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You made an appointment to see someone for help, well done! Anxious for the appointment?

Here’s what you need to know.

This can feel really overwhelming or even a little scary and that makes sense. A reminder: doctors are there to help and guide you, not judge you. Not every doctor is the right match for every person. 

Unsure what to expect going into the appointment? First up…paperwork! (how exciting). This includes two forms called the PHQ-9 and GAD-7, these measure the level of anxiety and depression symptoms you are having, and how much they interfere with your day. Honesty is key. It helps your doctor know how to best help you!

Self-check: What stressors do I have around me? Stress in me (how do I talk to myself and treat my body)?

Self-check: Did any other questions come to mind? What worries do you have? 

Don’t want to take medication or not ready? Other alternative treatment or combination treatment:

• Talk therapy 🙂
• Lifestyle approaches (this may be challenging due to the intensity of your symptoms and that’s okay!)
• Track your mood daily to highlight any patterns here 
• Peer support groups
• Mindfulness or meditation try this! or this one! 

Ketamine assisted therapy (we have this at TCA)

Quick reminder: Depression can be a normal reaction to abnormal life events. The human experience is impacted greatly by the things happening around us. Medication is not meant to be a bandaid to the concerns. It is meant to be a tool that supports lifting you up, to allow you the space to process and grow. This is also where therapy comes in! A combination of talk therapy and medication can improve outcomes and lower changes of recurrent symptoms. 

Whatever you decide to do, trust yourself! You know yourself and your symptoms best! You can always speak about it to a therapist as well. Reach out using the button below to schedule with one of ours.

Self-check: How do you and those around you view mental health? How was it viewed growing up?

More than 1 in 5 U.S. adults experience mental illness every year, with 15.5% of U.S. adults experiencing Major Depressive Disorder . Depression symptoms are common and can be debilitating, impacting day to day functioning at work, school, or at home.

Common symptoms include: 

• Feelings of sadness, hopelessness, or worthlessness
• Angry outbursts or irritability
• Loss of interest in normal activities (hobbies, sex, sports)
• Sleep changes, insomnia or sleeping too much
• Change in appetite – eating too much or too little (compared to your normal)
• Frequent or recurring thoughts of death, suicidal ideation, or suicide

Self-check: Do any of these feel familiar? What is that like for you?

Wait, what is suicidal ideation?

Suicidal ideation, or suicidal thoughts, are thoughts that are intrusive, recurring, or distracting around suicide and death. So what can these thoughts look like? There are two types: passive suicidal ideation and active suicidal ideation. 

Passive suicidal ideation:

I wish that I won’t wake up tomorrow.

Today was so difficult, I wouldn’t mind if life was over. 

*no current plan or intent to make these thoughts a reality

*does not = suicide or self-harm

Active suicidal ideation:

Persistent, specific thoughts of a plan to end one’s life including details

Warning signs can include giving away important things to others, writing a note, creating a specific plan with a means (a way to do it)

If you are reading these and have these thoughts, contact emergency services (911 or 988) for immediate help.

Self-check: Do any of these feel familiar? What is that like for you?

What causes depression?

A mixture of social, psychological, and biological factors (ex: adverse life events like unemployment, grief, trauma, and even genes inherited from your parents). Life comes with many difficult and straining challenges that can impact us deeply. What helps while waiting for an appointment? Try these: TIPP skills or relaxation skills  

You are not alone in the human experience, or in having these symptoms! Reach out for support!

References

 Mental Health By the Numbers. (2025). Retrieved from https://www.nami.org/mental-health-by-the-numbers/

 Depression (major depressive disorder). (2026). Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

 Cleveland Clinic (2025). Suicidal Ideation (Suicidal Thoughts). Retrieved from https://my.clevelandclinic.org/health/symptoms/suicidal-ideation

 Depressive disorder (depression). (n.d.). Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression

Miller shared Aron’s estimate that this trait makes up 20% of the general population, and around 50% of therapy clients. Given that most therapists are also clients, many of us therapists are likely carry this trait as well! This was demonstrated in the group of us, with most of us nodding our heads along, throwing “me!” in the chat box, and considering other diagnoses we’ve been given and how they might relate to masking this trait, or wondering how much conditioning has played a part in the experience of mental illness. What if these traits were valued instead?

For a general overview of the traits, Miller recommends a handy-dandy acronym (don’t we love those in this field!?)

D.O.E.S

D-Depth of processing-slow to make decisions, deep thinking and feeling, commonly perfectionistic tendencies

O-Overstimulation/Over-Arousability-overstimulated by sensory input, but also novelty, sudden change, complexity, transitions, potentially easily overwhelmed by having many things to process

E-Emotional Reactivity-a strong reaction to positive and negative experiences, easily impacted by the emotions of others, may cry easily

S-Sensitive to Subtle Stimuli-ability to notice subtle differences or changes through their sensory fields.

André Solo (2023) outlines 4 Scientific Theories Behind this trait, noting that these are currently the dominant theories and models presented:

1. Sensory Processing Sensitivity: This is Elaine Aron’s theory, and the most widely known. Aron proposes that sensitivity is a trait, and that sensitive people are processing information differently at the level of the brain, which has not been fully proven. She theorizes that this sensitivity leads to traits like empathy, sensitivity to subtle sensation, and overstimulation. According to Solo, researchers estimate this trait is more proposed to be around 30% of the population, not 20%.
2. Differential Susceptibility-J. Belsky’s theory was organized around the question of why some had these traits and others didn’t. He points toward the evolutionary advantage and describes those with this trait as more shaped by how they are nurtured than non-sensitive people, who remain somewhat fixed. This is nature’s adaptation for the best opportunity for survival. He theorizes the sensitivity trait will propel children along who grow up in nurtured, safe environments, and keep those who have had less than nurturing environments alive and surviving, due to their ability to adapt.
3. Biological Sensitivity to Context-Similar to Differential Susceptibility, this theory, proposed by W. Thomas Boyce and Bruce J. Ellis, focuses on child development. Instead of proposing that those with the trait are born this way, they proposed that their environments shaped them to be more sensitive.
4. Diathesis-Stress vs. Vantage Sensitivity-These models are combined into a theory about advantages and disadvantages of the sensitive. On the one hand, sensitive people have a more difficult time under stressful circumstances, but they also benefit more from positive ones than the average person.

Miller shared with us some gems I’d like to share with you here (and thus hopefully remember them myself!)

We talk a lot about safety in therapy. Our brains scan for safety 4 times a minute and there are 3 layers of it:

1. Interoceptive Safety (what are we feeling in our bodies?)
2. The environment
3. Interpersonal: relating with the other, specifically their nervous system

In the therapeutic relationship, all are important! But the most pronounced is the relationship itself. Miller differentiated between two types of self-disclosure: a hot topic for therapists, and the theme of many hilarious therapist reels and memes. See below:

image from @cloud09therapy

The classical way we tend to think of self-disclosure is one where we share personal information. But the other, particularly important as highly sensitive people working with other highly sensitive people is something she refers to as “Therapist’s self-involving (TSI) interventions, utilizing the nervous system and emergence in the field of the therapy as an intervention, i.e. “I noticed something shifting when you said that. What are you feeling now?”

Sound like something you’re interested in engaging with? We’ve got you. Reach out now to inquire about our therapists that specialize in working with Highly Sensitive populations and other neurodivergent traits.

References

Sólo, A. (2023, November 22). The 4 wildly different theories researchers use to explain highly sensitive people. Sensitive Refuge. https://highlysensitiverefuge.com/four-theories-of-sensitivity-highly-sensitive-people/

Miller, Katherine. (2026, March 5) Self-Disclosure, Felt Safety, and the Highly Sensitive              Person. Tucson Counseling Associates

Still can’t figure it out? We’ve got you. Reach out now to inquire about our family therapy services.

What Clients Rarely See Behind the Scenes

When people hear that a therapist or practice doesn’t take insurance, the assumption is often that providers are being greedy or inflexible. The reality is far more complicated.

Insurance companies can:

• Change policies with little notice

• Retroactively take back payments for sessions that happened months or even over a year ago

• Admit billing errors were their fault—and still delay returning funds

• Reduce reimbursement rates with no negotiation

• Deny care that was previously authorized

• Create administrative requirements that increase costs while reducing access

Meanwhile, premiums and deductibles continue to rise for clients, while reimbursement for mental health clinicians continues to shrink.

Why We Stay In-Network Anyway

Despite all of this, we continue to fight to accept insurance because we believe our clients deserve to use the benefits they work hard to pay for.

As a practice, we:

• Spend countless unpaid hours dealing with claims, audits, denials, and appeals

• Monitor policy changes that could affect your care

• Advocate directly with insurance companies when access is threatened

• Absorb rising overhead costs—rent, payroll, training, licensing, compliance, technology

• Offer reduced rates and flexibility when we can

• Push back when changes would harm clients or clinicians

We do this not because it’s easy or profitable—but because access matters.

When Insurance Denies Care or Requests Payment

When insurance companies deny claims or retroactively take money back, it can sometimes result in a balance owed by the client. We know this is frustrating and confusing—especially when you’ve done everything “right.”

We ask for grace in these moments.

Please know:

• These situations are rarely due to clinician error

   

• We advocate whenever possible

   

• Denials are often the result of opaque, shifting insurance rules

   

• We are navigating the same system you are—just from the provider side

   

We will always communicate transparently, work with you when possible, and treat these situations with care and respect.

How Clients Can Advocate for Their Mental Health Benefits

One of the most powerful forces for change is insured members speaking up. Insurance companies respond far more quickly to pressure from clients than from providers.

You can help by:

• Calling your insurance company when care is denied and asking why

• Requesting written explanations of policy changes

• Filing formal complaints with your state insurance regulator

• Contacting elected officials about how these decisions affect real people

• Asking insurers to explain how mental health parity laws are being upheld

• Sharing accurate information when clinicians are blamed for systemic failures

Your insurance is not a favor—it’s something you pay for. Mental health care is not optional or expendable.

But the past two years have shaken that confidence. I was somewhat of an early adopter of AI tools, fascinated by what they could do and curious about how they might help my clients. I still think they can be genuinely useful for certain tasks. But I’ve also watched something else happening- a consolidation of power so rapid and enormous that it feels almost mythic. Bloomberg columnist Matt Levine once wrote that companies like OpenAI or Anthropic could “create God and then ask it for money” (Levine, 2023). I haven’t been able to stop thinking about that line. The biggest pattern of the past couple decades is that Silicon Valley keeps remaking the world in pursuit of scale, profit, and novelty, while being almost completely uninterested in the fallout.

Therapy is very much part of that fallout.

Most people don’t think about the fact that AI lives inside enormous, resource-hungry data centers that companies like Amazon are racing to build. My own community in Tucson, AZ recently fought against one. We were told it would be “water positive,” that it would secure our place in the next tech boom, that it would bring jobs. But it felt like propaganda, and my neighbors, people who had done their homework, challenged every slide the developers tried to peddle in our community town halls. When the project was voted down, the company refused to accept the result and began pushing it through anyway. It was the thinnest veneer of progress laid over a deeper engine of corporate greed.

This same dynamic is creeping into mental healthcare. I’m not actually afraid for my own job. If we ever reach the point where AI fully replaces therapists, there will be much bigger societal problems—mass unemployment, widespread destabilization, grief and confusion on a scale that no amount of “mental health tech” can fix. What I am afraid of is something more mundane: the slow, bureaucratic shift where insurance companies start steering people toward chatbot “therapy” by waiving copays or raising them for real humans. When I say this to colleagues, we give each other that momentary look—the one that mixes horror with recognition. Because we know that dystopia isn’t that far off based on how insurance companies already treat us. 

Meanwhile, the psychological risks are already here. There’s a growing body of cases describing something like AI-induced psychosis—individuals incorporating chatbots into delusional systems, or interpreting AI-generated messages as divine, threatening, or conspiratorial. Psychologist Azadeh Joon has documented emerging patterns of clients who spiral into psychosis fueled by generative AI interactions (Joon, 2024). There are also early legal cases alleging that AI conversations contributed to a child’s suicide (Bloomberg Law, 2024; Guardian, 2024). Vulnerable minds are being shaped by systems designed to maximize engagement, not wellbeing.

And even for people who aren’t psychotic, the lines get blurry. One of my clients, who is working on trusting her own intuition, started using ChatGPT late at night after arguments with her partner to check whether she was “being reasonable.” I gently asked her, “Does this align with your goal of trusting yourself more?” She immediately understood what I meant. But the pull was strong, AI is always awake, always validating, often sycophantically so.

I felt that pull myself. One night at 2 a.m., stuck in an OCD spiral, I decided to try using AI for support. I wasn’t seeking reassurance, I knew I was in an obsessional loop, and I wanted strategies. I know ERP well, and I explicitly instructed the model not to reassure me. To my surprise, it actually helped. I even shared the transcript with my own therapist, who specializes in OCD, and we were both impressed.

Mary Shelley understood this long before any of us. In the recently released Frankenstein movie, Victor is asked whether he considered the consequences of creating life, and he sheepishly admits he hadn’t. The danger wasn’t just playing God, it was the utter lack of emotional intelligence and foresight. Many scholars argue Shelley was not only critiquing hubris but also the early roots of a mindset that would later animate Silicon Valley: “move fast and break things” without stopping to ask what—or who—might shatter.

AI is here to stay. It will make some things easier. It might even enhance therapy in certain ways. But I believe with my whole heart that it cannot replace what happens between two human beings sitting together in a room. And if we lose that, we lose more than a profession, we lose a piece of our ability to know ourselves and to be in community with each other.

So I’m trying to imagine the world I want for my children, and the world I want to practice therapy in. A world where we fight—politically and culturally—to keep human connection at the center. A world where we slow down, where we gather, where we remember what it feels like to be held in another person’s presence.

Because the portal is opening regardless. But how we walk through it—together or alone—is still up to us.

Did you know each person dreams, on average, 6 dreams a night? That means if you live to be 80 years old, you will have spent 6 years of your life dreaming! There are many solid theories about why we dream and research that shows us dream deprivation leads to poor health outcomes. So we know that dreaming is important, even if we don’t recall them upon waking.

Instead of speaking to functionality, as there is extensive information and research out there on that, I want to know:

What would it look like for you to cultivate a relationship with your dreams?

Dreams are as natural as our breath, our digestion, our heartbeat. I want to propose that a relationship with our dreams is a deeper relationship with ourselves. Sure, we don’t need to pay attention to these processes in order for them to keep functioning but when we do, we enter into a greater sense of aliveness, awareness, and sensitivity. We move from objectivity into relationship. Cultivating, and tending to it, is inherently meaningful.  Dreams humble us with their ludicrousness, horror, beauty, awe. They invite us into a deeper dialogue with nature, ourselves, and, as a result, those around us.

Many dreamworkers, while coaching people to enhance dream recall, will firstly invite people to take an interest in their dreams, and will subsequently offer a variety of ways to enhance dream recall. Journaling, recording, or drawing them for instance, even if they are simple fragments or feelings or colors. However, the late Jeremy Taylor, beloved and revered dreamworker, reverend, and activist, proposed that most people struggle with recall because they don’t have safe and encouraging spaces of interest to speak of them.

What if the therapy room could be one of those spaces?

Dr. Leslie Ellis, author of A Clinician’s Guide to Dream Therapy: Demystifying Dreamwork, lists the following reasons that it should be:

• They are creative and engage our clients in the therapy process
• They point to our most salient emotional concerns
• They bypass our internal editing process and normal defenses and so are honest representations of our life situation
• Dreams can bring a new and wider perspective on a situation that is stuck or static
• Dreams provide diagnostic information and can be indicators of clinical progress
• Dreams help to regulate our emotions and are implicated in memory consolidation
• Dreams can be a safe pathway to working with trauma

I like to think of dreaming as the space where our egos go to bathe and merge back into the source from which they came. And working with our dreams intentionally, while we’re awake, helps us integrate what we saw, heard, felt, and experienced, allowing our new sense of ego to emerge in the process.  But most of all, it communicates to this part of ourselves that it is valuable, worthwhile, and meaningful.

Taylor refers to dreams as “over-determined”, meaning that they have many meanings. On a physical level, they may bring us information about our health. On an emotional level, they might show us feelings that are repressed or inflated. On a spiritual level, they can reveal where we truly feel connected in our lives.  Dreamwork inspires us, literally breathing life into us, as the etymology of ‘inspire’ goes. And the more dreamwork we do, the more flexible our egos, and the more adaptable we become. We already work on the flexibility of our egos in therapy, but why not bring in the voice of our inner therapist?

Go ahead. Try it out. Let me know how it goes!

Interested in exploring your dreams more intentionally? Reach out here to schedule!