Counseling Services

With my concierge practice, you have direct access to me, your clinician - there’s no secretary, receptionist, answering service, virtual assistant, or case manager to go through. If you reach out after business hours on weeknights, weekends, or holidays, you will not be handed off to an on-call therapist you've never met who doesn't know your case; you will hear back directly from me. 

In contrast to the heavy caseload that is typical of agency work, as a concierge therapist, I schedule fewer clients so I can devote more time and energy to each of you and provide more flexible scheduling options. I deliberately set aside time between clients to think about your sessions, plan follow-up treatment strategies, communicate or collaborate with your other healthcare providers, and leave an opportunity to continue past the scheduled time if you find you need to extend your session because you've had a rough week or you're in the middle of a breakthrough. 

I offer extended hours during evenings and weekends to provide flexibility and accommodate different schedules. See my therapy services and fees page for scheduling details. 

I offer same-day service for emergencies for clients who have been through the intake process, though we may meet for emergencies by phone rather than video. 

If you're a current client, you'll have access to me between sessions via text messaging seven days a week for appointment-related concerns and other quick questions. Your questions do not have to be urgent. If you're a current client, you can text me any time. My notifications settings are silent, so you can text when it's convenient for you.  For current clients, I respond to phone calls and emails quickly, within 24 hours or less, seven days a week, often within the hour. 

You will have direct access to your private therapy and training site between sessions so you are never without content to learn, skills to work on, and activities to enhance your healing. 

Unlike agency and insurance-based practices, decisions about your care are made by you and me - client and clinician - not by insurance companies, and not by administrators who have not seen you for therapy and who may or may not have clinical training. Insurance companies dictate the length, frequency, and duration of your sessions, and require certain types of diagnoses before they will authorize your treatment as “medically necessary.” They may even insist on locking you into a diagnosis much earlier than some diagnoses should be determined, saddling you with a label that follows you anywhere your medical record is shared. The freedom to diagnose only when warranted allows us to favor a wellness model rather than focus exclusively on the illness model inherent to the medical field. Your treatment is based on your presenting problems and goals, whether or not they support a formal diagnosis. 

Treatment is designed around what works for your needs. I treat you as the one-of-a-kind person you are instead of subjecting you to a one-size-fits-all approach. My treatment planning process is research-based, but it's also creative, innovative, and tailored to your individual needs and goals. Your treatment plans are unique to you. Your treatment plan is an outline of the things you want to work on, and it is written in language that makes it clear what’s expected of both of us. 

My policies and procedures are designed and implemented directly by me, not by a bevy of non-clinical professionals and consultants who have never met you. This person-centered approach emphasizes transparency, integrity, and accountability.

Devoting thorough attention to a small caseload allows me to show up for you and be fully present because it prevents therapist overload, inattentiveness, and burnout. I will always give you my 100% best. An hour-long session is a full hour, not 45-50 minutes. Same with a half hour, or any scheduled block of time. What you schedule is what you get. Your time is valuable and I place a premium on providing you with comprehensive, quality care. I never double-book or overbook. I am prompt for appointments, and in the event of internet outages or other technical issues, I have contingencies in place so we can access our session via alternative HIPAA-secure media.   

As a concierge practice, I acknowledge that sometimes a session may go over five to ten minutes, I do not penalize you for that or cut you off as is the often the custom in an insurance-driven practice where appointments are scheduled back-to-back. 

I handle things differently when you are late to an appointment. First, I'll reach out by text and email to make sure you're aware of the time, didn't forget, or aren't injured. Then I'll wait for the duration of the time you scheduled. Many clinical practices have a policy to wait 15 minutes for you, then assume you're a no-show and move on with their day. I'll stick around in case you show up. I might log off the video, but I'll be watching my phone to see if you text or call. Because of the late cancellation fee, you've paid for that session either way, so it's your time. If you don't show, I'll spend the time updating your chart. If you do show, we'll use the time that's left. 

As a concierge practice, I omit insurance companies and refrain from employing additional staff. This cuts out the number of people who read your chart and gets us as close as possible to complete confidentiality. For limitations to confidentiality, please refer to my confidentiality policy on my policies and procedures page.

All of the modalities I use are strength-based. What is strength based therapy? A strength-based approach gives you the power to shape your reality. With a variety of strength-based styles of therapy, we work together to identify the many resources that are available to you - both internally and externally. This process taps into the personal traits and strategies that have helped you survive adversity in the past and boosts your ability to believe in your own resilience. A strength-based approach looks at what’s been holding you back and supports you in moving forward with dignity instead of pathologizing you. This technique steers away from self-stigma, social stigma, professional stigma, and institutional stigma. The strength-based approach helps you see your value, brings hope into your life, and shows you that you have more choices than you might think you do. 

Solution-focused therapy assumes that you have the strength and skills to be your best self. It shifts attention from problems to solutions and looks at what you want for your future. Like positive psychology, solution-focused therapy is grounded in optimism, agency, and clarity of purpose. Solution-focused therapy isn't about me suggesting solutions for you; it's about me asking the questions that increase your awareness of your ability to figure it out. Solution-focused therapy asserts that you are the world's foremost expert on you.

Positive psychology is about finding meaning and satisfaction in life by focusing on what's right with you instead of focusing only on what's wrong with you. This approach does not discount what you feel is wrong in your life or what feels wrong in your spirit. Instead, it seeks to look at the inherent capabilities you have forgotten or may not realize you have. We don't just solve problems or repair damage - we identify your talents and capabilities and build solutions that support your pursuit of joy, self-efficacy, and fulfillment. With this approach, we work on creating the nurturing life that you deserve by recognizing your agency - the amount of personal control you believe you can exert over your life. 

Think of positive psychology as the activation of your psychological immune system. Positive psychology emphasizes flourishing, wellbeing, resilience, and hope. It is a research-supported, strengths-based approach.  Hope theory and choice theory are part of the positive psychology family of modalities, and I incorporate their teachings in my work.

The idea behind cognitive behavioral therapy is that the way you think affects how you feel and how you behave. Cognitive behavioral therapy, or CBT for short, focuses on problems stemming from your thought and behavior patterns and helps you identify and implement solutions you are willing to use. That’s the key for me - solutions you are willing to use. If you aren’t open to a particular strategy, it’s not going to work for you, and it’s my job to help you find a different one. Sometimes it’s the willingness itself we need to work on first, starting with your self-talk. How we talk to ourselves is a key feature of strength-based approaches, and I lean toward building your confidence and resilience, even with a modality like CBT in which we examine the patterns that are causing you problems. 

With CBT, we spend some time reviewing the past - not to assign blame or make you feel like crap about yourself, but as a source of information. Information is power. Information arms you to make decisions that serve you instead of hurting you. 

Some of the areas we focus on in CBT work include problem solving, cognitive restructuring, communication, setting goals, facing fears, and managing yourself through healthy habits and positive activities.

The term dialectics as it is used today originated with Georg Wilhelm Friedrich Hegel in the 19th century. Dialectics refers to the presence of opposing forces or constructs. A popular example is that we can love someone and also have powerfully negative feelings toward them. Another example is that we can acknowledge that at any moment, there are things over which we are powerless, but there are also things over which we have power. That juxtaposition in our lives creates a dialectic in our emotional state. We can feel distress and at the same time, manage that distress by using mindfulness skills to induce calm. In many approaches to therapy, your therapist tells you they accept you where you are at, but that the purpose of therapy is work that involves change. We know you are doing your best, but we also know that learning new skills and behaviors will help you create a life that you will consider worth living. Accept/change, power/powerlessness, distress/calm, acceptance/change - these are dialectics. Balancing these opposing forces is a challenging skill to learn. Therapy validates your frustrations and helps you see how to manage that balancing act. If you know what borderline personality disorder looks like from the inside, you know how hard it is to calm those racing thoughts, self-doubts, high-tension emotions, and resentments toward life's inequities.

Dialectical Behavior Therapy, known as DBT, is an evidence-based skills-based model of therapy. What DBT means is that we learn how to live with dialectics in a way that helps us cope with all the stress and anxiety life throws at us. DBT has four modules, the order of which I prefer to vary depending on the usefulness of those skills at each point in our work. The modules include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT includes psychoeducation, discussion, and worksheets. Phone coaching is a useful component of DBT in that it reinforces skills practice when you are confronted with real-life situations in which you need to use the skills. 

DBT was originally developed to treat borderline personality disorder, self-destructive behavior, and suicidality, but research has shown it to be effective in treating anxiety, stress, low self-esteem, trauma, substance use disorders, and eating disorders. Some of the goals of DBT are to equip you with coping skills, give you more control over your choices and improve your quality of life, much like the other modalities I use.  If you find yourself wanting to escape from your life, DBT will help you surmount that feeling.  

DBT is typically delivered in group format over two six-month cycles. Please note that I do not use DBT in the traditional cycles, as I work primarily with individuals in my practice. I have made adaptations to the DBT program based on the needs of my clients and the online private practice environment.  

The concept of humans having personal agency refers to our ability to exercise control over our lives - our thoughts, actions, environments, and choices. Agency speaks to the heart of being human, in that choice is the foundation of empowerment. Much of the stress we experience in life is fear-driven. When we lack control, whether over minor or major issues, we feel trapped. Human agency allows us to develop resilience, self-awareness, and self-efficacy, leading to a greater sense of control over ourselves, our relationships, and our environments. Both self and environment play key roles in human agency. As I mentioned above, agency plays a key role in positive psychology. 

From the time we are born, our agency is shaped by what we observe - first in our environment, and eventually in ourselves. Alfred Badura, the originator of social learning theory, contributed greatly to the field of psychology and the literature on human agency.  Bandura’s social learning theory takes the position that throughout our lives, we learn from watching others as they model behaviors. In order to learn from observing others, we have to want to pay attention, we have to retain what we’ve learned and be able to reproduce it, and we have to be motivated to learn it. Bandura said that we learn to self-regulate through observing ourselves, having standards by which we judge ourselves and others, and reinforcing our adherence to those standards by rewarding ourselves when we stick to them. 

Because we are social creatures, my work stresses the relevance of identifying personal heroes who model the kind of person we wish to be. Sometimes those heroes are famous people, and sometimes they are people we interact with in our everyday lives. As an example, Fred Rogers (aka Mister Rogers) is one of my heroes because he exemplifies values I find admirable. My mom is a personal example for the same reason. Using the models we identify as our heroes motivates us to emulate the qualities we find attractive in others, qualities that lead others to respect and appreciate us for the valuable individuals we are. 

Personal agency is prominent in hope theory, a member of the positive psychology family of theories. While social learning theory posited that agency stems from external influences, hope theory asserts that agency is motivated by internal factors. According to hope theory, one's belief in one's self grows from success at attempting and reaching the goals one pursues. The more we experience successful outcomes as a result of our actions, the more we believe in our capacity to succeed at the goals we wish to achieve. Research shows that higher hope and belief in our capabilities strengthens our self-esteem, decreases anxiety, lessens chronic pain, increases energy, and leads to a greater sense of well-being.

Mindfulness practice shows up in the research literature and strategies of all of the above approaches. It’s that important. Mindfulness practice gives you a level of self-control that cannot be achieved in any other way. Unfortunately, there are a number of stereotypes associated with mindfulness. Rest assured, there are myriad ways to practice mindfulness. Finding creative ways to work mindfulness into your life is both fun and rewarding; that is my promise to you. I believe so strongly in the benefit of mindfulness skills that I feel comfortable making you that promise. 

Mindfulness practice can take many forms in the context of therapy. Mindfulness-based interventions can include talk therapy, health education, relaxation training, and social skills training.  Mindfulness practice is holistic in that it improves your mind-body-spirit connection through increased self-awareness and self-control. 

Mindfulness practice has many health benefits. It helps you manage chronic pain, manage weight, and mitigate the risk of heart disease. It may decrease cognitive decline from aging or Alzheimer’s, improve your immune response, and alleviate gastrointestinal difficulties. Mindfulness practice also helps you cope with emotional challenges such as anxiety, stress, depression, and anger. Mindfulness practice improves memory and focus, improves sleep, reduces emotional reactivity, decreases loneliness, and helps you control intrusive thoughts. If you’re in recovery from addiction, mindfulness is a fantastic tool for managing obsessions, compulsions, and cravings. In the social arena, mindfulness can improve your relationships at home and at work and enhance your ability to deal with conflicts.  

Twelve-Step Facilitation (TSF) is a fancy way of saying that the therapist believes in the efficacy of 12-step programs and encourages clients to seek out and participate in the 12-step program of their choice. When using TSF, I assign readings, videos, and meetings from a variety of 12-step programs, then provide additional worksheets to help you process what you’ve seen and heard. Because 12-step recovery is a drastic lifestyle change for those who are new to it, it can be helpful to process your thoughts and feelings about it in a safe space like therapy.

As a person in long term recovery, I have participated in several 12-step programs and have lived experience working the program of my choice. This experience gives me a frame of reference beyond my clinical training that provides you with added support. You may wonder then, what is the difference between being your therapist and being your sponsor? Well, here it is. In twelve-step recovery, we have a saying, “I’m not going to work harder at your recovery than you do.” That’s something you might hear from a sponsor. As your therapist, I believe it’s my job to work harder at your recovery than you do, until the point when you have reached your therapeutic goals and are ready to be discharged from therapy. 

Twelve-step programs are an abstinence-based approach to recovery that involves a desire to stop using one’s drug of choice, a willingness to work the twelve steps with a sponsor, and a willingness to participate in a peer-led recovery support community. Studies show that TSF outperforms other treatment methods in maintaining abstinence. 

Note that while I do believe that 12-step programs work, I view them as one tool of recovery - not the only tool. Even if you choose to try a twelve-step program, I urge you to supplement that program with other recovery tools. And if you’re someone who isn’t comfortable with this approach, we will find another one for you. 

The Power Threat Meaning Framework (PTMF) was developed by psychiatrists in the United Kingdom. It is a conceptual perspective rather than a clinical model. It represents an approach to therapy that steers away from the traditional medical model which depends heavily on diagnoses. 

Instead, the PTMF views mental health issues as threat responses, and considers symptoms of mental health issues to be 1) our reactions to our experiences and 2) the adaptations we’ve made to survive the things we’ve been through that threatened our sense of self-worth and our understanding of personal power. 

I incorporate this framework into my clinical practice because I support the notion that diagnoses can be both useful and harmful, and that it is the responsibility of the therapist to recognize the difference and adjust the treatment plan accordingly. I am not anti-diagnosis; I am against premature diagnosis or diagnosis for the sake of insurance reimbursement. I believe in a wellness model of therapy, but that doesn't mean denying the existence of illness. 

I borrow techniques from other modalities that share common elements with the above approaches, such as Rational Emotive Behavior Therapy (REBT) and motivational interviewing, along with process-based therapies such as Narrative Therapy, Acceptance and Commitment Therapy (ACT), Emotional Freedom Technique (EFT), and expressive arts.

It's important to me to choose methods that are supported by research. If you'd like to know more about these theories and methods, please see my references page.