Are you currently accepting new clients?

Yes. We are currently welcoming new individual and couples clients across Virginia, Florida, Washington DC, and Maryland — both in person at our Fairfax, VA and Miami, FL offices and via secure telehealth.

What happens during the free consultation?

The free 15-minute consultation is a low-pressure phone call. We'll talk briefly about what brings you in, answer any questions you have about our approach, and help you figure out which therapist might be the best fit. There's no commitment required — it's just a conversation.

How do I schedule a free consultation?

The easiest way is to use our online booking link — you can pick a time that works in about 60 seconds. Click Book a Free Consultation in the navigation bar, or visit our Schedule page. If you'd prefer to reach out first, you can also use our contact page and we'll respond within one business day.

What should I expect in my first paid session?

Your first session is mostly intake — your therapist will ask about your background, what's bringing you in, your goals, and any relevant history. You won't be expected to go deep on your first visit. Think of it as a mutual conversation to understand each other and establish a direction. Sessions are 45–50 minutes depending on your therapist.

What actually happens in a sex therapy session? Will I be asked to do anything sexual?

No — and this is the most common misconception about sex therapy. Sessions are fully clothed, conducted in a standard therapy office or via secure video, and there is no physical contact of any kind. We talk: about your experiences, emotions, relationships, history, and goals. You may be given exercises to practice privately at home between sessions, but nothing happens in the room that wouldn't happen in any other form of therapy.

What is the difference between sex therapy and regular therapy?

Sex therapy is a specialized form of psychotherapy focused on sexual health, functioning, and intimacy. Our therapists hold advanced credentials — including AASECT certification — that go well beyond standard licensure. This training equips them to address concerns like sexual dysfunction, desire discrepancy, sexual trauma, and intimacy in ways that most general therapists are not trained or equipped to do.

Can I come alone if my partner won't join me?

Absolutely. Individual sex therapy is effective and appropriate even when a partner isn't present or isn't ready to participate. Many clients work through deeply personal concerns — sexual trauma, low desire, anxiety, body image, or sexual dysfunction — entirely on their own. If couples work becomes relevant later, that's a conversation we can have when the time is right.

Do I have to talk about things I'm not ready to discuss?

No. You set the pace. Our therapists are trained to follow your lead, and you are never pressured to share more than you're comfortable with. Building a sense of safety in the room is always the first priority — the deeper work follows from there.

How long does therapy typically take?

It depends on your goals. Some clients address a focused concern in 8–12 sessions. Others work with us for a year or more on deeper relational or trauma-related issues. Your therapist will discuss realistic timelines with you early on, and you'll revisit them as the work evolves. Progress is always the measure — not time.

How often will we meet?

Weekly sessions are our standard recommendation. Consistent, regular sessions tend to produce the most meaningful and lasting progress. Bi-weekly scheduling is available in some circumstances. We generally don't recommend monthly sessions — the gap between appointments limits continuity and momentum.

Is everything I share completely confidential?

Yes. Everything discussed in sessions is strictly confidential under HIPAA and professional ethics standards. There are narrow, legally required exceptions — such as if we have reason to believe someone is in immediate danger — and your therapist will explain these clearly in your first session. What you share about your sexuality, relationships, history, or identity will never be disclosed without your explicit written consent.

I'm embarrassed to talk about sex with a stranger. Is that normal?

Completely normal — and expected. Most clients feel some version of this before their first session, and many describe it as the thing they were most worried about. Our therapists have heard it all, and they're specifically trained to make these conversations feel less daunting over time. The free 15-minute consultation is a good first step: a short, low-stakes call that lets you get a sense of us before committing to anything.

Do you work with LGBTQ+ clients and non-traditional relationship structures?

Yes, wholeheartedly. Cushing Counseling is an affirming, judgment-free practice. We welcome clients of all sexual orientations, gender identities, and relationship structures — including non-monogamous, polyamorous, and kink-aware individuals and couples. You do not need to explain or justify who you are here. Our therapists are trained in LGBTQ+ affirming care and approach every client with genuine respect and curiosity.

Do you work with individuals, couples, or both?

Both. We offer individual therapy, couples therapy, and integrated couples and sex therapy. Some clients start individually and bring a partner in later. Others come as a couple from the start. We'll help you figure out the right format during your free consultation.

What does therapy cost?

Session rates vary by therapist: Vanessa Cushing, LPC, CST (AASECT Certified) — $350 / 50 min. Radiance Sanneman, LCPC — $210 / 50 min. Alexandria Da Ponte Cheatham — $175 / 50 min. Noelle Harris, LMSW — $165 / 45 min individual, $220 / couples session. Every new client receives a complimentary 15-minute telephone consultation at no cost.

Do you accept insurance?

We are a private-pay, out-of-network practice and do not bill insurance directly. However, we partner with Thrizer, which allows many clients to use their out-of-network mental health benefits automatically — so you may pay significantly less than the full session rate, depending on your plan.

What is Thrizer and how does it work?

Thrizer is a service that verifies your out-of-network insurance coverage upfront and collects only your estimated share at the time of service. They file the claim automatically after each appointment and your reimbursement comes directly from your insurer. No superbill wrangling, no waiting on reimbursements, no paperwork on your end.

Can I get a superbill to submit to my insurance myself?

Yes. We can provide a superbill at any time — a detailed receipt that includes diagnosis codes, procedure codes, and your therapist's credentials. Just ask your therapist and we'll generate one for any session.

Do you offer sliding scale or reduced rates?

We have a limited number of reduced-fee spots available. If cost is a barrier to starting therapy, please mention it during your free consultation and we'll do our best to find an option that works.

What is your cancellation policy?

We ask for at least 24 hours' notice to cancel or reschedule. Late cancellations and no-shows may be charged the full session fee. We understand that life happens — please just reach out as soon as you know.

What payment methods do you accept?

All fees are collected via credit card on the day of your session, automatically. Your card is kept securely on file — there are no invoices or checks to manage.

Where are your offices located?

We have two physical locations: Fairfax, Virginia — 12875 Yates Ford Rd, Clifton, VA 20124. Miami, Florida — 244 Biscayne Blvd, Miami, FL 33132. We also see clients throughout Virginia, Florida, Washington DC, and Maryland via secure telehealth.

Do you offer online therapy?

Yes. All of our therapists offer HIPAA-compliant telehealth sessions via secure video. Many clients prefer telehealth for the flexibility and privacy it offers. Session quality and fees are the same whether you meet in person or online.

Is telehealth as effective as in-person therapy?

Research consistently shows that telehealth is equally effective as in-person therapy for the concerns we treat — including sexual dysfunction, trauma, desire issues, and relationship challenges. Many clients actually find it easier to open up from the comfort and privacy of their own space.

What states do you serve via telehealth?

We are currently licensed to see telehealth clients in Virginia, Florida, Washington DC, and Maryland. If you are located outside these states, reach out and we can discuss your options or provide a referral.

How do I choose which therapist to work with?

Start with our About Us page to read about each therapist's training, style, and areas of focus. Practical factors like fee and availability matter too. If you're not sure, mention it during your free consultation — we'll help match you with the best fit. It's also completely fine to try a first session and reassess.

What is AASECT certification?

AASECT stands for the American Association of Sexuality Educators, Counselors and Therapists. The AASECT Certified Sex Therapist credential is the gold standard in the field. Earning it requires a master's or doctoral degree in a mental health discipline, hundreds of hours of specialized training in human sexuality, supervised clinical hours with a certified supervisor, and ongoing continuing education. Vanessa Cushing holds this certification, placing her among a small number of AASECT-certified sex therapists in the country.

What specialties does the practice cover?

Cushing Counseling therapists collectively specialize in sex therapy and sexual dysfunction, couples therapy and intimacy, trauma therapy and sexual trauma recovery, LGBTQ+ affirming care, and Internal Family Systems (IFS) therapy.

When Communication Problems Mean Couples Therapy | Cushing Counseling

Communication struggles are one of the most common reasons couples seek support. If you’re wondering whether those missed connections, spiraling arguments, or growing silences are just a rough patch or a deeper sign that you need help, you’re not alone. At Cushing Counseling, we specialize in helping couples—across Virginia, Maryland, DC, and Florida—understand what’s beneath persistent communication problems and how to move toward genuine connection again. This comprehensive guide walks you through how to recognize when communication issues indicate it’s time for couples therapy, what to expect in the process, and why seeking expert-led support can be a turning point for even the most stuck relationships.

A couple having a serious conversation indoors, expressing emotions and misunderstanding.

What Counts as a Communication Problem (and What Doesn’t?)

Every relationship faces occasional misunderstandings. But if recurring patterns go unresolved or start to erode your sense of partnership, these are often signs that deeper intervention is needed.

Normal, repairable miscommunications: Arguments that resolve quickly, rare tension, and both people apologizing or reconnecting.
Serious problems: Repeat arguments that never conclude, feeling like emotional roommates, fear of bringing up key topics, constant sense of being misunderstood, or ongoing resentment. If you notice three or more of these issues lasting over two to three months, it’s likely time for professional couples therapy.

Patterns matter more than perfection. Occasional conflicts are natural, but if avoidance, chronic tension, or harsh escalation have become your new normal, that deserves attention.

Key Signs You Shouldn’t Ignore

The same fight plays out again and again, with no resolution.
You plan conversations in advance, fearing they’ll end badly.
Important topics—money, sex, family—are chronically avoided.
Either or both partners feel perpetually misunderstood.
Minor issues escalate intensely and rapidly.
Daily communication is limited to logistics, not emotions or connection.
You’re keeping mental tallies of hurts or disappointments.

If these patterns sound familiar, it’s not a sign of failure. It’s a sign that the usual tools aren’t enough, and outside support—like what we offer at Cushing Counseling—could help you break free from longstanding cycles.

When Is It Time to Seek Couples Therapy?

Many wait until the brink of separation before asking for help. Years of waiting can make repair much more difficult. From our experience at Cushing Counseling, it’s wise to consider therapy at any of these points:

Daily life is impacted: Fights that spill into work, sleepless nights, or dread about coming home are strong indicators that things won’t fix themselves.
You’ve tried everything else: Self-help books, advice podcasts, promises after conflict. If you’ve made sustained efforts for several months without progress, underlying issues often need an expert’s perspective.
Communication problems start to affect sex, trust, or emotional safety: When arguing leads to withdrawal, loss of intimacy, breaches of trust, or feels emotionally unsafe, don’t wait—these situations signal deep patterns best addressed with professional guidance.

Why Communication Issues Are Seldom Just About Communication

People often believe they simply need to "communicate better," but at Cushing Counseling we see that communication breakdowns are usually rooted in:

Attachment styles—for example, one partner’s tendency to pursue while the other withdraws.
Unhealed trauma—particularly sexual or relational trauma, which can make some topics feel dangerous.
Sexual shame, cultural or religious beliefs that cause anxiety or confusion when discussing intimacy.
Conflicting family backgrounds—differences in upbringing or values around finances, parenting, or role expectations.

Effective therapy addresses these layers alongside practical skills training for communication, ensuring repair is possible on a solid foundation.

From below of ethnic female with short curly hair standing and arguing with boyfriend on street in daylight

What Happens in Couples Therapy at Cushing Counseling?

We take a warm, nonjudgmental, structured approach to couples therapy, whether you need to address communication, intimacy, or related issues:

Free 15-minute consultation: We start with a no-pressure phone call to clarify your concerns, outline goals, and match you with the best clinician on our team.
Initial intake sessions: The first few sessions involve both partners together, then often individually. This lets us understand your unique patterns, strengths, and challenges without pressure.
Weekly online sessions: Most couples begin with weekly 50-minute sessions, where we slow down your usual conflict, practice new skills, and explore connections between present problems and past experiences.
Concrete practice between sessions: You’ll be given structured experiments (such as daily check-ins or weekly relationship talks) to anchor your progress outside of therapy.

Our approach is informed by evidence-based methods (Gottman Method, CBT, Emotionally Focused Therapy, Internal Family Systems, and more). This means more than just learning to speak differently—it’s about building relationship safety, self-awareness, and lasting change.

Five Communication Exercises You Can Try at Home

Before or during therapy, these practices can help interrupt old patterns:

10-Minute Daily Check-In: Sit down for ten distraction-free minutes and each share something that went well today, something hard, and one thing you appreciate about your partner.
“I Feel/I Need” Statements: Express needs directly instead of blaming. For example: “I feel overwhelmed when we argue before bed. I need us to schedule tough talks for the weekend.”
Weekly Relationship Talks: Once a week, each partner shares a highlight, a hurt, and a small hope for the coming week.
Time-Out Rule: Either partner can call a break in conflict to prevent escalation. Always agree on a return time.
The Appreciation Ratio: Aim for three specific appreciations daily, shifting from criticism to connection.

If you try these for a month and are still stuck—repetitive arguments, emotional distance, or impacts on intimacy—it’s a signal that therapy could make a real difference. For a more advanced look at navigating tricky communication and sexual desire differences, see our in-depth post on getting online couples counseling for both communication and sex.

What Makes Cushing Counseling Different?

As a nationally recognized leader in sex and couples therapy, our team brings a depth of expertise few practices can match. All therapists at Cushing Counseling are rigorously trained with specialty certifications in sex, couples, and trauma therapy. Our sessions are:

Ethical and evidence-based: We believe in clear, honest communication, ethical care, and up-to-date research so clients feel secure and respected.
LGBTQ+ affirming and culturally aware: We honor all identities, orientations, and backgrounds, understanding how these influence communication styles and needs.
Genuinely compassionate: We know change requires feeling safe and respected, even when facing hard truths.

Keen to understand more about our approach and philosophy? Learn about the difference between a sexologist and sex therapist in our blog here.

What to Expect—Logistics and Support

Session format: Fully remote, private, HIPAA-compliant video sessions (no travel or parking stress).
Frequency: Weekly to start, with the potential to reduce as progress is made.
Investment: Sessions with residents start at $150/50min. Specialized, private pay care—meaning time is respected, and you receive undivided attention from experts.
Insurance options: Out-of-network benefits can be accessed via partners like Thrizer, making your experience smooth and predictable.

FAQ: Couples Therapy for Communication Problems

What if my partner doesn’t want to come?

You can start therapy solo. Many partners join after noticing changes and feeling safe about the process. We routinely help clients navigate this initial hurdle.

Is therapy only for couples on the verge of breakup?

No. Many couples attend during moderate struggles, before problems become entrenched. It’s much easier to correct patterns early on.

Will therapy focus only on communication?

Not at Cushing Counseling. True repair addresses emotional safety, relational patterns, intimacy, and the unique factors shaping both partners’ experiences. Skills and insight work hand-in-hand.

How long does it take?

Most couples see meaningful change in 8 to 12 weeks when engaged regularly. Deeper or longstanding issues may require a longer process.

Will my sessions be confidential?

Absolutely. All our sessions are private, never recorded, and handled with the highest standard of confidentiality and respect.

What if our issues are mostly about intimacy, not daily life?

You’re in the right place. Our training in sex therapy means we can seamlessly help with communication, desire, and physical intimacy, all under one roof. See our guide on finding support for mismatched desire for more insights.

In Summary

If you and your partner are stuck in loops of misunderstanding, escalating arguments, or silent resentment, you do not have to wait until "rock bottom." With the specialized, compassionate support found at Cushing Counseling, couples across DC, Maryland, Virginia, and Florida have discovered new pathways to trust, connection, and growth.

If you’re ready for change—or even just ready to talk about the possibility—schedule a free confidential consultation with us. It’s your first, pressure-free step toward a healthier, more fulfilling relationship. Learn more at Cushing Counseling.

When Communication Problems Mean It Is Time for Couples Therapy