Dynamic Deconstructive Psychotherapy (DDP)

Dynamic Deconstructive Psychotherapy (DDP) is a time-limited, once-per-week individual treatment. DDP is based on the hypothesis that neurocognitive deficits in emotional processing account for much of BPD psychopathology. DDP emphasizes the therapist’s nonjudgmental and nondirective stance toward the patient. The focus of treatment consists of helping patients identify and verbally express their emotions, construct coherent narratives of their interpersonal experiences, and integrate polarized attributions about self and others. Patients are encouraged to express and think about their emotions and interpersonal experiences without resorting to compensatory maladaptive behaviours. The therapy involves four distinct phases over a period of 12 to 18 months, which consist of the development of a therapeutic alliance, identification and integration of distorted attributions, acceptance of limitations of self and others, and differentiation from the therapist.

Only one RCT to date has investigated dynamic deconstructive psychotherapy. This small trial (N = 30) examined DDP for patients with BPD and comorbid alcohol abuse. DDP was compared with a treatment-as-usual condition, which actually involved a greater number of patient-contact hours. Patients who received DDP showed significant improvement at 12 months in parasuicidal behaviour, BPD symptomatology, alcohol abuse, and need for institutional care and medications. Gains made by patients in the DDP condition were sustained at 30 months post-baseline and remained significantly superior to the treatment-as-usual outcomes.