Thoughts on Record: Podcast of the Ottawa Institute of Cognitive Behavioural Therapy

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Empathy is widely viewed as the cornerstone of effective therapy—but what if we’ve been misunderstanding it all along?

In this episode, Dr. Pete Kelly sits down with Dr. Douglas Flemons, to discuss his new book Empathic Engagement in Clinical Practice. Flemons challenges the common assumption that empathy is something therapists simply have, reframing it instead as something we do—moment by moment, in relationship.

Together, they explore empathy as an active, relational process; unpack the critical distinctions between empathy, sympathy, and compassion; and examine why well-intentioned empathic efforts can sometimes miss the mark or even undermine the therapeutic alliance. The conversation also addresses therapist burnout, emotional boundaries, and how clinicians can engage deeply with clients without overidentifying or becoming emotionally depleted.

This episode is essential listening for clinicians who want to refine their relational skills, strengthen therapeutic presence, and practice empathy in a way that is both clinically effective and personally sustainable.

🔑 Key Topics Covered

• Why empathy has become conceptually confused in psychotherapy
• Empathy vs. sympathy vs. compassion
• “Feeling into” rather than “feeling with” clients
• Empathy as a relational process, not a personality trait
• How empathy dissolves the therapist-as-outsider experience
• Common empathic missteps—and how to avoid them
• Empathy with individuals vs. couples and families
• “Both–and” empathizing in complex clinical situations
• Therapist burnout, boundaries, and emotional sustainability
• How clinicians can tell when empathy is truly landing

👤 Author Bio

Douglas Flemons, PhD, LMFT is an emeritus professor, AAMFT Clinical Fellow, and internationally recognized educator with decades of experience in psychotherapy, supervision, and clinical training. He is the author of Empathic Engagement in Clinical Practice (published by the American Psychological Association, 2026), a work that integrates philosophy, neuroscience, and clinical research to clarify what empathy actually is—and how it functions in therapeutic relationships.

Dr. Flemons is widely respected for translating complex theoretical ideas into practical, usable clinical guidance. His work emphasizes empathy as an interactive, ethically grounded process that strengthens therapeutic relationships while supporting therapist resilience, sustainability, and self-care.

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In this episode, we are joined by Dr. Jesse Finkelstein to discuss Real Skills for Real Life, co-authored with Dr. Shireen Rizvi. The book offers a practical, accessible introduction to Dialectical Behavior Therapy (DBT), translating a well-established clinical framework into skills that can be applied in everyday life.

Rather than focusing on diagnoses, Real Skills for Real Life centers on universal human experiences—stress, emotional overwhelm, relationship challenges, and loss—and presents DBT as a compassionate, skills-based approach to navigating them. The conversation broadly explores how DBT balances acceptance and change, why a skills-focused lens can reduce shame, and how evidence-based psychological tools can be used outside the therapy room.

This episode is relevant for clinicians, students, and general listeners interested in grounded, practical approaches to emotion regulation, relationships, and resilience in an increasingly complex world.

Jesse Finkelstein, PsyD
Dr. Jesse Finkelstein is a licensed clinical psychologist and DBT trainer based in New York City. He earned his PsyD from Rutgers University, where he received extensive training in DBT under the mentorship of Dr. Rizvi. He has since built a clinical practice specializing in emotion regulation, anxiety, and interpersonal effectiveness.

Dr. Finkelstein is known for his engaging teaching style and his ability to translate complex psychological concepts into clear, practical guidance for both clinicians and the general public. In addition to his clinical work, he provides DBT training and consultation and is committed to making evidence-based skills approachable, flexible, and relevant to everyday life.

Shireen L. Rizvi, PhD, ABPP
Dr. Shireen Rizvi is a licensed clinical psychologist, Professor of Clinical Psychology at Rutgers University, and an internationally recognized expert in Dialectical Behavior Therapy. She trained under Dr. Marsha Linehan at the University of Washington and later founded the Rutgers DBT Clinic, where she has played a central role in training clinicians and advancing the dissemination of evidence-based care.

Dr. Rizvi’s research and clinical work focus on emotion regulation, trauma, and the application of DBT across diverse clinical and real-world contexts. She is board certified in Behavioral and Cognitive Psychology and is the author of numerous peer-reviewed publications and books, including Chain Analysis in Dialectical Behavior Therapy. She is widely respected for bridging rigorous clinical science with compassionate, accessible teaching.

Website: https://www.shireenrizvi.com

Rutgers University Profile / Rutgers DBT Clinic: https://psych.rutgers.edu/academics/clinical-psychology/clinical-faculty/shireen-l-rizvi

LinkedIn: https://www.linkedin.com/in/shireen-rizvi-1a5544193/

Jesse Finkelstein, PsyD

Website:  www.axiscbt.com

Instagram: https://www.instagram.com/talkisgood/

LinkedIn:

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In this episode of Thoughts on Record, we’re joined by Drs. Robyn D. Walser and Darrah Westrup—two of the world’s leading experts in Acceptance and Commitment Therapy (ACT) and trauma treatment. Their new book, You Are Not Your Trauma, offers a compassionate and practical guide to healing that helps readers move beyond symptom management and toward a life anchored in meaning, connection, and psychological flexibility.  In this conversation we explore the book’s three-phase model of trauma recovery:

1. Building safety and foundational skills
2. Engaging in exposure and experiential work
3. Reconnecting with values, identity, and life direction

Throughout the conversation, Drs. Walser & Westrup discuss the central ACT principle that healing is not about erasing traumatic memories but changing our relationship with them. They emphasize how trauma often narrows a person’s world—through avoidance, emotional numbing, and self-protective habits that once served a purpose but now limit growth. ACT offers a path toward gently expanding one’s life again, guided by values rather than fear.

This episode is ideal for clinicians, trauma survivors, and anyone interested in a more flexible, humane approach to trauma recovery.

Bios

Dr. Robyn D. Walser is Director of TL Consultation Services, Associate Director at the National Center for PTSD, and Assistant Clinical Professor at the University of California, Berkeley. A leading figure in Acceptance and Commitment Therapy (ACT), Dr. Walser has co-authored multiple books and over 60 peer-reviewed articles. Her work focuses on trauma, mindfulness, and clinical innovation, and she is widely regarded as one of the foremost experts in ACT for trauma recovery.

Dr. Darrah Westrup is a licensed clinical psychologist, trainer, and author with decades of experience in treating trauma and anxiety-related disorders. She previously served as the Director of Training and Dissemination at the National Center for PTSD and has been instrumental in adapting ACT principles for wide-scale use in both clinical and non-clinical settings. Dr. Westrup brings a clinician’s nuance and a trainer’s clarity to her writing and therapeutic work.

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In this episode of Thoughts on Record, we sit down with Dr. Shirley Hershko, one of the foremost voices in the understanding of ADHD in girls and women. Her work has been central in challenging long-standing assumptions about how ADHD presents across the female lifespan—from childhood and early adulthood through motherhood, career transitions, perimenopause, and menopause.

Together, we explore why ADHD in women remains underdiagnosed, how cultural expectations shape symptom expression, and why internalizing presentations like anxiety, perfectionism, and emotional dysregulation often obscure the true clinical picture. We also discuss the impact of hormonal fluctuations, the role of trauma, and the unique diagnostic challenges clinicians face. Finally, we examine how treatment needs to be adapted to support women at different life stages, including those diagnosed later in life who are grappling with identity shifts, grief, and self-understanding.

This conversation offers clinicians, clients, and the general public a comprehensive look at the nuanced realities of ADHD in women.

Key Themes We Explore

• How ADHD in women is often misunderstood or hidden, including the influence of socialization and internalizing symptoms
• Diagnostic challenges, including confusion with anxiety, depression, trauma, and the effects of hormonal changes
• How ADHD evolves across the life span, particularly during major transitions such as parenting, career demands, perimenopause, and menopause
• Effective treatment considerations, including medication, psychotherapy, coaching, and lifestyle strategies
• Identity and emotional experiences, such as self-esteem, grief, and reinterpreting one’s life story after a late diagnosis

Dr. Shirley Hershko is an ADHD specialist, therapist, diagnostician, professor, and researcher at the Hebrew University. With more than two decades of clinical experience focused on ADHD in girls and women, she offers comprehensive diagnostics and therapy worldwide through secure digital platforms.

Dr. Hershko hosts a widely followed podcast, leads a Facebook community of 50,000 members, and is the author of the best-selling book Making Sense of ADHD. Her work centers on helping individuals with ADHD better understand their strengths, challenges, and unique neurocognitive profiles.

• Website: https://shirleyhershko.com
   

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In this conversation, we speak with psychotherapist and author Melissa Fulgieri, LCSW about her powerful book Healing Relational Trauma, which offers a deeply human and integrative approach to understanding the ways our early relationships shape who we become. We explore how awareness, compassion, and self-trust can help us move from survival to connection—transforming old patterns rooted in attachment wounding and developmental trauma.  The conversation also touches on themes of reparenting, nervous system regulation, relational repair, and the ongoing process of finding safety within ourselves and others.

Themes of Discussion

• Understanding Relational Trauma: Moving beyond “big T” events to include chronic emotional disconnection and unmet needs.
• The Legacy of Attachment: How early caregiving experiences shape self-worth, emotional regulation, and intimacy in adulthood.
• Breaking Cycles: Recognizing and transforming unconscious relational patterns that keep us stuck in repetition.
• Embodied Healing: Learning to recognize trauma responses in the body and fostering regulation through awareness and self-compassion.
• Boundaries and Self-Trust: Reclaiming agency and rebuilding a sense of safety when these capacities were never modeled.
• Connection as Medicine: Viewing relationships not as sources of pain to avoid, but as opportunities for repair and growth.
• Integrative Approaches: How modalities like CBT, family systems, mindfulness, and EFT can work together in trauma recovery.
• Cultural & Generational Context: Understanding how family legacies and social systems influence the experience of healing.
• Seeing Wounds as Invitations: Embracing pain as a portal to deeper authenticity, resilience, and relational depth.

Melissa Fulgieri, LCSW is a licensed clinical social worker, psychotherapist, author, adjunct professor, and speaker specializing in trauma-informed care and relational dynamics. With over a decade of clinical experience, she works with individuals and couples to address the enduring impact of childhood trauma on adult attachment, emotional regulation, and interpersonal functioning.

Her integrative framework blends trauma-focused CBT, family systems theory, emotionally focused therapy (EFT), and mindfulness-based approaches. Melissa is the author of The Couples Therapy Activity Book and Healing Relational Trauma, and is recognized for her grounded, compassionate, and accessible clinical voice. She maintains a private practice in New York and teaches in graduate-level social work programs.

Connect with Melissa:
🌐 melissafulgieri.com

📸 @melissafulgierilcsw

💼 LinkedIn

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Parenting can often feel like a relentless series of checkboxes—milestones to hit, skills to teach, problems to solve. Yet beneath all of this lies something far deeper: the opportunity to cultivate wholeness, authenticity, and love, both in ourselves and in our children.

In this episode, When At the Zoo Watch the Humans author Patrick Ney joins Dr. Pete Kelly for a discussion on reframing how we think about parenting. Drawing from his work with All About Parenting and his own personal journey through trauma, Patrick shares a vision of parenting as a deeply human and relational process—one rooted in connection rather than control.

This wide-ranging conversation touches on key ideas from Patrick’s book, including the metaphor behind When At the Zoo Watch the Humans, the impact of modern media and technology on family life, and the essential importance of community and self-compassion in the parenting journey.

Whether you’re a parent, clinician, or simply someone interested in human development, this episode offers rich insight into the emotional work of raising—and becoming—whole human beings.

Themes & Topics Discussed

• The inspiration behind When At the Zoo Watch the Humans and its central message
• “Wholeness” as a redefinition of success in parenting
• How parents can embrace their natural therapeutic role without feeling overwhelmed
• Balancing love, discipline, and emotional attunement
• Parenting through the lens of trauma recovery and personal growth
• The power of self-compassion and forgiveness in family life
• How modern technology and media shape emotional development
• The importance of community and shared experience in parenting
• Practical strategies for conflict resolution and strengthening parent–child bonds

Patrick Ney is the Lead Trainer at All About Parenting, a global parenting education organization. Over the past five years, he has conducted hundreds of online seminars and workshops, reaching thousands of parents worldwide. His work is grounded in neurodevelopmental and relational principles, emphasizing authentic connection, empathy, and emotional resilience.

Patrick is also the author of When At the Zoo Watch the Humans, a transformative exploration of the psychological and emotional dimensions of parenting. Originally from the UK, he now lives in Poland with his family, where he continues to inspire parents through teaching, writing, and public speaking.

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🎙️ Episode Overview

Clinical documentation: every therapist’s frenemy. For many mental health professionals, paperwork is one of the most persistent sources of stress—filled with contradictory advice, defensive writing habits, and the ever-present fear of audits or legal scrutiny. Add to that an endless backlog of notes and inconsistent training, and it’s no wonder documentation can feel more like a burden than a cornerstone of good clinical care.

With the rise of AI-powered tools—from automated note generation to smart treatment planners—clinicians are hopeful for relief. But new tools bring new questions: What’s ethical? What’s secure? And when does AI truly enhance care, rather than just speed up a flawed process?

Dr. Maelisa McCaffrey, licensed psychologist and founder of QA Prep, joins us to explore the evolving landscape of clinical documentation, how to write better notes with less stress, and how to use AI responsibly while maintaining human-centered care.

💡 Key Themes & Questions

• What are the biggest misconceptions about what needs to be included in clinical documentation?
• The most common documentation pitfalls among early-career therapists—and how to course-correct.
• Finding the balance between clinical thoroughness and legal protection.
• How to tailor documentation to its intended audience—billing, risk management, continuity of care, etc.
• Using documentation as a therapeutic tool, not just an administrative task.
• Key documentation strategies for high-risk situations (e.g., suicidality, child protection).
• How trauma-informed principles can guide respectful and non-stigmatizing notes.
• Best practices for open notes and client portals—writing transparently while maintaining clinical utility.
• Navigating couples and family therapy notes where multiple perspectives intersect.
• The impact of AI tools (scribes, generators) on documentation quality and clinician workload.
• Ethical and practical considerations when integrating AI into clinical workflows.
• Why clinicians must remain the final editors of AI-assisted notes.
• The future of AI in clinical outcome tracking and safety monitoring.
• Addressing concerns about liability and false confidence in AI-generated documentation.
• If Maelisa could change one thing about how clinicians approach documentation—it would be what?

🧠 Guest Bio

Dr. Maelisa McCaffrey, Psy.D. is a licensed psychologist, nail design enthusiast, and multi-passionate entrepreneur. Through her company QA Prep, she helps therapists transform documentation from a source of dread into a meaningful part of clinical practice. Maelisa focuses on the why behind documentation standards, helping clinicians think critically and ethically while maintaining their authenticity. Living with ADHD herself, she brings humor, practicality, and real-world insight to her trainings, empowering therapists to write notes with confidence and clarity.

🔗 Connect with Dr. McCaffrey

• Website: QA Prep
• YouTube: QA Prep Channel
• Instagram: @maelisamccaffrey
• LinkedIn: Dr. Maelisa McCaffrey

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In this episode, Dr. Claire Sira and Tom Hudock join me to discuss their new book Feeling Loved with Adult ADHD. We explore how ADHD can quietly undermine even the strongest relationships—and how partners can move from shame and blame to empathy and trust.

Together we cover:

• Emotion dysregulation and its impact on intimacy
• ADHD as a “third partner” in relationships
• Moving from criticism to curiosity
• The “Trust Account” metaphor for building connection
• Navigating over-functioning vs. under-functioning roles
• Shame spirals, defensiveness, and timing in conflict
• Practical tools like boundaries, and empathy skills
• How worksheets and reflective exercises support real change
• Signs of hope for couples who feel stuck or disconnected

If you’re living with ADHD, partnered with someone who is, or working clinically with these dynamics, this conversation offers both compassion and practical strategies.

Dr. Claire Sira Dr. Sira earned her PhD in Clinical Psychology with a specialization in Neuropsychology from UVic in 2007. After working as a Neuropsychologist at Victoria General Hospital for five years, she transitioned to full-time private practice in 2014. In 2019, she expanded her focus to include assessing and treating ADHD in adults and youth, recognizing the similarity between executive function impairments in adult ADHD and those resulting from acquired brain injuries. As a co-founder of ADHD For Life, Dr. Sira has developed an efficient ADHD assessment process for psychologists and physicians. Additionally, she and her co-founder offer online coaching programs and books for adults with ADHD. Dr. Sira frequently presents on ADHD to healthcare professionals and provides supervision and training to therapists looking to enhance their skills in ADHD assessment and treatment. She also consults with clinics and specialized teams to integrate mental and behavioral healthcare into their services.  Lastly, Dr. Sira is a past president of the British Columbia Psychological Association Board of Directors and is currently serving a three-year term as a Director at Large on the Canadian Psychological Association Board of Directors.

👉 drclairesira.ca

Tom Hudock Known for starting organizations in technology, education, and psychology, Tom Hudock is more than a startup junkie—he is a coach, mentor, advocate, and partner. In a world where leaders are often lauded for being harsh, Tom does it all with compassion for the people, process, and product he seeks to elevate. But like many entrepreneurs, his path has not always been easy. As a young man, Tom left an Engineering degree to develop Canada’s 2nd Microsoft Windows-based Point-Of-Sale software, selling it across North America. After a successful exit to a plastics and paints retailer, he built his consulting expertise with government and big business while co-founding ADHD For Life and Hyperfocus Software.  In 2015, Tom co-founded Rethink Thinking Foundation, a non-profit hosting 250-teen weekend events with headliners like Sir Ken Robinson. He later launched Arc Academy of Inquiry, a registered middle school rooted in self-direction, resilience, and inquiry-based learning. Through challenges and failures came deep lessons and clarity. Today, Tom champions the underdog and finds his strongest inspiration by investing in people with drive and forward-thinking ideas.

👉 https://adhdforlife.com/about-us

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In this conversation, neuroscientist and author Dr. Nikolay Kukushkin joins us to explore some of the deepest questions about the human mind. Drawing from his book One Hand Clapping, Dr. Kukushkin offers a rare synthesis of biology, evolution, and philosophy—challenging us to reconsider not only how the mind works, but what it means to be a mind at all.

Topics & Questions Covered:

• What inspired One Hand Clapping and the central questions it seeks to answer
• The brain as a “singularity” of nature’s complexity and its implications for consciousness
• Consciousness through the neurobiology of psychedelics
• The value and meaning of memory vs. the present moment
• The dopamine “economy” and its links to addiction, burnout, and anxiety
• Why unpredictability—not reward—drives behavior
• “The cortex wants peace, the reward system wants chaos” – reconciling two competing systems
• How social life shaped intelligence and what loneliness does to the brain
• Can AI help us understand our own minds?
• The role of uncertainty in long-term happiness and mental wellness
• Why “life isn’t a problem to solve—it’s something to be experienced”

Nikolay Kukushkin, PhD, is a neuroscientist, writer, and science communicator whose work bridges hard science and human experience. Trained at institutions such as Oxford and Harvard, he has conducted pioneering research on memory formation, synaptic plasticity, and the neural basis of learning. Currently based at NYU’s Carew Laboratory, he investigates the molecular foundations of behavior.

Beyond his academic work, Dr. Kukushkin has written hundreds of popular science articles in both Russian and international media, earning recognition for his ability to combine clarity, scientific rigor, and philosophical insight. One Hand Clapping is his first book in English, following its acclaimed Russian release by Alpina Non-Fiction. He lives in New York with his wife, continuing to explore what makes the human brain not only a machine of thought but a vessel of meaning.

Learn More:
Website: nikolaykukushkin.com

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Clinicians will often hear their clients express deeply felt needs, only to admit they’ve never shared them with their partner—usually due to fear of vulnerability or a defensive, adversarial dynamic that makes intimacy feel unsafe.  In today’s episode, we are joined by Dr. James Cordova—Professor of Psychology at Clark University and creator of The Relationship Checkup—to discuss his new book, The Mindful Path to Intimacy. Dr. Cordova’s book offers a powerful framework for understanding and transforming these relational patterns through the lens of mindfulness, compassion, and shared vulnerability.

In our conversation, we explore:

• Why intimacy is often more terrifying than people expect—and why it’s worth the risk
• How mindfulness can serve as both a spiritual and relational practice
• The idea that attention is the most basic form of love
• Why many couples shift from infatuation to frustration, and what can be done about it
• How interpersonal neurobiology helps us understand the push-pull of closeness and withdrawal
• Ways to navigate shame, trauma histories, and fear of being fully seen in love
• What distinguishes couples who flourish from those who simply coexist. 

Dr. James Cordova is a Professor of Psychology at Clark University and the creator of The Relationship Checkup, a pioneering, preventative intervention designed to assess and strengthen couples’ relationships before problems escalate. He has led major research initiatives—including a $1.3M Department of Defense-funded RCT with Lt. Colonel Jeffrey Cigrang and a $1M NIH grant—demonstrating the model’s effectiveness in both military and civilian populations. As founder and president of Arammu: The Relationship Checkup, Inc., Dr. Cordova is scaling this approach nationwide, training over 1,000 military counselors and integrating the model into primary care. He is the author of The Marriage Checkup, The Story of Mu, and The Mindful Path to Intimacy, the latter of which offers mindfulness-based tools for cultivating emotional and spiritual connection.

To learn more about Dr. Cordova and his work, visit:
https://relationshipcheckup.com
Or check out his latest book, The Mindful Path to Intimacy, from Guilford Press.