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.

Porn & compulsive behaviour · 8 min read

Porn Concerns: Therapy Without the Shame or the Panic

Whether you are worried about your own use or reeling from discovering a partner's, the useful question is not whether porn is an addiction. It is what it is costing you.

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

Concerns about pornography are best assessed by function and cost rather than by frequency or by whether it qualifies as an addiction. If use is compulsive, escalating against your intentions, interfering with work, sleep, partnered sex, or your own values, that is treatable — and treatable without shame-based methods.

Start with the honest part: 'porn addiction' is contested

There is genuine, ongoing disagreement among clinicians and researchers about whether compulsive pornography use is best understood as an addiction. What is not contested is that some people experience their use as out of control, and that the distress attached to it is real and worth treating.

This matters practically, because a great deal of the material online is written by programs with a position to sell, and much of it leans on shame and on fear-based claims. Shame is not a treatment. It reliably increases secrecy and, in most people, increases the behaviour it was meant to stop.

So we work from a different question: what is your use doing in your life, and what is it costing?

Signals worth taking seriously

You have repeatedly decided to cut back and have not been able to.
It is eating time you needed for sleep, work, or the people you live with.
Partnered sex has become less appealing or harder to respond to.
You are using it to regulate distress — after conflict, when anxious, when low — rather than out of desire.
Content has escalated in a direction that conflicts with your own values, or that distresses you.
You are hiding it in ways that are themselves damaging the relationship.
There is risk attached — at work, or of any illegal content, which requires immediate professional help.

Frequency is a poor measure

Two people can use pornography with identical frequency and have completely different clinical pictures. One integrates it comfortably into their life and relationship. The other is using it to avoid feeling something, losing hours they intended to spend elsewhere, and unable to stop despite deciding to.

Treatment tracks function, not volume. It also takes seriously the possibility that someone's distress comes from a moral or religious framework that conflicts with their behaviour — a real and painful conflict, but a different problem than compulsivity, and one that responds to different work.

If you are the partner who found out

Your distress does not depend on how the clinical debate resolves. Discovery can land as a genuine betrayal — because of the secrecy, because of what it seemed to mean about your desirability, because the person you trusted has been managing an entire area of their life away from you.

We do not ask partners to be reasonable about this before they have been allowed to be upset about it. Partner work in these cases usually covers what actually happened versus what you have filled in, what disclosure will and will not include, what rebuilt trust would concretely require, and what you each want your sexual relationship to be — which is a question that has often gone unasked for years.

What treatment involves

Component	What it does
Functional assessment	What the behaviour is doing — regulating anxiety, avoiding intimacy, filling time, chasing novelty.
Screening for what is underneath	Depression, anxiety, trauma histories, ADHD, and loneliness frequently sit beneath compulsive patterns.
Practical structure	Changing access, timing and cues, so willpower is not the only mechanism.
Building other regulation	If the behaviour is the only thing that reliably settles you, removing it without a replacement fails.
Repairing partnered sex	Reconnecting arousal to a real person, at real speed, with real feedback.
Couple sessions	Disclosure, trust rebuilding, and the sexual conversation that was never had.

What we will not do

Tell you that any use is inherently pathological.
Use shame, accountability theatre, or purity framing as a treatment method.
Tell a partner their distress is overblown.
Diagnose an addiction in order to sell a program.

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 porn addiction a real diagnosis?

It is genuinely debated among clinicians and researchers, and it is not established in the way substance addictions are. What is clear is that out-of-control sexual behaviour and the distress around it are real and treatable — which is what we work with, rather than the label.

How much is too much?

There is no threshold. The clinically useful measure is function and cost: whether it is compulsive, whether it conflicts with your intentions, and what it is displacing in your life.

Can porn cause erectile dysfunction?

This is widely claimed online and the research is not settled. What we see clinically is more specific: a conditioned arousal pattern built around particular stimulation and novelty that partnered sex does not reproduce. That responds to retraining, and any erection change is also worth a medical evaluation.

My partner says it means he does not want me. Is that true?

Usually not in the way it feels, but that answer alone helps nobody. The hurt is about secrecy and meaning, not arithmetic, and it needs to be worked through rather than argued away.

Do you work with religious clients on this?

Yes, and we take your framework seriously rather than treating it as the problem. We also distinguish between compulsive behaviour and moral distress about behaviour that is not compulsive, because they need different work.