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Every episode
Psychiatry & Psychotherapy Podcast
30 episodes
Working with Transference: Timing, Technique, and the Here-and-Now with Jonathan Shedler
Aug 14, 2026 · 1 hr 13 min
In this practical Q&A episode with Dr. Jonathan Shedler, the psychodynamic psychotherapy cohort explores working with transference in real time, focusing on timing, technique, and the here-and-now. Shedler addresses how to recognize meaningful transference patterns, decide when an interpretation will open growth versus overwhelm the patient, and adapt the work across levels of personality organization (neurotic versus borderline). The discussion covers handling negative and erotic transference,…
Mentalization-Based Therapy (MBT) Explained: Practical Techniques to Improve Clinical Outcomes in Borderline Personality Disorder, OCD & Narcissism
Jul 29, 2026 · 1 hr 29 min
In this episode, Dr. David Puder speaks with Robert Drozek, clinical director of the Mentalization-Based Treatment (MBT) Clinic at McLean Hospital and teaching associate at Harvard Medical School, about practical Mentalization-Based Therapy techniques to improve clinical outcomes in borderline personality disorder (BPD), OCD, and narcissism. Drozek explains the "What, Why, and How" model of mentalizing, how to address psychic equivalence (rigid certainty), pretend mode, and teleological thinking…
Nancy McWilliams on Shame, Transference, Personality Disorders & Becoming a Better Therapist
Jul 17, 2026 · 1 hr 39 min
In this in-depth interview, Dr. David Puder welcomes renowned psychoanalyst and author Dr. Nancy McWilliams to discuss essential clinical topics from her seminal books Psychoanalytic Diagnosis and Psychoanalytic Psychotherapy. Dr. McWilliams shares practical wisdom on working with shame in therapy by emphasizing self-acceptance over mere self-knowledge, along with powerful insights into transference, countertransference, and projective identification. The conversation explores how different ther…
Murderbot: Schizoid Personality, Neurodivergence, and the Search for Humanity in AI
Jun 26, 2026 · 59 min
Dr. David Puder and Dr. Eric Bender explore the Apple TV+ series Murderbot through a psychiatric lens. Based on Martha Wells' Murderbot Diaries, they analyze the hacked SecUnit's journey as a profound portrait of schizoid personality dynamics, neurodivergence, social anxiety, masking, trauma, and the deep human longing for connection while fearing it. Drawing on Nancy McWilliams' work on schizoid dynamics and D.W. Winnicott, the discussion examines AI identity, reflective functioning, PTSD, and…
Side Effect Mastery in Psychopharmacology: Rawlings–Thompson A-F Classification, Low Slow Titration & Real-World Management with Dr. Michael Cummings & Dr. Blaire Heath
Jun 19, 2026 · 1 hr 29 min
Dr. David Puder sits down with psychopharmacology expert Dr. Michael Cummings and Dr. Blaire Heath to discuss Side Effect Mastery in Psychopharmacology. This episode dives deep into the Rawlings–Thompson A-F Classification system for understanding and managing medication side effects, emphasizing low and slow titration strategies to improve tolerability and patient outcomes. They discuss practical, real-world approaches to common challenges, including orthostatic hypotension, excessive sweating…
Disengagement Precedes Enactment: Mastering Countertransference with Dr. Karen Maroda
Jun 12, 2026 · 1 hr 34 min
In this episode of the podcast, Dr. David Puder sits down with Dr. Karen Maroda, a renowned psychoanalyst, assistant professor of psychiatry at the Medical College of Wisconsin, and author of influential books including The Power of Countertransference and The Analyst's Vulnerability. Together they explore a powerful clinical insight: disengagement precedes enactment. Learn how therapists' unprocessed countertransference (irritation, boredom, guilt, anger, or helplessness) often leads to emotion…
Male Survivors of Sexual Abuse: Shame, Masculinity, Disclosure & Healing in Therapy with Doriel Jacov
Jun 5, 2026 · 1 hr 25 min
Doriel Jacov joins Dr. Puder to explore the often-overlooked struggles of male survivors of sexual abuse. With one in six males experiencing childhood sexual abuse before age 18, Jacov unpacks the profound impact of shame, masculinity norms, disclosure barriers, and identity fractures that make healing uniquely challenging for men. The conversation covers grooming, power imbalances, coercion, the myth that survivors become abusers, arousal and body betrayal, sexual identity confusion, trauma ree…
Trauma-Specific Reflective Functioning (T-RF): 5 Trauma Mentalization Profiles & Impact on Parenting
May 29, 2026 · 1 hr 30 min
In this episode, Dr. David Puder explores Trauma-Specific Reflective Functioning (T-RF) with researchers Dr. Nicholas Berthelot and Dr. Julia Garron-Bissonnette. Discover how childhood trauma affects mentalization and learn about the five distinct trauma mentalization profiles identified in mothers with histories of maltreatment: identification with the perpetrator, functionally grandiose, absorbed in trauma, global failures in mentalization, and those with no major failures who show remarkable…
Cohort Group Consultation and Reflective Function: Transforming Countertransference into Clinical Insight
May 22, 2026 · 52 min
In this episode, Dr. David Puder is joined by cohort leaders Dr. Allie Riege and Dr. Jeremiah Stokes to explore how reflective function transforms countertransference into deep clinical insight. Through their experience leading psychodynamic cohort consultation groups, they discuss the challenges therapists face with vulnerability, disavowed emotions, and the gap between theory and real-world application. The conversation dives into common therapist personality dynamics, enactments, boredom and…
Understanding Mature Defense Mechanisms in Psychotherapy: Nancy McWilliams Framework with Clinical Examples from the Tuesday Cohort
May 11, 2026 · 2 hr 9 min
In this episode, Dr. David Puder and the Tuesday 2025–2026 Psychotherapy Cohort explore mature and neurotic defense mechanisms through the lens of Nancy McWilliams' influential framework. Building upon the previous discussion on primitive defenses, they provide an in-depth look at how higher-level defenses such as regression, repression, compartmentalization, isolation of affect, intellectualization, rationalization, moralization, undoing, displacement, reaction formation, and sublimation operat…
Primitive Defense Mechanisms Explained: Sexualization, Dissociation, Acting Out, Withdrawal, Denial, Splitting, Omnipotent Control, Projective Identification
Apr 24, 2026 · 2 hr 40 min
In this episode, Dr. David Puder and his talented Cohort deliver a comprehensive exploration of primitive defense mechanisms, which are the earliest, most fundamental ways the mind protects us from overwhelming anxiety, trauma, and threats to the self. Drawing directly from Nancy McWilliams' Psychoanalytic Diagnosis, they break down key primitive defenses. You'll hear clear definitions, developmental origins, clinical presentations, countertransference implications, literary examples, and real-w…
Problem-Focused Psychodynamic Psychotherapy: Targeting Symptoms, Relationships, Trauma & Behavioral Change with Dr. Fredric N. Busch
Apr 10, 2026 · 1 hr 38 min
In this episode, Dr. David Puder sits down with Dr. Fredric N. Busch, psychiatrist, psychoanalyst, and clinical professor at Cornell and Columbia, to explore Problem-Focused Psychodynamic Psychotherapy, which is a practical, targeted approach that integrates psychodynamic principles with clear symptom relief, relationship repair, trauma processing, and behavioral change. Dr. Busch explains how to identify core problems in the very first session, build a focused psychodynamic formulation, and tra…
Psychiatrist Effect in First-Episode Psychosis: HAMLETT Study, Antipsychotic Tapering, Dopamine Supersensitivity & Sex Differences with Franciska de Beer
Apr 3, 2026 · 1 hr 12 min
In this episode, Dr. Puder sits down with Franciska de Beer, MSc, first author of landmark HAMLETT-OPHELIA Consortium papers in JAMA Psychiatry, World Psychiatry, and Psychological Medicine. They dive deep into the psychiatrist effect in first-episode psychosis, revealing that individual psychiatrists explain approximately 10% of variance in positive symptom improvement and daily functioning, even after controlling for medication dose. The conversation explores groundbreaking HAMLETT findings on…
Dissociative Identity Disorder (DID) Explained: Trauma, Neuroscience, Controversies & Recovery
Mar 21, 2026 · 1 hr 16 min
In this episode of the Psychiatry Podcast, Harvard experts from McLean Hospital: Dr. Melissa Kaufman, Dr. Matthew Robinson, and cognitive neuroscientist Dr. Lauren Lebois. Join Dr. David Puder to deliver the clearest, most evidence-based explanation of Dissociative Identity Disorder (DID) available today. Discover how DID is a developmental post-traumatic adaptation rooted in repeated childhood maltreatment, explore the neuroscience behind hyperarousal versus shutdown states (including groundbre…
Understanding Delusions Leading to Violence: Types, Assessment, AI Risks & Treatment in Forensic Psychiatry
Mar 13, 2026 · 1 hr 29 min
In this episode, Dr. David Puder is joined by forensic psychiatrist Dr. Michael Cummings, who has spent his career at the world's largest forensic state hospital, and child psychiatrist Dr. Blaire Heath, to examine how fixed false beliefs, or delusions, can lead to aggression and violence. Each guest brings their expertise to discuss the major delusion types most associated with harm in forensic settings, including persecutory, Capgras (impostor syndrome involving loved ones), Cotard's ("I am de…
What Is Reflective Functioning? Mentalization, Attachment Theory & RF Scoring with Dr. Miriam Steele
Mar 6, 2026 · 1 hr 26 min
In this episode, Dr. Puder hosts a conversation with Dr. Miriam Steele, a leading expert in reflective functioning (RF), mentalization, and attachment theory. They explore the origins of RF from the pioneering work of Peter Fonagy and John Bowlby in the London Parent-Child Project, its role in predicting secure attachments and sensitive parenting, and distinctions from empathy. Conversation topics include cutting-edge research on mentalization-based treatment (MBT) and transference-focused psych…
Hard Feelings: Daniel Smith on Embracing Shame, Envy, Annoyance, and the Wisdom in Dark Emotions
Feb 27, 2026 · 1 hr 55 min
In this compelling episode, Dr. David Puder sits down with New York Times bestselling author and psychotherapist Daniel Smith to explore his latest book, Hard Feelings: Finding the Wisdom in Our Darkest Emotions. They dive deep into the often-avoided world of "negative" emotions like shame, envy, and annoyance, revealing how these hard feelings carry profound wisdom rather than being obstacles to banish. Drawing from Smith's personal experiences, they discuss double binds, screen memories, disso…
Empathy in Therapy: Mastering Empathic Engagement with Dr. Douglas Flemons
Feb 20, 2026 · 1 hr 16 min
In this episode, Dr. Puder engages in a profound conversation with Dr. Douglas Flemons, a seasoned marriage and family therapist and author of the newly released Empathic Engagement in Clinical Practice. Drawing from over 30 years of supervising family therapists, Dr. Flemons redefines empathy as an active, pursued skill rather than a passive feeling, distinguishing it sharply from sympathy. Explore common misconceptions, the pitfalls of sympathetic responses, debates on cognitive versus affecti…
How to Overcome Guilt: Break Free from Unreasonable Expectations with Jennifer Reid, MD
Feb 6, 2026 · 1 hr 6 min
In this episode, we welcome psychiatrists Dr. Jennifer Reid (author of Guilt Free: Reclaiming Your Life from Unreasonable Expectations) who explores why guilt feels so overwhelming amid post-COVID pressures, perfectionism, and endless roles. Dr. Reid and Dr. Puder differentiate guilt from shame, highlighting adaptive healthy guilt for repairing relationships versus maladaptive generalized guilt tied to depression, anxiety, burnout, and cognitive distortions. The discussion covers childhood roots…
Schizoid Dynamics Explored: Kafka's Writings, Fear of Engulfment, and Clinical Insights for Better Empathy
Jan 30, 2026 · 1 hr 49 min
In this episode, Dr. David Puder hosts a discussion on schizoid personality dynamics through the lens of Franz Kafka's life and writings. Discover why the DSM-5's surface-level criteria for schizoid personality disorder falls short, often missing the intense inner conflict between a profound yearning for connection and a paralyzing fear of engulfment. Drawing on the Psychodynamic Diagnostic Manual (PDM), Nancy McWilliams' insightful perspectives, and Kafka's unsent "Letter to His Father" plus cl…
Disavowed Anger and Positive Emotions with Paul Wachtel
Jan 5, 2026 · 1 hr 44 min
In this episode, renowned psychologist Paul Wachtel, PhD, returns to explore disavowed anger and disavowed positive emotions in psychotherapy. Discover how anger differs from simple repression, its roots in childhood and preverbal experiences, its positive functions (like self-protection, boundaries, and drive), and the vicious cycles of over-niceness that can lead to frustration, psychosomatic symptoms, or explosive outbursts. Dr. Wachtel also contrasts collaborative, integrative approaches wit…
Countertransference and Transference with Frank Yeomans, MD
Dec 16, 2025 · 1 hr 46 min
Join Dr. David Puder and renowned psychodynamic expert Dr. Frank Yeomans in this Q&A episode on countertransference, transference, and projective identification in psychotherapy. Drawing from object relations theory and Transference-Focused Psychotherapy (TFP), Dr. Yeomans illustrates these concepts with real clinical examples. Explore how therapists can harness countertransference to deepen empathy, how this differs from DBT, the challenges of training, and the limitations of AI in therapy. By…
"AI Psychosis": Emerging Cases of Delusion Amplification Associated with ChatGPT and LLM Chatbot Use
Nov 21, 2025 · 1 hr 20 min
Prolonged conversations with ChatGPT and other LLM chatbots have created rapid developments of severe delusions, paranoia, and even death by suicide in some cases. In this episode, Dr. David Puder sits down with Columbia researchers Dr. Amandeep Jutla and Dr. Ragy Girgis to unpack five shocking real-world cases, explain why large language models are dangerously sycophantic, trained to agree, mirror, and amplify any idea instead of challenging it. By listening to this episode, you can earn 1.25 P…
Genetic and Environmental Influences of Schizophrenia
Nov 7, 2025 · 1 hr 19 min
In this episode, Dr. Puder is joined by Dr. Liam Browning and Dr. Nicholas Fabiano to explore the complex genetic and environmental factors that contribute to schizophrenia. They unpack how heritability is measured, what twin and genome-wide association studies reveal, and why the "missing heritability" problem matters for our understanding of mental illness. The discussion also covers how prenatal factors, childhood trauma, cannabis use, and social adversity increase risk and how modern neurosc…
Combatting the Negative Effects of Sleep Deprivation
Oct 31, 2025 · 1 hr 8 min
In this episode, Dr. David Puder and Dr. Brandon Luu explore the science of sleep deprivation. How missing sleep impacts your brain, metabolism, emotions, and long-term health. Discover evidence-based strategies that can help you protect cognitive performance and recover from sleep loss, including exercise, creatine, caffeine, and bright light therapy. We'll discuss studies showing how even short bouts of high-intensity interval training (HIIT), proper creatine dosing, and morning light exposure…
Devaluation, Transference, Narcissism with Diana Diamond
Oct 24, 2025 · 53 min
In this episode, Dr. David Puder is joined by world-renowned psychologist Diana Diamond, PhD to explore devaluation, narcissism, attachment, and transference in psychotherapy. Together they examine why patients with narcissistic personality traits or narcissistic personality disorder (NPD) often devalue their therapists, how dismissing and disorganized attachment styles shape treatment, and why these cycles can be so painful for clinicians. Dr. Diamond shares clinical insights from Transference-…
Intergenerational Trauma Explained: The Role of Reflective Function and Mentalization in Healing Attachment
Oct 17, 2025 · 1 hr 11 min
In this episode, we explore how intergenerational trauma shapes attachment patterns and how reflective function (RF) and mentalization can help break the cycle. Drawing on research from Fonagy, Slade, and Berthelot, we examine how trauma-specific reflective functioning influences disorganized attachment and how therapies such as Mentalization-Based Therapy (MBT), Transference-Focused Psychotherapy (TFP), and Minding the Baby (MTB) strengthen reflective capacity and promote secure attachment. Joi…
Understanding Real Event OCD: When the Past Fuels Obsession
Sep 26, 2025 · 1 hr 7 min
In this episode, Dr. David Puder is joined by OCD specialist Kevin Foss to dive deep into Real Event OCD, which is a form of obsessive-compulsive disorder where real past experiences become the focus of endless rumination, guilt, and shame. Together, they unpack the symptoms, real-life examples, and how this subtype differs from PTSD, moral injury, and other forms of OCD. The discussion highlights evidence-based treatments like Exposure and Response Prevention (ERP), Acceptance and Commitment Th…
Identity Diffusion
Sep 16, 2025 · 1 hr 38 min
In this episode, Dr. David Puder and Mark Ruffalo dive into the history and theory of identity diffusion, from Kernberg's structural model and Gunderson's work on BPD to Akhtar's clinical descriptions. We explore how identity diffusion shows up in patients' lived experiences—feelings of emptiness, fractured self-image, lack of authenticity—and what these struggles mean for psychotherapy. You'll also hear practical insights into treatment, including empathetic confrontation, fostering continuity…
Cannabis and Depression, Anxiety, PTSD, Sleep, and Cognitive Function Update and Review
Aug 29, 2025 · 1 hr 11 min
In this episode, we explore the latest 2025 research on cannabis and mental health. Our discussion covers how cannabis use impacts depression, anxiety, PTSD, sleep, cognitive function, and cannabis use disorder (CUD). While many patients report short-term relief from symptoms, studies reveal complex risks, including increased odds of mood disorders, suicidality, impaired cognition, and withdrawal challenges. We also examine the evidence behind medical marijuana for PTSD and anxiety, the role of…
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