The Carlat Psychiatry Podcast

Latest Episodes:

Treating Couples: Integrative Behavioral Couple Therapy — Balancing Acceptance and Change Andrew Christensen, PhD Oct 19, 2026

Show notes

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, 2026

Duration: 44 mins 19 seconds

Learning Objectives

After 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

How Much Do SSRIs Really Help Kids with OCD? Oct 12, 2026

Show notes

Parents often come into treatment hoping an SSRI will make their child's OCD disappear. But how much relief do these medications actually provide? Today, we look at a large meta-analysis that gives us a more realistic picture of what SSRIs can and can't do for pediatric OCD.

CME: Take the CME Post-Test for this Episode

Published On: 10/12/2026

Duration: 14 minutes, 12 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.

Treating BPD Series, Episode 4: Mentalization-Based Treatment—From Reacting to Reflecting with Carla Sharp, PhD Oct 05, 2026

Show notes

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 Objectives

After 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 Interview

What mentalizing is and its role in psychological functioning
How mentalizing develops throgh early “serve-and-return” interactions
Mentalizing difficulties in borderline personality disorder
Strengthening mentalizing as the core treatment target of MBT
What an MBT session looks like in practice
Experience-near exploration and the mentalizing loop
Empathic validation and managing emotional arousal
Affect elaboration and working with underlying emotional experience
Mentalizing relationships with others and with oneself
How patients and therapists determine the focus of an MBT session
The three pre-mentalizing modes: psychic equivalence, teleological mode, and pretend mode
Recognizing when mentalizing has gone offline
The therapist’s use of self in MBT
The mentalizing stance: curiosity, uncertainty, and “not knowing”
Recognizing progress and the generalization of mentalizing outside therapy

ADHD Undone: The Corporate Practice of Medicine Sep 28, 2026

Show notes

Prescribing stimulants outside of ADHD is not illegal, but what Done did sent the clinical leader to jail. We look at what went wrong and what the charges were, and end with a research update that improves access to psychiatric care the honest way.

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Published On: 09/28/2026

Duration: 15 minutes, 25 seconds

Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

ADHD Undone: The Stimulant Conspiracy Sep 21, 2026

Show notes

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 Episode

Published On: 09/21/2026

Duration: 26 minutes, 00 seconds

Chris 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.

ADHD Undone: A Telehealth Tale Sep 14, 2026

Show notes

A Silicon Valley founder built a telehealth company to make ADHD treatment as easy as ordering takeout, until federal prosecutors traced 37 million pills of Adderall back to the clinic. We follow Done from venture-backed startup to criminal conviction, and ask what the case means for how we diagnose and treats ADHD. Plus: a new FDA approval adds a third option to the ADHD reuptake-inhibitor family.

CME: Take the CME Post-Test for this Episode

Published On: 09/14/2026

Duration: 13 minutes, 34 seconds

Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Medication or Therapy? A Clinical Framework for Substance Use Disorders Sep 07, 2026

Show notes

Today, we’re tackling a deceptively simple question that comes up all the time in clinical practice: When should we prioritize medication, when should we emphasize psychotherapy, and when can we recommend both? This question comes up especially often with patients who are new to treatment. They’ll ask, “Do I need a medication?” or “Can I just do therapy?” And while it’s tempting to answer in generalities, the evidence actually gives us much clearer guidelines, depending on the substance that the patient is using.

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Published On: 09/07/2026

Duration: 10 minutes, 57 seconds

Noah Capurso, MD, and Suzanne Decker, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

CBT-I: The First-Line Treatment for Chronic Insomnia with Dr. Donn Posner (Part 2 of 2) Aug 31, 2026

Show notes

Dr. Donn Posner is a leading expert in Cognitive Behavioral Therapy for Insomnia (CBT-I), founder and president of Sleepwell Consultants, and an adjunct clinical associate professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. He is co-author of Cognitive Behavioral Therapy for Insomnia: A Session-by-Session Guide, and he has trained and consulted with clinicians nationally and internationally across nearly four decades of clinical practice.

In this second of two episodes, the conversation turns from what CBT-I is to how clinicians actually learn and deliver it. Dr. Posner reviews the available training pathways and what proficiency really requires, and explains why sleep hygiene — the advice most patients have already heard many times over — does not treat chronic insomnia, even though it has a place later in the work. He identifies the high-yield principles any clinician can apply immediately, including a fixed morning wake time, early light exposure, and getting out of bed when not sleeping. He then examines sleep effort as a perpetuating factor and CBT-I as fundamentally a therapy of acceptance, describing how he prepares patients for a treatment that will make them feel worse before it makes them better, and how cognitive work addresses the fear and resistance that follow. He closes with what clinicians should expect from a course of treatment — typical length and spacing, responder and remitter outcomes, and the durability of gains — along with how he handles sleep medication and why guidelines place CBT-I ahead of hypnotics.

Learning Objectives

After completing this educational activity, participants should be able to:

Explain why sleep hygiene is ineffective as a monotherapy for chronic insomnia, and describe the more limited role it plays within a full course of CBT-I.
Identify high-yield behavioral sleep medicine principles — including a fixed morning wake time, early light exposure, and getting out of bed when not sleeping — that clinicians can apply before completing formal CBT-I training.
Describe sleep effort as a perpetuating factor, and summarize how the cognitive and acceptance-based components of CBT-I address the dysfunctional beliefs and resistance that arise during treatment.
Summarize the expected course and outcomes of CBT-I (including typical session number and spacing, responder and remitter outcomes, and durability of gains) and explain why guidelines position CBT-I ahead of hypnotic medication.

Topics Covered in This Interview

Pathways to training in CBT-I and behavioral sleep medicine
Board certification in behavioral sleep medicine
Why sleep hygiene alone does not treat chronic insomnia: the dental hygiene analogy
Where sleep hygiene does belong within CBT-I
Available CBT-I training programs and online options
How clinicians become proficient: consultation, community, and case experience
High-yield behavioral sleep principles any clinician can apply
Sleep regularity, fixed wake times, and morning light exposure
Why getting out of bed is the hardest intervention for patients to accept
Sleep effort as a perpetuating factor
What good sleepers do — and do not do — to fall asleep
CBT-I as a therapy of acceptance
Preparing patients for the work: “I'm going to make you worse before I make you better”
The cognitive component: uncovering and debunking dysfunctional beliefs
Common patterns of resistance, and exposure as the remedy
Typical treatment length, session spacing, and pacing
Responders versus remitters, and what the outcome data show
Durability of gains and the role of sleep self-efficacy
Managing and tapering sleep medication alongside CBT-I
Why guidelines position CBT-I ahead of hypnotic medication

CBT-I: The First-Line Treatment for Chronic Insomnia with Dr. Donn Posner (Part 1 of 2) Aug 24, 2026

Show notes

Dr. Donn Posner is one of the most active educators in CBT-I. He's founder and president of Sleepwell Consultants, adjunct clinical associate professor in Psychiatry and Behavioral Sciences at Stanford, and spent twenty-five years before that as director of behavioral sleep medicine at the Sleep Disorders Center of Lifespan Hospitals.

In this first of two episodes, Dr. Posner explains that chronic insomnia is a disorder in its own right — not just a symptom of something else — driven by perpetuating factors that become the targets of treatment. He covers:

How insomnia disorder is defined, and what a proper CBT-I assessment looks like
The sleep diary as the clinician's version of an X-ray
The two core behavioral components — sleep restriction (more accurately, time-in-bed restriction) and stimulus control — and the mechanisms each one targets: homeostatic sleep drive and conditioned arousal
Why sleep can't be willed — it's never under a patient's voluntary control
How far the protocol can flex for individual patients
The evidence base showing CBT-I works even alongside depression, anxiety, PTSD, or chronic pain — and that those conditions don't need to be treated first

Length: 28 Minutes

Adult ADHD 4: Other Causes Aug 17, 2026

Show notes

How to separate adult ADHD from other causes of cognitive problems like bipolar disorder, sleep apnea, medication effects, brain injury, temperament, and malingering.

CME: Take the CME Post-Test for this Episode

Published On: 08/17/2026

Duration: 15 minutes, 35 seconds

Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

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