Metamorfosis

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...

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 th...

In this episode, we explore how intergenerational trauma shapes attachment patterns and how reflective function (RF) and mentalization can help break the cycle. Drawing on research from Fonagy, Slade, and Berthelot, we examine how trauma-specific reflective functioning influences disorganized attachment and how therapies such as Mentalization-Based Therapy (MBT), Transference-Focused Psychotherapy...

In this episode, Dr. David Puder is joined by OCD specialist Kevin Foss to dive deep into Real Event OCD, which is a form of obsessive-compulsive disorder where real past experiences become the focus of endless rumination, guilt, and shame. Together, they unpack the symptoms, real-life examples, and how this subtype differs from PTSD, moral injury, and other forms of OCD. The discussion highlights...

In this episode, Dr. David Puder and Mark Ruffalo dive into the history and theory of identity diffusion, from Kernberg’s structural model and Gunderson’s work on BPD to Akhtar’s clinical descriptions. We explore how identity diffusion shows up in patients’ lived experiences—feelings of emptiness, fractured self-image, lack of authenticity—and what these struggles mean for psychotherapy. You’ll al...

In this episode, we explore the latest 2025 research on cannabis and mental health. Our discussion covers how cannabis use impacts depression, anxiety, PTSD, sleep, cognitive function, and cannabis use disorder (CUD). While many patients report short-term relief from symptoms, studies reveal complex risks, including increased odds of mood disorders, suicidality, impaired cognition, and withdrawal...

Parenting brings love, joy and plenty of emotional challenges. In this episode, clinical psychologist Dr. Alissa Jerud explores how parents can better understand and regulate their emotions instead of getting stuck in cycles of frustration, anxiety, or control. Drawing on exposure therapy, DBT skills, and her Emotion-Savvy Parenting approach, Dr. Jerud introduces practical tools: the ART framework...

In this episode, I engage in a shared-interest conversation with Dr. David Mintz, a psychiatrist with over 30 years of experience at the Austen Riggs Center, about his book Psychodynamic Psychopharmacology: Caring for the Treatment-Resistant Patient. Mintz explores the integration of psychodynamic principles into medication prescribing, emphasizing that psychiatric treatments are not purely biomed...

Join Dr. David Puder and renowned psychopharmacologist Dr. Michael Cummings as they dive deep into the complex relationship between psychiatric medications and weight gain. In this episode, they explore the metabolic challenges posed by antipsychotic medications, focusing on cutting-edge solutions like GLP-1 agonists. Whether you're a mental health professional or someone impacted by these medicat...

In this episode, we explore the innovative work of Dr. Paul L. Wachtel, a leading psychologist known for his integrative approach to psychotherapy. Dr. Wachtel challenges single-framework therapy models, advocating for a flexible approach that draws from cognitive-behavioral, psychodynamic, humanistic, and other modalities. We discuss his concept of the "disavowed self"—the parts of oneself that a...

In this episode, Dr. David Puder and Liam Browning delve into the ancient practice of sauna and modern heat exposure therapies, exploring how they influence both physical and mental health. From boosting cardiovascular and cognitive health to potentially alleviating symptoms of depression and chronic diseases, this discussion reveals the science behind heat therapy's therapeutic effects. Discover...

In this episode, we dive into the fascinating world of expressive writing and explore how turning your trauma into a narrative can lead to real mental and physical benefits. Join us as we break down the science behind the Expressive Writing Paradigm and share groundbreaking research by Dr. James Pennebaker and others. From reducing PTSD symptoms to improving mood and stress levels, discover how th...

Eating disorders are often understood through a medical or behavioral lens, focusing on symptom reduction. But what if we’ve overlooked something deeper—something rooted in the complex emotional lives of our patients? In this episode, Dr. Tom Wooldridge, a psychoanalyst and expert in eating disorders, joins Dr. David Puder to explore the psychoanalytic perspective on treating these conditions. By...

There is an extensive history of psychiatry and politics intersecting. Perhaps the most visible flashpoint occurred during the 1964 presidential campaign and gave rise to a movement in organized psychiatry that has resulted in issuance of formal ethical guidance (the “Goldwater Rule”). In this episode, Dr. David Puder and Dr. Mark Mullen discuss the pros and pitfalls of the Goldwater Rule and psyc...

In this week’s episode, we continue our series on Adverse Childhood Experiences by delving deeper into the lasting effect of ACEs on the brain and body. We explore the intricate impact of ACEs on the HPA axis, inflammation, and neurobiology, shedding light on their role in various psychiatric disorders. We highlight how these changes may indicate a shared phenotype resulting from early adversity b...

Listening to The Shrink Next Door elicited a range of emotions in me, including angst, sadness, intrigue, and heartache. For those unfamiliar with the story, it revolves around a psychiatrist named Ike who isolates his patient, Marty, from his family, takes over his business, lives in his house, charges him over a million dollars, and makes him undertake various projects for him. We will discuss t...

The purpose of this episode is to provide a clear and simple guide for clinicians on the diagnosis of complex PTSD (C-PTSD) and how it differs from post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). It is intended to complement and add to recent episodes on attachment and trauma: 213: Reflective Functioning , 203 and 204 on adverse childhood experiences.  In today’s e...

In this episode, we welcome back Dr. Michael Cummings to answer questions sent in by podcast listeners. Topics include Valproic Acid, Lithium, Treating Veterans, Restless Leg Syndrome, and much more.    By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

In this episode, we discuss “reflective function,” which is a precursor to the concept of mentalization. Reflective function is best understood not as synonymous with mentalization, but as a scale from -1 to 9, based off certain adult attachment interview questions that measure the person’s ability to describe their own and others’ internal states, motivations, and articulate a nuanced and unique...

In today’s episode, we talk with Dr. Bruce Perry who co-authored, The Boy Who Was Raised As A Dog, Born For Love: Why Empathy is Essential and Endangered, and What Happened to You? Conversations on Trauma, Resilience, and Healing (2021). We are also joined by Megan White Zappitelli, M.D., a child and adolescent psychiatrist, and Maddison Hussey, M.D., a child and adolescent fellow.  By listening t...

In this episode, we are joined by a panel of experts to discuss treatment of psychosis. Experiences of psychosis are common. When these experiences lead to interference in achieving life goals and/or distress, individuals can benefit from seeking evidenced-based care. The earlier individuals experiencing psychosis come to treatment, the better the outcomes. We are all allies in connecting these yo...

In this episode, we welcome back fan favorite Dr. Michael Cummings and ask questions sent in by listeners. Topics include Schizophrenia, Social Media Trends, and the SSRI controversy. We are thrilled to dedicate an episode that allows individuals to ask pointed questions and glean from Dr. Cummings' expertise.  By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link...

Learning how to approach patients with PTSD and severe trauma is necessary to help long term. Dr. Patricia Resick has plenty of experience in dealing with PTSD and is on the podcast today, sharing her wisdom so that we may better serve patients suffering from trauma.  By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Therapies of depth, insight, and relationship have been missing from, if not pushed out of, the public conversation on mental health treatment. After decades of attack from multiple fronts, these therapies are misunderstood, undervalued, and overlooked by the general public. In order to address this challenge and change this trajectory, we must start by listening to the public and understand their...

In this Episode, Dr. David Puder, Dr. Adam Borecky, and Joanie Burns discuss the 5-factor approach to holistic, patient-centered psychiatric care. This approach takes into account that each individual who seeks care is unique in their physiological and psychological make-up and that multiple factors influence both physical and mental health (for better or worse).  The 5-factor approach to treatmen...