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 arise that results in a benefit for the patient.
Dynamic deconstructive psychotherapy, formulated by Robert J. Gregory , pursues the purpose of the person 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 (idea that the “self” exists only in relation to other objects) or the philosophy of deconstruction (reorganization of thoughts to the 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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Dynamic Deconstructive Psychotherapy
Dynamic deconstructive psychotherapy is designed for the care approach of people suffering 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 presents a succession of therapeutic modules justified by the neurological disturbances 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 (especially decision making and attributional processes). In addition , 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 consists of weekly sessions of 45-50 minutes , which extend over 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 directed towards the evocation of moments of interpersonal conflict that the patient has lived in the preceding days, which will be explored by a therapist who takes on a progressively less directive position, emphasizing through all this individual responsibility.
Then we will see an analysis of all the areas contemplated in the application of the procedure, as well as the techniques to be deployed in each case.
One of the fundamental purposes of dynamic deconstructive 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 on during the sessions. In cases of greater difficulty, metaphors can be used, which imply a space that borders both sides, at the limit of what is thought and narrated.
The model suggests that people with BPD have difficulty in carrying out such a transformation process, perceiving that some of the most notable nuances of what they wish to convey are lost through coding. However, 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 exploited in the therapeutic act.
What the therapist does in these cases is to recall with the patient the most recent examples (of everyday life) in which some overwhelming or difficult experience could have arisen, with the aim of dissecting them into more discrete units and basting them in a manner consistent with the Logic of your 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 these 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 a meaning to the experience. That is, interpret them in an integrated way.
The authors place special emphasis on patients with BPD often showing a disorganized pattern of attachment, which arises as a result of experiences of abuse / abuse. In this case the person fights against the desire for approximation and the contradictory need for distancing, who live in the same space and who build the base from which the next step of therapy pendulums: the polarization of emotions and links with the rest.
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The constant oscillation of mood and 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 foundations on which to support itself or a foreseeable logic . This way of living and feeling can generate a deep existential confusion, and is one of the reasons why the individual feels a deep emptiness when he looks inside.
The person would be debated in a constant ambivalence between search and avoidance, or between approaching and fleeing , which is rarely resolved adequately. The self-image would therefore be very unstable, to the point that it would cost a lot to find words with which to describe what one is. One of the most relevant aspects to be treated in this phase of the intervention involves the secondary consequences of the review: excessive or very poor impulse control, and inflexible projection of all responsibility on oneself or others (without gray areas) .
Throughout this stage it is important to provoke in the person reflection processes in which to avoid judging the experience , so that it can be located on a plane that allows the weighted analysis of what you feel. 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 triggered them.
The model proposes, in short, that perpetual lability of mind (and the valuations 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 the ties that bind him to others.
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The negative interpretation of any event depends on its outcome 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 any adverse event could have been avoided if the triggering agent had desired it, or in what way the grievance occurred deliberately and definitely maliciously.
The third phase aims to strengthen the mentalization 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 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 any intentionality that connects them. In the event that this is the case, the derived emotions must be addressed with precision.
It also seeks the adoption of an external observer position of all internal processes, so that they are devoid of emotion and can be analyzed more objectively (discriminating what is real from what is not at all). This process is very important for the assumption of fear of abandonment, because it arises without objective reasons for this and produces a very deep discomfort.
Through the reinforcement of otherness , the person seeks to differentiate himself from others , separating his own fears from the way he perceives others, and feeling like the agent agent 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 he assumes an active role regarding his conflicts and social problems.
Management of problematic behaviors
The TLP 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 generate harm to oneself or others, and that eventually pose some danger to one’s life: unprotected sex, self-harm of various considerations, abuse of narcotic substances, irresponsible driving or other acts in which they are assumed 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 leads to an unconsciousness about the way in which negative interactions alter emotion, so that discomfort is perceived in a vague and intangible way. This circumstance is linked to impulsive acts that lack an objective, since the coordinates for the causes and consequences of the affection 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 the judgment that blocks the weighted analysis of the nuances that are included in the situation , which would result in an enormous difficulty in making decisions (since the benefits and disadvantages are not contemplated simultaneously , but one or the other in isolation). There are also difficulties in inhibiting impulses, since extreme emotions usually precipitate acts charged with an unstoppable intention.
Difficulties in otherness would hinder the effective separation of the real and the symbolic, generating spurious associations between the acts and their consequences (“I cut myself to alleviate the suffering”, “I drink to drown the sorrows”, etc.). 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.).