CBT, DBT & Renewing the Mind: Practical Tools for Perfectionism, Imposter Syndrome & Emotional Regulation w Dr. Lisa Napolitano

Hello there fearfully and wonderfully made human. It's me Diana from Through the Valley Therapy and Transform Mind Consulting and Coaching. and I want to welcome you back to the Holistic Counselor Podcast where faith, science, and holistic healing intersect. Today's episode is one I've been looking forward to for months because we're diving into a therapy that has been at the very heart of my own clinical journey, cognitive behavioral therapy or CBT.

This was one of the very first modalities I leaned on in my work alongside Rogerian approaches. And truthfully, CBT has shaped not only how I help my clients, but also how I live in my own life. Because when we challenge our thoughts, we transform our behaviors and in turn our lives.

As scripture reminds us, it is about renewing the mind. I first met today's guest, Dr. Lisa Npalitano, at a CBT networking event right here in Boca Raton, Florida. And let me tell you, when I realized who she was, I knew I had to invite her on the show.

Dr. Napalitano is a licensed clinical psychologist in New York and Florida, board certified in behavioral and cognitive psychology. She's the founder and director of CBT DBT Associates, the president and founder of the Florida CBT Association, and a fellow and certified trainer with the Academy of Cognitive and Behavioral Therapies, an honor earned by fewer than 200 therapists worldwide.

She has over 20 years of experience, is an author, researcher, and mindfulness teacher, and she is truly one of the leading voices in CBT today. My hope is that this episode not only equips you with powerful CBT tools, but also helps break down old narratives that have kept so many from seeking help.

May it open the door to seeing therapy not as a label, but as a pathway to true healing and wholeness. So take a deep breath and settle in because I hope this conversation is filled with practical strategies, encouragement, and a few transformative aha moments you can carry with you into this new year.

Dr. Napalotano, thank you so much for being here.

Thank you so much for that introduction, Diana. It's a pleasure to be here. Okay. So, before we even uh get into the therapy side of our brains, can you just share your personal journey and what led you to become a psychologist?

Sure. Um, so it was a bit of a convoluted path. You know, I majored in political economy in college. Um, I went to school in New York City at Barnard, at Columbia, and then went on to law school. Uh, so psychology really wasn't on my radar.

And I think it's interesting when we when I look back on my career and I think when we all look back that the mix of intention and serendipity um you know that is responsible for where we end up. I was living in DC working for a large firm and near Georgetown University and decided to take an introductory seminar in psychology and fell in love with the subject matter. um you know I felt it was a subject that informed my understanding of others but also myself

and um one course led to another and the faculty suggested I pursue graduate studies. So that's how that came about.

Wow.

Yeah.

Yeah. That's wonderful. And can I ask where you grew up?

I grew up outside of New York City in Westchester County.

Okay. All right. And then you came to Florida. Do you do you live in Florida or New York?

I live in Florida.

Okay. And um yeah, I had a condo in Florida for many years. I've always loved Miami. Um

particularly Miami Beach and uh yeah, I just felt a special affinity for Miami Beach from the first time I visited it.

And it didn't occur to me to live there full-time until the pandemic and that's when I moved down. So I've been in full-time [clears throat] about

Yeah.

Yeah.

All right, man. Yeah. That's wonderful. All right. So in in many faith communities, right, because that's the community I mostly serve is in the in the Christian community and faith community. And I'm realizing more and more that

being a Christian therapist now for five years, like specifically private practice because I worked in alternative high schools most of my career in Broward County. So I had, you know, we are trained ethically and clinically to serve everybody in that capacity. But I also understand that in in my community, the the black indigenous people of color community and churches, Christian churches, there is so much stigma.

There's still so much stigma and it seem as something for crazy people people or only for those who will be diagnosed and medicated. How can we reframe therapy as a pathway to growth, healing, and wholeness instead?

Yeah, that's a great question. I I think in my opinion so much of the stigma comes from how we conceptualize or think of psychological problems and I as a clinical psychologist I'm not working from the biio model right so the b the biomed model um we're thinking of psychological problems as brain diseases right it's a diseasebased model.

And the intention was actually ironically to decrease stigma to say look these disorders are no different than uh chronic health conditions like diabetes or you know heart disease but inadvertently and there's research actually to support what I'm saying dating back to 2015 there was a special issue of the behavior therapist on this very topic the biomemed model actually has not decreased stigma in fact they're suggest estion, it may have increased it.

It makes psychological problems frightening to other people. Right? So for me to say I have anxiety, I have to say I'm sick. The other unfortunate consequence of the model is it kind of undercuts

what Christians and people of other faiths believe agency that the individual has free will, right? And the ability to change their behavior and their thoughts. Wow.

And also decreases um expecties for treatment that it would be effective, right? Because if I have a brain disease, I need either brain surgery or I need medication. Um and then my hopes for engaging in a therapeutic process with you would be pretty capped, pretty limited on, you know, the amount of change that I could expect.

Yeah.

So, I want to validate the stigma. Um I think I think in large part it comes from that model. Um

what was the name of the biomedical because you mentioned I would love to put these things in the show note anytime any send you references. Yeah the biomemed model um was really promoted by the national institute of mental health. it was going to be um the decade of the brain and science was going to engage in this process for each disorder to find the particular uh disturbance in the brain.

So it's very um what we would call reductionistic and till this day there's very there's no evidence to show this. There's some correlational data but certainly not causation. So I think to dispel stigma and you know I'm passionate about CBT. I think and it sounds like you are too.

We share that passion.

Yeah.

One of the beautiful things about CBT is we think of psychological problems in really non-stigmatizing ways.

We're not saying listen you're sick.

Right?

And when I think someone's sick like think about it. But if the therapist is sitting with someone who's sick, it's going to affect their stance, how they interact with the other person. I feel CBT is is much more egalitarian, like we're equals. You know, I struggle with things.

You struggle with things maybe to a greater degree,

but we're thinking of problems as patterns in behavior, in thinking, in emotional responding. And then as the CBT therapist, teaching skills to change those patterns. That's a very different model.

Yeah, it is. I love that. Um, so let's talk about CBT because I know it's get thrown around with our own our own network, right? colleagues and stuff, we speak that language. And so to me, many of my listeners do not speak the therapeutic language and that's what they fear the most like the word therapy or mental illness or things like that.

So let's explain to to the audience cognitive behavioral therapy in a way that feels approachable, practical, and hopeful. How do you do it?

Yeah. So I would say very simply first of all I explain there are many different therapies under this umbrella of CBT many DBT dialectical behavior therapy we can talk about is one of them but in essence CBT is saying um we're looking at how we construe our world you know what we believe about ourselves others the future um understanding how do we come to form those beliefs and then examing ing how they affect us emotionally and behaviorally, right?

What I think affects how I feel, what I do,

and then looking at them for accuracy. So, I always explain to clients, our thoughts are not always facts. That's an essential part of CBT. Um, I can think, you know, I'm a woman, I'm a psychologist, fact, fact. But then I have I may have another thought that's more um not so easily factual, right?

like imposter syndrome,

right? I'm a failure. Um I'm unable

or who am I to do this,

right? I'm unqualified.

Yes.

Yes. Yeah.

Uh so that's not so clearly factual. So and that's going to affect me when I think that emotionally. So it would be really important to bring that into awareness and then evaluate it for accuracy. Um, so another important part of CBT is learning about our cognitive distortions.

We're all prone, including CBT therapists, to biases or errors in our thinking,

right?

Yeah.

And learning which of those errors do I engage in, what's distorting my thinking,

and then learning to offset for that.

Yeah. Can can you name a few of those cognitive distortions?

Sure. I was thinking about a bunch this morning. Um, in social anxiety, which is a condition where people um, when they're in social situations, there's an increase in anxiety and hyper self-consciousness, a shift in focus to the self. And it's it's very common when people are socially anxious to mind readad, to make guesses about what other people are thinking about them.

Yeah.

And those thoughts increase their anxiety.

Right.

Right. Um, so it's very important to ask, first of all, how do I know what other people are thinking? Assuming they're even thinking about me.

Exactly. Because most people aren't thinking about you. I'm just going to be right on. Right. That's what I learned with CBT. It's like most people are in their own little world worried about what you're worried about themselves.

Yeah. Or another one that I see is um shoulds, right? Shoulds are very interesting.

And in CBT we teach clients um you know I sh you should do this I should do this uh slowm moving pedestrians let's say we were in Manhattan um should stay to the right and then I leave my office trying to make mad dash to an exercise class and we've got people walking five across really slow I'm going to get really angry right so shoulds are generally our arbitrary preferences for how things would be how others would behave if we were masters of the universe.

Right.

Yeah. So by reframing that as I would prefer, you know, I would prefer pedestrians that walk slowly, stay to the right, but the facts are they don't. It changes how I respond emotionally. So we see a lot of shoods in anger management. Also a lot of personalizing, right?

Like

Yeah. taking things personal.

Yeah. like it's not bad service, but you're doing this to me,

right?

Let's let's talk that about that a little because I do see that a lot, especially I think it's when we're like in areas that are with so many different cultures and people, right? We make a lot of assumptions and I see that because I mean I grew up in New York.

I've been in in Deerfield Beach, Florida for like the last 40 40 years, but but still, right? I mean, you you have road rage. You have uh people that popping off on their kids. You and it's like, you should have known better, right?

And it's like, wait, but they're eight years old. Why would they know? They're not an adult. You're expecting this thing on them, right? And it's and it's not putting guilt and shame because that's the thing we carry a lot is the guilt and the shame of these cognitive distortions.

Yeah. And I think you know another type of CBT that's really relevant

um is dialectical behavior therapy which is based very much on the spiritual tradition of Buddhism. Having compassion for the self, loving regard when we um identify the distortions we're engaging in, not beating yourself up, not being ashamed about it, noting it and then changing it.

Right. Yeah.

Yeah.

Yeah. How do we how do we change it? What what other um

tools that that you utilize without giving everything away? Because I know you want people to work with you or your or your or your therapist. And it's the same for me, but it it's also like we're we are only

able to have as many clients as our bandwidth can uh withstand, right? And that's why this podcast exists, Dr. Napalitano is because I want the listener when they stop listening that they're like, "Oh, I could do this one thing."

Yeah. One thing,

right? But I want to give them some more things.

No, we need to give them some more. And I I think there's so many great I was thinking about this before I jumped on today. self-help books, great um you know, podcasts that specialize in cognitive science findings, which CBT is based on, useful tips like the Uberman podcast, just fantastic.

Yeah.

Um that's one of my faves. Um and some really wonderful introductory to CBT self-help books like Feeling Good by David Burns or you can do this yourself. But I think an overarching error or bias in our thinking is confirmation bias.

It's one of the most interesting ones. And what that means is we're motivated to prove ourselves true to confirm what we already believe. So we're all forming theories. I like this metaphor of the person is scientist. To understand our world, we're creating theories, right?

Um but we generally are not engaging in in good science in terms of testing them out because of the confirmation bias. I will selectively pay attention to what confirms or supports what I already believe.

Yes.

Right. So if someone believes I'm unlikable,

they're going to pay very close attention to any evidence of dislike from people and they're going to systematically overlook rather evidence of being liked and that just strengthens their belief. So in CBT a very simple technique that we use over and over again is called two column technique and it's very important to do it old school pen and paper not in your head not typing it's more powerful when you're writing

yes

making two columns and looking at the evidence for the left hand column that supports your belief

and the right hand column the evidence that contradicts it.

Okay? because that's what we're overlooking.

Yeah.

Can we do that now? I mean, I know because let's talk about the imposttor syndrome one, right? Because that's what I hear a lot. I I work with um [clears throat]

quite a few women, 25 to 35 year olds that are like the first generation being raised with social media because when you said confirmation bias, man, we are in our echo chamber and this is the division we feel, but that is not the truth.

Because I'm I'm constantly asking that question. Where's the evidence that that's exactly what's happening? Cuz our brains are not meant to have the global world news in the palm of our hands and then it goes into our system because we are scrolling and every time we scroll [clears throat]

confirmation bias and echo chambers and then now we're believing that is the truth and the psychosis that I'm seeing with some people

because of that is like whoa. So how let's let's do the imposttor syndrome one. So, okay.

Yeah,

I'm I'm doing the two the two.

So, you're going to do the two columns and we're evaluating the belief I'm an impostor.

Is that your belief, Diana?

Do you want to phrase it differently? All right.

No, it's it's not it's it's more of like who am I to be able to do this?

I'm not competent to do this. I'm not qualified to do this.

Then I would ask how strongly do you believe that from zero to 100? Because you know we can believe things to varying degrees [snorts] and the more strongly we believe these negative thoughts the more strongly they affect us emotionally.

Yeah.

Right. I could have a fleeting thought. You know you're an idiot if I you know I'm typing a document and I make a mistake. It's not upsetting to me because I don't believe it. But if you really believe you're not qualified.

Yeah.

That's going to kick up I would imagine fear because you're in over your head. you're in an executive position and you don't know what you're doing. That's frightening, right? But then why do you say that? Like what is that based on? What are the facts that support the idea you're not qualified to do this?

Can you think of any facts? It it isn't facts, I don't think. It's more of the narratives probably growing up of uh those different humans that were in my village. Yeah. Okay.

So, that's interesting. And and that's not unusual that sometimes when I ask what are the facts to support it, we come up with nothing, right? Or very little.

Sometimes what people may write is um a a lot of clients with imposttor syndrome are perfectionistic. And it's sort of there's a belief if I'm not the best then I'm not qualified. Okay.

Right.

Yes. Dr. No. And the reason I I've I go to therapy, so I do my work. So that's why I'm like, okay, I' I've pinpointed, but what you're saying is spot on. I want to go there for a little bit while longer if we can because I really would love to help a listener that is struggling with that that perfectionism because there's a lot on us women especially and women of color.

Yeah. and women that um follow the Christian religion.

There's so much of that that I hear constantly. So, okay, I'm not qualified or what are the others that you hear?

I'm not good enough. That is the classic core belief. So, in CBT, just to backtrack a little, we're focusing on three levels of thinking. This may be more detailed than your audience knows or they may find it interesting. We have these things called automatic thoughts that just pop into your head without effort, right?

You may look at my screen and think a lot of windows, the very large hotel behind me. That's a fact. But some of those automatic thoughts are biased. We also have an intermediate level of thinking and those are our assumptions, right? And our conditional beliefs and our rules.

So I'll give you an example. Um if I am if I tend to be perfectionistic very common belief is I'm not good enough just in general I may have a conditional belief if then belief if I'm not the best then I've failed.

So the threshold for failure is much lower than someone else who doesn't have that belief. Right? They may have formed that in grade school if they took ballet or they participated in sports after school. If they're not the best on the team, then they've failed, right?

Yeah.

Also, this core assumption that perfection is desirable, which not everybody shares and that blows their mind. They think everyone has the same assumptions as me. That's why this is so important to examine like how am I setting up things, right?

Yes. And then the last level of thinking are your core beliefs. Your beliefs about yourself, right? Longstanding beliefs typically we form in adolescence uh early adulthood before our brain is fully formed and they tend to be very um [sighs] distorted black and white thinking.

Either I'm a winner, I'm a loser. Right.

Yeah.

Um

I'm pretty, I'm ugly.

Exactly. Yeah.

Over the course of our lives,

despite evidence to the contrary

because of confirmation bias, right? So, this is how this explains how you're working with young women who are incredibly talented. Um, this explains the imposttor syndrome. Um, they've achieved a lot, but yet they still have this belief they're inadequate or they're failures or they're not good enough.

Yeah.

Right. So, that's all working together. Um, and a great a great resource. The techniques I'm going to share um are in a book called Never Good Enough by Monica Bosco Ramirez. Um, it's a wonderful self-help book for perfectionists.

Yeah. Wonderful. Another one of another book to put on my

Yeah. So, I mean, if you came in with that belief

Yeah. My first question to all my clients who say I'm not good enough is for what? Like what does that even mean? Right.

Yeah.

You may not be good enough for the, you know, the US Olympic ski team, but you're you're good enough, right, to get down most intermediate um ski trails in the US. So, we need to put it into some context because that's that's that thought reflects overgeneralization.

That's another bias in thinking. It's too global and good enough for what? So, we need to kind of put a context on it and then look at the evidence for and against, right?

And so, if it's I'm not good enough to do this job, I think what would be relevant are your reviews. The fact that you're doing your job kind of contradicts it. You're getting paid that someone hired you, right?

Yeah. Yeah. And what may go in the four column is,

you know, so and so is performing high at a higher level than me.

Yeah.

And that's not, you know,

Yeah. And then that's a comparison um trap that we're in in this day and age because I know growing up I we I don't know how old you are. I'm not going to ask, but I am a Gen Xer and we did not have this.

We had comparison with Cosmopolitan and maybe the few commercials that were out there because there was three or four channels but but nowadays the younger the zelennials and the genzers and then the ones that were now raising the littles that are genphas like it is cons I see it in my grandchildren the comparison like well so and so has their own YouTube channel and I'm sitting there like oh my word

yeah that's the pitfall of comparison mind And it, you know, it puts limits on our ability to celebrate our own successes and it's not even relevant. We're socialized um to think comparatively I think particularly in school.

Yes.

What's my ranking? Where do I fall out?

But if I asked you Diana, how tall are you? And you said I'm shorter than Jane and taller than Bill. It's irrelevant. I still have no idea how tall you are. Right. So sometimes these comparisons don't bring any relevant information to the table.

Yeah.

We can be great therapists without being the best in the world.

Know how you would determine, right?

Yep.

Yeah.

Yeah. I mean, we can have all the accolades and PhDs and everything on our walls, but to to me, our work is to first do no harm,

right? And we each have how many uh billion people are in the world, right? And we can't see them all anyway. And it's just that's what I try to have whoever comes to me because I do have too not only imposttor syndrome that comes in a lot.

It is the analysis paralysis.

Yes.

You know what I'm talking about?

like it it is that they want to move forward and start a company or start something or go to a class or and they and then they they get they take the information in in in like trying to gently get them to okay you got it what's the fear you want to now create what's the fear and that this is where a lot of these other uh cognitive distortions come in the black and white thinking like

everything so what do you think of analysis paralysis Well, you know, a major contributing factor to that is perfectionism in my opinion.

And you know the way I approach perfectionism because it is such a common pro problem in high achievers is to be nuanced to be selective not dare to be average but let's examine how perfectionism is working for you and let's channel it selectively but let's define what it even means so we'll know when we've reached it.

Right? I'm out here trying to be perfect and I don't even know what it means. And that's often the case with clients, right?

So for each task defining what perfection is so that you'll know if you've hit it and you know if we think of a continuum, right? One point we've got perfection and the the other point we have zero and 50% 75. So, it's not quite perfect, but it's above average.

It's pretty good. When I'm writing an email, um, inter office email, does it need to be 100? Do I need to spend hours crafting it? Probably not, right? That's good. But if it's a if I'm doing a presentation to the team, then define what constitutes perfection.

Um, I love this system. It's called continuum technique. Okay? because you can give yourself constructive feedback on your performance and we demystified what perfection is. So I think some of that paralysis comes from striving for something and we haven't even defined it.

Yeah.

Right.

Yeah. Right.

So defining it up front so you know how close you are to it or what else you need to do to hit it. Deciding if it's even necessary. Um, and then I think some of the paralysis stems from this inability to build on your prior successes, right?

Yeah. Okay. Yeah.

And that undercuts confidence. So for a lot of my clients with uh imposttor syndrome, I have them keep accomplishment logs. These can go back um, you know, years. and their job is for each year professional personal um accomplishments and then periodically updating and also reviewing it.

So when they have that thought like who am I? You go back and you look at that that's who you are.

Yeah.

Right.

I love it. I call it I call it in my practice because we some wherever your brain goes your energy flows. And so sometimes our brain automatically, like you were saying before, will go into the negative or into

and and to me it's like, okay, let's let's have triggers and glimmers. Triggers and glimmers. And every time because as your therapist, I I you know, I take notes and everything, but it's just like understanding, okay, all right, now you've felt all your triggers in your body.

How do we end with realizing how far you've come already?

Yeah. And in in DBT,

and I use this in CBT as well,

um, for your listeners, dialectical behavior therapy, um, practicing the skill, it's very skills based of acknowledging incremental change.

Okay?

Right? Positive trends.

So maybe I'm not I'm not running a marathon. I'm still doing, you know, a mile or two and getting winded. But compared to my baseline, which was no running, there's been some improvement. That's the relevant reference point. Not where I want to go, but where I started, and then motivated to keep going

and acknowledge that progress.

I'm a big fan of apps, too, because you do get the positive reinforcement and

Oh, you mean apps on your phone?

Apps on your phone or like uh for fitness or whatever people's goals. Do you have a favorite one

or do you have

I love Strava for fitness goals.

Okay.

Because you you do get positive reinforcement from the other members. They

I never heard of that one. Yeah, Strava. I love that.

Workouts. You get um and the most powerful way for your listeners who are not familiar with these behavior change strategies to change your behavior is positive reinforcement. Not beating yourself up, not chastising yourself.

Yeah. we have to question why we do that. I think it's like you said earlier uh becoming curious or like becoming that curious observer of yourself. I know a little bit of DBT. I mean I utilizes it some back when I was working with teenagers but I'm not certified in it.

I and I know

I've had another person come on and talk about it. But because some of the listeners probably this might be the first episode they've ever listened to. I want to go Can we go into DBT a little bit more?

Yeah, I would love to.

Yeah. Uh so why DBT for you? Like how what do you see? Can you explain to the audience what exactly it is and why it started and why you or and and maybe who you use it for the most?

Yeah. So I mean I gravitated towards DBT pretty early in my um graduate school um training. Yeah.

And I think because it really resonated with my own mindfulness practice and um my view of of human nature which I've shared you know that we have one of the assumptions of DBT that's quite beautiful is we all have inherent wisdom there may be obstacles to accessing it but we can everything we need isn't here you know that therapist's job is is to help guide them to access that wisdom Um and DBT is was designed originally

by um someone named Marshall Inahan who's a behavioral psychologist of note um but also a Zen Roshi which is a highly esteemed teacher in the Zen tradition and u for your listeners this is a philosophy not a religion I guess Marca was actually a Roman Catholic um

I didn't know that.

Yeah. So what we're doing is bringing together, she brought together a very seamless integration of Zen,

Buddhism, which is very skills-based. We talk a lot in Zen about skillful means and behavior therapy. And it was designed for people originally who are chronically suicidal and self-injurious, right? a pretty severe

population but since that time has been adapted

um and its applicability has really exploded u to treat a variety of problems um particularly impulsivity but there's also an adaptation of DBT for people who are overcontrolled and um what do you mean by that overcontrolled

yeah so more like um anorexia obsessivecompulsive personality disord disorder. People who are very rigid.

Yeah.

As opposed to very obviously emotional, very impulsive,

do things in the heat of the moment. There

Yeah. Like, and I'm going to name a few diagnosis because we're we're in that field and and and I want someone that if they've ever been diagnosed with borderline personality disorder or because that's where I hear that DBT helps the most. But I want them to understand like there is hope because some people get so stuck in the diagnosis that they

Yes.

So that's why I want to bring that up a little. Dr. Napoleon.

Yeah. It's a very controversial diagnosis. And you know when DBT came on the scene, Marshall Inhan redefined what borderline personality disorder is. And that went a long way towards decreasing the stigma associated with that diagnosis. Um she redefined it as a disorder of pervasive difficulty regulating emotion.

Yeah.

And she even wanted to change the name of the disorder.

I didn't know that. See, look at I love this. I love when I have a guest that's teaching me because that's my curiosity and and if I'm learning and I'm a therapist for a couple decades like wow.

Yeah. The borderline that comes from psychoanalytic literature and that means you're on the borderline between psychosis and neurosis.

Okay.

And here's a behavioral psychologist wanting to take it out

of that theoretical frame.

And what what she says and this is called a biosocial model. So this is the model that's used in DBT to explain how BPD develops and how it's maintained.

Really?

Yeah. And what the model says is there are certain people who uh by virtue of their biology are um emotionally vulnerable. All right? So what that means is they have a lower threshold for responding to things that prompt emotions. So, if there were sad music playing in the background right now, um, I would be quicker to feel sadness perhaps than someone else who's not emotionally vulnerable.

My emotion would be more intense relative to other people.

Yeah,

most of my clients know this to be true. Um, and it would be longerlasting. So I might leave this cafe still feeling sad and then something else happens to prompt a different emotion and that maintains my vulnerability. Right.

Yeah.

So that though in and of itself is not enough. We have to put that person into a particular kind of environment. Right. So it's bio and social

and the environment um is called the invalidating environment. And it could be the community at large,

right?

Uh typically it's the family of origin.

And invalidation for your listeners is the opposite of validation. If I validate you, I communicate I get it. It makes sense. You feel that way. You think that, right?

I'm not even agreeing with you, but I can still validate you.

Yeah.

In validation, I imply that's crazy. I could do that by saying it or I could just, you know, make a face. um it doesn't make any sense. I could punish you for expressing your emotion or your point of view. Completely ignore it. So the invalidation in the invalidating environment can take many different forms.

It could be sexual, physical, emotional abuse. But for many of my clients, it's just a mismatch. Like we have very emotional child and hyperrational parents and don't get it.

Yeah.

Right. there's a lot of love, but they just respond in an invalidating way,

right? Or what what that child needed or not understanding the different personalities that we have or how we're uniquely made. Like how I said in the beginning, fearfully and wonderfully made. We have a thumbrint. We each are made

and and that makes so much sense. And also I would say because I worked in the with the community uh you know the black indigenous people of color community a lot. It is knowing that a score the adverse childhood experience score when you have a high score

CPTTSD is a real thing and a lot of us clinicians don't are not either educated culturally competent or they don't understand what I'm even talking about right now with the high ACE score and understanding that that sensitivity is your brain on fire trying to protect itself.

Right. Exactly. And the beauty of this model.

Yeah.

Just finish it up. So there's this ongoing transaction between the environment and the biologically vulnerable child. And you know several consequences of this skills deficits. They don't learn the skills they need to regulate their emotions.

So we remedy those skills deficits and skills training group. but also self-invalidation, repeating the messages of the invalidating environment to yourself, dismiss your own emotions. You think in a dating context, why doesn't a client pick up on red flags? Because they're self-invalidating.

Yeah.

Right.

Yeah.

So, self invalid self- validation is a skill that we teach.

Okay. We teach people mindfulness skills so they can cultivate real time mindful awareness of their emotions. uh their urges so they can better regulate them their thoughts. But the pro this part of DBT I think you're really going to love particularly people um of religious faith or you know spiritual backgrounds um to get think of who this treatment was created for people who are chronically suicidal.

They're not invested in life. I am so quick to think of checking out to effectively treat, and I think this is the genius of DBT. Um, to effectively treat suicidality, we've got to get people invested in life. Help them build what she calls the life worth living, a life that reflects your values, your priorities, offer satisfaction and reward.

So, when we're working with clients in DBT, I want to know what are your values? How are these reflected in your life right now? If they're not, what goals can we set so that they are reflected?

Right. So, it's more than just looking at your thinking. It's the context of your life.

Right.

Right. Um and giving them the tool set. That's what I saw missing in some places that I worked for and and school systems like I mean they they just started like putting social emotional learning. And I think if we were able to do that in many of our systems of of like communication skills, fitness, right?

Fitness, social emotional learning, I don't care what religion you are. These are just tools that if we could give our children, the next generation, then they'll know how to critically think,

listen to that inner voice, you know, their wisdom, their their gut, you know, because we could talk about the whole science between the gut and the brain and polyagal theory and stuff like that, but

but for for those that like are like, whoa, this is pretty cool. I want to work. I want to know. I want to understand like I'm going to put everything you talked about CBT, but is there like a self-help book that you know with DBT

or something like that?

Um, yeah, I will send you the reference later. Um, it's not by Marshall Inan. It's by someone named McKay. He wrote a workbook that's very useful.

Um,

cool.

You can do as a self-help resource.

Okay.

Um, yeah. So I it really has the potential to empower people both CBT and DBT and transform lives. But I think the self- validation when you're talking BIPO community, people who've experienced extensive invalidation,

yes,

trauma is so important.

Yeah. No, it is. And and it's the us trying to learn to trust a system that hurt us. Does that make sense? It's like, you know,

that's that's been a fight when I was at Nova Southeastern University and I had professors and I was just always questioning the the DSM and I'm going, wait a minute, but you're not putting in like the religious concept of someone that might be raising with voodoo or something like that. like they're hearing things because their family, you know, it's like it was more complicated and I realize why sometimes because of the insurance model and the convention and model and the westernized

confirmation bias and but it's not it's now because we have such a global effect now more than anything and everything like to me a a human being that's listening to this right now I want them to understand that they have the ability to have agency Yeah, they have agency.

They need to have done it. But that's a common belief. I can't, right?

I can't.

Yes. Dr. Napal. So, tell me about um are you seeing clients?

I see a limited number of clients in my practice.

Okay. And um yeah, I think the most common problems I treat are perfectionism, worry, which is another bias in thinking um and negativity bias. You kind of touched on

that's one that's really entrenched for all of us. Our brains are like sponges for negative information.

Yeah. And a nice little practice to offset for that

is because we can rewire our brains.

Yes,

CBT changes the brain. Meditation changes the brain. Little practices change the brain. You can do this yourself. I'm a big proponent of logs.

Um, deliberately bringing your awareness to things that are positive every day and just bullets, just writing them down. Good night's sleep, good coffee like my view, productive day at work, nice dinner, you know, with the family. And just keep doing that. And what you're trying to do is rewire your brain to be aware of what's positive.

Right. The negative exists. We all know that. But if only focused on the negative, my view is very skewed.

Yeah.

Right.

For real, it is. Wow. I could actually sit here and talk to you for long time, but I want to respect your time and I just So before we say goodbye, how can someone find you in your work

and in case they want because do you have other clinicians that work for you?

No longer. It's just me. I'm in concierge private practice.

Okay. All right. And so, yeah. I And you're still like taking in uh clients like you said, concierge, but are is there a waiting list?

Yes. Um, but you can follow me at Dr. Lisa says on Instagram. Um, I do a lot of blogging on drispalitano.com.

Okay. And if you're a clinician listening and you're interested in CBT, I just want to make a plug for the Florida CBT association. We're we're having our first uh networking event on October 16th at Lropical in Winwood. So, you know, it' be wonderful to see everyone.

Yes. Yeah. And there's supervis I mean not super I'm a qualified supervisor. So, there are interns listening to this probably throughout the state of Florida. So, yeah. CBT like because some people are like well I don't know you know EMDR and and we have all these different modalities but do Dr.

Not politan. I want people to understand. Yeah, we might. It's like having all the different versions of the Bible to read, right? It's like,

you know, like you have to figure out what works for you. So, it's naturally done in your practice as a therapist, right? or if it was done to you in your healing. Like to me CBT helped me so much to challenge the thoughts because I was

you know there was a long time that I thought I was stuck say in my neighborhood

or I was stuck with this certain situation whatever it is and so when I learned these skills and I started challenging and you know it's becoming responsible for yourself basically right because I could stay in the victim blame game like oh no it's their fault their fault their fault.

Yes,

but that that doesn't help. I mean, it helps you for a little bit to have to go through that pain and the grief, right, and move through that system. But

if you're in it constantly, it's not helping you.

Well, I think so many people don't even know they're in it.

That's it.

They don't know they're in it. They don't know what their beliefs are. That I'm a victim,

right?

That I have bad luck.

Yeah. And I think the beauty of CBT is bringing those beliefs into awareness because they're there whether you're aware of them or not and they are affecting your life.

Yeah.

So making them explicit in deciding do I want to have this belief.

Yep.

Yeah. And and that we have a choice to to do the work. The work's hard. You know, I I I also

I also come to find out that a lot of human beings just want the easy way out or the quick fix. And that's the thing. And it's like % magic bullet

medication or treatments that promise to cure, you know, with one session.

Yeah.

Um, right.

Always highly skeptical.

I'm open to the idea, but

Right. You know,

I hear you. I hear you.

Yeah. Well, it is. It's being curious and questioning and understanding and and and being responsible for all the all the different parts that come up because I'm into the IFS thing now. Oh my goodness. It's almost like

every time I find something new that I like get on fire for, I'm like, "Oh." And my husband's like, "Are you ever going to pay attention to me?"

Anyway, well, I really really appreciate everything will be in the show notes that's uh of resources and your website and social media. Is there anything you'd like to say to the audience before we say goodbye?

Yes, I would. I I would love to instill hope in person the personal change is is possible at any age. Um and to believe in yourself.

Yeah.

That you have the capacity to create a life that offers satisfaction and reward.

Yep. It's never too late.

It's never too late. And I think the first step is to investigate potential therapists and look for someone who's approached what he or she is saying if it resonates with you and trust your gut.

That's it. Your instinct and just listen. I think with uh with the Buddhist uh mindset, I understand that because I've studied a lot of world religions and also understanding in my in my faith that I believe in is it it's learning to be still.

Be still. And that's the hardest thing to do in a westernized because it's about go how much money can we make? Go. How much money can we make? And we have to understand the purpose like what is your legacy and why are you on this earth?

What's my purpose?

What's my purpose and everyone has one?

They do,

right?

Otherwise life is just meaningless. You know creating meaning.

Yes.

That's very important. We create the meaning.

Yes. So

keeping values. Yeah.

That's it. That's it. So, finding a qualified therapist that understands and has compassion and yeah, I'm a big I I love my DBT and my CBT colleagues, IFS colle, EMDR. I mean, it's a lot of of information out there, but honestly, like if you take the time to take a deep breath and do some breath work and be still, it's going to be uncomfortable for those that have a lot of um trauma or

they get uh you know, but write it down. Just like Dr. Napalitano said, write it down, log it down. There's apps that I'll put in the show notes that she talked about. There's mood apps. I love those mood apps that they put their moods in and and these are free.

So like I will put in free things because I know not everybody can't afford or they're like I don't have time for this.

Yeah.

I would say this is what I would like to say and when I tell clients and I say if you never come back and see me again I will not be offended.

That's right.

So much data on the effectiveness of exercise as a standalone treatment for anxiety and depression. more and

every year.

Yes.

Get some kind of exercise going. And then the benefits of a mindfulness practice and there are free apps.

There's inside timer. There are free exercise resources. I know we have classes on the beach in Miami Beach

for the community. Doesn't have to be a gym. Find a way that you like. Those two things will really make a difference if you're struggling with anxiety and depression right now.

Yes. Because anxiety and depression in my worldview is and I'm not talking about my faith worldview. I'm just talking about as a therapist. The these are symptoms, not diagnosis. And I know we'd love to diagnose them and it's okay. I know we need to for some people have to do that.

But you have to have an understanding those are symptoms that overlap in different diagnosises. And and anxiety and depression is your body telling you, "Hey, hello." you know, let's do something about it. And you're right, we're we're holistic beings. We're a mind, a body, and a spirit.

Yeah.

And we need to tend to all parts of us. And I love that. So, Dr. Napalitana, this was such a blessing. Thank you so much for coming on. If you do another CBT thing around in North uh, you know, in Palm Beach County, because I'm closer to that than down in Miami, I would love to know.

So, make sure

let me know. Yeah,

please. I would be there in a heartbeat. And um for the listener, thank you for listening all the way through. And do not forget to trust in the Lord. Guard your heart and renew your mind. Bye.

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