The Carlat Psychiatry Podcast

Dr. Carla Sharp is a leading expert in Mentalization-Based Treatment (MBT), developmental psychopathology, and the treatment of personality disorders. She is the John and Rebecca Moores Professor of Clinical Psychology at the University of Houston, where she serves as Associate Dean for Faculty and Research and directs the Developmental Psychopathology Lab and the Adolescent Diagnosis, Assessment, Prevention, and Treatment Center. A prolific scholar with more than 380 peer-reviewed publications and eight books, she has made substantial contributions to the development and dissemination of mentalization-based approaches and is a certified supervisor and licensed trainer in MBT for both adults and adolescents. In this episode, Dr. Sharp offers a comprehensive introduction to MBT as a treatment for BPD — from what mentalizing is and how it develops through early “serve-and-return” interactions, to how disruptions in this capacity contribute to the difficulties characteristic of BPD. She takes clinicians inside an MBT session, explaining experience-near exploration, empathic validation, affect elaboration, and the mentalizing loop. She also unpacks the three pre-mentalizing modes — psychic equivalence, teleological mode, and pretend mode — and discusses the therapist’s use of self, the importance of maintaining a curious “not-knowing” stance, and how clinicians can recognize when a patient’s capacity to mentalize is strengthening.

Learning Objectives
After completing this educational activity, participants should be able to:
Define mentalizing and explain how disruptions in its development and functioning contribute to borderline personality disorder.
Describe how MBT uses experience-near exploration, empathic validation, and the mentalizing loop to strengthen a patient’s capacity to reflect on the mental states of self and others.
Identify the three pre-mentalizing modes — psychic equivalence, teleological mode, and pretend mode — and recognize when mentalizing has broken down in a clinical interaction.
Apply the MBT mentalizing stance, including curiosity, uncertainty, and therapist use of self, to support reflective functioning in patients with borderline personality disorder.

Topics Covered in This Interview
What mentalizing is and its role in psychological functioning
How mentalizing develops throgh early “serve-and-return” interactions
Mentalizing difficulties in borderline personality disorder
Strengthening mentalizing as the core treatment target of MBT
What an MBT session looks like in practice
Experience-near exploration and the mentalizing loop
Empathic validation and managing emotional arousal
Affect elaboration and working with underlying emotional experience
Mentalizing relationships with others and with oneself
How patients and therapists determine the focus of an MBT session
The three pre-mentalizing modes: psychic equivalence, teleological mode, and pretend mode
Recognizing when mentalizing has gone offline
The therapist’s use of self in MBT
The mentalizing stance: curiosity, uncertainty, and “not knowing”
Recognizing progress and the generalization of mentalizing outside therapy

Prescribing stimulants outside of ADHD is not illegal, but what Done did sent the clinical leader to jail. We look at what went wrong and what the charges were, and end with a research update that improves access to psychiatric care the honest way.

CME: Take the CME Post-Test for this Episode
Published On: 09/28/2026
Duration: 15 minutes, 25 seconds

Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Done paid clinicians by the refill, not the visit. We trace how a telehealth company built its business model around stimulant prescriptions. Along the way you’ll learn why amphetamines are the #1 stimulant in America, but rarely used outside the US.Plus: a research update on tapering and switching sleep medication.

CME: Take the CME Post-Test for this Episode
Published On: 09/21/2026
Duration: 26 minutes, 00 seconds

Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

This activity includes brief excerpts from interviews conducted by the faculty member with informants. The interviewees provided historical information and/or commentary as source material only. They did not participate in planning, developing, reviewing, editing, or approving the educational content of this CME activity and have no role in controlling its content. The faculty member independently selected, contextualized, and incorporated the interview excerpts into the presentation.

A Silicon Valley founder built a telehealth company to make ADHD treatment as easy as ordering takeout, until federal prosecutors traced 37 million pills of Adderall back to the clinic. We follow Done from venture-backed startup to criminal conviction, and ask what the case means for how we diagnose and treats ADHD. Plus: a new FDA approval adds a third option to the ADHD reuptake-inhibitor family.

CME: Take the CME Post-Test for this Episode
Published On: 09/14/2026
Duration: 13 minutes, 34 seconds

Chris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Today, we’re tackling a deceptively simple question that comes up all the time in clinical practice: When should we prioritize medication, when should we emphasize psychotherapy, and when can we recommend both? This question comes up especially often with patients who are new to treatment. They’ll ask, “Do I need a medication?” or “Can I just do therapy?” And while it’s tempting to answer in generalities, the evidence actually gives us much clearer guidelines, depending on the substance that the patient is using. 

CME: Take the CME Post-Test for this Episode
Published On: 09/07/2026
Duration: 10 minutes, 57 seconds

Noah Capurso, MD, and Suzanne Decker, PhD, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.