For high-achieving adults considering therapy
Your Questions, Answered
The questions that tend to come up before reaching out, from how the work happens to whether what you are carrying even counts.
You do not have to have named what is going on, or decided to do anything about it, to read this. Some of these questions are about working with me. Most are about what you might be living with. I tried to answer both honestly.
Do I even have a problem?
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Yes, and it is the thing the people I work with get stuck on most. Functioning well and struggling privately are not opposites. The high-functioning presentations I specialize in are missed precisely because everything visible looks fine. You do not have to be falling apart to deserve help.
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The fact that you are asking usually means it is worth taking seriously, not that you are exaggerating. Eating disorders are badly under-recognized in people who are competent, employed, and composed. If food or your body takes up mental space you resent, that is real, whatever it is called. More on high-functioning eating disorders.
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Yes. Clinically significant eating disorders happen across a wide range of body sizes, and many people who are not underweight are struggling seriously. Not being underweight is one of the most common reasons this goes unrecognized, including by the person living it. Weight is not the measure of whether it counts. More on high-functioning anorexia.
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Probably, yes. There is no severity you have to reach before your experience is legitimate. The belief that it has to get worse before it deserves attention is one of the things that keeps people stuck for years.
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It can be. When eating "clean" stops being about health and starts running your day, shrinking what you will eat, and producing real anxiety when a rule breaks, the health framing is often covering something more rigid. The label matters less than whether it is costing you.
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Because from the inside it does not feel like control. It feels like something you cannot put down. What reads as discipline to everyone else is often the thing running you, and the admiration makes it harder to name. More on perfectionism.
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Almost no one who worries they are making it up is making it up. That worry is part of the pattern: you are so used to handling things that struggling feels like an indulgence you have not earned. You do not need anyone else to confirm it is real for it to be real.
The food and body part no one sees
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Because when food becomes the way you manage anxiety, control, or feeling, it stops being food and becomes a full-time mental job. The constant calculating is not greed or vanity. It is what happens when one part of life is carrying more than it was built to carry.
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Because the control you hold all day has a limit, and the private hours are where it runs out. What happens alone is usually the pressure of the day finding its only exit. It is one of the most recognizable patterns I see, and it is not a willpower failure. More on high-functioning binge eating.
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Because restriction can quiet anxiety and create a sense of order, at least briefly. That relief is real, which is exactly why it is so hard to let go of, and why over time it asks for more and returns less. Feeling steadier when you restrict is not a sign it is working. It is a sign of what it has been doing for you. More on high-functioning anorexia.
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Because eating you cannot fully control, in a setting you cannot fully manage, touches the exact thing the disorder is organized around. Most people I work with have gotten very good at hiding how much effort a normal meal out takes. That effort is information, not a flaw.
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Because somewhere along the way eating got wired to worth, so a meal stopped being a meal and became a verdict. That wiring is learned, it is common, and it can be undone. Guilt after eating is a symptom to understand, not a rule to obey.
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A body image that can hijack an entire day is usually not really about the body. It is about what the body has come to stand in for: control, worth, whether today is allowed to be a good day. That is why reassurance about how you look never lands. The work is on the meaning, not the mirror. More on body image.
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Nothing that insight alone was ever going to fix. These patterns are not held in place by a lack of information. They are held by what they have been doing for you, which is why knowing better does not become doing differently. That gap is the whole reason the work exists.
Perfectionism, control and achievement
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Because the goalpost is built to move. When worth is tied to performance, no result settles the question for long, so the win gets filed and the next thing starts before you have felt anything. That is not a motivation problem. It is a pattern, and a tiring one. More on perfectionism.
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Because rest, to a system that runs on earning, registers as falling behind rather than recovering. If slowing down brings guilt or low-grade dread instead of relief, that is worth taking seriously. It usually means the drive stopped being something you use and became something that uses you.
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It becomes a problem when the standard is one you can never meet, when your sense of yourself rises and falls with your output, and when the cost shows up as anxiety, burnout, or a private harshness toward yourself. High standards are not the issue. What happens to you when you miss them is.
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Because to a perfectionist a small mistake is rarely small. It reads as evidence about who you are rather than a normal error, so the reaction is out of proportion to the event. The work is on that translation, the automatic jump from "I did something wrong" to "something is wrong with me."
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Because caring raises the stakes, and if a thing has to be excellent, starting means risking that it will not be. Perfectionistic procrastination looks like not caring when it is the opposite. It is fear of the gap between the standard and the attempt.
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Probably nothing that success was ever going to fix, which is the part no one warns you about. When the achievement runs on self-criticism and fear rather than wanting, arriving does not feel like anything. That is a common and workable place to begin, not a sign of ingratitude.
Anxiety, and the late nights
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Because your nervous system is registering a threat and there is nothing to do about it at three in the morning. It is one of the most common things people describe, and it usually eases as the underlying pressure is addressed, faster when you are working with the thoughts during the day rather than only meeting them at night.
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Because anxiety is not always about the present. Often it is an old alarm system doing its job too well, or the background hum of a life run on high standards and control. "Nothing is wrong" and "I am anxious" can both be true, and the gap between them is worth understanding rather than arguing with.
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Very often, yes. Anxiety, perfectionism, and disordered eating tend to share the same machinery: the need for control, all-or-nothing thinking, worth that has to be earned. That is why working on one usually means touching the others, and why I treat them together rather than as separate problems.
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Because the day gives you structure, a role, and people who need things from you, all of which is genuinely stabilizing. Night takes those away. The unraveling is not weakness. It is what was held all day finally arriving, with nowhere left to be performed.
I've tried other things before
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Often because previous therapy treated the surface, the anxiety or the eating, without reaching the perfectionism and the need for control underneath. If your last therapist did not specialize in this, or treated your ambivalence as resistance, that is a real gap, not proof that therapy cannot help you.
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Because intensive programs are built to stabilize acute situations, which is a different job from the ongoing, individual work of understanding why the pattern exists and what it has been for. Many people need the program first and this work after. Still struggling does not mean you failed treatment.
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Because diets are very good at producing short-term results, which is not the same as being designed to produce lasting ones. When you restrict what, how much, or when you eat, your body and brain respond: hunger increases, food becomes more salient, and your body adapts. Over time, staying on the diet gets harder and harder.
What if that is not a lack of willpower or something wrong with you, as the diet industry would love you to believe, but simply because diets are not sustainable or effective in the way we have been promised? I do not see the goal as finding the perfect diet you can finally stick to forever, because it probably does not exist. I help clients step out of the cycle altogether: eating in a way that is nourishing and sustainable, tuning back into their body's cues, becoming less preoccupied with food and weight, and caring for their health, if that is a goal, without making weight loss the measure of success.
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It depends on your medical and psychological situation, and it is worth sorting out honestly early on. My practice is individual outpatient therapy for people functioning well enough to work at that level. If you need more, a consultation is a good place to figure that out together rather than guessing.
Keeping it private, and telling people
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You do not have to tell anyone in your life to begin. Therapy is a place to say it out loud to someone whose job is to help, and for many people that first private disclosure is the thing that loosens the grip the secret has had. Who else you tell, and when, stays your decision.
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No. Whether, when, and how you tell anyone is your call, and many people recover without ever making that a condition of the work. The disclosure that matters most is simply saying it in the room, to someone who will not be shocked by it.
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You may not have to explain it to anyone before you understand it yourself, which is part of what the work is for. The gap between how your habits look from outside and how they feel from inside is real, and getting clear on it for yourself usually comes before any conversation with someone else.
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By starting exactly where you are, which is allowed to be halting and vague. You do not need the right words, a diagnosis, or a tidy story. A consultation is built for people who have never said any of this to anyone, and the relief of it finally being heard is usually larger than the fear of saying it.
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The goal is not to take your standards away and leave nothing. It is to loosen the ones that have quietly narrowed your life, so steadiness is not something you have to earn through control. What you keep and what you set down is something we work out together, not something done to you.
What therapy with me is actually like
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This is one of the most common fears, and a fair one to ask directly. My work is outpatient talk therapy, not a weight-focused program. I do not weigh you, set targets, or hand you a meal plan, and weight is not how we measure whether this is working. We start with what the eating has been holding. If your situation involves medical risk that needs a higher level of care, the consultation is where we would name that honestly.
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That is expected, not a problem, and it does not mean you are not ready. For many people the pattern is doing something they value, so ambivalence about giving it up is part of the picture. Good work makes room for that part rather than trying to override it.
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No, not the way you are picturing it. The aim is not to remove your coping and leave a hole, but to build something steadier underneath, so the old strategy is no longer the only thing keeping you upright. Nothing gets taken before something else is in place.
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Only as much as it turns out to matter, and never on a schedule I impose. Some of the work looks backward at where a pattern was learned, because that is often what loosens it. But this is not archaeology for its own sake, and we go at a pace that feels safe.
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I draw mainly on cognitive behavioral therapy, psychodynamic therapy, and acceptance and commitment therapy, tailored to the person rather than a fixed protocol. In plain terms, we work with the patterns keeping something stuck, understand where they came from and what they have been protecting, and build the capacity to live differently.
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Not being sure is not the same as not being ready, and a consultation does not commit you to anything. Most people I work with were never fully ready. They were just tired enough of the pattern to look at it honestly, which is a different and lower bar.
Cost, insurance and logistics
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Sessions, including the first intake session, are $300 for a 45-minute session.
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I am an out-of-network provider. If your plan has out-of-network mental health benefits, you may be reimbursed for part of each session, and I can give you a superbill to submit. It is worth calling the number on your card to ask about your out-of-network coverage before assuming you cannot afford care.
If you want to move forward with scheduling an intake session at the end of the consult call, it’s also an opportunity for us to discuss scheduling and logistics. You don’t need to be sure about working with me to schedule a consult!
Please reach out on my contact form (or by email or phone) to schedule your free consultation.
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You can check your out-of-network benefits in about two minutes using the tool on this page. Many clients are reimbursed for a meaningful portion of the session fee once their out-of-network deductible is met.
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I keep a limited number of sliding-scale spots for people who cannot manage the full fee. If cost is a barrier, reach out and I will let you know whether one is currently open.
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Sessions are 45 minutes, and I usually meet with clients weekly. Consistency is where therapy does its best work, so we find a regular weekly time. As you go, we can adjust the frequency up or down as your needs change.
Getting started
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You do not need to be in crisis or have a clear diagnosis to begin. People come because something feels off: stuck, overwhelmed, anxious, disconnected, or repeating patterns that are not serving them. If you want to understand yourself better, or need support with what you are facing, therapy is a good place to start. It is also okay to be unsure. The first session is often just about seeing how it feels.
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Yes. I offer a free fifteen-minute phone consultation. It is a chance to tell me briefly what you are struggling with, ask anything about starting therapy, and get a feel for whether we are a good fit. You do not need to be sure about working with me to book one. You can reach me through the contact form, by email, or by phone.
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No. Many of the people I work with do not meet full criteria for anything, and plenty never get a formal label. What matters is whether the way you are currently living is sustainable, not whether it has a clinical name.
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No. I am a psychologist, not a prescriber. If medication seems worth exploring, I will say so and help you find a psychiatrist who can evaluate it.
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I see clients in person in Silver Spring, Maryland, and virtually across Maryland, New York, and all PsyPact states, which is 43 states currently. Virtually, that includes people in Bethesda, Rockville, Chevy Chase, Washington DC, and New York City. I hold a direct New York license, so New York clients are a core part of my virtual practice, not an afterthought.
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Yes, with the standard legal exceptions: imminent risk of harm to you or someone else, suspected abuse of a child or vulnerable adult, or a court order. These are covered in your intake paperwork, and I would rather you ask about them than wonder.
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If you are in immediate danger or having thoughts of ending your life, call or text 988 now, before booking anything. If you are physically unwell from your eating, that is a medical situation worth a doctor's visit alongside anything else, and the National Alliance for Eating Disorders runs a free helpline if you want to talk it through first. Outpatient therapy is for people well enough to work at that level, and a consultation can help you tell the difference.
Wondering what your insurance will cover?
Use the tool below to check your out-of-network benefits in under two minutes. Many clients are reimbursed for a significant portion of the session fee.
Still have a question?
I’d love to talk.
If your question is not here, or you cannot quite put words to what is going on, that is normal, and it is a reason to book a consultation rather than a reason not to. You do not have to arrive with it figured out.