Lots of us treat simple, limited problems that benefit from brief psychotherapy, like insomnia or phobias.

Today, Alan Francis shows us how to adjust our approach for problems that are simple and those that are complex.

Welcome to the Carlite Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chrisaken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Alan Francis wears many hats, but none of them quite capture who he is as a psychiatrist.

He chaired the fourth edition of DSM, but he's also a vocal critic of the manual's diagnostic overreach.

He is a biological psychiatrist who specializes in psychotherapy, and a trained psychoanalyst who advocates for CBT.

In my own career, I was always a few steps behind him.

I started training at Cornell, where Alan had recently left to become chair at Duke.

Then I moved to Duke, where he had just stepped down his chair and left, and in both

institutions, he left a strong legacy. He was one of the most talked about attendings, even in his

absence. At last, I caught up to him in this interview, but in no way can I say that I

pin down his ever-roving and creative mind.

Thank you for joining us, Alan. A lot of people probably know you for your work on DSM-4,

but tell us about your work as a psychotherapist.

The way I see it, psychotherapy is part of every contact of the patient. So I don't see

psychotherapy is something you only do in 45-minute sessions. I see psychotherapy is something

you're doing. If you see someone for 15 minutes in the emergency room, that's psychotherapy. So it's always a very big part of all my clinical practice and everything I did

clinically. But also, I spent a great deal of time and energy and interest in teaching psychotherapy

and also in trying to develop programs that would help to unify psychotherapy so that people wouldn't come out saying,

I'm a psychodynamic psychotherapist, I'm a cognitive therapist, on a behavioral therapist,

...