What I Treat and How I Work
I take a targeted, individualized approach to therapy rather than a one-size-fits-all model,
because many people seeking care for anxiety, depression, trauma, and related emotional
difficulties have already tried approaches that were too general or not effective.
I specialize in working with adults experiencing anxiety disorders, depressive symptoms,
trauma-related distress, relationship difficulties, and treatment-resistant conditions that
have not improved with previous therapy or medication. My focus is on identifying the
specific patterns that are maintaining symptoms and directly working to change them in a
structured and practical way.
Treatment is collaborative, focused, and goal-oriented. Rather than open-ended discussion
without direction, sessions are designed to create clarity, momentum, and measurable
improvement over time.
If you are considering therapy, the first step is a brief 15-minute consultation call to
determine whether this approach is a good fit for your needs and goals.
Areas of Focus
Most clients come to therapy experiencing more than one of these concerns at the same
time. This is common, and treatment is not based on a single diagnosis or label. Instead,
the focus is on understanding how these patterns interact and affect your daily life,
emotions, and relationships.
I work with adults experiencing anxiety disorders, depression, trauma-related symptoms,
relationship difficulties, chronic stress, low self-confidence, and treatment-resistant
conditions that have not improved with previous therapy or medication.
If you are wondering whether your situation fits, this is often where people begin. The goal is
not to categorize you, but to understand what is maintaining your symptoms and how to
change it in a structured and effective way.
Depression
Depression is more than sadness. It can involve a persistent low mood, negative self-talk,
loss of motivation, emotional fatigue, and a gradual erosion of self-esteem and interest in
daily life. For some individuals, even when medication helps, it can also leave a sense of
emotional flattening, numbness, or disconnection from others.
I specialize in working with adults experiencing depression that has persisted over time,
including cases where previous therapy or medication has provided limited or incomplete
relief. This includes treatment-resistant depression and long-standing depressive patterns
that feel difficult to break.
If you have been struggling for years or feel stuck in a cycle that has not improved with prior
treatment, therapy focuses on identifying the patterns maintaining those symptoms and
working toward meaningful, measurable change in mood, motivation, and functioning
Anxiety
Anxiety can involve persistent worry, panic symptoms, overthinking, and a constant sense
of being on edge. These experiences do more than create distress — they can interfere with
work performance, relationships, sleep, concentration, and overall quality of life.
I specialize in helping adults experiencing anxiety disorders, chronic worry, panic symptoms,
and related stress responses that have persisted over time or have not responded well to
previous treatment. This includes cases where anxiety feels physically and mentally
overwhelming or difficult to control.
While many approaches focus primarily on symptom management, my work focuses on
identifying and changing the underlying cognitive, emotional, and behavioral patterns that
drive the anxiety response. The goal is to reduce symptoms at their source and create
lasting improvement in how anxiety is experienced and managed.
Trauma and PTSD
Trauma can occur suddenly or develop over time, and it can significantly change how
people experience safety, relationships, and daily life. For many individuals, trauma-related
symptoms may include hypervigilance, intrusive memories, avoidance behaviors, emotional
numbing, anxiety, and difficulty feeling fully present.
I have worked for decades with adults experiencing trauma and post-traumatic stress
disorder (PTSD), including veterans, first responders, and individuals affected by other
traumatic life experiences. Treatment is grounded in my concept that PTSD is an injury, not
a mental illness, and as such, I consider my approach to this problem as Psychological
Rehab. This approach is structured to help reduce the intensity of trauma-related responses
and improve day-to-day functioning.
My focus is on helping individuals modify unhelpful threat responses, process traumatic
memories in a structured and controlled way, and reduce avoidance patterns that limit
quality of life. The goal is to restore a greater sense of safety, stability, and flexibility in how
life is experienced.
Adults with ADHD and Executive Functioning
Many adults with ADHD describe a lifelong sense of frustration — wondering why tasks that
seem simple for others feel overwhelming, inconsistent, or difficult to complete. This can
show up in daily life as difficulty initiating tasks, staying organized, managing time, following
through on responsibilities, or maintaining routines.
Over time, many individuals internalize the belief that they are simply “not trying hard
enough,” despite repeated efforts to improve. These experiences often contribute to chronic
self-criticism, low confidence, anxiety, and emotional exhaustion.
In my work, we begin by addressing the internal narrative and self-talk that has developed
over years of misunderstanding these patterns. This is often an important first step,
because meaningful change is difficult when the underlying beliefs about yourself remain
unchanged.
From there, treatment focuses on practical and individualized strategies based on how your
brain functions. This may include structured behavioral approaches, executive functioning
supports, coordination around medication evaluation when appropriate, and developing
routines that are realistic, sustainable, and tailored to your needs.
Adults Shaped by Difficult Childhoods
Growing up with emotionally immature or narcissistic parents,
unpredictable home environments, emotional or physical neglect or abuse, or chronic
childhood bullying often leaves adults with recognizable patterns that persist long after
childhood ends. These may include people-pleasing, chronic self-doubt, difficulty trusting
others, problems making or keeping close friends, emotional shutdown, or anger that
feels confusing or disproportionate.
Ketamine and Psychedelic-Assisted Psychotherapy
Most people who find their way to this work have already tried conventional therapy. It helped —
or it didn’t — but something remained stuck.
Psychedelic-assisted psychotherapy is not a shortcut. It’s a different door.
Dr. Shapiro specializes in ketamine-assisted psychotherapy, psychedelic-assisted
psychotherapy, psychedelic preparation and integration, and microdosing support — available
via telehealth nationwide. His approach treats psychotherapy as the core of the work, with
psychedelics functioning as accelerants: substances that can temporarily loosen rigid patterns
of thinking and emotional processing, opening access to material that’s hard to reach otherwise.
He calls this the neuropsychological flexibility window — a temporary state where past
experiences, present patterns, and future possibilities become more emotionally and
psychologically available. The goal isn’t the experience itself. The goal is what you do with it,
clinically, before and after.
This work isn’t right for everyone. If you want to understand whether you’re a good candidate,
schedule a consultation.
Life-Cycle Transitions
Life transitions do not have to be negative to feel destabilizing. Major changes such as
promotion, career shift, retirement, divorce, becoming an empty nester, or other significant
life adjustments can create uncertainty and emotional disruption, even for highly capable
individuals.
This uncertainty can contribute to anxiety, self-doubt, indecision, and a sense of feeling
stuck or disconnected from one’s usual confidence and direction. These reactions are
common during periods of adjustment and change.
In therapy, we focus on clarifying what is driving the hesitation or emotional difficulty,
identifying unhelpful thought and behavioral patterns, and developing practical strategies to
restore stability, confidence, and forward movement during periods of transition.
Childhood Emotional Abuse, Neglect, and Bullying
Many adults continue to struggle with patterns that began in childhood. Growing up with
emotionally immature or narcissistic parents, experiencing emotional neglect, abuse, chronic
criticism, unpredictable home environments, or bullying can have lasting effects that persist well
into adulthood — often showing up as anxiety, depression, low self-esteem, people-pleasing,
perfectionism, emotional reactivity, and relationship patterns that feel confusing or stuck.
These experiences shape how you learned to think about yourself, regulate emotions, and
relate to others. What helped you adapt as a child can become limiting as an adult. In clinical
practice, these struggles are understood as the long-term effects of childhood trauma,
attachment wounds, and developmental experiences — not character flaws, and not permanent.
Dr. Shapiro combines cognitive behavioral therapy (CBT) with a structured clinical examination
of how early experiences continue to shape current thinking, emotional reactions, relationships,
and self-worth. The focus isn’t on spending years revisiting the past — it’s on identifying patterns
that were once adaptive and are now limiting, and replacing them with healthier ways of
thinking, relating, and responding.
Therapy targets stronger boundaries, more secure relationships, improved self-confidence, and
greater emotional stability.
Psychology, Behavior, and AI
Artificial intelligence is no longer a future development — it is already shaping how people
think, communicate, and process information. Its psychological impact is emerging quickly
and is increasingly relevant to mental health, behavior, and emotional functioning.
Used intentionally, AI tools can support self-reflection, increase insight, and complement
therapeutic work. Used without awareness, they may also reinforce avoidance, emotional
disconnection, dependency on external feedback, or difficulty tolerating uncertainty.
In clinical practice, I am actively engaged in understanding and working with these
emerging effects of technology on behavior, cognition, and emotional health. This includes
both direct clinical work and professional consultation in this evolving area of psychology.
The goal is not to fear technology, but to understand how it influences attention, behavior,
and emotional regulation — and to help individuals use it in ways that support psychological
health rather than undermine it.
What to Expect
My approach to therapy is active, structured, and goal-oriented. Rather than focusing on
open-ended discussion alone, the work centers on understanding what is keeping you stuck,
developing a clear direction for treatment, and making meaningful, measurable changes
over time.
Much of my work is grounded in cognitive-behavioral and evidence-based principles.
However, therapy is not reduced to worksheets or surface-level symptom management. We
look at the full context of your life — including your values, relationships, stress levels,
physical health, daily habits, and the learned emotional and behavioral patterns that may no
longer be serving you.
Sessions are focused
Each session has a clear purpose. We may work through difficult thoughts, emotions, or
experiences, but always with the goal of increasing insight, identifying patterns, and
applying practical change.
There is work between sessions
Sustained change often happens between sessions. You may be asked to observe patterns,
practice new skills, or approach situations differently in daily life. This helps extend
progress beyond the therapy hour and supports lasting improvement.
I am direct and engaged
If I notice patterns such as avoidance, emotional blocks, or inconsistencies that are
important to your progress, I will address them openly and respectfully. Therapy is most
effective when it is honest, collaborative, and active on both sides.
Relationships and life context matter
Although I work with individuals rather than couples or families, the relationships,
environments, and systems around you significantly influence emotional wellbeing. Family
dynamics, work stress, and relationship patterns are often important parts of the
therapeutic work.
The goal is resolution, not endless coping
While coping skills can be helpful, the long-term goal is not simply to manage symptoms
indefinitely. The focus is on reducing the patterns that maintain distress so you can
experience greater stability, clarity, and independence in your life.
Who I Work With
My practice is built for adults who are done settling for “good enough” when it comes to their mental health. That looks different for everyone, but my clients tend to share a few things in common:
You’ve tried therapy before and it didn’t stick. Maybe it helped for a while. Maybe it never really clicked. Either way, you’re not looking for the same experience with a different person in the chair.
You’re dealing with something that medication alone hasn’t fixed. Prescriptions have their place, but they’re not a complete solution for everyone. If you’ve been through the medication cycle and you’re still struggling, therapy can address what pills can’t.
You want someone who will be straight with you. I’m not the right fit for everyone. If you’re looking for a therapist who mostly listens and validates, that’s not me. If you want honest feedback, clear direction, and someone who will push you because they actually want you to get better, we’ll get along fine.
You’re a functioning adult carrying more than people realize. A lot of my clients look fine from the outside. They go to work, they take care of their families, they keep it together. But underneath that, something’s been off for a long time. You don’t have to be in crisis to deserve help.
My Fees
My practice is designed for adults who are ready for a more focused, active, and effective
approach to their mental health care. While each person’s situation is different, many clients
share similar experiences and concerns.
You’ve tried therapy before, and it didn’t fully help
Many of my clients have been in therapy previously for anxiety, depression, trauma,
ADHD-related challenges, or relationship difficulties. It may have helped temporarily or not
felt like the right fit. In these cases, the goal is not to repeat the same experience, but to
take a more structured and targeted approach to change.
Medication alone hasn’t been enough
Some individuals have worked with medication for mood, anxiety, or attention-related
symptoms but still feel stuck. While medication can be helpful, it does not always address
the underlying cognitive, emotional, and behavioral patterns that maintain distress. Therapy
can help target those areas directly.
You want a direct, structured approach
My style is active and engaged. I provide honest feedback, clear direction, and a structured
approach to treatment. This work is collaborative, but it is not passive. It is best suited for
individuals who want clarity, accountability, and meaningful change rather than open-ended
support alone.
You are functioning, but struggling internally
Many clients are high-functioning in daily life — managing work, family, and responsibilities
— while privately experiencing anxiety, depression, emotional exhaustion, or a sense that
something is not right. You do not need to be in crisis to benefit from therapy. If something
feels persistently off, it is valid and worth addressing.
The focus of this practice is helping adults move beyond symptom management toward
lasting change in how they think, feel, and function in daily life.
Fee Schedule:
| Service | Cost |
|---|---|
| Initial Evaluation | $350 |
| Individual Therapy (40-45 minutes) | $225 |
| Abbreviated Session (15-20 minutes) | $150 |
| Ketamine-Assisted Psychotherapy | $325 per hour |
| Physician or Professional Consultation | $150 |
| VA Claim Assessment and Consultation | $200 per session (4-session minimum) |
Cancellation Policy: Missed sessions or cancellations made with less than 12 hours’ notice will be charged the full fee of that appointment.