Practice in Action: Diagnosing Differentially

Practice in Action: Diagnosing Differentially

What happens when the symptoms fit… but the diagnosis doesn’t? In this episode of Psyched to Practice, Paul Wagner and Ray Christner break down the messy reality of differential diagnosis and why so many mental health conditions can look nearly identical on the surface. From ADHD and anxiety to autism, depression, sleep problems, medical conditions, and substance use, they explore how clinicians can avoid jumping to conclusions and start asking better questions. Ray shares practical ways to rule diagnoses in and out without getting trapped by confirmation bias, while Paul highlights how curiosity, collaboration, and ongoing assessment can completely change treatment outcomes. They discuss why diagnosis should be treated like a working hypothesis instead of a fixed answer, how overlapping symptoms create false positives, and the danger of diagnostic overshadowing when one diagnosis hides another. The episode also explores why women with ADHD were so often missed for years, how medical conditions can mimic mental health disorders, and why gathering information from parents, spouses, and caregivers can completely change the clinical picture. This episode is packed with practical insights for therapists, psychologists, counselors, and anyone trying to better understand the complexity behind mental health diagnosis. Brightminds Ad PAR Ad This episode is brought to you by PAR [https://www.parinc.com/home?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts]. Explore the AI Report Writer here: https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] Learn more about the RIAS-2 NU here: https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] To hear more and stay up to date with Paul Wagner, MS, LPC and Ray Christner, Psy.D., NCSP, ABPP visit our website at:  http://www.psychedtopractice.com [http://www.psychedtopractice.com]  “Be well, and stay psyched"

Masters in Practice: Prolonged Exposure for PTSD: Innovations to Improve Access, Engagement, and Outcomes

Why do so many therapists hesitate to use exposure therapy for PTSD, even when the research strongly supports it? In this episode of the Psyched to Practice podcast, Ray sits down with Dr. Carmen McLean and Dr. Elizabeth Goetter to unpack the myths, fears, and misunderstandings surrounding Prolonged Exposure Therapy (PE). Together, they explore why avoidance keeps PTSD symptoms alive, why many clinicians feel anxious delivering trauma-focused care, and what the science actually says about retraumatization, dropout rates, and treatment outcomes. The conversation also dives into some of the newest developments in PTSD treatment, including intensive treatment models, telehealth delivery, virtual tools, culturally responsive adaptations, and how PE is being used with complex comorbidities like substance use, borderline personality disorder, and suicidality. Along the way, they reflect on the legacy of Dr. Edna Foa, the pioneer behind PE, and discuss why evidence-based trauma treatment still remains out of reach for far too many people. This episode is packed with practical insight for clinicians, graduate students, and anyone interested in how trauma treatment continues to evolve. Their New Book: https://link.springer.com/book/10.1007/978-3-031-72720-7 [https://link.springer.com/book/10.1007/978-3-031-72720-7] Brightminds Ad PAR Ad This episode is brought to you by PAR [https://www.parinc.com/home?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts]. Explore the AI Report Writer here: https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] Learn more about the RIAS-2 NU here: https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] To hear more and stay up to date with Paul Wagner, MS, LPC and Ray Christner, Psy.D., NCSP, ABPP visit our website at:  http://www.psychedtopractice.com [http://www.psychedtopractice.com]  “Be well, and stay psyched"

Practice in Action: It's the Final (School Year) Countdown!

As the school year winds down, many students hit a wall. They’re tired, overwhelmed, and often feel like it doesn’t even matter anymore. Missing assignments pile up, motivation drops, and even high-achieving students start to question whether it’s worth the effort. In this episode, Paul and Ray break down what’s really happening during this final stretch. They explore why students feel “over it,” how burnout shows up differently across age groups, and what clinicians and parents can actually do to help. You’ll hear practical strategies for tackling missing work without overwhelm, using “good enough” in a productive way, and helping kids regain momentum when they feel stuck. They also address the stress around standardized testing and how to reframe it so it doesn’t define a child’s sense of self. This conversation is packed with real-world tools you can use immediately in sessions, at home, or in schools to help kids finish the year with less stress and fewer regrets. Brightminds Ad PAR Ad This episode is brought to you by PAR [https://www.parinc.com/home?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts]. Explore the AI Report Writer here: https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] Learn more about the RIAS-2 NU here: https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] To hear more and stay up to date with Paul Wagner, MS, LPC and Ray Christner, Psy.D., NCSP, ABPP visit our website at:  http://www.psychedtopractice.com [http://www.psychedtopractice.com]  “Be well, and stay psyched"

Masters in Practice: Real Skills for Real Life, DBT for Everyday Living w/ Dr. Jesse Finkelstein

What if the problem isn’t that your clients don’t have the right tools—but that the tools don’t feel usable in real life? In this episode, we sit down with Dr. Jesse Finkelstein to unpack how DBT moves beyond worksheets and into everyday decision-making. We break down what DBT actually is, why it works across diagnoses, and how its core ideas—like holding two truths at once—can shift the way clinicians think about change. You’ll hear how skills like mindfulness, distress tolerance, and emotion regulation show up in ordinary moments, not just crisis. We also explore why clients often avoid using skills, how to make them more engaging, and what it looks like to translate complex concepts into something people will actually use. If you’ve ever had a client say “I know what to do, I just don’t do it,” this conversation gives you a different way to approach that gap. His book: https://a.co/d/01LfKduu [https://a.co/d/01LfKduu]  Brightminds Ad PAR Ad This episode is brought to you by PAR [https://www.parinc.com/home?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts]. Explore the AI Report Writer here: https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] Learn more about the RIAS-2 NU here: https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] To hear more and stay up to date with Paul Wagner, MS, LPC and Ray Christner, Psy.D., NCSP, ABPP visit our website at:  http://www.psychedtopractice.com [http://www.psychedtopractice.com]  “Be well, and stay psyched"

Masters in Practice: School Refusal Behavior & Family Collaboration w/ Tom Brant, Eric Elias, & Courtney Huguenin

School refusal isn’t just about kids staying home. It shows up in subtle ways—frequent nurse visits, missed classes, late arrivals, and quiet disengagement that often goes unnoticed until it becomes a major problem. In this episode, we break down what’s actually driving school refusal behavior and why a one-size-fits-all approach doesn’t work. Drawing from real clinical and school-based experience, we explore the four core functions behind these behaviors and how they often overlap in ways that make intervention more complex than it seems. You’ll hear how anxiety, avoidance, attention-seeking, and access to more rewarding alternatives all play a role—and how modern factors like virtual learning, technology, and shifting family dynamics are changing the landscape. We also walk through practical, evidence-based strategies that clinicians, schools, and families can use together. From distress tolerance and exposure work to environmental changes and caregiver collaboration, this episode focuses on what actually helps move kids back toward consistent school engagement. If you’re working with students who are struggling to attend—or families who feel stuck—this conversation will give you a clearer framework and more confidence in how to respond. Brightminds Ad PAR Ad This episode is brought to you by PAR [https://www.parinc.com/home?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts]. Explore the AI Report Writer here: https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/ai-report-writer?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] Learn more about the RIAS-2 NU here: https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts [https://www.parinc.com/product/groups/rias-rist-assessments?utm_campaign=38111624-Psyched%20to%20Practice%202026&utm_source=P2P%20Podcast&utm_medium=Related%20Podcasts] To hear more and stay up to date with Paul Wagner, MS, LPC and Ray Christner, Psy.D., NCSP, ABPP visit our website at:  http://www.psychedtopractice.com [http://www.psychedtopractice.com]  “Be well, and stay psyched"