Psychofarm Podcast

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

Many adults who struggle with concentration, disorganization, or procrastination wonder if they have ADHD. But when is it ADHD, and how can you suss this out? In this episode, two psychiatrists explore a nuanced case of possible ADHD to demonstrate why diagnosis isn’t always straightforward. They discuss how personal history, childhood environment, mood swings, and even personality traits can all cloud the clinical picture. Listeners will learn how a comprehensive evaluation is done, what other conditions can mimic ADHD, and which practical strategies (like structured routines or therapy) can help improve focus. We emphasize careful assessment and a holistic approach to treating attention difficulties. 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 Workshop Alliance Rupture Repair with Dr. J. Christopher Muran & Dr. Catherine Eubanks When: Thursday, November 13 (1:00–4:00 PM EST) Where: Virtual via Zoom Cost: $60 CE | $50 General | Students 50% off (code: STU) CEs: APA for psychologists; NYSED for LCAT, LCSW, and clinical psychologists Description: 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=oddtdtcreator Recommended Books & Videos Therapist Performance Under Pressure: Negotiating Emotion, Difference, and Rupture by Catherine Eubanks & J. Christopher Muran https://www.apa.org/pubs/books/therapist-performance-under-pressure Rupture and Repair in Psychotherapy: A Critical Process for Change edited by J. Christopher Muran, Catherine Eubanks, & Lisa Wallner Samstag https://www.apa.org/pubs/books/rupture-repair-psychotherapy Video: Rupture and Repair in Psychotherapy https://www.apa.org/pubs/videos/rupture-repair-psychotherapy Alliance-Focused Training: An Evidence-Based Guide to Negotiating Ruptures in Therapy by J. Christopher Muran, Catherine Eubanks, Lisa Wallner Samstag, & James Macdonald https://www.apa.org/pubs/books/alliance-focused-traininga Video: Using Alliance-Focused Training https://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

Why does it feel like everyone thinks they have ADHD lately? In this episode, two psychiatrists discuss the differential of ADHD. They explore how social media trends (like viral TikTok videos) are fueling ADHD self-diagnosis, and they emphasize the importance of careful evaluation. You’ll learn how to think through whether it’s ADHD vs. look-alike conditions such as depression, anxiety, trauma, OCD, sleep deprivation, or even just chronic stress and burnout. The doctors also talk about the burnout mental health providers are facing with so many people seeking ADHD meds, and they share their balanced approach to diagnosing and treating attention issues in an evidence-based way. 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 dive into the complexities of the therapeutic alliance and the real challenges psychiatrists face in everyday practice. From patients insisting on ADHD diagnoses and stimulant prescriptions to those requesting Xanax, disability paperwork, or resisting involuntary admission, we role play common clinical encounters and discuss practical strategies for navigating them. Drawing on concepts like collaboration and alliance, we highlight tools for psychiatrists, therapists, and clinicians to manage difficult conversations without burning out. 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

Boundaries aren’t just rules in psychiatry… they’re part of the treatment itself. In this episode, we explore therapeutic ruptures, transference and countertransference, and how clear treatment frames protect patients, clinicians, and the therapeutic process. From handling “doorknob comments” to navigating burnout, we highlight the practical ways psychiatrists and therapists can use boundaries to strengthen care and reduce resentment. 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 this fast‑paced Psychopharm podcast, we break down the OCD medication algorithm for obsessive compulsive disorder. You will hear about pushing SSRI doses, switching to Luvox or clomipramine, adding low‑dose antipsychotics, and glutamate modulators such as N‑acetylcysteine and ondansetron. The conversation also demystifies BrainsWay H7 deep TMS, explains realistic expectations for symptom reduction, and stresses that exposure response prevention remains the centerpiece of care. Helpful for psychiatrists, NPs and trainees who want clinical pearls without the fluff. NAC: https://drive.google.com/file/d/1b7ZBeFDKAAwLhfzUo0Jv58jEL7B70l5r/view 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

Join us in this podcast episode focused on Obsessive Compulsive Disorder, where we explore the DSM‑5 criteria, differentiate OCD vs generalized anxiety, and discuss the neurobiological roots of compulsive behavior. We cover practical guidance on exposure response prevention (ERP), using the Yale‑Brown Obsessive Compulsive Scale as a screener, and outline medication strategies like high‑dose SSRIs to support psychological treatment. Ideal for clinicians and anyone seeking to understand or treat OCD effectively. 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

We unpack the anxiety medication algorithm, moving from first-line SSRI picks like Sertraline and Escitalopram to augmentation with buspirone, gabapentin and lavender. CBT, mindfulness and evidence-based psychopharmacology weave throughout the podcast, so clinicians prescribe appropriately and with the right psychoeducation. 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 explore anxiety not as a disease in itself, but as a critical signal from your mind and body. We discuss how this signal can point to deeper issues like hidden emotions or relational trauma, and why common diagnoses like GAD (Generalized Anxiety Disorder) often miss the true source of the problem. We also cover the fundamental brain science of fear, the key differences between anxiety, panic, and worry, and introduce five different treatment models designed to help you find and resolve the root cause. 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

This episode looks at the practical assessment of personality. We explore the nuances of psychiatric diagnosis, moving beyond simplistic heuristics with a focus on the DSM-5's Alternative Model for Personality Disorders. Learn about assessing self-functioning (identity, self-direction) and interpersonal functioning, using clinical interviewing, psychosocial history, and even your countertransference as vital tools for a more comprehensive understanding of personality pathology in busy clinical settings. 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

This episode delves into Good Psychiatric Management (GPM), a practical framework developed by John Gunderson for treating Borderline Personality Disorder (BPD), though its principles offer broad utility across diagnoses. The hosts discuss the importance of integration, managing expectations (both patient and provider), and robust psychoeducation regarding BPD's features, heritability, and treatment course. Key GPM tenets are explored, including focusing on life outside therapy (work/relationships), the adjunctive role of medication, fostering accountability, and the significance of the therapeutic relationship itself as part of the treatment. 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

Dive deep into the practicalities of psychiatric medication management for PTSD in this clinical discussion. We explore the often limited evidence base and the necessity of off-label prescribing, focusing on strategies for stabilization, safety, and trust… the first stage of trauma treatment. Learn about experience-based approaches using SSRIs like sertraline, sleep aids such as trazodone and gabapentin, the cautious use of antipsychotics, and why benzodiazepines are discouraged. The conversation also touches on managing sleep disturbances and dissociation, situating medication as a supportive tool alongside essential psychotherapy and lifestyle changes, guided by principles like Pierre Janet's three-stage model. 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

Join us for an in-depth exploration of trauma and Post-Traumatic Stress Disorder (PTSD). This episode moves beyond common language to establish a clinical definition of trauma, detailing the DSM-5 criteria required for a PTSD diagnosis. The hosts break down the core PTSD symptom clusters – intrusion, avoidance, negative alterations in cognitions/mood, and arousal/reactivity – providing clear examples like flashbacks, hypervigilance, and negative self-beliefs. They delve into the concept of dissociation, its role in trauma, and the challenges it presents in assessment. Listeners will gain crucial insights into the diagnostic process, common misdiagnoses (like mistaking PTSD for depression), the vital importance of earning therapeutic trust, and effective interviewing techniques for sensitive topics, ultimately highlighting why accurate identification is key to recovery. 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

This conversation explores key aspects of forensic psychiatry, including the insanity defense, dissimulating patients, and how clinical practice intersects with legal systems. It highlights the importance of open-ended dialogue, nuanced diagnosis, and maintaining empathy without succumbing to cynicism. 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

Join us in a conversation about involuntary commitment, and the legal framework behind psychiatric treatment. We discuss real-world scenarios, share insights into how clinicians juggle patient autonomy versus societal protection. Whether you are new to the field or a seasoned professional, this episode offers valuable perspectives on balancing ethical duties, legal obligations, and patient 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

In this episode, we sit down with Dr. Chris Aiken to look at a big question: when do we treat an underlying deficit in psychiatric illness? Focusing on difficult-to-treat depression, our conversation delves into the deficit model and looks at different paradigms, from neuroprotective strategies and lifestyle interventions to the nuanced use of medications like SSRIs, lithium, and thyroid hormones, as well as targeted supplements. Tune in for a thought-provoking discussion that looks at when we approach treating depression by focusing on its underlying causes. http://www.carlatreport.com https://chrisaikenmd.com/partners/ https://chrisaikenmd.com/supplements 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

Schizophrenia treatment is complex, and choosing the right antipsychotic can make all the difference. In this episode, we take a deep dive into schizophrenia medications... breaking down the pros and cons of different antipsychotics, metabolic risks, sedation issues, and the challenges of adherence. We discuss how to tailor treatment to individual patients, avoid unnecessary side effects, and improve long-term outcomes. Whether you're a clinician prescribing antipsychotics or someone looking to understand schizophrenia medications better, this discussion offers practical insights and evidence-based strategies for optimizing treatment. 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 is the future of psychiatric treatment? In this episode we explore groundbreaking innovations in neuromodulation, AI driven diagnostics, and the evolving business of mental healthcare. Dr Owen Muir discusses why business and policy are as crucial as clinical advancements in ensuring that cutting edge treatments like accelerated TMS, noninvasive vagus nerve stimulation, and AI assisted tardive dyskinesia detection actually reach patients. From reshaping psychiatric training to rethinking what it means to cure mental illness, this conversation challenges how we view progress in psychiatry. Tune in to discover how technology, policy, and medical practice are converging to transform the field. 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

Medications and therapy are the foundation of mental health treatment, but what else can you do to improve your well-being? In this episode, we explore the essential lifestyle changes that can make a profound impact on mental health. From exercise and behavioral activation to socialization, sleep, and mindfulness, we break down practical, evidence-based strategies that go beyond prescriptions. We also discuss how avoiding substances and engaging with the right self-help resources can support long-term recovery. Whether you're a clinician, a patient, or just someone looking to optimize mental well-being, this episode offers actionable insights to help build a sustainable, holistic approach to mental health. Tune in for a deep dive into the three pillars of treatment and why lifestyle changes are just as crucial as medications and therapy. 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 engaging episode, Dr. Owen Muir dives into the science and practice of Transcranial Magnetic Stimulation (TMS), exploring its transformative role in modern psychiatry. The conversation begins with a historical look at how TMS emerged from groundbreaking research in the 1980s, evolving into an FDA-approved, noninvasive treatment for mental health disorders such as treatment-resistant depression, OCD, and bipolar disorder. Listeners are taken on a journey through the mechanics of TMS, from precise brain mapping and neural synchronization to the innovative use of accelerated TMS protocols that offer rapid symptom relief. Dr. Owen Muir unpacks how TMS harnesses magnetic fields to stimulate neural circuits, effectively “resetting” brain rhythms and boosting neuroplasticity. They discuss real-world clinical applications, sharing insights on how tailored coil positioning and stimulation patterns can lead to significant improvements in mood regulation and cognitive function. The podcast also addresses practical challenges, including optimizing treatment intervals, insurance hurdles, and the future of neuromodulation in psychiatry. Whether you’re a clinician looking to stay up to speed on the latest in TMS research or a patient exploring nonpharmacological options for mental health care, this episode provides a comprehensive and accessible overview of TMS technology and its promising impact on mental health treatment. Join us as we decode the complexities of TMS and reveal how this innovative therapy is reshaping the landscape of 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