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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

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  

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. Link to blog Link to YouTube video

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. Link to blog Link to YouTube video

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. Link to blog. Link to YouTube video

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 relations. The discussion also highlights the role of trauma, reflective functioning, countertransference, and the deeper tragedy of pathological narcissism. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video

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, and therapists alike. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video

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 misunderstood dimensions of mental health.   By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog.

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 cannabis and psychiatry, this update will help you better understand the science, myths, and clinical realities of cannabis use. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

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 the parent you want to be. Connect with Alissa Jerud on her Instagram or LinkedIn Check out her new book Emotion-Savvy Parenting.  Announcement: for interest in psychotherapy cohort, go to www.psychiatrypodcast.com/cohort By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube   

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 Psychiatry CME Credits. Link to blog. Link to YouTube video.

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 autoimmune or metabolic conditions. Finally, it offers practical, evidence-based guidance for both inpatient stabilization and outpatient follow-up care. Whether you're a psychiatrist, pediatrician, therapist, or student, this episode offers life-saving insights into one of the most overlooked syndromes in child psychiatry. By listening to this episode, you can earn 1.0 Psychiatry CME Credits. Link to blog. Link to YouTube video.

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 how early attachment, trauma, and family dynamics shape adult behavior. Whether you're a therapist, student, or simply a fan of the show, you'll gain insight into how The Bear reflects complex inner worlds. Link to blog. Link to YouTube video.