Understanding the DBT House Model

Dialectical behavior therapy (DBT) is a third-wave therapy modality that teaches the following four overarching skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness [*]. In this treatment system, clients are often taught these skills through several activities, one of the most notable being the DBT house.

What Is the DBT House?

The DBT house is an activity that serves as a visual representation of a person’s inner world. Personal aspects that are tapped into include coping strategies, values, emotions, thoughts, and behaviors. Through this activity, patients undergoing DBT can gain insight into these aspects holistically and determine their resources and areas for growth.

How Does the DBT House Work?

When working through one’s mental health issues, a clinician may propose for the client to work on the DBT house activity, encouraging them to fashion their own house by means of drawing or other art materials. The DBT house can even be created digitally. In undergoing this process, clients are invited to immerse themselves in introspection and self-discovery. Moreover, the DBT house activity can facilitate the application of DBT skills learned in therapy. By identifying several aspects of your inner world, you can also discern what dialectical skills would be of help to you in addressing the challenges you are faced with.

To begin the DBT house activity, the client draws a house, with all of its different parts, that will serve as a metaphor relating to their thoughts, emotions, and personal experiences. Afterward, their therapist will guide them as the client reflects on what they have come up with in the activity. This includes how they perceive themselves, their life, and the world, as well as how they are all interrelated.

What Are the Components of the DBT House?

Drawing a DBT house can be easy because more likely than not, clients already know what constitutes a house. There are stories, doors, walls, foundation, a roof, and so on. In this article, the house of DBT will be discussed in detail, with each component identified and explained.

Level 1. As with most houses, there are levels or stories. The first level of the DBT house centers on behaviors. More specifically, this level pertains to the unhealthy or maladaptive behaviors that a person wants to work on or improve. By determining such behaviors in Level 1, people will gain a deeper understanding of the things that they do that do not serve a meaningful or helpful purpose and can work toward developing healthier behaviors that promote authenticity and overall well-being. Thus, Level 1 of the house of DBT is all about responsibility over one’s behaviors.

Level 2. In Level 2, the client explores the emotions that they ideally want to experience in a healthy manner. By recognizing what these emotions are, clients in turn are also able to identify which feelings they find most challenging to deal with. As a result, through the DBT house activity, the individual can figure out what tools and DBT skills they need to combat those difficult or overwhelming emotions.

Level 3. The Level 3 component of the DBT house activity is quite simple in theory. In this level, individuals are encouraged to think about what makes them happy. Specifically, the third level of the house of DBT points to those things that make the client happy. Alternatively, it can also be directed at the things that the client would want to feel happy about.

Level 4. Level 4, the last level of the DBT house, dives deeper, going beyond what has been identified in Level 3. In the fourth level, people are instructed to draw or write their responses to the following question: What would a life worth living look like for you? In other words, what are the client’s reasons for living? What brings you meaning and purpose, and how would your life look if you were living intentionally and feeling hopeful for the future?

Foundation. If the DBT house serves as a metaphor for your psychological life, then what does the foundation represent? In this activity, the foundation is analogous to your values. Examples of values include honesty, integrity, and respect. Such values underscore your belief system; with that said, they are said to govern your life. Furthermore, this component in the house of DBT allows you to have a purposeful and moral life. The foundation of your DBT house must therefore be strong and stable for the sake of your emotional health.

Walls. What purpose do the walls in your house serve? For one, they provide support. They also enforce boundaries, separating the things that are valuable to you from those external factors that could harm or interfere with your sense of safety and security. Thus, the walls in the DBT house represent those interpersonal skills that protect you from threats and that support you. Here, the question to consider is: Who or what supports you?

Roof. What the roof represents is somewhat similar to the meaning behind the walls of your DBT house. However, whereas walls are a metaphor for your personal boundaries, the roof pertains to those individuals or things that protect you from harm. The question here is, who or what protects you?

Door. In the house of DBT, doors open us up to the possibilities of forging emotional connections and important relationships. However, they also allow us to keep people out of our lives. Thus, the door in the DBT house is symbolic of the value of healthy relationships and their role in enhancing one’s well-being. It asks, what do you hide from other people?

Chimney. The DBT house also includes a chimney as part of its analogy. By drawing a chimney, the individual engaging in the DBT house activity is also able to represent some of the ways they can destress and relieve some of the pressure that they feel. In other words, the chimney in the house of DBT serves as a metaphor for ways that allow you to blow off steam.

Billboard. While it very well may be that most houses do not have billboards, your DBT house does. In your billboard, the question being asked is: “What are things about yourself that you are proud of?” Examples of responses include life, academic, or professional accomplishments; strengths; skill sets; and traits or characteristics.

Benefits of Using the DBT House

The DBT house activity serves many purposes in and outside of therapy, offering therapeutic benefits such as the following:

• Increased understanding of triggers. Learning what triggers lead to your unhealthy behaviors or harmful situations can help you avoid them. By identifying triggers, you can prevent putting yourself in environments where those triggers are present and thereby reduce the risk of a relapse. Learning DBT skills such as the DBT house has, in fact, proven to be effective in preventing relapse [*].
• Identification of healthier coping strategies. Not only does working on your DBT house assist you in discerning which areas in your life warrant the use of healthier coping strategies, but it also helps you learn which coping strategies have worked for you in the past and will be effective to use when dealing with future problems or situations.
• Improved self-awareness. Research has shown that the core components of DBT enhance self-awareness, which is one of the keys to improved mental health and well-being [*]. By listing your strengths and areas for improvement in the form of a metaphorical house, you can deepen your self-understanding about who you are and what your life has been like (as well as what your life could be like).

How to Create Your DBT House

Now that you know all of the components found in the house of DBT, the following is a step-by-step procedure on how to create your very own DBT house:

1. Draw a house. Your DBT house should include all of the components mentioned earlier, namely the foundation, walls, roof, door, chimney, and billboard. It should also have four levels.
2. Draw (or jot down) your responses to each of the questions posed by each component. For example, in Level 1 of the DBT house activity, the question would be: What unhealthy behaviors would you want to work on or improve? Possible answers to this question include (but are not limited to) indulging in vices, isolating yourself from your loved ones, and skipping classes or work.
3. Reflect on your DBT house, as well as your responses. This is usually done with the help of a mental health professional who is knowledgeable with DBT interventions. More often than not, the DBT house activity is integrated with other techniques, and variations of its use depends on whether DBT is applied with children or whether DBT is for teenagers.

Who Uses the DBT House?

Clients who are best suited for undergoing dialectical behavior therapy are often encouraged to work on the DBT house activity, as advised by their therapist. Such client populations include people with borderline personality disorder (BPD), those who engage in acts of self-harm, individuals who suffer from suicidal ideation or suicidal tendencies, and the like. However, virtually anyone can use the DBT house if they want to work on those areas that need improvement and to solidify their strengths.

Can the DBT House Be Used Outside of Therapy?

The DBT house activity can absolutely be done outside of therapy. Some therapists assign this as a homework assignment to their clients to be done in between sessions. Then, clients are asked to showcase their house of DBT to their therapist so that the mental health professional can guide the client through the third step of the activity, which is to reflect on the completed DBT house.

The Bottom Line

Dialectical behavior therapy demands a lot of therapeutic work from both the client and their therapist, as well as motivation from the client to change and improve. However, activities such as the DBT house can make the therapeutic process fun and interesting for the client. Other activities that can enhance DBT sessions include using our DBT worksheets, which can be used as self-help, or presented to your therapist. Regardless of whether you live with a mental health condition or just want to become a better version of yourself, creating your own DBT house will definitely help steer you toward the path of self-awareness, creativity, and improved mental health.

References:

1. Linehan MM and Wilks CR. The course and evolution of dialectical behavior therapy. 2015.
2. Brown, MZ and Chapman AL. Stopping self-harm once and for all: Relapse prevention in dialectical behavior therapy. 2007.
3. Swenson CR and Choi-Kain LW. Mentalization and dialectical behavior therapy. 2015.