All Posts by Cisais


About the Author

Carmen provides confidential, fee-for-service, psychotherapy services to help both men and women work through their anxiety, performance and procrastination issues. Her practice combines practical advice, support, reality testing and goal-oriented outcomes. Please contact Carmen at 530.601.1003 to learn more.

Jan 03

Legal Update: No Surprise Act

By Cisais | Anxiety and Trauma

Happy New Year!

In December 2020, Congress passed the No Surprises Act to reduce unexpected medical bills on patients. This goes went into effect January 1, 2022. New information about this law and requirements just became available. Below you will find information regarding this law and links to gather more information

There are important requirements when seeking out of network care or if you are uninsured. The information is somewhat unclear as to how this impacts our relationship, however I am taking a proactive step to address this and provide notice and documents. 

You will find 2 forms to complete prior to our next appointment. These forms in no way change or supersede our current billing arrangements

  1. A Good Faith Estimate for 2022, based on our highest clinical rates, although your rate may be lower if you have made prior arrangements with your clinician.
  2. A notice of acknowledgment regarding about Good Faith Estimates

Information regarding this law and links to gather more information

According to The Center for Medicare and Medicaid services : https://www.cms.gov/nosurprises/consumers/new-protections-for-you

What are surprise medical bills?

If you have health insurance and get care from an out-of-network provider or at an out-of-network facility, your health plan may not cover the entire out-of-network cost. This can leave you with higher costs than if you got care from an in-network provider or facility. In the past, in addition to any out-of-network cost sharing you might owe, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid, unless banned by state law. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill.

What are the new protections if I have health insurance?

If you get health coverage through your employer, the Health Insurance Marketplace®, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:

  • Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
  • Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
  • Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
  • Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills. You’re not required to sign this notice or get care out-of-network.

What if I don’t have health insurance or choose to pay for care on my own without using my health insurance?

If you don’t have insurance or you choose to pay for care without using your insurance (also known as “self-paying” for care), these new rules make sure you can get a “good faith” estimate of how much your care will cost, before you get care.

Are there exceptions to these protections?

Some health insurance coverage programs already have protections against high medical bills. You’re already protected against surprise medical billing if you have coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE.

Regarding Good Faith Estimates: https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance

Getting cost estimates before you get an item or service if you’re uninsured or self-pay

Beginning January 1, 2022, if you’re uninsured or you pay for health care bills yourself (don’t have your claims submitted to your health plan), health care providers and facilities must provide you with an estimate of expected charges before you get an item or service. This is called a “good faith estimate.” Providers and facilities must provide you with a good faith estimate if you request one, or after you’ve scheduled an item or service. It should include expected charges for the primary item or service you’re getting, and any other items or services that are provided as part of the same scheduled experience.

Thank you for your cooperation!

davis ca online teletherapy
Apr 02

What is Teletherapy?

By Cisais | Anxiety and Trauma

Teletherapy, (also referred to as telehealth, online therapy or telemedicine) is a form of video meetings that allow therapists to provide services to clients via a secure 2-way video session. It also provides the opportunity for consultation with family members, teachers and other providers involved in the client’s care. Surveyed patients participating in teletherapy say they are very satisfied with the care they are receiving and that they feel teletherapy is a reliable form of practice. In addition, they find that they are able to keep their appointments on a more regular basis.

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Who is Teletherapy For?

Teletherapy is beneficial for a range of people, for a diverse set of circumstances or experiences, including couples, individuals, groups and teens. Teletherapy has been around since the 1990s in the United States and is considered a highly effective method for therapy delivery.

Research studies, many of which are listed in bibliography format by the Telemental Health Institute, also indicate that telemental health is equivalent to face-to-face care in various settings and an acceptable alternative.

Here’s some research:​

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.

How can I prepare for my first Teletherapy session with Life Compass?

Joining your first session is straightforward. Here are some items you will need or should consider”

  • A private space (office, home, parked car, or even a walk in the park).
  • A computer, tablet, or phone (no applications or software to download).
  • A web camera (built in to your computer, external or on your phone).
  • A microphone (built it, headset, or earbuds).
  • An internet connection with a bandwidth of at least 10 MBPS. We recommend an Ethernet cable over Wifi when possible to ensure you receive the best possible connection through your internet provider (but this is not mandatory). You can check your internet speed here.
  • Shut down all background applications to ensure Teletherapy session receives the majority of your internet’s bandwidth, especially applications that use your camera.


Not quite sure if online therapy is right for you? Do you have questions? 

Life Compass offers a free, 15 minute consultation. We’ll talk a about your goals, gather some background information, and see if we’re a good fit.

Complete the form below or call/text us at 530.341.8180 to get started.



Oct 25

What is Play Therapy?

By Cisais | Anxiety and Trauma

As psychotherapists, our focus is in child development and play therapy. We use a playful and individualized approach to empower children to cooperate, self-regulate and effectively communicate their needs.

Play therapy is most often used with children ages 3-12 and usually occurs in weekly sessions.  Some children’s behaviors may improve very quickly with play therapy (averaging 15-20 sessions), while others may have more serious or ongoing problems that may take longer to resolve. Play therapy works best when a parent, family member, or caretaker is supportive and actively involved in the treatment process.

Why Play Therapy?

Developmentally, even the brightest children have not developed the capacity to use the insight-based verbal reasoning– which is needed to be successful in one-on-one talk therapy. What works in the world of play therapy is that it play can be used as a language by the child,  overcoming the challenge of more traditional language-based communication while still allowing the therapist to assess and respond to the underlying needs of the child-client. Also, because therapy sessions are child-centered, there is less resistance and often more rapid change than with talk therapy.

Play therapy is different from regular “playdates” because in these specialized sessions, therapeutic space is created to allow the child-client to express, address, and resolve the challenges they have faced. Play provides a psychological distancing from a child’s issues and allows expression of thoughts and feelings– which is the process work of therapy. Through play, therapists can help children learn more adaptive behaviors when there are emotional or social skills deficits. Children learn to communicate with others, express feelings, modify behavior, develop problem-solving skills, and learn a variety of ways of relating to others. Even the most troubling problems can be confronted in play therapy and lasting resilience can be discovered, rehearsed, mastered, and adapted into lifelong strategies.

Play therapy is effective with children experiencing life stressors, such as relocation, hospitalization, chronic illness, abuse, domestic violence, and natural disasters. Therapeutic play and can be used with children dealing with:

  • anger management
  • grief and loss
  • divorce, family dissolution, and abandonment
  • crises and trauma
  • anxiety
  • depression
  • ADHD
  • Autism or pervasive developmental disorder
  • academic and social problems
  • learning disabilities
  • conduct disorders
Nov 18

Are We a Right Fit?

By Cisais | Motivation and Choice , Musings

Carmen-Isais-Coach-and-CounselorOne-on-One Coaching

My clients change.  This is something I say often.  And it is true.

The vast majority of my clients achieve success for themselves. This is because I only work with clients who I believe will succeed.

If I sense up-front that someone isn’t right for my approach, I’d rather not take take their time or money.  Read below to find out if you and I were meant to be…

verified by Psychology Today

My clients –

  • Are looking for a short-term boost rather than a long-term solution.
  • Want to passively have someone “fix them”.
  • Are serious about getting their problem solved.
  • Are ready to take responsibility for their lives and relationships.

I look forward to working with you if –

  • You are ready to do the work it takes to get your goal accomplished.
  • You are ready to learn and change to achieve your outcome.
  • You take responsibility for your decisions and actions.
  • You want a natural, drug-free solution to your issue.

A few other things you should know about me

  • Pricing:  The services I offer enable clients to make profound changes in their lives, usually very quickly.  I charge accordingly.
  • Approach: All work is done with a tailored, one-on-one approach working with me directly.  There are no use of scripts, light/sound goggles or CDs.  In addition to weekly goal oriented solutions, working with me often involves coaching and tasks done outside of the office. Yes, I give “homework”.  :)
  • Medication:  I cannot prescribe, nor am I a proponent of psychotropic drugs. That being said, I understand that they can be a short term buffer between “no longer” and “not yet”.  For most, there are great alternatives to anti-anxiety and antidepressant medications. and I have great referral sources to local medical doctors who can support that. Let’s talk.

If you have read this far, thank you. If you have questions and would like to reach me, please do not hesitate in contacting me via email or by phone at (530) 601-1003 .









Nov 16

Thinking As a Way of Being

By Cisais | Health , Motivation and Choice

second thoughtsThose of us on the path of personal and spiritual growth have a tendency to analyze our unhappiness in order to find the causes and make improvements. But it is just as important, if not more so, to analyze our happiness. Since we have the ability to rise above and observe our emotions, we can recognize when we are feeling joyful and content. Then we can harness the power of the moment by savoring our feelings and taking time to be grateful for them.

Recognition is the first step in creating change, therefore recognizing what it feels like to be happy is the first step toward sustaining happiness in our lives. We can examine how joy feels in our bodies and what thoughts run through our minds in times of bliss. Without diminishing its power, we can retrace our steps to discover what may have put us in this frame of mind, and then we can take note of the choices we’ve made while there. We might realize that we are generally more giving and forgiving when there’s a smile on our face, or that we are more likely to laugh off small annoyances and the actions of others when they don’t resonate with our light mood.

Once we know what it feels like and can identify some of the triggers and are aware of our actions, we can recreate that happiness when we are feeling low. Knowing that like attracts like, we can pull ourselves out of a blue mood by focusing on joy. We might find that forcing ourselves to be giving and forgiving, even when it doesn’t seem to come naturally, helps us to reconnect with the joy that usually precedes it. If we can identify a song, a picture, or a pet as a happiness trigger, we can use them as tools to recapture joy if we are having trouble finding it. By focusing our energy on analyzing happiness and all that it encompasses, we feed, nurture, and attract more of it into our lives, eventually making a habit of happiness.

Nov 16

What is PTSD?

By Cisais | Anxiety and Trauma

PTSD is the acronym for Post Traumatic Stress Disorder and refers to a cluster of symptoms that result from a past trauma. But what’s a trauma?. Trauma refers to a psychological or emotional imprint that occurs when an event or series events threatens our sense of safety or well-being to the extent that our minds react to protect us from any further exposure.

In order to protect ourselves until we are either healthy enough or supported well enough to address issues from the past, sometimes, our experience or memory of a traumatizing event can be compartmentalized or stored away. PTSD can be diagnosed as soon as 30 days after an event or as long as 30 years or more after an event. The good news is that the healing process can begin at any time.

Nov 12

Couples Therapy

By Cisais | Couples and Relationships

First, it is important to realize that couples therapy, marriage counseling, and marital therapy are all the same. These different names have been used to describe the same process, with the difference often based on which psychotherapy theory is favored by the psychologist using the term, or whether an insurance company requires a specific name for reimbursement.

Couples therapy is often seen as different from psychotherapy because a relationship is the focus of attention, instead of one individual diagnosed with a specific psychological problem. This difference only arises if you consider psychological problems to be similar to medical illnesses, and therefore confined to a “sick” individual who needs treatment. That medical model of psychological diagnosis and treatment is common, but is really inadequate to describe and resolve psychological problems. All psychological problems, and all psychological changes involve both individual symptoms (behavior, emotions, conflicts, thought processes) and changes in interpersonal relationships.

Couples therapy focuses on the problems existing in the relationship between two people. But, these relationship problems always involve individual symptoms and problems, as well as the relationship conflicts. For example, if you are constantly arguing with your spouse, you will probably also be chronically anxious, angry or depressed (or all three). Or, if you have difficulty controlling your temper, you will have more arguments with your partner.

In couples therapy, the therapist will help you and your partner identify the conflict issues within your relationship, and will help you decide what changes are needed, in the relationship and in the behavior of each partner, for both of you to feel satisfied with the relationship.

These changes may be different ways of interacting within the relationship, or they may be individual changes related to personal psychological problems. Couples therapy involves learning how to communicate more effectively, and how to listen more closely. Couples must learn how to avoid competing with each other and need to identify common life goals and how to share responsibilities within their relationship. Sometimes the process is very similar to individual psychotherapy, sometimes it is more like mediation, and sometimes it is educational. The combination of these three components is what makes it effective.

Nov 12

Conversations with Couples

By Cisais | Couples and Relationships

It is very common for couples to contact me and, in our first conversation prior to an appointment, ask for help in these areas:

  • Infidelity/Trust Issues
  • Communication ‘Tools’ or ‘Skills’
  • Parenting Issues
  • Anger Issues
  • Intimacy Issuesand…last but not least….
  • ”I’m pretty sure my husband is a Narcissist”

One might think that all of these issues are varied and drastically different from one another.  What might ‘anger’ issues have to do with ‘infidelity’”? What does ‘communication’ have to do with ‘parenting’ or ‘intimacy’ issues?  Actually, this is where therapy becomes therapy vs. communication coaching or teaching.

Follow me here……I can teach you communication skills, I can provide you models for effective parenting, I can provide you with self soothing/de-escalation skills to interrupt patterns of impulse and anger, we can even identify blocks to vulnerability or access to one’s own emotional responses, and, there is tremendous  initial value and insight by acquiring these skill sets….this is important stuff for sure.

However, these are what I deem to be behavioral changes vs authentic changes.  Have you ever heard of, or known a ‘dry drunk’ (excuse my slang)?  This is person who has changed their maladaptive behavior (alcohol = bad idea) for a less damaging behavior (sober = better idea)…but what about the reason the person drank, or had the affair or was a rigid parent or was prone to rage in the first place?  Changing behavior may not change the underlying dynamic…at all.  Dry drunks are difficult by nature, a person who has had an affair and stops is no less prone to a relapse than a person refraining from alcohol…..unless underlying issues are addressed.

Behavioral changes are only part of the process.  They are put in place to prevent more damage from occurring to the relationship, and, ‘they’ are in no way the fruition of a couple’s journey towards true partnering for life.

What all of these issues in fact have in common is, how we are attached or bonded, to others and ourselves.  At the core of us all we have experienced some loss or disconnect in our primary attachments very early in life.  Having had firm attachments to a healthy primary care giver, we are able to develop a strong sense of self and maintain that self even in the deepest of relationships.  When we have experienced poor attachment or bonding, or, when we have had a strong bond to a primary caregiver with a strong deficits, we develop our own deficits in our ability to access our self.  It is from these broken attachments (which literally we all have to some extent) we can cause problems in our relationships.  In Susan Johnson’s book, Hold Me Tight, she describes healing these attachments to one’s partner and within one’s self as the basis of the most effective approach to couples counseling to date.

As a couples therapist for over 16 years, this model has been extremely complementary to the work I do with couples.  This level of work with couples is profound.  Each partner is able to see how their own woundedness is working them from the inside-out, affecting perception of their partner, keeping them stuck in a cycle but not understanding exactly what the cycle is, how it starts or how to interrupt it.

As a couples therapist, I will often meet with partners individually, early on, to get a separate assessment of their current perception(s), a sense of their strengths in problem solving and communication, where blind spots might be and, family/relationship history.  This more progressive/aggressive approach to treatment is a departure from traditional couples counseling.  However, I have yet to work with a couple who has not appreciated this part of the process, and, benefited from it.

The direct benefit to the client is really being heard, without judgement, knee jerk reactions, making a big plan right away or, taking either side.  How it makes the process more efficient is by providing me clearer insight into isolating who is contributing what to the overall dynamic.  And when I say ‘efficient’ I mean it saves everyone time, money and allows us to get traction in doing the individual work necessary in closing the distance between partners.

Nov 12

Diffusing Parent Conflict After Divorce

By Cisais | Divorce

Increasingly in our family law court system we are seeing divorces that can be identified as “High Conflict”.  Entire careers, and hundred of thousands of dollars are being made by this phenomena, and whether you consider this wrong or right, one thing we can probably all agree on is that YOU do not want to be the less that 10% of  divorces that use 80% of the family court resources.

If you are recently divorced and find your co-parenting relationship starting to deteriorate, it is important to stop divorce conflict before it goes too far. Here is my advice to you:

1. Love Your Child More Than You Hate Your Ex.

During divorce, and sometimes long after, parents are so consumed with their hurt and resentments that they retreat into survival mode. For some parents, survival mode equals attack mode. The idea that children are resilient enough to be immune is a myth.

In my work with anxiety and trauma clients, I have adult clients of High Conflict divorce, who at age 20, 30 & 40 are still suffering the emotional damage caused them by having been witness to their parent’s anger towards one another. In adults this effect manifests itself as anxiety, depression, neurosis and chronic health issues. And this damage is not intentional. Minimizing one’s own behavior or blaming a children’s fragility occurs because the High Conflict parent must focus on their own survival. The unintentional damage that loving parents cause their children seems inevitable because these parents do not have the knowledge and practical skills to parent in a crisis. Throughout a difficult divorce, parents’ unbridled emotions almost always put their children in harm’s way.

Refocusing your energy on the childhood experience is paramount to good parenting. Connecting more with your child’s needs and separating them from your own is not so easy when you are flooded with resentment for your ex-spouse. Get really authentic about how you have been inauthentic in your parenting.  Have you made some less than stellar choices under the guise of the children’s “best interest”?  If you cannot bring yourself to make amends with the other parent, find a trusted friend or family member to get clear on this.  This is hard work, I know, but it is necessary work.

Love your child more than you hate your ex, and let that love motivate you.

2. Pay Your Child Support.

It is amazing to me that anyone would need convincing on this issue, but alas… While there are legitimate cases where a parent is unable to pay (job loss, illness, family hardship), in my mediation work I have seen most cases of “failure to pay” are born out of simple spite and vindictiveness. Indeed, if you can afford to see me and pay my mediation fee of $250 an hour, then certainly you can afford to contribute to the care and well-being of your child.

Deliberate non-payment of support, coupled usually with purposeful underemployment, is just gross negligence. And to be clear, this goes for both parents. While the term “Deadbeat Dad” gets passed around a lot, increasingly, Mothers too are falling under the “deadbeat” parent laws across the nation. At the time of this writing, the United States Census shows only 57% of Moms required to pay child support for their children actually do so. Meanwhile, a simple internet search results in a plethora of websites aimed at helping Fathers avoid paying child support. Presumably, there is a demand for this service. Get it together Mom and Dad, equally.

Deliberate non-payment of support adds fuel to the high-conflict fire of divorce. If a healthy co-parenting relationship is not possible between you and your ex-spouse, at the very least separate out your anger with your spouse from your legal and moral obligation to your children. Your children know what is going on and they will grow to understand the motivation.

In his discussion of how children cope with high conflict divorce, San Francisco Psychotherapist and licensed clinical social worker, Paul Livingston, writes that in these circumstances of High Conflict “children are faced with a barrage of words, events and thoughts that they are not prepared to deal with in any healthy way.

According to Livingston and a growing body of research, children who are witness to their parent’s anger towards one another are more likely to suffer as students, experience deteriorated relationships with peers, have a lower level of self-confidence, more anxiety and feelings of depression than they would otherwise. Divorce doesn’t ruin children. Angry, divorcing parents do.

3. Do the Work You Need to do to Heal After a Divorce.

Grieve your Divorce. I don’t care how lousy your ex might have been, a divorce is the death of a dream that did not come true. It is painful, regardless of who initiated the separation. And every divorce deserves to be grieved. Pretending it is a celebration is not only unhealthy, it is inauthentic.

Keep old friends. Make new friends. Divorce can be confronting to others. Be prepared to lose some friends and support. Consider that these occurrences usually have nothing to do with you and are just representative of what happens in the world of transition… things get lost. Be open to new people, new support and new friends.

Get Professional Help. If you want to keep those friends, both new and old, don’t make them responsible for holding the entire magnitude of emotionality you might be dealing with. Moreover, your friends and family are not objective. While you might not always like what you hear from them, they are still unlikely to successfully facilitate the radical self-examination you may need to experience in order to learn and grow. And really, why go through the pain of divorce without at least some growth?

happy_kids_divorceIf you have children, leftover issues from the marriage, such as anger, pain, betrayal and loss of trust can interfere with how you show up as a Mother or Father. Parenting becomes the scene for unresolved marital issues and no one suffers more than the children.

My husband’s psychotherapy website includes the phrase, “Change is inevitable. Growth is optional. Choose wisely.” Heed those words, always, but especially in the face of divorce.

If you recognize yourself in any of this– that level of awareness is HUGE and it is the first step. Without being made wrong or being judged, consider contacting an experienced Divorce Coach or counselor to help move you through the “no longer” and “not yet”.  A lot of little lives depend on it.

Nov 10

EMDR Therapy and Trauma

By Cisais | Anxiety and Trauma

Trauma survivors often complain of recurring nightmares, sudden tearfulness, flashbacks, aversions to places or people and even somatic/physical discomforts. Eye Movement Desensitization and Reprocessing (EMDR), is a technology created about 20 years ago by Francine Shapiro, PhD. EMDR involves systematically bringing highly charged images/experiences to the conscious self without hypnosis where they can be rationally dealt with and resolved into normal memory. This process is rapid and is noted in psychology journals as the most effective treatment available for PTSD.

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