Deconstructive dynamic psychotherapy: characteristics and uses

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

Deconstructive dynamic psychotherapy, formulated by Robert J. gregory, pursues the purpose that the person connects with their own emotional experiences and develops positive relationships with those who live with them.

It is based on classic psychoanalytic models, such as object relations (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).

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

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Deconstructive dynamic psychotherapy

Deconstructive dynamic psychotherapy

is designed for the care approach of people suffering from Borderline Personality Disorder (BPD), with a dismal 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 have a deleterious impact on processes such as memory, affect regulation and executive functions (especially decision making and processes attributional). Besides association, attribution and otherness would be compromised; three facets with a key role in emotional experiences and their integration. The treatment is aimed at modifying the neurocognitive springs that are involved in each of them.

The program is made up of weekly sessions of 45-50 minutes duration, which last for a year or a year and a half, depending on the severity of the symptoms and the objectives 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 embraces a progressively less directive position, emphasizing responsibility throughout individual.

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 endow them with greater objectivity. It is about transforming the symbol (or thought) into verbal content, which will be the raw material with which we will work during the sessions. In the most difficult cases, metaphors can be used, which imply a space that borders on both sides, at 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 by coding you miss out on some of the more noticeable nuances of what you want convey. Nevertheless, they can show their internal states with great ease resorting to art in all its formsTherefore, this becomes a tool in the association process between emotion and verbalization that can be used in the therapeutic act.

What the therapist does in these cases is recall with the patient the most recent examples (from everyday life) in which some overwhelming or difficult experience, with the aim of dissecting them into more discrete units and weaving them together coherently with the logic of their own narrative. The underlying intention of all the 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 that are experienced with acts of reality, so that they are integrated in the context of the things that happen during the day to day. This task pursues the purpose of eliminating the ambiguity of the feeling and understanding 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 proximity and the contradictory need for distancing, which coexist in the same space. and that build the base from which the next step of the therapy hangs: the polarization of emotions and the links with the the rest.

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2. Attribution

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

The person would debate a constant ambivalence between seeking and avoiding, or 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 dealt with in this phase of the intervention involves the secondary consequences of what has been described: control excessive or very deficient impulses, and inflexible projection of all responsibility onto oneself or others (without gray).

Throughout this stage it is important to arouse in the person reflection processes that avoid judging the experience, so that he can locate himself on a plane that allows the weighted analysis of what he feels. And it is that 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 detonated.

In short, the model proposes that the perpetuation of mood (and of the assessments 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 himself and of the ties that unite him to others.

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3. Otherness

The negative interpretation of any fact depends on its result and the voluntariness that is 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 would have wanted it, or how the injury occurred deliberately and definitively malicious.

The third phase aims strengthen the mindset process, or the ability to subtract communicative elements (sender, message, receiver, etc.) to assess them objectively and from affective neutrality. From this, limits are drawn between negative acts and the identity of their author, creating distance between the signified-significant and thus contributing to identify the presence or absence of some intentionality that connect. In the event that this is the case, the derived emotions must be accurately addressed.

The adoption of a position of external observer of all internal processes is also sought, so that they remain devoid of emotion and can be analyzed in a more objective way (discriminating what is real from what is not in absolute). This process is very important for the assumption of fear of abandonment, since 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 himself from others, separating his own fears from the way he perceives others, and feeling like the agent subject of his existence. The therapist must avoid any paternalistic attitude, reaffirming the identity of the person with whom he is interacting, because at this point it is essential that you assume an active role regarding your conflicts and your problems of nature social.

Managing problem 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 harm oneself or others, and that eventually pose a danger to one's life: unprotected sex, self-harm of diverse consideration, abuse of narcotic substances, irresponsible driving or other acts in which risks to physical or psychological integrity are assumed.

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 previously described).

The deficit in the association area entails an unconsciousness about the way in which the Negative interactions alter emotion in such a way that discomfort is perceived in a vague and intangible. This circumstance is linked to impulsive and aimless acts, since they could not locate the coordinates for the causes and consequences of the affect that is being experienced in a Given moment. The behavior that would be carried out to face stressors would be erratic or chaotic.

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

Difficulties in alterity would hinder the effective separation of the real and the symbolic, generating associations spurious between acts and their consequences (“I cut myself to alleviate suffering”, “I drink to drown my sorrows”, etc.). Compromise in this area would also imply confusion in introspection processes (sensation of inner emptiness), and some of the cognitive biases that are most frequently manifested during this disorder (arbitrary inference, generalization, etc.).