What is the DBT House of Treatment?

Dialectical Behavior Therapy (DBT) is gaining more and more exposure. 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 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 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 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 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.”