Therapy for Executives

Yes. Helm Psychology is a private-pay practice, which matters more here than people expect. When you pay privately, no diagnosis is submitted to any insurance company, and nothing about your treatment enters an insurance database or any third-party system. Your therapy is protected by the same confidentiality laws that govern all psychotherapy, and it stays between you and us.

If you want to seek out-of-network reimbursement, just know the tradeoff first: a superbill includes a diagnosis code, and your insurer will see it. Plenty of executives skip the reimbursement for exactly that reason. But it’s your call either way, and nothing gets submitted unless you ask.

Confidentiality in therapy does have narrow legal limits that apply to everyone, mainly around imminent safety concerns—we’ll walk through all that together before starting. Beyond that, we work with a lot of people whose careers depend on discretion, and we run the practice accordingly.

Coaching focuses on your performance. Therapy helps you as a whole person. 

A good executive coach helps you with strategy, leadership skills, communication, and specific professional goals. That's valuable, and many of our clients have a coach they like. But coaching runs into a wall when the problem isn't a skills gap. If you keep having the same conflict with every co-founder, if you can't delegate no matter how many frameworks you've tried, if the anxiety stays no matter how well things are going, those aren't strategy problems. They're patterns, and they usually have a history that started long before your career did.

That's what therapy is for. We look at where those patterns come from, what they've been doing for you, and why they've been so hard to change from the outside. This is also why therapy is confidential health care with legal protections, while coaching conversations generally aren't protected at all—that’s also worth knowing if you've been using a coach as a de facto therapist.

You also don't have to choose one or the other. Coaching and therapy work on different layers, and plenty of our clients do both.

Fair question, especially if you've researched your options. There are therapies built around protocols, worksheets, and measurable session-by-session goals, and if you're someone who runs on frameworks, those probably sound efficient.

But here's the problem we see over and over with executives: structured approaches hand your problem-solving machinery one more thing to execute. You do the homework, you apply the techniques, you perform therapy well because performing well is what you do. The symptom gets managed for a while. But the pressure underneath doesn't move, because the part of you that turns everything into a project is the same part that's been keeping the real material out of reach.

Depth-oriented therapy works differently, and for executives especially, that's the point. Instead of a curriculum, we try to create room for you to notice what you avoid, follow what comes up, and understand where the drive, the pressure, and the patterns actually come from. It's less immediately gratifying than a checklist. But it's also how change happens at the deeper levels where your recurring problems live: the ones that have already outlasted every framework you've thrown at them.

No. Before becoming a psychologist, Dr. Annia Raja worked as a management consultant at Boston Consulting Group and an investment banking analyst at Morgan Stanley. She's been inside the rooms where performance is measured constantly, the hours don't end, and everyone is smart, driven, but running on fumes. Dr. Chaim Rochester has spent years working with executives and other people in high-stakes roles, in both therapy and coaching, and much of his caseload has been leaders carrying exactly this kind of pressure.

So when you talk about board dynamics, comp negotiations, a co-founder conflict, or the particular loneliness of being the person everyone reports to, you won't be starting from scratch. We know these worlds firsthand from the inside, and we have built Helm Psychology accordingly.

This worry comes up more than you'd think, and usually not out loud at first. The fear underneath it is often: if therapy softens the pressure I feel, then maybe it’ll soften my drive too. Maybe the anxiety is the engine, and if you take it apart, nothing else shows up to do its job.

In our experience, it works the other way around. The drive and the anxiety feel fused because they’ve shown up together for so long, but they're actually not the same thing. What therapy can help loosen are the parts of the anxiety that hurt you: the self-punishment after a mistake, the inability to stop scanning for problems even when things are okay, the sense that any pause means that you’re falling behind. But your judgment, ambition, and competitive instinct don't live there. If anything, they can have the capacity to get sharper when they're no longer running through all that static of constant anxiety and fear.

No, and honestly, the work issues are rarely just work issues. The same patterns that show up in how you lead tend to show up in your marriage, your parenting, your friendships, and your relationship with yourself. Constant internal pressure tends not to stay within the boundaries between office and home, and neither does the exhaustion.

So while a work situation can often be what brings executives in, the therapy itself is about attuning to your whole life. That might mean your relationship with your spouse, old family dynamics that still have their hooks in you, health, identity, grief, or existential questions of what all this effort is actually for. Whatever you bring, we work with the whole person, and in our experience, that's also what ends up helping the most.

Weekly therapy is our standard rhythm, and it's how we work with most clients. Depth-oriented therapy needs enough continuity to build on itself. With long gaps between sessions, therapy tends to stay at the surface level of updates and catching up. And some clients meet more often than weekly, whether during intensive stretches of therapy or simply because they want more room in the work.

That said, we know some executives' calendars genuinely can't hold a standing weekly appointment, between travel, board cycles, and quarters that eat everything around them. This is why we also offer two therapy intensive formats as alternative time containers.

Monthly Intensive Therapy means longer sessions on a monthly or biweekly cadence: therapy still has continuity, but each meeting gives enough room to settle in and go deep, rather than trying to squeeze everything into a standard weekly session. Focused Therapy Intensives are different: a longer session, or a short series of them, built around one specific thing that needs concentrated attention. That might be a decision you've been circling, a leadership transition, burnout that's come to a head, or a stuck pattern you want real time with. Some executives use a Focused Therapy Intensive to start therapy with momentum, while some use it alongside ongoing work. You can read about both formats on our Therapy Intensives page.

If you're not sure what would fit with your life, that's a normal topic for us to discuss on a consult call.

Yes. Helm Psychology operates exclusively online through a secure, HIPAA-compliant platform. We're licensed in California and Texas and participate in PSYPACT, which lets us work with clients in 40+ states across the U.S.

Most of the executives we work with actually prefer it this way. No commute, and sessions can happen from your office, home, or a hotel room in another city. It also means therapy doesn't get interrupted by travel, a relocation, or a new role across the country, so your therapy can stay consistent even when nothing else is. You can read more about how depth-oriented work translates to a virtual setting on our online therapy page.

Helm Psychology is a private-pay practice. We are not in-network with any insurance companies, and we don't bill insurance directly.

For a lot of the executives we work with, that's part of the appeal. Paying privately means that no diagnosis gets submitted to an insurance company, no treatment records enter an insurance database, and no third party gets a say in how long or how deep the work goes.

That said, if your plan includes out-of-network benefits, you can still pursue them if you wish. We can provide monthly superbills, and depending on your plan, we can often submit out-of-network claims electronically on your behalf. Reimbursement rates vary a lot between plans, so it's worth asking your insurer specifically about out-of-network outpatient psychotherapy. Check our main FAQs for more detailed information on this.

One thing to know before you decide: a superbill has to include a diagnosis code, and your insurance company will see it. Some executives look at their reimbursement rate and decide it's worth it. Others would rather keep therapy completely outside the insurance system, even at a higher out-of-pocket cost. There's no wrong answer, but it should be your call, made with full information. We can go over things with you before anything gets submitted anywhere.