When most people think of DBT, they think of the 6-month skills training group, diary cards, phone coaching, and chain analyses. While all of these are key parts of DBT, there’s much more to it than what meets the eye. DBT is divided into four distinct stages that are designed to guide you through varying levels of emotional and behavioral healing.
Stage 1 – Severe Behavioral Dyscontrol to Behavioral Control
The first stage of DBT is focused on getting control over life-threatening behaviors, such as attempting suicide, nonsuicidal self-injury, and other behaviors that threaten the life of the client. Most people seeking DBT experience severe emotional dysregulation that is causing them intense pain and suffering in their day-to-day lives. They’re in crisis and want their pain and suffering to end. In an attempt to solve problems, they likely experience extreme emotions and act impulsively, which ultimately causes more pain.
The goal of this stage is to get control of their behaviors that are life-threatening, threats to treatment, or major threats to their quality of life while increasing behavioral skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. Marsha Linehan often refers to this stage as climbing out of hell because while they want to live without the pain that they’re currently experiencing, the path to do that is also on fire (a.k.a. extremely difficult). DBT is an intensive and difficult treatment. It requires a commitment to stay alive and to work towards finding life to be worth living. Things may seem to get worse before they get better and it might take a long time to climb out of hell. As they progress through stage 1, they learn to cope more effectively with the things in life that cause them pain and learn to prevent crises from happening sooner and sooner. During this time, they learn how to tolerate the emotional pain while changing their ineffective coping strategies in order to accept and change.
Stage 2 – Quiet Desperation to Emotional Experiencing
Most people think that DBT ends after they graduate from skills training or they solve the big problems. Treatment can stop there, but it isn’t solving the long-term problems that contributed to the ineffective behaviors that were targeted in stage 1. Stage two of DBT focuses on turning “quiet desperation” to emotional experiencing – to be able to experience emotions without the threat or worry that an urge to act on a problem behavior will emerge. Therapists help clients explore suppressed emotions, recognize patterns in their thinking, and develop self-compassion. The goal is not just to control emotional responses but to fully experience emotions without becoming overwhelmed by them.
During this stage, some people may do trauma processing in order to reduce their suffering. Many individuals have underlying emotional wounds that contribute to their distress, and this stage encourages them to confront and process these experiences in a safe and structured manner.
Others may focus on cognitive modification, or changing how one thinks about things. Our thoughts are a powerful source for our emotions and how we see the world. By changing how we think, it can help change how we feel about things and how we act.
Stage 3 – Problems in Living to Ordinary Happiness and Unhappiness
Now that the client has their emotion regulation skills on lock, we transition into the third stage of DBT. It focuses on solving problems in living and accepting the ordinary happiness and unhappiness of life. Most, if not all of the crisis fires have been put out and they have gained control of their intense emotional responses. People often want to try and solve all of their problems in earlier stages. However, while this is understandable, this isn’t possible until this stage. In stage 3, you can focus on the things that contribute to stress but weren’t major links to problem behaviors. It’s now time to problem-solve! Stage 3 often focuses on improving relationships, increasing self-esteem, and setting more long-term goals. It emphasizes increasing joy and satisfaction in daily life by engaging in activities that bring purpose and fulfillment.
Stage 4 – Incompleteness to Capacity and Sustained Joy
The final stage of DBT is about attaining a deep sense of self-awareness and fulfillment. At this point, individuals have developed strong coping skills, maintained stable relationships, and are living their life worth living. The emphasis shifts to personal growth, spiritual exploration, and achieving a sense of wholeness. Therapists help clients embrace their strengths, pursue personal passions, and continue developing their sense of self. The ultimate goal is to achieve a state where emotional distress no longer dominates their lives, allowing them to thrive independently and confidently.
Some DBT therapists may only work with people during stage 1 or 2 of treatment. It is every DBT therapist’s hope that all clients reach stage 4 of treatment, whether the therapist is able to be there to witness it or not. There is no timeline on how long it will take to reach stage 4, it really depends on each person and their experiences. Whether struggling with intense emotions or seeking self-improvement, DBT provides a structured path toward resilience and well-being.
About the Author
Robyn Williams (she/her), M.A., LPC is a Licensed Professional Counselor who specializes in dialectical behavior therapy. Robyn works with teens and adults in a compassionate judgment-free manner to meet clients where they are in life. Robyn helps her clients develop the tools they need in order to live their life worth living, and find what means most to them. Robyn believes that while therapy can be intimidating at times, it can be a conduit for personal growth. Click here to learn more about Robyn’s experience and therapeutic approach.