Radical Acceptance & Real Life Skills with Dr. Shireen Rizvi

Join Dr. Pete as he welcomes his dear friend and trusted former colleague, Dr. Shireen Rizvi to the show. Dr. Rizvi is a licensed clinical psychologist, board certified in Dialectical Behavior Therapy and Cognitive Behavioral Therapy otherwise known as DBT & CBT - a very popular topic here at On Air With Dr. Pete. Dr. Rizvi has spent the last 25 years conducting research and training in DBT and spent her early years as a student being mentored by the one and only, Dr. Marsha Linehan, THE developer of DBT. Talk about a dream mentorship! Dr. Rizvi is a wealth of knowledge and this is a must listen episode! 

Learn more about Dr. Rizvi here:
https://www.shireenrizvi.com

Purchase Dr. Rizvi's New Book Here:

https://www.amazon.com/Real-Skills-Life-Navigating-Relationships/dp/1462555578

Learn more about DBT Here:

https://www.youtube.com/@DBTRU

Transcript

SPEAKER_00 0:17

Hello and welcome back to On Air with Dr. Pete. I'm your host, Dr. Pete Economo, and well, I have a pretty cool guest today because this is a friend. Uh I guess I have to call her a former colleague. Sad. Not really. She'll always be a friend and a colleague. Uh Dr. Shireen Rizvey is here today. Dr. Rizve is a licensed clinical psychologist. She's board certified in dialectical behavioral therapy, cognitive behavioral therapy, which that's where we first met. And uh she's a rock star in that world. Um she spent 25 years conducting research and training in DBT. And early years, uh, she was mentored by Marsha Linahan, uh, Dr. Marsha Linahan at Washington, the developer of DBT. So uh that is pretty amazing mentorship, and she's passed that on in the family tree to amazing graduate students who are doing great stuff. And uh Shireen, friend, colleague, thanks for being here.

SPEAKER_01 1:14

Thank you so much for having me. Do you remember when we first met? I don't remember when we first met, but I do have memories of talking to you about the Rutgers job when I was in a car in New York City parking somewhere in the West Village. Where were you going? I have that memory for some reason. I have no idea where I was going, but I do remember talking to you and encouraging you to apply and to come. Maybe you had already been offered and were considering coming. I think so. I think that's what we were talking about. But when did we first meet?

SPEAKER_00 1:47

Well, okay, by the way, a job that you knew nothing about because like because nobody knew anything.

SPEAKER_01 1:54

True, true. But I knew that I wanted you to come and be close to me. How's that?

SPEAKER_00 2:00

I love it. I'll take that. Uh so we well, we first met at the New Jersey ACBS, which I was forming with Erica Miller. And so we brought you in to do a DBT talk uh on like maybe on um shame. And is that sound about right? And we it was in a chocolate in a chocolate store.

SPEAKER_01 2:22

Oh yes. Now I remember. What year was that? Do you think?

SPEAKER_00 2:27

I don't remember. That was the best.

SPEAKER_01 2:29

We talked in the chocolate store and then we got chocolates afterwards.

SPEAKER_00 2:33

We got chocolate, yeah. Erica knows how to do a good presentation and conversation. Yes. Yeah, yes. Shout out uh to Erica. So that that's where we first met.

SPEAKER_01 2:42

Okay.

SPEAKER_00 2:43

Yeah, I remember that. And uh, because the chocolate and shame, and it was just lovely. Um, and so I'll tell our listeners that the reason I was at the uh introduction saying that you're a former colleague, uh, because yes, you were one of the reasons I accepted the job. Um and you recently made some changes, which is we I guess we'll talk about, which is super exciting for you. Um so we um so share about your background first though, because obviously Ruckers, you were there for what, 18 years? 17? 15, 15 years. 15 years, yeah. Okay. So tell tell tell everyone about that background.

Building DBT Training And Clinic

SPEAKER_01 3:18

About my time at Ruckers. So well, before that, I will say that, you know, thank you for the very kind introduction. I did do my graduate program um with Marsha Linahan at the University of Washington. And as a you know, PhD student in clinical psychology, I was really raised in this. When I say raised, I mean in the culture of academia then to with the idea being that a department of psychology, tenure track, research job is is what you need to do. And in many ways, I wanted to do that because I wanted to emulate what Marcia had done so successfully. And so I first got a job at the new school of social research in New York City for a couple of years before three years before moving to Rutgers, where I was professor in the Graduate School of Applied and Professional Psychology for 15 years. And there I actually really got to do what I wanted to do, which was in large part to mirror my training experiences. So when I learned from Marcia, she had a training clinic where she actually would the lore is, and whether, you know, maybe this is 50% true, but the lore is she would call the inpatient units nearby in Seattle and say, send us the worst of the worst, your hardest people, and then give them to our students. So she had a trial by fire uh approach. And then I wanted to do that for Rucker students, and so I started my own clinic, the uh we called it DBTRU. Uh, I've trained dozens of students um through there that are now all throughout the world doing good things.

SPEAKER_00 5:02

Literally throughout the world, just just so people know, because they move on and and that's really amazing. And so I yeah, I don't know if I gave that enough of an emphasis in the opening about Washington because that was I mean, it is such a tremendous program, and obviously having her as your mentor. Um you also the another thing that we connected on was that you were uh classmates with Jonathan Fader there. Isn't that true?

SPEAKER_01 5:25

That is true, yes.

SPEAKER_00 5:26

Jonathan and I were ahead of you or about no same year, same year. Yeah, you guys came in together.

SPEAKER_01 5:33

Yeah, we did. Oh, so we spent most Friday nights together in the library doing stats homework. Very exciting.

SPEAKER_00 5:40

Very exciting. Yeah. Um, and so I guess how did people choose if they went to like study with Marsha or not? Or you knew that you wanted to go there to do that?

SPEAKER_01 5:49

I wasn't sure actually. At the time when I was applying for grad school, I uh uh had been working in a lab, a research lab on eating disorders and the development and application of cognitive behavioral therapies for eating disorders. And so when I applied to grad school, I actually applied to all, you know, when when you're in this type of program, you apply to work with a particular faculty member. So I applied to work with all faculty at universities that were doing eating disorders research, with one exception, and that was uh Marsha.

SPEAKER_00 6:25

Interesting. And what made you choose her then at that exception then? I she probably wasn't as known then, right?

SPEAKER_01 6:32

It's interesting because this was 1998. Her book had uh come out in 93, but but still I think it was it was not what it is now for sure. Uh so um, and actually, I think that's what made me appealing to her as a student because the research lab that I was working in at Stanford on eating disorders had a faculty member named Christy Telch who was actually the first to adapt DBT skills for eating disorders and got research. So I worked on that study, and so when I applied to grad school, I could tell Marsha I've had some exposure to DBT and DBT research. And at that time, there weren't many people in my position who could say that, right?

SPEAKER_00 7:14

That was very West Coast, yeah. I mean, I would say DBT was more popular on the West Coast, and it took some time to get onto the East Coast.

SPEAKER_01 7:21

I think that's probably true. Yeah.

SPEAKER_00 7:23

And I actually say you're the re you and maybe like two other people are probably the reason it got to the East Coast in a heavy kind of way.

SPEAKER_01 7:30

Well, that's kind, but I think there's a lot of us. It's an army, it's an army.

SPEAKER_00 7:34

It's it's an army. Well, it just for the record, like this is sort of how all of our lunches have gone historically, and our I've I've said I should be Shireen's PR. Uh and right? I mean, fault you fault me for that.

SPEAKER_01 7:48

They hire you immediately.

SPEAKER_00 7:49

Yeah, yeah, because well, we gotta promote the the other thing that traditional researchers don't do well is promote well, okay. I'm gonna say this promote them in a way that is digestible for others. Like I think we'll promote ourselves because we self-promote and it's sort of like this vacuum. And I I can say that, I think you could say that now that you're out of it. Um, but yours is like it's genuine because the work that you who is going to hospitals to take the most difficult patients to fix? Who's doing that? You know, most people are myself, like I, you know, I'm in sports, it's cute, it's sexy, like, you know, we're not trying to take like severe pathology. Your work, so let's break that down for listeners. Like, how would you most simply kind of uh describe DBT to listeners who if they don't know what it is?

SPEAKER_01 8:31

Yeah, well, just building upon what yours what you were um starting to talk about is that when Marcia developed this treatment, what it came out of her attempting to apply what we might call standard cognitive behavioral therapy to uh a population that had not had CBT before. And that population was chronically suicidal and self-injuring women at the time who met criteria for borderline personality disorder. And all the early studies, research, in fact, the treatment manual says borderline personality disorder on it, um, that was the population of interest because she really wanted to treat people that um for whom there was no other, there was no evidence-based treatment. Uh and in fact, most people thought they couldn't improve. And that was it, right? So she developed uh DBT after her experiences of seeing that standard cognitive behavioral therapy didn't work as well with this population. She wanted to keep the essence of CBT, obviously uh tried and true, evidence-based approaches uh to mental health problems, but realized that there were some limitations. Um, so one limitation was she started to go in and really emphasize change. You know, you have all of these problems. We got to work on changing your life and changing all of your problems and figuring out how your thoughts contribute to this and your behaviors, et cetera. And when she did that, the people that she was treating had actually a very strong negative reaction. They were basically like, how could you possibly suggest that I can change this if you knew how hard this was, if you knew how much pain I was in, if you knew how long I've had these problems, you would never suggest that I could easily change it. And if I could have changed it, I would have changed it myself a long time ago, right? Yeah. Um, so then she realized that what she needed to do was emphasize and incorporate a focus on validation and acceptance. Like actually, everything is perfect as it is. Of course, you are in pain and you're suffering given everything that has happened to you and your learning history and your biology and all of that. So she started to do that, a lot of heavy validation and acceptance. And when she kind of leaned too much on that, what she found was there was a reaction to that too, which is of course, yeah, okay, you understand me, but if you really understood me, you would realize I'm in hell and you would try to get me out of that.

SPEAKER_02 11:12

Out of hell, right? Yeah.

SPEAKER_01 11:13

Yeah. So that's where this I the notion of dialectics came in, which is ultimately striving to balance and to integrate change and acceptance.

SPEAKER_00 11:24

Yeah. Did she use the word? I don't want to talk too much about her because we're here to talk about you, but um, you know, I I know as a Zen practitioner that that's a lot of also that influenced the modalities. Um did you hear a lot about Zen in your graduate training?

SPEAKER_01 11:39

Oh, for sure. Because she was actually a Zen student. She was going to retreats at least twice a year. Her own experiences with Zen informed her development of the treatment. Yeah. So uh so yeah, and we did mindfulness at every meeting. It was uh it was the culture there.

SPEAKER_00 11:55

Yeah, okay. That's really cool to hear. Uh, you know, um, because you you I think you know that about that. I'm a Zen teacher as well. And uh so like understanding that, but it's very it's very important uh to keep them separate, you know. I think at least like my Zen teacher is also he's a PhD in psychoanalysis. I don't think they do that anymore, but that's his PhD. Um and so he'll always say, like, they're so different. And I'm like, well, suffering is suffering, it's universal, and that's sort of at the foundation of DBT, too. Like, how do we help people alleviate suffering by understanding the dialectics that we all you know live in?

SPEAKER_02 12:29

Um okay.

Dialectics And Zen Influence

SPEAKER_00 12:30

So I'm gonna jump to radical acceptance then, because I want to hear you as the expert kind of describe that because that's a big piece of it, and you just beautifully articulated that around the idea of the dialectic. So um explain uh radical acceptance for listeners.

SPEAKER_01 12:44

Sure. So radical acceptance is integral to the delivery of DBT as a therapist, and it is also a skill that we teach our clients to learn and practice, right, along with many other skills, which we'll probably talk about. But radical acceptance as a skill is of course one of the most challenging, I think, for people because what it is telling us to do is to completely, totally, radically accept this one moment or this situation exactly as it is. And even sometimes just saying that and hearing that, like people are like, no, I refuse, right? And that's the that's the reaction that often comes up because actually so much of the time we're we're we don't realize it, but we're rejecting reality.

SPEAKER_00 13:36

Yeah. Right. Well what's actually what's in front of you. What you know, what just came to mind is like, do you have like what's your top two favorite skills uh in dbt?

SPEAKER_01 13:49

I would probably say well, favorite in terms of what I use most often. Uh, and this has evolved over time because I do think that there's like uh almost developmental progression. But for me, my top two now are radical acceptance and mindfulness of current emotion. I love it. Learning to just sit and be mindful of your emotion without acting on it.

SPEAKER_00 14:15

So as you were describing radical acceptance, I was like, I wonder if this is her favorite. That's where that thought came from. I was like, I've you know, yeah.

SPEAKER_01 14:21

Well, it's so critical, I feel like, um, because it actually is, you know, we talk about this uh in the book. When I teach, it's radical acceptance is for when life is not going the way you want it to go, which is pretty much all the time, right? Some aspect of our life, you know, we might be generally content or happy, but there's always something we're not. And a lot of the times we're not happy or content. Uh, we're upset with the way the world is, we're upset with how another person behaves, we're upset with ourselves and sure and what we're like. So there's basically it's it's a constant practice, radical acceptance to say this is exactly as it is.

SPEAKER_02 15:06

Yeah.

SPEAKER_00 15:07

So now you are the director of psychology training and director of dbt services and research. Um, so tell us about your new role uh and and and what's what's good about it, what's what's challenging.

Radical Acceptance Explained

SPEAKER_01 15:20

Yeah, so I'm now those things at Montefiro Medical Center in the Bronx. Um, this was, you know, actually in in a way I can loop it back to the DBT skills because um I was at a point where I had been, you know, at Rutgers for 15 years. I it it um it contributed so much to my career. I mean, I would not be where I am today without the experiences and support and research and students and all the stuff I did that I when I was there. So for a long time it was exactly what I needed and wanted. And then I started to notice that I was having um emotions. Uh and I, you know, I'm not this is not particular to where, but just in general, and I think this happens to a lot of people, like just a dissatisfaction, right? And I realized after trying to fight it for a couple of years, actually, that my way of uh what I needed to radically accept was that I was no longer uh content in the job that I was in, and that I was really craving novelty and something new. And so that was radical acceptance moment, which led me then to make changes, right? So people think that radical acceptance means you just like passively say, Oh, everything is shit, and I accept it, and then I don't do anything. But actually, in that moment, like that's a great example of how radical acceptance, actually really acknowledging and accepting, oh, I'm not happy in my job right now, led me to make a wise decision. Let me look for something else that I feel like will meet me where I am right now.

SPEAKER_00 17:08

So, another skill we'll give to listeners since you just mentioned the wise decision, so wise mind. Um, that's always been one of my favorites.

SPEAKER_01 17:16

Yeah. Why is it your favorite?

SPEAKER_00 17:19

Well, I guess it's like the Zen part about it. Because for me, so in Zen we call it middle path, and you're trying, you know, and so it to me it's every like there's like I'll say there's three sides to a coin. You know, most people say there's two sides and kind of living in that dialectic, and it's like, no, you could take a nickel and very easily stand it up along the circumference, you know, and and that's what to me, that's what DBT is, that's what well-being is, that's what this is. So um, how would you just how would you describe why is wise mind not on your top two?

Favorite Skills And Everyday Use

SPEAKER_01 17:47

Oh, well, because you forced me to pick two, so to pick two. But if you asked me on any other day, who knows what I would say, right? Yeah. Um wise mind refers to in dbt language, it's another skill that we practice as therapists, that we teach uh clients, is to say that we want to try to get into a place or a state of mind where we feel centered, um, kind of at peace more often, right? And that's what we call wise mind. And wise mind is the integration of these two other states of mind, or the middle path, if you will, between these two other states of mind that we refer to as emotion mind on the one hand and reasonable mind on the other hand. And the idea is that a lot of the problems that we experience or the behaviors that cause problems for us is because we're actually in one of two extremes. We're in emotion mind where our emotions are controlling what we do, right? Or we're in reasonable mind where we're discounting all emotions and we're just like going through the motions of something in a very logical way. And both of those have their places. Like we're not saying that those are bad to be in. However, uh, they often miss important information when we are too much in either extreme. And that's why we strive to find that place where we can say, what is, you know, we can actually ask ourselves, what's the wise thing to do here in any moment? And that will often elicit an answer that might be different than what you were thinking.

SPEAKER_00 19:21

And I could say that I've observed you be that way. Like you live that, you lead by that, you know, you're a colleague like that. Uh, I've always enjoyed watching you because I I was in emotion mind for a a while for the last few years together. Um, you know, and just to watch you kind of navigate that. And I love that you shared that this change for you in career was your own radical acceptance. And and to highlight that, it doesn't mean you stay there. Every athlete I work with is like, I'm not radically accepting this. This is dumb. I want to get somewhere else. You can't get there until you accept it.

SPEAKER_01 19:56

Yeah, that's great.

SPEAKER_00 19:57

So talked about the book because this is like super cool. Uh just came out this month, right?

SPEAKER_01 20:02

Yep.

SPEAKER_00 20:03

Yeah.

Wise Mind And Middle Path

SPEAKER_01 20:03

Uh so the book is called Real Skills for Real Life. Yes. Real Skills for Real Life, a DBT guide for navigating stress, emotions, and relationships. I had to take a peek at it because I forgot what it was. I wanted to make sure I got it right. It's everything after the colon. Uh the co-author of this book with me is actually um Jesse Finkelstein, who was a student of mine at uh Rutgers. What is amazing about Jesse, and well, he's amazing in many ways, but um, psychology for him was a second career. His first career was in graphic design and user experience. And he so he took a class with me. I'll get to the book eventually, but he took a class with me, and um, you know, he had come into grad school thinking that he was gonna go down the road of becoming a psychodynamic um therapist. Until he met you. That's exactly right. And I'm not, by the way, he would say that, and I've heard him say that a million times, so I'm not making this up. That I uh in my classes on the foundations of CBT and then DBT, it really changed him and what he wanted to do. And he is now an amazing therapist. What he brought, so I taught him a lot. He taught me so much because one of the things that he has brought to the table is saying something that I think we all know but don't know how to address, which is that we are terrible psychologists and treatment researchers are terrible at marketing, at making our stuff engaging and interesting. And so everybody knows about pharmaceuticals, you know, everybody has heard Prozac and uh they might not take it, but they've heard of it. How many people have heard of CBT or DBT? A much smaller percentage, right? Yeah. Um, so we started collaborating on a couple of things. The first thing that we collaborated on was back in 2020 when it was COVID, we got a grant to help to do some research on helping undergrad students during COVID. Yeah. Um a cat is making an appearance. Sorry, but that's Jimmy. Yeah, he's on my left, but then he just uh stuck his head up and now he's gonna mess with the microphone. Okay. That's perfect. So um, so we got money to do a small research study to um provide coping skills to undergrads who were dealing with the effects of COVID and being at home and not being on campus. And as part of that research, what we did was we made 14 animated videos that were five minutes or less teaching DBT skills. And Jesse did all the animations, they were amazing. So we did the study, and then after the study was done, I was like, why the hell not? Let's put this on YouTube and make it freely available for people. And I have have just been shocked, and actually, this is the only thing that impresses my children about my job, which is it that it's popular. Like we have um 2 million, 2.7 million views, I think, across all the videos. They've been translated to different languages. So if people want to see it, they can go to YouTube. Um, the channel is dbtru.

SPEAKER_00 23:25

We'll put that, we'll put that in the show notes.

SPEAKER_01 23:27

Oh, great. So then after that, realizing the success of that, we started to talk about what else could we do to make these skills more accessible. Yeah. And we decided to write this book. So now I finally got to the book. The book, I think, is um, you know, there is a skills manual that goes with DBT that Marcia obviously wrote. It is 225 handouts and worksheets. It is amazing. It is an amazing encyclopedia. We are not intending our book to replace that. Right. And the feedback we get from a lot of people is that it's very dense, very hard to understand. And it is not, it was never meant for people who are not in DBT therapy. Right. Right. So if you were not in DBT therapy, but you wanted to learn the DBT skills, there's not a lot of options for you. True.

SPEAKER_02 24:15

That's right.

SPEAKER_01 24:16

So that's why we wrote this book. And the book is really uh designed to be user-friendly. There's illustrations, there's how-to, there's um is it 26 dbt skills? Is that we took 26 of the skills, which I think are like pretty much the core skills that you would get in a standard DBT program.

SPEAKER_02 24:35

Yeah.

Career Pivot Through Acceptance

SPEAKER_01 24:36

Uh, and we taught it in ways that like you don't have to have any experience with DBT to pick it up and learn. And what we're hearing so far, because people have gotten some advanced copies and talked about it, is that therapists are liking it because it gives them different ways to think about and teach the skills. They're also seeing, oh, this is going to be great for my clients who want to, you know, know more about DBT. But really, again, just saying we were really hoping that that anyone could pick up this book and and learn more about DBT skills.

SPEAKER_00 25:05

Right, because you don't have to be borderline or an eating disorder to use dbt. And I think that's what I'm hearing you say in this, because it is uh by the way, she's drinking from a mug that says world's most okayest mom or world's okayest mom. So that's uh that's how wise and middle path we are.

SPEAKER_01 25:21

This is dialectical or in here?

SPEAKER_00 25:22

Yes, we're just okay, and that's okay.

SPEAKER_01 25:26

We're the okayest.

SPEAKER_00 25:27

We're the okayest. You have one other thing that your kids are really proud of is that you um I can get them tickets any game that they want to go to.

SPEAKER_01 25:34

Yes, they uh they are they love Dr.

SPEAKER_00 25:36

Pete for uh for not at all selfish reasons, for for for sports events, and I love I love spoiling people that like to be at the venues and the events, so I it is my pleasure. Yeah, so I love that this book. I thank you for sending the an advanced copy and just to you know look and I yeah, it's it's digestible, and thank you for doing that because that's what we need, you know. I think um the adolescent manual, I thought did that for some in some ways, you know, yeah, for for the world, just to like break it down a little bit, and when you work with these different groups, you have to think about how do I take these abstract ideas because then is very abstract, you know, the foundation of DBT is abstract. So how do I make it? And I think that's what you both did here. So that's super cool.

SPEAKER_01 26:19

Thank you.

SPEAKER_00 26:20

Yeah, so um, so tell us uh you know where people can find this and and and a little, you know, if they want to get uh, you know, if they need treatment or anything like that, where would you send people to?

SPEAKER_01 26:32

Well, so the book is available at Guilford Um Press or Amazon or anywhere else. I think you can order books um starting now.

SPEAKER_02 26:41

Yeah.

SPEAKER_01 26:42

Uh my website, which has a link to various resources that I've developed, is uh sharenrisvey.com and the YouTube videos or the channel DBTRU. If you are looking for a DBT therapist, this is of course more complicated than what I just rattled off because there are a lot of therapists who have learned some things about DBT. Yep. There are fewer therapists who do what I call DBT by the book. Yes. And depending on how severe your problems are and what you're looking for, it's important for anybody who's seeking out therapy to know what they need and to ask the right questions. Um, so I do tell people when they're looking for DBT therapists to ask the therapist, do you do the full model of DBT? Do you only do parts of DBT? And if only parts, what parts do you do? Um, to really try to ask uh questions about how to um find out how close what they're doing is to the manual.

Note: Chapter order corrected in timeline

SPEAKER_00 27:50

Really good advice. And um set you know, said well, and it's it's important to know that because there's there's someone out there for everyone. So, Shireen, Dr. Rizby, thank you so much for being here and uh for blessing us with your time and with this wonderful book.

SPEAKER_01 28:03

Thank you. It was so fun to talk with you.

Real Skills For Real Life Book

SPEAKER_00 28:06

All right, you're an inspiration, and I wish you continued success in this book. So thank you for listening at home. You'll have all those links in the show notes, and we will be back next week. Until then, spread a little kindness and stay well.