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.

Midlife & menopause · 8 min read

Sex, Desire and Menopause: Therapy for What Changes

Sex changes in perimenopause and after. That is not the end of your sex life — but the version that worked before will need rewriting.

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

Soft folds of warm cream linen in low raking light

The short answer

Menopause changes the physical and hormonal conditions sex depends on — lubrication, tissue comfort, and how desire is triggered. Most of what people experience as losing their sex drive is actually a shift from spontaneous to responsive desire, combined with physical changes a physician can treat. Both parts are addressable.

Perimenopause, menopause, and why the distinction matters

Perimenopause is the transition — hormone levels fluctuate rather than simply decline, which is why symptoms can be erratic and why people are often told nothing is wrong. Menopause is the point after which periods have stopped for a full year, and postmenopause is everything after.

The sexual changes usually start in perimenopause, often years before anyone names what is happening. If you are in your forties and something feels different, you are not imagining it and you are not too young.

What actually changes

Vaginal dryness and thinner, more fragile tissue, which can make previously comfortable sex uncomfortable or painful.
Slower arousal — the body still responds, it just needs more time and more direct stimulation than it used to.
Less spontaneous desire. Wanting sex out of nowhere becomes rarer; wanting it once things are already pleasurable does not.
Changed orgasm — sometimes less intense, sometimes needing more sustained stimulation.
Sleep disruption, hot flashes, and mood changes, which affect sex indirectly but powerfully.
Body image shifts that have nothing to do with how you actually look.

The desire piece, reframed

The single most useful idea for most people in this stage is the difference between spontaneous and responsive desire. Spontaneous desire arrives before anything happens — it is the version films depict and the version most people assume is the only real one. Responsive desire arrives after pleasurable touch has already started.

Responsive desire is not lesser and it is not a symptom. It is extremely common at every age and becomes the dominant mode for many people in midlife. The practical consequence is significant: waiting until you feel like it may mean waiting indefinitely, whereas agreeing to start and letting desire catch up usually works.

That only functions inside a relationship where you can genuinely stop at any point. Without that, it becomes obligation, and obligation kills desire faster than menopause does.

What belongs to your physician

Several of the changes above have medical treatments, and a sex therapist is not the person to prescribe or recommend them. Bring these to a gynecologist or menopause specialist:

Vaginal dryness and tissue changes — there are local treatments, and your physician can tell you whether they fit your history.
Systemic hormone therapy — a decision that depends on your personal medical history, and one to make with a physician who knows it.
Pain that persists despite lubricant and slower arousal.
Any bleeding after menopause, which should be evaluated promptly.
Medications you are taking that may be affecting desire or arousal.

What sex therapy does

Concern	What we work on
“I never want it anymore”	Distinguishing desire loss from a shift to responsive desire, and rebuilding the conditions that trigger it.
Pain or discomfort	Coordinating with your physician, plus graded work so the body stops anticipating pain.
A partner who feels rejected	Couple sessions that separate the physiological change from the story being told about it.
Sex has stopped entirely	Restarting deliberately, in stages, rather than waiting for a spontaneous moment that is not coming.
Grief about the change	Space for it. Something is genuinely different, and skipping past that does not help.

If you are the partner

The most common mistake is reading reduced initiation as reduced attraction and responding by withdrawing. That leaves both people alone with the same fear. The second most common is over-monitoring — checking whether it is working, which introduces exactly the pressure that makes responsive desire impossible.

What helps is unhurried, non-goal-directed touch that is genuinely allowed to go nowhere, and a direct conversation about what feels good now rather than what used to.

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 it normal to lose interest in sex during menopause?

Changes in desire are extremely common in perimenopause and after. What often gets labelled as losing interest is a shift from spontaneous to responsive desire, sometimes compounded by discomfort, poor sleep, or medication. Common does not mean untreatable.

Will hormone therapy fix my sex life?

That is a question for a physician who knows your medical history. Hormone treatments can address specific physical symptoms; they do not by themselves resolve responsive desire, relationship dynamics, or anticipatory pain — which is the part therapy addresses.

Why does sex hurt now when it never did before?

Thinner, drier tissue is a frequent cause, and it is worth a medical evaluation. Once pain has occurred a few times the body also begins bracing in anticipation, which adds a second layer that therapy treats.

Is it too late to fix this?

No. People rebuild satisfying sex lives well into and beyond this stage. What usually has to change is the assumption that it should look exactly like it did at thirty.

Should we come as a couple?

If you have a partner and the change is affecting the relationship, couple sessions tend to help most — largely because so much of the damage comes from unspoken conclusions on both sides.