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.

Poisons of desire · 10 min read

The Poisons of Sexual Desire

Anger, guilt, inhibition, fear, obsession, shame and anxiety. Named plainly, because you cannot fight what you will not say out loud.

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

Seven recurring factors suppress couple desire: anger, guilt, inhibitions, fear, obsessions and compulsions, shame, and anxiety (both anticipatory and performance). Awareness of a poison and its self-defeating effect is the first step in removing it.

Book a free 15-minute consultation

If you can name your poison but not move it, that is exactly what therapy is for.

Anger and guilt

Anger destroys intimacy and fuels sexual avoidance. Where anger has hardened into coercion or pressure, it becomes a major driver of inhibited desire — sex stops being an offer and starts being a demand.

Guilt is the most self-defeating emotion of the set. Guilt lowers self-esteem, and lowered self-esteem makes the same behaviour more likely to repeat. It pushes people to put themselves down and isolate from their partner, which is the opposite of sharing pleasure. Confronting guilt is concrete: take responsibility for the behaviour, apologise, make amends, and then use everything you have to stop the behaviour.

Soft folds of warm cream linen in low raking light

Inhibitions

Inhibition looks like poor body image, reluctance to initiate, unwillingness to let go in front of your partner, embarrassment at being nude, self-consciousness about making a request, reluctance to try anything new, and fear of rejection or embarrassment.

Inhibitions take the fun out of sexuality. They produce rigid roles and stereotyped expression, and sex becomes mechanical and stale — which drains desire. Functionally, inhibition is a psychological form of withholding: you are guarded, behind a wall, not free with yourself or your partner.

Obsessions, compulsions and shame

Obsessive thoughts interfere with spontaneity and with communication. Attention that is spent monitoring cannot be spent on sensation or on your partner.

Shame is the negative thought and feeling attached to past experience. These experiences are better confronted, worked through and then accepted than kept secret. The worst thing a traumatic incident does is become a shameful secret that quietly governs sexual self-esteem for years afterwards.

Anxiety: anticipatory and performance

Both forms share a mechanism: attention leaves the body and goes to evaluation. Anything that returns attention to sensation — slower touch, lower stakes, a gear that is not intercourse — works against both.

	Anticipatory anxiety	Performance anxiety
When	Before a sexual encounter	During a sexual encounter
Content	Will I be good enough? Will it hurt? Will I be rejected? Will something embarrassing happen?	Am I pleasing my partner? Am I taking too long, or not long enough? Am I doing this right?
Usual roots	Past negative experiences, trauma, cultural and religious messaging	Self-esteem, body image, past criticism
Typical effect	Avoidance of sex and of intimacy altogether	Difficulty staying aroused, racing heart, muscle tension

Exercise: naming your poisons (part 1)

Step C is the one people want to skip. Every poison is doing a job. Until the job is named, removing the poison feels like being asked to give up your only defence.

A. Individual poisons and turn-offs. List them alone — angry thoughts, inhibitions about your body, specific fears.
B. Couple poisons and turn-offs. What the two of you do together that shuts desire down.
C. Advantages of keeping them. Be honest: protection from anxiety, keeping control, punishing your partner.
D. Life without them. Describe, in detail, how your life and relationship would look if you released these entirely.

Exercise: owning your role (part 2)

When you exchange lists, honour your partner's vulnerability and honesty. Nothing on these pages is admissible in a future argument.

E. Own your role. What is your part — not your partner's — in maintaining the couple poisons?
F. Deconstruct each couple poison: the advantages of keeping it, what life would be like without it, and the advantages of resolving it.

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

Step three: make a plan

The exercise ends with something specific and testable, not a resolution to do better.

Worked example. Poison: anger. Couple poison: "I am angry that my partner wants sex all the time, so I refuse to have sex with them." Resolution: release the anger carried from earlier in the relationship, in writing or out loud; let sex become free-flowing and fun again; agree explicitly that sex is not a weapon, it is something you both enjoy.

Three key learnings to leave with: awareness of the poison and its self-defeating effect comes first; you are responsible for your own attitudes and behaviour; and you need a clear, specific plan to reduce both individual and couple poisons.

Frequently asked questions

What if my partner will not do the exercise?

Do parts A, C, D and E yourself. Naming your own poisons and your own role changes the dynamic even one-sided, and it is often what makes the other person willing to join.

Is anger always a poison?

Anger itself is information. It becomes a poison when it is carried into the bedroom, or when sex is withheld or demanded as its instrument.

I think my poison is trauma, not a habit. Where do I start?

With trauma-informed work rather than with the couple exercise alone. We use Internal Family Systems for this, so that the part of you that shut sex down is worked with rather than overridden.

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 5 Gears of Touch — A shared language for touch, from affectionate to intercourse, that takes the pass/fail out of sex.
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.
McCarthy (1999) — Marital style and its effects on sexual desire and functioning — Journal of Family Psychotherapy, 10(3), 1–12. Source of the 15–20% and 50–75% figures used on these pages.
AASECT — Find a certified sex therapist — Useful if you are outside Virginia, D.C., Maryland or Florida.

Next step

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