Dialectical Behavior Therapy (DBT) is becoming an increasingly popular treatment option for teens who struggle to practice self-regulation, maintain healthy relationships with friends and family members, and manage their big emotions, and for good reason.
DBT has proven effective for helping treat and reduce the symptoms of a variety of behavioral and emotional issues including bipolar disorder, self-harm behavior, suicidal ideation, depression, and post-traumatic stress disorder among other mental health issues.
While it can be devastating as a parent to watch your teen struggle with mental health or behavioral issues, you can help your teen combat these circumstances when you encourage them to try DBT.
As they work through what is referred to as the DBT “House of Treatment” model, you will begin to notice significant positive changes in your teen.
The four stages of DBT
The DBT House of Treatment model involves four stages of treatment that will help your teen progress from severe problem behaviors that seem nearly impossible to cope with to self-fulfillment and actualization.
Imagine that your teen is stuck in the lowest level of a home that is beginning to flood. With each floor they climb, they are becoming safer and growing to the point where they are no longer at risk of drowning.
The same idea applies to DBT. As your teen progresses through each stage of treatment, they will eventually grow to the point where they are able to regulate their emotions and cope with any mental health issues they face in a healthy manner.
Here are the four stages of DBT and how they represent the journey your teen will take as they work to achieve their goals:
Stage 1: The basement
When your teen is in stage one, they are often in crisis. They are typically engaging in life-threatening behaviors or treatment-interfering behaviors like severe addiction, self-harm, or suicidal acts that show that they are not currently capable of handling the stressors and mental health issues they are facing.
During this stage, teens need treatment at either a psychiatric hospital or a residential treatment center where they will receive the supervision, treatment, and care they need 24/7 until they are able to reach the next stage of DBT and no longer find themselves in a state of crisis.
This stage is accurately called the basement because when teens are in this stage, they feel like they are not able to go or feel any lower than they do. Oftentimes teens in this stage describe their life as “hell,” and they engage in the only behaviors they know will offer even temporary relief from their pain.
This means letting problem behaviors take control and feeling like they are their mental illness or the sum of their mistakes and, as a result, that they will never be able to get better.
Stage 2: First floor
When teens are on the first floor, their conditions have vastly improved from the time that they were in the basement stage, but they are still not quite feeling comfortable or safe.
If the basement level feels like hell, then the first floor, while offering some relief, is still pretty hot.
During this stage, teens aren’t engaging in life-threatening behaviors anymore, but this means they also aren’t able to experience temporary relief from their pain that came from these harmful behaviors.
While it is good that they are not in crisis, it is important to realize that this stage often comes with heightened feelings of anxiety, fear, depression, and shame.
As teens navigate this stage of DBT, treatment typically focuses on helping them reach emotional stability. Therapists will help your teen recognize and combat negative thought patterns and help them learn to cope and recover from trauma or previous harmful situations that caused them to be in crisis.
Stage 3: Second floor
Teens that reach this stage of DBT are able to learn and apply the coping strategies they learn in therapy to the situations and emotions they are facing in real life.
During this stage, they will be able to practice mindfulness, emotion regulation, and other skills to help improve their quality of life.
Although this stage is far from the basement stage, teens still tend to struggle with maintaining close, healthy interpersonal relationships, asking for help when needed, and going straight to their DBT skills and resources when faced with new or intense emotions and circumstances.
Stage 4: Roof
The last stage of the DBT House of Treatment model is the roof. Picture the roof of your home or a home in your area. If you were to literally stand on this roof, there are a couple of things that would be true:
1.) You would no longer be inside the house
2.) You would be at a vantage point that allows you to see far more than you could when you were inside the house
These ideas are metaphorically true for your teen when they reach this stage of DBT. Teens who are in this stage are no longer inside the house, meaning they are no longer in any imminent danger from flooding or other dangers that are present in the basement and are no longer in need of intensive, structured therapy in order to cope with situations and emotions they face in life.
Furthermore, your teen will have a new perspective. Instead of feeling like they are their mental illness, they will have adopted positive thought patterns and the growth mindset necessary for being able to handle changes that come their way.
During this stage, teens typically have healthy coping strategies that they can utilize when they are feeling overwhelmed, they can regulate their emotions and behavior, and they understand and practice radical acceptance.
Supporting your teen
If you want to help your teen get to a place where they are able to enjoy life using positive thought patterns and behaviors, healthy coping mechanisms, and other helpful strategies, then you should consider dialectical behavior therapy.
After their initial session, your teen will begin to move through the DBT House of Treatment until they reach the roof and achieve their wellness goals.
As your teen navigates life during this difficult time, you can offer additional support by remembering the following:
Healing doesn’t happen overnight. It’s a process, and it will take time. Just because your teen has an outburst after a couple of weeks of therapy doesn’t mean that it isn’t working. Continue to encourage your teen to attend therapy, celebrate their small successes, and remain patient.
The DBT House of Treatment stages are not always linear. Your teen might go from the first floor back to the basement a couple of times before they are able to progress to the second floor. While it may be frustrating, this is normal, and you should continue to offer your teen support during these moments.
Learn more about dialectical behavior therapy and how it can help your teen when you visit our website.