Personality disorders can be a real therapeutic challenge, facing which it is essential to display the maximum of professional competence and human sensitivity. It is only from this confluence that a formula can emerge which translates into a benefit for the patient.
Dynamic deconstructive psychotherapy, formulated by Robert J. Gregory, Pursues the person’s goal of connecting with their own emotional experiences and developing positive relationships with those who live with them.
It is based on classical psychoanalytic models, such as object relations (the idea that the “me” itself exists only in relation to other objects) or the philosophy of deconstruction (reorganization of thoughts in the face of logical contradictions and sophisms which can condition or distort it).
Below we will take a look at its basic features., With a brief theoretical delineation of the proposal and a detailed analysis of its objectives.
Dynamic deconstructive psychotherapy
Dynamic deconstructive psychotherapy is designed to support people with borderline personality disorder (BPD), With a grim prognosis due to the concordance of other circumstances of clinical severity (drug addiction, interpersonal conflicts, etc.). It raises a succession of therapeutic modules justified by the neurological disorders found in these patients through neuroimaging studies (on the hippocampus, the amygdala, the anterior cingulate cortex and the prefrontal areas).
These functional and structural alterations would generate a deleterious impact on processes such as memory, affective regulation and executive functions (in particular decision-making and attribution processes). outraged association, attribution and otherness would be compromised; three facets with a key role in emotional experiences and their integration. The treatment aims to modify the neurocognitive mechanisms involved in each of them.
The program consists of weekly sessions of 45 to 50 minutes, Which extend over a year or a year and a half, depending on the severity of the symptoms and the goals achieved throughout the process. Emphasis is placed on the evocation of moments of interpersonal conflict that the patient has experienced in the previous days, which will be explored by a therapist who takes a less and less managerial position, emphasizing through it all the individual responsibility.
Below, we will see an analysis of all the areas considered in the application of the procedure, as well as the techniques to be deployed in each case.
One of the fundamental goals of dynamic deconstructive psychotherapy is to improve a person’s ability to translate their subjective experiences into words that give them greater objectivity. It’s about transforming the symbol (or thought) into verbal content, Which will be the raw material to work with during the sessions. In the more difficult cases, metaphors can be used, which involve a space that limits both sides, at the limit of what has been thought and told.
The model suggests that people with BPD find it difficult to complete such a transformational process, perceiving that by coding some of the most notable nuances of what they wish to convey are lost. However, they can come and show their inner states with great ease by resorting to art in all its forms, So that it becomes a tool in the process of association between emotion and verbalization which can be exploited 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 an overwhelming or difficult experience might have arisen, with the aim of dissecting them into more discrete units and weaving them together. . the logic of his own story. The underlying intention of all possible agents involved is analyzed, as well as the responses of oneself and those of other participants to the situation.
The goal is to link the emotions felt to the acts of reality, So that these are integrated into the context of things that happen day to day. The purpose of this task is to eliminate the ambiguity of feeling and understanding the situations by which to make sense of the experience. In other words, to interpret them in an integrated way.
The authors place particular emphasis on the fact that patients with BPD often exhibit a disorganized bonding pattern, which results from experiences of abuse / maltreatment. In this case, the person struggles against the desire for approach and the contradictory need for distance, which coexist in the same space and build the basis from which the next stage of therapy takes place: the polarization of emotions and the links. with the others.
The constant oscillation of mood and polarization in how others are valued it generates in the person with BPD a feeling of discontinuity in the experience of life, as if they lacked a foundation on which to base or a predictable logic. This way of living and feeling can generate a deep existential perplexity, and it is one of the reasons why the individual feels a deep emptiness when looking within.
The person would debate in constant ambivalence between pursuit and avoidance, or between approach and flight, Which is rarely resolved correctly. Self-image would therefore be very unstable, to the point that it would be very difficult to find words to describe what it is. One of the most relevant aspects to deal with in this phase of the intervention concerns the secondary consequences of the review: excessive or very weak control of impulses, and inflexible projection of any responsibility on oneself or on others (without gray areas).
Throughout this stage, it is important to arouse in the person thought processes in which judging experience is avoided, So that he can be placed on a plane that allows weighted analysis of what he feels. And it is that people who suffer from BPD can make interpretations of their selves that frame them as victims or tormentors, which leads them to feelings of helplessness or self-rejection that do not fit at all. with the objective parameters of success he blew them up. .
The model proposes, in short, that the perpetual lability of mood (and the assessments made of others) can lead to a painful dissolution of one’s own identity. By actively seeking balance, based on objectively described facts, it is possible for the person to define a tight image of himself and the bonds that bind him to others.
The negative interpretation of any fact depends on its result and on the voluntary character that is attributed to the hand of the one who performs it. In other words, to what extent it is considered that the undesirable consequences of an adverse event could have been avoided if the initiating agent had wished it, or in what way the grievance occurred deliberately and definitively in a malicious manner.
The third phase aims strengthen the mentalization process, Or the ability to subtract elements of communication (sender, message, receiver, etc.) to assess them objectively and affectively neutrality. From there, boundaries are drawn between negative acts and the identity of their author, creating a distance between signifier-signifier and thus helping to identify the presence or absence of any intentionality that connects them. In this case, the resulting emotions must be dealt with precisely.
It also seeks to adopt a position of external observer of all internal processes, so that they are devoid of emotion and can be analyzed more objectively (distinguishing what is real and what is not real. all). This process is very important for the fear of abandonment hypothesis, as it occurs without any objective reason and produces very discomfort. deep.
By reinforcing otherness he seeks to differentiate himself from others, Separate their own fears from how they perceive others and feel like the subject agent of their existence. The therapist must avoid any paternalistic attitude, reaffirming the identity of the person with whom he is interacting, because at this stage it is essential that he takes an active role vis-à-vis his conflicts and problems of a social nature.
Managing problematic behavior
TLP is characterized by a concatenation of outsourcing problems, Beyond the complexities of the inner life of those who suffer from it. These are behaviors that cause harm to oneself or to others, and that end up endangering life: unprotected sex, self-harm of all kinds, drug addiction, irresponsible behavior or other acts in which one takes risks for physical or psychological integrity.
The current model understands that these are behaviors associated with problems in the three areas mentioned, which can be explained by functional impairment of different brain systems involved in the regulation of emotions and in the perception of identity as a coherent phenomenon (which have already been described previously).
Deficiency in the association zone leads to unawareness of how negative interactions alter emotion, such that discomfort is perceived vaguely and intangibly. This circumstance is related to impulsive and aimless acts, as they could not locate the coordinates of the causes and consequences of the affection experienced at a given time. The behavior that would be implemented to deal with stressors would be erratic or chaotic.
The attribution deficits would be linked to a judgmental polarity that blocks the weighted analysis of the nuances included in the situation, Which would lead to enormous difficulty in decision making (since the pros and cons are not considered simultaneously, but one or the other in isolation). The difficulties in inhibiting impulses are also consistent, as extreme emotions often precipitate acts of uncontrollable intent.
Difficulties of otherness would hinder the effective separation of the real and the symbolic, generating false associations between acts and their consequences (“I make cuts to relieve suffering”, “beak to drown the sorrows”, etc.). Engaging in this area would also involve 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.).
- Gregory, RJ and Remmen, AL (2008). Manual psychodynamic therapy for treatment-resistant borderline personality disorder. Research and Practice of Psychotherapy Theory, 45 (1), 15-27.
- Majdara, E., Rahimian, I., Talepasand, S. and Gregory, RJ (2018). The effectiveness of dynamic deconstructive psychotherapy in the treatment of borderline personality disorder: introduction of an evidence-based therapeutic model. The Journal of Urmia University of Medical Sciences, 29 (6), 1-19.