The basement is usually a place where there is a lot of fire and pain. It’s a difficult place where no one wants to be, but many people who struggle with emotion dysregulation find themselves stuck there. Suicidal thoughts or attempts, regular self-harm, an active eating disorder or substance abuse are examples of behaviors that keep people in the basement.
The basement feels like Hell, and that it can’t get any worse. Many clients accept, or try to accept, they are in Hell. But in Hell there is no water or relief, so they turn to behaviors that may temporarily mask their pain, such as self-harm or other self-destructive behaviors.
Level one can also be described as being out of control. Out-of-control behaviors ultimately make life feel out of control. Clients aren’t functioning in daily life; the effect of their mental illness has taken over.
In the client’s mind, the illness comes to define who they are. It’s hard to separate pathology and behavior from who they really are, because “I am my illness” has been their mantra for so long.
Once clients get out of the basement, they notice it’s not as bad as Hell, but it’s still not comfortable. The floor is still hot and there’s still no water or sense of relief.
Relief is hard to find because the main change in this stage is that many out-of-control behaviors have stopped. Self-harming and suicidal behaviors are no longer happening.
Without water or relief, anxiety levels start to rise. Clients are not burning, but they are exhausted. They have given up behaviors that gave them temporary relief.
Families experience their own anxiety as roles in the family start to change. It is common for clients to go back and forth between the basement and first floor during the first few months of treatment. Everyone progresses at different speeds, and temporary regression is to be expected at times.
As clients deal with the behaviors getting in the way, they move to the second floor. This is where we work on the behaviors interfering with their quality of life.
Challenges here are often poor relationships: not being well connected, or feeling intimidated to get close to people because it’s scary.
On this floor there IS water, so clients start to find some relief. They learn coping skills through DBT skills training: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness (and Walking the Middle Path in DBT-A).
Relief can trigger nervousness and fear. It’s often a life they’ve never quite lived, and the unknowns bring anxiety. Fear may lead them back down to Hell because, even though it is miserable, it’s familiar.
Every house has a roof, and when you get on it, the view is amazing! Your perspective is changed.
You are now open to every weather pattern that may come into your life. At some point radical joy and acceptance must take place. This is a difficult stage to reach, and it takes time.
Accepting the experiences and feelings that come into your life, much like the rain or the sun. We experience pain and loss, but we can also experience joy. Both exist and can co-exist, and we don’t have to go back to self-destructive behaviors.
Those on the roof have developed strong, healthy coping skills. They have learned to accept pain and joy, and in place of self-destructive behaviors there is self-compassion and fulfillment in healthy relationships.
