The Carlat Psychiatry Podcast

Dr. Andrew Christensen, distinguished research professor of psychology at UCLA and co-developer of Integrative Behavioral Couple Therapy (IBCT), explains how IBCT balances acceptance and change in treating relationship distress. He walks clinicians through the assessment and feedback process and the DEEP formulation, describes the three core interventions—empathic joining, unified detachment, and practical problem-solving—and discusses treatment length, termination, and training resources.Published On: October 19, 2026Duration: 44 mins 19 secondsLearning ObjectivesAfter completing this educational activity, participants should be able to:· Describe the core principles of Integrative Behavioral Couple Therapy and explain how acceptance-focused and change-focused interventions are integrated in treating relationship distress.· Distinguish rule-governed change from contingency-shaped change and explain how in-session emotional experiences can facilitate more constructive couple interactions.· Identify the components of the IBCT DEEP formulation—differences, emotional sensitivities, external circumstances, and patterns of interaction—and describe their role in assessment and treatment planning.· Describe how empathic joining, unified detachment, and practical discussions are used to help couples address emotionally significant conflicts more constructively.Topics Covered in This Interview· The distinctive challenges and advantages of conjoint couple therapy· How IBCT developed from traditional behavioral couple therapy· Integrating acceptance and change in relationship treatment· Why behavioral assignments and communication skills may not produce enduring change· How partners’ differences can be sources of both attraction and conflict· Rule-governed behavior versus contingency-shaped change· Facilitating spontaneous change through emotionally meaningful in-session interactions· How therapists decide when to emphasize acceptance or direct change· The IBCT assessment sequence: conjoint interview, individual sessions, and feedback· Assessing intimate partner violence, commitment, and competing relationships· The DEEP formulation: differences, emotional sensitivities, external circumstances, and patterns of interaction· Identifying recurring conflict cycles and developing a shared, less blame-focused understanding· Collaboratively setting the agenda for active treatment sessions· Empathic joining and the development of compassionate conversations· Unified detachment and examining patterns of conflict together· Practical discussions and preparing for challenging situations· Experiential learning versus direct instruction in couple therapy· Treatment duration, outcomes, termination, and follow-up sessions· IBCT training opportunities and the OurRelationship online program

Dr. Carla Sharp is a leading expert in Mentalization-Based Treatment (MBT), developmental psychopathology, and the treatment of personality disorders. She is the John and Rebecca Moores Professor of Clinical Psychology at the University of Houston, where she serves as Associate Dean for Faculty and Research and directs the Developmental Psychopathology Lab and the Adolescent Diagnosis, Assessment, Prevention, and Treatment Center. A prolific scholar with more than 380 peer-reviewed publications and eight books, she has made substantial contributions to the development and dissemination of mentalization-based approaches and is a certified supervisor and licensed trainer in MBT for both adults and adolescents. In this episode, Dr. Sharp offers a comprehensive introduction to MBT as a treatment for BPD — from what mentalizing is and how it develops through early “serve-and-return” interactions, to how disruptions in this capacity contribute to the difficulties characteristic of BPD. She takes clinicians inside an MBT session, explaining experience-near exploration, empathic validation, affect elaboration, and the mentalizing loop. She also unpacks the three pre-mentalizing modes — psychic equivalence, teleological mode, and pretend mode — and discusses the therapist’s use of self, the importance of maintaining a curious “not-knowing” stance, and how clinicians can recognize when a patient’s capacity to mentalize is strengthening.Learning ObjectivesAfter completing this educational activity, participants should be able to:Define mentalizing and explain how disruptions in its development and functioning contribute to borderline personality disorder.Describe how MBT uses experience-near exploration, empathic validation, and the mentalizing loop to strengthen a patient’s capacity to reflect on the mental states of self and others.Identify the three pre-mentalizing modes — psychic equivalence, teleological mode, and pretend mode — and recognize when mentalizing has broken down in a clinical interaction.Apply the MBT mentalizing stance, including curiosity, uncertainty, and therapist use of self, to support reflective functioning in patients with borderline personality disorder.Topics Covered in This InterviewWhat mentalizing is and its role in psychological functioningHow mentalizing develops throgh early “serve-and-return” interactionsMentalizing difficulties in borderline personality disorderStrengthening mentalizing as the core treatment target of MBTWhat an MBT session looks like in practiceExperience-near exploration and the mentalizing loopEmpathic validation and managing emotional arousalAffect elaboration and working with underlying emotional experienceMentalizing relationships with others and with oneselfHow patients and therapists determine the focus of an MBT sessionThe three pre-mentalizing modes: psychic equivalence, teleological mode, and pretend modeRecognizing when mentalizing has gone offlineThe therapist’s use of self in MBTThe mentalizing stance: curiosity, uncertainty, and “not knowing”Recognizing progress and the generalization of mentalizing outside therapy

Done paid clinicians by the refill, not the visit. We trace how a telehealth company built its business model around stimulant prescriptions. Along the way you’ll learn why amphetamines are the #1 stimulant in America, but rarely used outside the US.Plus: a research update on tapering and switching sleep medication.CME: Take the CME Post-Test for this EpisodePublished On: 09/21/2026Duration: 26 minutes, 00 secondsChris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.This activity includes brief excerpts from interviews conducted by the faculty member with informants. The interviewees provided historical information and/or commentary as source material only. They did not participate in planning, developing, reviewing, editing, or approving the educational content of this CME activity and have no role in controlling its content. The faculty member independently selected, contextualized, and incorporated the interview excerpts into the presentation.

Premenstrual hormones can destabilize mood, worsen ADHD, trigger psychosis, and drive binge eating. This episode walks through the tools to manage hormonal fluctuations in female patients, from SSRIs to overlooked supplements to the lamotrigine-contraceptive drug interaction.CME: Take the CME Post-Test for this EpisodePublished On: 06/23/2026Duration: 23 minutes, 32 secondsChris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Psilocybin is going mainstream: Trump has signed an executive order opening psychedelics to patients with severe mental illness, and one in eight American adults has already tried it. But as we dig into the research, a more complicated picture emerges, one that separates the profound personal experience from the clinical evidence.CME: Take the CME Post-Test for this EpisodePublished On: 06/15/2026Duration: 18 minutes, 34 secondsChris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

What if the patients we assume are safest from suicide are actually the ones we miss? Today we're talking about suicide risk in autistic youth, why it's higher than many clinicians expect, how distress shows up differently, and what small changes in our assessment process and treatment can make a real difference.CME: Take the CME Post-Test for this Episode Published On: 06/01/2026Duration: 18 minutes, 29 seconds Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

In 1966, Johns Hopkins opened the first gender surgery clinic in the US. Thirteen years later, a single study shut it down. We examine what the research said, what it didn't say, and how new standards of care emerged from the ashes.CME: Take the CME Post-Test for this EpisodePublished On: 05/18/2026Duration: 13 minutes, 39 secondsChris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Medical societies are reversing decades of support for gender-affirming care in youth — but is it the science driving the shift, or the politics? This episode walks through the evidence, from randomized trials to regret rates, and finds a more complicated picture than either side presents.CME: Take the CME Post-Test for this EpisodePublished On: 05/04/2026Duration: 13 minutes, 09 secondsChris Aiken, MD, and Kellie Newsome, PMHNP, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.