Concierge Psychology
For the ones who want a psychologist reachable before a difficult week turns into a difficult month, who have found that a callback three days later comes too late to matter, and who want more room in a single relationship with a clinician than a fifty-minute hour every other week was ever built to hold. Concierge psychology changes the structure of access to Alafiora's clinical work. The depth of that work, and the training and attention behind it, stays exactly the same.
The Executive Concierge Retainer sits alongside Alafiora's standard fee-for-service care as a parallel tier of access, both drawing on the identical clinical relationship underneath. Every client who works with Dr. Esther Lapite-Garrett, a licensed psychologist and the founder of Alafiora, whether in a standard weekly session or inside the concierge tier, receives the same doctoral-level clinical training and the same depth-oriented, attachment-centered approach in the room. What concierge care changes is the amount of access surrounding that work: how soon a psychologist can be reached and how much room exists between formal sessions. The quality of the clinical work itself stays constant across both tiers. A client considering standard care should read this page and feel informed. A fifty-minute session held every week or two is simply a different, and for most clients an entirely sufficient, structure for the same clinical relationship.
- Care in Place Before the Hard Week Begins
- A Genuinely Small, Capped Caseload
- What Happens Between Sessions
- What the Retainer Includes
- An Additional Access Layer
- Common Questions About Concierge Psychology
No section by that word. The menu holds the complete site.
Care in Place Before the Hard Week Begins
Building In Support Ahead of a Crisis
What "Access Before a Crisis" Actually Means
Most therapy, by design and by necessity, responds to what a client brings into the room that day. A standard session runs for its scheduled hour and then ends, and whatever happens between one Tuesday and the next is carried by the client alone until the following appointment. A therapist or psychologist working this way is not doing anything wrong; a defined hour is how the great majority of clinical relationships are structured, and for good reason. This works well for a great many presentations and a great many clients, and it is not being described here as a limitation to escape. The concierge retainer exists for a different situation: a client whose life produces real strain between sessions with enough frequency, or enough unpredictability, that waiting for the next scheduled hour is itself a meaningful cost. Concierge clients are not, as a rule, in worse shape than standard clients. Some clients' circumstances, a demanding leadership role, a family navigating something ongoing, a period of genuine instability with no fixed end date, benefit from a psychologist already positioned to respond as something develops. A psychologist who first learns about a shift a week or two later, at the next scheduled session, is starting from further behind.
This is the proactive logic concierge medicine has already established in physical health: a physician who knows a patient well enough, and has enough room in an intentionally smaller panel, to notice a shift early, before it becomes acute. Concierge-tier care applies the identical logic to psychological care: the clinical outcome sought stays the same one every client at Alafiora is working toward. What concierge access actually changes is timing, when, and how quickly, the same clinical relationship can be brought to bear on whatever is actually happening.
A Genuinely Small, Capped Caseload
Why the Executive Concierge Retainer Stays Capped
A Capacity Fact About One Solo Psychologist's Availability
The responsiveness described on this page only works because the number of people holding a concierge relationship with Dr. Lapite-Garrett at any one time stays genuinely small. This is a plain fact about what one solo psychologist can actually hold; it is neither a marketing device nor a countdown. A single clinician who stays reachable and personally engaged between sessions can only sustain that level of availability for a limited number of relationships before the responsiveness itself starts to erode for everyone holding one. The caseload is capped for exactly that reason. Reachability promised to too many people stops functioning as reachability for anyone holding it.
This is stated once, plainly, because it is a true and fixed limit on what one solo practice can hold, stated for the sake of straightforward clarity about that limit. There is no ideal moment to inquire and no cost attached to asking now versus later beyond the ordinary fact that a capped caseload can, at any given time, be at capacity. Availability is confirmed directly, through the inquiry path below, and is never displayed as a live countdown anywhere on this site.
What Happens Between Sessions
Structured Responsiveness Beyond the Standard Fifty Minutes
The Actual Difference in Access
The small caseload described above is what makes a specific, concrete difference possible in practice. The concrete difference the concierge retainer offers is a shorter, more direct path back to Dr. Lapite-Garrett between formally scheduled sessions than standard care is structured to provide. Standard care holds a defined, appropriate boundary between sessions, one that serves the great majority of clients well and is never treated on this site as a shortfall. Concierge care is built specifically to extend that boundary: faster response windows when something comes up outside a scheduled hour, and a more direct line back to the same clinician a client already knows and trusts. A concierge client is not routed through a general practice inbox or left waiting for the next opening on the calendar.
This is a defined, structural difference in how quickly and how directly a concierge client can reach the same psychologist already doing the work, built around the small caseload described above. The number of contacts, calls, or messages themselves is never fixed or tracked. No solo clinician can sustain unlimited contact or constant availability at every hour of every day and still do careful clinical work with anyone, and concierge care does not promise that. The exact shape of that access, response windows, the channels used, how it is coordinated around Dr. Lapite-Garrett's own schedule, is worked out individually once a concierge relationship begins. What a given client's life actually requires shapes that arrangement, adjusted individually for each person who holds one.
This tier is not an emergency or crisis service and does not replace 911, 988 (the Suicide & Crisis Lifeline), or a hospital emergency room for acute risk. If you are having thoughts of suicide, are in crisis, or do not feel safe right now, please call or text 988 or call 911 immediately, at any hour. Waiting for a response through the concierge tier is not the appropriate step in that moment.
What the Retainer Includes
The Monthly Investment and Its Itemized Scope
Executive Concierge Retainer Pricing and Inclusions
That access is structured, not open-ended, and it comes with a defined monthly figure and a defined scope. The concierge retainer begins at $9,500 a month. This figure covers a defined and itemized scope of care, adjusted to fit each client's own life and circumstances:
- Up to twelve individual therapy sessions of fifty minutes each, scheduled once, twice, or three times a week and adjustable based on clinical need and mutual availability
- Up to two extended or intensive sessions of eighty to a hundred and ten minutes a month, substitutable for standard sessions when clinically indicated
- Priority scheduling, with flexible rescheduling and no late-cancellation penalty for changes made within the same calendar month
- Up to four hours a month of structured care coordination with psychiatrists, attorneys, fiduciaries, family-office professionals, and other trusted advisors, only where clinically indicated and with the client's expressed consent
- Curated between-session clinical homework, with targeted written feedback built around each client's specific goals and pace
- Secure messaging access during standard business hours, Monday through Friday, nine in the morning to six in the evening
- Digital therapeutics evaluation and integration where clinically appropriate
- Up to two collateral or family-system consultations per quarter, where clinically indicated and with role boundaries defined in advance
Travel, accommodations, and any extended forensic work fall outside this monthly figure. Each is negotiated separately and documented in a written agreement before that portion of an engagement begins.
Secure messaging is not monitored continuously and is not built for emergencies or situations involving imminent risk. This practice does not provide crisis or emergency services. Anyone in crisis should call 911, go to the nearest emergency room, or contact a local crisis line; emergency care is not part of the retainer and cannot be delivered through it.
An Additional Access Layer
Concierge Care Sits on Top of the Existing Clinical Relationship
How This Fits With Standard Fee-for-Service Care
That figure and that scope only make sense in context of what they are actually adding to. The concierge retainer is best understood as an additional layer of access built around an existing clinical relationship. It is a smaller, more available tier of the same clinical work, and the clinical depth stays identical either way. A client keeps standard care in place and adds concierge access around it, gaining more room around the edges of the work and a caseload small enough to make that responsiveness real. Full session formats and current fee-for-service rates are detailed on the practice's fee page, which remains the place to look for standard pricing; this page exists to describe the access structure concierge care adds.
Reading a page about concierge access is not the same as deciding it is the right fit, and it does not need to be. Some readers arrive already certain this level of access matches what their week actually looks like. Others are simply curious what the term means before deciding anything at all. Both are welcome to ask. Dr. Lapite-Garrett holds the concierge caseload personally, alongside her standard fee-for-service practice, and confirms current availability directly with anyone who inquires.
Common Questions About Concierge Psychology
What Prospective and Current Clients Ask About This Tier
Concierge Access, Availability, and Fit
Is the Executive Concierge Retainer a higher level of clinical care than standard sessions?
No, and this distinction sits at the center of the whole page: concierge care is not a better or more advanced version of the clinical work itself. Every client receives Dr. Lapite-Garrett's same doctoral-level training and the same undivided attention in session. Concierge care changes access and availability around that clinical relationship; the standard of care inside it stays constant either way.
How small is a concierge caseload, exactly?
Small enough that a solo psychologist can genuinely remain reachable and responsive to every client holding one. This is a capacity limit; no specific published number exists. The caseload stays capped because a psychologist stretched across too many concierge relationships loses the very availability the tier is meant to offer.
What does being reachable "between sessions" actually look like?
A more direct, faster path back to Dr. Lapite-Garrett than standard care is structured to provide, worked out individually with each concierge client based on what their circumstances actually require. It is a defined, meaningfully shorter response window than standard scheduling allows, with clear bounds around when it applies.
Is concierge care meant only for people already in crisis?
Not primarily. Many clients choose this tier specifically to have support in place before a difficult period becomes an acute one. They ask for more access early, before a situation has already escalated. A client already in an acute situation is equally welcome to inquire; readiness for concierge care is not judged by how far along a difficulty already is. Concierge access is not a substitute for emergency or crisis services at any point: if you are having thoughts of suicide, are in crisis, or do not feel safe right now, please call or text 988 (the Suicide & Crisis Lifeline) or call 911 immediately. A scheduled or concierge response is not a substitute for that call.
Does choosing concierge care change what actually happens in a session?
Not in any way that alters the clinical work itself. Sessions follow the same clinical approach and the same depth of engagement as standard care. What concierge clients experience differently lives around the sessions, in how quickly and directly they can reach their psychologist between them.
How do I find out if a spot in the concierge retainer is currently available, and what does it cost?
The concierge retainer begins at $9,500 a month, covering the itemized scope of sessions, priority scheduling, and structured care coordination described above. Availability is a separate question from price: the caseload's small size means openings shift on their own timeline, independent of the monthly figure, so current availability is confirmed directly through inquiry. This page states the monthly figure; availability itself is confirmed by asking directly. Anyone considering concierge care is welcome to ask what is currently open, alongside any question about how the figure or its inclusions would apply to a specific situation.
Begin a Confidential Conversation About the Concierge Retainer
Inquiring about concierge-tier care is a brief, confidential conversation, held within the same legal and professional limits of confidentiality any licensed psychologist explains before clinical work begins, where the only subject is whether this particular structure of access fits what a client's life actually requires right now. This conversation is equally available to a current standard-care client who has independently begun wondering whether concierge access might fit, and to someone inquiring about Alafiora for the first time; either way, the decision to explore concierge access starts with the client. It is never something Dr. Lapite-Garrett raises or suggests inside a session.
For anyone who wants to understand the standard fee-for-service structure this tier sits on top of before asking anything further, the Rates and Fees page linked above covers that ground directly, and this page can always be bookmarked, or the QR code in the footer scanned, to keep this practice's information close until the timing feels right.
Every session at Alafiora is held by one licensed psychologist
Dr. Esther Lapite-Garrett is the founder and sole practitioner of Alafiora. There are no associates, no rotating providers, and no case handoffs: the person who reads a client's history in the first session is the same person still holding it two years later. She is licensed in New Mexico and Indiana, with additional state licensure underway.
Her training is doctoral-level, which typically extends several years beyond a master's-level license in assessment, diagnosis, and the treatment of complex, overlapping presentations. She keeps a deliberately small caseload so that depth is possible, participates in ongoing peer consultation and clinical training, and maintains her own personal therapy.
Whatever brought someone to this page today is never put on trial here
A consultation is a brief conversation with no obligation attached. Those already certain they are ready are equally welcome to begin directly with a first session.