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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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