Therapy on the Cutting Edge

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 psychotherapy—an 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 “hurt people hurt people”—the 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 “didn’t mean it” or was simply reacting from trauma. The belief that someone is merely “wounded” 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 capacity—and, 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 “good” 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 Checklist–Revised (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-making—not treatment.

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 Veteran’s 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 doesn’t 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 “stuck points”. There may be assimilated “stuck points" that the person has taken from the traumatic experience and over accommodated "stuck points”< 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 “stuck points”. 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 someone’s 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 Matt’s research into linguistic patterns in different DMS disorders throughout the various editions of the DSM. He also discusses his work group’s 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.

In this discussion, Fred Luskin—psychologist and director of the Stanford Forgiveness Projects—dives into the power of forgiveness. He shares his journey from personal struggles with forgiveness to groundbreaking research. Fred advocates for a secular approach to make forgiveness accessible, emphasizing that it benefits the injured party, not the perpetrator. He critiques the misuse of 'trauma' labels that can hinder healing and promotes mindfulness as a tool for present moment awareness. Ultimately, he presents forgiveness as an essential practice for fostering love and joy in our lives.

Jeff Greenwald, a licensed marriage and family therapist and world champion tennis player, dives into the synergy of sports psychology and clinical therapy. He discusses how anxiety permeates both athletics and family dynamics, emphasizing the need for tailored therapeutic approaches. Greenwald introduces practical frameworks like the four dimensions of focus and the concept of 'permission to miss,' highlighting how these tools help young athletes navigate pressure and performance. He also addresses the influence of family dynamics on athletic development and the shift from outcome to mastery mindsets.

In a captivating discussion, psychotherapist Michelle Ferris shares her journey from a dysfunctional upbringing to becoming a codependency expert. She defines codependency as over-functioning for external validation and emphasizes the importance of boundaries. Michelle highlights the dual nature of hypervigilance—it can be a gift but also lead to anxiety. Through befriending oneself and setting limits, she encourages healing and self-connection, while addressing the role of shame in recovery. Michelle’s insights are both practical and empowering.

In this episode, I speak with Rachel about using Energy Psychology (EP) and Sound Healing (SH) in her psychotherapy work. Rachel describes how she was originally trained psychodynamically and had been in psychodynamic therapy herself. After Rachel learned about EP from her acupuncturist she pursued training in the approach, and found it was very effective with clients. She also worked with an EP psychotherapist and experienced a significant shift. Rachel explains that EP facilitates changes in subtle energy resulting in shifts in behaviors, emotions, physical symptoms, anxiety, PTSD, performance and other issues. Rachel discussed the most well-known EP approach, Emotional Freedom Technique (EFT). Many people have learned it as a technique to help regulate the nervous system. With more in depth training, EFT can be used for a variety of issues one might bring to a therapist. Rachel discusses how she integrates SH into other EP techniques. She has found that it often increases the speed and ease of change. Rachel discussed the significant research support for EP, including numerous double blind, randomized and controlled research studies. Lastly, Rachel shared practical strategies listeners can use to calm their nervous system and also demonstrated the sound produced by her various SH instruments. Rachel Michaelson, LCSW is a licensed clinical social worker in the state of California with over 35 years of clinical experience. Along with providing individual and group psychotherapy, Rachel is a clinical supervisor and consultant, who specializes in energy psychology and sound healing. She is a certified Diplomate in Comprehensive Energy Psychology (D-CEP) and has training in several energy-based therapeutic modalities including Emotional Freedom Technique (EFT), Havening Techniques, Advanced Integrative Therapy (AIT), Tapas Acupuncture Technique (TAT,) Psych-K, Trauma Tapping Technique and other energy medicine techniques. Rachel has developed an Energy Psychology protocol called Release Issues Past and Present which she uses with individuals and in groups and teaches to other mental health providers. When working with clients, Rachel often integrates sound healing by utilizing calibrated tuning forks and chimes to facilitate change. For over 25 years Rachel has been providing training to mental health professionals on a variety of topics including Energy Psychology, Sound Healing, trauma informed care, clinical supervision, law and ethics, telehealth, diagnoses, time and paperwork management, and suicide. Rachel is a past chair of the Association for Comprehensive Energy Psychology’s Humanitarian Committee.

In this episode, I speak with Nigel about his work with Integrative Attachment Therapy (IAT). He discusses how his studies with Dan Siegel, M.D. and his meditation training in the Tibet Bon Dzongchen, led him to be very interested in what is a “mind”, how it works, what its about, and how ti develops. He discussed how attachment is the basis for the development of the mind, which we create "bottom up in our relation to others. He explained that the key developmental processes for the mind include attachment, care and nurturance, social rank, sexual identify and safety. He said that the novel part of the work that Daniel Brown, Ph.D., the coauthor of Attachment Disturbances in Adults: Treatment for Comprehensive Repair, was using an ideal parental figure to repair what had or had not been established in development. Nigel talks about the three pillars of IAT, where the therapist and client are collaborating on the work they’re doing together at the beginning of the session, doing the imaginal intervention of the ideal attachment figure, and then using metallization to process the experience and gain new awareness. He explained that they are helping a client to connect with the felt experience of feeling safe, seen, being able to trust and other elements of experiencing a secure attachment with this imagined parental figure. He shared that the conditions for a secure attachment include embodied trust, felt safety, being good enough, that its ok to explore, being able to down regulate the nervous system, and knowing your a good person. He spoke about how transference is encouraged to be shared directly with the therapist, and discussed using metallization, rather than using the therapist to provoke transference and letting it build up and then be worked through. We also discussed his work with psychedelics and its ability to help clients to integrate experiences in a different interpretive map. Nigel Denning, M.Psych, MA is a Counselling Psychologist and Director of Integrative Psychology and Medicine in Melbourne, Australia. Nigel is Research Fellow at Australian National University. Nigel has been involved in developing the Three Pillars of Attachment Repair and Integrative Attachment Therapy with David Elliott and Traill Dowie and developing the IAT Training Program. Nigel is a nationally recognized expert in family violence, institutional abuse, trauma and attachment-focused practice. Nigel is also clinical lead in several psychedelic medicine trials and a trainer in psychedelics and holotropic breathwork, having studied under Stanislav Grof. In addition, Nigel is a long-term meditation practitioner and teacher in the Tibet Bon Dzogchen tradition. Nigel has a profound understanding of how Eastern practices affect the mind and their subsequent connection to psychotherapy. Nigel is a jovial and kind person who is passionate about improving the world one mind at a time.

In this engaging discussion, Peter Fraenkel, an Associate Professor of Psychology and expert in last-chance couples therapy, shares insights from his extensive experience working with couples on the brink of separation. He delves into the Creative Relational Movement approach that breaks cycles of conflict by fostering vulnerability and addressing gender dynamics. Peter outlines key principles for effective therapy, suggests actionable strategies for couples, and explores common scenarios they face. His expertise shines as he offers hope for transformative change in strained relationships.

In this episode, I speak with Chandra about her path into trauma-informed work with young children and their caregivers. Raised in San Francisco by parents who worked in child welfare, Chandra was exposed early to stories of trauma and healing. Before age 7, several of her friends lost their parents to cancer, which inspired her to become a doctor. In high school, during an internship on a pediatric oncology ward she noticed that while physical health was prioritized, children’s emotional needs were often overlooked. This realization led her to study psychology. After college, Chandra worked at a residential program with children aged 6–12. She found the children often opened up about trauma during informal moments—car rides, bedtime, or watching TV—highlighting the need to involve caregivers in the healing process. In 1998, Chandra interned with Dr. Alicia Lieberman at UCSF’s Child Trauma Research Program, where she trained in Child-Parent Psychotherapy (CPP), an evidence-based treatment for young children under age 6 who have experienced trauma. She later developed the CPP fidelity framework and co-authored the second edition of the manual. Chandra noted a key challenge: although many parents recognize their child’s trauma, few clinicians are trained to work effectively with young children. Many therapists also avoid discussing trauma directly with young children, which can leave them alone with their experiences. CPP begins with the therapist meeting alone with the caregiver to supportively explore the child’s symptoms, experiences of trauma, the caregiver’s own history, including how past experiences may shape the parent's responses. Then the therapist and caregiver gently acknowledge past traumatic experiences to the child—“speaking the unspeakable”—and help the child process their experiences using developmentally attuned pacing and modalities, including play and art. As children process their experiences they sometimes shift topics or activities or seek physical comfort when they begin to move outside their window of tolerance. Therapists help parents understand this process, attune to their child’s needs, and support their child. CPP has a strong evidence base, including five randomized controlled trials. It has shown positive outcomes for preschoolers exposed to violence and infants and toddlers who experienced maltreatment. Notably, a recent study found CPP is associated with lower epigenetic age acceleration in trauma-exposed children aged 2–6—suggesting a measurable impact at the biological level. Chandra Ghosh Ippen, Ph.D. is a child trauma psychologist specializing in working with families with children under age 6. She is co-developer of Child-Parent Psychotherapy, the associate director of the Child Trauma Research Program at the University of California, San Francisco, and a member of the Board of Directors of Zero to Three. She has spent over 30 years conducting clinical work, research, and training in the area of childhood trauma and diversity-informed practice. She is also an award-winning children’s book author and has written 5 children’s books as well as the free Trinka and Sam disaster series, which has been translated and distributed to over 400,000 families around the world.

In this episode, Heather discusses her background and how she came to working with couples in therapy. She discussed how usually, when a partner in a couple has significant PTSD, it is recommended that each do individual therapy, but as she discussed, that doesn’t mean the couple doesn’t continue to struggle in their relationship. She shared how in her research with couples, where one person was a child sexual abuse survivor, the Emotionally Focused Couples Therapy approach was helpful, but it was difficult to complete Deescalation Stage, since there was a great deal of emotional dysregulation and difficulty with mentalizing. Heather discussed her conceptualization of Complex PTSD and how she began starting with cognitive-based interventions to help clients understand trauma, their reactions to trauma, and learn skills for emotional regulation and mentalizing, which is being able to reflect on one’s own perceptions of the other, what the other may be experiencing/thinking, and how one might be being perceived. She explained how helping improve these skills helps to couple to address the effects of the trauma together and then allowing for the couple to do the relationship work. She talked about refining her Developmental Couples Therapy for Complex Trauma approaches, trained other clinicians, writing a treatment manual and conducting research. Heather also shared that she had recently published a workbook for clients, “Healing Broken Bonds: A Couple's Workbook for Complex Trauma” which goes through Developmental Couples Therapy for Complex Trauma step-by-step from a client’s perspective. She describes how it’s being used not only alongside treatment, but independently by couples and individuals. It can be paired with episodes of her podcast Healing Broken Bonds that help walk people through the concepts. ​ Heather MacIntosh, Ph.D., CPsych is a clinical psychologist, Associate Professor, and Director of the Couple and Family Therapy Clinic at McGill University where she is the recipient of the H. Noel Fieldhouse Award for Distinguished Teaching. Heather is author of Developmental Couple Therapy for Complex Trauma a Manual for Therapists and Healing Broken Bonds: A Couple's Workbook for Complex Trauma. She is also the developer and host of Healing Broken Bonds, a podcast featuring couples dealing with the impacts of complex trauma in their relationships. Developmental Couple Therapy for Complex Trauma is an evidence based, psychoanalytically informed treatment approach, developed by Heather, for working with couples dealing with the impacts of complex trauma. Heather is the author of over 60 peer reviewed journal articles, book chapters, and treatment manuals. She is in demand as a speaker at international conferences and workshops as well as a resource for local and national media in the areas of trauma, couple and family relationships and issues, and queer and trans wellbeing. She leads an active funded research program having been principal researcher on over $500,000 in peer reviewed research grants and an active co-investigator on over $7,000,000 more with other internationally recognized colleagues. Heather’s research primarily examines the impact of early life trauma on the process and outcome of couple therapy. In addition, she studies the experiences of 2SLGBTQIA+ trauma survivors in therapy, in healing their sexual selves, adapting and integrating models of treatment to ensure accessibility and inclusion of Indigenous, racialized, queer, and trans, graduate student therapist trainees and clients. Heather lives and works on land of the Crawford Purchase Mohawk territory “purchased” for settlement by United Empire Loyalists at the end of the American Revolutionary War. MerryMac Farm is in Eastern Ontario, Canada, where she strives to live with the land in peace, and to bring healing through therapy offered in relation with her Icelandic horses, her retired RCMP Musical Ride Horse, three Ojibwe Spirit Ponies, and a cadre of other creatures who bring joy, hilarity, and love to life.