the other in isolation). There are also difficulties in inhibiting impulses, since extreme emotions tend to precipitate acts charged with irrepressible intention.

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 suffering", "I drink to drown my sorrows", etc.). The involvement of this area would also imply confusion in the processes of introspection (feeling of inner emptiness), and some of the cognitive biases most frequently manifested during this disorder (arbitrary inference, generalization, etc.).