Q: Do you take insurance? Do you take OHP?

A: More information about this is available in our Fees and Insurance page

Health insurance can be confusing, so we’re happy to explain the process to you, and ensure that you fully understand exactly how much you’ll be paying us.

Q: Do I have to come for counseling the same time every week?

A: It depends on the availability of the counselor you see. However, most of our counselors have flexible schedules, and can easily see you at a different time every week.

Q: Why is there a waitlist? Why can’t I see someone right away?

A: We do deeply apologize that our new clients need to wait for services with us. Portland is experiencing a huge demand for mental health services right now, and there are, unfortunately, not enough experienced therapists in the area to meet the demand.

We understand that it is hard to wait when you’re in pain. However, we want to help you any way we can. We are happy to provide you with regular updates to current wait times, and help you find available outside services if you’re in crisis or need help sooner.

Q: Do you do couples’ counseling?

A: Yes, we do. Some of our counselors have extensive training in couples’ counseling, and they work with couples of all ages, races, sexualities, and gender identities. In addition, they work with couples who are in open, non-traditional, or poly relationships. They also work with triads, communes, and poly families.

Q: Will my health insurance cover couples’ counseling?

A: Most private health insurance companies will cover couples’ counseling. One exception is OHP. They will not cover couples’ counseling, as it is not considered a medical expense. 

Counseling for Transgender and Gender-Nonconforming Individuals

Q: Do you write letters of recommendation for hormones and/or surgery?

A: Yes. We write letters of recommendation for both hormones and surgery. We recognize that these procedures can drastically help improve one’s mental health. When your body finally begins to match the person you feel you are inside, you might feel happier, more relaxed, and less conflicted about your gender. We can process and discuss this in therapy.

Q: How long do I have to see my counselor before they will write me a letter?

A: The short answer: probably a few weeks, although each person is different. The long answer: The World Professional Association for Transgender Health (WPATH) states in their Standards of Care that “therapy is not a prerequisite” for either hormones or surgery. This means that, under WPATH Standards of Care, you don’t have to go through therapy before you can access these procedures. However, you do have to have a “mental health screening” to ensure that you are psychologically and practically prepared to start these procedures. Keep in mind that a “screening” is more of an assessment, and not really the same as therapy. Many doctors who prescribe hormones feel comfortable enough to do this screening themselves. For all surgeries, however, surgeons and insurance companies require that this “screening” be done by a mental health professional.

In our practice, a typical screening usually takes about 2-4 sessions. During this time, we will collect your history, talk to you more about your gender, and make sure you understand the risks and benefits of hormones and/or surgery. We can also help you plan for the emotional, psychological, and financial aspects of surgery. After the screening, we will typically write you a letter (the most common scenario) or recommend further therapy (for some circumstances, such as substance addiction, as a client cannot safely take hormones while actively in addiction).

Q: Do you write “second letters” for surgeries that require more than one therapist letter?

We certainly do! However, our surgery assessments still usually take 2-4 sessions. We prefer to get to know you a bit, and to offer any support that we can in planning for your surgery. That said, if you’re looking for a more “one and done” longer appointment, we do know of some therapists who offer that, and we can refer you to them.

Q: After you write me a letter, can I still see you for therapy?

A: Most clients choose to continue therapy with us after we have written them a letter. We encourage this! Our clients have told us that being able to have a “transition ally,” and a safe, supportive space to discuss and reflect on their transition, was immensely helpful for them. In addition, many clients come to work on issues not related to, or only slightly related to, transition, such as trauma, anxiety, or family problems.

Clients might also find that hormones can change their emotions, thoughts, or reactions to events. It can be helpful to have a therapist with whom to discuss these things.

A few clients choose not to see us for therapy after we write them a letter, and that is perfectly okay as well. Some of these clients will return to us in the future if they face unexpected challenges during their transition.

Q: I have depression (or anxiety, or bipolar disorder, or PTSD, etc). Will you still be able to write me a letter after 2-4 sessions?

A: In most cases, yes. Mental health conditions, such as depression and anxiety, can be related to the feeling that one’s body does not match one’s gender (gender dysphoria). Having access to medical interventions such as hormones or surgery can greatly help to reduce the symptoms of depression, anxiety, and other mental health conditions. In addition, having a mental health condition usually does not impair your ability to make your own medical decisions.

The WPATH Standards of Care state that if you have a mental health condition, it must be “reasonably well-controlled” before you can be prescribed hormones or undergo surgery. What does “reasonably well-controlled” mean? This will probably be different for every client. You and your counselor can discuss what “reasonably well-controlled” means to you. In some cases, it might mean being able to come in and see us on a regular basis to process your feelings and get support. However, this does not mean we will delay writing you a letter; we usually simply write in your letter that you have a mental health diagnosis, and that we plan to address this with regular therapy. Or, “reasonably well-controlled” might mean that you have an established support system and a safety plan in place. We have never had a physician, or insurance company, reject a letter of recommendation based on a client’s mental health diagnosis. The medical community is becoming more aware that mental health diagnoses should not disqualify a transgender individual from obtaining medical interventions.

Our clients tell us that it is a relief to be able to “be themselves” around us, and fully express their pain and struggles without worrying that something they say is going to disqualify them from getting a letter. We are aware that, historically, therapists have been “gatekeepers,” holding the unfair power to decide whether or not a client could access medical interventions. Our goal is to create as little hassle for you as possible to access these interventions, while at the same time providing you with individualized support under the WPATH Standards of Care.

Q: I have been told that I need three (or six, or twelve) months of therapy before I can get a letter. Is this true?

A: Under WPATH Standards of Care, this is not true. You are not required to have therapy to get a letter of recommendation, only a mental health screening. Of course, many clients find that therapy can be extremely helpful to them throughout their transition. But the decision to pursue therapy is yours alone.

Q: My child says they are transgender. Can I sit in with them in the session?

A: Yes, and we encourage it! As a parent, you have the greatest influence over your child— transgender youth with supportive families are exponentially less likely to suffer depression and have problems in adulthood. When a child or teen comes out as transgender, this means a change for the whole family in some way, and therapy can be very helpful to help parents, siblings, and other family members navigate that change. Therapy can help increase communication between you and your child, especially around topics like name change, appearance, medical options, transition at school, and coming out to other members of the family.

Of course, sometimes your child will not want you to sit in on session. In this case, we’ll discuss our options and try to find some sort of compromise for all parties (maybe you will sit in for the first ten minutes of sessions, or only every other session).