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.

Tools · 8 min read

The 5 Gears of Touch: A Shared Language for Physical Intimacy

Most couples have exactly two categories of touch: nothing, and sex. Five gears give you the middle, and the middle is where desire is rebuilt.

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

Two glazed ceramic vessels standing close together, casting overlapping shadows

The short answer

The five gears of touch are affectionate, sensual, playful, erotic and intercourse, mapped onto a 1–10 subjective arousal scale. Naming gears lets couples ask for touch without implying intercourse, which removes the pressure that drives avoidance.

Book a free 15-minute consultation

We teach this in session, with your own arousal ranges rather than a chart.

Why gears at all

When touch has only two settings, every hug becomes a question about sex and every no becomes a rejection. That is the mechanism behind loaded initiation.

Gears fix it with vocabulary. "I want gear two tonight" is a request that cannot be misread and does not commit either of you to anything further. Each gear is valuable in its own right, and each is also a bridge to the next when both of you want it to be.

The five gears

Gear	What it is	Subjective arousal (1–10)
1 · Affectionate touch	Clothes-on touch: holding hands, hugging, kissing. Not treated as sexual — it is the foundation of intimate attachment.	Baseline
2 · Sensual touch	Non-genital pleasuring, clothed, semi-clothed or nude: head, back or foot rubs, cuddling, cradling each other.	1–3
3 · Playful touch	Genital and non-genital touch intermixed, semi-clothed or nude: touching in the shower or bath, full-body massage, dancing, lighthearted games.	4–5
4 · Erotic touch	Erotic non-intercourse touch — manual, oral, rubbing or vibrator stimulation. Mutual or one-way; may end in orgasm or transition onward.	6–10
5 · Intercourse	A natural continuation of pleasuring and eroticism, not a pass-fail performance test.	7–10

Notes on each gear that matter clinically

Gear 1 is not foreplay. Couples who drop affectionate touch lose their attachment baseline long before they lose sex.
Gear 2 is where most low-desire couples restart. It is safe, low-pressure, and valuable on its own — not a down payment on gear 5.
Gear 3 works because of unpredictability and play. That is the specific quality that goes missing when sex becomes a routine or a duty.
Gear 4 is the hardest gear for most couples, and the most neglected. It carries vitality and creativity into a long relationship.
Gear 5 goes better when you enter it already at a 7 or 8 and keep multiple forms of stimulation going, rather than treating intercourse as a separate event that must succeed.

Exercise: map your own gears

Separately, write down what belongs in each gear for you, and the arousal number you would actually give it. Then compare. Couples routinely find that the same act sits in different gears for each of them — which explains a startling number of past misunderstandings.

Then agree on two things: how you will name a gear when you initiate, and how either of you can decline a gear without it meaning anything about the relationship.

A single teal armchair beside a small wooden table in soft daylight

Frequently asked questions

Is this the same as sensate focus?

Related but not identical. Sensate focus is a structured therapy exercise; the gears are an ongoing shared language for everyday life, and they extend all the way through erotic touch and intercourse.

Does using gears make sex clinical or unromantic?

For the first few weeks it feels deliberate. Then it disappears into how you talk. What it removes is anxiety, and anxiety is far less romantic than vocabulary.

What if we cannot get past gear two?

That is common and it is workable. Something is usually blocking the bridge — anxiety, pain, resentment or shame — and that is what we would look at directly.

Keep reading

Desire Discrepancy Therapy — Mismatched desire is the most common reason couples come to sex therapy. Here is how it is actually treated.
The Pursue–Withdraw Desire Cycle — Pursuit → pressure → avoidance → rejection → more pursuit, and how to interrupt it.
The Poisons of Sexual Desire — Anger, guilt, inhibition, fear, shame and anxiety — named, and then worked with as a team.
When Do Couples Stop Having Sex? — What the research says about timing, prevalence and who withdraws.

Also on this site

Meet the team — Who you would actually be sitting with.
Fees & FAQs — Rates and what a session costs.
Schedule a free consultation — Fifteen minutes, no cost, no pressure.
Couples therapy — When the issue is the relationship, not only the bedroom.

Clinical resources this page draws on

McCarthy & McCarthy — Rekindling Desire (3rd ed., Routledge, 2020) — The couple-oriented desire model this cluster teaches from, including the poisons and the gears of touch.
AASECT — Find a certified sex therapist — Useful if you are outside Virginia, D.C., Maryland or Florida.

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