What happens in this kind of therapy?
We talk, and I listen closely, including to the things you say without meaning to. There's no script and no set agenda. Over time we start to notice what matters to you, what keeps repeating, what you steer around, and what happens between the two of us in the room. I'm less interested in handing you techniques than in understanding you, because the understanding is usually what frees things up. People often arrive wanting relief from a symptom and find, somewhere along the way, that what they actually wanted was harder to name and worth more.

How is this different from CBT, coaching, or the therapy apps?
Those approaches are real and they help a lot of people, often quickly, especially with a specific symptom you want to manage. This is a different thing for a different need. If your trouble keeps coming back in new clothes, or you sense there's something underneath it you've never quite reached, a skills-and-symptoms approach can leave the root untouched. An app can give you tools and a place to vent at 2 a.m. What it can't give you is a person who stays with you over time, who remembers, who notices the pattern you can't see because you're standing inside it. That relationship is most of how this works.

I've tried therapy before and it didn't change much. Would this be different?
Maybe. It depends on what didn't work. Some people have had therapy that was kind but never went deep, or that felt like a worksheet. Some weren't ready yet, or the fit was wrong, which matters more than people think. If you have the feeling that you understood your problems and still didn't change, that's worth talking about directly. Understanding alone doesn't always do it. Something has to happen between two people, over time, for an old pattern to lose its grip.

Do I need a diagnosis, or a crisis, to come?
No. A diagnosis describes a cluster of symptoms. It doesn't tell you much about a person, and we are not our diagnoses. Plenty of people come without anything obviously wrong, just a sense that something is off, or stuck, or smaller than it should be. That's reason enough.

What if I can't say what's wrong?
That's a fine place to start, and often the truest one. Not being able to put it into words is usually not a failure of effort. The things that drive us tend to stay out of view, and they show up sideways, in a mood you can't account for, or a situation you keep ending up in. You don't have to arrive with it figured out. Figuring it out, together, is the work.

How long does it take, and how will I know it's working?
It varies, and I won't pretend otherwise. Most people feel some relief early, just from being heard and taking their own life seriously with someone. Symptoms tend to ease over the following weeks. The deeper changes, the ones in how you relate to yourself and to other people, take longer, because those patterns were a long time forming. I can't undo what happened to you. What can change is your relationship to it, so that what you once carried alone becomes something you can think about and bear. You'll know it's working when your life starts to feel more like yours.

What is the consultation, or thought-partner, work? 
Some people come to me not for therapy but for sustained, confidential attention to something they're working through: a decision, a project, a hard professional question, a piece of writing, a problem of leadership. The structure is different and the frame is plainer, but the kind of attention is the same. Some call it coaching. I think of it as the same depth, pointed at something specific you're working at.

How much does therapy cost? Do you take insurance? 
Fees are set during the first call. I'm in-network with WellFleet Student Health. For everything else I'm an out-of-network provider, so I don't bill insurance directly, but many PPO and POS plans cover a meaningful part of out-of-network mental health care. It's worth calling the member services number on your card and asking about your out-of-network outpatient mental health benefits. I provide a superbill after each session for reimbursement.

Do you offer therapy over video?
Yes. I see people by secure video across Oregon, Maryland, and New York, and in person in Ashland. Most of my practice is remote, and the depth of the work holds up well over video. It helps to have a private, steady place to talk from, where you can speak freely and won't be interrupted. 
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