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.

Orgasm · 7 min read

Difficulty Reaching Orgasm: What Helps

Never had one, lost the ability to have one, or can only get there alone — three different problems with three different answers.

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

Difficulty reaching orgasm usually comes down to three things: the type of stimulation available, the amount of pressure and self-monitoring in the moment, and physical or medication factors. Which of the three is driving it depends on whether you have never had an orgasm, recently stopped having them, or can reach one alone but not with a partner.

Three different situations

Pattern	What it usually points to	Where treatment starts
Never had an orgasm at all	Usually unfamiliarity with what your body responds to, sometimes combined with a restrictive upbringing around sex.	Self-exploration work, at your own pace and privately.
Used to, and now cannot	Something changed — medication, hormones, health, stress, sleep, or the relationship.	Timeline mapping and a medical or prescriber conversation.
Alone yes, with a partner no	A stimulation gap, self-monitoring, or difficulty letting go in front of someone.	Bridging the gap between solo and partnered stimulation, plus removing the performance frame.

The stimulation gap

Most people with a vulva need direct clitoral stimulation to reach orgasm, and intercourse alone does not reliably provide it. This is ordinary anatomy, not a dysfunction, and yet many people spend years believing something is wrong with them because a form of sex that was never likely to produce an orgasm did not produce one.

For people with a penis, the equivalent gap is usually a solo pattern involving pressure, speed or context that a partner does not reproduce. Both versions respond to the same principle: widen what your body can respond to, and make sure partnered sex actually includes the stimulation that works.

The pressure problem

Orgasm requires attention to be inside the experience. The moment you start tracking whether it is going to happen, attention moves outside it, and arousal follows attention. This is why trying harder is counterproductive and why the pressure of a partner waiting is one of the most effective ways to prevent it.

A large part of treatment is deliberately removing the outcome — including agreeing, for a period, that orgasm is off the table entirely. That sounds backwards. It works because it disables the monitoring.

Physical and medication factors

SSRIs and some other psychiatric medications commonly delay or block orgasm. Ask your prescriber; do not adjust anything alone.
Hormonal changes — postpartum, breastfeeding, perimenopause and menopause.
Pelvic floor issues, nerve conditions, diabetes and other medical factors, which warrant an evaluation.
Alcohol and cannabis, which frequently blunt the response.
Exhaustion and untreated depression or anxiety, which affect the whole arousal system.

What treatment involves

Depending on which pattern brought you in, some combination of: an accurate assessment and any medical referral; directed self-exploration so you learn what your own body responds to before asking a partner to; sensate focus to take the outcome off the table; bridging exercises that gradually move what works alone into partnered sex; and, where relevant, work on the beliefs about sex you were raised with, which for many people are doing more to block orgasm than anything physical.

What we will not tell you

That you need to relax. If that worked you would not be reading this.
That orgasm is the point of sex. Plenty of good sex does not include one, and treating it as the scoreboard is part of what keeps it out of reach.
That there is a technique everyone responds to. There is not.

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

I have never had an orgasm. Is something wrong with me?

Almost always no. Most people who have never had one have simply never had access to the kind of stimulation, privacy, or permission required. It is one of the more responsive concerns in sex therapy.

Why can I orgasm alone but not with my partner?

Usually a stimulation gap plus self-monitoring. Alone there is no audience, no timing pressure, and exactly the touch that works. Treatment closes that gap in both directions.

Is it normal not to orgasm from intercourse?

Yes. Most people with a vulva need direct clitoral stimulation, which intercourse alone does not reliably provide. That is anatomy, not dysfunction.

Could my antidepressant be causing this?

It is a recognised side effect of several medications. Raise it with the prescriber who manages it — there are often options, and none of them involve stopping on your own.

Do I need to bring my partner?

Not necessarily. A good deal of this work is individual. Partner sessions help most when the difficulty has become a source of pressure or hurt between you.