Dynamic deconstructive psychotherapy

Domain I · Psychodynamic & depth psychology · Robert J. Gregory

What it is

In the manual, association, attribution and alterity are not stages. They are three neuroaffective capacities, each with its own technique set, and the therapist can use any of them at any point. Treatment itself runs through four thematic stages, each named by a question: I "Can I be safe here?",…

Format

• Format. Individual sessions, weekly, for 12 months, with the end date set at the start. The manual is inconsistent on session length: Chapter 2 says 1 hour, while the written agreement says 45–50 minutes. Allow about 90 minutes for session 1. Sessions 2–3 complete the frame. Twice-weekly sessions…
• NREPP describes the treatment as lasting 12–18 months. If a patient is not ready at 12 months, the options are monthly maintenance sessions or 6-month blocks of weekly booster sessions.

Who practises it, and how they are trained or regulated

• Session 1: chief complaint;
• Adherence. The manual's DDP Adherence Scale (Appendix A) rates sessions. It also lists the common enactments. About 70% is cited as the acceptable adherence threshold. Advanced competency means taking at least two patients through all four stages, with weekly consultation.
• Version followed: Robert J. Gregory, Dynamic Deconstructive Psychotherapy (DDP): Clinical, Training, and Research Manual, v. 07.05.22 (SUNY Upstate, free PDF). This is the individual, weekly, 12-month format. It is supplemented by the Upstate web-based DDP training modules (Association, Attribution, Alterity–Real, Enactment). The Group DDP manual (Jackson & Riggall 2024) is used only where marked. Only manual…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• your own urge to list the harms. That provokes opposition and is an enactment.
• mirroring that slides into validating a feeling as "right". That is an enactment.
• a prescriber who says "it's just a chemical imbalance," which undermines the alliance.
• numbness or confusion, which point to a dissociative gap. Stay with what the patient can name.
• any implied criticism of you inside the patient's explanation. Receive it without defending yourself.

Problems the guide addresses

• Problems the sources address
• Problems the sources do not address

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.