Therapy for women who look fine to everyone and are struggling privately
Fifty-minute sessions with Dr. Elena Vance, a licensed psychologist in California: $180 a session, in person in Pasadena or by secure video anywhere in California, for anxiety that coexists with a demanding job, a full life, and a standard you cannot switch off. The 15-minute call before you book is free.
What high-functioning anxiety actually looks like
High-functioning anxiety is not a formal diagnosis. It describes people whose worry is well hidden and whose performance is unaffected, which is why it often goes unnoticed for years. It rarely looks like panic. These are the things clients describe in the first session.
You are the one who has it handled
Friends, family and colleagues bring you their problems. You rarely mention yours, because theirs always seem heavier.
Your standards are high and non-negotiable
Good is not a category you recognise. Work gets redone, emails get re-read, and the day ends later than it should.
Rest feels like a debt
You cannot sit still without a reason. A quiet evening turns into planning, tidying, or answering one more message.
The worry arrives at night
The day holds it together. The small hours audit everything you said, did, or might have missed.
You say yes before you check
New commitments arrive before you have looked at whether there is room, and the bill comes two weeks later.
It looks like competence from outside
Performance is unaffected, which is exactly why it goes unnoticed, including by you.
Who this is for, and what changes
This suits women carrying demanding jobs, early motherhood, study, or all three at once, who function well and are tired of what it costs. The goal is not lower standards. It is choosing them on purpose.
Worry that has a shape
Naming the pattern makes it workable. Right now it simply feels like your personality.
Standards you chose yourself
We separate the standards that are yours from the ones you absorbed, so you can keep some and drop others deliberately.
A way to stop at the end of the day
Practical routines that close the working day, so the evening stops being the second shift.
Room for what you do not say
Fifty minutes where nobody needs you to be competent, and nothing you admit becomes a problem to manage.
Words for what is happening
Saying it clearly to a partner, a manager or a doctor instead of minimising it, so the people around you can respond to the real thing.
A plan for the bad weeks
What to do when deadlines and feelings land together, decided while you are calm rather than in the middle of it.
What we actually do in the room
Cognitive behavioural therapy, acceptance and commitment therapy, and compassion-focused work. Which one leads depends on whether your week is driven by worry, by avoidance, or by a voice that is never satisfied.
Cognitive behavioural therapy
We test the prediction instead of obeying it. Most of what anxiety forecasts does not happen, and tracking that changes what it can convince you of next time.
Acceptance and commitment therapy
For thoughts that will not be argued away, we practise making room for them and choosing where your attention goes.
Compassion-focused work
For the internal critic. We look at where that voice came from and what a day sounds like when it is not running things.
Behavioural experiments
Small deliberate tests between sessions: the email sent without the fifth re-read, the evening ended at an agreed time.
Sessions that fit around a working week
Sessions are $180 and last fifty minutes, by video anywhere in California or in person in Pasadena, with a free fifteen-minute call first. These are the questions that come up most for people holding a lot together at work.
Before and after the working day
Early mornings and early evenings are kept for people who cannot step out at midday. Tell me your hours and we will find the slot that survives your calendar.
If saying it out loud is hard
People who cope well in public are often practised at describing their week accurately and feeling none of it. We work with what stays flat, at whatever pace that takes.
How often we meet
Weekly to begin with, occasionally twice weekly for a short stretch, then fortnightly or monthly as the work holds. Nothing is open-ended unless you want it to be.
Discretion
Sessions are confidential. If you work in a small industry or a public role, we agree how scheduling, reminders and invoices should look so nothing visible gives the wrong thing away.
Questions people ask before the first session
The FAQ page covers fees, insurance and confidentiality in more detail.
Is high-functioning anxiety a real diagnosis?
It is a description rather than a formal diagnosis. In practice it usually maps onto generalised anxiety, perfectionism, burnout or a demanding season. Part of the first sessions is working out what is actually going on and whether a formal assessment would help.
I manage fine day to day. Do I need therapy?
Managing fine is the reason many clients wait for years. If the cost is showing up in your sleep, your patience or your relationships, that is reason enough. You do not have to be unable to cope before it is worth addressing.
Will therapy mean lowering my standards?
No. We look at which standards serve you and which ones only cost you, and you decide what stays. Most clients keep more than they expected and drop one or two that were never theirs.
How long does this usually take?
Many clients notice a difference in the first four to six sessions, and a typical course runs twelve to twenty. There is no minimum commitment, and we review whether it is working as we go rather than at the end.
Can therapy help if I have been like this for years?
Yes. Patterns that have been running for a decade take longer to shift than recent ones, but they are not fixed. Much of the work is noticing what has become automatic and building something more deliberate in its place, and progress is reviewed as you go.
Want to talk it through first?
The consultation is fifteen minutes, free, and commits you to nothing. Bring the question you are not sure how to ask.
If anxiety is not the whole picture
The practice also covers the postpartum year and the squeeze between work and home. The method is the same; what we focus on shifts.
Postpartum support
For worry, checking and self-pressure in the first years after a baby, including the version that arrives after a straightforward birth.
Work-life integration
For the stretch when work and caregiving both want the best of you. Boundaries, guilt, and deciding what actually has to give.
If keeping it together is getting expensive, that is reason enough
The consultation is a conversation, not an assessment. Describe what a normal week looks like, ask what therapy would change, and decide afterwards.
