Frequently Asked Questions

I ask a lot of questions, and you are welcome to, too! See below for some additional info on general, online, and teen counseling. If you don't find what you're looking for here, please send me a message.

General counseling questions

• How do I know if I need counseling?

  Asking for help is wise and accepting responsibility for change takes guts. Counseling is a personal, individualized service, and you and others who care about you are in the best position to consider whether or not it may be a helpful tool for you at this time.

  You are welcome to send me a message with your questions or schedule a free, confidential phone or video consultation to explore how counseling might fit with your needs.

• What is a consultation call?

  A consultation call is an informational phone or video call that allows you to briefly share your overall counseling goals or priorities and ask me questions and learn about my practice in order to help further determine whether my services and skills may be a good match for your needs. It's an easy way for potential new clients to schedule a time when we're both available to speak in person since I'm often tied up in scheduled appointments during office hours.

  A consultation call is just a pre-scheduled business call to help you get a clearer sense of who I am and what I do, not a therapeutic counseling session or a sales pitch (and the term "consultation" is a bit misleading since I'm not typically offering advice aside from whether I feel my practice may fit your needs as described). Consultation calls are not required prior to scheduling a new client first session, but they can be helpful for confirming whether my services may support your goals prior to beginning the counseling process.

  You can use my online calendar to schedule a free 15-minute consulation call. Or if you'd rather connect by email, you can use the form on my Contact page to send me a secure message (please make sure to provide your secure, private email address and check your spam/promotions folders for my response). If you're ready to begin the process of scheduling a first counseling session for you or your teen, you can also use the contact form to request new client registration.

• What can I expect in my first counseling session?

  Counseling begins with discussion on a topic you are uniquely qualified to be an expert on—yourself! The first session is also an opportunity for you to ask questions about anything related to counseling and my practice and to share your thoughts openly and honestly.

  If you're the sort of person who likes to have more detail about what to expect, keep reading! As we begin our session, I will introduce myself, make sure our video connection is working well, and confirm your identity and location. I will address any initial questions you may have and we will take some time to discuss your reasons for requesting counseling. I will review your initial intake information with you, ask you background details, and collect additional personal history in order to have a more complete understanding of you, your experiences, and how I might be most helpful. Although we may touch on some of the topics you want to explore more deeply through counseling, I will ask you to primarily share the big picture of who you are and what brings you to counseling during the first session so that we can focus full attention in greater depth to those areas in the future. We will also begin to discuss what you are hoping to achieve through counseling and the types of approaches you may find most helpful.

  There are two dimensions to counseling—your life outside counseling, which we will often discuss, and whatever is occurring in the moment as we discuss things during the session. We often experience a wide range of feelings and reactions as we reflect on the topics and themes that bring us to counseling. I will encourage you to observe and describe these emotions and thoughts as they occur, as these are opportunities to build awareness and practice skills in real time. This is about simple, nonjudgmental observation, not any "correct" way of responding, such as noticing out loud that you feel scared to answer a question, proud to recount an accomplishment, or confused by a comment I made.

  While we will cover many topics in the first session, you are always invited to share additional information or concerns at any time throughout counseling and as new thoughts and experiences arise.

• How long does counseling last?

  The overall length of counseling can vary widely depending on individual clients' needs and providers' approaches and modalities, ranging from a few sessions (e.g. talking through a short-term stressor) to several years (e.g. working through a life-altering experience) to a lifetime (e.g. managing enduring conditions or situations that benefit from ongoing support).

  The clients I work with are most typically either seeking counseling to address a specific current issue or challenging situation, which might involve weekly sessions over the course of an average of 3 to 9 months, or looking to develop an ongoing counseling relationship that will support navigation of complex life challenges and allow for in-depth work that integrates personal factors, past experiences, and current goals, which might continue for 1 or 2 years or beyond, often decreasing in appointment frequency as intensity of concerns subside and skills, confidence, and other supports expand.

  I welcome conversations regarding the length and frequency of counseling as they relate to your unique needs, including any financial limitations. Whenever possible, I prioritize appointment scheduling availability for returning clients who request to reconnect with counseling services.

• What if I feel like I'm not getting the results I want?

  Please simply say so, and we'll discuss it. A benefit of counseling is that practicing potentially uncomfortable conversations is very much a normal part of the process. In some cases, I will encourage you to take an honest look at what may be getting in the way of your goals and how you might approach things differently; in other cases, I may ask you to consider redefining your goals or changing how you are measuring your success. We may discuss things that I can do differently or add to your counseling to better assist you. If one or both of us determine that you may be served more effectively by a different provider or an area of focus or intervention I don't offer here, I can assist you in preparing to take that next step.

• Do you offer family or couples counseling?
  No, I do not offer multi-person counseling modalities (families, couples, groups) in an online format. Clients may discuss choosing to invite others to participate in relevant aspects of their individual counseling at times. I also request parent/guardian engagement where clinically indicated when working with teens under 18.

• What is the difference between counseling and therapy?

  The short answer is that there isn't any consistent difference between the terms "counseling" and "therapy." You can call me a counselor or a therapist, and call my services counseling or therapy, and you'll be correct either way. Some locations and entities have specific definitions they assign to each word, but overall you'll have to look closer at the training, credentials, experience, theoretical orientation, intervention tools, population focus, and personality of individual counselors and therapists to really get a sense of what is offered and may work best for you.

  If that sounds overwhelming, it's helpful to know that according to research the strength of the relationship you develop with a counselor or therapist is as much or more of a predictor of positive outcomes than the specific type of treatment intervention you receive. This means you should feel comfortable trusting yourself when seeking out counselors that you feel could be a good “fit” for what you're looking for with respect to who they are and how they understand you and your goals (with the recognition that it's often your counselor's job to help you experience and tolerate discomfort at times).

• What do the different credentials held by clinicians mean (LICSW, LMFT, LCPC, PsyD, etc.)?

  Unless you have an interest in deeply understanding this topic, the simplest thing to do is to ask counselors directly about their degrees and licenses and how these relate to what they do. A counselor's credentials are important in confirming that they can legally and ethically offer services and have met minimum professional standards for education, training, and performance, but beyond that I personally would not say that a particular credential will tell you much about an individual counselor's strengths, experience, or practices, even at a basic level (e.g. a Marriage & Family Therapist may work with individuals and a Social Worker may work with couples). Most generalizations I could draw contain too many exceptions to be useful.

  You may, however, learn something useful by understanding why a counselor chose their particular professional direction. For example, I chose social work as my path into counseling because of social work's emphasis on understanding ourselves within our broader social contexts. We're not just disconnected brains under microscopes, and as I thought about becoming a counselor, I was not interested in pathologizing the negative personal impacts of social problems or assuming unearned authority over other people's lives. Social work addressed these ideas and offered me a more complete framework for understanding people and how I can be helpful.

  There is a lot of overlap in the educational training and scope of practice among licensed mental health professionals and a lot of variation among individual clinicians' philosophies, interests, skills, and approaches. In addition, there are not uniform licensing or degree requirements, regulations, or titles across individual states or among adjacent professions. This all makes it challenging to differentiate comprehensively by credentials, although you can check out a profession's representing national organization to get a sense of its overall mission and focus. Here's a very brief overview:

  Licensed Clinical Social Workers LCSW (MT), LICSW (WA)

  Master's level licensed clinicians who have met their state's standards for independent advanced practice. Their professional organization is the National Association of Social Workers. SWLC (MT) and LSWAIC (WA) are post-graduate candidate/associate clinicians gaining training and supervision toward independent licensure.

  Licensed Marriage & Family Therapists LMFT (MT & WA)

  Master's level licensed clinicians who have met their state's standards for independent advanced practice. Their professional organization is the American Association for Marriage & Family Therapy. MFTLC (MT) and LMFTA (WA) are post-graduate candidate/associate clinicians gaining training and supervision toward independent licensure.

  Licensed Mental Health Counselors LMHC (WA)

  Licensed Clinical Professional Counselors LCPC (MT)

  Master's level licensed clinicians who have met their state's standards for independent advanced practice. Their professional organization is the American Counseling Association. PCLC (MT) and LMHCA (WA) are post-graduate candidate/associate clinicians gaining training and supervision toward independent licensure.

  Licensed Clinical Psychologists PsyD, PhD, or EdD (MT & WA)

  Doctoral level licensed clinicians who have met their state's standards for independent advanced practice. Their professional organization is the American Psychological Association.

Online counseling questions

• What is online counseling?

  Through Cross Country Counseling, online counseling is outpatient mental health counseling conducted remotely via secure live videoconferencing. I offer the same quality of counseling online that I do when working with clients in person. The main difference is that we are connecting and communicating via the internet instead of within a brick-and-mortar office.

  While the coronavirus pandemic rapidly increased remote access to healthcare, many areas of the field are still developing and implementing comprehensive standards for online practice, each state regulates it a bit differently, and there is not yet a universal name for this type of service. The current most-used terms are “telehealth” and “telemental health,” though these titles most often refer to real-time video communication and typically exclude services delivered by audio-only telephone. You may also find online counseling described using a variety of other related terms such as remote or distance counseling/therapy, teletherapy, e-therapy, telepsychology, telebehavioral health, telemedicine, virtual counseling/therapy, etc. I've chosen to call my telemental health practice "online counseling" since this is a straightforward, easily understood description of the actual service and delivery method.

• What do I need in order to be able to participate in online counseling?

  You will need access to:

  • A desktop or laptop computer, tablet, or smartphone with internet capability and an integrated or external camera and microphone. Older computers and devices provide weaker data security.
  • A stable high speed wired or wireless internet connection to support video streaming. An internet connection speed of 10 Mb/s (1.25 MB/s) or higher is recommended for optimal connectivity and quality.
  • The most up-to-date version of your web browser.
  • If you are using a smartphone or tablet for video, you'll need to download and install a free mobile app called Telehealth by SimplePractice. If you are using a desktop or laptop, you won't need to download or install anything to access video sessions.
  • A quiet, private location with adequate lighting and minimal distractions to conduct sessions. Using headphones can assist with sound isolation.
  • Location in one of my areas of license: Washington state or Montana.
• How is online counseling different from in-office counseling?

  The primary difference is that online counseling occurs remotely by video rather than by meeting in a physical office. When you are working directly with a licensed provider, the content and format of online counseling should not be much different from in-office sessions except for any natural limitations imposed by technology and distance.

  For example, in online counseling we primarily rely on facial expressions for nonverbal cues versus being able to view someone's whole body language. And while there's always the risk of paper files being improperly accessed or traffic and weather interrupting an in-person service, electronic data breaches and technological service disruptions are unique risks of online communication. Since I am not physically in the room to respond to problems or emergencies during an online counseling session, I will provide you with a plan for troubleshooting potential technological issues and help you to develop a local emergency action plan.

  For some people, meeting remotely from a familiar space can provide increased comfort and privacy while decreasing feelings of vulnerability or anxiety. Online counseling can make scheduling more convenient and flexible by eliminating the extra time and costs associated with traveling to an office. It can also offer greater choice by allowing more provider options than may be available locally. Remote counseling also gives increased access for clients unable to attend in-person appointments for medical or mental health reasons or due to transportation barriers.

  For others, safe and private personal space to meet remotely may not be available, or being physically present in a counseling office or in the same room as the counselor may feel important to treatment. It may be important for some clients to have a counselor who is physically located in their local community and already well-connected with other local community resources. Not everyone has access to the technology required for online counseling and some may desire to avoid the risks of electronic data transmission. People with emergent safety concerns may require in-person care.

  Whether online or in-office counseling is the best option for you will depend on your individual needs and preferences. If you're curious about online counseling but not sure what it's like, feel free to request a free video consultation to explore and discuss it further.

• Are there issues or conditions that may not be appropriate for online counseling?

  Research outcomes have not revealed specific diagnostic contraindications for video-based counseling versus in-person service. However, certain types of clinical assessment or intervention require in-person interactions or observations, and conditions associated with a higher level of potential safety risk or possible need for increasing levels of active assessment, support, and intervention or community-based coordination of services may be better served through localized and in-person care.

  I am not able to offer remote crisis intervention, on-call services, or local in-office visits through Cross Country Counseling. Therefore I am not the best provider for people who may potentially benefit from these levels of service, such as those experiencing recent past or current active suicidality or homicidality; active high-risk self-harm, active high-risk mania, or active high-risk addictions; severe eating disorders; active psychosis or significant cognitive impairment; or a current risk for interpersonal violence or abuse within present place of residence.

  If you are experiencing any of these or other acute conditions, please know that there ARE providers and organizations offering professional help for these issues and there is always emergency support available for you through 911, your local hospital emergency room, and a range of local and national organizations and hotlines (for national crisis support examples see the bottom of my Main page). Each person's needs are unique and you are welcome to request a consultation call to discuss yours further.

• Does online counseling work?

  Yes, research confirms that online counseling via live video is associated with the same levels of outcomes and client satisfaction as in-person counseling. This does not mean that it is the best option for every person in all circumstances, and you are welcome to ask me questions or schedule a consultation call to help determine what might work best for you or your teen.

  The "online" aspect of online counseling refers only to the service delivery method. Licensed clinicians are still required to maintain the same standards when practicing online as they do for in-person service.

Teen counseling questions

• How is teen counseling different from adult counseling?

  When working with teens, the teen is my primary client. When appropriate to a minor client's clinical needs, I may request that a parent/guardian is involved in a portion of the initial intake process, and I may also request at times that a parent/guardian plans to join the final 20 minutes of a session with the teen, either for a routine check-in to discuss relevant goals together or as requested by either the teen or parent to address an important topic.

  In my online practice I have found that I can be most helpful to teens who have their own personal goals and interest in engaging in talk therapy. I do not provide online family counseling, and I may encourage parents/guardians experiencing communication, trust, or behavioral concerns with their teen to consider working with a family therapist or their own individual counselor for support in these areas.

  Minors over age 13 in Washington and over age 16 in Montana have the legal option to request mental health services with reduced parent/guardian engagement or without parent/guardian consent or notification. Parents/guardians may also request mental health evaluation and related services for their teen if under age 18 and medically necessary. Clients over 18 years of age and emancipated minors are legal adults with respect to mental health services and privacy rules.

• How does privacy work with teen counseling?

  Counseling is most effective when we are able to be fully honest, and privacy is essential in allowing us to speak openly on deeply personal topics. This is certainly no different for teens. In order to encourage honest engagement, I ask parents/guardians serving as legal representatives of minor teens to voluntarily decline to exercise their right to request the details of their teen's counseling activities or records unless they have reason to believe that doing so is necessary to address an imminent safety risk or the teen has volunteered the release of information.

  I do not serve as an intermediary in passing private and personal information between teens and parents/guardians. Teens above the age of ability to provide independent consent to mental health services (age 13 in Washington, age 16 in Montana) may choose additional privacy protections for their mental health information and records.

  Counselors are permitted, and in some situations required by law, to share the private information of minors with parents/guardians or other authorized individuals when involving a potential imminent safety risk to the minor or others and in disclosures or evidence of possible child, dependent adult, or elder abuse or neglect. I prefer to involve teens in the process of sharing this type of information with others where possible. I also have the option to not disclose information shared by a minor to a parent/guardian if I have a reasonable belief that doing so may be detrimental or endanger the child.

  For additional information on privacy protections and limits for personal health information, please see my Privacy page.