Category: Transforming Trauma Podcast

Cultivating a culture of transparency is a challenge for any organization. Recording it for posterity on a podcast is a lesson in embodied connection. On this episode of Transforming Trauma, host Emily Ruth welcomes back Brad Kammer, Training Director and Senior Trainer at Complex Trauma Training Center (CTTC), and Stefanie Klein, CTTC’s Assistant Training Director and Trainer, for a heartfelt and candid year-end conversation. The trio celebrates all that CTTC has accomplished and discusses challenges associated with creating and maintaining innovative, supportive programming. 

“We’re excited about what we’ve accomplished. But, even more than that, it’s just this community we’re building,” says Brad, noting the hundreds of therapists trained by CTTC since it opened its doors in early 2024. CTTC was founded to provide a relational, diverse, inclusive, depth-oriented professional community for those seeking a supportive network of therapists working with complex trauma.

Providing a professional community for mental health professionals, CTTC offers various events and programs, including the NARM® Therapist and NARM® Master Trainings (the NeuroAffective Relational Model).  “I fell in love with [NARM] because it supported me to be more effective from a place of more ease inside of myself,” says Stefanie. “Being a therapist can be a very hard, lonely job,” she says. “I very much believe that the community that we’re creating and our approach to mentorship goes a long way in supporting a feeling that we’re all in this together.”

Ongoing development programs will also enjoy greater prominence in 2025. Brad shares about their new program, “SPACE, which stands for Supporting Presence, Awareness, Connection, and Embodiment, is…about this deepening into the inner development work of therapists..” SPACE will focus on supporting more self-awareness and intrapersonal insight. The three levels that SPACE explores are the persona, interpersonal and transpersonal.  Brad acknowledges that the transpersonal level is not openly articulated in most clinical orientations, “and yet almost every therapist is oriented to it, on some level.” SPACE aims to create room for reflection on all three levels, despite which clinical modality one uses.  The hope being that it creates more effectiveness and fulfillment for therapists in their work with clients.

CTTC’s commitment to community engagement and thoughtful program development will culminate at its inaugural retreat in September 2025, which invites anyone who has trained in NARM or through CTTC to attend.  Brad shares that they decided not to structure it as a conference, where it feels more academic, and instead “it’s really about having time as a community to nourish each other on all levels.” While there will be time for great theoretical and cognitive nourishment, there’s also going to be programming designed for support, community engagement, and meaningful connection. “The best part of it is being together and having all these different connections in an environment where we can just be ourselves and connect deeper with one another,” he says. 

And, of course, CTTC will continue to be the home of this podcast. “This continues to be such an amazing place to get to share and support each other and learn from each other,” Stefanie says of Transforming Trauma. We couldn’t agree more.

Transforming Trauma is grateful to Brad and Stefanie for their continued generosity of spirit. We are grateful to CTTC for providing therapists with the clinical training, mentorship, ongoing consultation, community engagement, and personal support to realize increased well-being and fulfillment.

MENTIONED IN THIS EPISODE

The Practical Guide for Healing Developmental Trauma: Using the Neuroaffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma

RECOMMENDED EPISODES

Creating SPACE for Self-Discovery and Community Support for Therapists

Reflections for the New Year on Connection and Continued Growth for The NARM Training Institute with Faculty Members Brad Kammer, Stefanie Klein, and Marcia Black

GUEST BIOS

Brad Kammer is the Training Director and Senior Trainer at the Complex Trauma Training Center. He is a licensed marriage and family therapist, somatic experiencing practitioner, and NARM master therapist who has been in the trauma field for 25 years. He has co-authored The Practical Guide for Healing Developmental Trauma: Using the Neuroaffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma, which presents one of the first comprehensive therapeutic models for addressing adverse childhood experiences (ACEs) and complex post-traumatic stress disorder.

Stefanie Klein is the Assistant Training Director and Trainer in the Complex Trauma Training Center. She’s a licensed clinical social worker, NARM master therapist, consultant, and trainer. She has spent over 25 years in her Los Angeles private practice specializing in treating adults with trauma and anxiety disorders. Stephanie is excited to be part of the leadership of the Complex Trauma Training Center. She looks forward to continuing to support therapists who are looking to have more ease and efficacy in their practice.

Did you know that the diagnostic criteria for borderline personality disorder (BPD) has remained the same since it was officially added to the third edition of the Diagnostic and Statistical Manual for Mental Disorders in 1980? 

Forty years later, BPD remains deeply misunderstood by the public and isolating for those who live with the condition. One psychotherapist thinks it’s time for a change. He wants to help mental health professionals, especially those who are newer to the field, gain greater appreciation for the nuances inherent to the disorder and compassion for clients with BPD.

On this episode of Transforming Trauma, host Emily Ruth chats with Mark L. Ruffalo, MSW., D.Psa., about his extensive work in the field of borderline personality disorder. The pair discuss the history of BPD, its symptoms and characteristics, and overlap with C-PTSD. They also explore the agonizing realities of living with BPD and the moral judgments that many clients must endure. Mark also gives advice on how to apply effective psychotherapy when treating clients with BPD.

Mark has broad clinical experience in the psychoanalytic treatment of a range of psychiatric conditions, with particular interest in the psychotherapy of schizophrenia and borderline personality disorder.  “The term borderline––existing on the border between psychoneurosis and psychosis––has been used in psychiatry and psychology for 80 years or so,” Mark says. However, the concept of borderline personality disorder wasn’t operationalized until the 70s when John Gunderson argued that the core of BPD manifests itself in interpersonal relationships. “Very unstable, chaotic relationships,” observes Mark, adding, “often marked by a push-pull pattern where I’m going to push the other person away, then pull him or her back in towards me, and then I’m gonna push them away again.”

While the maladaptive behavior and communication strategies may have arisen as coping mechanisms in response to childhood trauma (BPD and C-PTSD are often co-occurring conditions), Mark cautions practitioners not to generalize. “A large percentage of BPD patients have endured horrendous childhood abuse. But, then you see cases where there really does not seem to be any evidence of childhood mistreatment, maltreatment, abuse, or neglect,” he says. “There’s good research to show that about 50% of BPD seems to be inherited, that there’s a genetic component to this condition.”

Treating clients with BPD poses unique challenges, especially for newer clinicians. Mark describes how he uses a clinical approach called transference-focused psychotherapy (TFP). “In TFP, the focus of the treatment is on the relationship between the patient and the doctor or the patient and the therapist,” Mark explains. “That becomes the arena in which all of these conflicts and problems and dilemmas play out.”  Similar to the intersubjective approach of NARM, the relational component becomes very important, particularly since many therapists struggle with strong countertransference reactions with clients with BPD.

One such countertransference reaction is when the therapist feels compelled to collude with a client’s distorted worldview. “Therapists can get into a lot of trouble if they repeatedly simply validate the patient’s externalizing defenses,” confides Mark. His advice for therapists is for them to recognize their narcissistic desire to be seen as helpful, then enlist ongoing support from a supervisor or peer group. “BPD is a very nuanced, complicated condition. And the relationship between you and the patient is even more complicated because you’ve got two psychologies at play. You’ve got the patient’s mind and your mind,” Mark emphasizes. “Any attempt to oversimplify this really complex condition is bound to fail.”

Transforming Trauma thanks Mark for challenging our community to reject the oversimplification of borderline personality disorder and practice greater discernment when entering into therapeutic relationships with clients living with BPD.  

GUEST CONTACT AND BIO

Website

Mark L. Ruffalo, M.S.W., D.Psa., is a psychotherapist in private practice in Tampa, Florida, and serves as Assistant Professor of Psychiatry at the University of Central Florida College of Medicine and Adjunct Instructor of Psychiatry at Tufts University School of Medicine. He has broad clinical experience in the psychoanalytic treatment of a range of psychiatric conditions with particular interest in the psychotherapy of schizophrenia and borderline personality disorder. During his training at the University of Pittsburgh, Mark worked with severely ill patients in long-term psychotherapy, an area in which he has developed significant expertise. 

He has published previously in the American Journal of Psychotherapy, Psychoanalytic Social Work, Psychiatric Times, and the Journal of Nervous and Mental Disease. He currently serves as Co-Director of the Psychotherapy Track at the UCF/HCA Orlando Psychiatry Residency Program and is the Founding Editor of The Carlat Psychotherapy Report. Mark’s current research interests include the object relations theory of borderline personality disorder; communication dilemmas, paradoxes, and double binds in personality pathology; and deficits in logical reasoning in psychotic and borderline states.

MENTIONED IN THIS EPISODE

Carlat Psychotherapy Report

John Gunderson, MD

I Hate You––Don’t Leave Me

Gerald Adler, MD

The Concept Of Paleologic Thinking According To Arieti

Joel Paris, MD

Marsha Linehan, PhD

Otto Kernberg, MD

Glen Gabbard, MD

Frank Yeoman, MD, PhD

The Menninger Clinic

Paul Watzlawick

RECOMMENDED EPISODES

What Good Psychotherapy Looks Like With Dr. Jonathan Shedler

Championing Relational Therapeutic Solutions in a Quick-Fix World With Dr. Jonathan Shedler

Personality and the Alchemy of Therapeutic Change with Nancy McWilliams, PhD

Sex is one of the most complex barriers to true intimacy in a relationship. It’s also one of the least-discussed topics in therapy, and not necessarily because couples are reluctant to talk about it. Instead, therapists often avoid discussing sex due to their perceived lack of subject knowledge or confidence in their therapeutic skills. However, one sexologist believes that therapists have already developed a baseline competency in sex-related issues simply by being human. Those trained in the NeuroAffective Relational Model® (NARM®) are even better positioned to help couples improve their physical and emotional bonds.

On this episode of Transforming Trauma, host Emily Ruth welcomes Clinical Sexologist and Psychologist Rikke Pristed to discuss the interplay between sex, trauma, and connection (or lack thereof). What are the protective behaviors or survival styles hindering honest communication in adult relationships, and do they differ between the genders? The pair also discuss best practices for applying NARM in couples therapy and strategies for supporting a client’s capacity to move beyond the performative and experience truly mind-blowing sex.

Rikke has worked as a therapist since 1999. She lives in Denmark, where she has a private practice focused on both couples and individual adults. Rikke has recently completed her NARM Master Training and is in the process of transforming her practice into a primarily NARM-oriented practice.

“I discovered through working with sexology that a lot of people have trauma that is not sharp trauma, not from being raped necessarily, but seems like it is rooted more deeply,” asserts Rikke. That realization led her to find a modality to better integrate the nuances of a client’s lived experiences, family dynamics, and cultural influences. “I stumbled upon NARM, and it just made so much sense to me,” she said. “It’s really enriched my work tremendously.”

Sexology, for those unfamiliar with the science, is the multidisciplinary study of human sexuality. “We look both at the biology and psychology of sexuality,” says Rikke, who further describes sexology as a biopsychosocial model. “It’s more like a holistic approach to what influences our sexuality and different sexual problems. For instance, erectile dysfunction or premature ejaculation, something that seems really physical or biological. But, it could also be lack of desire,” she says, a challenge that might stem from a psychological issue.

NARM provides couples with a foundation for identifying patterns that have become entrenched in their relationship and play out in their sex life. But how to conduct couples therapy sessions that utilized NARM but didn’t trigger the very strategies that Rikke was trying to help her clients overcome?

She recalls asking Brad Kammer, CTTC Director and NARM Senior Trainer, the same question. “He said it would be a good idea to do individual therapy [in addition to the couples work] because the relationship would benefit from that.” And, no wonder. It’s much easier to relate to yourself, your sexuality, and your relationship when your partner isn’t in the same room.

Rikke agrees. “I started splitting up my couples, and it’s really working out very well. I’m loving it, and they’re loving it. “

Transforming Trauma appreciates Rikke for her thoughtful use of NARM in couples therapy. Her work invites couples to explore their individual desires and reconnect with one another on a more open and honest level.

GUEST CONTACT AND BIO

Website

Rikke Pristed is a clinical psychologist, a clinical sexologist and has completed the Master Training with NARM. She has been working as a therapist since 1999. She lives in Denmark and has a private practice. She works with adults and sees both couples and individuals. She sees people both in person and online. Rikke is currently transforming her practice to become primarily NARM oriented. She is 53 years old and has three grown up children and 4, soon to be 5, grandchildren.

MENTIONED IN THIS EPISODE

Tell Me What You Want

Dr. David Schnarch

The Plissit Model

Recognition of neurodiversity has increased rapidly over the last decade. But as more people enter the discourse about cognitive functioning differences like ADHD, dyslexia, and autism, a polarization of opinions follows, even among mental health professionals.  How do we navigate important discussions about neurodivergence when many people are so quick to pathologize individuals for their differences? 

On this episode of Transforming Trauma, host Emily Ruth is joined by Daniel Morehead, MD., a leading voice for mental health advocacy and author of Science Over Stigma: Education and Advocacy for Mental Health. Before becoming director of Psychiatry Residency training at Tufts Medical Center in Boston, MA, he enjoyed 20 years of private practice in Austin, TX. 

Emily Ruth and Daniel examine what it means to be neurodivergent, the role variation plays in evolution, and the radical act of greeting neurodivergence with curiosity and humility. The pair also discuss the intersection between folks who have experienced trauma and those who identify as neurodivergent. 

Daniel has lofty goals for psychiatry and humanity in general. “It’s a vague one,” he admits, “but close to my heart––a shared experience of the wondrous complexity of what each human being is, individually, and the joy of exploring and better understanding that.” To that point, he has long advocated for mental health and adjacent professionals to move beyond merely acknowledging the stigma that often accompanies both the diagnosis and treatment of mental illness. Daniel advises folks to actively prevent causing harm in the first place. 

Our work begins with removing self-imposed barriers. “There’s no us people and those people,” says Daniel. “There’s not this illusory separation of, well, I’m a mental health professional and, then on the other side, there are people who have struggles or illnesses––as if I don’t have them.”

Daniel recommends that those in mental wellness and trauma care-related fields think more deeply and consistently about developing relationships. It’s wise counsel that mirrors the NeuroAffective Relational Model (NARM). In both instances, practitioners are invited to shift their attention away from ticking boxes in the DSM and focus on fostering meaningful connections––between therapist and client, client and society. “We share the suffering, but at the same time, [I’m] very inspired by talking to people about their experiences, pains, and even traumas. Not that it was good that it happened; it wasn’t,” he clarifies. “But, the wonder of how people survive and adapt and grow and heal is just so spectacularly beautiful.” 

In a culture that continues to force a singular “right way” of thinking, Daniel maintains that we must honor the myriad ways our brains and nervous systems differ. In that way, he posits, we include more people in society than we exclude. “Getting sick, having a disorder, having an illness, having things wrong with you developmentally––all of which I’ve experienced––they’re part of being human. And, we’re not less than.”

Transforming Trauma appreciates Daniel’s open-hearted approach to witnessing those who identify as neurodivergent. His work is a constant, compassionate reminder that neurodivergence is a process of evolution, and no one should feel ashamed of their differences.

GUEST CONTACT AND BIO

Psychiatric Times

Email

Daniel Moorhead, MD, is a psychiatrist who speaks nationally for mental health education. He is the author of Science Over Stigma: Education and Advocacy for Mental Health, and the Director of Psychiatry Residency Training at Tufts Medical Center in Boston, MA. Prior to this, he enjoyed a private practice in Austin, TX. For over 20 years, Dr. Morehead has maintained interest in psychotherapy, brain science, and spirituality.

QUOTES

“We’re human beings, and the human condition is that we all suffer. We are all subject to illness, inevitably.” 

“People dealing with trauma are, for good reason, often sensitive to misunderstanding or rejection or being left out or forgotten. And then, people with neurodiversity are often in the same position.”

“Being different is a setup for being wounded, if not traumatized.”

“We can do better as a culture, but I also want to say, sometimes when we think we’re perfecting our culture, we’re actually wounding a different set of people. We’re just changing the set of people that get wounded.”

“I have grown children. It was an embarrassment to me that I was a psychiatrist and I couldn’t ‘do better’ as a parent.” 

Dr. Jonathan Shedler needs no introduction on Transforming Trauma! The renowned psychologist, author, consultant, researcher, and clinical educator is perhaps best known for his article The Efficacy of Psychodynamic Psychotherapy, as creator of the Shedler-Westen Assessment Procedure (SWAP) for personality diagnosis and clinical case formulation, and co-author of the Psychodynamic Diagnostic Manual. He’s also the creator of PsychScan, an AI-guided assessment that frees therapists to treat clients rather than spend their valuable time assessing symptoms.

Dr. Shedler is perhaps slightly less well-known for having previously appeared on this podcast, where he shared his views on the defining characteristics of good psychotherapy. He also provided insight into the widening chasm between research conducted by academic psychologists and “real life” psychotherapy, as well as the common misconceptions around transference and countertransference.

On this episode of Transforming Trauma, host Emily Ruth welcomes Dr. Shedler back to expand on the original conversation, delving deeper into the elements that make up good psychotherapy and the importance of connection between therapist and client. The pair also explore critical flaws in the Diagnostic and Statistical Manual of Mental Disorders (DSM), how modern social subcultures provide a disturbing camouflage for disassociation, and the three pillars of an effective therapeutic working alliance.

“Health insurance companies don’t really like what I would call meaningful psychotherapy,” Dr. Shedler says, acknowledging the extreme pressure that psychotherapists are under on all sides to cure clients or release them in the most cost-effective time frame. Adding to the squeeze are academic psychologists who promote manualized therapy, a tight timeline of 8-12 sessions, as the gold standard of efficacy. Dr. Shedler wants therapists to understand the value of providing truly consequential psychotherapy no matter the time spent and feel confident in their skills despite the  “quick fix” messaging.

Connection is essential to providing and receiving good psychotherapy––and a guiding principle of the NeuroAffective Relational Model (NARM®). “[Therapy] has to take place in a relational context where we don’t feel under threat, where we can experience the therapy relationship as a safe harbor from which it becomes possible to explore the corners of our own minds,” explains Dr. Shedler, “including the dark corners.” Therein lies the first job of an effective psychotherapist: to create a secure relational attachment that makes it possible for the client to do the difficult work of examining all parts of themself.

Dr. Shedler hopes psychotherapists recognize how genuinely significant a step it is for clients to seek therapy in the first place. “When somebody comes to psychotherapy, there’s at least an implicit acknowledgment that there’s some way that [the client is] contributing to their own difficulties or perpetuating [the] difficulties,” he says. “The purpose of psychotherapy is to help people change something about themselves that, number one, is causing difficulties for them. Number two, is something that psychotherapy could realistically help them to change, and number three, is something that they would like to change about themselves; those three conditions must exist in order to do psychotherapy,” Building the container of trust required for those three conditions takes time, something that the DSM and manualized therapy don’t (or won’t) allow for.

“People want real therapy,” Dr. Shedler asserts, even in––or especially in––our fast-paced, relationally challenged society. “Real therapy means really getting to know people as individual humans.” He advises psychotherapists to honor their own humanity, undeterred by the DSM or insurance company rulings. “There’s so much pressure to compromise. Don’t give in.”

Transforming Trauma is extremely grateful to Dr. Shedler for his 25+ years of teaching psychologists, psychiatrists, and psychoanalysts how to provide meaningful therapy. We thank him for his generosity of time and wisdom.

MENTIONED IN THIS EPISODE

PsychScan

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TT114: Championing Relational Therapeutic Solutions In A Quick-Fix World

GUEST CONTACT AND BIO

Website

Jonathan Shedler, PhD, is an American psychologist known internationally as an author, consultant, researcher, and clinical educator. He is best known for his article The Efficacy of Psychodynamic Psychotherapy, which won worldwide acclaim for firmly establishing psychoanalytic therapy as an evidence-based treatment.

Dr. Shedler’s research and writing are shaping contemporary views of personality styles and their treatment. He is author of over one hundred scientific and scholarly articles, creator of the Shedler-Westen Assessment Procedure (SWAP) for personality diagnosis and clinical case formulation, and co-author of the Psychodynamic Diagnostic Manual (PDM-2 and forthcoming PDM-3). He has more than 25 years of experience teaching and supervising psychologists, psychiatrists, and psychoanalysts.

Dr. Shedler lectures internationally, leads workshops for professional audiences, consults to U.S. and international government agencies, and provides expert clinical case consultation to mental health professionals worldwide. He is a Clinical Professor in the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco (UCSF) and a faculty member at the San Francisco Center for Psychoanalysis.