With so many developments in the field of psychotherapy, so many integrations, innovations, and shifts from evidence-based to common factors, its hard to keep up! Therapy On the Cutting Edge is a podcast with hour long interviews of clinicians that are creating, innovating, researching, developing, and perfecting treatments for clients.
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Cutting Ties with Your Parents: Healing and Boundaries
Episode 85
Monday, July 20, 2026 ⢠Duration 54:22
In this episode, I speak with Sharon Martin, LCSW, about her clinical work with adults navigating family estrangement and the complex process of deciding whether to limit or cut off contact with parents. Sharon, a psychotherapist with over 25 years of experience, specializes in working with adult children of alcoholics and individuals from dysfunctional family systems. Her work focuses on helping clients process the long term effects of developmental trauma and build healthier, more authentic lives. Sharon explains that many individuals seeking therapy may initially present with concerns such as anxiety, depression, or relationship difficulties, only to discover underlying patterns rooted in early family dynamics. These experiences often include chronic shame, hypervigilance, perfectionism, and a reliance on external validation, factors that can make navigating family relationships particularly challenging in adulthood. A central focus of the conversation is the decision-making process around estrangement. Sharon emphasizes that, contrary to common portrayals, estrangement is rarely a single, definitive event. Instead, it often involves cycles of limited contact, attempts at repair, and periods of withdrawal, as individuals grapple with both the desire for connection and the need for self protection. She highlights the emotional complexity of this process and the importance of allowing clients to determine what level of contact feels appropriate for them. We also discuss the role of boundaries, including how individuals can begin to define what constitutes a healthy relationship, often for the first time. Sharon discusses the importance of recognizing and naming harmful or abusive patterns, while also addressing the internalized beliefs that can make it difficult for individuals to prioritize their own needs. Building self trust, self worth, and a clearer sense of identity are key components of this work. The conversation further examines broader systemic and cultural influences, including family expectations, caregiving roles, financial dependence, and cultural norms around filial responsibility. Sharon acknowledges the additional layers of guilt and pressure that can arise in collectivist contexts or when aging parents require care, and she encourages a more flexible, individualized approach to navigating these responsibilities. Sharon also shares insights from her book, Cutting Ties with Your Parents, which is designed to support individuals who are considering or have already made the decision to distance themselves from their families. The book outlines a three part process: making peace with the decision, healing from both developmental trauma and estrangement related wounds, and moving forward by cultivating healthy relationships and a more authentic sense of self. Finally, we discuss important considerations for clinicians working with this population. Sharon highlights the lack of formal training in this area and underscores the importance of therapists examining their own biases, particularly the tendency to prioritize reconciliation. She emphasizes the need to support client autonomy, respect the pace of the decision making process, and create a space that is validating rather than prescriptive.
Sharon Martin, DSW, LCSW, is a licensed psychotherapist, writer, and speaker with over 25 years of clinical experience. She specializes in working with adult children of alcoholics and individuals from dysfunctional family systems, helping them heal from developmental trauma and build healthier relationships. Sharon is the author of Cutting Ties with Your Parents, a therapeutic guide designed to support adults navigating family estrangement. Her work integrates a range of approaches, including cognitive behavioral therapy, family systems theory, and trauma informed care, with an emphasis on self compassion and empowerment.
Working with Couples and Addiction Through the Lens of Attachment in Emotionally Focused Couples Therapy
Episode 84
Monday, June 29, 2026 ⢠Duration 46:47
In this episode, Kara speaks about her work with couples who are struggling with addiction. She discussed obtaining a family systems training in a couples and family clinic in Montreal, and then moving to an outpatient clinic in Vancouver for individualâs struggling with addiction. She explained that many of the clients wanted to bring in their partner and/or family members, so she turned to the research to learn about treatment with couples with addiction. She found that most of the research was on a behavioral approaches, but not on the approach she was using, Emotionally Focused Couples Therapy, until she came upon a theoretical extension that had been proposed using EFT. She decided to go back to school and get her PhD, and do research on the use of EFT with couples in the context of substance use and addictions. She shared that colleagues expressed concerned about whether it was ethical to work with couples and addiction, and she explained that this perspective often coming from behavioral models of addiction, rather than looking at attention through the lens of attachment. She discussed how people donât set out to become addicted, but usually use substances to manage suffering or pain, and by strengthening the attachment relationship, it can lessen the dependence on the substance. Through her research, she found that there needs to be some level of stability around the substance use for the couples work to make sense because the individual(s) need to be functioning to engage in couples work. There also needs to be some core connection that is worth working on, which through the work, can lessen the distress and even the hyperfocus on the addiction. She explained that all of the couples she worked with in the study were in early recovery. She shared that when there was a partner who wasnât addicted, they were often having an inner conflict, having been told to not be codependent, to detach, but at the same time to love their partner, seeing them as more than an addiction. She discussed how Sue Johnson, Ph.D. discussed dependency, and how we have to have "effective dependence" in relationship, rather than dependence being synonymous with codependency. Learning how to depend on another in a healthy way, that is functional rather than having someone else take over for you. She shared that starting with the relationship, and helping that be solid, can then even be a resource for the person to go off and take steps in their individual life. She shared the common pattern is that the person in recovery is the withdrawer and the partner not having addiction, often being in the pursuer position. She shared that the EFT approach is helpful in understanding that cycle, and helping the partner to turn to the other, when feeling like turning towards substance use, and the partner can be there, without becoming fearful of their partnerâs struggling. Often the withdrawn partner doesnât share this, for fear the partner will freak out, or become hyper vigilant. She explained that partners who are in recovery should have lots of different tools and supports, in addition to the relationship, while having the relationship be a safe haven for them to turn for support. We discuss working with clients with active addiction and working with them when they maybe didnât come in due to substances, but not turning them away as theyâre seeking help. She explained that when coming to therapy, often the therapist assumes the addiction is the problem, although the couple may be wanting to work on other additional issues, and couples have reported to her that other therapists have only focuses on the addiction, and it was not a good fit for what they were looking for. She discussed working with couples where abstinence is the goal as well as working with couples using a harm reduction model. Lastly, Kara discusses her current research with couples where one partner has started adopting conspiracy theories or misinformation and therapy options that help couples.
Kara Fletcher, PhD, MSW, RSW is the Director of the Social Work Research Centre at the University of Regina and an Associate Professor at the University of Regina Faculty of Social Work, Saskatoon Campus. She is also a trained AAMFT couple and family therapist. Her program of research seeks to better understand the impact of mental wellness, substance use and trauma on couple, family, and community well-being. Her current research is considering the impact of conspiracy theories, misinformation, and political polarization on intimate relationships. Kara recently published "Integrative Approaches to Couple and Family Therapy in Canada: A Beginnerâs Guideâ.
Helping Women on Their Journey Through the Five Phases of Divorce Grief
Episode 83
Monday, March 2, 2026 ⢠Duration 56:46
In this episode, Oona discusses how she went through her own divorce a number of years ago and found that there were not that many resources for women. After moving through her own divorce and becoming resettled, she started running groups for women going through divorce and has run numerous groups over the years. She shared that through working with many women, she began to find patterns and themes and wrote a book for women to help them as they make this transition in their life. She explained that the Kubler-Ross model of grief was helpful, but wasnât quite capturing the nuances of divorce. She described what she calls the five phases of divorce, which are Heartbreak, Roller Coaster, Mending, Letting Go and Moving On. In the Heartbreak phase, she explained that whether the person initiated the divorce or not, there is a great deal of pain and heartbreak and its a time for the therapist to be fully present with their client. The Roller Coaster phase features a mix of emotions with sadness, anger, fear, shame, and other emotions, and can be confusing since there may be conflicting emotions. For example, someone might feel a great deal of anger and maybe hate, but at the same time sadness and love. Helping clients to understand that this is a phase of the process of moving through divorce can help clients to understand that this will not last forever and to be patient with themselves, rather than rushing into another relationship or self medicating. The Mending phase is a time to turn toward the self instead of spending so much energy on the ex or the divorce. Mending includes a process of renegotiating boundaries, not only with the ex around what their interactions will be like or how they will coparent, but also their friends, family, and in laws. She explained that itâs a time for reevaluation and many people also begin to reevaluate their boundaries with others in their life. The fourth phase is Letting Go and is an important component of healing. When people divorce, they not only let go of their spouse, but also their identity of being a married person, as well as their identity of being part of an intact family. Lastly, in the Moving On phase, she explains that the person is shifting their focus away from the divorce and towards the future, whether that be in another relationship, their work, their children or a new venture. She explained that sometimes people can get stuck in a phase like the Roller Coaster phase, and it can be helpful to work with them in becoming unstuck. The process of the therapist figuring out whether this is part of the natural process or whether the client is stuck can be difficult to differentiate. We discuss getting legal consultation and Oona recommends against therapists referring to a specific lawyer because all divorces are different, but instead encouraging clients to do a lot of research to find what is the right fit for them. We also talked about co-parenting counseling and how itâs different than therapy where youâre not working on the relationship between the couple, but helping them work together for the best interest of the child. Oona shares how valuable the groups have been for her clients. Her book, Unhitched: The Essential Divorce Guide for Women just came out the week before the interview and is reflective of so many womenâs journeys through the process. She also said she is providing trainings for therapists to learn how to run the divorce support groups for women and is leading a two day long Institute at the American Group Psychotherapy Association Conference in NY in March for therapists experiencing divorce.
Oona Metz, LICSW is a Licensed Independent Clinical Social Worker, a Certified Group Psychotherapist, and a Fellow of the American Group Psychotherapy Association. She has 30 years of experience working with individuals, families, and groups. Her private practice offices are located in Brookline and Arlington, Massachusetts. She is active on numerous committees and boards related to group therapy and prioritizes ongoing learning in diversity, equity, and inclusion. Her practice is focused on treating the emotional aspects of divorce and group therapy, and she leads three weekly divorce support groups. She is the author of Unhitched: The Essential Divorce Guide for Women. You can learn more about her at her website oonametz.com
From Emotionally Sensitive to Overcontrolled Emotions, Using Dialectical Behavioral Therapy and Radically Open Dialectical Behavioral Therapy to Find Balance
Episode 82
Monday, February 23, 2026 ⢠Duration 54:47
In this episode, Alicia discusses her work with Dialectical Behavior Therapy and Radically Open DBT. She explains that she was first exposed to DBT in her predoctoral internship at Marin General Hospital, where part of the rotation was to run a DBT group and fell in love with its practicality and giving people real tools they could take away. She explained that it was great to see clients using the tools and finding success, so she got went and got trained with Marsha Linehan, Ph.D. and Behavioral Tech and made DBT her focus. She explained that DBT is especially helpful for clients who describe themselves as emotionally sensitive or struggle to âride the waveâ of emotions that feel overwhelming. Alicia discusses the five modules of DBT that she works from, including mindfulness, distress tolerance, affect regulation, interpersonal skills, and âwalking the middle path,â (which is related to validation and reinforcement in family emotional dynamics). Alicia goes on to explain the use of the modules in working towards emotional awareness, getting through emotional crises, and radical acceptance of emotions. We also discuss coping skills and exposure therapy and how there are tools to expand oneâs window of tolerance as well as self-soothing skills utilized to sit with oneâs emotions. We speak on what dialectics in DBT refer to: holding two truths at a time, as opposed to relying on rigid, black-and-white thinking, which can exacerbate feelings of distress and overwhelm. Alicia discusses Radical DBT, or Radically Open DBT, and how it is different from regular DBT as it expands radical openness, self-inquiry, and accepting imperfection in oneself in treating emotional OC (overcontrol) disorders such as Anorexia Nervosa, OCPD, and chronic depression. We discuss how RO DBT benefits clients who experience rigidity in their overcontrol as well as shame, anxiety, and hypervigilance in their daily life. Alicia discusses her website, Therahive, which provides DBT skills online for clients as well as training for therapists to make DBT accessible throughout the world. We discuss how important having a supportive community is for clinicians who are providing DBT and how DBTâs model includes a therapist consultation group. Lastly, we discuss phone coaching with clients and how it is utilized with clients who are struggling with self-harm and other behaviors and how therapists navigate personal boundaries around time with family and time off, while also being available for clients in need.
Alicia Smart, PsyD is a licensed clinical psychologist in California with over 20 years of clinical experience providing evidence-based mental health care to children, adolescents, adults, and families. She began seeing clients during graduate training and has worked across community mental health, medical, and private practice settings throughout her career. Alicia earned her B.A. in Psychology and Chemistry from New York University and her Doctorate in Clinical Psychology (PsyD) from the California Institute of Integral Studies. She is a DBT-Linehan Certified Clinician and has extensive experience treating mood and personality disorders, trauma, anxiety, grief, ADHD, autism-spectrum presentations, and chronic emotion dysregulation. Her work frequently integrates DBT into suicide risk management, neurodivergent-affirming care, and complex relational systems. She is the Founder and Clinical Director of Guidepost DBT in Corte Madera, California, where she oversees a team of therapists providing comprehensive Dialectical Behavior Therapy (DBT) and evidence-based care. In addition to clinical leadership, Alicia provides training, supervision, and consultation to clinicians seeking advanced education in DBT and related approaches. Alicia is also a co-founder of TheraHive, an innovative online DBT skills and learning platform designed to make high-quality DBT education more accessible to individuals and clinicians worldwide.
Why We Miss Girls with ADHD â and How Hormones Hold the Key
Episode 81
Monday, February 2, 2026 ⢠Duration 53:16
In this episode, Alecia explores the critical intersection of women's mental health, ADHD, and reproductive psychiatryâan area where science is only beginning to catch up with women's lived experiences. Alecia's journey into psychiatry began in Sacramento, California, where she witnessed profound disparities in healthcare access across diverse communities. After seeing loved ones struggle with both physical and mental illness, she pursued medicine with a mission. During medical school, she gravitated toward geriatric psychiatry, drawn to the complexity of caring for older adults. But during residency, her focus began to shift as she became fascinated by something even more fundamental: the intricate dialogue between mind and body. This growing interest led her to consultation-liaison psychiatry, formerly known as psychosomatic medicine, where she served as chief resident. The field gave her a lens to understand how physical illness shapes mental health and vice versaâa perspective that would profoundly inform her later work. She went on to complete a consultation-liaison psychiatry fellowship at the University of Chicago, followed by specialized training in reproductive psychiatry. Aleciaâs attention to health disparities guided her toward women's and minority mental health, populations that remain vastly underfunded and underresearched. In her clinical work, she began noticing a troubling pattern: many patients struggling financially, physically, and emotionally actually met criteria for ADHD, yet had never been properly identified or treated. These missed diagnoses often compounded existing challenges, leaving people to navigate life with an invisible burden they didn't understand. In our conversation, Alecia illuminates why girls with ADHD are so often overlooked. While boys typically display hyperactive, disruptive symptoms that demand attention, girls more commonly present with inattentivenessâdaydreaming, losing track of conversations, internal restlessnessâsymptoms easily misattributed to anxiety or depression. This diagnostic blind spot means girls are less likely to receive appropriate medication and more likely to struggle silently through years of self-blame. Alecia then guides us through the remarkable role hormones play in ADHD across the female lifespan. She explains how estrogen acts as a neuroprotective force, supporting the neurotransmitter systems that govern focus and impulse control. During the menstrual cycle, as estrogen and progesterone fluctuate, women with ADHD experience predictable shifts: heightened impulsivity and hyperactivity when estrogen dips after ovulation, and increased inattention, depression, and anxiety when both hormones plummet before menstruation. Strikingly, about sixty percent of women with ADHD also meet criteria for Premenstrual Dysphoric Disorder, underscoring just how intertwined hormones and mental health truly are. The postpartum period presents another vulnerable window. When estrogen declines after delivery, previously manageable or even unrecognized ADHD symptoms can suddenly intensify, leading to new diagnoses during what is already a demanding transition. Alecia thoughtfully discusses navigating stimulant medication during pregnancy, emphasizing that treatment decisions must honor each woman's unique circumstances while weighing risks and benefits for both mother and baby. As women approach perimenopause and menopause, declining and erratic estrogen levels can trigger cognitive changes, mood shifts, and worsening ADHD symptomsâyet clinical guidelines for diagnosis and treatment in this population remain virtually nonexistent. Alecia addresses the ongoing debates around hormone replacement therapy, noting that timing matters: estrogen therapy initiated earlier may offer benefits with fewer risks than when started later in life. She also discusses how certain SSRIs may help manage perimenopausal symptoms by supporting neurotransmitter function. What emerges most powerfully from this conversation is Alecia's compassion and her insistence on one fundamental principle: believe women. Listen to their experiences. Include their families in care. The science, she acknowledges, still has considerable catching up to doâbut in the meantime, women deserve to be heard, validated, and treated with the individualized, evidence-informed care that respects the full complexity of their lives.
Alecia Greenlee, MD, MPH is a board-certified psychiatrist who brings both rigorous training and deep humanity to her work with women navigating ADHD and co-occurring mental health conditions. After earning her medical degree from UC San Francisco, she completed her psychiatric residency at Harvard Medical School/Cambridge Health Alliance, where she served as chief resident in consultation-liaison psychiatry and developed expertise in collaborative care and mental health services for vulnerable populations. She went on to fellowship training at the University of Chicago, first in consultation-liaison psychiatry and then in reproductive psychiatry, gaining specialized knowledge in how the body and mind interact throughout women's lives. Allecia specializes in comprehensive psychiatric evaluation and evidence-based treatment for adults, with particular expertise in how hormonal changes throughout the female lifespanâfrom menstrual cycles to pregnancy to perimenopauseâinfluence ADHD symptoms and overall mental health. Her commitment to health equity drew her to focus on women's and minority mental health, populations often underserved by research and clinical resources. She approaches each patient with cultural attunement and warmth, creating collaborative, safe spaces where people from all backgrounds feel genuinely heard. Her practice reflects a commitment to whole-person care that considers not just psychiatric symptoms, but the complex interplay of biology, identity, life circumstances, and medical conditions that shape each individual's treatment needs.
A Psychoanalytically Informed Systemic Approach to Helping Wounded Families Heal
Episode 80
Monday, January 26, 2026 ⢠Duration 55:33
In this episode, I speak with psychologist Kenneth Perlmutter about his work with wounded family systems and how his background shaped his therapeutic approach. Kenneth shared that he originally planned to go to medical school but switched to journalism, then worked in advertising in San Francisco in the 1980s. During that time, he worked with a therapist who made a profound impact on him, which ultimately inspired him to pursue graduate training and become a therapist himself. In 1989 he joined Boyer House as an intern, later becoming the Clinical Milieu Director, and it was there that he was placed on the Family Therapy team and found he really enjoyed working with family dynamics. Kenneth explained that his work is heavily informed by psychodynamic and psychoanalytic thinking, especially the ways people relate to others across different parts of their lives. He shared that his current clinic functions as a full-service mental health center with significant expertise in substance abuse, addiction recovery, and trauma-related disorders, and that many of their referrals involve college-age and young adult clients whose families are struggling to support them. We discussed how he uses a psychoanalytically informed systemic approach, paying close attention to attachment patterns, the familyâs stage of development, and even reflections on his own family system. He talked about how wounded family systems often fall into patterns of dependency, such as exaggerated dependency, hostile dependency, or chronic dependency, and how parents may unknowingly reinforce these dynamics. He explained that he looks closely at what he calls the âSâ actions,â which include serving, soothing, saving, smoothing, solving, sacrificing, and sobbing, and how these actions often keep families stuck in their roles. He shared that when parents begin to shift their focus toward their own needs and adjust their responses, children often change their behaviors in positive ways. Kenneth also discussed how families tolerate hostility and how interventions often start by looking at the behaviors that enable it. He explained that part of the work is helping families understand how their system functions, what they want more or less of, and what keeps them locked in certain roles. He postulates on what can be considered ârightâ or âwrongâ actions as a result of these pressures and gives the example of sending an adult child money time and time again under tenuous circumstances. He claims that what would be âwrongâ in fact, would be not to reflect at all on how the parentâs actions are affecting the childâs behaviors. Kenneth calls these narratives âthe lies that bindâ, explaining that the most common belief is that whatever âSâ behavior is at play is what is keeping this family member alive and well. This distorted narrative keeps a tight grip on current dynamics and gives the parent a false sense of control. Being locked in this âif onlyâ mindset is either aspirational or regretful. We ended the conversation by talking about his Model of Stress-Induced Impaired Coping. Kenneth explained that every family develops its own stress-driven roles and that members often fall into patterns such as escaping, distracting, blaming, or fixing. He described how he helps families understand what holds them in these roles, what reinforces them, and how these patterns originally developed, so they can move toward more flexibility and healthier ways of relating.
Kenneth Perlmutter, PhD, is the founder of the Family Recovery Institute and a licensed psychologist specializing in Family Systems. He has 35 years of experience working with complex psychological and behavioral health disorders. In 2008, he founded The Family Recovery Institute to provide multi-disciplinary treatment for individuals and families including dynamic therapy, family systems work, group therapies, healing workshops and clinician training. He has pioneered and validated a theory of family system woundedness with a corresponding recovery model he calls Stress-Induced Impaired Coping. He wrote the book Freedom from Family Dysfunction: A Guide for Families Battling Addiction or Mental Illness specifically for family members who love someone battling addiction or mental illness but âwant to break the cycles of codependency and relapse plaguing their dysfunctional systems.â He has overseen the design and installation of the family treatment program for Bayside Marin, Morningside Recovery, Safe Harbor Treatment Center for Women, Casa Capri/Windward Way and other national-level programs. In addition, he conducts a twice-monthly therapy group for parents of troubled teens and stuck young adults and has historically conducted several healing workshop for families of the White Mountain Apache Reservation in Whiteriver, AZ. As a professional educator, he has served on the graduate faculty for San Francisco State Universityâs Counseling Department and as Associate Professor of Chemical Dependency Studies at Cal State East Bay.
Going Beyond âHurt People Hurt Peopleâ: Rethinking Narcissism and Personality Disorders
Episode 79
Monday, December 1, 2025 ⢠Duration 58:27
In this episode, I speak with Peter about his work on narcissism and its place within the broader spectrum of personality disorders. He shares that when he was in graduate school for literature, he was required to participate in a course of psychotherapyâan experience that sparked his interest in the field and eventually led him to pursue clinical training. Peter explains that he became increasingly interested in personality disorders, especially after having his own personal encounter with someone exhibiting narcissistic traits. This experience helped shape his focus in this area of study. He notes that the field of psychotherapy often views narcissism through the lens of âhurt people hurt peopleââthe idea that harmful behavior stems from unresolved trauma. While that framework can sometimes be useful, Peter believes it may also lead people to remain in harmful dynamics for too long because they extend too much empathy and assume the behavior is unintentional. He discusses meta-analytic research on twins showing that roughly 50% of psychological traits are heritable; in some studies, narcissistic traits have been found to be up to 79% heritable. Peter emphasizes the importance of clinicians and clients understanding that, in many cases, narcissistic individuals do know their behavior is harmful and continue it because it benefits them. This runs counter to the prevailing idea that such behavior is purely unconscious or trauma-driven. He acknowledges that this perspective is controversial and that he has received criticism for challenging long-standing therapeutic assumptions. When working with clients, Peter helps them navigate the cognitive dissonance between their painful or abusive experiences and their belief that the narcissistic individual âdidnât mean itâ or was simply reacting from trauma. The belief that someone is merely âwoundedâ and reacting can keep people in unhealthy relationships far beyond what is safe or reasonable. We also discussed the differences between narcissism and antisocial personality disorder. Peter explains that one way to determine whether a person is workable is to assess their collaborative capacityâand, importantly, for therapists not to assume there is mutual agreement on collaboration or shared responsibility. He underscores the importance of validating victims of these relational dynamics, reminding them that no matter how much self-work they do, they may not be able to improve the relationship because the problem may not be about them at all. Part of his work involves helping clients reconnect with their sense of self, especially when an invalidating environment has led them to doubt their own perceptions, question their reality, or even wonder whether they are a âgoodâ person.
Peter Salerno, PsyD, is a Doctor of Psychology, retired licensed psychotherapist, and nationally recognized expert on personality disorders and pathological relationships. Over the course of his career, he has specialized in personality disorders, family trauma, complex trauma, and pathological abuse. He was trained and qualified to administer the Hare Psychopathy ChecklistâRevised (PCL-R), the gold standard for identifying psychopathy in clinical and forensic settings. He was also a featured expert in the docuseries Ted Bundy: Dialogue with the Devil, streaming on Hulu and Disney+. His work has always been driven by a passion for understanding the human mind and helping people make sense of some of its most challenging and misunderstood conditions. Today, he uses that expertise to help people around the world understand painful, confusing, and often manipulative relationship dynamics. While he no longer practices traditional therapy, he offers remote consultations focused on clarity, insight, and practical decision-makingânot treatment.
Helping Veterans Using Cognitive Processing Therapy (CPT) and Research on Linguistic Themes in the DSM and Artificial Intelligenceâs Accuracy in Diagnosis
Episode 78
Monday, November 24, 2025 ⢠Duration 58:01
In this episode, I speak with Matt about his work with veterans, PTSD and his research on AI's ability to diagnose mental health disorders. Matt explained that he got into the field of psychotherapy after being a patient, working through his own issues after being in the Marines. He found the process very helpful and went on to become a therapist and initially worked with unhoused populations, psychosis and gang young, but wanted to go into working with veterans and first responders, treating PTSD. He shared that he never intended to go into research, but after doing his dissertation, he thought he might as well publish it, and then was invited to be part of a research group. Matt shared that most of the treatment for veterans is provided by the Veteranâs Administration, although they did not hire clinicians with his licensure. He explained that he was fortunate to get connected with an organization called the Head Strong Project that provides services to active duty military and veterans addressing PTSD and suicide prevention. He said that many of his clients often have a history of trauma, in addition to their experience in the military, as well as around 50% of his clients also have comorbid ADHD. Matt discusses the three major evidence based approaches to treating trauma: Prolonged Exposure (PE), Cognitive Processing Therapy, & Eye Movement Desensitization Reprocessing. He shares how the dropout rate for PE is 40% and EMDR is not always successful, which might be due to the eye movements and that not being as effective with those in the military, although he doesnât know any research backing that up. Matt explained that he uses CPT and in the approach, the focus is on beliefs or what they refer to as âstuck pointsâ. There may be assimilated âstuck points" that the person has taken from the traumatic experience and over accommodated "stuck pointsâ< which are things that the person now believes and has adjusted their thinking patters as a result of the trauma. He explains the treatment starts off with psycheducation and teaching coping skills, then addressing the âstuck pointsâ. He explained that they help the clients break down thinking patterns from events, then usechallenging questions, identify cognitive distortions, use cognitive reframing, and put this all together into a challenging questions worksheet. He shared that once you have that framework in place, then you follow up on five themes which include: Safety, Trust, Power & Control, Esteem, and Intimacy, then work through stuck points in each of those areas. Finally, you work through the traumatic narrative and what you believed before and what you believe now. We discussed the five themes and how particularly discussed an intervention called the Trust Star, where the person picks aspects of someoneâs personality, and rates how that leads them to be more trusting of them or less. The breaks out of the all or none thinking around trust. Lastly, we discuss Mattâs research into linguistic patterns in different DMS disorders throughout the various editions of the DSM. He also discusses his work groupâs research into having AI review vignettes and try to arrive at a diagnosis. He reported that Chat GPT did worse than chance, Claude was about as good as chance, and Gemini had a 97% rate of accuracy. We discuss AI and its use related to therapy.
Matt Rensi, Ph.D., LPCC, is a licensed counselor in California, Oregon, and Idaho. He holds a Ph.D. in counselor education and supervision, often teaching at various universities. He currently works primarily with law enforcement, veterans, firefighters, and active duty military personnel. His primary focuses are PTSD, substance use, ADHD, marital or couples issues, and anything that may be associated with that cluster of struggles. Matt conducts research on various topics as part of an independent research team. He is a clinical partner with The Headstrong Project and the SOF Network. Matt is also a clinician at the Institute for the Advancement of Psychotherapy and its specialty center, the Bay Area Center for ADHD.
Utilizing Forgiveness to Allow Oneself To Be Connected to The Now and Increasing Our Capacity for Love and Joy
Episode 77
Monday, October 13, 2025 ⢠Duration 53:47
In this episode, Fred discusses how in college he got very interested in spiritual questions and read books, learned how to meditate, thought a lot about deeper meaning and opened a vegetarian restaurant in Santa Cruz. After having his first child, he went to graduate school and decided to do his dissertation on the topic of forgiveness, which was something that he struggled with in his own life, describing himself as âdramatically unable to forgiveâ. He shared that the dissertation was a great success and received a lot of media attention, which set him in this direction in his research. He shared how they went for a secular approach, because a religious approach involved a lot of tribalism, and they were all essentially different portals to enter into the work of forgiveness. They integrated mindfulness and a Buddhist influenced Cognitive Behavioral Therapy, which were not common in psychotherapy then. We discussed my interpretation of his work and how Iâve conceptualized is as forgiveness is for you, not for the other person who did the harm. Fred discusses the term âtraumaâ and how sometimes it is used in situations that may not be trauma, and labeling it that way can lead to blame, rather than the empathy for what one has gone through and allowing the person to cope with their life right now. He discussed how forgiveness can allow us to be more connected to what is happening with oneâs life, right now, in the present. He shared that an essential part of forgiveness is acknowledging our vulnerability, which never goes away, and accepting that vulnerability and not blaming that which reminds us of how vulnerable we are. He said he learned more about mindfulness from Jon Kabat Zinn, Ph.D. and how when you increase awareness, you increase choice. We discussed his work with people from Northern Ireland, Israel, Palestine, Sierra Leon, Columbia and people after 9-11 and how one of the hardest parts related to forgiveness is when there are different sides, as forgiveness may lead the personâs âsideâ to label them as a traitor. In discussing how to forgive when the person is not safe because they may not be out of the situation, like Israel and Gaza, this lead to a discussion of what makes us safe. He shared that often armoring up, becoming bitter, and trusting others less and being more guarded may feel like itâs protecting us, but it also limits our capacity for love and joy. He shared that mindfulness helps us bring ourselves back to the now and in this very moment, we are usually safe. He explained that our threat response overreaches, and combatting that overreach is important to connect us to our present safety and abundance that we may have. He discusses his new workbook, The Forgive for Good Recovery Workbook, that helps people through a process of forgiveness. He leaves us with one of his favorite quotes about forgiveness: "Itâs giving up all hope for a better past".
Frederic Luskin, Ph.D. is a psychologist in Counseling and Health Psychology from Stanford University where he has been teaching for the past 30 years. Currently, he is on the faculty for the Stanford School of Business Executive Education program where he teaches mindfulness, emotional intelligence, psychological safety, and positive psychology to executives from all over the world. He serves as Director of the Stanford University Forgiveness Projects, researching the positive effects of forgiveness for a healthy and happy life. Fred is one of the worldâs recognized authorities on forgiveness of self and others. Heâs been interviewed and featured in such media outlets as The New York Times, O Magazine, Today Show, LA Times, Time Magazine, Huffington Post, and CBS Morning News. In addition, heâs published 3 books and dozens of articles on forgiveness. His book Forgive for Good is the best-selling secular self-help book published on the topic of forgiveness.
Building a Mastery Mindset: Integrating Sports Psychology and Clinical Practice
Episode 76
Monday, October 6, 2025 ⢠Duration 55:58
In this episode, Jeff Greenwaldâworld champion tennis player, licensed therapist, and sports psychology consultantâoffers a rare glimpse into the intersection of clinical therapy and high-performance coaching. Jeff highlights how anxiety has become the predominant struggle both inside and outside of sport, often crippling athletes and families alike. Drawing on nearly three decades of experience, he explains how his dual training allows him to work not only on performance enhancement but also on the deeper roots of anxiety, perfectionism, and family dynamics that shape an athleteâs experience. He shares how he integrates Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Motivational Interviewing, and Somatic Psychotherapy, tailoring each to the unique needs of athletes. Jeff clarifies how sports psychology typically focuses on attention control, motivation, and performance skills, while clinical practice digs into family systems, emotional regulation, and underlying anxiety. Listeners will also hear about Jeffâs practical frameworks, including the four dimensions of focus (narrow/broad, internal/external) and his âremote controlâ metaphor from The Mental Edge for Young Athletes. These models help young athletes understand they have multiple tools at their disposalâbut itâs their responsibility to choose and apply them in the heat of competition. A major theme of the conversation is Jeffâs emphasis on the âpermission to miss.â With statistics showing that 70% of kids quit sports by age 16, Jeff underscores the importance of helping athletes reframe mistakes, embrace imperfection, and cultivate a mastery mindset focused on growth and process rather than outcome. Over time, athletes learn to anchor their confidence in the skills they can controlâtheir routines, effort, and perspectiveârather than in outcomes they canât. This framework not only reduces anxiety but also fosters resilience, freedom, and joy in sport. He also shares how parents can best support their childrenânot by rushing in to fix, but by validating their experiences and normalizing their anxiety. As a competitive athlete himself, and still competing internationally, Jeff has demonstrated how you can transform from a tentative, perfectionistic mindset to a full realization of your ability through the mastery mindset, which also catapulted him to world No. 1 in his age group. He shares how this breakthrough was instrumental to his work and how grateful he is to be in a position to help the thousands of athletes he has worked with over the past 27 years.
Jeff Greenwald, MFT, is a world champion athlete, licensed psychotherapist, best-selling author, and one of the worldâs leading mental coaches for athletes. With over 25 years of experience helping youth, college, and professional competitors thrive under pressure, Jeff brings a rare blend of elite performance insight and clinical expertise to his work. He is the author of the international bestseller The Best Tennis of Your Life, which has sold over 80,000 copies worldwide, and the new book The Mental Edge for Young Athletesâa groundbreaking guide for building confidence, emotional resilience, and a stronger mindset in sports and life. Jeff has worked with athletes across every major sport and consulted for national teams, Fortune 500 leaders, top junior academies, and competitive athletes at all levels of sport. He is a two-time ITF World Champion and was inducted into the Northern California Tennis Hall of Fame in 2019 for his contribution in the field of sports psychology and success as a world-ranked tennis player. Through his writing, coaching, and speaking, Jeff empowers athletes and their families to navigate the mental game with clarity, courage, and lasting confidence.
