Psychofarm Podcast

Psychodynamic therapy interventions are the focus of this episode, organized through a practical levels framework for clinicians. Dr. Fu and Dr. Greg break down empathic mirroring as a way to keep the patient’s narrative moving, clarification as a tool for deepening detail, confrontation as a gentle way to point out patterns or discrepancies, and interpretation as the rare intervention that should come only after enough groundwork. Along the way, they connect these skills to diagnostic interviewing, medication management, forensic psychiatry, therapeutic alliance, and the difference between helping a patient talk more and pushing too quickly toward insight. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Suicide risk assessment is often taught like a checklist, but this episode argues that the real work is formulation. We talk about why history is only the starting point, how acute and chronic risk differ, and why suicidal ideation can mean very different things depending on context. We cover stress-related suicidality, intoxication, baseline recurrent thoughts, mood and psychotic disorders, OCD intrusive thoughts, hospitalization decisions, red flags, countertransference, and documentation. The result is a practical psychiatry conversation for clinicians and trainees who want to think more clearly about suicide risk without pretending they can predict the future. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Mindfulness in psychiatry is the focus of this episode, with Doctors Malzberg and Fu treating it as a practical clinical skill rather than vague wellness advice. They define mindfulness as deliberate attention to the present moment without judgment, then connect it to DBT, MBCT, ACT, anxiety, depression, PTSD, substance use, and trauma-informed care. The conversation also covers when mindfulness should be modified, why it is not always a standalone treatment, and how clinicians can teach it through short, scheduled practice, DBT “what skills,” grounding techniques, and careful follow-up. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Psychodynamic technique is the throughline of this episode, which argues that the core skills of therapy belong at the center of psychiatry, not at the margins. The conversation maps five levels of intervention, from level zero through interpretation, while stressing that the most important work usually happens earlier: frame, alliance, follow the affect, and technical containment. Rather than glamorizing clever interpretations, the episode shows why reflective listening, emotionally accurate language, and careful therapeutic interventions help patients think, regulate, and elaborate on their experience. It’s a practical discussion for clinicians who want to improve interviewing, formulation, and treatment across everyday psychiatric practice.Lots of material from this lecture is from here: https://www.appi.org/Products/Psychotherapy/Clinician-Technique-in-Personalized-Psychotherapy This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

In this episode, Dr. Malzberg and Dr. Fu tackle one of psychiatry’s hottest diagnostic debates: complex PTSD versus borderline personality disorder. They walk through the DSM-5 and ICD-11 definitional differences, the historical roots of the C-PTSD concept in Judith Herman’s work, and the real clinical distinctions clinicians can use to differentiate the two. More than a theoretical argument, the conversation zeroes in on how to communicate these diagnoses to patients, why BPD stigma drives some of the debate, and what therapies fit each presentation… from DBT and mentalization-based therapy to EMDR and trauma-focused approaches. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Bipolar diagnosis is tricky without labs, so this episode lays out a practical, semi-structured interview you can use in real clinics. We start with what many clinicians skip: a medication and substance timeline, plus medical causes, before jumping into mood symptoms. Then we map major depressive episodes, screen for hypomania with narrative follow-ups, and compare behavior to baseline instead of trusting yes/no answers. Along the way we cover classic pitfalls and mimics, including PTSD insomnia, borderline traits, psychosis-related agitation, and ADHD mislabeling. Finally, we talk about when tools like the MDQ or Rapid Mood Screener help, and why collateral history can change the case. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

What does “psychosis” actually mean, and how do clinicians recognize it in practice? In this episode, we define psychosis as a syndrome (not a single diagnosis) and walk through the core symptom domains: delusions, hallucinations, disorganized thinking/speech, disorganized behavior, and negative symptoms. We focus on the differential diagnosis, including how to distinguish schizophrenia-spectrum and schizoaffective disorders from mood disorders with psychotic features, trauma-related phenomena, borderline personality disorder, neurodevelopmental presentations (including autism spectrum traits), and substance-induced psychosis. We share red flags that can be easy to miss, like new-onset suspiciousness, functional decline, social withdrawal, and subtle thought disorganization, and we emphasize the value of collateral history and longitudinal follow-up. We close with treatment implications: when antipsychotics are helpful, why risks and benefits need to be individualized, and when psychotherapy and supportive interventions are the better first move. Educational disclaimer: This episode is for educational purposes only and is not medical advice. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Today we tackle a nerve-wracking topic for many clinicians: psychiatric disability assessments and paperwork. We break down everything from FMLA leave and short-term disability to Social Security benefits, explaining how to evaluate mental health impairments and fill out disability forms ethically. They discuss how to handle patient requests for time off work, balance treatment with recovery, and even touch on ADA accommodations like emotional support animals. Without the jargon, they share tips to avoid pitfalls and personal biases, helping you feel more confident in this tricky area. It’s a practical guide to navigating the gray areas of disability claims in mental health care. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Dr. Catherine Eubanks, PhD joins us to unpack the therapeutic alliance in everyday practice: how to spot withdrawal and confrontation ruptures, why Bordin’s goals–tasks–bond still predicts outcomes, and how metacommunication jump starts repair. We translate research into concrete moves you can use in brief psychiatric visits, psychotherapy, and supervision. We discuss telehealth, boundaries, and measuring ruptures with the 3RS system. Clinicians, trainees, and curious listeners will leave with a clearer lens and usable language for repair that strengthens trust and improves care across settings.Upcoming WorkshopAlliance Rupture Repair with Dr. J. Christopher Muran & Dr. Catherine EubanksWhen: Thursday, November 13 (1:00–4:00 PM EST)Where: Virtual via ZoomCost: $60 CE | $50 General | Students 50% off (code: STU)CEs: APA for psychologists; NYSED for LCAT, LCSW, and clinical psychologistsDescription:A 3-hour transtheoretical workshop on recognizing and repairing alliance ruptures. Includes didactics, video analysis, and skills training to improve repair strategies and strengthen therapeutic effectiveness.Register: https://www.eventbrite.com/e/alliance-rupture-repair-3-ces-tickets-1797546502979?aff=oddtdtcreatorRecommended Books & VideosTherapist Performance Under Pressure: Negotiating Emotion, Difference, and Ruptureby Catherine Eubanks & J. Christopher Muranhttps://www.apa.org/pubs/books/therapist-performance-under-pressureRupture and Repair in Psychotherapy: A Critical Process for Changeedited by J. Christopher Muran, Catherine Eubanks, & Lisa Wallner Samstaghttps://www.apa.org/pubs/books/rupture-repair-psychotherapyVideo: Rupture and Repair in Psychotherapyhttps://www.apa.org/pubs/videos/rupture-repair-psychotherapyAlliance-Focused Training: An Evidence-Based Guide to Negotiating Ruptures in Therapyby J. Christopher Muran, Catherine Eubanks, Lisa Wallner Samstag, & James Macdonaldhttps://www.apa.org/pubs/books/alliance-focused-trainingaVideo: Using Alliance-Focused Traininghttps://www.apa.org/pubs/videos/using-alliance-focused-training This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Is psychoanalysis still relevant in modern psychiatry and medication management? We unpack psychodynamic therapy, DSM-5 personality disorders, object relations, ego psychology, splitting, projective identification, attachment theory, and how solid psychiatric formulation improves outcomes in even medication management. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

In this episode we break down how to run a focused, humane, and evidence informed psychiatric intake. We start with setting the frame and role clarity, then show how to use a free narrative to map life course symptoms before moving into targeted history, DSM-5 criteria, and the mental status exam. Along the way we tackle common requests for ADHD or autism evaluations, the risks of checklist thinking, and when to pivot to structured tools. We close with communicating impressions, treatment planning, and next steps. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

In this episode, we examine the complex phenomenon of erotic transference in psychiatric care and the critical role of maintaining ethical boundaries. Using the therapeutic frame as our guide, we unpack how patients may develop romantic or sexual feelings toward their psychiatrist… especially during medication management… and why strong boundaries and reality testing are essential to safeguard the treatment process. Drawing on clinical experience and ethical principles, this episode offers clinicians strategies for addressing counter-transference, reinforcing the therapeutic alliance, and knowing when referral or supervision is necessary to protect both patient welfare and professional integrity. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

In the pilot episode of You Tell Me, the hosts dive into the controversial question: “What’s the harm in more widespread stimulant use?” They explore Silicon Valley’s productivity culture, stimulant risks, and the ethical dilemma of turning psychiatry into a tool for optimization. From there, the conversation shifts into a lighter segment on the stereotypes of medical specialties. The episode ends with a candid discussion on trauma, codependency, and why inpatient psychiatry often misses the mark.This off-the-cuff episode blends unfiltered opinions with occasional psychiatric insights… approachable for clinicians, medical students, or anyone curious about the culture of modern psychiatry. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com