Intro to DBT 1: The House and the Stages of Change

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The Journey towards wellness for someone suffering from mental illness, is described in DBT as a house. The house has a basement, a main floor, second floor and a rooftop. The journey starts in the basement, where suffering is at its worst. Behaviours are out of control, life is excruciating. It is hell. This would be the place where a person is suffering from regular panic attacks, suicidal thoughts, substance abuse, isolation, and extreme emotional pain.

The way out of the basement is up the stairs; when a person begins to reach out for support. The stairs are slippery and dangerous, and its easy to fall back to the basement but there is no other way out.

Once the person reaches the first floor, they will find it is a place of quiet desperation. The problem behaviours are under control, and the pain is not so urgent, but the person is still miserable.

The next stage is to climb to the second floor. Here there is a comfortable chair, food to eat, and a lovely view of the world outside. The person may choose to sit here for a long time, simply enjoying the calm and peace that comes with wellness. Many people stay at this level, which is fine, this is where everyday life is not a constant struggle, life is just life. This is the place of ordinary happiness and unhappiness. Things are balanced here.

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The final stage is optional; it leads to the rooftop. This is a place of radical joy, where the person may cultivate deeper meaning in life. The view is spectacular and the rewards are abundant, but the rooftop is also unprotected. The person is vulnerable to the elements, and its a long way down if one should fall. You have to be careful on the roof.

The journey from the basement to the roof is a long and difficult one. For a long time I believed I could find a shortcut. I wanted to get straight from the basement to the roof without doing any of the work involved. It can’t happen like that. There is no short cut. You have to go through each floor.

When you make a commitment to work towards wellness you have to understand that there will be changes you need to make in your life. DBT outlines 6 stages of change to help guide you through this process:

  1. Precontemplation: At this stage there is no intention to change, but it is considered. Gather information, consider feelings and social valuing.
  2. Contemplation: A serious consideration and intent to change. A consideration of self-value.
  3. Preparation: Making a commitment to change. Some action taken towards intent to change.
  4. Action: Successful alteration of behaviour. Substitution of alternatives, opening oneself to others, avoiding and countering expected high-risk situations. Reward yourself!
  5. Maintenance: Remaining free of problem behaviour. Continue to substitute alternatives and avoiding and countering expected high-risk situations.
  6. Termination: Experiencing no temptation. Total confidence in all previous high-risk situations.

NOTE: Relapse can occur at Action (4). Return to Contemplation (2) and continue.

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When I started DBT I was probably somewhere between 1 and 2. I knew something had to change but I wasn’t sure what that was yet. It took many weeks before I was able to come up with a plan with the help of my therapist, pinpoint the problem behaviours I needed to fix and work towards reaching my goals through steps 3, 4, and 5. I probably stumbled and still do sometimes. Especially when it comes to keeping myself safe from high-risk situations. Temptation to relapse can be pretty attractive, but I am a little wiser now, and I know that I can always go back to the stages of change and use the skills I’ve learned to keep myself safe and healthy. It’s a long and hard journey, but absolutely worth it!