Typically, I start with a brief introduction of myself, my educational background, and the limits of confidentiality. Then, I ask about your safety and whether you have had any self-harming thoughts. I do this with every client. Next, I “throw the ball back to you” and ask you to expand on what you have been struggling with and what you would like to work on. I will likely ask questions about your current symptoms and end with setting goals that we can work on together.

I offer both in person and virtual sessions. My office is located at 108 SE 124th Ave. Suite #20, Vancouver, WA 98684. For virtual sessions, all you need is access to internet and a private location. A therapy link is emailed or texted to you prior to the session and you can use your phone or a computer to log into the session. In addition, for virtual sessions, clients must be located in either Oregon or Washington, since I am only licensed in those two states.

As a client, you must be located in either Oregon or Washington since I am licensed in those two states. In addition, you need to be in a private space so that you can have confidentiality.

Please let me know if you will not be in Oregon or Washington. Unfortunately, I cannot see you if you are not located in one of those two states and we will have to postpone our sessions until you are back in Oregon or Washington.

As a therapist, I make it a rule to not initiate contact with any clients that I see in the “real world.” This is to protect your confidentiality. If you feel comfortable approaching me, you may. I recommend that we keep greetings short so that deep or vulnerable content does not get shared outside of the confidential therapy room.

You can reach out to me after hours either via phone, email, or through the secure messaging platform in the client portal. However, I am a firm believer in work-life balance and try to not look at my work email or phone when I log off for the day or for the weekend. I tend to get back to clients within 24 hours on weekdays and between 48 to 72 hours after weekends, holidays, or a vacation. If it is an emergency and you need a quick response, call your local county crisis number, dial 911, or go to your local emergency room. Some emergency numbers include:

  • National Suicide Prevention Lifeline: 800-273-8255
  • Multnomah County Crisis Line: 503-988-4888
  • Washington County  Crisis Line: 503-291-9111
  • Clark County Crisis Line: 800-626-8137

Generally speaking, no. Therapy is a confidential space, which is what makes it so unique. However, during certain scenarios (e.g., if we hear that you will harm yourself or someone else, if you authorize us to talk to another person/organization, with insurance companies if you want us to help with billing), then we may share your information with someone else. Most therapists will attempt to talk to you first before breaking confidentiality because we know how important it is to have a safe space.


In-network providers have an agreement with your insurance company to provide services to insured members (you) at a discounted rate. Typically, if you look at your insurance plan benefits, there is a deductible you may have to reach first and then a co-pay/co-insurance you have for every visit.

In contrast, out-of-network providers do not have an agreement with your insurance company. Look at your insurance plan or call your insurance provider to see if you have out-of-network benefits. Some plans do, some plans don’t. An out-of-network provider will usually cost more out-of-pocket than an in-network provider. Typically, there is a separate out-of-network deductible that you have to reach before insurance may cover some of the cost. Please note, some insurance companies do not cover out-of-network services and as a result, you as the client would be responsible for all costs incurred. Still have questions? Call the number on the back of your insurance card and they can help explain your benefits to you.

A superbill is a document that allows clients to bill their insurance company directly after having paid the therapist for services out-of-pocket. It includes information such as the date of the service provided, procedure codes and a total balance paid. Once you as the client pay your fees, you are provided with a superbill that you can then submit to your insurance company. You can then use the superbill to try to get reimbursed for the session by your insurance company. However, this depends on if your plan offers out-of-network benefits.

Cash, checks (made out to “Izmirian Counseling, PC”), or credit card (HSA/FSAs accepted as well).

I have a 24-hour cancellation policy. Please remember to cancel or reschedule 24 hours in advance. Since your appointment time has been reserved for you and cannot be filled by another client without sufficient notice, you will be charged for missed appointments unless you provide 24-hours notice that you will miss the session. Appointments canceled with less than 24-hours notice will be billed to you at a rate of half the session fee. If you no-show your appointment, you will be charged the full fee for the session since that time has been reserved for you. Insurance companies will not pay for missed sessions or for the portion of a session for which you are not present because you are late. This means that you will be responsible for the full session fee or for the portion of the session that your insurance will not reimburse because you were late. Since the cancellation policy applies regardless of the reason for your absence, please call me or email me as soon as you know that you will be unable to attend.