The Stages of DBT Treatment: Road Map for LGBTQ+ Clients
Introduction
It’s not easy to find your balance when it feels like parts of your life are out of control. Whether it’s emotions that feel like they’re running the show or past traumas that still sting, creating balance can feel tough. Enter Dialectical Behavior Therapy (DBT), a powerful therapy designed to help you regulate your emotions, manage distress, and build a life you’re proud of.
For us LGBTQ+ folks, the challenges of navigating identity, discrimination, and societal pressures can add extras layers of complexity to emotional wellbeing. This is where DBT shines. It can be used as an affirming, structured approach to address emotional chaos, trauma, and everyday stress. So, let’s break down the stages of DBT and see how it can be a game-changer for mental health!
Stage 1: Stabilizing and Managing Life-Threatening Behaviors
DBT was created by Marsha Linehan, who designed the therapy to take place over the course of four stages. Not every client needs to do deep work in all four stages. Your therapist can help you figure out where to start, and where to go. If you picture the stages of DBT like the levels of building a house, then the first stage of DBT, the foundation, is all about keeping you safe and helping you get some control. This phase is especially crucial if you're dealing with things like self-harm, suicidal thoughts, or substance use. The goal at this stage is to regulate your emotions so that you can build stability.
What does “stabilizing” actually mean? For those of us in the LGBTQ+ community and beyond, we may face discrimination, internalized stigma, or rejection. The emotional waves from those experiences can be overwhelming. What you create in Stage 1 is like a solid foundation. You are building something that is going to withstand powerful emotions and outlast whatever storms are brewing outside.
Skills You’ll Learn in Stage 1:
Mindfulness: Being present in the moment without judgment (yes, even when your mind is racing).
Distress Tolerance: Survive crises without making things worse.
Emotion Regulation: Weathering those emotions that feel like they’re out of control.
The goal here is to get a handle on your day-to-day emotional ups and downs. Whether it’s managing the sting of microaggressions, family rejection, or daily work stress, Stage 1 is about creating a foundation of emotional safety.
Stage 2: Addressing Trauma and Emotional Pain
If you are starting from Stage 2, then you have already built stability and want to work on addressing emotional pain and trauma. This stage is where the deeper healing really begins. For many queer people, this can mean processing painful experiences such as coming out, rejection from families and loved ones, or traumatic incidents.
If Stage 1 is about building a foundation to withstand emotional storms, Stage 2 is about quieting the source of some of those storms by addressing past trauma. It's about acknowledging past hurts, giving yourself space to feel, and moving through the pain with the tools you’ve learned.
Skills You’ll Learn in Stage 2:
Advanced Emotion Regulation: Fine-tuning how you manage emotions so they don’t run the show.
Interpersonal Effectiveness: Navigating relationships with confidence and clarity.
Resilience Building: Navigating past trauma and learning to move forward.
This stage is all about validating your experiences. DBT offers you the tools to process it all without getting stuck in it. Healing from these experiences allows you to step into your true self with confidence and resilience.
Stage 3: Building Self-Respect and Improving Quality of Life
If you are starting at Stage 2, you have built emotional stability and processed some of the past hurts. You are ready to build something beautiful: a life that feels fulfilling and aligned with your values. Stage 3 is all about self-respect, agency, and taking control of your own happiness.
For the queer people that I work with, this stage can be deeply affirming. It’s about shedding the negative self-talk and the internalized biases. It’s about the freedom to focus on what’s important to you. Maybe it’s pursuing a career you’re passionate about, building meaningful romantic relationships and friendships, or simply living authentically without fear of judgment.
Skills You’ll Learn in Stage 3:
Assertiveness: Standing up for yourself in a way that feels empowering and kind.
Self-Validation: Learning to validate your own emotions and identity, especially when the world might not.
Life-Planning: Setting long-term goals that reflect your values and dreams, and learning to make choices that align with the life you want to live.
Stage 3 is where you take ownership of your life and make choices that reflect who you truly are, not who the world expects you to be.
Stage 4: Moving Toward a Life of Meaning and Fulfillment
Finally, Stage 4 of DBT is where the magic happens. It’s about creating a life that feels meaningful, joyful, and fulfilling—one where your identity is celebrated, your relationships are healthy, and your mental health is solid. In short, this stage is about thriving.
For LGBTQ+ people, this stage is often where you fully embrace your identity. All parts of you are welcome, and you feel confident in navigating the full range of your emotions. The hard work of the previous stages has paid off, and now you’re using everything you’ve learned to stay mindful in living a life that feels right for you.
Skills You’ll Learn in Stage 4:
Mindful Living: Practicing mindfulness in every aspect of your life, from relationships to work.
Emotional Mastery: Applying emotion regulation techniques so you can handle life’s challenges with grace.
Sustained Resilience: Staying strong in the face of adversity, whether it’s societal pressures or personal challenges.
Stage 4 is all about living fully. It’s not just about surviving anymore—it’s about thriving as your full, genuine self.
How DBT is Structured
There’s different ways DBT is practiced in the real world. Full-scale, by-the-book DBT, called Comprehensive DBT, involves the three components of individual therapy, group therapy, and phone coaching. Also, there’s a fourth component behind the scenes, which involves the group of DBT therapists working as a team to deliver this treatment.
Individual Therapy: One-on-one sessions with your therapist to focus on your personal goals and challenges.
Group Skills Training: A supportive group setting where you learn and practice DBT skills with others. This part feels like a class, and moves through the DBT Skills Manual one worksheet at a time.
Phone coaching: Real-time 24/7 help when you need it most, so you can use your DBT skills to manage crises as they arise.
Whether you’re learning skills to manage identity struggles or navigating difficult relationships, the blend of individual and group support provides a safe, affirming space for growth.
The type of DBT we offer at Full Focus Therapy is not comprehensive DBT. We don’t offer 24/7 phone coaching. Instead of going through the manual in a prescribed order, we tailor treatment to the individual, relying on the skills of DBT when they are most needed.
Why DBT Works for LGBTQ+ Individuals
LGBTQ+ affirming therapy is life-changing treatment. You can read more about how queer-affirming DBT works in this article. DBT was not originally designed with LGBTQ+ people in mind. And yet in combination with the principles of queer-affirming work, it can be an incredibly effective therapy for LGBTQ+ folks. Here’s why:
Affirming and Nonjudgmental: DBT meets you where you are and accepts you as you are, making it an affirming approach for LGBTQ+ people who may have faced rejection or invalidation.
Focus on Emotional Regulation: Managing emotions is especially valuable for LGBTQ+ individuals, who often deal with stressors like discrimination, identity-related anxiety, and societal pressure.
Building Resilience: DBT helps you build emotional strength and resilience in the face of life’s challenges, empowering you to navigate a world that doesn’t always understand or support you.
Conclusion
DBT isn’t just about stopping the emotional rollercoaster—it’s about building a life you love, where your identity is celebrated and your emotional well-being in strengthen. Progressing through the stages of this type of therapy brings you closer to emotional balance, resilience, and a life with meaning. Whether you’re dealing with trauma, struggling with identity, or just wanting to find more stability, DBT has some tools to help you thrive.
If you’re looking for an affirming and transformative therapy, DBT might just be the answer you’ve been looking for!
Resources
Find LGBTQ+ DBT Therapists: Check out local organizations or websites like Psychology Today to find affirming DBT therapists. You can contact us at Full Focus Therapy as well!
LGBTQ+ Support Groups: Community groups, both online and in-person, can offer a safe space to practice DBT skills and connect with others.
Books on DBT: “The Dialectical Behavior Therapy Skills Workbook” is a great resource to explore DBT on your own.
It’s time to take the next step toward emotional healing—one stage at a time!