How to Be Patient

Margaret took the captain’s chair for this one, and I was just along for the ride—straight into the deep waters of psychodynamic and psychoanalytic therapy. We start with the basics: what do these words actually mean, and why do they still make some clinicians roll their eyes while others swear by them? From Freud’s infamous couch to modern relational therapy, we unpack the myths, the methods, and the mysteries that still define this approach.

Along the way, we wrestle with big questions: What’s really happening in the therapeutic relationship? Why does transference matter? And is there value in a therapy that sometimes feels more like philosophy than science?

And because talking about it wasn’t enough, we try it on for size—running a live role-play where I attempt a psychodynamic formulation in real time. (Spoiler: it’s as messy and awkward as you’d imagine, but also revealing in ways I didn’t expect.)

This isn’t a lecture or a history lesson. It’s us exploring why psychodynamic therapy still sparks curiosity, skepticism, and maybe even wonder—and asking what it means for the future of how we help people heal.

Takeaways:

Therapy on the Couch: Why psychoanalysis still matters, even if we roll our eyes at Freud.
The Mirror Effect: How transference and countertransference shape every session more than we realize.

Cracks in the Foundation: Why psychodynamic work digs into the “basement” instead of just fixing surface problems.
Between Science and Story: The tension between falsifiability and the lived experience of patients.

Practice Makes Awkward: A live role-play that shows just how messy (and revealing) this approach can be.

Citations:

Kassaw K, Gabbard GO. Creating a psychodynamic formulation from a clinical evaluation. Am J Psychiatry. 2002 May;159(5):721-6. doi: 10.1176/appi.ajp.159.5.721. PMID: 11986123.

Summers, R. F., Barber, J. P., & Zilcha-Mano, S. (2024). Psychodynamic therapy: A guide to evidence-based practice (2nd ed.). The Guilford Press. Chapter 1 cited

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This episode might feel like a gut punch, in the most important way. Margaret and I sat down with Alyson Stoner to talk about what it means to be raised in the spotlight, what happens when systems prioritize performance over people, and how we reckon with that legacy in healthcare. There’s a vulnerability here that caught me off guard and I think that’s the point. If you’ve ever wondered what lies beneath the polished performances we all grew up watching, this one’s for you.

Takeaways:

The Performance Trap: We unpack how young performers are trained to suppress needs for the sake of applause—and what that does long term.

Behind the Curtain: Alyson shares a raw, unfiltered look at what fame masked, and what it demanded.

Trauma in the Body: We explore how unresolved pain shows up in physical health—and how the body never really forgets.

Reclaiming Identity: From child star to advocate, Alyson walks us through the messy, powerful work of redefinition.

What Healing Can Look Like: It's not about fixing—it’s about reconnecting. And sometimes the most honest therapy isn’t clinical at all.

Want more Alyson Stoner:

IG: @alysonstoner

TikTok: @alysonstoner

YouTube: @TheRealAlysonStoner

Citations:

Orenstein GA, Lewis L. Erikson's Stages of Psychosocial Development. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556096/

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Margaret and I sat down to speak on a topic we rarely hear spoken plainly: suicide. We didn’t plan to tidy anything up or wrap it in easy language. Instead, we tried to sit with it—the fear, the responsibility, the human ache behind it all. We talk about how suicide shows up in our clinical work, how it’s shaped us personally, and why we both believe silence helps no one. This isn’t a “how-to” or a lecture. It’s a real conversation between two people trying to hold space for pain, and maybe offer a little hope in the process.

Takeaways:

Let’s Start with the Silence – We unpack why suicide feels unspeakable in both professional and personal spaces.

The Weight of the Question – Margaret and I talk about what it’s like when someone asks, “Are you thinking about hurting yourself?”

Clinician Meets Human – We explore the blurry line between being the helper and being the one in crisis.

Words That Don’t Fix But Still Matter – Sometimes just saying “I’ll sit with you” carries more power than advice.

Not a Lesson—A Lived Experience – This episode isn’t scripted or solved. It’s honest, messy, and real.

Citations:

Margaret’s Discussion portion and most referenced informed by review ch: Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, Volume 11, 2025 Published. Chapter 31.1: Psychiatric Emergencies: Suicide Overview, Risk and Protective Factors, Treatment, and Prevention

Suicide Crisis Syndrome Reference: Melzer, L., Forkmann, T., & Teismann, T. (2024). Suicide Crisis Syndrome: A systematic review. Suicide and Life-Threatening Behavior, 54, 556–574. https://doi.org/10.1111/sltb.13065

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This episode felt like a deep exhale. Margaret runs solo today, as she sat down with Dr. Hillary McBride—psychologist, author, and researcher—to talk about embodiment, trauma, and the radical act of tuning back into ourselves.

We talked about what it means to feel your feelings in your body, why disconnection often begins as protection, and how pleasure, presence, and play can be part of the healing process. It’s about more than coping. It’s about coming home.

This one surprised me, and stayed with me. I think it might do the same for you.

Takeaways:

Embodiment isn’t about perfection—it’s about presence.

Disconnection from the body is often a trauma response we learned for survival.

Reconnecting with your body can feel foreign, even frightening—and still be worth it.

Healing doesn’t always mean “feeling better”—sometimes it just means feeling.

Your body can be a place of safety, wisdom, and even joy—but you don’t have to rush to get there.

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While in psychiatry we avoid using declarative or certain language about mechanisms, it can be helpful to think about the narratives that drive people to behavior that will ultimately end their life. In this episode Margaret and I review the Durkheim principles of suicidality following the four categories: anomic, fatalistic, egoistic and altruistic. We talk about how each has a distinct flavor in the clinical setting and which ones are better handled by safety planning or solution based interventions.

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It’s Part 2 of our deep dive into eating disorders—and this time, we’re going even deeper. We kick off by unpacking our mock therapy session with Dr. Helen Liljenwall, which unexpectedly hit close to home for all of us. Then we take a sharp turn into the medical realities of starvation, including refeeding syndrome, the female athlete triad, and why your heart is always in the equation (literally).

But what happens when patients refuse to eat—and we have to decide whether they need a psychiatric hold? Who gets to say when a person with an eating disorder has lost capacity? And is “terminal anorexia” a compassionate truth—or a dangerous excuse?

If you’ve ever wondered what it really takes to treat eating disorders, this is the episode to hear. It's raw, real, and it doesn’t flinch.

Takeaways:

Refeeding syndrome isn’t just a med school concept—it’s a real, life-threatening danger in eating disorder treatment.

Psychiatric holds for anorexia raise tough ethical questions about autonomy, capacity, and what it means to save a life.

That fake therapy session? It’s not so fake when the emotional stakes are this high.

The eating disorder voice can sound like discipline—but it’s often masking deep distress.

Terminal anorexia is a controversial idea… and we don’t shy away from the controversy.

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This is Part 1 of our two-part deep dive into eating disorders—and we’re starting at the beginning. Margaret and I sit down with psychiatrist and eating disorder specialist Helen Liljenwall, MD to walk through the basics: What are the major types of eating disorders? What do they actually look like in real life? And how do we treat something that’s rooted in both biology and culture? We cover everything med school skipped—then try to practice what we’ve learned in a fake (but emotionally real) therapy session with Dr. Helen as the patient. Spoiler: it got uncomfortable in all the right ways.

Takeaways:

Eating disorders don’t come with a single look—or a single diagnosis. We break down the ones you’ve heard of and the ones you haven’t.

Every med student should hear this conversation. Because we weren’t taught how to spot this stuff—let alone treat it.

Practicing therapy with an expert in the “patient” seat is more terrifying than it sounds.

This isn’t just about food. It’s about fear, shame, and survival strategies.

We’re not pretending to know everything. We’re starting with the basics—so we can learn to do better.

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Margaret and I talk about what it feels like to care for patients who remind us a little too much of ourselves, especially when we’re also the ones filling out the paperwork for a psychiatric hold. We dig into what a 5150 (or 5585) really means, how to sit with that kind of authority, and the emotional mess of seeing a patient’s fear reflect your own.

Psychiatric holds carry legal weight, but emotional weight, too. We talk about what it’s like to sit with both.

Takeaways:

Signing a psych hold form never feels casual—especially when the patient could’ve been me.

Overidentifying isn’t compassion—it’s a signal that I might need supervision, fast.

Letting go of a patient isn’t always a failure. Sometimes it’s a kindness.

Psychiatric holds carry legal weight, but emotional weight, too. We talk about what it’s like to sit with both.

Empathy is powerful—until it gets in the way. Learning where to stop is part of learning how to stay.

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In this episode, Margaret and I take on burnout—what it actually is, where the term came from, and how to tell when you’re not just tired, but something deeper is cracking. We dig into the history, the Maslach Inventory, moral injury, and why burnout isn’t in the DSM (yet). We also share our own unhinged burnout moments (yes, mine involves harmonica) and explore how to tell the difference between burnout, depression, and just being in the wrong place.

Reference: MBI Self Test: https://drive.google.com/file/d/16OJpRvvrGfs8SEEXgKk_Em8NgZerZkdo/view

Takeaways:

Did I buy a harmonica during a burnout spiral? Yes. Was it helpful? Also yes.

Burnout isn’t just a vibe—it has a whole inventory. We took it, and let’s just say… some of us are more charred than others.

Moral injury hits different when you’re the one holding the clipboard. Especially when someone else made the call.

Burnout and depression aren’t the same—but they like to hang out. And sometimes you don’t know which one’s driving.

Not all coping strategies are cute. Some look like spreadsheets. Some look like chili’s. Some look like crying in a hospital bathroom.

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This might be our nerdiest episode yet—and that’s saying something. In our Season 2 kickoff, Margaret and I sit down with Dr. Margo Funk, psychiatrist and QTC whisperer, to explore the strange, stressful overlap between psychiatry and cardiology. We talk about our worst fears on call, how to spot when an EKG is lying to you, and why it might be time to stop blaming Haldol and start looking at your T wave. There are metaphors involving horses, guns, Timberlake, and Kool-Aid. Somehow, it all makes sense. If you’ve ever been scared of EKGs, risk calculators, or calling your attending at 2AM—this one’s for you.

Takeaways:

I thought I understood the QT interval—until I realized I didn’t. Turns out, there’s a difference between what the EKG says and what your patient actually needs.

Not all meds are the villains we make them out to be. Spoiler: Haldol gets a redemption arc. Trazodone… does not.

I finally learned what that weird slope on the T wave actually means. And yes, it involves potassium.

ICD storms are real—and they are terrifying. Dr. Funk explains why treating the aftermath is as critical as preventing the next one.

Sometimes the bravest thing you can do is call your attending. Or carry a caliper. Or question the computer.

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Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

Watch on YouTube: @itspresro

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Produced by Dr Glaucomflecken & Human Content

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