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DBT House: What is the DBT House of Treatment?

With every passing year, Dialectical Behavior Therapy (DBT) is gaining more and more exposure in the mental health world. Parents and therapists recognize DBT’s remarkable value in helping teens with emotional dysregulation, self-harming behavior, suicidal ideation, and other mental health and/or behavioral issues.  

But even if you’re familiar with DBT, did you know that there are four different stages of treatment?

The DBT “House of Treatment” model, created by Dr. Marsha Linehan, explains these four levels. As your teen’s behaviors and goals change over time, he or she can move through all these stages of treatment.

DBT House Stage 1

Credit: Dr. Charles Swenson, author of DBT Principles in Action: Acceptance, Change, and Dialectics (Guilford Press, 2016).

If your teen is chronically engaging in major life-threatening behaviors, they are in Stage 1 of DBT. Stage 1 is otherwise known as “the basement,” or “hell.” Your teen may be severely addicted, dangerously self-harming, and/or attempting suicide. Teens in this stage are in so much internal pain and suffering that they cannot cope with life. They are in distress 24/7.

This stage corresponds to treatment at a residential treatment center or psychiatric hospital, where teens will receive supervised care 24/7. Inpatient treatment primarily focuses on eliminating all life-threatening behaviors, removing treatment-interfering behaviors, and reducing behaviors that severely impact functioning. The number-one focus is on crisis management and stabilization.

DBT House Stage 2

In Stage 2 of DBT, otherwise known as “the first floor,” teens are still suffering…but in “quiet desperation.” Their behaviors are not chronically life-threatening. However, they still need a lot of help in regulating their emotional volatility.

Therapy in Stage 2 of DBT focuses less on eliminating life-threatening behavior and more on emotional stability. Dialectical Behavior Therapy will help your teen increase their emotional self-awareness, replace negative thinking patterns with positive ones, and become more comfortable living with themselves. Stage 2 of DBT is also the stage when teens work more comprehensively on recovering from trauma or posttraumatic stress (PTSD).

DBT House Stage 3

At this stage, your teen is learning more and more about DBT skills, and should now be using those skills to cope with everyday issues in life.

In Stage 3 (“the second floor”), DBT addresses ways to help your teen solve daily problems and issues. Your teen will learn to identify their values and maintain positive behaviors and thinking patterns. At this point, your teen may be living at home and going to school. However, they still need help managing emotions on a day-to-day basis and accomplishing their life goals.

DBT House Stage 4

In the House of DBT, Stage 4 (the “Roof”) symbolizes life after leaving the four walls of structured treatment.

Here, teens should continue applying their DBT skills to seek out opportunities that fulfill them and make them happy. When life comes with its routine shares of obstacles, your child should be able to apply Dialectical Behavior Therapy skills to cope independently and “achieve a life worth living.”

What Is The Purpose of The DBT House?

The DBT house of treatment is a visual aid that helps teens get a better grasp of how DBT treatment works. The DBT house activity gives your teen a picture to refer back to showing them what their rock bottom was, what their goals are, and what progress towards thriving looks like.

Now that you’ve had the DBT house explained in brief in the sections above, here are its key benefits in therapy:

  • The house of DBT activity helps your teen identify their primary problems and goals. In stage one, your teen can self-identify the struggles that hold them back, as well as the goals that will move them up from stage one to stage two. 
  • DBT resources for parents and counselors give teens an end goal for treatment. A linear resource like the DBT house activity helps your teen see the purpose of their treatment and where they’re headed. The activity also affirms that recovery, growth, and thriving are all possible. 
  • The DBT house of treatment can increase self-awareness for teens in therapy. When your teen can self-identify the stage where they are in the DBT house, it gives them the resources they need to start moving up to the next stage. Using the activity provides your teen, their family, and their counselor with a starting point for meaningful, effective treatment.

How Do You Use a DBT House in Therapy?

You can use the DBT house in therapy to help your teen develop greater self-awareness and a deeper understanding of what recovery looks like. This exercise can also empower and motivate your teen to be present and active in their own recovery.

DBT House Model Activities

You can use DBT house model activities with your teen at different stages in their recovery process. During a crisis, the DBT house of treatment can help your teen see that there is still hope and motivate them to engage in recovery. As your teen grows and develops, moving up through the levels of the house, you can continue using the house activity to help them eliminate life-threatening behaviors and develop meaningful, beneficial skills.

For more helpful DBT tools, we encourage you to visit our DBT resources for parents page.

Dialectical Behavior Therapy (DBT) at Evolve 

If your teen is struggling with major depression, ADHD, an eating disorder, or other mental health roadblocks, DBT can help. We also understand that it can be hard to know where to start when you’re looking for DBT programs for your teen. If your last Google search was “Residential DBT programs adolescent near me,” we can help you find what you’re looking for. Contact us today at 1-866-204-9519 for a free consultation.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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