Frequently Asked Questions

  • Dr. Julia Smith is currently accepting individuals via telehealth for anxiety, depression, attention-deficit hyperactivity disorder, and autism spectrum disorder. The fee per session for an individual is $175 | 50 min.

    Dr. Smith will provide a super bill for you as an out-of-network provider.

  • As an established Teletherapist, I work with individuals located in California, New Mexico, and Michigan. By using a secure system, I am able to provide effective Telehealth therapy and coaching that meets you where you are - in your location!

    All sessions are held on a HIPAA-compliant platform. Any confidential and personal health information (PHI) should not be sent through standard email. Therefore, I have a secure client portal for sending messages, scheduling appointments, and payments.

    Please contact me for available hours.

  • Types of Anxiety Disorders and Care

    Generalized Anxiety Disorder

    People with a generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.

    Generalized anxiety disorder symptoms include:

    • Feeling restless, wound-up, or on-edge

    • Being easily fatigued

    • Having difficulty concentrating; mind going blank

    • Being irritable

    • Having muscle tension

    • Difficulty controlling feelings of worry

    • Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

    Panic Disorder

    People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.

    During a panic attack, people may experience:

    • Heart palpitations, a pounding heartbeat, or an accelerated heart rate

    • Sweating

    • Trembling or shaking

    • Sensations of shortness of breath, smothering, or choking

    • Feelings of impending doom

    • Feelings of being out of control

    People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia (see below).

    Phobia-related disorders

    A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

    People with a phobia:

    • May have an irrational or excessive worry about encountering the feared object or situation

    • Take active steps to avoid the feared object or situation

    • Experience immediate intense anxiety upon encountering the feared object or situation

    • Endure unavoidable objects and situations with intense anxiety

    • There are several types of phobias and phobia-related disorders:

    Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

    • Flying

    • Heights

    • Specific animals, such as spiders, dogs, or snakes

    • Receiving injections

    • Blood

    Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

    Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

    • Using public transportation

    • Being in open spaces

    • Being in enclosed spaces

    • Standing in line or being in a crowd

    • Being outside of the home alone

    People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

    Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.

    Care

    Therapists help treat phobias by using psychotherapy, also known as talk therapy. The patients receive CBT (cognitive behavior therapy), where they can learn how to think, react, and behave to whatever it is that they fear. It is meant to reduce the feeling of overwhelming anxiety.

    Medications, on the other hand, aren’t a cure but they help patients deal with symptoms.

    Individuals can also learn stress-management techniques, such as meditation, yoga, or other holistic approaches.

    For more information visit The National Institute for Mental Health information: https://www.nimh.nih.gov/health/topics/anxiety-disorders

  • Depression commonly manifests physically, through stomach pains, headaches, disrupted or excessive sleep, and motor control difficulty. While the causes of depression are often hard to identify, a predisposition for it runs in families and it can be triggered by trauma and adverse life circumstances. Depression is diagnosed more frequently in women and tends to display differently in women than in men.

    Symptoms of Depression

    Depression is a mental illness which is characterized by prolonged emotional symptoms including:

    • Apathy

    • Sadness

    • Guilt

    • Exhaustion

    • Irritability

    • Hopelessness

    • Pessimism

    • Loss of Interest or Pleasure

    • Difficulty Concentrating

    Along with life circumstances, people tend to suffer higher rates of depression after giving birth and in late fall. Depression and anxiety often exacerbate each other and people with depression commonly have difficulty concentrating on tasks and conversations. Some people abuse alcohol and drugs or overeat as a way of coping, causing them to develop other medical problems. Depressed people are also at increased risk for self-harm.

    Treatment

    A person must experience symptoms for at least two weeks to be diagnosed with depression. Every case is unique and requires individual attention and the right diagnosis. There are effective ways of treating depression, which include talk therapy, adopting a healthier lifestyle, and medication. Talk therapy has been proven to be effective in the treatment of depression and Cognitive-Behavioral Therapy (CBT) is an identified best practice.

    For more information visit The National Institute for Mental Health information: https://www.nimh.nih.gov/health/topics/depression

  • While ADHD is associated with focus, it takes in so much more. In both children and adults, it impacts the ability to realize your potential, persists in intensity with age, and interferes with self-esteem, school performance, work accomplishment, socialization, clarity, organization, getting things done, mood, and coping effectively with life. Therefore, getting diagnosed and treated as early as possible can aid in building effective coping skills and the right kind of emotional resilience to mitigate the impact. In addition to learning to cope with the challenges, it is important to see and integrate the strengths in each child and adult with ADHD.

    General Description

    Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

    Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

    Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.

    Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

    Treatment

    Available treatments may reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, lifestyle enhancement, or a combination of treatments.

    In addressing psychotherapy, behavioral and cognitive-behavioral therapies provide demonstrated benefits in learning to manage the symptoms of ADHD and build a healthy sense of self. This is essential for building resilience against vulnerability to problematic behaviors.

    Behavioral therapy is a type of psychotherapy that aims to help a person change their behavior. It might involve practical assistance, such as help organizing tasks or completing work, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:

    • monitor their own behavior

    • give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting

    In general, therapy helps a person learn how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to new awarenesses, generate a positive personal belief system, and to develop skills that can improve performance and effectively live life.

    For more information please visit: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd

  • Autism Spectrum Disorder (ASD) is a lifelong neurological condition that impacts perception, processing, and interactions with the world. It is referred to as a “spectrum condition” because the sensory issues associated with ASD affect people differently and to varying degrees. Symptoms can be mitigated and psychotherapy plays a role in the treatment.

    Symptoms

    A diagnosis by a medical professional at any age and degree of symptoms helps to understand, access one's inherent abilities, and respond appropriately to the symptoms.

    A note to highlight is that individuals with ASD, particularly girls, learn to mask or camouflage the more obvious signs of autism and the deep, underlying fear that goes with it. So, it often goes undiagnosed. The condition persists, though.

    Some common symptoms at any age are:

    • Difficulties with communication

    • Avoidance of eye contact

    • Persistent draw towards solitude

    • Difficulty with the rhythm and timing in life and relating

    • Delayed language development

    • Persistent repetition of words or phrases

    • Difficulties adjusting to minor changes in routine or surroundings

    • Restricted interests

    • Repetitive behaviors

    • Unusual and intense reactions to sensory stimuli such as sounds, smells, tastes, textures, lights, colors, and/or the emotional climate of others

    • ASD presents as a distinct neurological condition, yet may occur alongside trauma and other mental health conditions.

    Care

    Psychotherapy assists in screening and managing autism. The results of therapy can be significantly beneficial. At the onset of psychotherapy, it is important to recognize personal strengths, abilities, and unique ways of experiencing life. The focus is on emotional and relational well-being along with functional skills that address self-care, self-referencing behavior, and meaningful work.

    The sensory issues and anxiety that interfere with connectedness and relating are an important focus. The symptoms associated with ASD do not change the capacity and need for an identity beyond a diagnosis and to have significant relationships.

    Therefore, in the treatment process, it is of critical importance to help those with ASD to understand and apply knowledge and skills for self-regulation in meeting self and attachment needs. Educational, mindfulness, and behavioral strategies are applied to generally gain an appropriate level of competence in well-suited career pursuits, relationship skills, and expanding on shared interests.

    Contextually, it is also important to consider the significance of a safe relationship climate. There is a need for empathy and understanding. There must be an underlying positive belief system that focuses on strengths rather than deficits and provides the space to have a sense of self. These features are important in any caring or significant relationship. Yet the quality is crucial for mitigating the sensory issues in ASD and energizing the value of having a well-developed identity while supporting healthy relating.

  • A number of benefits are available by participating in therapy and coaching. You are able to work through difficult emotions such as anger, hurt, and sadness to gain a sense of relief and resolution. For the situations you are dealing with in receiving professional care, it provides support, problem-solving skills, and coping strategies for issues such as depression, anxiety, relationship troubles, unresolved childhood issues, grief, stress management, and body image issues. Therapy also provides the opportunity to pursue accomplishments towards your dreams and goals, make gains in personal growth, expand self-development, improve interpersonal relating, address family concerns, work on couples issues, and improve your ability to manage the ins and outs of daily life. Therapy and coaching bring new perspectives to your issues and life, often pointing you in the right direction. The benefits you obtain depend on how well you use the process and put into practice what you learn.

    Benefits available from therapy include:

    • Attaining a better understanding of yourself, your goals, and values

    • Gaining insight and skills for improving your relationship with yourself and with others

    • Finding resolution to the issues or concerns that led you to therapy

    • Learning new ways to cope with stress and anxiety

    • Managing anger, grief, depression, and other emotional pressures

    • Improving communications and listening skills

    • Changing old behavior patterns and developing new ones

    • Expanding your sense of choice and decision-making

    • Improving your self-esteem and boosting self-confidence

  • Mental and behavioral health issues can significantly hinder learning, wellness, and fulfillment. The impact also shows up in how effectively and joyfully you can give and receive love. Although the impact of psychological health cannot necessarily be seen, it is still a health condition, just like a fractured bone. In fact, untreated mental and behavioral health problems often grow like an illness such as cancer.

    Issues involve emotion, thought, words, and behaviors. Varying levels of distress show up in problems with functioning in personal, social, vocational, and/or family life. They take many forms – some are mild and only interfere in limited ways with daily life, such as certain phobias (abnormal fears). Other mental health conditions are so severe that a person may need care in a hospital. In most cases, issues can be resolved or managed with appropriate care. Signs and symptoms run differently, depending on the disorder, circumstances, and other factors.

    Signs and symptoms of mental health issues may include:

    • Feelings of sadness for a prolonged period of time

    • Extreme mood changes of highs and lows

    • Excessive anger or violence

    • Undue fears or feelings of guilt

    • Withdrawal from usual activities and relationships

    • Changes in energy, sleep, or eating

    • Confusion and lowered ability to concentrate

    • Abuse of alcohol and/or drugs

    • Inability to cope on a daily basis, manage stress, or get tasks done

    • Suicidal thoughts

  • Suicidal thoughts and behavior are common with some mental illnesses. If you think you may hurt yourself or have thoughts of suicide, do get help right away:

    Call 988 immediately. This is quick access number to the National Suicide Prevention Lifeline number.

    Call a suicide hotline number. The U.S. National Suicide Prevention LIfeline phone number is 1-800-273-TALK (1.800.273.8255) or visit Vibrant Emotional Health Safe Space for digital resources.

    Call a healthcare provider.