Your Questions, Answered

Extended, focused therapy: a half day, full day, or several days built around one goal, instead of fifty minutes a week. We prepare beforehand, do the deep work with real time to finish what we start, and meet afterward to help it all land. The formats are described on the services page.
Weekly therapy is a slow, steady walk; an intensive is a deliberate expedition. Nothing about an intensive replaces ongoing therapy; many clients do both, and I'm glad to coordinate with your therapist. What an intensive offers is what a weekly hour structurally can't: enough uninterrupted time for your nervous system to go all the way into something and all the way through it.
Not required, but strongly recommended, and I'll ask.
An intensive opens things up. What comes loose needs somewhere to go over the weeks and months afterward, and that isn't what this practice does; I'm here for a defined stretch, not the long haul. A weekly therapist is who catches what surfaces.
If you have one, I'll ask you to sign a release so we can coordinate before and after. That isn't a formality. If something significant comes up during your intensive, or if we have to stop early, they need to know and they need to be reachable.
If you don't have one, we'll talk about it at the consultation. In most cases, getting connected with someone will be part of the plan before we set dates.
Less mysterious than you'd think. We start by settling in and revisiting the plan we built in your prep session. The middle is the work itself, EMDR, Brainspotting, IFS/Parts Work, Play Therapy, etc, in stretches with breaks for water, food, movement, and air. We end each day by grounding, reviewing, and setting you up for the evening. You'll never be pushed faster than your system can go; intensives make room for the work, they don't force it.
Both are brain-based approaches that help the nervous system reprocess experiences that got stuck, rather than just talking about them. EMDR uses structured sets of bilateral stimulation while you hold a memory lightly in mind; Brainspotting uses eye position to access where your brain is holding something. In an intensive we use whichever fits you, sometimes both. If those two sentences raised ten questions, good; that’s what the free consultation is for.
Internal Family Systems, Ego States, and in general terms, Parts Work, and it's less mystical than the name sounds. Parts Work modalities start from something you already know from the inside: part of you wants to heal, part of you is terrified to look, part of you learned long ago to protect you by any means necessary. Parts Work treats those parts with curiosity instead of judgment, helps them stop working against each other, and reconnects you with the steady core self underneath them all. In intensives, Parts Work often works alongside EMDR and Brainspotting; the Parts Work helps everything else go deeper and land softer.
People who know what they're circling: a specific trauma, a stuck pattern, grief with roots, something an upcoming life event is pressing on. They ask for basic day-to-day stability and a willingness to go toward the hard thing with support. They're not crisis care, and they're not a fit for everyone or every season, which is exactly what we figure out honestly at the consultation, with no pressure in either direction.
No. Room to Breathe is private pay only, which is what makes intensive formats possible; insurance plans are built around the weekly hour and don’t cover extended sessions. You’ll receive a Good Faith Estimate before we begin so there are no surprises. HSA and FSA funds can often be used for psychotherapy; check with your plan administrator.
Formats and current investment are listed in the Services section. Every format includes the free consultation, a preparation session, the intensive itself, and an integration session.
Great question, and it deserves a straight answer. An intensive isn't a therapy session with a bigger price tag; it's a different product. The fee covers the hours you see (a half day to multiple days of one-on-one clinical time) and the ones you don't: the preparation session, a treatment plan built specifically for you, the integration session after, and my availability around your intensive rather than squeezed between eight other clients. It's also worth doing the math honestly: a full-day intensive delivers roughly the clinical hours of two to three months of weekly sessions, concentrated enough for the work to build on itself instead of restarting every week. For the right person at the right time, that concentration is the value. And if the number simply isn't workable right now, that's a real answer too; weekly therapy remains a good path, and the consultation is a great place to talk honestly about fit, timing, and payment.
Your dates come off my calendar the moment you book, and a multi-day block isn't something I can refill on two weeks' notice. So the terms here are firmer than they'd be for a weekly session, and I'd rather you know that now than at signing.
A 50% deposit holds your dates, and it's non-refundable from the moment you book. Inside 21 days of your preparation session, the full fee stands. Cancellations need to come in writing.
You can reschedule once with more than 21 days' notice.
If something genuinely unavoidable happens, tell me as soon as you know. I hold one discretionary exception per client for things like illness, hospitalization, or a death in the family, and it moves your fee to new dates rather than refunding it.
And if I'm the one who has to cancel, you get everything back or new dates with priority, your choice. You shouldn't absorb a cancellation you didn't cause.
Then I'll tell you, and I'll tell you why.
Intensives ask a lot of a nervous system in a short window. Sometimes the honest answer is that the timing isn't right: you're in the middle of something acute, or you don't have enough support around you yet, or the groundwork that would make an intensive land hasn't been laid. That's not a verdict on you and it isn't permanent.
When I say not yet, I'll tell you what would need to be different and roughly when it would make sense to revisit. And I'll help you figure out where to start in the meantime, whether that's with someone else or somewhere else entirely.
Not yet is a real answer here, not a soft no.

Yes. Room to Breathe is my separate, private-pay intensive practice, founded alongside Back to You Counseling, which continues as my insurance-based weekly practice. Separate businesses, same therapist, same care.
Possibly, and I'll be open with you about how this works. Because your weekly therapy is billed through insurance and intensives are private pay, there are insurance contract rules and professional ethics guidelines about how the two can fit together, and those rules exist to protect you, not to gatekeep you. What they mean in practice is that the answer is individual: it depends on your insurance plan, what we're working on, and whether an intensive would genuinely add to your care rather than duplicate something your coverage already provides. So bring it up in session and I'll walk you through exactly what applies to your situation, including if the honest answer is "not this" or "not yet." Whatever we decide will be collaborative, documented, and decided by what's best for your care, and your weekly therapy with me never depends on your answer.
Your integration session is where our work together ends, unless you book again.
That's by design. An intensive is a defined piece of work with a beginning and an end, not the start of an ongoing therapy relationship. You'll leave with a clear sense of what moved and what's worth continuing to work on.
If you have a weekly therapist and a release on file, I'll loop them in on what we did and what I'd recommend going forward. That handoff is a big part of why I ask about ongoing therapy up front.
You're welcome to come back. A second intensive means fresh screening and a new agreement, because circumstances change and I want to be looking at where you actually are rather than where you were.
I honestly can’t provide you a guaranteed outcome. What I can tell you is what intensives are built to do: give deep work the time it actually needs. Some people come for one focused intensive; some do a series; some fold intensives into ongoing therapy. What you can expect from me is honesty at every step about what I'm seeing and what I'd recommend.
For most intensives, no, and that's about the work rather than hospitality. What we're doing needs the room to be yours.
Ketamine-assisted sessions are different, and it isn't optional: you'll need someone to drive you here and take you home. They don't have to wait on site, but they do need to be reachable the whole time and able to come back when I say you're ready. You'll name a backup as well. The medicine keeps working after we finish, and one of the things it works on is your sense of how you're doing.
If you're traveling in for a multi-day intensive, bringing someone along is a good idea regardless. Having a person on the other side of the door at the end of a hard day matters more than people expect.
Partially. Brainspotting and EMDR can both be done well via telehealth for clients in states where I’m licensed: VA, NC, and SC. Ketamine-assisted work is in person only at this time. In-person intensives happen in my Henrico, VA office.
Not at Room to Breathe. Intensives here are for adults, 18 and up.
I do have a long history with kids and families; I was a school counselor for twenty-plus years and I'm a Registered Play Therapist. That work continues at Back to You Counseling Services. If you're looking for support for a younger person, reach out and we'll figure out what makes sense.
For some clients, ketamine can help the nervous system access and process what's otherwise hard to reach. Here's how the roles work: all medical care, the screening, prescribing, dosing, and medical monitoring, is handled by Journey Clinical, a separate medical provider. My role is the therapy: preparing you, supporting you during the experience, and doing the integration work where the change actually takes hold. Ketamine sessions are 3 hour sessions, only with medical clearance, and only when it makes clinical sense. It's an option, never a default.
Usually not. Journey Clinical typically prescribes enough for one or two sessions to start, so they can see how you respond, and a full course tends to run six to eight or more. The sessions build on each other.
That doesn't mean committing to eight sessions on day one. It means we plan your course together, with your prescriber, so you know what you're stepping into and what it costs before you start. More on how that works on the ketamine page .
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Yes. Ketamine is an FDA-approved medication that licensed medical providers can prescribe off-label for mental health treatment, which is a legal and increasingly common practice. The medical piece stays entirely with the prescriber; the therapy stays with me.
Two broad approaches, and which one fits is a decision made together with the prescriber. Psycholytic dosing is a lower dose that softens the nervous system's defenses while you stay present and connected; we can talk and do therapy during the experience itself, which pairs beautifully with EMDR and Brainspotting. Deeper dosing is a fuller inward journey; the experience does more of its work internally, and the therapy happens in the preparation before and the integration after. All ketamine in my intensives is orally administered (a lozenge or troche) at this time, with dosing determined and medically overseen by Journey Clinical. Neither approach is better; they're different doors into the same work, and part of preparation is choosing yours.
No, and please don't wait for a consultation. Call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. Room to Breathe will still be here when you're through the acute moment.
Please either contact me via the contact me here form at the top of the page, or fill out this consultation form. We meet via Google Meet for 15 minutes, and figure out whether an intensive fits what you're carrying. That's the whole first step.