Dr. Elena Reyes, LCSW
Reyes Counseling · solo practice · Sounding Board
Your clinical sounding board
A sounding board, on your side.
Reflective, evidence-anchored, and always yours to overrule. It reads your own clients’ data — never a generic script — and it never pretends to be you.
Needs your attention · measurement-based
off trackPriya Nair
GAD · session 8 · CBT (exposure)
Priya crossed a threshold — the number moved before your next session.
Her GAD-7 climbed 9 → 13 this week and her companion check-ins dropped off. Two signals that don’t surface in a room until the room’s already tense — caught early, together.
What I’m noticing
The rise lands right after last week’s exposure homework. Sometimes anxiety spikes before it settles; sometimes it means the step was too big. Her own history leans toward the first — but it’s worth holding both.
One reflective move
A brief check-in before her next session could tell you which — the evidence on measurement-based care leans toward acting on a threshold crossing early rather than waiting for the hour. Entirely your read.
Anchored in: Priya’s GAD-7 history · companion activity · last week’s care plan
Measurement-based care
Every client, sorted by trajectory — not by who spoke up last.
- Maya AlvarezOn track
PHQ-9 11 → 8 · GAD-7 → 9
Skills generalizing
- Devon WrightOn track
PHQ-9 6 → 5 · steady
Homework complete
- James OkaforWatch
GAD-7 9 · quiet 5 days
Gentle nudge sent
- Priya NairOff track
GAD-7 9 → 13 · crossed threshold
Review flagged
Trajectory, not a snapshot — the shift is the signal.
After your last session · Maya
What I saw you do well — and one door for next time.
What worked. You let Maya reach the reframe herself instead of handing it to her — that’s exactly why it generalized to a real work trigger this week. Socratic to the last question.
One alternative. For the Sunday-evening dread she keeps naming, the evidence base leans toward behavioral activation before more cognitive work — scheduling one valued activity may move it faster than another thought record. A question, not a correction.
For next time. A brief values check-in could anchor that activation and keep her ahead of the anticipatory spike — and it doubles as the “why” that keeps her homework adherence high.
Keeping you current
Practice notes drawn from your recent sessions — reflective prompts, not directives.
A pattern across your caseload
Three of your GAD clients flagged Sunday-evening dread this month. When anticipatory anxiety clusters like that, scheduling a valued activity often moves it faster than more cognitive work — worth holding for Maya and James both.
You’re screening every two weeks
For a client in an active-change window, a weekly ultra-brief check — even a single mood rating in the companion — can surface drift sooner. Priya is this month’s case for it.
When a client goes quiet
Silence after a hard session can read as disengagement or as processing. A low-demand, autonomy-respecting reach — “no need to reply” — tends to preserve the alliance either way.
A reflective aid, kept current for you. It surfaces questions; your clinical judgment — and formal supervision — govern. Confirm against current guidelines.