Therapy on the Cutting Edge

In this episode, I speak with Julian Ford, Ph.D., A.B.P.P. who discusses his work with PTSD, Complex PTSD, Developmental Trauma Disorder and the T.A.R.G.E.T. Model for treatment. Julian shared that he had started out working as a line staff in a state psychiatric facility, then went on to working with the Veteran’s Administration. He discussed working with Veterans with trauma and seeing that they struggled with much more than just the symptoms of PTSD. He explained that he worked with the National Center for PTSD, which is part of the VA system, then got connected to a Child Psychiatry working group through Darmouth. He shared that they had found that clients diagnosed with ADHD and many with ODD, also had trauma, that was undiagnosed. We discussed what CPTSD is and how the nervous system reactivity is central to the diagnosis. Julian discussed how their model starts with psychoeducation, and explaining to the client they have an “alarm” in their brain, which is what leads to this reactivity. Understanding that can help access the frontal lobe to be able to understand and decrease the reaction to the reactivity. He explained that he works with clients and their nervous systems in various ways, depending on what the client’s entree is, whether it be emotional, cognitive, somatic or other. He shared that the model he uses also helps the person connect to their values, and seeing the values in their stories about past and present events. In reflecting these values to the clients, it helps them to see their self and symptoms having protected them during these times of survival, and they can still live guided by those values, although without the context of threat. He shared that he helps clients to connect with that sense of self that is values driven, which helps to alleviate the trauma narrative that the client is broken, defective, unlovable or other forms of shame. We discussed the difficulties related to sense of self that is part of the CPTSD diagnosis. We also discuss the work from 2000 in identifying trauma in cases of ADHD and ODD, and how the diagnosis of trauma maybe missed sometimes. He shared that it is “both and”, where the child may also have those diagnoses and trauma, although identifying the trauma allows the therapist to bring in trauma informed or trauma focused therapy.

Julian D. Ford, PhD, ABPP, a clinical psychologist, is Professor of Psychiatry at the University of Connecticut School of Medicine, where he is Director of the Center for Trauma Recovery and Juvenile Justice (emeritus) and the Center for the Treatment of Developmental Trauma Disorders. He has served as President of the International Society for Traumatic Stress Studies, is a Fellow of the American Psychological Association and the International Society for Traumatic Stress Studies, and is Editor of the Journal of Trauma and Dissociation and Associate Editor of the Journal of Racial and Ethnic Health Disparities. Julian has published more than 350 articles and book chapters. He is author of Crises in the Psychotherapy Session: Transforming Critical Moments Into Turning Points, coeditor of Treating Complex Traumatic Stress Disorders in Adults, Second Edition, and Treating Complex Traumatic Stress Disorders in Children and Adolescents, and coauthor of Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach. His research focuses on developmental trauma disorder and the Trauma Affect Regulation: Guide for Education and Therapy (TARGET) therapeutic intervention.

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.

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 individual’s 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 don’t 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 wasn’t 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 partner’s struggling. Often the withdrawn partner doesn’t 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 didn’t come in due to substances, but not turning them away as they’re 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 Beginner’s Guide”.

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 wasn’t 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 it’s 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 it’s different than therapy where you’re 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 women’s 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

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 “ride the wave” 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 “walking the middle path,” (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 one’s window of tolerance as well as self-soothing skills utilized to sit with one’s 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 DBT’s 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.