In this episode of the podcast, Dr. David Puder sits down with Dr. Karen Maroda, a renowned psychoanalyst, assistant professor of psychiatry at the Medical College of Wisconsin, and author of influential books including The Power of Countertransference and The Analyst's Vulnerability. Together they explore a powerful clinical insight: disengagement precedes enactment. Learn how therapists' unprocessed countertransference (irritation, boredom, guilt, anger, or helplessness) often leads to emotional withdrawal before erupting into destructive enactments that can rupture the therapeutic relationship.

Dr. Maroda shares candid examples from her own practice, including a personal enactment she later processed with her patient, and demonstrates practical strategies for catching disengagement early, using constructive self-disclosure, and maintaining emotional presence. The conversation features a live role-play, deep discussion of parentification in therapists' histories, setting healthy boundaries, managing guilt and shame, and turning potential pitfalls into opportunities for deeper connection.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Doriel Jacov joins Dr. Puder to explore the often-overlooked struggles of male survivors of sexual abuse. With one in six males experiencing childhood sexual abuse before age 18, Jacov unpacks the profound impact of shame, masculinity norms, disclosure barriers, and identity fractures that make healing uniquely challenging for men. The conversation covers grooming, power imbalances, coercion, the myth that survivors become abusers, arousal and body betrayal, sexual identity confusion, trauma reenactment, and the complex transference dynamics that arise in therapy, including erotic transference and projective identification.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In this episode, Dr. David Puder explores Trauma-Specific Reflective Functioning (T-RF) with researchers Dr. Nicholas Berthelot and Dr. Julia Garron-Bissonnette. Discover how childhood trauma affects mentalization and learn about the five distinct trauma mentalization profiles identified in mothers with histories of maltreatment: identification with the perpetrator, functionally grandiose, absorbed in trauma, global failures in mentalization, and those with no major failures who show remarkable resilience. The conversation examines how these different ways of processing trauma significantly impact parenting, attachment security, and the intergenerational transmission of trauma.

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 cohort leaders Dr. Allie Riege and Dr. Jeremiah Stokes to explore how reflective function transforms countertransference into deep clinical insight. Through their experience leading psychodynamic cohort consultation groups, they discuss the challenges therapists face with vulnerability, disavowed emotions, and the gap between theory and real-world application. The conversation dives into common therapist personality dynamics, enactments, boredom and irritability as valuable clinical data, and how group consultation helps clinicians develop greater self-awareness and empathy in their work. Drawing from Nancy McWilliams' Psychoanalytic Diagnosis and key concepts like concordant and complementary countertransference, this episode offers practical wisdom for mental health professionals seeking to improve their reflective functioning and psychodynamic case conceptualization.

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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.

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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.

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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.

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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.

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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.

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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.

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