In order to move on, you must understand 

why you felt what you did 

and why you no longer need to feel it.  

--Mitch Albom

Counseling is a therapeutic process that focuses on helping individuals, couples, and families understand and resolve problems, modify behavior, and make positive changes in their lives. 

Counseling is instrumental in helping individuals reconcile with the unique challenges they face, how those challenges impact themselves and others, and what they can do to improve the situation and prevent future problems.  This typically involves addressing and reducing symptoms of underlying mental health issues, working with and through challenging emotions, healing from historical trauma and working to prevent future harm, and gaining ongoing support with specific challenges and life transitions, all while building and strengthening habits and routines that support personal wellbeing and healthy connections with others.  

Counseling provides a safe and confidential environment to discuss and explore feelings, beliefs, or behaviors, work through challenging experiences, and better understand ourselves and others. 

Note that at this time, the only insurance I accept is Oregon Health Plan Medicaid for Central Oregon--PacificSource Community Solutions.  For all other insurance companies I am an Out-of-Network provider.  I can provide clients with a Superbill which they can submit to their insurance companies for potential reimbursement.  

The Therapeutic Process

If you're interested in counseling, check out the different therapeutic approaches and settings below.  We'll discuss these options during our New Client appointment.  After this conversation and a thorough review of your client paperwork, I will create a plan for the therapeutic services that may be beneficial at this time, and include that information in a Service Proposal.  You'll have the opportunity to review this proposal, and let me know if it works or not.  If not, we work together to modify it until it outlines a course of action that we can agree upon.  Once the Service Proposal is approved, it is called the Service Plan. The Service Plan will be utilized to guide our work together.  Since it is a working document, it is expected to evolve, by mutual consent, with the changing needs of everyone involved.  

Therapeutic Approaches

Clients typically use counseling to address their most challenging issues.  The most difficult ones include:

Counseling professionals have developed therapeutic approaches and techniques to assist with these types of issues.  Counselors are ethically required to complete training in the approaches and techniques that they utilize with clients.  

All therapeutic approaches and therapeutic techniques utilized at COEXISTUS are evidenced based approaches.  This means that research continually demonstrates effectiveness in their application for specific issues or with certain populations.  Most therapeutic approaches utilized at COEXISTUS are considered transdiagnostic or helpful for most clients regardless of the issue they face or diagnosis they may have.  Since I'm able to utilize a wide variety of therapeutic approaches, and often people have multiple issues or concerns that do not fit neatly in one diagnostic category or another, these counseling services are considered to be integrative (combining separate approaches) and eclectic in nature (selectively using techniques from different approaches to more effectively meet you needs at this time).  I also offer various formalized interventions designed to assist with specific issues that require us to follow prescribed processes as directed by the creators of the intervention in effort to achieve maximum benefit.   

These approaches tend to place value on the importance of thoughts and cognitive patterns in influencing feelings and behaviors AND the importance of learning to be more present focused and aware of how our minds and bodies are functioning moment by moment.  All of us are a bit "bruised" by challenges in the past and most of us have had some type of traumatic history that may continue to negatively influence us today.  

Regardless of the approach, a systems perspective can help increase stability, safety, and security both individually and in the entire system.  A higher functioning system increases the likelihood that its members will get their needs met and thrive.  Higher functioning members are better able to work together as allies not adversaries, increasing their capacity to deal constructively with difficult life challenges and major life transitions. 

Descriptions of Approaches

General Terms / Brief Descriptions

This section contains a brief overview of general terms and concepts that apply to all therapeutic approaches utilized at COEXISTUS.

Transdiagnostic:  The theory or approach has been found to be helpful for most clients independent of diagnoses.

Integrative:  Different theories or approaches are woven together and utilized as appropriate. 

Eclectic:  Various approaches and technique are selectively applied in order to best meet client needs.

Attachment Informed:  Research has revealed that family of origin and interpersonal dynamics significantly impact our health and wellbeing throughout life.  There are distinct patterns of functioning in interpersonal relationships--secure, insecure avoidant, and insecure anxious. There are significant benefits to intentionally creating more secure relationships whenever possible.

Trauma Informed:  Trauma research indicates that trauma is more common, pervasive, and detrimental than what was previously understood; we have new insights on how trauma negatively affects us personally, interpersonally and as a society; and best practices have been developed to improve caretaking, medical and mental health services.   

Neuroscience Informed:  New knowledge of how the brain and nervous system function reveal the importance of working with our bodies instead of against them for healing, personal development, and enhanced connections with others.  Nervous system dysregulation seems to be a common factor in chronic personal and interpersonal problems.  It's apparent that we all can benefit from learning how to utilize mind and body integration to better self-regulate and co-regulate with others in order to improve our level of functioning and how we impact each other.     

Strength Based:  It is often more helpful to notice and build strengths rather than focusing on reducing/eliminating deficits, spend resources on solution building rather than problem solving, talk about what you want instead of what you don't want, and focus on building a rich and full life instead of just avoiding or trying not to do things. 

Wellness Based:  Wellness encompasses 8 mutually interdependent dimensions:  physical, intellectual, emotional, social, spiritual (or meaning making), vocational, financial, and environmental.  Neglect of any one dimension over time will adversely affect the others ultimately leading to decline in health, well-being, relationships, and quality of life.  

Systems BasedWe are all members of different interconnected groups of people.  Each group develops and refines processes that work to serve individual and group interests, needs and objectives.  How well individual members function influences the system's functioning, just as the group's level of functioning impacts both its members and other groups.  Recognizing our interdependence with others helps us become more aware of our impact on the systems that shape and support long-term patterns of behavior.  By understanding and changing the processes that are not working well for the individual members or the system as a whole, we can expand the choices available to us and create long-term solutions to chronic problems in the interest of leading healthier, happier lives.  


Brief Descriptions of Specific Interventions and Techniques

This section contains a brief description of the main theoretical approaches, models, and interventions utilized at COEXISTUS.    

Stages of Change Model:  A model that describes a person's readiness to change and outlines a change process that is common for anyone making any kind of change or modifying any problematic behavior.  Also called the Transtheoretical Model (TTM).  

Motivational Interviewing (MI) is an approach designed to help clients resolve ambivalent feelings and insecurities to find the internal motivation needed to change problematic behavior or work towards meeting a goal.  Ambivalence is a state of having conflicting feelings toward something, feeling torn between two or more options or opinions, or feeling uncertain or indecisive about something.  

Maslow's Hierarchy of Needs:  a model of understanding motivation and personal development presented as a pyramid, outlines five levels of human needs: physiological, safety, love/belonging, esteem, and self-actualization. Maslow proposed that these needs must be satisfied sequentially, starting from the base.  Basic levels of functioning are characterized by struggling to meet the needs on at the bottom of the pyramid, while higher levels of function are characterized by having the bottom level needs met on a consistent and reliable basis, which frees people up to pursue the higher level needs.  

Non-Violent Communication (NVC):  a system of interpersonal communication that fosters empathetic connection,  understanding, and conflict resolution; also called Compassionate Communication.

Erikson's Psycho-Social Development Theory:  A framework for understanding individual struggles and growth across different stages of life which can foster insight for caregiving as well as self-awareness and self-compassion enabling clients to explore and resolve conflicts related to identity, relationships, and life transitions.

Chickering's Theory of Identify Development:  a framework that describes the various stages individuals go through in their journey of personal growth and development.  This theory highlights the importance of experiencing and adapting to various life challenges and transitions.  Identity formation is influenced by personal and environmental factors and is viewed as a lifelong process--individuals evolve and refine their sense of self throughout their lives.   

Transition Theories:  different theories that provide frameworks for understanding and navigating through life transitions.  Transitions are viewed a normal part of life and individuals can experience a range of emotions, challenges, and vulnerabilities during these periods of change.  Understanding typical transition contexts, components, and opportunities can help individuals better cope with transitions and find meaning and growth amidst the challenges.  

Problem Solving Therapy (PST):  an approach designed to reframe problems; to enhance coping skills for minor stressors, chronic daily problems, and traumatic events; and to practice more effective problem solving strategies.  

Dialectical Behavioral Therapy (DBT):  a skills-based intervention that includes mindfulness, interpersonal effectiveness, emotional regulation and distress tolerance to replace harmful, self-defeating behavior with skillful behavior and living in a more mindful manner.

Acceptance and Commitment Therapy (ACT):  an approach that utilizes acceptance as a way to deal with negative thoughts, feelings, symptoms, or circumstances while encouraging increased commitment to a lifestyle of healthy and constructive activities that uphold client's values and and is more consistent with client's stated goals.   

Emotion Efficacy Therapy:  an 8 session structured intervention combining ACT and DBT designed to help clients more effectively experience difficult emotions, recover more quickly from being emotionally dysregulated, break out of patterns of responding that are maladaptive, and express what they value especially when distressed.  

Unified Protocol (UP):  a structured 16 session protocol for the transdiagnostic treatment of the wide range of emotional disorders (not just anxiety and depression) that drive unwanted behaviors like emotional blow-ups or melt-downs, aggression, avoidance, isolation, self-sabotage, eating issues, addictive behaviors, etc.--designed to help clients confront, experience, and regulate challenging emotional states.

Narrative Therapy: an approach that builds awareness of the stories we naturally tell ourselves and others, take a closer look at them, critically analyze them and rewrite them into more accurate or helpful stories.  

Relational-Cultural Therapy:  an approach that focuses on building insight and awareness of a client's relational images--positive or negative expectations created by past relationships that in turn influence present and future relationships.  Negative relational images often fuel fear, misunderstanding, disconnection, isolation, conflict, polarization, discrimination, abuse/aggression/violence, bias, abuse of power, assumed privileges and social injustice (sexism, racism, classism, homophobia, mysogyny, ageism, ableism, etc.).   

Cognitive Processing Therapy (CPT):  a highly structured 12 session intervention proven to modify unhelpful thinking patterns about challenging experiences and traumatic events and how they impact our beliefs about ourselves, others and the world.

4 Blinks Version of Flash:  a brief, structured rapid memory reconsolidation technique that has been shown to effectively take the charge out of troubling or traumatic memories.  

Safe and Sound Protocol:  A brief, structured, 10 hour somatic intervention which is the application of the Polyvagal Theory of Nervous System Regulation, Social Engagement and the Science of Safety.    

Written Exposure Therapy (WET):  A brief, structured, 5 session narrative intervention, created to assist in processing and reconciling with traumatic experiences. 

Interpersonal Neurobiology (IPNB):  an approach combining attachment, narrative therapy and neuroscience to improve understanding of personal and interpersonal functioning.  

Somatic Therapy:  a body centered therapy that utilizes mental and physical activities to release pent-up tension in the body that negatively impacts emotional and physical wellbeing.  Techniques include meditation, mindfulness exercises, breathing activities, stretching/yoga, tapping, shaking, physical movements/exercises, walking, etc. 

Solution Focused Brief Therapy (SFBT):  a brief approach that helps clients move from being stuck in problems/deficits to recognizing their own strengths and resources so that they are internally motivated and have the confidence to find their own solutions that aid in working toward their preferred future.    

Solution Focused Narrative Therapy (SFNT):  an approach combining Solution Focused Brief Therapy and Narrative Therapy to help clients recognize and examine their current stories about self, others, and the world while building upon their strengths and abilities to envision and craft preferred outcomes.  

Cognitive Behavioral Therapy (CBT):  a therapeutic approach that helps clients manage symptoms/problems by identifying and changing unhelpful patterns of thoughts and behavior. 

Cognitive Behavioral Therapy & Exposure and Response Prevention (CBT-ERP):  an approach to assist clients with discomfort, avoidance, automatic thoughts, preoccupation, obsessions, worry, anticipatory anxiety, avoidance, compulsions, impulses, addictions, urges to abuse substances/self/others with the goal of retraining response patterns to achieve more helpful outcomes. 

Rational Emotive Behavioral Therapy (REBT):  an approach that builds awareness of and agency over our own irrational thinking patterns that cause us to experience the disturbing emotions and behaviors which negatively impact ourselves and others.     

Schema Therapy:  an approach that involves identifying life-long unhelpful patterns of thinking and behaving (called schemas) that act like a filters through which all thoughts, feelings, behaviors, experiences and situations are viewed, distorting our perceptions, resulting in mental health conditions, poor relationships and overall instability until clients intentionally engage in work to deliberately modify them.   

Cognitive Behavioral Therapy for Impulse Control Disorders (CBT-ICD):  a structured intervention program of at least 8 sessions designed to assist clients who have difficulties resisting urges to engage in behaviors that are excessive or ultimately harmful to oneself or others.  

Overcoming ADHD:  a structured 12 session cognitive behavioral approach to help people with ADHD become their own coach and learn their own accommodations (changes to the environment/processes) and compensatory skills (life-hacks) in order to improve their level of functioning and set themselves up for reaching more goals.  

Parent-Teen Therapy for Executive Functioning Deficits and ADHD:  a structured intervention program of at least 15 sessions to assist teens with attention, executive function, and motivation deficits and to support the parents in overcoming negative parenting patterns and enriching their relationship with their teen.  

Attachment Narrative Therapy (ANT):  a model that applies narrative therapy to relationship and family dynamics.  

Emotionally Focused Therapy for Individuals, Couples and Families:  an approach that uses emotional connection to interrupt dysfunctional patterns of interaction in order to have repair experiences that strengthen attachment bonds.  

Family Systems Trauma/Stress Model:  A structured system based intervention (for co-parent systems or family units who can and want to work together directly) intended to systematically guide the family through a process to address trauma/stressors and work together to overcome hardships for the benefit of everyone involved.

Child Focused Therapy (CFT) for Separated Families:  an intervention for high conflict divorced/separated parents designed to address issues causing the child stress and anxiety and generate solutions that provide both accountability and relief to all members of the child's family system.  

Family System Therapy for Parent Child Contact Problems (FST-PCCP):  a time-limited therapeutic intervention for high conflict co-parents whose children are resisting or refusing contact with one parent.  The aim is to address and neutralize safety issues and concerns while gradually introducing levels of contact so that repairs can be made and a relationship can be enhanced.  Both parents are involved (most often separately) throughout the duration of this therapy.    

Integrative Attachment Family Therapy:  a structured, relatively brief intervention designed to help heal and strengthen the parent-child relationship through positive interactions, co-regulation, exploration, awareness building, reparative experiences, and meaning making aimed at building secure attachment relationships.  This intervention focuses on one parent-child relationship at a time and involves a combination of individual meetings with the parent as well as parent-child sessions.  

Discernment Counseling:  a structured intervention to assist couples who are contemplating divorce/separation to build awareness of both partners' interests and concerns, to clarify what if anything needs to happen in order to stay together, and to determine if they are willing to delay divorce/separation for a specific period of time to allow parents to participate in services and demonstrate that agreed upon changes have occurred, and to reassess at a later date whether or not to divorce/separate.

Solution Focused Systemic Therapy with Couples and Families:  an approach combining Solution Focused Brief Therapy and Systemic Therapy to help apply systems thinking to the solution focused approach.  

Supportive Parenting for Anxious Childhood Emotions (SPACE):  a structured intervention for parents to assist with child related anxiety (especially be helpful for resist/refusal dynamics in co-parenting systems).  

Alternatives for Families CBT (AF-CBT):  an extensive therapeutic intervention with a prescribed number of sessions that focuses on repairing a parent-child relationship following parental use of abuse. 

Options in Therapeutic Settings 

Most services are conducted remotely via teletherapy. Session format depends upon where clients are located, current levels of hostility between clients, and general safety considerations.

Telehealth Therapy

Telehealth is counseling that is provided remotely via a secure video platform.  This format allows you the convenience of being in the comfort and privacy of your own home while in session.  This format is utilized for individual, couple, co-parent, and family sessions.  Whether people are together or on separate computers depends upon where they are located, safety considerations, and current levels of hostility.  

Group Therapy

This format allows participants to learn alongside and from others who are going through similar challenges and life transitions.  People from the same family system do not attend the same groups.  

Walk and Talk Therapy

There is a growing interest in counseling sessions being held outdoors.  The format allows you to get some light physical activity, fresh air and sunlight, all while immersed in the healing power of nature during your session.  This format is utilized for individuals and two-party sessions only.  


There is a growing evidence for the effectiveness of multiple sessions occurring during a weekend or throughout each week rather than the traditional once-a-week frequencyThis format allows clients to do in-depth, concentrated work, more rapidly.  This format is utilized for individual, couple, co-parent, and family sessions and can occur different combinations of remote and in person sessions. 

If you would like to learn more about our counseling services, please schedule the free initial consultation by clicking on the button "Contact Coexistus" below in order to help you determine whether or not you would like to become a counseling client with Coexistus LLC.    

Would you like to schedule an individual, 

free 20 minute initial consultation

Great!  Click the "Contact COEXISTUS" button below.  It will take you to the Contact COEXISTUS page on this website and fill out the Service Inquiry form.  This tells me why you're seeking services at this time and when you're available for an individual, free 20 minute initial phone/video consultation.  

 Existing Counseling Clients can use the link below to access the counseling client portal.  

Trauma in a person decontextualized over time can look like personality, trauma in a family decontextualized over time can look like family traits, trauma decontextualized in a people over time can look like culture.

Resmaa Menakem