What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy, originated by Marsha Linehan, Ph.D. in 1991, is a
type of therapy that is designed to help individuals who have difficulty in regulating their emotions.

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Do you have an “Intensively Trained” DBT team?


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What does DBT treatment at The Koch Center entail?

At The Koch Center, we offer the protocol originally designed by Dr. Marsha Linehan. “Full” DBT therapy means that an individual is in: 1) one (or more) weekly DBT skills group(s), and 2) weekly individual DBT Therapy.

However, we recognize that each person’s situation is unique. As such, we create an individualized treatment plan for each patient. We offer several DBT services including:  group DBT skills training, individual DBT therapy or skills training, diary card review, family or parent skills training (individual or group), family therapy, and medication management.

In some cases, a person may only be in a once-weekly DBT skills group at The Koch Center, while continuing with his/her outside therapist. In other cases, a patient may require more extensive support throughout the week. That patient may be in multiple DBT groups as well as individual DBT therapy.

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What are the Four DBT Skills?

There are four skill areas in DBT:

Core Mindfulness: These skills teach patients to retrain their focus to the here and now in order to help them attain attentional and emotional control.

Distress Tolerance: Tolerating distress is one of the most difficult tasks people need to learn. This skill set teaches individuals how to cope with and distract themselves during moments of overwhelming emotion and during a crisis.

Emotion Regulation: Individuals are taught the basic components of feelings, as well as means to enhance and more fully enjoy positive emotions, while concurrently decreasing and tolerating negative feelings.

Interpersonal Effectiveness: The aim of this set of skills is to teach individuals the basics of interpersonal interactions including how to ask for help and reassurance from others, how to assert one’s needs, and how to express one’s self in a manner that others can readily respond to.

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What is a Diary Card?

A diary card is a grid-like form that helps patients track target symptom occurrence(s) and DBT skill use.

Together a patient and his/her group or individual therapist tailor the diary card to address specific targets for change.

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Where can I find a Diary Card?

You can print blank diary cards from here:  www.kochcenter.com/dbt.zip.

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What does “dialectical” mean?

Essentially, “dialectical” means that two things (even opposites) can exist at the same time.  While the term “dialectics” may seem difficult at first, the concept is fairly straightforward. Dialectical means that absolute “truth” is never a certainty. In fact, the world is full of paradox and contradiction. Dialectics as they’re used in DBT help people “live in the gray.” For example, DBT assumes that even though someone is struggling with a symptom or problem, that person is doing the best s/he can. The goal in DBT is to learn new skills to live a better life.

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Why do some people struggle so much to manage emotions and other people don’t?

DBT proposes that emotion dysregulation results from both biological and environmental influences. Biology may predispose individuals to experience emotion at a certain intensity.  DBT helps people better understand their emotions and offers concrete coping skills.

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My therapist suggested that I do DBT. Does that mean I have Borderline Personality Disorder (BPD)?

While DBT was originally designed for those individuals diagnosed with borderline personality disorder, it has since been shown to be effective in helping people with a wider range of issues

The efficacy of DBT with patients with BPD led Dr. Linehan and her colleagues to apply and research the use of DBT with other populations (including substance abusers, depressed patients, those with anger management difficulties). Current research is ongoing with still other populations (including patients with eating disorders, anxiety, adolescent issues). At The Koch Center, we have found that DBT is helpful for individuals with a wide range of issues and diagnoses, not only those diagnosed with borderline personality disorder.

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What are the requirements for being in a skills training group?

We require each group member to be in weekly individual therapy, either at The Koch Center or with a therapist outside of our center. If a patient is working with an outside therapist, we will ask the patient to consent to us speaking with the outside therapist. By coordinating with an outside therapist we are better able to provide maximum cohesion and continuity in treatment.

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What happens in the skills training group?

The agenda of a skills group might entail: 1) a brief check-in from each group member; 2) a group mindfulness exercise; 3) homework review; 4) new skill learning and discussion; 5) homework/practice assignment for the week; and sometimes 6) another mindfulness exercise.

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How many group members are in each group?

Most Koch Center groups are small — typically from 4 to 8 members (but this varies).

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What if I don’t like being in therapy groups? Is there some other way to do DBT?

If you’ve determined that you don’t like therapy groups based on past experience, you might be surprised at how different a DBT group is. Unlike groups where members discuss whatever topics are on their minds, DBT groups are highly structured. The goal of each skills group is the acquisition and practice of the DBT skills. While being in a group is the most traditional way to learn DBT skills, in certain circumstances, individual skills coaching or family skills training is available.

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How long will it take?

It takes about 6 months to complete the four modules of skills in a DBT Skills group. Some clients choose to repeat the skills group in order to solidify skills acquisition. Others stop after one round of skills training.

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What is a Parent/Family Group?

Within the context of DBT, parent groups at The Koch Center extend skills teaching to parents and family members. Parents and family members learn the same tools that their loved one is learning in DBT. This permits a common language that can facilitate reinforcement of skill use and better coping at home.

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I like my individual therapist; do I have to switch in order to be in your DBT program?

No, but you must be seeing your therapist weekly. We also must be able to speak with your outside therapist to provide maximum cohesion and continuity in treatment.

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I don’t have an eating disorder. Do you just treat people with eating disorders?  Can I still do DBT?

Certainly. While eating disorders are one of our areas of specialty, we do not
only treat people with eating disorders. We work with men and women with a wide
range of diagnoses. Our DBT groups are tailored to people with emotion
regulation difficulty. One does not need to have an eating disorder to be in our
DBT groups.

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I have an eating disorder. Do you offer supportive meals?

Supportive meal groups are not of our intensive programs. We are
able to offer individual eating with one of our nutritionists or therapists.  If someone needs supportive meals throughout the week, we may provide referrals to programs that offer a higher level of care.

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What will happen at my first appointment?

The first appointment is referred to as the “initial assessment.” At this first appointment, a therapist will ask you questions about your situation, types of problems you are experiencing, your personal and family history and other relevant information. After your assessment, our treatment team will devise an individualized treatment plan based on the information obtained during the assessment, as well as information provided by (with your consent) other (current or past) treatment providers.

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What should I do if I experience a crisis while in treatment?

Please call 911 in an emergency/life threatening situation. In Bergen County, you can call (201) 262-HELP if you are experiencing a mental health crisis. We do not offer 24 hour
coverage or support.

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Where can I learn more about DBT?

Dr. Marsha Linehan’s book, Skills Training Manual for Treating Borderline Personality Disorder, is considered the “gold standard.” You may order a copy through Amazon by clicking here:  http://kochdbt.com/resources/book-recommendations (each group member is expected to have a copy of this book).

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How does insurance and payment work?

The Koch Center is considered an “out-of-network” treatment provider with insurance companies. As such, payment is due at the time of each session. At each session, we will provide you with an itemized bill that you can submit to your insurance carrier for reimbursement based on your particular plan’s policies.

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How do I find out how much my insurance company will reimburse me for your service?

If you would like to find out how much your insurance company will reimburse, you should contact your insurance carrier and ask how much they will reimburse for the specific services you are seeking (i.e., initial assessment (cpt code 90791), individual psychotherapy (cpt code 90834), and group psychotherapy (cpt code 90853). Be sure to ask the following: the percentage the insurance company will reimburse, whether or not you have a deductible, if there is a maximum allowable amount per service, and whether or not you need preauthorization or precertification before beginning treatment.
Some insurance companies require the patient to get preauthorization or precertification (by phone).  Other insurance companies require us (The Koch Center) to get the necessary preauthorization or precertification.

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I called my insurance, but the information they gave me is confusing. Can you help?

For questions related to payment or insurance, please contact our office manager, Rifka Kreiter, at 201-670-1066 ext. 4.

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How do I get started?

To make an appointment, please call Dr. Cyndi Koch at (201) 670-6450 ext. 1, email us at info@thekochcenter.com, or use the contact form below.

Your Name (required)

Your Email (required)

Your Phone Number


Your Message

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My adolescent needs DBT but refuses to attend. What can I do?

You can attend. We have DBT groups for parents only. Sometimes parents attending on their own can be a good way to approach this problem. In our parent DBT groups, parents are able to learn the DBT skills and get individual problem solving strategies to help them with their adolescent. When one part of the family system changes, it can have a positive impact on the family dynamic.

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I’m worried that my adolescent will be put with other kids who are too different from my child. Does this happen?

We complete a thorough assessment with every adolescent to ensure that each group is comprised of members who are appropriate in terms of age and symptomatology.

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I have an HMO (no insurance out-of-network benefits). I’d still like to seek treatment at The Koch Center. Help?

We have found that some insurance companies will agree to approve a single case agreement (ad-hoc agreement) as they are unable to provide a DBT program within their network. For more information, please, contact Dr. Cyndi Koch at 201-670-6450 x1.

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