Épisodes

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

    Understanding Mature Defense Mechanisms in Psychotherapy: Nancy McWilliams Framework with Clinical Examples from the Tuesday Cohort
    May 11 2026
    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
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    2 h et 9 min
  • Primitive Defense Mechanisms Explained: Sexualization, Dissociation, Acting Out, Withdrawal, Denial, Splitting, Omnipotent Control, Projecti

    Primitive Defense Mechanisms Explained: Sexualization, Dissociation, Acting Out, Withdrawal, Denial, Splitting, Omnipotent Control, Projecti
    Apr 24 2026
    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
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    2 h et 40 min
  • Problem-Focused Psychodynamic Psychotherapy: Targeting Symptoms, Relationships, Trauma & Behavioral Change with Dr. Fredric N. Busch

    Problem-Focused Psychodynamic Psychotherapy: Targeting Symptoms, Relationships, Trauma & Behavioral Change with Dr. Fredric N. Busch
    Apr 10 2026
    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
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    1 h et 38 min
  • Psychiatrist Effect in First-Episode Psychosis: HAMLETT Study, Antipsychotic Tapering, Dopamine Supersensitivity & Sex Differences with Fran

    Psychiatrist Effect in First-Episode Psychosis: HAMLETT Study, Antipsychotic Tapering, Dopamine Supersensitivity & Sex Differences with Fran
    Apr 3 2026
    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
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    1 h et 12 min
  • Dissociative Identity Disorder (DID) Explained: Trauma, Neuroscience, Controversies & Recovery

    Dissociative Identity Disorder (DID) Explained: Trauma, Neuroscience, Controversies & Recovery
    Mar 21 2026
    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
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    1 h et 16 min
  • Understanding Delusions Leading to Violence: Types, Assessment, AI Risks & Treatment in Forensic Psychiatry

    Understanding Delusions Leading to Violence: Types, Assessment, AI Risks & Treatment in Forensic Psychiatry
    Mar 13 2026
    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
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    1 h et 29 min
  • What Is Reflective Functioning? Mentalization, Attachment Theory & RF Scoring with Dr. Miriam Steele

    What Is Reflective Functioning? Mentalization, Attachment Theory & RF Scoring with Dr. Miriam Steele
    Mar 6 2026
    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
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    1 h et 26 min
  • Hard Feelings: Daniel Smith on Embracing Shame, Envy, Annoyance, and the Wisdom in Dark Emotions

    Hard Feelings: Daniel Smith on Embracing Shame, Envy, Annoyance, and the Wisdom in Dark Emotions
    Feb 27 2026
    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
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    1 h et 55 min