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.

Sexual function · 7 min read

Delayed Ejaculation: Why It Happens and How Therapy Helps

The sexual concern almost nobody writes about honestly — what causes difficulty reaching orgasm with a partner, and what actually changes it.

Written and clinically reviewed by Vanessa Cushing, LPC, NCC, MS — AASECT-Certified Sex Therapist, licensed in Virginia, DC, Maryland & Florida.

Two glazed ceramic vessels standing close together, casting overlapping shadows

The short answer

Delayed ejaculation is persistent difficulty reaching orgasm despite adequate arousal and stimulation, most often with a partner rather than alone. The common drivers are a solo arousal pattern a partner cannot reproduce, medication side effects, and performance pressure — and each responds to a different part of treatment.

What delayed ejaculation is

Delayed ejaculation describes needing an unusually long time to reach orgasm, or not reaching it at all, despite wanting to and despite adequate stimulation. It becomes worth treating when it is distressing — to you, to a partner, or both — not when it crosses some clock threshold.

The pattern that brings most people in is situational: orgasm is reliable alone and unreliable or impossible with a partner. That distinction is the single most useful piece of information at intake, because it points almost immediately at the mechanism.

The cause people are never told about

A solo arousal pattern can be specific enough that a partner cannot reproduce it. Speed, grip, pressure, position, the particular kind of stimulation involved, and often the visual or fantasy context all get paired together over years of repetition. The body learns that combination as the route to orgasm, and partnered sex is simply a different, gentler, less predictable set of inputs.

Nothing about this is a moral problem, and it is not a sign that something is broken. It is conditioning, and conditioning is reversible. Treatment involves deliberately widening the range of stimulation that leads to orgasm so that partnered sex is inside it — a gradual retraining process, done at home, at your own pace.

Other common contributors

Medication — SSRIs and some other prescriptions are well known to delay orgasm. Talk to your prescriber. Do not stop or change a psychiatric medication on your own, and do not take advice about it from a therapist.
Alcohol and substances, which blunt sensation and delay the reflex.
Performance pressure — once you are monitoring whether it is going to happen, you are observing rather than participating, and observation reliably interrupts arousal.
Conception pressure. Sex that has a deadline and a purpose becomes a task, and orgasm resists being a task.
Ambivalence or unspoken resentment in the relationship, which the body sometimes registers before the conversation does.
Medical and neurological factors, which is why an evaluation is worth having if this is new or accompanied by other changes.

Why it hurts the relationship so much

Delayed ejaculation is unusually painful for couples because of what a partner assumes it means. The most common private conclusion is: he is not attracted to me. The second most common is: he is holding something back. Both are usually wrong, and both go unspoken for months.

Meanwhile the person experiencing it starts avoiding sex to avoid the failure, which confirms the partner's theory. This is why partner sessions do so much of the work here — often more than the behavioural piece.

What treatment involves

Component	What it addresses
Assessment	Solo versus partnered pattern, medication list, substance use, timeline, relationship context.
Medical referral where indicated	Ruling out or addressing physical and pharmacological contributors, via your physician or prescriber.
Stimulation retraining	Gradually broadening the range of touch and context that leads to orgasm, so a partner's stimulation falls inside it.
Sensate focus	Removing the outcome as the goal, which is what disables the self-monitoring.
Couple sessions	Repairing the rejection story, and rebuilding sex that is not a performance test.

When to seek help

It is distressing you, your partner, or both.
You are avoiding sex to avoid the outcome.
It started after a medication change — bring this to your prescriber first.
It is affecting family-building plans.
It is new, and accompanied by other physical changes — see a physician.

Where we work

Sessions are available in person in Fairfax, VA, and by secure telehealth throughout Virginia, Washington, D.C., Maryland, and Florida. Therapy is licensed by state, so the state you are physically sitting in during a session is the one that has to be covered.

Frequently asked questions

Is delayed ejaculation a sign I am not attracted to my partner?

Usually not. The most common driver is a conditioned arousal pattern that partnered sex does not reproduce, followed by medication effects and performance pressure. Attraction is one possibility among several, and it is not the first one we assume.

Can antidepressants cause this?

Delayed orgasm is a recognised side effect of several psychiatric medications, SSRIs among them. That is a conversation for the prescriber who manages your medication — not something to change on your own or on a therapist's say-so.

How long does treatment take?

It depends heavily on which mechanism is driving it. A medication effect can resolve quickly once your prescriber adjusts it. A long-standing conditioned pattern takes longer, because it is unlearning. We will give you an honest read after assessment, not before.

Do I have to bring my partner?

No. Individual work is effective, particularly on the retraining piece. But if the relationship has absorbed a rejection story, partner sessions usually shorten the whole process.

Is this the same as anorgasmia?

They overlap. Anorgasmia describes the absence of orgasm; delayed ejaculation describes the pattern where it takes very long or does not happen with a partner. Treatment shares most of the same structure.