Advanced Consultation

Behavioral parent training doesn't have to be cold or rigid, and is much more than star charts and rewards. It can be relational, warm, and practical, shifting underlying patterns and promoting change via everyday interactions. Dr. Rachel LaFleur and Dr. Sofia Goltsberg explain how bevioral parent training, inclusive of Parent-Child Interaction Therapy (PCIT), uses live coaching, attention, and calm boundaries to help families build new patterns, grow skills, manage conflict, reduce parental stress, and promote effecitve coparenting. They discuss who may benefit from behavioral parent training, how it can support children with challenges such as tantrums, anxiety, OCD, ADHD, and sleep issues, and why this approach can help parents feel more confident and less stuck. The conversation offers parents and clinicians a clearer, more compassionate view of behavioral therapy.

Resources:

• Dr. Goltsberg at Expand Psychology: https://expandpsychologyva.com/sofia-goltsberg
• Consultation with Dr. LaFleur: https://stonyrunpsych.com/professional-consultation/
• PCIT International: https://www.pcit.org/
• Facebook Group for Behavioral Parent Training Therapists (clinicians only): https://www.facebook.com/groups/bptconnect
• Sign-up for Basecamp (for Certified PCIT Therapists only) https://docs.google.com/forms/d/e/1FAIpQLScOCvAvAKQUpK1VmIxvRfJEyPYO-1Cg97wKm2SZ4SaEcicx2w/viewform

02:48 — Why Parent Training Works
06:19 — Different Forms of Behavioral Parent Training
06:52 — PCIT and Live Coaching Explained
10:53 — How Behavioral Treatment Can Be Relationship-Centered
16:46 — Shaping the Environment, Not Blaming the Child
24:13 — Teaching Regulation Through Parent Responses
30:15 — What Teaching “Coping Skills” Looks Like in Behavioral Work
35:08 — Who Can Benefit From Behavioral Parent Training
43:19 — Parent Consistency is Fair, Emotionally Safe, and Effective
48:25 — The Role of Assessment and Diagnosis
51:41 — Key Takeaways for Families
55:24 — Training and Resources for Clinicians

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In this episode, Rachel LaFleur, PhD, Stephanie Davis, PhD, and Julie Brownley, MD, PhD unpack one of the most ethically complicated parts of clinical work: self-disclosure. They explore how disclosure can build rapport, deepen trust, and repair ruptures, but also create shame, blur boundaries, or shift emotional labor onto the client.

Stephanie opens with the central question: when is disclosure appropriate in therapy, and when does it cross the line?

Julie describes training at Hopkins with an extremely strict "never disclose" stance, and how that approach felt limiting and unrealistic in practice.

A powerful example: Julie tells a patient she is pregnant, and the patient is upset not because care was worse, but because the lack of disclosure felt strange and disconnected.

Stephanie distinguishes between intratherapeutic disclosure—sharing what is happening in the relationship and room—and extratherapeutic disclosure, such as having a child or experiencing depression.

Stephanie emphasizes that disclosure is not just biographical facts. It can mean naming what the clinician is experiencing with the client.

Rachel highlights how context matters and explains how limited personal sharing can be useful with pediatric patients, especially when rapport is hard to build, such as inviting her dog into a first session.

The conversation explores how lived experience can reduce shame and increase connection, while also carrying the risk that clients feel responsible for the clinician’s emotions.

Political disclosure comes up as a difficult issue in a polarized climate, with clients sometimes wanting to know whether a therapist shares their views before feeling safe.

The clinicians discuss how demographic differences, racism, sexism, religion, and bias can enter the room, and how some moments are clinically relevant while others should be set aside.

The group describes the importance of contextualizing visible emotion, including tears or frustration, so clients do not feel they need to take care of the therapist.

Stephanie shares a moment when her frustration slipped out, leading to an apology and reflection on how disclosure can be useful when handled honestly.

The conversation closes with a research tangent on sexual attraction disclosures, which all three agree are high-risk, ethically fraught, and not something to normalize.

00:00 - Opening the disclosure debate in therapy
01:19 - Julie’s training: a strict no-disclosure culture
02:05 - The pregnancy example that changed Julie's perspective
05:23 - Why disclosure can be necessary in the therapeutic relationship
06:21 - Intratherapeutic vs extratherapeutic disclosure
08:19 - Training differences
10:08 - How clinicians weigh the utility of sharing
12:38 - Telehealth and keeping home life out of session
14:07 - Lived experience as a teaching tool, not a burden
17:11 - Expert power vs referent power in therapy
20:20 - When clients ask for personal disclosure directly
22:24 - Political affiliation and therapeutic safety
25:58 - Choosing a therapist who understands your lived experience
27:31 - The vulnerability of being the therapist
30:27 - Rachel on crying and contextualizing emotion
32:17 - Julie on joy, sadness, and not making it about her
35:20 - Reassurance seeking, shame, and therapeutic timing
36:15 - Being real in the room without becoming the focus
37:47 - Using disclosure to challenge distorted beliefs
39:32 - Building safe relational experiences
40:15 - When tears open the door to deeper work
41:50 - Apologizing after a disclosure misstep
43:10 - Stephanie’s indvertent disclosure and repair
46:08 - Calling out inadequate care without collapsing into blame
49:45 - The power of saying "I could be wrong"
52:27 - The discomfort of sexual attraction disclosures

The conversation covers the impact of pediatric ADHD on families, the complexities of diagnosing and treating ADHD, and the psychological and social implications of ADHD. The conversation delves into the challenges of managing ADHD in children, emphasizing the importance of a holistic approach that includes behavioral intervention, medication, and parental support. The impact of ADHD on relationships, the role of medication, and the significance of parental involvement are key themes explored in the discussion.

Takeaways

• Pediatric ADHD affects families and has a genetic basis.
• Diagnosing and treating ADHD requires a nuanced approach and can have a significant impact on self-image and relationships. ADHD management requires a holistic approach.
• Medication and behavioral intervention are both essential for effective ADHD management.

01:10 — Hello

03:30 — Understanding Pediatric ADHD

07:15 — The Importance of Early Diagnosis

11:37 — The Role of Clinicians in ADHD Identification

16:50 — Medication and Its Implications

20:52 — Self-Image and ADHD

23:38 — The Impact of ADHD on Relationships

24:48 — Understanding ADHD: The Execution Gap

27:33 — The Role of Medication in ADHD Management

30:01 — Behavioral Interventions: Timing and Effectiveness

32:24 — The Importance of Environment and Relationships

36:44 — Navigating Parental Emotions and Expectations

42:06 — The Holistic Approach to ADHD Treatment

49:03 — Building Support Systems for Parents

55:00 — The Power of Consistency in Parenting

The conversation delves into behavioral parent training and Parent-Child Interaction Therapy (PCIT), the impact of parenting influencers and recommendations of gentle parenting, and the methods for promoting emotion regulation in young children and addressing challenging behaviors. It emphasizes the need for clear scripts and decision trees for parents to follow in moments of their and their child's intense emotion dysregulation. The discussion also highlights the significance of practicing coping skills outside of the most distressing moments and the role of parental modeling in teaching children how to cope effectively.

Takeaways

• There are clear skills parents can learn to promote their children's emotion dysregulation and reduce family stress.
• Parenting influencers and social media can contribute to misinformation and confusion about effective parenting strategies.
• The therapeutic alliance between parents and clinicians is crucial in behavioral parent training.
• The inner dialogue of parents and their ability to navigate their own emotions play a significant role in supporting children's emotional regulation.
• Behavioral parent training emphasizes the importance of clear scripts and decision trees for parents to follow in moments of intense emotion dysregulation.
• Practicing coping skills outside of the most distressing moments and parental modeling play a crucial role in teaching children how to cope effectively.

Chapters

0:05 — Introduction to Advanced Consultation Podcast

0:55 — Nickname Revelations

3:43 — Exploring Emotional Dysregulation in Young Children

6:56 — Therapeutic Approaches and Building Trust

9:48 — The Importance of Parental Involvement

12:53 — Understanding Tantrums and Emotional Triggers

15:47 — Navigating Parenting Challenges and Strategies

18:50 — The Role of Positive Reinforcement

21:52 — Adapting Interventions to Family Needs

24:54 — Modeling Emotional Regulation for Children

27:58 — Navigating Parental Dysregulation

30:58 — Understanding Tantrums and Emotional Outbursts

33:12 — What is the Role of Co-Regulation in Young Children's Coping?

36:17 — The Impact of Parental Responses on Child Emotions

40:34 — Behavioral Parent Training Techniques

44:15 — Teaching Social Skills and Managing Interruptions

50:35 — The Importance of Planned Practice

56:17 — The Value of Proactive Treatment for the Whole Family

The conversation delves into the critical topic of postpartum mental health, covering perinatal mental health conditions, postpartum psychosis, and postpartum OCD. It also explores medication, psychothearpy, and social support considerations for postpartum mental health. The conversation covers a range of topics related to postpartum mental health, including medication management, challenges in diagnosis and treatment, the impact of mental health on parenting and vise versa, the role of sleep, pressure on new parents, support systems, flexibility in postpartum planning, maternal mental health and breastfeeding, postpartum trauma and recovery, prioritizing maternal mental health, treatment approaches for postpartum OCD, balancing media exposure, and resources for postpartum mental health.

Resources:

Call or text the National Maternal Mental Health Hotline: 1-833-852-6262

Call or text the National Suicide Prevention Hotline: 988

Information page on postpartum psychosis help

Chapters

• 00:00 Introduction to Postpartum Mental Health
• 01:29 Perinatal Mental Health Conditions
• 03:05 Postpartum Psychosis
• 04:36 Postpartum OCD
• 06:03 Differentiating Intrusive Thoughts, Delusions, and Hallucinations
• 19:24 Recognizing Mania and Psychosis
• 25:19 Medication Considerations for Postpartum Mental Health
• 28:09 Postpartum Medication Management
• 29:07 Challenges in Diagnosis and Treatment
• 30:36 Impact of Mental Health on Parenting
• 31:34 The Role of Sleep in Postpartum Mental Health
• 32:58 Pressure on New Parents
• 33:25 The Postpartum Experience
• 35:19 Support Systems for New Parents
• 36:22 Flexibility and Adaptability in Postpartum Planning
• 37:04 Maternal Mental Health and Breastfeeding
• 38:01 Postpartum Trauma and Recovery
• 38:58 Postpartum Mental Health and C-Sections
• 39:13 Prioritizing Maternal Mental Health
• 43:42 Treatment Approaches for Postpartum OCD
• 45:12 Managing Intrusive Thoughts in Postpartum OCD
• 51:25 Balancing Media Exposure and Mental Health
• 54:32 Resources for Postpartum Mental Health

The conversation delves into the impact of accommodation on anxiety and OCD, the role of reassurance seeking, and how behavioral parent training can be an important framework for families of young children. The speakers seek to highlight the ways that reducing accommodation can empower clients, as well as their family members and loved ones. Drs. Davis, Brownley, and LaFleur speak the importance of fostering client self-trust and autonomy and avoiding paternalistic approaches.

Takeaways

• Accommodation has a significant impact on anxiety and OCD treatment outcomes.
• There is important nuance to addressing accommodation.
• Empowering self-trust and autonomy is essential in OCD and anxiety treatment.

Chapters

• 00:00 Introduction and Topic Overview
• 02:59 The Impact of Family Accommodation
• 09:59 Reassurance Seeking and Accommodation
• 18:49 Behavioral Parent Training and Co-Sleeping
• 24:51 The Myth of Supportive Parenting
• 26:35 Understanding Behavioral Function
• 28:00 Challenges in Accommodation Reduction
• 29:12 Empowering Parents and Loved Ones
• 30:26 Behavioral Psychology and Clinical Terminology
• 32:00 Understanding Extinction Burst
• 33:15 Collaboration and Communication with Providers
• 35:59 Medication, Accommodation, and Trust
• 40:24 Empowering Self-Trust and Autonomy
• 45:29 Mechanics and Holistic Care in Treatment
• 49:09 Empowering Self-Trust and Autonomy

Welcome to the first episode of Advanced Consultation with Dr. Rachel LaFleur, Dr. Julie Brownley, and Dr. Stephanie Deverich Davis. The conversation delves into the complexities of GLP-1 medications, covering their physiological impact, psychiatric application, and influence on addictive and compulsive behaviors. It also explores the challenges of prescribing GLP-1 medications and the psychological impact of highly processed foods. The conversation delves into the limited research available regarding GLP-1 medications and mental health, the multifactorial nature of treatment resistance, the interplay between inflammation and endocrine systems, the prescription and oversight of GLP-1 medications, and the sensitivity required when addressing weight and mental health issues.

Takeaways

• GLP-1 medications have a significant impact on hunger management and addictive behaviors.
• The influence of highly processed foods on hunger drive and psychological well-being is a critical area of concern. GLP-1 medications pose challenges for some individuals
• Treatment resistance is multifactorial
• Inflammation and endocrine systems are interconnected
• Prescription and oversight of GLP-1 medications require thorough evaluation
• Sensitivity is crucial when addressing weight and mental health issues

Chapters

• 00:00 Introduction to GLP-1 Medications
• 00:49 Understanding GLP-1 Medications
• 02:15 Prescribing GLP-1 Medications
• 03:13 Challenges in Prescribing GLP-1 Medications
• 04:13 Psychiatric Application of GLP-1 Medications
• 06:03 Physiological Impact of GLP-1 Medications
• 10:13 GLP-1 Medications and Addiction
• 11:21 Impact of GLP-1 Medications on Compulsive Behaviors
• 13:03 GLP-1 Medications and Hunger Management
• 19:01 The Influence of Highly Processed Foods
• 23:32 The Psychological Impact of GLP-1 Medications
• 26:28 Challenges with GLP-1 Medications
• 27:09 Multifactorial Nature of Treatment Resistance
• 31:49 Inflammation and Endocrine Interplay
• 41:01 Prescription and Oversight of GLP-1 Medications
• 48:23 Weight and Mental Health Sensitivity