A diagnosis is a description of a pattern. It is not a description of you.

If you arrive with a diagnosis, we work with it. If you arrive without one, what happens next depends on which path you are on. If we are billing your insurance, you will have a diagnosis on your chart from the first session; insurance does not pay otherwise. If we are working self-pay, you can begin without one, and we can decide together whether assigning one would serve the work.

Either way, what I will not do is treat a diagnostic label as if it explains your life. Anxiety is a real category. So is depression. So is ADHD and PTSD and BPD and the rest. Categories are useful. They become harmful when they replace the work of actually understanding what you are living with. The label tells us where to look. The work is what we find when we look.

Symptom management has a place in this work. If you are not sleeping, we work on sleep. If you are panicking, we work on the panic. The work has to meet the urgency where the urgency is, and sometimes the urgency is the whole reason you reached out.

But once the urgency settles, the question usually changes. The question is no longer how to keep your symptoms quiet. The question becomes what your life is for, what the symptom was telling you, and what becomes possible when you are not spending all your energy managing.

Most of the people I work with already know how to manage. They have been managing for years. What they have not had is somewhere to put the part of themselves that has been managing this whole time. That part deserves a chance to stop. That is what this work is also for.

Most therapy in the United States is talk therapy. Most talk therapy treats the body as the place where the client sits while the work happens above the neck. I do not.

The body holds what language cannot reach. A person can talk about a loss for an hour and not feel it. The same person can take a slower breath and find the loss waiting where it has been all along. Words can be a way of approaching what is true. Words can also be a way of staying just out of reach of it. Part of my work is noticing which is which.

This does not mean every session is somatic work. It means that what your body is doing while you talk is part of what we are paying attention to. The breath that catches when you mention your mother. The shoulders that rise before a hard sentence. The silence that lands different from a silence ten minutes earlier. We attend to that. Not as a technique. As a discipline of listening.

I am in-network with Blue Cross Blue Shield of Texas, and I also see clients self-pay. Both options are real, and the right choice depends on what you are coming for.

When insurance pays for therapy, the insurance company gets a vote in what therapy is. They require a diagnosis. They require a treatment plan organized around symptom reduction. They may require session counts that fit a cost-effective model rather than a clinical one. For a lot of presenting concerns, that structure is fine and the work moves anyway. For some kinds of work, particularly depth work that does not map cleanly onto a diagnostic code, the insurance frame can shape the therapy in ways that are worth thinking about ahead of time.

Self-pay means we work to your timeline, toward the goals you actually have, with records that belong to you and to me rather than to a third party with a financial stake in what they say. For some clients, those are deciding factors. For others, BCBSTX coverage is the difference between starting therapy and waiting. The first call is free. We can figure out together which path fits what you are looking for.

I am bilingual and bicultural, originally from Socorro, just outside El Paso. Most of the therapeutic frameworks I trained in came out of a tradition that did not have me, or anyone like my family, in mind when it was being built.

That does not mean I throw the frameworks out. It means I hold them lightly. I notice when a tool was built for a client who did not have to translate themselves twice a day. I notice when a recommendation assumes a kind of family that is not the kind of family you came from. I notice when the work I was trained to do has a cultural accent it did not know it had.

If you are a client whose life sits inside that gap, your gap is part of the work. You do not have to explain why your mother's voice is in the room with you when you are deciding something. We can just attend to that. If you are a client whose life does not sit inside that gap, the same care applies, just from a different starting place. Cultural humility is not a feature for clients of color. It is a discipline that shapes how I work with everyone.

I do not believe people need to find meaning in their oppression. I do not believe the answer to a hostile world is a more resilient inner attitude. Some of what people carry is not theirs to fix. It belongs to a system that needs to change, and pretending the work is internal when the injury is external is a way of making people responsible for what was done to them.

I also do not believe that naming the external injury is the whole work. Some things can be changed inside the room, even when what is happening outside the room cannot. What therapy can honestly offer is one or two hours a week in which the conditions are different enough that something inside you, that has not been moving, can move. Choice that has felt abstract can start to feel real. That is not a small thing. It is also not everything. I try to be honest about both.

Rush you through a protocol you did not ask for. Treat your inner life as a problem to be optimized. Pretend that talking about a feeling is the same as feeling it.

Tell you what your symptoms mean before you have told me what you are living with. Replace your judgment with mine. Mistake the goal of therapy for the goal of feeling better as quickly as possible.

Promise you what therapy cannot promise. The work does not guarantee that you will be free of pain. It offers the possibility that the pain you carry will become more your own, more understood, less a thing that runs you from underneath. That is what I can offer. Anything else would be dishonest.