Executive therapy — a confidential room for the person everyone escalates to.

The higher you go, the fewer people you can be honest with. Your team can't see you struggle. The board wants results. Your closest peers are competitors. Executive therapy is clinical work built for that specific kind of isolation — not performance coaching wearing a mental health label. Matthew Sexton, LCSW provides confidential, schedule-flexible telehealth therapy for C-suite executives, founders, and senior leaders in New York, Maine, Delaware, and Florida.

Matthew Sexton, LCSW, NATC is a licensed clinical social worker in New York, Maine, and Delaware, registered with Florida as an out-of-state telehealth provider, and a credentialed Narcissistic Abuse Treatment Clinician. He has spent fourteen years in clinical practice and healthcare systems, and writes for the people who hold everyone else together.

In crisis right now? Call or text 988 — this page can wait.

• Why therapy, not coaching

  Coaching is performance and skill-development work — often paid for and reported back to your employer. Therapy is licensed clinical work on mental health, identity, and the patterns driving your behavior, and it carries legal confidentiality protection that coaching structurally can't match when an employer is footing the bill. Most senior leaders end up needing both: a coach for strategy, a therapist for the weight underneath it.

• Decision fatigue at scale

  Senior leaders make dozens of consequential calls before noon, each one carrying headcount, capital, or reputational weight. That load doesn't just disappear at 5pm — judgment degrades, patience shrinks, and recovery time erodes across the day. Treatment gives you a structured place to offload high-stakes decisions and builds real recovery time into your actual schedule.

• Boundary collapse with your team

  Struggling to set limits with your team usually isn't a skills gap. It's often an old belief that your worth depends on being available, being approved of, or never being seen as difficult — and it usually predates the role by decades. This work separates the role from the person holding it, so the boundaries you set come from what the job actually requires.

• Family-of-origin patterns in leadership

  How you learned to handle conflict, respond to authority, and earn approval in your family of origin is running in your organization right now, whether you've named it or not. Schema-focused work maps those patterns directly and builds the capacity to interrupt them under pressure — replacing vague feedback with something specific enough to actually change.

• Confidential by design

  Most executives here choose to pay privately, out-of-network, and the reason is structural: on that route no claim is filed, no diagnostic code reaches your benefits administrator, and no record trails back to your employer, board, or investors. In-network through Alma is available if you would rather use your benefits — that route does file a claim, and I will say plainly what it does and does not expose before you choose. Sessions run on HIPAA-eligible telehealth, scheduled around earnings calendars, board weeks, and travel instead of a fixed weekly slot.

• Cost and availability

  Out-of-network is $225 per session, with a superbill each month for potential reimbursement. In-network through Alma is available for the plans Alma contracts with, where you pay your normal copay instead. I'm currently accepting new clients — there's a free call to talk through whether this is the right fit.