Do you take insurance?

No. The practice is out-of-network. Sessions are paid at time of service. A monthly superbill is provided for clients seeking partial reimbursement from PPO plans with out-of-network mental health benefits.

How does the PPO superbill workflow actually work?

Each month I generate a superbill — a clinical-grade receipt with diagnosis codes and CPT codes — that you submit directly to your insurer. Reimbursement amounts and timelines depend on your specific plan. Call the member-services number on the back of your card and ask: do I have out-of-network outpatient mental health benefits, what is my deductible, and what percentage do you reimburse for CPT 90834 / 90837.

What does "depth-oriented" mean in practice?

It means we trace symptoms to their context — your relationships, your history, the systems you operate inside — instead of only managing what surfaces this week. It is slower than skills-based or symptom-management work, and it tends to produce changes that hold.

Depth work needs continuity. Biweekly or as-needed cadences flatten the arc — the work becomes a sequence of crisis check-ins rather than a coherent process. Weekly sessions are the container that makes the rest of the frame work.

Matthew Sexton, LCSW · Private Psychotherapy

Therapy that doesn't pretend the room is empty.

A small, out-of-network telehealth practice for adults in New York, Maine, Delaware, and Florida. Depth-oriented work for people negotiating high-stakes work, complicated family systems, and the antagonistic personalities that show up in both — without the clinical theater that flattens what's actually happening.

Schedule a consult Read recent writing

Telehealth only · NY · ME · DE · FL Out-of-network · superbills provided Adult individuals, weekly

Focus areas

The work I do best.

Not every therapist should treat every condition. These are the patterns I know from the inside — clinical training plus repeated exposure across fourteen years of practice.

— 01

Narcissistic abuse recovery

Whether it's a parent, partner, or boss — the aftermath is similar: hypervigilance, guilt about boundaries, and difficulty trusting your own perception. We work on reality-testing, boundary construction, and dismantling the internalized critic.

Burnout & moral injury

Common in physicians, founders, and clinicians. Not depression — something more specific. The gap between what you were trained to do and what the system allows. We address the structural reality, not just your "resilience."

High-functioning anxiety

You perform well. Nobody would guess. But the internal experience is constant threat-scanning, catastrophic preparation, and exhaustion from maintaining the facade. We work on what happens when the performance stops.

Complex PTSD

Childhood or long-term relational trauma. Symptoms beyond classic PTSD — emotional dysregulation, identity disturbance, chronic shame, difficulty in close relationships. We use a structural approach, not only exposure work.

Executive pressure & isolation

Leadership at scale — founders, partners, senior clinicians, attorneys. Identity drift, decision fatigue, the loneliness of being the person everyone else escalates to. A confidential room where the role can be set down without consequence.

Healthcare worker & clinician therapy

Moral injury, compassion fatigue, system burnout — and the specific weirdness of being a clinician who needs clinical care. I have spent fourteen years in healthcare; the dynamics don't have to be re-explained.

How I work

Three commitments, kept across every session.

The pace and shape of the work get adjusted to the person. The principles below don't.

— 01

Collaborative

You are the authority on your life. I bring training, framing, and patient curiosity. We name what's working and revise what isn't, out loud, together.

— 02

Depth-oriented

Symptoms are usually downstream. We trace them — to relationships, to history, to the systems you're in — instead of only managing what surfaces this week.

— 03

Boundaried

Clear frame, clear scope, clear endings. No PHI by email, no between-session crisis line, no scope creep into coaching. The container is what makes the work safe.

Licensure & telehealth

New York · LMSW / LCSW Maine · LCSW LC22776 Delaware · LCSW Florida · LCSW

Telehealth sessions only; no in-person practice. You must be physically located in New York, Maine, Delaware, or Florida at the time of each session — telehealth is regulated by the state where the client sits, not the state where the clinician sits. Out-of-network — sessions are paid at time of service; superbills are provided for clients seeking partial reimbursement from PPO plans.

Recent writing

Notes from the practice.

Short, occasional, low-jargon. Written for people who are working with — or working around — someone difficult.

Clinical Commentary · Concept creep

Therapy speak: why everyone calls their ex a narcissist now.

M. Sexton · 18 min read · May 2026

Antagonistic Personality · Series

The grandiose colleague: a field guide for the people across the table.

M. Sexton · 9 min read · Apr 2026

Clinical · Method

Depth-oriented work in a symptom-management era.

M. Sexton · 6 min read · Mar 2026

Schedule a consult

A 20-minute call to see if this is the right fit.

Tell me a little about what's bringing you in and what you've already tried. We'll talk briefly, decide if working together makes sense, and — if it does — schedule a first full session.

No fee for the consult. No commitment. If I'm not the right person, I'll tell you and try to point you somewhere better.

Please don't include protected health information (PHI) in this form. We can go into specifics on the call.

If you are in crisis or thinking about harming yourself, this form is not the right channel. Call or text 988 (Suicide & Crisis Lifeline), call 911, or go to your nearest emergency room.