DBT-informed therapy for emotions that feel too big
DBT-informed psychotherapy in New York that pairs practical skills for intense emotions with the depth and warmth of an integrative therapy relationship.
When feelings arrive fast and overwhelming, it can be hard to think, let alone choose how to respond. Dialectical behaviour therapy offers a toolkit for exactly those moments: ways to ride out distress, steady your emotions, stay present and ask for what you need. I draw on DBT skills within individual sessions, alongside deeper exploration and psychiatric care where helpful, so the tools are tailored to your life rather than taught in isolation.
“You are doing the best you can, and you can learn to do things differently. Both are true at once.”
That balance, known as a dialectic, sits at the heart of DBT. It invites compassion for where you are and commitment to where you want to go.
What DBT-informed therapy offers you
Dialectical behaviour therapy (DBT) is a structured, skills-based approach originally developed to help people living with very intense emotions and the painful behaviours that can follow.
DBT combines elements of cognitive behavioural therapy with mindfulness practices drawn from contemplative traditions. Its defining idea is the dialectic: holding acceptance and change together. Rather than asking you to simply think differently, DBT acknowledges that your emotional reactions make sense given your history and biology, while also teaching concrete skills to reduce suffering and build a life that feels worth living.
DBT skills are usually grouped into four areas: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Together they help you notice what is happening inside you, get through crises without making things worse, understand and shift emotional states, and navigate relationships while keeping your self-respect.
In my practice I offer DBT-informed psychotherapy, which means I bring these skills and principles into individual sessions as part of an integrative approach. This is different from a comprehensive DBT programme, and I am open about that difference so you can choose the right level of support.
DBT-informed versus a full DBT programme
Comprehensive DBT typically includes weekly individual therapy, a weekly skills group, telephone coaching between sessions and a consultation team for the therapists. That full model can be essential for people with frequent self-harm, recurrent suicidal crises or very high-risk behaviour. I do not run a full DBT programme. If that level of structure would serve you better, I will say so honestly and help you find it, and I may still be able to support you psychiatrically alongside it.
How DBT skills fit my integrative work
Skills work best when they fit your actual life. Because my sessions are long and unhurried, we can learn a skill, practise it together, and also explore why a particular trigger hits so hard. Somatic awareness strengthens many DBT skills, since noticing your body is often the first sign that an emotional wave is building. Psychoanalytic and relational understanding then helps explain where those waves come from.
Where psychiatry comes in
Sometimes emotional intensity is amplified by underlying depression, anxiety, ADHD, trauma or mood instability. As a board-certified psychiatric nurse practitioner I can assess these, and if medication or supplements may help, we can consider them together. Steadier baseline mood often makes skills easier to use. Any medication change is gradual, collaborative and monitored, and skills remain central.
DBT-informed therapy may help if you feel overwhelmed
DBT-informed therapy suits people who want practical ways to manage strong emotions, alongside space to understand them. You might be highly sensitive, quick to react, or caught between shutting down and boiling over. It can also help people with ADHD, trauma histories or rejection sensitivity who find emotions arrive faster than words.
- Emotions that escalate very quickly
- Regretting what you say when upset
- Intense fear of rejection
- Urges to numb or escape
- Feeling empty or unstable inside
- Relationships swinging between extremes
- Struggling to calm down after conflict
- Difficulty asking for needs directly
- Harsh, all-or-nothing thinking
- Wanting skills alongside deeper therapy
DBT skills, taught with care
Sessions balance structure and flexibility. Some time may focus on a particular skill or a recent difficult moment; other time on the feelings and history underneath. We adapt the balance to what you need each week.
Mindfulness skills
Mindfulness is the foundation of DBT. We practise noticing thoughts, feelings and sensations without immediately acting on them, building a small but powerful pause between trigger and response that you can widen with time.
Distress tolerance
For moments when emotions feel unbearable, we build a personal plan of crisis survival skills, from changing body temperature and paced breathing to self-soothing and distraction, so you can get through without making things worse.
Emotion regulation
We learn to name emotions accurately, understand what they are telling you, and reduce vulnerability by looking after sleep, food, movement and stress. Small, consistent changes can make emotional storms less frequent and less intense.
Interpersonal effectiveness
We work on asking for what you need, saying no and handling conflict while protecting both the relationship and your self-respect. Role-play in session can make these conversations feel far more manageable in real life.
Chain analysis
When something difficult happens, we can map it step by step: the trigger, thoughts, body sensations, urges and actions. This curious, non-judgemental review shows where a different choice was possible and how to make it next time.
Psychiatric support
If mood, anxiety, attention or sleep difficulties are making skills harder to use, I can assess whether medication or supplements may help. Treatment is chosen together, introduced slowly and reviewed regularly within the same relationship.
DBT-informed therapy and full DBT
Both have value. The right fit depends on your level of risk, your goals and how much structure you need.
DBT-informed therapy here
- Individual 60 or 90-minute sessions
- Skills woven into integrative therapy
- Room for depth and history
- Psychiatric care in one relationship
- Suited to moderate emotional intensity
Comprehensive DBT programme
- Individual therapy plus skills group
- Between-session phone coaching
- Therapist consultation team
- Highly structured, manualised format
- Suited to frequent crises or self-harm
Starting DBT-informed therapy
We begin by making sure this is the right level of support for you.
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1
Free consultation 15 minutes
We talk about what you are struggling with and what you hope DBT skills might help with. I will ask gently about safety so I can recommend the right level of care, whether that is working with me, a full DBT programme, or both together.
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2
Assessment 60 or 90 minutes
We look at your emotional patterns, triggers, relationships, history and wellbeing in depth. If psychiatric questions such as mood, attention or sleep are relevant, I assess these too, so the plan reflects the whole of you.
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3
Building your skills plan
Together we choose which skills to focus on first, often starting with mindfulness and distress tolerance. You leave sessions with something concrete to try, and we review what worked and what did not when we next meet.
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4
Deepening and integrating
As skills become more natural, we spend more time on the roots of emotional intensity, using relational, somatic and psychoanalytic approaches. We keep reviewing progress and adjust the balance of skills and depth work as your needs change.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
DBT Psychotherapy FAQs
What is DBT-informed therapy?
DBT-informed therapy uses the principles and skills of dialectical behaviour therapy, such as mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, within individual psychotherapy. It is not the same as a comprehensive DBT programme, which adds a skills group, phone coaching and a therapist consultation team. In my New York practice, DBT-informed work is combined with integrative therapy and, where helpful, psychiatric care.
Do you offer a full DBT programme or DBT certification?
No. I offer DBT-informed psychotherapy within an integrative practice and do not run a comprehensive programme with skills groups and phone coaching, nor do I hold DBT certification. If you need that level of structure, for example because of frequent self-harm or recurring suicidal crises, I will help you find a suitable programme and can often continue to provide psychiatric support alongside it.
Is DBT only for borderline personality disorder?
DBT was first developed for people with chronic suicidality, often with a borderline personality disorder diagnosis, but its skills are now used much more widely. People with anxiety, depression, trauma, ADHD, rejection sensitivity or simply very strong emotions often find them useful. You do not need any particular diagnosis to benefit, and I approach labels thoughtfully and without stigma.
Can DBT skills help with ADHD and emotional dysregulation?
Many adults with ADHD experience emotions that arrive quickly and intensely, along with rejection sensitivity and impulsive reactions. DBT skills such as pausing, naming emotions and planning for triggers can be a helpful complement to ADHD care. As a psychiatric nurse practitioner, I can also assess ADHD and discuss medication or supplement options, so both sides are addressed in one place.
What happens if I am in crisis between sessions?
I do not provide between-session phone coaching in the way a full DBT programme does, which is one reason I discuss safety carefully at the start. Together we create a personal plan for difficult moments using distress tolerance skills and trusted supports. If you are ever at risk of harming yourself or in immediate danger, please call or text 988, or call 911.
How does DBT-informed therapy combine with medication?
Skills and medication can work well together. Medication may help steady baseline mood, anxiety or attention, making it easier to reach for a skill in the moment, while skills give you tools no prescription can offer. Because I can prescribe, we can decide together whether medication has a role, start gradually, and monitor carefully. Many people choose skills-based therapy without medication, and that is equally respected.
Will I have homework?
Usually there is some practice between sessions, because skills grow through use. That might mean trying a breathing technique when stressed, noticing emotions in a simple diary, or rehearsing a conversation. I keep practice realistic and adapt it to your energy and circumstances. If homework starts to feel like another pressure, we will talk about it and adjust.
Learn DBT skills in New York
If you want practical tools for intense emotions within warm, integrative care, book a free 15-minute consultation to talk about whether this is the right fit.