Specialized Virtual Therapy · Adults Only
The work we do and how we do it.
Each specialty area below is something I've trained in specifically, work with every week, and think about carefully. If you see yourself in more than one section that's common, and it's exactly what this practice is built for.
OCD & ERP Therapy
OCD is not what most people think it is.
Most people with OCD don't have the version they've seen on television. They have intrusive thoughts that feel unbearable. Rituals that are invisible to everyone around them mental reviewing, reassurance seeking, avoidance dressed up as caution. A certainty that if they just think about it long enough they'll find the answer that makes the anxiety stop.
It doesn't stop. That's the mechanism. And it's why standard anxiety therapy the kind that focuses on coping, identifying triggers, reframing thoughts often makes OCD worse over time instead of better. The treatment for OCD is different. It's called ERP.
What ERP actually is.
Exposure and Response Prevention is the gold-standard treatment for OCD, with decades of research behind it. It works by gradually and deliberately confronting the thoughts, situations, and uncertainty that trigger OCD without performing the compulsion that would normally relieve the anxiety.
That sounds counterintuitive. It is. It's also what actually works.
ERP is not about eliminating the intrusive thoughts. It's about changing your relationship to them so they lose their power to run your life. Done correctly, with a therapist who understands OCD, it produces meaningful, lasting change for the vast majority of people who complete it.
OCD presentations I work with.
OCD is highly variable. Some of the presentations I see most often include health OCD sometimes called health anxiety where the compulsion cycle centers on fears about illness, symptoms, and medical certainty. ROCD, where OCD targets the relationship and generates relentless doubt about a partner or the relationship itself. Harm OCD, where intrusive thoughts about causing harm feel like evidence of dangerous intentions. And the less-named presentations the scrupulosity, the existential OCD, the "pure O" that isn't actually pure O.
What these have in common is the cycle: trigger, obsession, compulsion, temporary relief, repeat. ERP interrupts that cycle at the compulsion. That's what changes things.
What to expect in OCD treatment.
We'll start with a thorough assessment understanding your specific OCD presentation, the obsessions that are most active, and the compulsions that are maintaining the cycle. From there we build a treatment hierarchy and begin ERP in a structured, collaborative way. You'll always know what we're doing and why. Nothing happens without your active participation.
Sessions are focused and direct. I'm not going to spend a lot of time talking about your childhood unless it's directly relevant to what we're treating. OCD responds to behavioral intervention, and that's where we spend our time.
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A: OCD and anxiety share surface features — worry, distress, avoidance — but the underlying mechanism is different. Anxiety responds to reassurance and coping. OCD is temporarily relieved by compulsions but worsened over time by them. The treatment approaches are also different: standard anxiety therapy can reinforce OCD cycles, while ERP specifically targets the compulsion that maintains OCD. Getting the right diagnosis matters for getting the right treatment.goes here
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A: Most people with OCD have received anxiety treatment rather than OCD-specific treatment. If previous therapy focused on coping skills, thought challenging, or relaxation techniques, it may not have targeted OCD directly. ERP is a distinct approach that most therapists are not trained in. If you've worked hard in therapy without meaningful progress on OCD symptoms, the issue is likely the type of treatment, not your effort.
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Q: Do I need a formal OCD diagnosis to work with you?
Ready to talk through whether this is a fit?
ADHD Therapy for Adults
ADHD is more than a focus problem.
Most adults who come in for ADHD aren't struggling primarily with focus. They're struggling with the gap between knowing what to do and being able to make themselves do it. The emotional intensity that surprises them. The way rejection, real or perceived, can derail an entire day. The chronic undercurrent of feeling like everyone else got a manual they didn't.
ADHD in adults has been undertreated, misdiagnosed, and misunderstood for long enough that most people walking in have developed a significant layer of shame on top of the actual ADHD. That layer has to be part of the work.
What ADHD actually looks like in adults.
It looks like always running a few minutes late despite genuine effort. Starting things with real momentum and finding them abandoned when the novelty wears off. Emotions that arrive faster and harder than seems reasonable and take longer to recover from. A sensitivity to criticism or perceived rejection that feels disproportionate but is neurological, rejection sensitive dysphoria is real, it's common in ADHD, and it's rarely talked about.
It also looks like being genuinely excellent at certain things, the hyperfocus, the creativity, the unconventional thinking while struggling significantly with things that seem effortless for everyone else. Both of those things are real. Neither cancels out the other.
ADHD, food, and the body.
One of the most common and least addressed presentations I work with is the overlap between ADHD and a complicated relationship with food. The part of the brain that regulates attention also regulates hunger and fullness cues. For many adults with ADHD this shows up as forgetting to eat during the day, then eating well past full in the evening. Or using food for stimulation when the nervous system is understimulated. Or a restrict-binge pattern that no amount of discipline has touched because discipline was never the issue.
Sleep disruption, chronic stress, and the physiological wear of years of dysregulation also affect how the ADHD brain functions and they're often part of the picture in ways that don't get named. This isn't lifestyle coaching. It's recognizing that the nervous system doesn't operate in isolation from the body it lives in.
It's a regulation problem, and it responds to being treated that way.
Late diagnosis and what comes with it.
A significant number of adults particularly women receive an ADHD diagnosis in their 30s, 40s, or later. That late diagnosis comes with a complicated emotional aftermath. Relief, because there's finally an explanation. Grief, for the years spent thinking you were failing at things that were actually harder for you than for other people. Sometimes anger. Sometimes a complete rereading of your own history.
That reckoning deserves real support. Not just strategies for managing ADHD going forward, but space to process what it means to understand your past through a new lens.
How I work with ADHD.
Therapy for ADHD here isn't a list of productivity hacks. It addresses the emotional layer dysregulation, shame, rejection sensitivity alongside the practical patterns. We use CBT and DBT skills adapted for how the ADHD brain actually works, not how it's supposed to work. We identify what's ADHD, what's been layered on top of it, and what needs to be addressed in what order.
If you're also working with a prescriber on medication, I coordinate with them when you want that. Medication and therapy together typically produce better outcomes than either alone.
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A: Yes, in meaningful ways. ADHD therapy accounts for how the ADHD brain processes information, manages time, and regulates emotion — and adapts accordingly. General therapy techniques often assume a level of working memory, emotional regulation, and follow-through that ADHD specifically impairs. Therapy that's actually useful for ADHD is structured, direct, and built around realistic implementation rather than insight alone.
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A: For most adults with ADHD, yes. Medication addresses the neurological component — the bandwidth, the regulation, the noise. Therapy addresses the patterns, the shame, and the relational impact that have built up over years. Medication without therapy often leaves the emotional and behavioral layer untouched. Most of my clients who are on medication notice that therapy moves differently once they have that foundation, but therapy is also useful without it.
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A: Many adults come in with a strong suspicion but no formal diagnosis. I don't diagnose ADHD — that requires a separate evaluation but I can do a thorough assessment of your presentation and help you understand whether pursuing a formal evaluation makes sense. If you've been wondering for a while, it's worth finding out.
Ready to talk through whether this is a fit?
Disordered Eating Therapy
The relationship with food is never just about food.
Disordered eating exists on a wide spectrum, and a lot of people in the middle of it don't recognize themselves in clinical language. They're not sure they're "sick enough" to deserve support. They've been told their relationship with food is just something to manage, or that they need more willpower, or that things could be worse.
Things could always be worse. That's not the standard.
If eating or not eating is taking up more of your mental energy than you'd like, affecting your body, your relationships, or your sense of self, that's worth addressing. You don't need to have a diagnosable eating disorder to deserve care. You need to be struggling.
What I work with.
Restriction and the beliefs that drive it. Binge eating including binge eating that comes with restriction, which is different from binge eating alone and responds to different treatment. ARFID, Avoidant/Restrictive Food Intake Disorder, in adults who have been misunderstood or dismissed for years about the way they eat. And the ADHD-food overlap the pattern that looks like disordered eating but is fundamentally a regulation problem, and gets worse with every intervention that treats it as a discipline issue.
I also work with the OCD-eating disorder overlap the rigidity, the rules, the compulsive quality that eating disorder behaviors sometimes carry. When restriction or food rules have an OCD mechanism underneath them, treating only the eating disorder produces limited results. Both need to be on the table.
How this work is different.
Eating disorder treatment here is not about getting you to eat differently as quickly as possible. It's about understanding what the eating behavior is doing what it's regulating, what it's protecting, what it's communicating and addressing that directly alongside the behavioral piece.
I coordinate with registered dietitians when appropriate, and I strongly believe that the best outcomes come from a treatment team where the therapist and dietitian are actually talking to each other. If you're already working with an RD, I want to be in contact with them. If you're not and you need one, I can help you find someone who fits.
This work is non-judgmental, non-diet, and paced with your actual capacity. It takes seriously the physiological side of the picture how restriction affects the gut-brain axis, how chronic stress and sleep disruption interact with the restrict-binge cycle, and what the body is actually doing underneath the behavioral pattern. It is also honest I won't tell you what you want to hear if it's not clinically accurate.
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A: ARFID stands for Avoidant/Restrictive Food Intake Disorder. It involves significant limitation of food intake based on sensory characteristics, fear of aversive consequences like choking or vomiting, or lack of interest in food — not body image concerns. In adults it's frequently dismissed or misunderstood. Treatment is CBT-based, specifically CBT-AR, and involves gradual, structured work on expanding food tolerance without pressure or shame. Adults with ARFID can and do make meaningful progress with the right support.
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A: Binge eating exists on a spectrum. Binge Eating Disorder is a diagnosable condition involving recurrent episodes of eating large amounts of food with a sense of loss of control. But binge eating that doesn't meet full diagnostic criteria is still worth addressing, particularly when it's causing distress or physical harm. It's also important to distinguish binge eating that occurs with restriction — the restrict-binge cycle — from binge eating that occurs on its own, because the treatment approach is different.
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A: Eating behavior is maintained by a combination of biological, psychological, and behavioral factors that willpower alone doesn't touch. Therapy addresses the function of the eating behavior — what it's doing for you — alongside the biological patterns that drive it. Most people who have been trying to change their eating on their own without success aren't lacking motivation. They're missing a map of what's actually maintaining the pattern.
Ready to talk through whether this is a fit?
Couples Therapy
When the relationship is carrying more than it should have to.
Relationships absorb a lot. When one or both partners are navigating OCD, ROCD, an eating disorder, or ADHD, the relationship absorbs those things too often without anyone naming what's actually happening.
The conflict that keeps repeating without resolution. The distance that builds after the same misunderstanding for the hundredth time. One partner feeling like they're managing everything and the other feeling like they can't do anything right. Neither of those people is wrong. They're both responding to something that hasn't been identified correctly.
What this is and isn't.
Couples therapy here is specialty-informed. That means if OCD is in the room including ROCD, where OCD targets the relationship itself and generates relentless doubt about your partner or your feelings I'm treating it as OCD, not as a communication problem. If ADHD is creating the pattern where one partner feels like the parent and the other feels like they're constantly failing, we're naming the ADHD and working with what it actually is.
This is not conflict resolution therapy. It's not a space where we work on I-statements until the relationship improves. It's direct, clinically grounded work on the patterns that are keeping the relationship stuck which usually means understanding each person's individual experience and the dynamic they've built together.
ROCD specifically.
Relationship OCD deserves its own mention because it's both common and commonly missed. ROCD involves intrusive doubts about the relationship "do I really love them?", "are they the right person?", "what if I'm making a mistake?" accompanied by compulsive checking, reassurance seeking, and mental reviewing that never actually resolves the doubt.
ROCD is not the relationship being wrong. It's OCD targeting the relationship. Treating it as a couples communication problem usually makes it worse. Treating it as OCD with ERP is what actually helps.
I work with individuals navigating ROCD and with couples where ROCD is affecting the relationship dynamic.
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A: Yes, in meaningful ways. ADHD therapy accounts for how the ADHD brain processes information, manages time, and regulates emotion — and adapts accordingly. General therapy techniques often assume a level of working memory, emotional regulation, and follow-through that ADHD specifically impairs. Therapy that's actually useful for ADHD is structured, direct, and built around realistic implementation rather than insight alone.
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A: ROCD is a subtype of OCD in which intrusive doubts target the relationship. The key features are intrusive doubts that feel urgent and distressing, compulsive behaviors aimed at resolving the doubt — reassurance seeking, mental comparison, checking feelings — and temporary relief that never lasts. The doubt keeps coming back regardless of what your partner does or says. If you've been questioning your relationship for a long time without resolution, and reassurance from your partner or from others doesn't hold, ROCD is worth exploring.
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A: Yes. Couples therapy is most effective before things reach a breaking point, not after. If there are patterns you can see but can't seem to change — the same argument repeating, growing distance, one of you managing more than feels sustainable — those are exactly the things therapy addresses well. Crisis is not a prerequisite.
Ready to talk through whether this is a fit?
Perimenopause & Menopause
The transition nobody prepared you for.
Perimenopause doesn't always announce itself with hot flashes. For many women especially those with a history of ADHD, anxiety, or OCD it announces itself as a sudden worsening of everything they thought they had managed. Emotions that feel uncharacteristically out of control. Anxiety that arrives without a clear trigger. Executive function that worked reasonably well until it didn't. A version of themselves they don't fully recognize.
That's not a mental health crisis. It's often estrogen.
Estrogen plays a direct role in regulating dopamine and serotonin, which means the hormonal shifts of perimenopause don't just affect the body they affect the brain systems that regulate mood, attention, and anxiety. For women who already have ADHD, OCD, or an anxiety history, perimenopause can look like decompensation. It often gets treated that way: medication adjustments, new diagnoses, therapy for things that didn't used to be problems. Sometimes the hormonal piece isn't named at all.
What this work actually addresses.
Therapy for perimenopause and menopause here isn't about managing hot flashes or accepting aging. It's about understanding what's changing neurologically and psychologically and why so the work we do in therapy is targeting the right thing.
That includes the ADHD-perimenopause overlap, where estrogen decline compounds executive dysfunction and emotional dysregulation in ways that can feel like ADHD suddenly stopped responding to everything that used to help. The anxiety and OCD activation that hormonal fluctuation can trigger. The identity piece the way this transition intersects with how women understand themselves, their relationships, and what they want the next chapter to look like.
This work is direct, clinically grounded, and takes the hormonal context seriously without reducing everything to it.
I also coordinate with prescribers and OBGYNs
when that's part of the picture. Hormonal and psychological factors interact, and the best outcomes usually come from providers who are actually in communication.
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A: Honestly, you might not — and that uncertainty is part of what makes this transition hard to navigate. Perimenopause doesn't have a clean start date, and its psychological symptoms overlap significantly with anxiety, depression, ADHD, and burnout. What tends to distinguish it is the pattern: symptoms that feel new or suddenly worse, a timeline that puts you in your late 30s to early 50s, and a quality to the dysregulation that doesn't quite respond the way it used to.
You don't need to have it figured out before reaching out. Part of the work is understanding what's hormonal, what's psychological, and what's the interaction between the two. That's a clinical question we work through together — not a prerequisite for starting.
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A: Significantly, and in ways that most people aren't warned about. Estrogen supports dopamine function, which is already dysregulated in ADHD. As estrogen declines, many women find that ADHD symptoms that were manageable — with medication, with systems, with hard-won strategies — suddenly aren't anymore. The medication feels less effective. The coping strategies stop holding. Emotional dysregulation intensifies. It can feel like the ADHD got worse overnight, when what actually happened is that the hormonal scaffolding that was quietly helping shifted.
This matters clinically because the intervention isn't just adjusting ADHD treatment. It's understanding that you're working with two overlapping systems that are both in flux — and treating them accordingly.
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A: No. You don't need a diagnosis, a confirmed hormone panel, or a conversation with your OBGYN before reaching out. Therapy doesn't require a medical workup to start, and you don't have to arrive with answers already in hand.
That said, if hormonal factors are part of the picture, I'll often encourage you to be in contact with a prescriber or OBGYN who takes the psychological side of perimenopause seriously — because the best outcomes usually come from providers who are communicating, not working in parallel. If you don't have that relationship yet, I can help you think through what to look for.
Ready to talk through whether this is a fit?
Overlap
When more than one of these is happening at once.
OCD and ADHD overlap more than most people realize and when they do, treating only one produces limited results at best. The rigidity and rule-following that looks like OCD. The impulsivity and avoidance that looks like ADHD. Sometimes they're both present. Sometimes one is masking the other. Getting the conceptualization right changes everything about what happens in treatment.
Disordered eating and OCD share a mechanism the compulsive quality of food rules, restriction rituals, and body checking isn't coincidental. Addressing the eating behavior without addressing the OCD cycle underneath it is why so many people plateau in eating disorder treatment.
ADHD and disordered eating, particularly the restrict-binge pattern and the ADHD-food regulation overlap, respond to treatment that understands both not sequential treatment for each.
Perimenopause intersects with all of it. ADHD that suddenly feels unmanageable. OCD that reactivates after years of stability. Disordered eating patterns that return or worsen. Understanding the hormonal context doesn't explain everything but ignoring it explains nothing. If you're in your late 30s, 40s, or 50s and things that used to work have stopped working, that's worth naming. This is the clinical territory this practice was built for. If you've been treated for one of these things and feel like something is still being missed, it probably is.
Ready to talk through whether this is a fit?
The Practical Details
What working together actually looks like.
Format All sessions are held via telehealth video, through a secure HIPAA-compliant platform. No commute, no waiting room. You can be at home, in your car, on a walk. The one requirement is a stable connection and a private enough space to speak freely.
Session length Individual therapy sessions are 50 minutes. Couples sessions are 50 minutes. Frequency is typically weekly, particularly in early treatment when momentum matters most.
Who I see Adults only. I do not work with children or adolescents. I do not provide crisis services if you're in acute crisis, please contact 988 or your local emergency services.
Where I'm licensed Currently licensed in Colorado, Idaho, South Carolina, and Arizona. California licensure is in progress. I can only provide therapy to clients who are physically located in a state where I hold an active license at the time of the session.
Getting started The first step is a free consultation a brief call to talk through what's bringing you in, what you're hoping for, and whether this is a good fit. No paperwork, no pressure, no commitment required to have that conversation.
If you saw yourself somewhere on this page
That recognition is usually worth paying attention to. Reach out. The consultation is free and there's no commitment attached to it. If this isn't the right fit I'll tell you, and I'll do my best to point you somewhere that is.
If this sounds like what you've been looking for
The consultation is free. You don't have to have it figured out before you reach out. Most people who contact me aren't sure yet that's normal, and it's fine. We'll talk through it.