+ What is counseling (aka therapy), and how does it work?

If you’re considering counseling, you may be feeling anxious, agitated, restless, or worried; or you may feel sad, tired, unmotivated, or withdrawn. You’re probably distressed and in pain. You may even feel numb — like you’ve lost a sense of connection to yourself, to others, and/or to purpose in life. You may be engaging in negative, limiting self-talk, and hold beliefs about yourself that are hurtful and ultimately unhelpful. You may be thinking: “I’m not doing well,” or, “There’s something wrong with me,” or, “I’m just not where (or who) I thought I would be,” or “I’ve lost myself, or my voice, somehow.” Let me assure you — change is possible.

As a therapist, I help you work on the parts of life that are painful or feel intolerable. I listen for challenges and struggles and strengths and resources, and offer guidance for how to better manage. I help you to discover how your unique history may be influencing your life in the present and your desired future. I pay close attention to your thoughts, feelings, and behaviors, both as you describe them and as they arise in the moment with me. I work to help you gain insight and understanding, explore and learn from your emotional experience, understand and reduce behaviors that are hurtful to you, and strengthen your sense of self.

Some of my overarching goals in my work are to help you:

• Increase self-compassion, self-awareness, and insight
• Manage difficult emotions, including sadness, fear, numbness, disconnectedness, etc.
• Attend to body process and breathing (an important regulator of energy and emotions)
• Live in the present moment, in the here-and-now (rather than in the future or the past)
• Identify limiting and unhelpful self-talk, and core beliefs that keep this in place
• Tend to unfinished business that may be keeping you stuck
• Make meaning out of what happens (and what has happened, and what you want to happen) in your life
• Develop additional strategies for engaging in life
• Improve your relationships with yourself and with others

This takes work, but I believe you can do it! I’m passionate about joining women on their journeys, and have more than fifteen years of experience helping clients achieve growth. I know it’s somehow backward, but I believe that learning to be who you are is the path to change.

+ Is therapy right for me? What will I get out of it?

People seek counseling for many reasons, ranging from anxiety or depression to concerns with identity (spirituality, LGBTQ issues, self-acceptance), difficulty in relationships (family, parenting, friends, spouse, roommates, coworkers/boss), challenging life transitions (adolescence to adulthood, new job or relationship, becoming a parent), or outright crisis. Sometimes they’d like to work through a “problem,” and sometimes they’re looking for personal growth; either way they’d like to have some additional support. Therapy can help with all of these concerns.

In terms of what you can expect to get out of it, I strive to help clients increase awareness and self-compassion, gain skills for staying with and listening to difficult emotions (sadness, fear, anger), practice being in the present (as opposed to looking back or thinking ahead), improve relational skills, and make meaning of their lives.

Clients who’ve worked with me have reported that they understand themselves better, struggle less, and feel more at ease overall. They've learned to treat themselves with more kindness than criticism, and shift from self-destructive to life-giving behaviors. They’ve learned to handle their emotions more effectively (especially fear, anger, and sadness). They’ve learned to listen to their own voice — to know how they feel, what they like, and what they want. They've grown to feel more like themselves. They’ve learned to move forward with courage (even when scared), and to let themselves be seen. They've practiced creating and holding boundaries they set (like saying “No,” or “That doesn’t work for me.”). They've been able to tell the truth about their lives and the systems they’re in, and to not take responsibility for what isn’t theirs. They've found themselves healthier in relationships and in healthier relationships. They've come to appreciate their innate worth and to find contentment in the everyday ordinary.

+ How can I find the best therapist in Nashville for me?

There are lots of searches for “best therapist in Nashville” (and I suspect in most other cities), which makes me smile because there are so many best therapists in Nashville and other places! The thing is, the best therapist for you might not be the best therapist for your friend, your coworker, your spouse, your roommate, your parent, or your child. All therapists, like all people, are different, so a lot of what makes counseling “work” is finding a good fit for you. A significant part of what makes for a good fit in therapy is the relationship that you and your therapist establish together. If you feel connected to that therapist and hopeful about the work you are doing together, you’re more likely to have a good outcome.

Folks who have researched what makes counseling effective across a variety of therapeutic approaches note the following common factors that make for good outcomes:

• Empathy — Does the therapist demonstrate empathy? Do they come across as caring and warm? Do they show that they can understand why you feel the way you feel, and can they let themselves be impacted by you? Can they see things from your perspective? Do you feel emotionally connected to them? Do you believe they care about you?
• Alliance — Does the therapist participate in forming a strong alliance? Are you and they in agreement about therapy tasks and goals?
• Expectations — Do you believe therapy will be helpful to you? People who are more hopeful to begin with generally have more favorable outcomes. If you don’t feel hopeful, that’s okay. It’s a starting point. Let your therapist know so they can aim to help you to become more so. For example, they might provide education, explaining their rationale for treatment and describing how it can work.
• Cultural adaptation — Does your therapist take context into consideration? Is their approach adapted for you, the person in the room? Important indicators of this include language (e.g., pronouns), cultural congruence (e.g., acknowledging racism and white privilege), the ability to incorporate what is meaningful and makes sense to the client (e.g., spirituality).
• Therapist Effects — The more skillful therapists are able to form stronger alliances, possess a greater number of interpersonal skills that facilitate awareness/change, and — here’s a surprising one! — express more professional self-doubt (you might think this one is weird, but studies show that those who question themselves more and are not overly confident or certain about themselves are actually better therapists), and spend more time outside of therapy practicing therapy skills.

Sources include Wampold (2015) and Laska, Gurman, and Wampold (2014).

To find the best therapist for you, you may have to do a little research! Ask around for referrals from people you know. Read therapist profiles on Psychology Today and look at therapist websites. Call a few therapists, ask a couple of questions, and see how it feels to talk with them on the phone. And finally, meet with someone in person. If you know right off the bat it’s not a fit, you may want to choose someone else. Often that very first therapist can help you find a better fit if you’re able to ask for their help. If you’re more ambivalent than sure about fit, you might want to give it another session or two to see if you and the therapist can strengthen the alliance and move toward meaningful help.

I strongly believe you should feel comfortable with the counselor you choose, and hopeful about the counseling. When you feel this way, counseling is more likely to be helpful to you.

+ Are you the best therapist in Nashville for me?

Maybe! :) Check out my about page to read a little more about me.

I take a relational, holistic (mind-body-spirit), client-centered approach to therapy, and am not highly structured or formulaic. I've done a lot of training in Gestalt therapy, which informs a lot of my work. If you’re looking for something like CBT or DBT, then we’re probably not a great fit, and that’s okay!

I take a bit of a backwards approach to the whole process, believing that slow is fast and less is more, and that change comes by being most fully who you are. I offer my attention and care, and therapeutic skill. Together with clients I create an open space to explore and to experiment with thinking, feeling, and action. I offer tools for dealing with challenging emotions (sadness, fear, anger, guilt). I help clients learn to tend to body process and breathing, rather than all thoughts all the time, and also learn to live in the present here-and-now moment, rather than past or future. I offer concrete strategies for getting unstuck from toxic systems and people and thought processes. I help with self-compassion, self-understanding and systems-understanding, and relational skills. I listen with an open mind, reflect back honestly what I see and hear and think and feel, and aim to stay practical with ideas and doable actions.

I work best with clients who are willing to play an active role in their own process — showing up both in and out of sessions by being present and curious, willing to consider new ideas, sit with feelings, and practice new behaviors. My job is to help with these tasks.

+ How long after I start counseling will I start to feel better? How long will I need to come to therapy?

Clients often report feeling some measure of relief after a few sessions; some even after the first session. In general, though, it takes a few months for most folks to make sustainable change. An important thing to remember is that people can initially feel a little worse after they start counseling, but that doesn’t mean counseling isn’t “working.” Think about it — if you’ve been using strategies like avoidance or numbing to keep anxiety at bay, and then you stop avoiding or numbing, you might feel an increase in anxiety. My aim is to provide support to help you gain awareness and skills to tolerate that increase, and practices to help you gain more balance long-term.

As for how long you’ll come to therapy, there’s really not one answer to this question. I’ve had clients come for a couple of months to several years, sometimes with breaks or pauses, and everything in between. It’s often true that while we ourselves may change, the situations or contexts we are in may not, and it can be helpful to have an ongoing source of support over time. Additionally, many people are interested in ongoing personal growth and development, and choose to stay long-term.

+ What if therapy isn’t working?

One thing to keep in mind is that it can take some time to establish trust in the counseling relationship, gain awareness of issues and contributing factors (both internal and external), and explore and engage in ideas and behaviors that might help. Before determining it’s not working, I’d recommend committing to 4 - 6 sessions within 1 - 2 months. I’ve had many, many people say over the years, “I tried that [fill in the blank with what the ‘that’ is — meditation, form of exercise, setting a boundary, etc.] once, and it didn’t work.” And they literally mean once. If you set out to run a 5k, and you’re starting from a mostly sedentary lifestyle, you’re probably not going to be able to run a 5k the first time you try. That doesn’t mean your body isn’t working, or that your efforts won’t build strength and confer benefits over time. You’ll most likely have to build up gradually. As is true of all forms of growth and learning, therapy is a practice that builds upon itself.

Of course there are times when despite everyone’s best efforts, clients aren’t moving toward their desired outcomes in therapy. Reasons for this are many. There could be a poor fit between therapist and client. There could be a lack of skill or or knowledge or effort on the part of the therapist. There could be a lack of skill or knowledge or effort on the part of the client. There could be extenuating, external circumstances that contribute to a block. Whatever the case may be, the best thing to do is to have an honest, open conversation about what isn’t working. Even having this conversation can strengthen the relational dynamic between therapist and client, who then may be able to regroup and adjust the approach so that it fits better. Or, it can lead to a shift toward referrals for other resources and providers who may be able to assist.

+ Are you open and affirming of the LGBTQIA community?

This is an absolute, unequivocal yes.

I’m a cisgender female ally (pronouns she / her / hers) who wants to put something positive into the world, in part as an undoing of some of the tradition in which I was raised. I grew up in evangelical Christianity, where among other things I learned (mostly indirectly) that to be anything other than a straight white male was to be less than. I learned not to trust my heart or my voice or my wants — not too much anyway — because they’d surely lead me astray. This isn’t the whole story, of course. I was part of liberal evangelical churches in those years, and remember with fondness many caring people who wanted most of all to communicate love and kindness and goodness, and to encourage me. Usually, for me, they did. I thought for a long time I’d be a minister of some sort, so after college I went to seminary and got a degree in theology. Mostly what I learned there was to think critically and to pay attention to how our contexts shape our beliefs, to appreciate and listen to and learn from people who are different from me, and to see beauty in the everyday ordinary. My journey has led me to distance from most institutional religion, but I carry with me to this day themes like, “You are loved,” “Love yourself,” “Love your neighbor,” “Be generous with what you have,” “Stand up for the oppressed,” and the like. These strengthen my desire to give back to those who have been hurt by the church — to speak truth to power, to stand with open arms and declare all people worthy of love and belonging and welcome.

Over the years it has been my privilege to sit with folks across the spectrum of gender identity and sexuality, often at the intersection of religion and/or family.

+ Do you only provide counseling for women?

A huge part of my initial and ongoing interest in being a counselor has to do with my want to highlight women’s voices. You may have heard about studies showing that girls start to lose their confidence, their voice, and their trust in themselves as early as elementary school. They don’t get called on as much. They’re told they’re too sensitive. They’re praised for tending to others’ needs. For those with overlapping identities — including race, class, ethnicity, sexuality, age, and religion — these kinds of oppressive and discriminatory experiences are even more prevalent and persistent. All of this can contribute to struggles with confidence, to self-doubt, to a highly critical inner voice, and to ongoing frustration and rage about toxic systems and environments. In my work I am passionate about centering women — listening to their stories, affirming their experiences, and honoring their role(s) within — and about providing support for those who seek to care for themselves and others amidst toxic systems and to break out of those systems where and when possible.

That said, I do see men in my work, and strive to be aware of the ways in which culture shapes them as well. Often, the men that I see have been told they're "too sensitive" or "too nice" and have felt unsupported in their emotional world.

+ Is your last name really Hope?

Yes it is, intentionally so. It’s not a name I was born with or married into or was given by anyone, but one I chose for myself following a period of significant upheaval in my life. I believe names can confer meaning and identity, and so I chose the name Hope as a reminder of who I am.

+ Where in Nashville is your office located?

My office is at 1410 17th Ave S. Nashville, TN 37212. It is centrally located on Music Row for people in Nashville, TN and Brentwood, TN. My office is walkable from the Vanderbilt University campus and the Belmont University campus, though of course many students use ridesharing services.

+ Do you offer online counseling in Tennessee?

Yes! I can provide online counseling (historically called telehealth) to clients who reside anywhere in the state of Tennessee. I’ve done this regularly since 2019 for clients who used to live in Nashville but moved somewhere else in the state, as well as occasionally for those who weren’t able to make it to their in-person session due to car trouble or a mild sickness. Of course since COVID-19 emerged in 2020, I’ve had much more experience doing therapy online. It’s not exactly the same as in-person therapy — neither the client nor the therapist has as clear of a read from tone of voice, body language, or facial expression, for example — but research has consistently demonstrated it to be effective for many of the concerns that bring people to therapy. In particular, there’s evidence that suggests it is helpful with stress, anxiety, and depression. And, it is often a more accessible option for those who’d like to save travel time, for those who live in rural areas, and for those for who struggle with social anxiety.

+ What are your hours? Do you have evening or weekend appointments?

I see clients both in person in my office in Nashville, TN, and online, Monday through Thursday, from 8am until 4pm. I do not have evening or weekend appointments.

+ How much does counseling cost?

My rate for each 50-minute professional counseling session is $175. My rate reflects my dedication, training, and experience within the field of therapy. I bring to the table over 15 years of direct therapy service, and along with that a high level of knowledge and skills. I am an avid learner, and am intentional about my continued professional growth. I have a limited number of spaces available at a reduced rate for those with financial constraints. From both personal and professional experience, I believe counseling is an excellent investment in your well-being.

+ Can I use my health insurance?

I am no longer an in-network provider with any insurance company. However, many plans will consider me an “out-of-network provider” and will cover a portion of our work together after you have met a deductible. Once the deductible is met, you may receive a reimbursement for a percentage of what your insurance company determines to be an acceptable fee, which may differ from actual cost. I will be happy to supply you with an invoice for services with the standard diagnostic and procedure codes for billing purposes, the times we met, applicable charges, and payments made. You can use this to apply for reimbursement.

If you would like to investigate the possibility of reimbursement for out-of-network coverage, please check your policy carefully and then contact your insurance provider. I can supply you with a list of questions that may be helpful to ask your insurance provider, should you request this.

+ Why would I or could I not use my insurance for therapy?

Because insurance companies only cover care that is "medically necessary," i.e. that which has a recognized mental health diagnosis attached, insurance does not cover the full range of concerns people bring to counseling. People seek counseling for many reasons, ranging from diagnosable depression or anxiety to concerns with identity (spirituality, LGBT issues, self-acceptance) or phase of life (transition to a new job or relationship, parenting, occupation).

Many clients choose not to use insurance because they do not want their counseling to be limited by diagnoses, treatment plans, type of therapy, or session limits as dictated by insurance companies. Many clients are also concerned about privacy. In order to obtain reimbursement, the insurance company has to know personal information about you and can review your records at their discretion. Mental health diagnoses, once submitted, become a part of your permanent health care record, and could potentially lead to limitations later on, such as denial for quality life insurance or health insurance. You are encouraged to contact your insurance company if you have any questions about what records they may or may not request and what implications they may have for your future health care needs.