Psychiatry & Psychotherapy Podcast

David Puder, M.D.

Join David Puder as he covers different topics on psychiatry and psychotherapy. He will draw from the wisdom of his mentors, research, in-session therapy and psychiatry experience, and his own journey through mental health to discuss topics that affect mental health professionals and popsychology enthusiasts alike. Through interviews, he will dialogue with both medical students, residents and expert psychiatrists and psychotherapists, and even with people who have been through their own mental health journey. This podcast was created to help others in their journey to becoming wise, empathic, genuine and connected in their personal and professional lives.

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276 episodes
Updated Wednesday

Episodes276

Newest first

Wednesday · 1 hr 28 min
Mentalization-Based Therapy (MBT) Explained: Practical Techniques to Improve Clinical Outcomes in Borderline Personality Disorder, OCD & Narcissism
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 and others. Link to blog Link to YouTube video
July 17 · 1 hr 39 min
Nancy McWilliams on Shame, Transference, Personality Disorders & Becoming a Better Therapist
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. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog Link to YouTube video
June 26 · 58 min
Murderbot: Schizoid Personality, Neurodivergence, and the Search for Humanity in AI
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. Link to blog Link to YouTube video
June 19 · 1 hr 28 min
Side Effect Mastery in Psychopharmacology: Rawlings–Thompson A-F Classification, Low Slow Titration & Real-World Management with Dr. Michael Cummings & Dr. Blaire Heath
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 after treatment failures. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog Link to YouTube video
June 12 · 1 hr 33 min
Disengagement Precedes Enactment: Mastering Countertransference with Dr. Karen Maroda
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 patient, and demonstrates practical strategies for catching disengagement early, using constructive self-disclosure, and maintaining emotional presence. The conversation features a live role-play, deep discussion of parentification in therapists' histories, setting healthy boundaries, managing guilt and shame, and turning potential pitfalls into opportunities for deeper connection. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog Link to YouTube video
June 5 · 1 hr 25 min
Male Survivors of Sexual Abuse: Shame, Masculinity, Disclosure & Healing in Therapy with Doriel Jacov
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. Link to blog Link to YouTube video
May 29 · 1 hr 29 min
Trauma-Specific Reflective Functioning (T-RF): 5 Trauma Mentalization Profiles & Impact on Parenting
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. Link to blog Link to YouTube video
May 22 · 51 min
Cohort Group Consultation and Reflective Function: Transforming Countertransference into Clinical Insight
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, this episode offers practical wisdom for mental health professionals seeking to improve their reflective functioning and psychodynamic case conceptualization. Link to blog Link to YouTube video
May 11 · 2 hr 9 min
Understanding Mature Defense Mechanisms in Psychotherapy: Nancy McWilliams Framework with Clinical Examples from the Tuesday Cohort
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 defenses, offering practical insights for recognizing and working with them effectively in psychotherapy. By listening to this episode, you can earn 2.0 Psychiatry CME Credits. Link to blog Link to YouTube video
April 24 · 2 hr 40 min
Primitive Defense Mechanisms Explained: Sexualization, Dissociation, Acting Out, Withdrawal, Denial, Splitting, Omnipotent Control, Projective Identification
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. Link to blog Link to YouTube video
April 10 · 1 hr 38 min
Problem-Focused Psychodynamic Psychotherapy: Targeting Symptoms, Relationships, Trauma & Behavioral Change with Dr. Fredric N. Busch
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. Link to blog Link to YouTube video
April 3 · 1 hr 11 min
Psychiatrist Effect in First-Episode Psychosis: HAMLETT Study, Antipsychotic Tapering, Dopamine Supersensitivity & Sex Differences with Franciska de Beer
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 care. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog Link to YouTube video
March 21 · 1 hr 16 min
Dissociative Identity Disorder (DID) Explained: Trauma, Neuroscience, Controversies & Recovery
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 living with DID and PTSD to full integration and recovery, offering real hope that this condition is treatable. Whether you're a clinician, someone with lived experience, or simply seeking the truth about dissociation, trauma, and identity fragmentation, this conversation will transform how you understand one of the most misunderstood psychiatric disorders. Presenters' conflicts of interest: Dr. Lauren Lebois reports unpaid membership on the Scientific Committee for the International Society for the Study of Trauma and Dissociation (ISSTD), spousal IP payments from Vanderbilt University for technology licensed to Acadia Pharmaceuticals and spousal private equity in Violet Therapeutics unrelated to the present work. Dr. Melissa Kaufman reports Member, DSM Review Committee, Internalizing Disorders (unpaid); Primary Investigator, National Institute of Mental Health; Board of Directors (unpaid), International Society for the Study of Trauma and Dissociation. Dr. Matthew Robinson and Dr. David Puder do not have any conflicts to report By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to Blog Link to YouTube video
March 13 · 1 hr 28 min
Understanding Delusions Leading to Violence: Types, Assessment, AI Risks & Treatment in Forensic Psychiatry
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 Brown Assessment of Beliefs Scale, the role of clozapine in reducing violence risk, and the use of cognitive behavioral therapy to create psychological "escape routes" by treating delusions as testable hypotheses. Modern risks are also addressed, including how AI chatbots and algorithms can reinforce and amplify delusional thinking and contribute to emerging cases of AI-related psychosis. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog Link to YouTube video
March 6 · 1 hr 25 min
What Is Reflective Functioning? Mentalization, Attachment Theory & RF Scoring with Dr. Miriam Steele
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 episode, you can earn 1.5 Psychiatry CME Credits. Link to blog Link to YouTube video Main Attachment
February 27 · 1 hr 55 min
Hard Feelings: Daniel Smith on Embracing Shame, Envy, Annoyance, and the Wisdom in Dark Emotions
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 sensitivity struggles, links to traits like idealization/devaluation in borderline patterns, and much more. Listen now for raw, insightful reflections on emotional authenticity and mental health. By listening to this episode, you can earn 2.0 Psychiatry CME Credits. Link to blog Link to YouTube video
February 20 · 1 hr 15 min
Empathy in Therapy: Mastering Empathic Engagement with Dr. Douglas Flemons
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 to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog Link to YouTube video
February 6 · 1 hr 6 min
How to Overcome Guilt: Break Free from Unreasonable Expectations with Jennifer Reid, MD
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 self-expectations, mental health providers seeking tools to manage guilt in patients and themselves, or listeners wanting to break free and reclaim emotional freedom through self-compassion and realistic accountability. By listening to this episode, you can earn 1.0 Psychiatry CME Credits. Link to blog Link to YouTube video
January 30 · 1 hr 48 min
Schizoid Dynamics Explored: Kafka's Writings, Fear of Engulfment, and Clinical Insights for Better Empathy
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. By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog Link to YouTube video
January 5 · 1 hr 44 min
Disavowed Anger and Positive Emotions with Paul Wachtel
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. Link to blog Link to YouTube video

Psychiatry & Psychotherapy Podcast

Mentalization-Based Therapy (MBT) Explained: Practical Techniques to Improve Clinical Outcomes in Borderline Personality Disorder, OCD & Narcissism

Nancy McWilliams on Shame, Transference, Personality Disorders & Becoming a Better Therapist

Murderbot: Schizoid Personality, Neurodivergence, and the Search for Humanity in AI

Side Effect Mastery in Psychopharmacology: Rawlings–Thompson A-F Classification, Low Slow Titration & Real-World Management with Dr. Michael Cummings & Dr. Blaire Heath

Disengagement Precedes Enactment: Mastering Countertransference with Dr. Karen Maroda

Male Survivors of Sexual Abuse: Shame, Masculinity, Disclosure & Healing in Therapy with Doriel Jacov

Trauma-Specific Reflective Functioning (T-RF): 5 Trauma Mentalization Profiles & Impact on Parenting

Cohort Group Consultation and Reflective Function: Transforming Countertransference into Clinical Insight

Understanding Mature Defense Mechanisms in Psychotherapy: Nancy McWilliams Framework with Clinical Examples from the Tuesday Cohort

Primitive Defense Mechanisms Explained: Sexualization, Dissociation, Acting Out, Withdrawal, Denial, Splitting, Omnipotent Control, Projective Identification

Problem-Focused Psychodynamic Psychotherapy: Targeting Symptoms, Relationships, Trauma & Behavioral Change with Dr. Fredric N. Busch

Psychiatrist Effect in First-Episode Psychosis: HAMLETT Study, Antipsychotic Tapering, Dopamine Supersensitivity & Sex Differences with Franciska de Beer

Dissociative Identity Disorder (DID) Explained: Trauma, Neuroscience, Controversies & Recovery

Understanding Delusions Leading to Violence: Types, Assessment, AI Risks & Treatment in Forensic Psychiatry

What Is Reflective Functioning? Mentalization, Attachment Theory & RF Scoring with Dr. Miriam Steele

Hard Feelings: Daniel Smith on Embracing Shame, Envy, Annoyance, and the Wisdom in Dark Emotions

Empathy in Therapy: Mastering Empathic Engagement with Dr. Douglas Flemons

How to Overcome Guilt: Break Free from Unreasonable Expectations with Jennifer Reid, MD

Schizoid Dynamics Explored: Kafka's Writings, Fear of Engulfment, and Clinical Insights for Better Empathy

Disavowed Anger and Positive Emotions with Paul Wachtel