For some people, the obstacle to therapy is not cost, time, or skepticism about whether it works. It is a genuine and specific concern about where the information goes.
Executives, physicians, attorneys, people with professional licenses, people with a public profile, and people whose business depends on reputation all have a version of this question. It deserves a direct answer rather than reassurance.
What confidentiality actually covers
What you say in a therapy session is protected health information. Your therapist cannot disclose it — including the fact that you are a client — without your written authorization.
The exceptions are narrow and identical for everyone in Nevada:
- An imminent risk of serious harm to yourself or another person
- Suspected abuse or neglect of a child or a vulnerable adult
- A valid court order
That is the list. Not a bad quarter, not a divorce, not an affair, not drinking, not a diagnosis.
The part people do not know: insurance creates a record
This is the practical detail that matters most and is rarely explained.
If you use insurance, the claim requires a diagnosis code, and that becomes part of your insurance record. For most people that is entirely unproblematic — health information is protected, and the era when a depression diagnosis routinely affected employment or life insurance is largely behind us.
But it is a real consideration in specific situations: some security clearances, certain professional licensing contexts, and some insurance underwriting.
If that applies to you, self-pay keeps the episode entirely outside any insurance record. No claim, no diagnosis code, no third party involved in decisions about your care.
That is a legitimate choice, it is more common than you would think, and nobody will ask you to justify it. Under the federal No Surprises Act you are also entitled to a written Good Faith Estimate of expected costs before you begin, which we provide as a matter of course.
Our self-pay rates are $150 per 50-minute session with licensed clinicians and $125 with associate clinicians.
Related: a therapist will not manufacture a diagnosis
Worth saying, because people occasionally ask.
Insurance reimburses treatment of a diagnosable condition. If you are coming in for something that does not constitute one — a difficult period, a decision, personal growth — no ethical clinician will invent a diagnosis to enable reimbursement. That is insurance fraud.
A therapist who declines is protecting you as much as themselves.
Practical discretion
Video sessions remove the waiting room question entirely. No building, no parking lot, no possibility of an awkward encounter.
Scheduling can work around a calendar — early morning, late evening, or a lunch hour.
Records. You are entitled to your own records under HIPAA. Note that a therapist's private process notes are treated differently from the clinical record, which is a distinction worth understanding if that matters to you.
What people in this position actually come in about
Frequently not what an outsider would guess.
- A marriage that has been functional and distant for years
- Adult children who are struggling, or who are not speaking to them
- The emptiness that arrives after achieving what you spent decades working toward
- Anxiety that has been managed with performance for so long it feels like personality
- Drinking that has become the way the evening ends
- A health diagnosis that reorganized everything
- Grief that never had room because there was a business to run
- Being the person everyone else depends on, with nowhere to put their own load
That last one is the most common. People who are relied upon by employees, family, and community frequently have no relationship in which they are permitted to not be fine.
The isolation of being the capable one
Success narrows the number of people to whom you can say something is wrong.
You cannot tell employees. Telling peers may have professional consequences. Family depends on your steadiness. And a social world where everyone is doing well makes being the one who is not feel conspicuous.
That is exactly what an outside room is for — someone with no stake in anything, who does not know anyone you know, and to whom nothing you say creates an obligation.
Attending, practically
Our east valley office on E Russell Road and our northwest office on N Durango Drive, plus secure video anywhere in Nevada.
We are in network with most major insurance plans if you want to use them, and self-pay is straightforward if you would rather not.
Nothing needs to look wrong from outside
Most people who come in for this have been managing something privately for years and are not in crisis. They are simply tired of carrying it without a single place to set it down.
That is a sufficient reason. Book a session.