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Author: Juliann Siwicki

  • Does Insurance Cover Therapy in Maryland?

    Does Insurance Cover Therapy in Maryland?

    On this page
    1. The short answer: usually, yes
    2. In-network vs. out-of-network (and why it matters)
    3. The five terms that actually decide what you pay
    4. How to check your mental health benefits in 10 minutes
    5. What to know by plan: Cigna, Aetna, CareFirst, UnitedHealthcare, Medicaid
    6. Does insurance cover couples and family therapy?
    7. If your therapist is out-of-network: superbills and reimbursement
    8. Insurance at Sanare Counseling
    9. Final thoughts

    The Short Answer: Usually, Yes

    If you’ve been putting off therapy because you’re not sure whether your insurance will pay for it, here’s the reassuring part: in most cases, yes — it does. Under federal law, most health plans are required to cover mental health and substance use care at the same level they cover physical health care. That rule is called mental health parity, and it’s the reason “I have a copay for a doctor’s visit” usually means “I have a similar copay for a therapy visit.” The harder part isn’t whether you’re covered — it’s understanding the specifics. How much is your copay? Do you have to hit a deductible first? Is the therapist you want in your network? Those answers vary by plan, and the language insurers use to describe them is genuinely confusing on purpose. This guide walks through exactly how to find out what you’ll pay, in plain English, so you can stop guessing and book the appointment.

    In-Network vs. Out-of-Network (and Why It Matters)

    The single biggest factor in what you pay is whether your therapist is in-network with your insurance.
    • In-network means the provider has a contract with your insurer and accepts a pre-negotiated rate. You usually pay just a copay (often $0–$40 per session) or a percentage after your deductible. This is the least expensive route.
    • Out-of-network means there’s no contract. You may pay the full session fee up front, then submit for partial reimbursement — if your plan includes out-of-network benefits at all. Some do; many narrower plans don’t.
    When you search “therapist that accepts my insurance,” what you’re really doing is filtering for in-network providers — because that’s where the cost is predictable. The good news is that a practice can be in-network with several major plans at once, which is why it’s worth asking a specific practice what they accept rather than assuming.

    The Five Terms That Actually Decide What You Pay

    You don’t need to understand all of insurance. You need to understand five words. Once these click, your benefits summary stops being a wall of jargon.
    • Copay. A flat fee you pay per session — say, $25. Simple and predictable.
    • Deductible. The amount you pay out of pocket each year before insurance starts contributing. If your deductible is $1,500 and you haven’t met it, you may pay the full negotiated session rate until you do.
    • Coinsurance. A percentage you pay after the deductible is met — for example, 20% of the session cost, with the plan covering the other 80%.
    • Out-of-pocket maximum. The most you’ll pay in a year. Once you hit it, covered care is essentially free for the rest of the plan year.
    • Prior authorization. Some plans require approval before certain services. For standard outpatient therapy this is increasingly rare, but it’s worth a quick check.
    Here’s the pattern most people land on: a modest copay per session, or full-rate sessions until a deductible is met and then a small coinsurance after that. Knowing which of those two scenarios applies to you is the whole game.

    How to Check Your Mental Health Benefits in 10 Minutes

    You can get a clear answer today without waiting on hold for an hour. There are two reliable routes. Option 1 — Call the number on your card. Flip your insurance card over and call the member services line (often labeled “Behavioral Health” or “Mental Health”). Tell them you want to verify outpatient mental health benefits and ask these exact questions:
    • “Do I have outpatient mental health coverage, and is telehealth therapy covered the same as in-person?”
    • “What is my copay or coinsurance for an outpatient therapy session — CPT code 90837?”
    • “Do I have a deductible, and how much of it have I met this year?”
    • “Do I need a referral or prior authorization for outpatient therapy?”
    • “Do I have out-of-network benefits if my provider isn’t in-network?”
    Option 2 — Let the practice check for you. Most practices, including ours, will run a benefits verification on your behalf before your first session so you walk in knowing your expected cost. This is usually the faster, less stressful option — you give them your insurance details and they come back with the numbers. When you reach out to schedule, just ask them to verify your benefits.

    What to Know by Plan: Cigna, Aetna, CareFirst, UnitedHealthcare, Medicaid

    Coverage details depend on your specific plan, not just the insurer’s name — two people with “Cigna” can have very different benefits. That said, here’s the general landscape for the major Maryland payers.
    • CareFirst BlueCross BlueShield. The largest insurer in Maryland, with strong outpatient mental health coverage on most plans. If you’re a CareFirst member, see our dedicated page on therapy with CareFirst BCBS in Maryland.
    • Cigna. Cigna administers behavioral health through Evernorth and generally covers outpatient therapy with a copay or coinsurance. This is a frequent question we get, including for couples work — more on that below.
    • Aetna. Broad behavioral health coverage on most commercial and federal (FEHB) plans, typically with a per-session copay once any deductible is met.
    • UnitedHealthcare / Optum. UHC routes behavioral health through Optum; outpatient therapy is widely covered, with telehealth treated the same as in-person on most plans.
    • Maryland Medicaid. Medicaid covers outpatient mental health care for eligible Marylanders, often with little or no out-of-pocket cost. See our overview of therapy with Maryland Medicaid.
    The takeaway: the major plans Marylanders carry almost all cover individual outpatient therapy. The variable is your specific copay, deductible, and network — which is exactly what the 10-minute check above tells you.

    Does Insurance Cover Couples and Family Therapy?

    This is one of the most common coverage questions we hear, and the honest answer is: it depends, and more often than you’d expect, no — at least not directly. Insurance covers care for a diagnosable mental health condition. Individual therapy for anxiety or depression fits that cleanly. Couples therapy, on the other hand, is sometimes billed under a relationship-counseling code that many plans don’t cover, because “the relationship” isn’t an insurable diagnosis. However, when one partner has a covered condition and the sessions are part of treating it, family or conjoint therapy codes are sometimes reimbursable. If keeping costs down matters for couples work — and for most families it does — it’s worth asking specifically how a practice bills it, and whether a pay-over-time or self-pay rate might actually be simpler than insurance. The right move is to ask before the first session, not after.

    If Your Therapist Is Out-of-Network: Superbills and Reimbursement

    Sometimes the therapist who’s the best fit isn’t in your network. That doesn’t automatically mean full price forever. If your plan includes out-of-network benefits, you can often recover a meaningful portion of what you pay. The mechanism is a superbill — an itemized receipt your therapist provides that includes the diagnosis and billing codes. You submit it to your insurer, and if you have out-of-network coverage, they reimburse you a percentage (often 50–70%) after any out-of-network deductible. Practical tips:
    • Confirm you have out-of-network benefits first — narrow HMO and some marketplace plans don’t include them.
    • Ask your therapist to provide a superbill monthly; many do this automatically.
    • Keep submissions consistent — reimbursement is retroactive to when you started, as long as you submit within the plan’s window.

    Insurance at Sanare Counseling

    At Sanare Counseling, we try to make the money part of therapy as un-stressful as the rest of it. We work with Maryland clients across most major plans and verify your benefits before your first session so there are no surprises. What working with us looks like on the insurance side:
    • Most major plans accepted, including CareFirst BCBS, Cigna/Evernorth, Aetna, UnitedHealthcare/Optum, and Maryland Medicaid (HealthChoice)
    • We verify your specific copay, deductible, and coverage before your intake — you’ll know your expected cost up front
    • Virtual therapy across Maryland, billed the same as in-person under most plans
    • Transparent self-pay and pay-over-time options when insurance isn’t the simplest route — including for couples work
    • Superbills (via our Reimbursify partner) for out-of-network reimbursement, plus HSA/FSA accepted and sliding-scale options for those who qualify
    • Same-week appointments — you don’t have to wait six weeks for an intake
    If you’re not sure what your plan covers, you don’t have to figure it out alone before reaching out. Send us your insurance details when you request a consult and we’ll run the check for you.

    Final Thoughts

    The cost of therapy is one of the biggest reasons people delay getting help — and a lot of that hesitation comes from not knowing rather than from the actual price. For most Marylanders with insurance, outpatient therapy is covered, and the real out-of-pocket cost is far lower than people assume before they check. The most useful thing you can do today is the 10-minute benefits check. Once you know your copay or deductible, the decision gets a lot simpler — and if the numbers feel like one more thing to manage, that’s exactly the kind of thing we’ll handle for you.

    Your Path to Care Schedule An Appointment

    Juliann Siwicki, LCPC

    By Juliann Siwicki, LCPC

  • Therapy for Federal Employees in Maryland: When Your Career Becomes the Source of Your Stress

    Therapy for Federal Employees in Maryland: When Your Career Becomes the Source of Your Stress

    On this page

    1. Why so many federal employees are reaching out right now
    2. The unique stressors of federal work
    3. When “high-functioning” stops working
    4. The grief of a career that’s changing
    5. Anxiety, burnout, or “this is just what work is like now”
    6. Why generic therapy advice doesn’t always fit federal work
    7. What therapy can actually help with
    8. Practical things to start with this week
    9. Address federal employee mental health at Sanare Counseling
    10. Final thoughts

    Why So Many Federal Employees Are Reaching Out for Therapy Right Now

    If you work for the federal government in Maryland and you’ve been feeling more anxious, more cynical, or more exhausted than you used to, you’re not imagining it. Something has shifted in the federal workforce over the last couple of years, and the mental load it’s putting on people is real.

    The phone calls we’re getting at Sanare have changed. A few years ago, a federal employee reaching out for therapy was usually working through something personal – a difficult relationship, a family loss, a long-running anxiety pattern. Now, more and more often, the source of distress is the job itself. Reorganizations. Return-to-office mandates. RIF notices. Security clearance pressure. Watching colleagues get cut. Wondering if you’re next. The disorientation of a career path that suddenly feels less stable than it did a year ago.

    If any of that resonates, this article is for you. We work with Maryland federal employees across agencies and across pay grades, and what we keep hearing is some version of: “I’ve been pushing through this for months and I think I need help.” You probably do. And there’s effective care that’s actually built for the specific stressors you’re navigating.

    The Unique Stressors of Federal Work

    Federal employment comes with a set of pressures that don’t show up in most workplace mental health content, which is part of why generic advice often falls flat.

    Some of what makes federal work uniquely stressful right now:

    • RIF anxiety. Knowing that staffing decisions are being made in places you can’t see, on timelines you don’t control, while you’re expected to keep performing.
    • Security clearance and the cost of “looking” stressed. A real fear that mentioning mental health support could surface in a clearance review – even though, in most cases, seeking therapy alone doesn’t impact a clearance and not getting care is more risk than getting it.
    • Return-to-office shifts. Disrupting routines that took years to build, often with little notice, and rebuilding child care, commute, and household logistics on the fly.
    • Mission-purpose erosion. Joining federal service because you believed in the work, then watching that work get destabilized or reframed in ways that don’t match why you signed up.
    • Hierarchy and inability to push back. Career systems where pushing back has consequences and where “just leave” isn’t a simple option after years of vested benefits.
    • The watching. Seeing colleagues, mentors, and friends get cut, retire early, or quietly move on – and not knowing what that means for you.

    These aren’t small stressors layered on top of a normal job. They’re systemic, ongoing, and largely outside your control. That combination – high pressure plus low control – is one of the most reliably anxiety-producing setups your nervous system can encounter.

    When “High-Functioning” Stops Working

    A lot of federal employees we work with describe a version of the same pattern: they used to be the person who absorbed pressure without showing it. They prided themselves on being steady, on staying calm in chaos, on being the colleague leadership relied on. And now they’re noticing that the same strategies that worked for years aren’t working anymore.

    Some of the signs we hear most often:

    • Dreading Sundays in a way you never used to
    • Sleep getting worse – falling asleep fine, then waking at 3am running through work scenarios
    • Irritability spilling into your home life when you used to compartmentalize cleanly
    • Trouble focusing on things you used to find interesting – a podcast, a book, a hobby
    • Physical symptoms creeping in: chronic neck/shoulder tension, stomach issues, headaches you can’t shake
    • A growing sense of cynicism about the work you used to care about
    • “Numbing” patterns – extra drinks, doomscrolling, skipping meals, withdrawing from people

    If “high-functioning” used to be your default and now it’s costing more energy than it produces, your nervous system is telling you something. It’s not a character flaw. It’s a signal that the workload you’re carrying – emotional and logistical – has exceeded what your current coping strategies can handle.

    The Grief of a Career That’s Changing

    One thing rarely named in workplace mental health content is grief. Not grief over a loss of a person, but grief over a version of your career – and yourself – that no longer exists.

    If you joined federal service in your 20s or 30s expecting certain things to be true:

    • That seniority would be rewarded
    • That mission would matter more than politics
    • That stability was the trade-off for not getting private sector salaries
    • That the work would be respected, even if it wasn’t glamorous

    …and you’re now in a place where some of that feels less reliable, what you’re feeling might genuinely be a form of grief. Career grief can look like depression. It can also look like rage, withdrawal, hypervigilance, or going numb. None of those are signs that something is wrong with you. They’re recognizable responses to losing something that mattered.

    Naming it as grief – out loud, in a room with someone trained to help – often changes how it feels to carry.

    Anxiety, Burnout, or “This Is Just What Work Is Like Now”

    A common question we get from federal employees: “Is what I’m feeling a real mental health issue, or is this just what work is like now and I should toughen up?”

    Here’s the honest answer: it can be both. The conditions are real. And your nervous system has limits. The fact that the stressors are externally legitimate doesn’t mean your body and mind are equipped to absorb them indefinitely.

    A few quick distinctions that help:

    • Anxiety tends to show up as worry that doesn’t stop when the workday ends. A racing mind at 3am. Physical symptoms (chest tightness, shortness of breath) when nothing acute is happening. A constant low hum of dread, even on a Saturday.
    • Burnout tends to show up as exhaustion that doesn’t lift with weekends or vacation. Cynicism toward work you used to find meaningful. A drop in performance despite real effort. Feeling depleted before the workday even starts.
    • Depression tends to show up as anhedonia – losing pleasure in things you used to enjoy. Heaviness, hopelessness, or feeling flat. Withdrawing from friends and family.

    You can have more than one of these at the same time. You can also have a real, justified response to a hard situation that still warrants professional support. “Reasonable response” and “needs treatment” are not mutually exclusive.

    Why Generic Therapy Advice Doesn’t Always Fit Federal Work

    A lot of mental health content tells you to “set boundaries with your boss,” “negotiate your workload,” or “consider whether the job is right for you.” Those are reasonable suggestions in most jobs. They land differently in federal work.

    You usually can’t just tell your supervisor you’re going to reduce your scope. You usually can’t just take a six-month sabbatical to figure things out. You probably can’t easily walk away from years of TSP contributions, pension vesting, and benefits accumulation.

    Effective therapy for federal employees has to start from where you actually are, not from where a generic productivity article wishes you were. That means working within the realistic constraints of your role – and helping you build internal resources, not just external changes.

    Some of what that looks like in practice:

    • Learning to regulate your nervous system in the middle of meetings you can’t leave
    • Building decision frameworks for what you can actually control versus what you can’t
    • Working through career grief without rushing to “fix” it before you’ve felt it
    • Identifying which parts of the stress are situational and which are activating older anxiety patterns
    • Planning for contingencies without spiraling – preparing for a RIF without letting that preparation become its own full-time anxiety job

    What Therapy Can Actually Help With

    Federal employees sometimes come into therapy worried that talking about work stress isn’t a “real enough” reason to be there. It is. Here are the things therapy can concretely help with for people in your situation:

    • Sleep. Targeted CBT-I and anxiety-focused interventions can meaningfully improve the 3am-wake-up pattern within a few weeks.
    • The mental load. Strategies for offloading the “always carrying it” weight, even when the external pressure doesn’t decrease.
    • Career grief and identity shifts. Space to actually feel and process the loss of a version of your career – without rushing through it.
    • Hypervigilance. Re-teaching your nervous system that it can stand down, even when the news cycle says otherwise.
    • Decision-making under uncertainty. Working through “should I stay, should I look, should I retire early” without making the decision under panic.
    • Relationships at home. Federal stress doesn’t stay at the office – therapy helps with the way it lands in your marriage, parenting, and friendships.
    • Coordinating medication evaluation if it makes sense. For some people, especially with persistent sleep or panic symptoms, an SSRI or SNRI in combination with therapy is meaningfully effective.

    A short note on confidentiality: in nearly all cases, seeking therapy on your own – paid for through your insurance or out of pocket – does not surface in a clearance review. Untreated mental health concerns generally pose more risk than treated ones. If clearance is a concern for you, this is something we can talk through directly.

    Practical Things to Start with This Week

    Even before you start therapy, there are things you can begin now that meaningfully help. These aren’t substitutes for professional support, but they’re a real first step:

    • Protect your sleep aggressively. No phone in bed, no news after 8pm, a consistent wake time. Sleep is the single highest-leverage thing you can do.
    • Move your body daily. A 20-minute walk after work measurably reduces cortisol. You don’t need a gym routine; you need a walk.
    • Limit the news inputs. Federal news has a unique ability to spike your nervous system because it’s personal. Pick two times a day to check, not all day.
    • Find one person you can be honest with. Not “venting.” Honest. About what you’re carrying.
    • Track when the spike happens. Three weeks of noticing “what was happening right before I felt the surge” produces enormously useful data for therapy.
    • Don’t make big decisions in the middle of a panic week. Your judgment in a high-cortisol stretch is genuinely worse. Postpone if you can.

    Address Federal Employee Mental Health at Sanare Counseling

    At Sanare Counseling, we work with federal employees across Maryland – from people just starting to notice the stress is taking a toll to people who have been white-knuckling through years of pressure and are ready to do something about it. The clinicians on our team understand the specific landscape of federal work in this region, and we tailor care accordingly.

    What working with us looks like:

    • Virtual therapy delivered to wherever you are in Maryland – your home, your office on a lunch break, your car in a parking lot – fitted around your schedule
    • Most insurance accepted, including the most common FEHB plans (Aetna, Cigna, UnitedHealthcare, CareFirst BCBS)
    • Same-week appointments – you don’t have to wait six weeks for an intake
    • Coordination with psychiatry when medication evaluation makes sense
    • Maryland-licensed clinicians, all with experience supporting people in high-pressure professional roles
    • Strict confidentiality – your sessions are private and don’t impact your clearance simply by happening

    You don’t need to be in crisis to reach out. In fact, the most effective time to start therapy is well before things hit crisis – when you have the bandwidth to actually engage in the work. If you’ve been telling yourself “maybe in a few months when things settle down,” consider that things may not settle down on the timeline you’re hoping for, and that you can start building support now.

    Final Thoughts

    Federal employees in Maryland are navigating a kind of professional pressure that doesn’t get talked about as often as it should. The stress is real, the stakes feel real, and the toll on your sleep, your relationships, and your mental and physical health is real. None of that is in your head, and none of it is a sign that you’re weak for finding it hard.

    The strongest move you can make right now isn’t pushing through. It’s recognizing that what you’re carrying has gotten heavier than what one person is built to carry alone, and asking for the right kind of support.

    If you’re in Maryland and any of this resonates, reaching out is a good first step. We’re here, we get it, and there’s effective care that can meaningfully change how this period of your career feels – even when the external pressure doesn’t go away.

    Your Path to Care Schedule An Appointment

    Juliann Siwicki, LCPC

    By Juliann Siwicki, LCPC

  • Adult ADHD or Just Anxiety? How to Tell the Difference

    Adult ADHD or Just Anxiety? How to Tell the Difference

    On this page

    1. Adult ADHD or anxiety: why the confusion exists
    2. The difference between adult ADHD and anxiety disorder
    3. Common adult ADHD signs that get missed
    4. Shared symptoms that overlap
    5. ADHD, anxiety, and your mental health
    6. Strategies that actually help
    7. Effective treatments for ADHD and anxiety
    8. When to reach out
    9. Address adult ADHD and anxiety at Sanare Counseling
    10. Final thoughts

    Adult ADHD or Anxiety: Why the Confusion Exists

    For a lot of adults, the first time they wonder whether they have ADHD is also the first time they realize the symptoms look a lot like anxiety. Trouble concentrating. A mind that won’t slow down. Restlessness, irritability, forgetting things you swore you’d remember. The internal experience can feel nearly identical from the outside, which is why so many adults spend years being treated for anxiety alone when something else is also at play.

    The key difference comes down to what your brain is doing – and why. Anxiety is your nervous system reacting to a perceived threat, real or imagined. Your thoughts race because your brain is on high alert, searching for danger. ADHD, by contrast, isn’t a response to threat. It’s a difference in how your brain regulates attention, motivation, and impulse – present from childhood, even when there’s nothing to worry about. The thoughts race not because something feels wrong, but because your attention has no off-switch.

    If you’ve ever sat down to do a simple task and watched your brain spiral into seventeen unrelated thoughts before you could pick up the pen, you know the feeling. The question is whether that experience is rooted in worry or in wiring.

    The Difference Between Adult ADHD and Anxiety Disorder

    Most adults who are eventually diagnosed with ADHD spent years assuming they were just anxious, lazy, or “bad at adulting.” But ADHD is a neurodevelopmental condition – not a personality flaw, not a stress response, and not something you grow out of. It’s defined by patterns of inattention, hyperactivity, and impulsivity that have been present since childhood and that meaningfully interfere with daily life.

    Anxiety disorders, by contrast, are characterized by persistent, excessive worry that often feels disproportionate to the actual situation. They can develop at any age and frequently flare in response to specific life stressors.

    Signs that you may be dealing with adult ADHD include:

    • Chronic difficulty starting tasks, even ones you want to do
    • Time blindness – losing track of how long things take or how much time has passed
    • A pattern of forgetting appointments, deadlines, or commitments despite your best efforts
    • Difficulty finishing what you start, especially when novelty wears off
    • Impulsive decisions you later regret – spending, eating, talking, switching jobs
    • Hyperfocus on things that interest you and complete blankness on things that don’t
    • A history of these patterns going back to school years, even if they were masked by being “smart” or “high-functioning”

    Signs that what you’re experiencing is anxiety:

    • Worry that feels impossible to control even when you try
    • Physical symptoms like chest tightness, racing heart, or shortness of breath
    • Avoiding situations because something might go wrong
    • A sense of dread that doesn’t match what’s actually happening
    • Symptoms that escalated during a specific life event or stretch of high stress

    The patterns can overlap, but the histories usually don’t. Anxiety often points to a stressor – even a long-running one. ADHD points back to childhood.

    Common Adult ADHD Signs That Get Missed

    A lot of adults – especially women, professionals, and people who were “gifted kids” – were never assessed for ADHD because they didn’t look like the stereotype of a kid bouncing off classroom walls. They look like someone who:

    • Stays up late to finish projects they procrastinated on all day
    • Has a phone full of half-written notes and abandoned to-do lists
    • Feels exhausted constantly because their brain never settles
    • Excels in jobs that are interesting and falls apart in jobs that aren’t
    • Loses keys, wallets, and phones with surprising frequency
    • Has a closet, car, or desk that looks like a small disaster despite real attempts to organize
    • Talks fast, interrupts despite trying not to, or zones out in conversations they care about

    If you read that list and feel called out, that doesn’t automatically mean you have ADHD. But it’s worth taking seriously. Adult ADHD is genuinely underdiagnosed, particularly in people who developed strong coping strategies early and have been white-knuckling their way through executive function challenges for decades.

    Shared Symptoms That Overlap

    Here’s where it gets complicated. ADHD and anxiety share a lot of surface-level symptoms, which is exactly why they get confused – and why they’re so often diagnosed together. Both can cause:

    • Restlessness and difficulty sitting still
    • Trouble concentrating or finishing tasks
    • Sleep problems and exhaustion
    • Irritability
    • A racing mind
    • Forgetfulness
    • Avoidance behaviors

    The internal experience, though, is worth paying attention to.

    • Anxiety feels like a threat. Something is wrong or about to go wrong. Your inability to focus stems from a sense of impending doom – even if you can’t name what it is.
    • ADHD feels like a chase. Your attention runs after the most novel, stimulating, or urgent thing in the room. Your inability to focus stems from your brain not being able to filter input, not from worry.

    Anxiety often makes you avoid tasks because you’re afraid of failing them. ADHD often makes you avoid tasks because they don’t activate your reward system enough to start them. The behaviors look similar from the outside. The reason behind them is completely different.

    ADHD, Anxiety, and Your Mental Health

    Untreated adult ADHD doesn’t just make life harder – it often causes anxiety as a downstream effect. Constantly missing deadlines, forgetting commitments, and underperforming despite real effort takes a toll. Over time, the chronic feeling of “I should be able to handle this” turns into “something is wrong with me.” That self-criticism feeds anxiety. Anxiety then makes the ADHD symptoms worse. The cycle compounds.

    Co-occurring ADHD and anxiety is extremely common. Research suggests that more than half of adults with ADHD also meet criteria for an anxiety disorder at some point in their lives. Treating only the anxiety while leaving the ADHD undiagnosed is one of the most common reasons people feel like their anxiety treatment “isn’t working.”

    This is part of why getting a clear assessment matters. The treatment paths for ADHD and anxiety are different – and the right plan for someone with both conditions looks different again.

    Strategies That Actually Help

    Whether you’re dealing with anxiety, ADHD, or both, there are concrete strategies that make a real difference day to day. None of these replace a proper evaluation, but they can help you stabilize while you figure out what’s actually going on.

    • Build external structure. Calendar reminders, alarms, visible to-do lists, body doubling (working alongside another person, even virtually). For ADHD especially, the things you can see and touch matter more than the things you intend to remember.
    • Move your body. Exercise reliably reduces both anxiety symptoms and ADHD-related restlessness. Even short walks help.
    • Protect your sleep. Sleep deprivation makes everything worse – focus, mood, impulse control, anxiety levels. Adults need seven to nine hours.
    • Reduce decision fatigue. Plan meals, lay out clothes, automate what you can. Both anxiety and ADHD drain a lot of mental energy on small choices.
    • Notice your patterns. Track when symptoms spike and what was happening before. Is it before deadlines? After conflict? When you’re under-stimulated? The pattern usually points toward what’s actually driving it.

    These help. They don’t usually solve the problem on their own, and that’s not a failure on your part. Some things genuinely need professional support to address.

    Effective Treatments for ADHD and Anxiety

    If self-management strategies aren’t enough – and for many adults, they aren’t – effective treatments are available for both conditions.

    • Cognitive Behavioral Therapy (CBT) is the most evidence-based treatment for anxiety disorders. It also has a well-established role in adult ADHD treatment, particularly for the emotional regulation and self-criticism that often come along with it.
    • Medication can be highly effective for both conditions. SSRIs and SNRIs are commonly prescribed for anxiety. Stimulant and non-stimulant medications are typically first-line for ADHD. A psychiatrist or qualified medical provider can help evaluate what makes sense for your specific situation.
    • ADHD coaching and skills-based therapy can teach executive function strategies that weren’t taught in school – time management, task initiation, working memory workarounds. This is different from anxiety treatment and often essential for adults newly diagnosed.
    • Combined care – therapy plus medication plus lifestyle changes – consistently produces the best outcomes for adults with co-occurring ADHD and anxiety.

    A proper assessment is the foundation for any of this. ADHD diagnosis in adults involves a thorough clinical interview, a review of childhood history (often pulling in family or school records), and standardized questionnaires. It’s not something a five-minute appointment can produce, but it’s something an experienced clinician can do.

    When to Reach Out

    If you’ve spent years wondering whether you have ADHD, anxiety, or some combination – and especially if previous treatment for anxiety alone hasn’t given you the relief you expected – it’s worth getting a real evaluation. The earlier you understand what’s actually going on, the better your tools.

    You don’t need to be in crisis to ask for help. Many adults discover ADHD in their 30s or 40s and describe diagnosis as one of the most clarifying things that ever happened to them – not because the symptoms disappear, but because they finally make sense.

    Address Adult ADHD and Anxiety at Sanare Counseling

    At Sanare Counseling, we work with adults across Maryland who are trying to make sense of symptoms that don’t quite fit a single label. Many of our clients come in convinced they have anxiety and leave with a more complete understanding of what’s actually been going on – sometimes that’s anxiety alone, sometimes that’s ADHD, sometimes both, and sometimes something different again.

    Maryland’s professional landscape can mask adult ADHD in particular ways. High-achieving roles in federal government, healthcare, law, education, and tech often reward the hyperfocus side of ADHD while making the executive function challenges harder to ignore. Many of our clients have spent years compensating with longer hours, more caffeine, and a private sense that everyone else seems to find this stuff easier. They’re not wrong. And they’re not the problem.

    We work with clients across the full range of presentations – from those just beginning to suspect ADHD or anxiety to those who’ve been managing symptoms for years. We offer:

    • Comprehensive assessment to distinguish ADHD, anxiety, and co-occurring conditions
    • Evidence-based therapy tailored to your specific situation
    • Coordination with psychiatry when medication evaluation makes sense
    • Skills-based work for executive function, emotional regulation, and stress management
    • Care delivered virtually across Maryland – fitted around your schedule, not the other way around

    You don’t need to know exactly what’s going on before you reach out. Figuring that out is part of what we do. If you’ve been managing on your own for a long time and it’s starting to feel unsustainable, that’s a perfectly good reason to make an appointment.

    Final Thoughts

    ADHD and anxiety can feel similar from the inside – the racing thoughts, the restless body, the trouble finishing things – but they’re rooted in very different processes. Anxiety is your nervous system responding to threat. ADHD is your brain regulating attention and motivation differently from the baseline most people are taught to expect.

    Distinguishing them matters because the treatment paths are different. Treating ADHD as if it were only anxiety leaves the underlying issue in place, which is one of the most common reasons people feel stuck despite real effort and real help. Getting a clearer picture of what’s actually happening is often the single most freeing step.

    If you’ve been wondering whether what you’ve been calling anxiety might actually be something else – or might be more than one thing – it’s a reasonable question to ask out loud. There are answers, and there’s effective care. Reaching out is always the right call.

    Your Path to Care Schedule An Appointment

    Juliann Siwicki, LCPC

    By Juliann Siwicki, LCPC

  • Is Online Therapy in Maryland as Effective as In-Person?

    Is Online Therapy in Maryland as Effective as In-Person?

    On this page

    1. What the research actually says
    2. When online therapy works just as well
    3. When in-person might be a better fit
    4. Why Maryland is well-suited for virtual therapy
    5. What good online therapy actually looks like
    6. How Sanare approaches virtual care
    7. Common questions about online therapy
    8. The bottom line

    You’ve been thinking about therapy for a while. Maybe a friend suggested it. Maybe you typed something into Google at 11 p.m. Maybe your doctor mentioned it. But every time you get close to booking, the same question stops you: Does therapy over video actually work, or am I getting a watered-down version of the real thing?

    The short answer: for most people and most concerns, online therapy works just as well as meeting in person. That’s not a marketing claim – it’s what the research has been showing for more than a decade, and what the American Psychological Association and major peer-reviewed studies now state plainly.

    The longer answer has some nuance. Here’s what we actually know.

    What the research actually says

    The evidence base on telehealth therapy is now substantial. A few of the findings that matter most:

    • A 2020 meta-analysis in the Journal of Anxiety Disorders reviewed 14 randomized controlled trials and found that internet-delivered cognitive behavioral therapy produced outcomes statistically equivalent to in-person CBT for anxiety disorders.
    • A 2021 systematic review in Telemedicine and e-Health looked at video-based therapy for depression across 33 studies and concluded that symptom reduction, treatment retention, and patient satisfaction were comparable to face-to-face care.
    • A large-scale Veterans Affairs study (Egede et al., 2015) comparing video-conferenced and in-person psychotherapy for over 200 older adults with depression found no significant difference in outcomes at 12 weeks or 12 months.
    • The American Psychological Association’s updated 2020 guidance, written after the broad shift to remote care during the pandemic, states that telehealth psychotherapy is an effective and acceptable treatment for most common mental health concerns.

    In other words: across decades of studies, multiple conditions, and many populations, the gap between virtual and in-person therapy is small or nonexistent for the things most people are coming to therapy to work on.

    When online therapy works just as well

    The research is strongest – and the equivalence to in-person care most consistent – for these common concerns:

    • Anxiety disorders (generalized anxiety, social anxiety, panic disorder)
    • Depression (mild, moderate, and many cases of severe)
    • Stress, burnout, and work-related distress
    • Relationship and couples issues
    • Adjustment difficulties (life transitions, grief, identity work)
    • ADHD support and coping strategies
    • Mild to moderate trauma symptoms

    If your reasons for considering therapy fall into these categories – and for most people they do – there is no clinical reason to wait for in-person availability when video care is available.

    When in-person might be a better fit

    Honesty matters here. There are situations where in-person care has practical or clinical advantages, and you should know what they are:

    • Active suicidal crisis or imminent self-harm risk. In-person assessment and proximity to higher levels of care matter when safety planning is acute. Online therapy can still be part of care here, but it shouldn’t be the only point of contact.
    • Severe substance use disorders requiring medically supervised detox. These need integrated medical care that virtual therapy alone can’t replace.
    • Some intensive trauma protocols. Specific EMDR and prolonged exposure protocols can be delivered virtually and often are, but a small subset of clinicians and clients prefer in-person for these.
    • Young children. Therapy with kids under 8 often relies on play, drawing, and observed behavior in ways video doesn’t fully capture.
    • Situations where home isn’t private. If you can’t speak openly without being overheard, video sessions lose part of their effectiveness. There are workarounds – phone sessions, scheduling around your day, sessions from your car – but it’s worth being honest with yourself about your space.

    For everything else – which is, again, most reasons most adults come to therapy – virtual care holds up.

    Why Maryland is well-suited for virtual therapy

    A few local factors actually make Maryland one of the better states to receive online therapy in:

    • Statewide licensure portability. A therapist licensed in Maryland can see clients anywhere in the state. So whether you live in Baltimore, Frederick, the Eastern Shore, or a small town two hours from the nearest mental health office, your access to a qualified clinician is the same as someone in Bethesda.
    • Strong insurance parity. Maryland law requires most insurance plans to cover telehealth mental health services on the same terms as in-person care. Aetna, CareFirst BCBS, Cigna, United Healthcare, and Maryland Medicaid all cover virtual therapy without separate copays or session limits.
    • Real provider scarcity in many counties. Western Maryland, the Eastern Shore, and rural parts of Southern Maryland have very limited in-person mental health access. Virtual care closes a gap that, for many residents, would otherwise mean no care at all.
    • Mature HIPAA-compliant infrastructure. Reputable Maryland practices use secure video platforms that meet HIPAA standards. Your sessions are private, encrypted, and protected the same way in-person sessions are.

    If the only thing keeping you from therapy is that the nearest office is 45 minutes away or that nobody in your area is taking new clients, virtual care is a real solution – not a compromise.

    What good online therapy actually looks like

    There’s a difference between “video therapy” and “therapy that works over video.” A few markers of the latter:

    • A licensed clinician, not an unlicensed coach or AI chatbot. Look for credentials like LCPC, LCSW-C, LMFT, or psychiatric NP after the provider’s name.
    • A real intake process. A 30-second marketing chatbot doesn’t replace a clinical interview. Good virtual practices spend time understanding what brings you in before matching you with a provider.
    • A specific treatment approach – CBT, ACT, EMDR, IFS, or another evidence-based modality – not a vague promise of “talking it out.”
    • A secure, HIPAA-compliant platform. Not just any video tool.
    • Insurance benefits confirmed in writing before your first session. You shouldn’t be surprised by a bill three months in.
    • A clear plan and check-ins on progress. If you can’t tell what your treatment plan is after a few sessions, ask.

    Online therapy isn’t a different kind of therapy. It’s the same therapy, delivered through a different channel. The quality of the clinician and the fit between you and them still matters most.

    How Sanare approaches virtual care

    We are a Maryland-only practice, by design. Every therapist on our team is licensed in Maryland, sees clients only by video, and has been matched to the kinds of clients they work best with – not just whoever is next on the waitlist.

    What that means in practice:

    • Same-week first appointments in most cases.
    • Insurance benefits verified in writing before you book.
    • A real human walks you through matching, scheduling, and any questions.
    • Sessions on a secure, HIPAA-compliant platform – no separate downloads, no patient portal labyrinth.
    • Care from clinicians who actually live and practice in your state.

    Common questions about online therapy

    Will my insurance cover it?

    In Maryland, most major plans do – including Aetna, CareFirst BCBS, Cigna, United Healthcare, and Maryland Medicaid. We confirm your specific benefits in writing before your first session so there are no surprises.

    Is video therapy really private?

    Yes, when it’s done right. Reputable practices use HIPAA-compliant platforms with end-to-end encryption. Sessions are private the same way in-person sessions are. The bigger privacy question is usually about your physical space – can you talk openly without being overheard?

    Can I do couples therapy or family therapy over video?

    Yes. Couples therapy in particular has strong evidence supporting virtual delivery. Family sessions work well when participants can be in the same room or call in from different locations – sometimes the latter is easier for scheduling.

    What if I want to switch to in-person later?

    You can. Online therapy isn’t a one-way door. Many of our clients find that virtual care works for them long-term; others use it as an entry point and decide later. Your treatment plan is yours.

    How quickly can I start?

    Most clients have their first session within a week of reaching out, often sooner. Filling out our intake form takes about two minutes; someone on our team responds within one business day.

    The bottom line

    Online therapy works. The research has been clear for over a decade, and the experience of millions of clients since 2020 has confirmed it: for most adults and most concerns, video sessions produce the same clinical outcomes as in-person care.

    For Maryland residents specifically, virtual therapy is often the better option – faster to start, easier to fit into your week, available no matter where in the state you live, and covered by your insurance the same way as in-person care.

    If you’ve been holding off because you weren’t sure whether it counted as real therapy: it does. It’s the same care, just on your couch instead of in a waiting room.

    When you’re ready, our intake team can have you matched with a Maryland-licensed clinician within 24 hours.

    Your Path to Care Schedule An Appointment

    Juliann Siwicki, LCPC

    By Juliann Siwicki, LCPC