Reality in Dialogue

Personality

Levels Over Labels: The Neurotic Personality

Irene Hurford MD on April 13, 2026

Some analysts approach diagnosis differently from the DSM. This overview of neuroticism uses levels of personality organization as a framework.

Some analysts approach diagnosis differently from the DSM. This overview of neuroticism uses levels of personality organization as a framework.

Psychoanalysis

Psychoanalysis Is a Type of Exposure Therapy

Irene Hurford MD on April 7, 2026

What do exposure therapy and psychoanalysis have in common? More than you think.

What do exposure therapy and psychoanalysis have in common? More than you think.

Psychosis

How to Start Dynamic Psychotherapy for Psychosis

Irene Hurford MD on March 28, 2026

Psychodynamic therapy for psychosis is transformative, but many therapists don't know where to start. I'd start here.

Psychodynamic therapy for psychosis is transformative, but many therapists don't know where to start. I'd start here.

Psychosis

Treating Psychosis: Why We Aren't Hearing Our Patients

Irene Hurford MD on March 19, 2026

Why therapists and M.D.s can't and don't listen with curiosity to their psychotic patients.

Why therapists and M.D.s can't and don't listen with curiosity to their psychotic patients.

Psychoanalysis

The Unexpected Benefit of Joining a Dying Profession

Irene Hurford MD on March 16, 2026

Personal Perspective: Once, psychoanalysis was all the rage. Now it's a bit of a pariah. Perfect. Let's join.

Personal Perspective: Once, psychoanalysis was all the rage. Now it's a bit of a pariah. Perfect. Let's join.

Mental Health Stigma

"Schizophrenia": A Label Without a Disease

Irene Hurford MD on March 11, 2026

For over a hundred years, the specter of a schizophrenia diagnosis has frightened patients and their families. Yet it confers no useful meaning for treatment or prognosis.

For over a hundred years, the specter of a schizophrenia diagnosis has frightened patients and their families. Yet it confers no useful meaning for treatment or prognosis.

Psychiatry

From River to Stream: How Vulnerability Becomes Illness

Irene Hurford MD on March 1, 2026

Our psychological development runs through our lives like a river. Trauma and adversity can act like a dam.

Our psychological development runs through our lives like a river. Trauma and adversity can act like a dam.

Trauma

Stop Playing Whac-A-Mole With Trauma

Irene Hurford MD on February 23, 2026

After trauma, sometimes a symptom is a communication, not another diagnosis.

After trauma, sometimes a symptom is a communication, not another diagnosis.

Psychosis

We Don't Know How Little We Know

Irene Hurford MD on February 20, 2026

Treating people with psychosis has helped me to understand how Americans can live in very different subjective realities.

Treating people with psychosis has helped me to understand how Americans can live in very different subjective realities.

Psychosis

How We Define Psychosis Matters

Irene Hurford MD on February 15, 2026

Psychosis is characterized by uncertainty and confusion—feelings that virtually everyone has experienced, albeit not to the same degree. Here's why acknowledging that could help reduce stigma.

Psychosis is characterized by uncertainty and confusion—feelings that virtually everyone has experienced, albeit not to the same degree. Here's why acknowledging that could help reduce stigma.

Child Development

Why Do Children Hear Voices?

Irene Hurford MD on February 13, 2026

There are multiple reasons children hear voices, and not all of them are worrying.

There are multiple reasons children hear voices, and not all of them are worrying.

Psychosis

Building a House: Treating Psychosis With Anti-Psychotics

Irene Hurford MD on February 12, 2026

Can anti-psychotics do all the work of healing from psychosis?

Can anti-psychotics do all the work of healing from psychosis?