--- title: "Insights · Writing on therapy, patterns, and depth work · Joshua Acosta-Duque, LCSW" description: "Long-form writing from a Columbia-trained LCSW on high-functioning anxiety, perfectionism, and why therapy sometimes doesn't land." lang: en json-ld: | [ { "@context": "https://schema.org", "@type": "WebSite", "@id": "https://withlovewellnesstherapy.com/#website", "name": "With Love Wellness Center", "url": "https://withlovewellnesstherapy.com", "inLanguage": [ "en", "es" ] }, { "@context": "https://schema.org", "@type": "MedicalClinic", "@id": "https://withlovewellnesstherapy.com/#clinic", "name": "With Love Wellness Center", "url": "https://withlovewellnesstherapy.com", "medicalSpecialty": "Psychiatric", "areaServed": { "@type": "State", "name": "California" }, "availableService": [ "Anxiety therapy", "EMDR & trauma therapy", "Relationship therapy", "Men's therapy", "Substance use & recovery", "Life transitions & grief" ], "telephone": "", "priceRange": "$$", "provider": { "@id": "https://withlovewellnesstherapy.com/#joshua" } }, { "@context": "https://schema.org", "@type": "Person", "@id": "https://withlovewellnesstherapy.com/#joshua", "name": "Joshua Acosta-Duque, LCSW", "honorificSuffix": "LCSW", "jobTitle": "Licensed Clinical Social Worker", "worksFor": { "@id": "https://withlovewellnesstherapy.com/#clinic" }, "url": "https://withlovewellnesstherapy.com/about", "knowsLanguage": [ "English", "Spanish" ], "hasCredential": { "@type": "EducationalOccupationalCredential", "credentialCategory": "license", "name": "CA LCSW #121584", "recognizedBy": { "@type": "Organization", "name": "California Board of Behavioral Sciences" } } }, { "@context": "https://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": 1, "name": "Home", "item": "https://withlovewellnesstherapy.com" }, { "@type": "ListItem", "position": 2, "name": "Insights", "item": "https://withlovewellnesstherapy.com/insights" } ] } ] --- [Skip to content](#main) [](/) [About](/about)[Approach](/approach) [Services](/services) [Who I work with](/who-i-work-with) [Insights](/insights)[Español](/es)[Contact](/contact) [Book a free call](/book) ![A folded newspaper beside a steaming ceramic coffee cup on a wooden table](/assets/hero-insights-KpSWoE2I.jpg) Insights # Writing on the actual work. Long-form notes on the questions people actually bring to a first session — not takes, not tips, and definitely not a diagnosis for the reader. [ Depth work High-functioning anxiety: what it actually is The version of you that shows up for everyone else is exhausted. Here's what's underneath it. Read ](/insights/high-functioning-anxiety) [ On the work When therapy didn't work last time 'I've tried therapy before and it didn't help.' Usually the reason isn't what you think it is. Read ](/insights/when-therapy-didnt-work) [ Getting started Are my problems 'bad enough' for therapy? The question itself is the tell. Here's what to do with it. Read ](/insights/are-my-problems-bad-enough) [ Patterns Perfectionism and anxiety are the same knot They aren't two problems that hang out together. They're one system doing one job. Read ](/insights/perfectionism-and-anxiety) [ On the work Why you can't think your way out of this 'I should be able to figure this out on my own.' A note on why insight alone doesn't do it. Read ](/insights/why-you-cant-think-your-way-out) ## Reading is one thing. Doing is another. [Book your free 15-min call ](/contact) With Love Wellness Center Depth-oriented therapy across California. Sessions in English & Español. Telehealth-only practice. Begin [Book your free 15-min call](/contact) In a crisis or emergency, call or text [988](tel:988) or [911](tel:911). Services - [All services](/services) - [EMDR therapy](/services/emdr-therapy) - [Anxiety & chronic stress](/services/anxiety-therapy) - [Trauma & PTSD](/services/trauma-ptsd-therapy) - [Relationship & attachment patterns](/services/relationship-therapy) - [Depression](/services/depression-therapy) - [Substance use, recovery & codependency](/services/substance-use-therapy) - [Burnout & high-achiever therapy](/services/burnout-therapy) - [Life transitions](/services/life-transitions-therapy) - [Grief & loss](/services/grief-therapy) - [Men's issues](/services/mens-therapy) Who I work with - [Overview](/who-i-work-with) - [Latino/a/x adults](/who-i-work-with/latino-therapy) - [LGBTQ+ adults](/who-i-work-with/lgbtq-therapy) - [Veterans & first responders](/who-i-work-with/veterans-therapy) - [High achievers](/who-i-work-with/high-achievers) Serving California - [California online therapy](/california-online-therapy) - [Los Angeles](/california/los-angeles) - [Orange County](/california/orange-county) - [San Diego](/california/san-diego) - [San Francisco](/california/san-francisco) - [San Jose](/california/san-jose) - [Sacramento](/california/sacramento) Insights - [All insights](/insights) - [High-functioning anxiety](/insights/high-functioning-anxiety) - [When therapy didn't work](/insights/when-therapy-didnt-work) - [Are my problems bad enough?](/insights/are-my-problems-bad-enough) - [Perfectionism & anxiety](/insights/perfectionism-and-anxiety) - [Can't think your way out](/insights/why-you-cant-think-your-way-out) Practice - [About Joshua](/about) - [Approach](/approach) - [Rates & insurance](/rates) - [Reviews](/reviews) - [Contact](/contact) En Español - [Inicio](/es) - [Sobre mí](/es/sobre-mi) - [Terapia de ansiedad](/es/terapia-de-ansiedad) - [Terapia de trauma](/es/terapia-de-trauma) - [Contacto](/es/contacto) With Love Wellness Center · Telehealth across California · sessions in English & Español. Individual results vary; therapy outcomes are not guaranteed. This website is for informational purposes only and is not a substitute for clinical care. Website by [Automaus.ai](https://automaus.ai) © 2026 With Love Wellness Center · Joshua Acosta-Duque, LCSW · CA LCSW #121584