Psychiatry & Psychotherapy Podcast

In this essential episode of the podcast, Dr. David Puder and reproductive psychiatrist Dr. Katrina Furey interview pioneering expert Dr. Margaret Spinelli on postpartum psychosis, covering its symptoms, diagnosis, treatment, and prevention. They explore the history of perinatal psychiatry, neonaticide and dissociation, the critical need for mother-baby units, rapid symptom progression, why timely hospitalization and treatment lead to full recovery for most women and much more.

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In this essential episode of the Psychiatry & Psychotherapy Podcast, Dr. David Puder sits down with internationally renowned expert Dr. Veerle Bergink, Director of Mount Sinai's Women's Mental Health Center, for an in-depth discussion of postpartum psychosis. Covering early warning signs and symptoms, differential diagnosis including anti-NMDA receptor encephalitis and thyroid issues, a highly effective acute treatment algorithm using benzodiazepines, antipsychotics, and lithium, the remarkable 98% remission rates with proper care, lithium's superior role in preventing relapse during the first postpartum year, the simple but powerful prophylaxis strategy of "baby out, lithium in" for high-risk women with bipolar disorder or prior...

In this episode, Dr. Puder talks with reproductive psychiatrist and psychoanalyst Dr. Alyson Gorun and Dr. Fredric Busch about postpartum depression and problem-focused psychodynamic psychotherapy. They focus on the five core conflicts (difficulty tolerating anger, idealized expectations of parenthood, struggles with dependence, fear of separation and abandonment, and fear of intrusion) that often underlie symptoms, shame, attachment reactivation, and stuck behaviors in the perinatal period.

This episode explores:

-How these dynamics emerge even when parents know what they "should" do

-How to integrate psychodynamic insight with medication, sleep, social support, and evidence-based care<...

In this episode of the Podcast, Dr. David Puder sits down with reproductive psychiatrist Dr. Katie Unverferth, Director of the UCLA Women's Life Center and Medical Director of the UCLA Maternal Mental Health Program, to clarify the critical differences between common postpartum intrusive thoughts of infant harm, postpartum OCD, and true postpartum psychosis. They discuss how nearly all new mothers experience ego-dystonic thoughts of accidental or intentional harm, how to screen without triggering concealment, when severity and compulsions cross into OCD, the role of high-dose SSRIs plus exposure and response prevention (ERP), red-flag signs of ego-syntonic content, agitation, insomnia...

In this episode, Dr. David Puder and his psychodynamic psychotherapy training cohort apply reflective function (RF) and mentalization concepts to John Steinbeck's masterpiece East of Eden. They examine how Reflective Function collapses under shame, rejection, threat, and attachment arousal across key characters. The discussion highlights that true personality health is not the absence of aggression, dependency, or guilt but the growing capacity to recognize conflicting self-parts, stay in contact with reality, and remain related to imperfect people.

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By listening to this episode, you can earn 1.5 Psychiatry...

In this essential episode, Dr. David Puder sits down with board-certified reproductive psychiatrist Dr. Katrina Furey to unpack postpartum psychosis. They cover its early warning signs, symptoms, diagnostic challenges, risk assessment, and evidence-based treatment. They discuss classic onset within days to weeks after delivery, common delusions centered on the infant, fluctuating mental status, the critical distinction from postpartum OCD, elevated risks of filicide and suicide, strong links to bipolar spectrum disorders, and the vital roles of lithium, antipsychotics, sleep protection, ECT, medical workup, and family support. Learn why this psychiatric emergency demands rapid intervention, how most women fully recover...

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, protecting the therapeutic frame, triangulation, idealization and splitting, devaluation, projection, and projective identification. Clinicians will also learn to use their own countertransference as essential clinical data, the ongoing value of consultation and...

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, and offers concrete strategies clinicians can use in session and assign as between-session work to help patients reconnect with difficult emotions, reduce intellectualization, and develop more flexible, reflective ways of understanding themselves...

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 therapist personality styles influence clinical work, strengths, and vulnerabilities. Additional highlights include building love and trust in the therapeutic relationship, protecting the therapeutic frame, setting early boundaries, and real-world guidance on handling stalking and boundary violations. 

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 what Murderbot reveals about humanity in the age of artificial intelligence. 

By listening to this episode, you can earn 1.0 Psychiatry CME Credits.

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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 (hyperhidrosis from SSRIs/SNRIs), tremor management, alopecia from valproic acid and lithium, anticholinergic burden, and much more. Dr. Cummings shares his insights on receptor dynamics, metabolizer status, bedtime dosing, and when to reconsider diagnosis af...

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 emotional withdrawal before erupting into destructive enactments that can rupture the therapeutic relationship.

Dr. Maroda shares candid examples from her own practice, including a personal enactment she later processed with her p...

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 reenactment, and the complex transference dynamics that arise in therapy, including erotic transference and projective identification.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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 resilience. The conversation examines how these different ways of processing trauma significantly impact parenting, attachment security, and the intergenerational transmission of trauma.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.<...

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 irritability as valuable clinical data, and how group consultation helps clinicians develop greater self-awareness and empathy in their work. Drawing from Nancy McWilliams' Psychoanalytic Diagnosis and key concepts like concordant and complementary countertransference...

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 operate in both everyday life and clinical practice. Filled with rich clinical examples drawn from outpatient psychiatry, emergency settings, trauma work, grief, OCD, and private practice, the cohort discusses the adaptive value as well as the potential costs of these de...

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-world clinical vignettes, plus a rich group discussion on when these defenses are adaptive versus maladaptive.

By listening to this episode, you can earn 2.5 Psychiatry CME Credits.

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 track progress on symptoms like anxiety, depression, panic disorder, disavowed anger, and over-responsibility rooted in trauma.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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 early antipsychotic tapering versus maintenance, dopamine supersensitivity after high-affinity D2 blockers, sex differences in treatment outcomes and clozapine levels during menopause, and why shared decision-making and reflective functioning matter more than ever in psychosis...

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 groundbreaking Reinders studies), debunk persistent media myths like Sybil, and navigate long-standing controversies around validity, Freud versus Janet, false memories, and DID versus BPD.

Dr. Kaufman shares her own courageous personal journey from...

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 dead"), erotomanic, jealous (Othello syndrome), somatic, and referential delusions. 

The episode covers practical clinical tools, including the Simple Delusional Syndrome Scale and B...

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 psychotherapy (TFP) for borderline personality disorder (BPD) and eating disorders, therapist RF's impact on patient outcomes, body image representations, and smartphone effects on parent-child bonds.

By listening to this...

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, dissociation, and the freezing response that shame can trigger. The conversation also covers annoyance as a temperament trait tied to highly sensitive, hyperpermeable nervous systems, noise...

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 affective empathy, the role of microexpressions and universal affective states, and practical strategies for building genuine therapeutic connections without imposing interpretations or judgment.

By listening t...

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 like parentification and socialization, narcissism's reduced guilt, therapist/doctor identity struggles with moral injury, and practical strategies like boundary-setting, reframing expectations, and safely referring unsafe patients without guilt. Ideal for anyone battling unreasonable...

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 classics like "The Metamorphosis," the group explores how schizoid traits differ from autism, involve hypersensitivity rather than social cue deficits, and manifest in creative, introspective individuals.

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 with more adversarial models, emphasizing how therapists can help patients reclaim disallowed emotions for a fuller, healthier sense of self.

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.<...

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 listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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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 Psychiatry CME Credits.

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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 neuroscience reframes schizophrenia as a disorder of brain connectivity rather than a single genetic disease.

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 can reverse many of the damaging effects of sleep restriction.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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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-Focused Psychotherapy (TFP), including how to recognize subtle and overt devaluation, how to hold boundaries, how to think psychodynamically about these behaviors, and how to respond without reenacting the patient's internal object...

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.

Join Dr. David Puder and colleagues as they discuss the science of mentalization, attachment repair, and trauma healing, bringing together psychoanalytic, developmental, and biological perspectives to offer hope and clinical insight for patients, parents...

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 Therapy (ACT), and medication options, while also offering guidance for loved ones supporting someone with OCD.

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 of self, and amplifying moments of authenticity. Whether you're a clinician, student, or simply curious about the complexities of identity, this conversation sheds light on one of the most important yet...

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 CBD and terpenes, and the long-term effects of cannabis on brain development, academic performance, and overall health. Whether you are a clinician, researcher, or someone curious about...

Parenting brings love, joy and plenty of emotional challenges. In this episode, clinical psychologist Dr. Alissa Jerud explores how parents can better understand and regulate their emotions instead of getting stuck in cycles of frustration, anxiety, or control. Drawing on exposure therapy, DBT skills, and her Emotion-Savvy Parenting approach, Dr. Jerud introduces practical tools: the ART framework (Accept, Regulate, Tolerate) to help parents stay grounded during emotional storms.

Whether it's managing anxiety, tolerating distress, or responding more calmly to your kids, this conversation is full of evidence-based strategies for building resilience, deepening connection, and showing up as...

In this episode, I engage in a shared-interest conversation with Dr. David Mintz, a psychiatrist with over 30 years of experience at the Austen Riggs Center, about his book Psychodynamic Psychopharmacology: Caring for the Treatment-Resistant Patient. Mintz explores the integration of psychodynamic principles into medication prescribing, emphasizing that psychiatric treatments are not purely biomedical but profoundly shaped by meaning, symbolism, attachment and interpersonal dynamics. Drawing from his work with treatment-resistant patients, often those with histories of early adversity, the discussion distills how psychodynamics influence medication efficacy, adherence, and overall recovery.

By listening to this episode, you can earn 1.25...

Catatonia in children and teens is underdiagnosed, frequently misunderstood, and potentially fatal if left untreated. In this episode, Dr. David Puder and Dr. Annabel Kuhn interview Dr. Joshua Ryan Smith—child and adolescent psychiatrist and division director at Vanderbilt University—to explore the essential clinical skills and medical knowledge needed to identify and treat pediatric catatonia.

You'll learn how to differentiate catatonia from other neuropsychiatric conditions in both neurodivergent and neurotypical children, how to apply tools like the Bush-Francis and Pediatric Catatonia Rating Scales. This episode also unpacks common misdiagnoses in cases involving autism spectrum disorder, schizophrenia, and...

In this episode, Dr. David Puder is joined by psychiatrist Dr. Eric Bender to explore the psychological depth of the Emmy Award-winning show, The Bear (FX). Through a psychodynamic lens, they examine Carmy's character—his trauma, complex PTSD, obsessive-compulsive personality traits, and avoidant attachment style. They also break down the borderline dynamics in his family, especially his mother's primitive defenses, identity diffusion, and projective identification.

The discussion covers dissociation, personality styles, sibling roles, and emotional neglect, drawing connections to clinical work and real-life therapy. This episode gives both clinicians and fans of the show a nuanced understanding of h...