Therapy on the Cutting Edge

W Keith Sutton PsyD
  • 4.9 (11)
  • Courses
  • Updated Biweekly

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.

  1. 15h ago

    The Hug That Got Ridiculed: How Boys Learn to Hide Their Hearts & Become Men Who Struggle with Emotional Intimacy

    In this episode, I speak with Fred Rabinowitz, Ph.D., Professor Emeritus of Psychology at the University of Redlands, about his nearly 40-year career at the intersection of psychology, masculinity, and men's mental health. Fred shares his personal journey, from growing up as the oldest of three boys with a father who was both a traditional male and an artist who encouraged emotional openness and close friendships, to a pivotal experience in first grade when hugging a friend led to being ridiculed. He discusses how that early moment shaped his understanding of how boys are socialized to suppress their emotional lives, shifting from open and affectionate to competitive and emotionally guarded. We discuss how Fred and his colleague Sam Cochran established one of the first university-based therapeutic men's groups at the University of Missouri in 1982, and the critical role that positive older male figures can play as mentors, helping young men feel less alone and creating a constructive cycle of emotional openness. Fred explains that therapy with men requires a different approach given the gender norms they have internalized, emphasizing the importance of entering with empathy and curiosity rather than judgment, building trust, and helping clients reflect on the underlying reasons for their behavior rather than simply naming symptoms. We discuss loss as a primary wound that often brings men into therapy, and how avoidance behaviors such as substance abuse serve as coping mechanisms. Fred describes how intimacy is frequently conflated with sex, and how emotional closeness between men is often perceived as threatening despite being a fundamental human need for connection. He also addresses the post-pandemic cultural landscape, critiquing the manosphere's emphasis on physical appearance and wealth as paths to fulfillment, and the need for greater empathy toward men within feminist movements. Fred shares stories from his latest book, Deepening Group Psychotherapy with Men, which chronicles the group dynamics of ten men in therapy and represents his favorite blend of storytelling and clinical practice. We also discuss Men and Depression, which examines black-and-white thinking, suicide risk, and the emotional disconnection that can leave men uncertain of their own emotional states. The conversation then turns to a forthcoming book on the psychology of poker, co-authored with Darren Elias. Fred recounts how their collaboration began when, as Dean, he mentored a young Darren through academic difficulties stemming from his lucrative online poker play, supporting his transition to a creative writing major. Fred discusses poker as a metaphor for how men conceal their emotions in everyday life, navigating vulnerability and alliance without revealing their hand. We also discuss his upcoming project Strength with Heart, a self-help book and workshop series designed to help men develop self-awareness and reflect on their experiences, and the broader challenge of reconciling strength with emotional openness and compassion. Fredric E. Rabinowitz, Ph.D. is a Professor Emeritus of Psychology at the University of Redlands, where he taught for nearly 40 years, including courses on the Psychology of Interpersonal Relationships. He earned his Ph.D. in Counseling Psychology from the University of Missouri-Columbia in 1984, where he and his graduate school colleague Sam Cochran co-led one of the first university-based therapeutic men's groups in 1982, a program that continues to this day with a thriving alumni network. Fred has maintained a private practice in Redlands, California, specializing in psychotherapy with men since 1986, including a weekly therapeutic men's group. He is a past president of the Society for the Psychological Study of Men and Masculinities (APA Division 51), having served as president in 2006, and was the lead author of the APA's first-ever Guidelines for Psychological Practice with Boys and Men, a landmark 13-year project. He is the author and co-author of numerous books on male psychology, including Man Alive: A Primer of Men's Issues (1994, with Sam Cochran), Men and Depression: Clinical and Empirical Perspectives (2000, with Sam Cochran), Deepening Psychotherapy with Men (2002, with Sam Cochran), Breaking Barriers in Counseling Men: Insights and Innovations (2014, with Aaron Rochlen), and Deepening Group Psychotherapy with Men: Stories and Insights for the Journey (2019). He is currently working on Strength with Heart, a practical guide to increasing male self-awareness and psychological flexibility, co-authored with Daniel Ellenberg. He is also writing a forthcoming book on the psychological dynamics of poker players, co-authored with Darren Elias. The collaboration grew out of a years-long mentorship relationship that began when Fred, then serving as Dean, guided a young Darren through academic difficulties stemming from his lucrative online poker play. An avid poker player who has competed in the World Series of Poker, Fred draws on that experience to explore how men navigate vulnerability, emotional concealment, and connection in everyday life.

    The Hug That Got Ridiculed: How Boys Learn to Hide Their Hearts & Become Men Who Struggle with Emotional Intimacy

  2. Sep 21

    If You’ve Seen One Person with Autism, You’ve Seen One Person with Autism: Diagnosing Autism and Its Varied Presentations

    In this episode, I speak with Celine Saulnier, PhD, a clinical psychologist and co-author of the Vineland Adaptive Behavior Scales, Third Edition, about the evolving science and clinical practice of autism assessment and diagnosis. Celine shares her path from training with M-CHAT developer Deborah Fein, to nearly a decade at the Yale Child Study Center, to directing clinical research at Emory University and the Marcus Autism Center, and finally to founding her own practice. We discuss the two hallmark domains of autism, social communication differences and restricted or repetitive behaviors, and why no single measure can capture the conditions variability across verbal ability, cognitive functioning, and presentation. She describes groundbreaking eye-tracking research showing that divergence from typical social attention emerges as early as six months of age, and research has led to FDA approval of a diagnostic technology called EarliPoint to identify autism in child from this young age up to eight years old. We also discuss the genetics of autism in children, including recurrence risk for siblings and the concept of the “broader autism phenotype,” where family members show subthreshold traits (or shadow traits) that still warrant support. We discussed aspects of autism, including theory of mind, sensory processing differences, and repetitive behaviors, as well as the chronic anxiety, dysregulation, and burnout that can result from navigating a world not built for neurodivergent processing. Celine distinguishes between camouflaging and masking, and discusses how these coping strategies, while adaptive in the short term sense, can be associated with poor mental health outcomes over time. Finally, we explore the range of interventions available across the lifespan, from parent coaching and skill building in early childhood to social skills groups, executive functioning coaching, and life coaching in adulthood. Celine Saulnier, Ph.D., obtained her doctorate in Clinical Psychology from the University of Connecticut, after which she completed a postdoctoral fellowship and then joined the faculty at the Yale Child Study Center, Yale University School of Medicine. At Yale, Celine worked closely with Drs. Sara Sparrow and Domenic Cicchetti investigating adaptive behavior profiles in Autism Spectrum Disorders. She became the Training Director and then Clinical Director for the Yale Autism Program, specializing in diagnostic evaluations of individuals with autism and related disorders across the lifespan. In 2011, she relocated to Emory University School of Medicine and the Marcus Autism Center to help develop and direct a large-scale clinical research program. In 2018, she opened her own diagnostic clinic and consulting company, Neurodevelopmental Assessment & Consulting Services (www.nacsatl.com) in Decatur, GA. Celine remains an Adjunct Associate Professor at Emory University, and she conducts national and international trainings to professionals on autism and related disorders. For her teaching, she was awarded the New England Educational Institute Outstanding Educator Award for Mental Health Education. Celine is on the editorial board for the Journal of Autism and Developmental Disorders, the Scientific Advisory Board of the Autism Science Foundation, and an Emeritus member of the Atlanta Autism Consortium's Board of Directors. In addition to co-authoring the Vineland-3, Celine has published numerous articles in peer-reviewed journals, and she has written two books, Essentials of Autism Spectrum Disorders Evaluation and Assessment and Essentials of Adaptive Behavior Assessment of Neurodevelopmental Disorders.

    If You’ve Seen One Person with Autism, You’ve Seen One Person with Autism: Diagnosing Autism and Its Varied Presentations

  3. Sep 14

    Identify the Alarm and Go Towards the Values: Using the T.A.R.G.E.T. model to address PTSD, Complex PTSD and Developmental Trauma Disorder

    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.

    Identify the Alarm and Go Towards the Values: Using the T.A.R.G.E.T. model to address PTSD, Complex PTSD and Developmental Trauma Disorder

  4. Jul 20

    Cutting Ties with Your Parents: Healing and Boundaries

    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.

    Cutting Ties with Your Parents: Healing and Boundaries

  5. Jun 29

    Working with Couples and Addiction Through the Lens of Attachment in Emotionally Focused Couples Therapy

    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”.

    Working with Couples and Addiction Through the Lens of Attachment in Emotionally Focused Couples Therapy

  6. Mar 2

    Helping Women on Their Journey Through the Five Phases of Divorce Grief

    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

    Helping Women on Their Journey Through the Five Phases of Divorce Grief

  7. Feb 23

    From Emotionally Sensitive to Overcontrolled Emotions, Using Dialectical Behavioral Therapy and Radically Open Dialectical Behavioral Therapy to Find Balance

    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.

    From Emotionally Sensitive to Overcontrolled Emotions, Using Dialectical Behavioral Therapy and Radically Open Dialectical Behavioral Therapy to Find Balance

  8. Feb 2

    Why We Miss Girls with ADHD – and How Hormones Hold the Key

    In this episode, Alecia explores the critical intersection of women's mental health, ADHD, and reproductive psychiatry—an 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 versa—a 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. Alecia’s 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 inattentiveness—daydreaming, losing track of conversations, internal restlessness—symptoms 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 symptoms—yet 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 do—but 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 lifespan—from menstrual cycles to pregnancy to perimenopause—influence 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.

    Why We Miss Girls with ADHD – and How Hormones Hold the Key
See All (88)

4.9
out of 5
11 Ratings

About

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.

Information

  • Creator
    W Keith Sutton PsyD
  • Years Active
    2020 - 2026
  • Episodes
    88
  • Rating
    Explicit
  • Copyright
    © 2020 Institute for the Advancement of Psychotherapy
  • Show Website
    Therapy on the Cutting Edge

You Might Also Like