High-performing on the outside.
Exhausted on the inside.
Online therapy for leaders, creators, and complex thinkers who want more than coping strategies.
You're doing well. So why does it feel this hard?
You’re capable, self-aware, and by most measures, doing well. You’ve built something real for yourself, whether that’s a career, a relationship, or a family life. Which can make it even more frustrating and perplexing when something still doesn’t feel right.
Maybe you’re more anxious than you used to be, quicker to irritability, or increasingly numb. Maybe you can see yourself avoiding certain things and still can’t quite understand why, or you know something is off but haven’t been able to get underneath it on your own.
It might be hard to acknowledge that your efforts haven’t done the trick, but you’ve come to realize it’s time to reach out for help—and you’re in the right place.
You might be here because…
- Your inner critic has gotten louder.
- You're spiraling over things that shouldn't matter.
- You're functioning but straining in silence.
- Your relationships are stuck in familiar loops.
- You're exhausted beyond what sleep can fix.
- Your past wounds and fears keep showing up in the present.
- Your go-to coping tools have stopped working.
- Your life looks great on paper. You know you're not.
My approach.
I’m a Licensed Marriage and Family Therapist based in San Francisco, providing online therapy throughout California. I work with people who are highly capable, strongly motivated, and are quietly paying for it. My clients tend to be deep thinkers and feelers, high achievers, and neurodivergent adults dealing with anxiety, burnout, and the long tail of trauma. They’re not struggling because they lack insight. They’re struggling because intellectual understanding alone is not enough. I use an integrative approach, including IFS and EMDR, to work with both the mind and the body where these patterns live.
The goal is not just to understand what happened. It’s to actually feel different, and to stay that way.
Anxiety & Trauma
You’ve probably developed some very effective ways of managing. The problem is they’re starting to cost more than they used to. We get underneath the patterns, not just around them.
High-achievers
You’re excellent at what you do. But somewhere along the way, what helped you succeed also became exhausting. The tools that got you here are not broken—they just were not built for this.
Neurodivergence
If you’ve spent your life being told you think too much, feel too much, or don’t quite fit the way others expect you to, you’re in the right place. Here, your unique way of being is welcomed.
Affiliations
About Me
Becoming a therapist wasn’t exactly a straight path, but looking back, there were signs. I was the kid my friends came to with their feelings and struggles, and I never really stopped being the listener and confidante for the people around me. Before training as a therapist, I traveled more than one career path and cultivated multiple passions. Then I experienced for myself how powerful therapy could be as a client. My view of my life shifted, and I realized I was ready to accompany others on their journeys.
As a therapist, I’m warm, direct, and collaborative, and genuinely fascinated by what makes each of us who we are. I feel humbled and honored (no, really!) to be invited into people’s lives, and it’s incredibly rewarding to help people find healing and become more of who they want to be.
Professional Testimonials
Truly, you couldn't ask for better than Cary Ann Rosko. I've known her since graduate school, and I have been impressed and inspired by her blend of a sharp mind and a compassionate heart since I met her. As a clinician, I take seriously the referrals I provide, and I don't hesitate to refer folks in need of a stellar psychotherapist to Cary Ann; in addition to trusting her with my professional reputation, I would entrust the care of a loved one to her in a heartbeat. Seriously, make the call.
— Emily O.
Cary is a genuine and insightful therapist that exudes warmth and wisdom. Every time I have consulted with her as a colleague, she has impressed me with her keen grasp of family systems and relationship dynamics that impact clients' struggles. Cary is a dedicated therapist that continues to hone her skills in various therapeutic modalities so she can serve her clients better. She intuitively understands her clients' experience, and has the uncanny ability to adapt her counseling style and approach accordingly. You are in good hands with Cary!
— Kavitha G.
Cary has been a trusted colleague since graduate school. I don't hesitate to refer to clients to her and when she's covered for me during vacations, I know my clients will be exceptionally well cared for. Cary is kind and conscientious, she's deeply compassionate but also careful and self-aware when it comes to the language she chooses and the way she relates to other humans. She's also really funny! She's a natural for therapeutic work and is especially attuned to working with trauma. Cary is quite wonderful!
— Emily F.
Finding Clarity
My monthly newsletter on mental health, relationships, and neurospiciness.
Finding Clarity
My monthly newsletter on mental health, relationships, and neurospiciness.
Ready to find out if we are a good fit?
Schedule a free 20-minute consultation, no commitment required. I see clients virtually across California.