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DBT: Four Stages of Treatment

What is DBT and what does it treat?

Dialectical Behavior Therapy (DBT) was founded in the late 1980s by Dr. Marsha M. Linehan, a psychologist and researcher. It was initially developed to treat individuals with Borderline Personality Disorder who experience intense emotional dysregulation, unstable relationships, and impulsive behavior. Over time, DBT has been adapted to address a broader range of mental health issues beyond BPD, including depression, anxiety, substance use disorders, and eating disorders. 

DBT integrates cognitive-behavioral techniques with mindfulness practices, emphasizing the development of skills to manage intense emotions, improve interpersonal effectiveness, tolerate distress, and foster self-acceptance. DBT is divided into four stages of treatment. Each stage is defined by the severity of the presenting behaviors, and therapists work with you to reach the goals of each stage in their progress toward having a life that  you experience as worth living.

Stage 1

In Stage 1, clients present as miserable in their present life, with  behavior that is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience as “being in hell.” 

  • The goal of Stage 1 is for clients to move from being out of control to achieving behavioral control. 

Weekly individual sessions, skills class attendance, and actively using phone coaching are all essential in this stage of treatment to achieve stability and safety. 

Stage 2

In Stage 2, client move into living a life of quiet desperation rather than being out of control: their behavior is under control but they continue to suffer, often due to past trauma and chronic experiences of invalidation. Their emotional experience may often be inhibited. 

  • The goal of Stage 2 is to help clients  move from a state of quiet desperation to one of full emotional experience; having the chance to feel the full range of emotions, without
    “falling apart or losing control.” Essentially this looks like having moments of joy and happiness alongside more challenging feelings of anxiety or pain.

Stage 3 

In Stage 3, the challenge is to learn to live a life with defined life goals, build self-respect, and find peace and happiness. 

  • The goal is that you lead a life of ordinary happiness and unhappiness and using skills to manage when intense disruptions might occur. 

Stage 4

For some people, a fourth stage is needed: finding a deeper meaning. Linehan has posited a Stage 4 specifically for clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of fulfillment, or a sense of connectedness to a greater whole.

  • In this stage, the goal of treatment is for you to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

What stage do you think you fall in? If you’re living a life that feels out of control, or you’re in quiet misery, would you like to be living a life of happiness and meaning instead? We would love to help build a life you love!

If you or a loved one could use help in this area, reach out at www.connectionsfamilycenter.com/contact and let us know you’re interested in our DBT program.

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