Gail Kirk Poust, LMFT

I'm a reproductive mental health therapist supporting adults in California with pregnancy, postpartum, infertility, pregnancy loss, PMDD and menopause as well as OCD and chronic pain.

You feel it in the moments nobody sees. The deep breath before you answer "how are you?" The calendar math you do in secret: cycle days, anniversaries, due dates that never became birthdays. The way you hold it together in the meeting, at the dinner table, in the group chat, and then fall apart alone in the car. It touches everything: your relationship, your work, your friendships, your faith in your own body. And the hardest part may be that from the outside, your life looks fine, so you've started to wonder if the problem is you. It isn't. Let me say that clearly, because you may not have heard it yet from anyone with the training to know: the problem is not you.

Who I work with

I'm Gail Kirk Poust, a Licensed Marriage and Family Therapist (CA #128899) and reproductive mental health specialist. My practice is built around the experiences that live in the gap between medicine and everyday life. Real, common, life-altering struggles that too often get waved away in a seven-minute doctor appointment:

Trying to conceive and infertility. The monthly swing between hope and grief. The injections, the acronyms, the waiting rooms. Watching everyone around you announce pregnancies while you quietly recalculate your future. The question underneath it all: who am I if this doesn't happen?

Pregnancy loss. Miscarriage, stillbirth, termination for medical reasons, all losses the world often refuses to treat as losses. There was no funeral, maybe no announcement, perhaps not even a name. Your grief is real anyway, and in our work it will be treated that way.

Pregnancy and postpartum. The identity earthquake nobody fully warns you about. Anxiety that patrols the night while the baby sleeps. Sadness or rage that feels like betrayal of the joy you're "supposed" to feel. You can love your child completely and still be struggling completely. Both can be true.

PMDD and severe PMS. If one to two weeks of every month taken over by rage, despair, or dread, and then it lifts when your period arrives. If this describes your months, you may be living with premenstrual dysphoric disorder. It is not a character flaw. It is a treatable condition, and I hold specialized training in treating it.

Perimenopause and menopause. Mood swings that arrive without warning, anxiety you've never had before, sleep that abandoned you, a sense of self gone blurry, while everyone from your doctor to the internet shrugs. I bring menopause-informed training and take this transition as seriously as it deserves.

OCD and intrusive thoughts. Unwanted thoughts and images that horrify you, and the checking, washing, confessing, mental reviewing, or reassurance-seeking that briefly quiets them. I provide Exposure and Response Prevention (ERP), the gold-standard treatment for OCD, including postpartum OCD, where intrusive thoughts about your baby can leave you too frightened to tell anyone. If that's you: having a thought is not the same as being a danger, and this is one of the most treatable conditions I work with.

Chronic pain and chronic illness. The grief of a body that changed the rules, the exhaustion of managing what others can't see, the loneliness of "but you look fine." Therapy can't cure your condition, I will never pretend otherwise, but it can change your relationship to it, and that changes everything else.

Across all of it, I work with adults of every gender (women, men, and LGBTQIA+ folx) with care that is culturally sensitive, trauma-informed, and affirming of whoever you are and whoever you're becoming.

Why this work is personal

I didn't choose this specialty from a textbook. I've been the person in the waiting room. My own path has included pregnancy loss, infertility, the disorienting transition to parenthood, perimenopause, and life with a chronic health condition. In my hardest season, I sat with the same unanswerable question many of my clients carry: what would make life meaningful if the future I'd planned wasn't available? The search for my answer eventually led me to this profession.

I share this for one reason: so you know what you won't have to do in my office. You won't have to convince me your pain is real. You won't have to translate. You won't have to perform being okay, or manage my reaction to your story. I've also done the strategies I'll teach you, not just studied them. When I tell you something works, that confidence comes from both sides of the couch.

My clinical foundation matches the personal one. I hold an M.S. in Marriage, Family and Child Counseling from San Francisco State University, and I've been practicing since 2014. My continuing training is deliberately concentrated in this niche: a Maternal Mental Health Professional Certificate, specialized training in treating PMDD and premenstrual disorders, menopause-focused training, trauma treatment certification, and advanced grief therapy training. I pride myself on finding the resources and trainings to support the real needs of my clients, so you receive the best care.

How I work

My foundation is Narrative Therapy, which grew out of my undergraduate studies in anthropology and sociology. I learned how culture writes itself into the most personal corners of our lives. Reproductive struggle is saturated with inherited stories: what a body should be able to do, what a mother should feel, how long grief is allowed to last, what counts as a "real" loss. When your life doesn't follow those scripts, it's easy to conclude you're the one who's broken. In our work, we'll examine where those stories came from, decide which ones deserve to keep speaking for you, and author ones that actually fit.

Around that foundation, I bring practical, research-supported tools chosen for your specific situation: CBT for the thought spirals, DBT skills for the emotional surges, ACT for making room for what can't be changed while building a life around what matters, ERP for OCD, and Gottman Method and Gordon Effectiveness Training for the strain these struggles put on relationships. Expect our sessions to be warm but purposeful: we'll set concrete goals early, measure progress against them, and I'll regularly send you home with something to practice. The hour we spend together matters most for what it changes in the rest of your life.

The practical details

All sessions are online, by secure, HIPAA-compliant video, for adults anywhere in California. This is a deliberate design, not a compromise. My clients include new parents who can't leave a sleeping baby, people mid-IVF whose calendars belong to a clinic, clients with chronic illness for whom a commute costs a day's energy, and people in parts of California where a therapist with this specialization simply doesn't exist nearby. Help should come to you. For OCD work, online is often an advantage: ERP exposures can happen in the real rooms where your symptoms live.

Sessions are 53 minutes. My private-pay rate is $160, and I provide Good Faith Estimates in accordance with the No Surprises Act. I'm in-network with NorCal Kaiser (via Allminds; Kaiser requires a referral, and I can walk you through getting one) and with Cigna, Aetna, Meritain, and Nippon (via Alma, which can verify your benefits before we begin). If you have out-of-network benefits, I provide superbills for reimbursement.

Starting is the hardest part — so we start small

Everything begins with a free 15-minute consultation: a short video or phone conversation where you tell me a little about what's going on, ask me anything, and we both get a feel for the fit. No forms-first gauntlet, no commitment, no pressure. If I'm not the right therapist for you, I'll say so honestly and point you toward someone who is. You've likely spent enough time not being helped.

You've been carrying this in the moments nobody sees. You don't have to keep carrying it there. Reach out when you're ready. I'm here, and I would be honored to hear your story.