Self Careapist Therapist Podcast

Radically Open DBT (RO-DBT): A Clinical Approach to Emotional Overcontrol With Ellen Astrachan-Fletcher

Your most contained, rule-following, hardest-working clients may be the ones standard DBT is least equipped to help. In this episode of Self Careapist Therapist, I sit down with Dr. Ellen Astrachan-Fletcher, lecturer at Northwestern University's Feinberg School of Medicine, Associate Professor of Psychiatry at UIC, and owner of EAF ReCenter. With over 30 years of clinical and teaching experience, Dr. Astrachan-Fletcher is a nationally recognized expert in both DBT and Radically Open DBT (RO-DBT). She is the co-author of two clinical workbooks used in eating disorder treatment programs across the country, and her third book, RO-DBT for Anxiety, is set for release in August 2026. We cover what RO-DBT is, who it's designed for, how it differs from standard DBT, and what a training path looks like for clinicians who want to learn it. What You'll Learn in This Episode: Radically Open DBT was developed by Dr. Tom Lynch after observing that many clients, particularly those with chronic depression, restrictive eating disorders, and anxiety, were not responding to standard DBT. Standard DBT targets emotional dysregulation, helping clients learn to contain and control. RO-DBT does the opposite: it targets emotional overcontrol, the pattern of holding emotions in, appearing fine, and disconnecting from authentic social signaling. Dr. Astrachan-Fletcher explains the concept of emotional leakage, the moments when a tightly controlled client expresses emotion in unexpected, often indirect ways. She walks through the three core treatment targets in RO-DBT: flexibility, receptivity and openness, and true connection. True connection, she is careful to clarify, is not having a large social network. It is the felt experience of being known and loved even in your most uncomfortable truths. We also discuss emotional loneliness, what Tom Lynch identifies as the core suffering of overcontrolled clients: feeling utterly alone in a room full of people. Dr. Astrachan-Fletcher explains how this loneliness develops from the overcontrolled pattern of masking inner experience and what RO-DBT teaches clients to do differently. Other topics from this conversation: The temperament and developmental origins of overcontrol, including the role of threat sensitivity and detail focus in shaping coping early in life. The three mind states in RO-DBT: fixed mind, fatalistic mind, and flexible mind, and how each shows up in session. The clinical presentation differences between emotionally undercontrolled and overcontrolled clients, and how easy it is to misread a controlled client as doing well. Why RO-DBT calls its group component a "class" rather than a group, and what that distinction signals about how overcontrolled clients experience social environments. How RO-DBT is transdiagnostic, reaching across depression, OCPD, restrictive eating disorders, anxiety, and several personality disorders.  Resources Mentioned: Official RO-DBT Training Site: radicallyopendbt.net EAF ReCenter (Dr. Astrachan-Fletcher's practice): eaf-recenter.com RO-DBT for Eating Disorders workbook by Dr. Astrachan-Fletcher RO-DBT for Anxiety (forthcoming, August 2026) by Dr. Astrachan-Fletcher Key Points: 00:00 Introduction 03:19 Emotional overcontrol defined 06:51 Overcontrol as the “high road” 09:03 DBT and RO-DBT as dialectics 12:50 Leakage in real life 15:05 Flexibility, openness, true connection 19:49 Social signaling 23:57 Frozen and masked expressions 25:28 Mirror neurons and Botox 28:02 The eyebrow wag 31:29 Self-inquiry and Malamati Sufism 35:38 Self-inquiry meets EMDR 39:14 Mindfulness differences 43:36 Playfulness and teasing 45:35 Screening and self-reporting 50:00 Skills class structure 53:28 Diagnoses that respond to RO-DBT 58:02 Self-care recommendation Ellen Astrachan-Fletcher is a licensed clinical psychologist, Founder of EAF reCenter, and expert in eating disorders, DBT, and Radically Open DBT (RO-DBT). With nearly three decades of experience spanning academia, clinical leadership, supervision, and training, she specializes in helping individuals cultivate authentic connection and emotional resilience.  Website: https://www.eaf-recenter.com/ [https://www.eaf-recenter.com/]   LI: https://www.linkedin.com/in/ellen-astrachan-fletcher-ph-d-ceds-s-faed-a2aa8151/?isSelfProfile=false [https://www.linkedin.com/in/ellen-astrachan-fletcher-ph-d-ceds-s-faed-a2aa8151/?isSelfProfile=false]    Lorain Moorehead is a therapist, consultant, and EMDR Certified, EMDRIA‑approved consultant specializing in trauma‑informed care and EMDR integration. She works with high‑achieving adults navigating anxiety, perfectionism, identity loss, and relational stress through depth‑oriented, evidence‑based approaches. Lorain brings advanced training in DBT and certification in Perinatal Mental Health, grounding her work in safety, attunement, and nervous‑system awareness. She also supports clinicians through supervision, consultation, and training, with a strong focus on ethical practice and clinical decision making.  Website: https://lorainmoorehead.com/ [https://lorainmoorehead.com/]    LinkedIn: https://www.linkedin.com/in/lorainmoorehead/ [https://www.linkedin.com/in/lorainmoorehead/]   Instagram: https://www.instagram.com/theselfcareapist/ [https://www.instagram.com/theselfcareapist/]   TikTok: https://www.tiktok.com/@theselfcareapist [https://www.tiktok.com/@theselfcareapist]    YouTube: https://www.youtube.com/playlist?list=PLjS1AkQopGeVq6eP-1j7Y4i-oloOPSJmw [https://www.youtube.com/playlist?list=PLjS1AkQopGeVq6eP-1j7Y4i-oloOPSJmw]   The Self Careapist Therapist Podcast is a biweekly conversation with Lorain Moorehead, LCSW a therapist in private practice.  With guests ranging from expert psychologists, therapists, researchers and authors, each episode offers a deep dive and keeps listeners from intern to advanced supervisor  in mind while dropping gems and aha moments for everyone who loves to learn! If you love learning and want to keep track of some future learning opportunities, grab your personal curriculum [https://lorainmoorehead.com/podcast] here! If you liked this episode, feel free to subscribe and leave a review! Your support helps us be a top mental health podcast and resource.  See you next week!

Why Clients Skip Their Second EMDR Session (And What It's Telling You)

Moments of hesitation after a first EMDR session often signal that meaningful work has already begun.   In this episode of The Self Careapist Therapist, I break down what’s really happening when clients feel unsure about continuing EMDR after their first session. I walk through common reactions like exhaustion, vivid dreams, confusion, and the sense that something shifted without fully understanding why.  I also talk about how to respond clinically. Sometimes it’s about better debriefing and helping clients understand what their brain is doing. In some cases, hesitation points to something deeper. Slowing down, strengthening safety, and meeting the client where they are can make the difference between dropout and meaningful progress. Let this episode sharpen how you interpret hesitation in your clients. Watch now Why Clients Skip Their Second EMDR Session (And What It's Telling You). Lorain Moorehead is a therapist, consultant, and EMDR Certified, EMDRIA‑approved consultant specializing in trauma‑informed care and EMDR integration. She works with high‑achieving adults navigating anxiety, perfectionism, identity loss, and relational stress through depth‑oriented, evidence‑based approaches. Lorain brings advanced training in DBT and certification in Perinatal Mental Health, grounding her work in safety, attunement, and nervous‑system awareness. She also supports clinicians through supervision, consultation, and training, with a strong focus on ethical practice and clinical decisionmaking. In 2025, she launched The Self Care‑apist Therapist Podcast, creating space for therapists to explore innovative, research‑backed modalities—including emerging conversations around KAP and trauma treatment. Website: https://lorainmoorehead.com/ [https://lorainmoorehead.com/]    LinkedIn: https://www.linkedin.com/in/lorainmoorehead/ [https://www.linkedin.com/in/lorainmoorehead/]   Instagram: https://www.instagram.com/theselfcareapist/ [https://www.instagram.com/theselfcareapist/]   TikTok: https://www.tiktok.com/@theselfcareapist [https://www.tiktok.com/@theselfcareapist]    YouTube: https://www.youtube.com/playlist?list=PLjS1AkQopGeVq6eP-1j7Y4i-oloOPSJmw [https://www.youtube.com/playlist?list=PLjS1AkQopGeVq6eP-1j7Y4i-oloOPSJmw]   The Self Careapist Therapist Podcast is a biweekly conversation with Lorain Moorehead, LCSW a therapist in private practice.  With guests ranging from expert psychologists, therapists, researchers and authors, each episode offers a deep dive and keeps listeners from intern to advanced supervisor  in mind while dropping gems and aha moments for everyone who loves to learn! If you love learning and want to keep track of some future learning opportunities, grab your personal curriculum [https://lorainmoorehead.com/podcast] here! If you liked this episode, feel free to subscribe and leave a review! Your support helps us be a top mental health podcast and resource.  See you next week!

ACT Then and Now: Why the Originator Turned a Framework Into an Invitation with Dr. Steven C. Hayes

What does it actually mean to practice ACT — and how would you know if you already are? Dr. Steven C. Hayes, the originator of acceptance and commitment therapy, joins the podcast to talk about the 45-year arc of ACT's development, where the field of psychotherapy has gone wrong, and what it would mean to truly serve the person sitting in front of you. This conversation covers the six core processes of psychological flexibility, why randomized controlled trials may be misleading your clinical work, and why Dr. Hayes thinks every therapist should start by trying ACT on themselves. If you have been ACT-curious, or if you have been using elements of it without naming it, this episode gives you the bones. Episode Timestamps 0:00 — Introduction 1:27 — What ACT is, and why it may already be in your practice 2:41 — ACT in a single sentence: open, aware, and actively engaged 4:48 — The origin story: personal suffering, panic disorder, and the limits of existing evidence-based therapy 8:08 — Did ACT precede DBT? Dr. Hayes on Marsha Linehan and the shared roots of third-wave approaches 10:35 — Process-based therapy: why the technique matters less than the mechanism 13:29 — What to do instead of drawing a fence around your modality 21:27 — The six core processes of psychological flexibility, explained one by one 29:32 — Reaching more people: how ACT is being used in lower- and middle-income countries 33:28 — Why your journal articles may be statistically misleading you (the ergodic theorem) 38:30 — Idiographic measurement: tracking the individual, not the aggregate 43:00 — PsychFlex and the Personalized Life Assessment Network: tools you can use now 48:51 — The eugenics roots of standard statistical methods in psychology 52:29 — The neurodiversity movement and what it gets right 56:00 — Outcome measurement that fits the actual person 1:01:35 — Where ACT is going: empowering clinicians from the bottom up Episode Highlights * ACT is not a set of techniques. It is a model built around processes of change — the small, repeatable behaviors that lift people up or push them down. A new randomized trial is published on ACT every two days. * Psychological flexibility — learning to be more open, aware, and actively engaged in meaningful life — is the core target of ACT. Dr. Hayes argues it is also the mediating mechanism behind DBT, MBCT, and most other third-wave approaches. * The six core processes of ACT are organized around three pairs: openness (cognitive defusion and acceptance), awareness (flexible attention and a transcendent sense of self), and engagement (values and committed action). They are not six separate things — they work as a system. * The statistical methods clinicians rely on — Pearson's R, analysis of variance, factor analysis — were developed by eugenicists and assume that differences between people predict any individual's future. The ergodic theorem, proven in the 1930s, demonstrates mathematically that this assumption is false. * Process-based therapy means starting with the person in front of you, identifying which processes are lifting them up or pushing the The Self Careapist Therapist Podcast is a biweekly conversation with Lorain Moorehead, LCSW a therapist in private practice.  With guests ranging from expert psychologists, therapists, researchers and authors, each episode offers a deep dive and keeps listeners from intern to advanced supervisor  in mind while dropping gems and aha moments for everyone who loves to learn! If you love learning and want to keep track of some future learning opportunities, grab your personal curriculum [https://lorainmoorehead.com/podcast] here! If you liked this episode, feel free to subscribe and leave a review! Your support helps us be a top mental health podcast and resource.  See you next week!

Accelerated Resolution Therapy (ART): How It Compares to EMDR with the founder, Lainey Rosenzweig, LMFT

What happens when a therapist takes EMDR training, loves the eye movements, and throws out the protocol entirely? Laney Rosenzweig did exactly that. In 2007, she walked out of an EMDR training room convinced there was a better way. Eighteen years later, ART (Accelerated Resolution Therapy) has been trained at military bases, studied at Mayo Clinic and Yale, and is resolving complex trauma in a single session. Laney joins the show to break down how ART works, who it helps, and what the training path looks like for licensed clinicians. Episode Timestamps •       0:38 - The origin story of ART •       9:27 - Modifications since the stroke and continued dedication •       10:14 - Commonalities between ART and EMDR origins •       11:48 - Eye movements vs. other bilateral stimulation methods •       13:45 - Positization and the role of humor in ART •       15:32 - The ART script and how it restructures trauma •       17:14 - ART training at military bases and Walter Reed •       18:33 - ART as a foundational model vs. EMDR •       19:24 - Free association vs. guided protocol •       22:56 - How to set expectations with new ART clients •       24:25 - The role of metaphor in ART •       26:23 - Staying passionate after decades of clinical work •       28:30 - What to expect from the basic three-day training •       31:43 - Practicum structure and the three-to-one ratio •       33:25 - Advanced training and credentialing pathway •       36:09 - Who is not a candidate for ART •       37:19 - How to explain ART to a new client •       39:56 - Working with children and the SAFT technique •       42:53 - Training licensed therapists and ethical considerations •       44:30 - Becoming an ART trainer •       47:36 - How ART grew through word of mouth and research •       54:03 - Free intro sessions and getting started •       58:12 - Self-care through ART Episode Highlights •       ART was developed after Laney found EMDR's free association protocol too unpredictable. By placing eye movements directly on the problem and building in a structured end point, she created a model that consistently resolves trauma in one session. •       The core mechanism is image rescripting combined with eye movements. Rather than asking clients to free associate, the ART script guides the brain to replace distressing images with positive ones, which Laney calls positization. •       Humor is a deliberate part of the ART approach. Laney gave the example of a palmetto bug phobia transformed into a favorable image of Willie Nelson. When clients can bring lightness to a previously terrifying image, the therapeutic shift has taken hold. •       Metaphor is built into the model, not added as an option. The brain processes in images during sleep, and ART mirrors that process. Clients who resist direct confrontation of a trauma can work entirely through metaphor, including a structured script for clients who fear change. •       ART is not free association. Unlike EMDR, the therapist guides the protocol from start to finish. Clients know what to expect and sessions have a clear endpoint, which Laney found critical for both therapist confidence and client safety. •       The three-day basic training The Self Careapist Therapist Podcast is a biweekly conversation with Lorain Moorehead, LCSW a therapist in private practice.  With guests ranging from expert psychologists, therapists, researchers and authors, each episode offers a deep dive and keeps listeners from intern to advanced supervisor  in mind while dropping gems and aha moments for everyone who loves to learn! If you love learning and want to keep track of some future learning opportunities, grab your personal curriculum [https://lorainmoorehead.com/podcast] here! If you liked this episode, feel free to subscribe and leave a review! Your support helps us be a top mental health podcast and resource.  See you next week!

Complex Trauma Approaches That Don't Retraumatize: The Four Blinks Version of Flash Technique

Can Flash technique fully and permanently resolve a trauma memory in a single session, with almost no distress, even in clients with complex PTSD? Thomas Zimmerman has been answering that question for four and a half years, and his answer is yes. In this episode, he walks through the science, the structure, and the live protocol of the Predictive Processing Flash technique (formerly Four Blinks Version of Flash), with me as the client. Thomas is a mental health therapist, EMDR consultant, author, podcaster, and trainer based in Cleveland, Ohio. He developed his version of the Flash technique, originally called Four Blinks, around a predictive mind model of the brain. He explains why that model changes how we understand trauma, memory, and healing, and why it means every client is capable of change. We cover the four resourcing tools that make this approach safe for complex presentations, how Flash differs from EMDR in every structural and theoretical way, and what is actually happening in the nervous system during a session. Then we do a live demo. I work through a real memory in real time. Thomas also offers free Flash trainings every two weeks, free bi-monthly consultation, and a free weekly self-care Flash group for trained clinicians. This is a conversation worth sharing with every trauma-focused colleague in your network. Resources: https://emdrwithcomplextrauma.com/, https://thomaszimmerman.us/ [https://thomaszimmerman.us/], https://emdrcleveland.com/ 1:00 - Thomas's background: 10 careers, trauma work, and finding Flash 3:10 - From CBT to EMDR to Flash, and why each mattered 5:32 - Watching 70 consecutive clients resolve trauma without significant distress 6:29 - Flash is not a resource. How Zimmerman changed his understanding 8:29 - The working mechanism: how Flash actually resolves memory 9:20 - Why Zimmerman moved away from the triune brain model 11:28 - The predictive mind model: predictions, error, and precision weighting 14:07 - Why effective trauma approaches feel culturally non-intuitive 19:00 - Demo setup: orienting to what Flash asks you to do 20:25 - Resource 1: Container 22:09 - Resource 2: Shop Vac 26:17 - Resource 3: Pleasant (Calm) Scene 28:44 - Resource 4: Sensory Grounding 34:06 - Selecting the memory and setting up the live demo 37:34 - The Flash demo begins 44:22 - The memory resolves: checking for distress on all channels 47:06 - The positive cognition that installed on its own 51:41 - Neurobiological debrief: what just happened in the predictive mind 58:18 - Free Flash trainings, consultation, and the weekly therapist self-care group 59:49 - Why Thomas offers all of this at no charge 1:02:43 - Thomas's book and the metaphorical index 1:05:19 - Self-care: what Flash has done for Thomas personally Episode Highlights * Flash technique fully and permanently resolves trauma memories, not just reduces distress before EMDR. Zimmerman watched 70 consecutive clients complete full adaptive resolution before he changed how he understood the modality. The Self Careapist Therapist Podcast is a biweekly conversation with Lorain Moorehead, LCSW a therapist in private practice.  With guests ranging from expert psychologists, therapists, researchers and authors, each episode offers a deep dive and keeps listeners from intern to advanced supervisor  in mind while dropping gems and aha moments for everyone who loves to learn! If you love learning and want to keep track of some future learning opportunities, grab your personal curriculum [https://lorainmoorehead.com/podcast] here! If you liked this episode, feel free to subscribe and leave a review! Your support helps us be a top mental health podcast and resource.  See you next week!