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

DBT for LGBTQ+ Mental Health: Self-Love, Emotional Resilience & Queer Joy With Dr. Kiki Fehling

What does DBT look like when it is truly LGBTQ+ affirming? In this episode of The Self Careapist Therapist, I sit down with Dr. Kiki Fehling to talk about DBT for LGBTQ+ mental health, minority stress, queer joy, self-love, emotional resilience, and what it means to apply skills in a way that actually honors context. We talk about why being queer is not the source of mental health harm, how anti-queer environments shape emotion dysregulation, and why DBT can be especially helpful when clinicians understand the transaction between identity, biology, environment, invalidation, and safety. If you are a therapist working with LGBTQ+ clients, or if you are trying to deepen your affirming practice beyond good intentions, this conversation offers a thoughtful clinical lens. Listen to the full episode of DBT for LGBTQ+ Mental Health: Self-Love, Emotional Resilience & Queer Joy With Dr. Kiki Fehling. Dr. Kiki Fehling, Ph.D., is a licensed psychologist and Linehan-Board-certified Dialectical Behavior Therapy (DBT) expert therapist. She specializes in emotional sensitivity, borderline personality disorder, self-harm and suicide, trauma, and LGBTQ+ mental health. She is the co-author of Self-Directed DBT Skills: A 3-Month DBT Workbook and regularly shares mental health tips and DBT-related posts through her @dbtkiki social media accounts. Her work focuses on making DBT skills more accessible and affirming for LGBTQ+ people, especially around self-love, emotional resilience, minority stress, and queer joy. Website: https://www.kikifehling.com/   [https://www.kikifehling.com/] Instagram: https://www.instagram.com/dbtkiki/  [https://www.instagram.com/dbtkiki/] Li: https://www.linkedin.com/in/drkikifehling/ [https://www.linkedin.com/in/drkikifehling/] FB: https://www.facebook.com/drkikifehling/  [https://www.facebook.com/drkikifehling/] Tiktok: https://www.tiktok.com/@dbtkiki [http://www.tiktok.com/@dbtkiki] 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!

Interracial Marriage: Love, Identity, and Navigating Differences with Geoffrey Greif and Victoria D. Stubbs

What can interracial couples teach therapists about race, family systems, and the conversations many clients are still learning how to have? In this episode of The Self Careapist Therapist, I sit down with Dr. Geoffrey Greif and Victoria D. Stubbs, LCSW, co-authors of Interracial Marriage: How Diverse Couples Navigate Relationships. We talk about what hundreds of interviews with interracial and interethnic couples revealed about communication, family approval, identity, power, children, language, safety, and the daily accommodations many couples learn to make. We also explore how therapists can approach these conversations with more humility, curiosity, and clinical nuance. Victoria shares how the six pillars of a brave space framework can support conversations about race, power, privilege, oppression, and identity, while Geoffrey highlights what research interviews can reveal that surveys often miss. Listen to this episode of Interracial Marriage: Love, Identity, and Navigating Differences with Geoffrey Greif and Victoria D. Stubbs Dr. Geoffrey Greif is a professor at the University of Maryland School of Social Work, researcher, author, and co-author of Interracial Marriage: How Diverse Couples Navigate Relationships. His work spans family relationships, fathers, adult sibling relationships, group work, and interracial marriage research. Website: https://geoffreygreifbooks.com [https://geoffreygreifbooks.com] Victoria D. Stubbs is the founder of Inner Truth Psychotherapy and Wellness, co-author of Interracial Marriage: How Diverse Couples Navigate Relationships and was previously a full-time clinical instructor at the University of Maryland School of Social Work.  Website: https://www.innertruthllc.com/ [https://www.innertruthllc.com/] Instagram: https://www.instagram.com/innertruthllc/ [https://www.instagram.com/innertruthllc/] Discover how love transcends boundaries — click the link to grab your copy of Interracial Marriage: How Diverse Couples Navigate Relationships in a Divided Time and explore the powerful, real stories that remind us that connection is stronger than division!  Buy the Book Here: https://www.amazon.com/Interracial-Marriage-Diverse-Navigate-Relationships/dp/0231218192 [https://www.amazon.com/Interracial-Marriage-Diverse-Navigate-Relationships/dp/0231218192] 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!

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 them down, and choosing methods that move those processes. The label you attach to it matters less than whether it works for that person. * Dr. Hayes recommends two starting points for clinicians: (1) do a perceived causal network with your client — map what matters, what helps, what hurts — and (2) track those nodes over time with a small number of personalized items. He has been doing this with himself for years. * ACT has more randomized trials from lower- and middle-income countries than any other psychotherapy model. Dr. Hayes attributes this to the process-based approach: when clinicians are empowered to apply principles in their own cultural language, the framework travels. Resource 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!