DBT Origins and Target Population

You can listen wherever you get your podcasts, OR— BRAND NEW: we’ve included a fully edited transcript of our interview at the bottom of this post.

In this episode of The Peaceful Parenting Podcast, I speak with Shireen Rizvi, PhD and Jesse Finkelstein, PsyD, about their book Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships.

We discuss what Dialectical Behavior Therapy (DBT) is, how it can help both ourselves and our kids with big feelings, and get into some of the skills it teaches including distress tolerance, check the facts, and mindfulness.

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We talk about:

* 6:00 What is DBT?

* 11:00 The importance of validation

* 13:00 How do parents manage their own big feelings?

* 16:00 How do you support a kid with big feelings, and where is the place for problem solving?

* 23:00 Managing the urge to fix things for our kids!

* 26:00 What is distress tolerance?

* 28:50 “Check the facts” is a foundational skill

* 34:00 Mindfulness is a foundation of DBT

* 36:45 How the skills taught through DBT are universal

Resources mentioned in this episode:

* Yoto Player-Screen Free Audio Book Player

* The Peaceful Parenting Membership

* Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships by Shireen Rizvi and Jesse Finkelstein

* Shireen Rizvi’s website

* Jesse Finkelstein’s websites axiscbt and therahive

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Podcast transcript:

Sarah: Hey everyone. Welcome back to another episode of the Peaceful Parenting Podcast. Today we have two guests who co-authored a book called Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships.

And you may be wondering why we’re talking about that on a parenting podcast. This was a really great conversation with Shireen Rizvi and Jesse Finkelstein, the co-authors of the book, about all of the skills of DBT, which is a modality of therapy. We talked about the skills they teach in DBT and how we can apply them to parenting.

They talk about how emotional dysregulation is the cause of so much of the pain and suffering in our lives. And I think as a parent, you will recognize that either your own emotional dysregulation or your child’s is often where a lot of issues and conflict come from.

So what they’ve really provided in this book—and given us a window into in this conversation—is how we can apply some of those skills toward helping ourselves and helping our children with big feelings, a.k.a. emotional dysregulation. It was a really wonderful conversation, and their book is wonderful too. We’ll put a link to it in the show notes and encourage you to check it out.

There are things you can listen to in this podcast today and then walk away and use right away. One note: you’ll notice that a lot of what they talk about really overlaps with the things we teach and practice inside of Peaceful Parenting.

If this episode is helpful for you, please share it with a friend. Screenshot it and send it to someone who could use some more skill-building around big emotions—whether they’re our own big emotions or our child’s. Sharing with a friend or word of mouth is a wonderful way for us to reach more people and more families and help them learn about peaceful parenting.

It is a slow process, but I really believe it is the way we change the world. Let’s meet Shireen and Jesse.

Hi, Jesse. Hi, Shireen. Welcome to the podcast.

Jesse: Thank you so much for having us.

Sarah: Yeah. I’m so excited about your book, which I understand is out now—Real Skills for Real Life: A DBT Guide to Navigating Stress, Emotions, and Relationships. First of all, I love the format of your book. It’s super easy to read and easy to use. I already thought about tearing out the pages with the flow charts, which are such great references—really helpful for anyone who has emotions. Basically anyone who has feelings.

Jesse: Oh, yes.

Sarah: Yeah. I thought they were great, and I think this is going to be a helpful conversation for parents. You’ve written from a DBT framework. Can you explain what DBT is and maybe how it’s different from CBT? A lot of people have heard more about cognitive behavior therapy than dialectical behavior therapy.

Shireen: Sure. I would first say that DBT—Dialectical Behavior Therapy—is a form of cognitive behavioral therapy. So they’re in the same category. Sometimes we hear therapists say, “I do DBT, but I don’t do CBT,” and from my perspective, that’s not really possible, because the essence of dialectical behavior therapy is CBT. CBT focuses on how our thoughts, behaviors, and emotions all go together, and how changing any one of those affects the others.

That’s really the core of DBT—the foundation of CBT. But what happened was the person who developed DBT, Marsha Linehan—she was actually my grad school advisor at the University of Washington—developed this treatment because she was finding that standard CBT was not working as well as she wanted it to for a particular population. The group she was working with were women, primarily, who had significant problems with emotion regulation and were chronically suicidal or self-injuring.

With that group, she found they needed a lot more validation—validation that things were really rough, that it was hard to change what was going on, that they needed support and comfort. But if she leaned too much on validation, patients got frustrated that there wasn’t enough change happening.

So what she added to standard CBT was first a focus on validation and acceptance, and then what she refers to as the dialectical piece: balancing between change and acceptance. The idea is: You’re doing the best you can—and you need to do better.

Jesse: Mm-hmm.

Shireen: And even though DBT was developed for that very severe group that needed a lot of treatment, one of the aspects of DBT is skills training—teaching people skills to manage their emotions, regulate distress, engage interpersonally in a more effective way.

Those skills became so popular that people started using them with everyone they were treating, not just people who engaged in chronic suicidal behavior.

Sarah: Very cool. And I think the population you’re referring to is people who might be diagnosed with borderline personality disorder. I bring that up only because I work with parents, not kids, and parents report to me what their children are like. I’ve had many parents worry, “Do you think my child has borderline personality disorder?” because they’ve heard of it and associate it with extreme sensitivity and big feelings.

A lot of that is just typical of someone who’s 13 or 14, right? Or of a sensitive child—not diagnosable or something you’d necessarily find in the DSM. I’ve heard it so many times. I say, “No, I don’t think your child has borderline personality disorder. I think they’re just really sensitive and haven’t learned how to manage their big feelings yet. And that’s something you can help them with.”

With that similar level of emotional intensity—in a preteen or early teen who’s still developing the brain structures that make self-regulation possible—how can we use DBT skills? What are a couple of ideas you might recommend when you have a 13-year-old who feels like life is ruined because the jeans they wanted to wear are soaking wet in the wash? And I’m not making fun—at 13, belonging is tied to how you look, what jeans you’re wearing, how your hair is. It feels very real.

So how might we use the skills you write about for that kind of situation?

Jesse: Well, Sarah, I actually think you just practiced one of the skills: validation. When someone feels like their day is ruined because of their jeans, often a parent will say, “Get over it. It’s not a big deal.” And now, in addition to fear or anxiety, there’s a layer of shame or resentment. So the emotion amplifies and becomes even harder to get out of.

Validation is a skill we talk about where you recognize the kernel of truth—how this experience makes sense. “The jeans you’re wearing are clearly important to you. This is about connection. I understand why you feel this way.” That simple act of communicating that someone’s thoughts and feelings make sense can be very powerful.

Alongside that—back to what Shireen was saying—there are two tracks. One is the skills you help your teen practice. The other is the skills you practice yourself to be effective. In that moment, your teen might be dysregulated. What is the parent’s emotion? Their urge? What skills can they practice to be effective?

Sarah: I love that you already went to the next question I was going to ask, which is: when that kid is screaming, “You don’t understand, I can’t go to school because of the jeans,” what can parents do for themselves using the skills you describe?

Shireen: I often think of the oxygen-mask analogy: put on your own oxygen mask before helping others. That was certainly true for me when I had fussy infants—how do you manage that stress when you are already heightened?

What do you need to do to regulate yourself so you can be effective in the moment? Sometimes that’s literally taking a time-out—leaving the room for a minute. The kid comes after you about the jeans, and you say, “Hold on, I need a minute.” You sequester yourself in the bathroom. You do paced breathing—a DBT skill that helps regulate your nervous system. You do that for a minute, get centered, and then return to the situation.

If you’re not regulated and your child is dysregulated, you’ll ping-pong off each other and it becomes messier and messier. But if you can regulate yourself and approach calmly, the whole interaction changes.

Sarah: It’s so interesting because people who’ve been listening to my podcast or know my work will think, “Oh yeah, these are the things Sarah talks about all the time.” Our first principle of peaceful parenting is parental self-regulation. It doesn’t mean you never get upset, but you recognize it and have strategies to get back to calm.

And I always say, if you forget everything else I teach about dealing with upset kids, just remember empathy—which is another way of saying validation. I tell parents: you don’t have to agree to empathize. Especially with situations like the jeans.

I love the crossover between the skills parents are practicing in my community and what you’ve written about. And again: those flow charts! I’m going to mark up my book with Post-its for all the exercises.

One of the things you talk about in the book is problem solving. As parents, we can find ourselves in these intense situations. I’ll give an example: a client’s daughter, at 11 p.m., was spiraling about needing a particular pair of boots for her Halloween costume, and they wouldn’t arrive in time. No matter what the mom said, the daughter spiraled.

This is a two-part question: If you’ve validated and they’re still really upset, how do you support a kid who is deep in those intense feelings? And when is the place for teaching problem solving—especially when there is a real logistical problem to solve?

Jesse: I’m going to say the annoying therapist thing: it depends. If we think about how emotions impact our thinking on a scale from 0 to 10, it’s very hard to engage in wise-minded problem solving when someone is at an 8, 9, or 10. At that point, the urge is to act on crisis behaviors—yell, fight, ruminate.

So engaging your child in problem solving when they’re at a 9 isn’t effective.

Often, I suggest parents model and coach distress-tolerance skills. Shireen mentioned paced breathing. Maybe distraction. Anything to lower the emotional volume.

Once we’re in the six-ish range? Now we can problem solve. DBT has a very prescribed step-by-step process.

But it’s really hard if someone is so dysregulated. That’s often where parents and kids end up in conflict: parent wants to solve; kid is at a 9 and can’t even see straight.

Sarah: Right. So walk us through what that might look like using the boots example. Play the parent for a moment.

Jesse: Of course. I’d potentially do a couple of things. I might say, “Okay, let’s do a little ‘tipping the temperature’ together.” I’d bring out two bowls of ice and say, “We’ll bend over, hold our breath for 30 seconds…”

Shireen: And put your face in the bowl of ice water. You left out that part.

Jesse: Crucial part of the step.

Sarah: You just look at the ice water?

Jesse: No, you submerge your face. And something happens—it’s magical. There’s actually a profound physiological effect: lowering blood pressure, calming the sympathetic nervous system.

I highlight for parents: do this with your child, not didactically. Make it collaborative.

And then: validate, validate, validate. Validation is not approval. It’s not saying the reaction is right. It’s simply communicating that their distress makes sense. Validation is incredibly regulating.

Then you check in: “Do you feel like we can access Wise Mind?” If yes: “Great. Let’s bring out a problem-solving worksheet—maybe from Real Skills for Real Life or the DBT manual. Let’s walk through it step by step.”

Sarah: And if you have a kid screaming, “Get that ice water away from me, that has nothing to do with the boots!”—is there anything to add beyond taking a break?

Shireen: I’d say this probably comes up a lot for you, Sarah. As parents—especially high-functioning, maybe perfectionistic types (I put myself in that category)—if my kid is upset, I feel so many urges to fix it right away. Sometimes that’s helpful, but often it’s not. They either don’t want to be fixed, or they’re too dysregulated, or fixing isn’t actually their goal—they just want to tell you how upset they are.

I have to practice acceptance: “My kid is upset right now. That’s it.” I remind myself: kids being upset is part of life. It’s important for them to learn they can be upset and the world doesn’t fall apart.

If they’re willing to do skills alongside you, great. But there will be times where you say, “I accept that you’re upset. I’m sorry you feel this way. It sounds terrible. Let’s reconnect in an hour.” And wait for the storm to pass.

Sarah: Wait for the storm to pass.

Jesse: I’ll say—I haven’t been a therapist that long, and I’ve been having this conversation with my own parents. Yesterday I called my mom about something stressful, and she said, “Jesse, do you want validation or problem solving right now?”

Shireen: Love it.

Jesse: I thought, “You taught her well.” I was like: okay, therapy works. And even having that prompt—“What would you like right now? Problem solving? Validation? Do you want me to just sit with you?”—that’s so useful.

Sarah: Yeah. I have to remind myself of that with my daughter, especially when the solution seems obvious to me but she’s too upset to take it in. Just sitting there is the hardest thing in the world.

And you’ve both anticipated my next question. A big part of your book is distress tolerance—one of the four areas. Can you talk about what distress tolerance is specifically? And as you mentioned, Shireen, it is excruciating when your kid is in pain or upset.

I learned from my friend Ned Johnson—his wonderful book The Self-Driven Child—that there’s something called the “righting instinct.” When your child falls over, you have the instinct to right them—pick them up, dust them off, stand them up. That instinct kicks in whenever they’re distressed. And I think it’s important for them to learn skills so we don’t do that every time.

Give us some thoughts about that.

Shireen: Well, again, I think distress tolerance is so important for parents and for kids. The way we define it in DBT is: distress tolerance is learning how to tolerate stressful, difficult, complicated situations without doing anything to make it worse. That’s the critical part, because distress tolerance is not about solving problems. It’s about getting through without making things worse.

So in the context of an interaction with your kid, “not making it worse” might mean biting your tongue and not lashing out, not arguing, not rolling your eyes, or whatever it is. And then tolerating the stress of the moment.

As parents, we absolutely need this probably a thousand times a day. “How do I tolerate the distress of this moment with my kid?” And then kids, as humans, need to learn distress tolerance too—how to tolerate a difficult situation without doing anything to make it worse.

If we swoop in too quickly to solve the problem for them—as you said, if we move in too quickly to right them—they don’t learn that they can get through it themselves. They don’t learn that they can right themselves.

And I think there’s been a lot written about generations and how parenting has affected different generations. We want our kids to learn how to problem solve, but also how to manage stress and difficulty in effective ways.

Sarah: I think you’re probably referring to the “helicopter parents,” how people are always talking about helicopter parents who are trying to remove any obstacles or remove the distress, basically.

I think the answer isn’t that we just say, “Okay, well, you’re distressed, deal with it,” but that we’re there with them emotionally while they’re learning. We’re next to them, right? With that co-regulation piece, while they’re learning that they can handle those big feelings.

Shireen: Yes. Yeah. Yeah.

Sarah: I thought it might be fun, before we close out, to do a deep dive on maybe one or two of the skills you have in the book. I was thinking about maybe “Check the Facts.” It would be a cool one to do a deep dive on. You have so many awesome skills and I encourage anyone to pick up your book. “Check the Facts” is one of the emotion regulation skills.

Do you mind going over when you would use Check the Facts, what it is, and how to use it?

Jesse: Not at all. Check the Facts is, in many ways, a foundational skill, because it’s so easy for us to get lost in our interpretation of a situation. So the classic example is: you’re walking down the street and you wave to a friend, and they don’t wave back. And I don’t know about you, but it’s easy for me to go to, “Oh, they must be mad at me.”

Sarah: Right, yeah.

Jesse: And all of a sudden, I’m spinning out, thinking about all the things I could have done to hurt their feelings, and yada yada yada. Then I’m feeling lots of upset, and I may have the urge to apologize, etc.

What we’re doing with Check the Facts is returning our attention back to the facts themselves—the things we can take in with our senses. We’re observing and describing, which are two foundational mindfulness skills in DBT. And then from that, we ask ourselves: “Does the emotion I’m feeling—the intensity and duration of that emotion—fit the facts as I’m experiencing them?”

So in many ways, this is one of those cognitive interventions. DBT rests on all these cognitive-behavioral principles; it’s part of that broader umbrella. Here we’re asking: “Do the facts as I see them align with my emotional experience?”

From there, we ask: if yes, then there are certain options or skills we can practice—for instance, we can change the problem. If no, that begs the question: “Should I act opposite to this emotion urge that I have?”

So it’s a very grounding, centering type of skill. Shireen, is there anything I’m missing?

Shireen: No. I would just give a parenting example that happens for me a lot. My kid has a test the next day. He says he knows everything. He doesn’t open the book or want to review the study guide. And I start to think things like, “Oh my gosh, he has no grit. He’s going to fail this test. He’s not going to do well in high school. He’s not going to get into a good college. But most importantly, he doesn’t care. And what does that say about him? And what does it say about me as a parent?”

I hope people listening can relate to these sorts of thoughts and I’m not alone.

Sarah: A hundred percent. I’ve heard people say those exact things.

Shireen: And even though I practice these skills all the time, I’m also human and a mother. So where Check the Facts can be useful there is first just recognizing: “Okay, what thoughts am I having in response to this behavior?” The facts of the situation are: my kid said he doesn’t need to study anymore. And then look at all these thoughts that came into my mind.

First, just recognizing: here was the event, and here’s what my mind did. That, in and of itself, is a useful experience. You can say, “Wow, look at what I’m doing in my mind that’s creating so much of a problem.”

Then I can also think: “What does this make me feel when I have all these thoughts?” I feel fear. I feel sad. I feel shame about not being a good parent. And those all cause me to have more thoughts and urges to do things that aren’t super effective—like trying to bully him into studying, all of these things.

Then the skill can be: “Okay, are these thoughts exaggerated? Are they based in fact? Are they useful?” I can analyze each of these thoughts.

I might think, “Well, he has a history of not studying and doing fine,” is one thing. Another thought: “Me trying to push him to study is not going to be effective or helpful.” Another: “There are natural consequences. If he doesn’t do well because he didn’t study, that’s an important lesson for him to learn.”

So I can start to change my interpretations based on the facts of the actual situation as opposed to my exaggerated interpretations. And then see: what does that do to my emotions? And when I have more realistic, fact-based thoughts, does that lead me to have a better response than I would if I followed through on all my exaggerated thinking?

Does that make sense?

Sarah: Yeah, totally makes sense. Are there any DBT skills that are helpful in helping you recognize when you need to use a skill—if that makes sense? Because sometimes I think parents might spiral, like in the example you’re talking about, but they might not even realize they’re spiraling. Sometimes parents will say, “I don’t even know until it’s too late that I’ve had this big moment of emotional dysregulation.”

Jesse: I think there’s a very strong reason why mindfulness is the foundation of DBT—for exactly the reason you’ve just described. For a lot of us, we end up engaging in behaviors that are ineffective, that are not in line with our values or goals, and it feels like it’s just happening to us.

So having a mindfulness practice—and I want to highlight that doesn’t necessarily mean a formal meditation practice—but developing the skill of noticing, of being increasingly conscious of what you’re feeling, your urges, your thoughts, your behaviors. So that when you notice that you are drifting, that you’re engaging in an ineffective behavior, you can then apply a skill. We can’t change what we’re not aware of.

Sarah: I love that. It’s so hard with all the distractions we have and all of the things that are pulling us this way and that, and the busyness. So just slowing down and starting to notice more what we’re feeling and thinking.

Shireen: There’s a skill that we teach that’s in the category of mindfulness called Wise Mind. I don’t have to get into all the particulars of that, but Wise Mind is when you’re in a place where you feel wise and centered and perhaps a little bit calmer.

So one question people can ask themselves is: “Am I in a place of Wise Mind right now?” And if not, that’s the cue. Usually, when we answer that we’re not, it’s because we’re in a state of Emotion Mind, where our emotions are in control of us.

First, recognizing what state of mind you’re in can be really helpful. You can use that as a cue: “I’m not in Wise Mind. I need to do something more skillful here to get there,” or, “I need to give myself some time before I act.”

Sarah: I love that. So helpful. Before we wrap up, was there anything you wish I’d asked you that you think would be really helpful for parents and kids?

Shireen: I just want to reiterate something you said earlier, which is: yes, this treatment was developed for folks with borderline personality disorder. That is often a diagnosis people run screaming from or are very nervous about. People might hesitate to think that these skills could be useful for them if they don’t identify as having borderline personality disorder.

But I think what you’re highlighting, Sarah—and we so appreciate you having us on and talking about these skills—is that we consider these skills universal. Really anybody can benefit.

I’ve done training and teaching in DBT for 25 years, and I teach clinicians in many different places how to do DBT treatment with patients. But inevitably, what happens is that the clinicians themselves say, “Oh, I really need these skills in my everyday life.”

So that’s what we want to highlight, and why we wrote this book: to take these skills from a treatment designed for a really severe population and break it down so anybody can see, “Oh, this would be useful for me in my everyday life, and I want to learn more.”

Sarah: Totally. Yeah. I love it. And I think it’s a continuum, right? From feeling like emotions are overwhelming and challenging, and being really emotionally sensitive. There are lots of people who are on that more emotionally sensitive side of things, and these are really helpful skills for them.

Jesse: Yeah. And to add on that, I wouldn’t want anyone—and I don’t think any of us here are suggesting this—it’s such a stigmatized diagnosis. I have yet to meet someone who’s choosing suffering. Many of us are trying to find relief from a lot of pain, and we may do so through really ineffective means.

So with BPD, in my mind, sometimes it’s an unfortunate name for a diagnosis. Many folks may have the opinion that it means they’re intrinsically broken, or there’s something wrong with their personality. Really, it’s a constellation of behaviors that there are treatments for.

So I want anyone listening not to feel helpless or hopeless in having this diagnosis or experience.

Shireen: Mm-hmm. Mm-hmm.

Sarah: Thank you so much. The question I ask all my guests—I’ll ask Shireen first and then Jesse—is: if you could go back in time, if you had a time machine, if you could go back to your younger parent self, what advice would you give yourself?

Shireen: Oof. I think about this a lot, actually, because I feel like I did suffer a lot when my kids were babies. They were super colicky. I didn’t sleep at all. I was also trying to work. I was very stressed. I wish that at that time I could have taken in what other people were telling me, which is: “This will pass.” Right? “This too shall pass,” which is something we say to ourselves as DBT therapists a lot. Time changes. Change is inevitable. Everything changes.

In those dark parenting moments, you get stuck in thoughts of, “This is never going to change. It’s always going to be this way. I can’t tolerate this.” Instead, shifting to recognize: “Change is going to happen whether I like it or not. Just hang in there.”

Sarah: I love that. My mother-in-law told me when I had my first child: “When things are bad, don’t worry, they’ll get better. And also, when things are good, don’t worry, they’ll get worse.”

Shireen: Yes, it’s true. And we need both the ups and the downs so we can actually understand, “Oh, this is why I like this, and this is why I don’t like this.” It’s part of life.

Sarah: Yeah. Thank you. And Jesse, if you do ever have children, what would you want to remember to tell yourself?

Jesse: I think I would want to remember to tell myself—and I don’t think I’m going to say anything really new here—that perfection is a myth. I think parents often feel like they need to be some kind of superhuman. But we all feel. And when we do feel, and when we feel strongly, the goal isn’t to shame ourselves for having that experience. It’s to simply understand it.

That’s what I would want to communicate to myself, and what I hope to communicate to the parents I work with.

Sarah: Love that. Best place to go to find out more about you all and what you do? We’ll put a link to your book in the show notes, but any other socials or websites you want to point people to?

Shireen: My website is shireenrizvi.com, where you can find a number of resources, including a link to the book and a link to our YouTube channel, which has skills videos—animated skills videos that teach some of these skills in five minutes or less. So that’s another resource for people.

Sarah: Great. What about you, Jesse?

Jesse: I have a website called axiscbt.com. I’m also a co-founder of a psychoeducation skills course called Farrah Hive, and we actually have a parenting course based on DBT skills—that’s thefarrahhive.com. And on Instagram, @talk_is_good.

Sarah: Great. Thank you so much. Really appreciate your time today.

Jesse: Thank you, Sarah.

Sarah: Thank you.

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