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How can we distinguish “real CBT” from supportive talk - does it include homework, clear goals, or a manualized plan? When therapy “doesn’t work,” is it the modality, the match, or weak training? Are common factors enough once symptoms disrupt daily life? Why does fragmented care push patients to choose meds or therapy by luck of first contact? When are meds a useful boost versus a detour from solving life problems? What’s distinct about DBT—skills, validation, and balancing change with acceptance? How does radical acceptance cut suffering without excusing harm? Which skills travel across diagnoses? How do we prevent therapist burnout and drift from the model? If we want durable gains, should we favor therapies that teach skills we keep after treatment ends?

Shireen Rizvi is a licensed clinical psychologist, board certified in Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT). She obtained her BA from Wesleyan University and her MS and PhD from the University of Washington.

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