Frequently Asked Questions

Why Therapy?

People seek therapy for all kinds of different reasons, among them issues with anxiety, perfectionism, low self-esteem, negative body image, disordered eating and binge eating, trauma and post-traumatic stress, relationship issues and life transitions. I believe we reach out for help when our distress is overwhelming our ability to cope with that distress, and we are looking for relief and support.

Therapy can be many things—it can be a way to teach valuable coping and self-care skills; a medium through which to process difficult emotions and learn more about ourselves and others; a means by which we can take away some of the power negative thought and behavior patterns can hold over us. At its core, therapy involves a unique type of relationship between therapist and client—one that is supportive, collaborative, affirming and healing.

What can I expect from therapy?

This is such a great question, albeit a tough one to answer! I probably can’t list all of the things you can expect, but I’ll try to give you a general idea, knowing that the answer to this question depends on a lot of things—including you. 

If you’re struggling with disordered eating and body image, I hope to help you turn down the noise in your head around food and exercise, and help you reduce reactionary eating and restricting so you can learn to eat more intuitively—the way I believe we are meant to eat (and all ate at one point!) with more joy and satiation and less guilt. I also hope you feel more neutral and accepting of (if not more positive about) your body as it currently is. The goal isn’t always to love how we look, but to cultivate our abilities to lead full, fulfilling, juicy lives regardless of how we look. Interestingly, honing in on and expressing your needs and desires in relation to food usually translates to an increased ability to express your needs and desire in other areas of your life, too.

If we’re working on anxiety and perfectionism, you’ll end up with more tools and skills to help you manage your anxiety and challenge the black-and-white thinking so common to perfectionistic tendencies. I hope you’ll also find greater self-compassion and an increased capacity for flexibility in everyday life.

If we’re working on adoption and identity-related concerns, I hope you find new ways to understand your story, and how you’ve come to be the way you are. You may also find a greater understanding of yourself in relationship to others, and if your relationships haven’t looked the way you’d like them to—I hope you find an increased ability to seek and create the kinds of relationships you want in your life.

While some of the therapeutic process may be uncomfortable at times—feeling our feelings isn’t always fun—you can also expect a good amount of laughter and celebration of victories, too. I think that is just as important as leaning into the harder stuff.

What are you like, as a therapist?

Warm, kind, funny, nonjudgmental, curious, humble, maybe a little irreverent—these are ways in which I’ve been described by others and ways in which I’d describe myself, too. I also identify as highly sensitive and social-justice oriented—my work is political because it has to be, and it’s important to me to acknowledge that. I’m committed to my own growth, personally and professionally, as well as committed to the ongoing practice of anti-racist learning and unlearning. And, I am so glad to be a therapist—it isn’t easy work, but it’s absolutely an honor and a privilege to be doing it.

I tend to be the best fit for clients who are also motivated, thoughtful, introspective, interested in personal growth, and most of all, willing to put in the work. I want meaningful change for you, but that isn't enough—you have to want it, too. And if you do, I’d love to support you in making those changes a reality.

How long does therapy take?

The answer to this depends on a few things: namely your presenting concerns and your goals It can also depend on your diagnosis (if you receive one for insurance-related reasons), your motivation for treatment, and your desire for ongoing support. As mentioned in my ‘services’ section, I can individualize my therapy based on your needs and goals, meaning I can offer both short and long-term therapy. At minimum, you could expect we might work together for just a few months; at length, we might continue as long as you find therapy helpful. This is something we’ll discuss in our first few sessions together, and also something we can check in on and refine over time.

What does ‘Health at Every Size’ mean?

Great question! ‘Health at Every Size’ (or HAES) is an approach and a growing movement which is based on the belief that everyone, at every size, is capable of pursuing health-related behaviors if they wish to, irrespective of weight loss. Let me say that again, because it’s so important—the HAES approach does not require, recommend or encourage weight loss for the pursuit of health. It recognizes that diets do not work and that attempts to lose weight almost always perpetuate weight cycling (rapid weight loss and weight gain) and disordered eating, and ultimately cause more harm than they do good. The HAES approach also embraces the concept of body diversity—the simple fact that there are many, many kinds of bodies in this world, as there always have been and always will be—and that all bodies are good bodies, worthy and fully deserving of respect.

Embracing this approach doesn’t negate the fact that our society is unfortunately steeped in diet culture, weight stigma and fatphobia—but it aims to help people, particularly those living in bodies and identities that are marginalized, externalize society’s problematic beliefs, and hopefully begin to believe they deserve better. Your body is not the problem—it never was. Society is the problem. Our capitalist culture, and the way it places more importance on making money than telling the truth, is the problem. Racism, White supremacy, ableism, sexism, homophobia, transphobia, ageism—these are the problems. Your body is just fine as it is—and if you have trouble believing and accepting this, as many people do, therapy can help.

Health-related behaviors, mentioned earlier, are exactly what they sound like—behaviors and practices designed to improve health (including physical, mental, emotional, spiritual, financial, etc.—since we know that all of realms of health are interconnected and have influence over each other). Health-related behaviors could include (but are absolutely not limited to): engaging in joyful movement, resting, getting adequate sleep, eating enough food, eating food that is satisfying and nourishing, going to therapy, meditating, building a self-care practice, taking a sick day, seeking regular medical care, starting a savings account—and many, many others. 

This approach can be life-changing and deeply affirming, and to be perfectly honest, as a social worker—a clinician whose education and training are deeply rooted in social justice—I think it’s unethical not to practice this way. As you can probably tell, I am deeply passionate on this subject, and absolutely love helping people learn about and embrace the Health at Every Size approach! If you’d like to learn more, please get in touch with me. I also include a list of resources and further reading on my website, too.

Tell me more about your commitment to social justice.

Absolutely. I try to make this commitment in a few different ways. First of all, ensuring that I’m doing my own work to unlearn and learn and educate myself, since that is my own job to do—this includes reading, taking Continuing Education courses and listening to podcasts on a variety of topics including social justice, racism and colorism, sexism, ageism and ableism, sizeism and anti-fat bias, and others. It also includes acknowledging my own privileges and ways in which I have benefited and continue to benefit from them.

Second, the financial piece. I keep a few low-fee spots in my practice in general, and in particular for clients who are Black and Indigenous People of Color; you can always expect those from me regardless of your income or level of need. I make regular donations to organizations that aim to uphold those with marginalized identities—some recent examples include Black Lives Matter PACs, the Trevor Project, the Loveland Foundation, First Nations Development, Together We Rise.

I’m not perfect and this is an ongoing commitment and practice for me, as I personally believe it should be for everyone with the privileges I hold.

At its core, therapy involves a unique type of relationship between therapist and client—one that is supportive, collaborative, affirming and healing.

What is Intuitive Eating?

Intuitive Eating is a way of eating that relies on the intuition we all had as children—intuition that has become repressed by years of living with diet culture, disordered eating and diet-related trauma. Developed in 1995 by two dieticians, Evelyn Tribole and Elyse Resch, Intuitive Eating involves intuitively making food choices based on what feels good to us, emotionally and physically. The approach is weight-neutral and teaches us to become more aware of our body and mind and their needs—since we have often lost touch with these needs over the years.The official Intuitive Eating approach is based on 10 principles, which are outlined on Evelyn and Elyse’s website as well as in the workbook. The last principle and end of the book does include more of a focus on health, so I’d like to mention that you can absolutely skip this part if you don’t feel it applies to you. You are not morally obligated to pursue health if it’s not within your personal value system, and I think you can practice Intuitive Eating without placing a heavy focus on pursuing health.

What isn’t Intuitive Eating?

It isn’t the Hunger and Fullness Diet, or any other diet or food plan. It is not a method of controlling weight or body size. Period. Full stop. It is also not something you can ‘fail’ or ‘get wrong’, since you are the expert on what feels good to your body and mind.

Do you take insurance?

No, I do not. I am considered an ‘out-of-network provider’, which means I am not paneled with any insurance companies. Insurance companies typically require a diagnosis to be made in order to reimburse a client for services—a diagnosis which becomes part of your permanent health record—and they can also influence things like length of treatment and type of therapy provided to a client. I personally feel these decisions should rest in the hands of the client and therapist—not an insurance company.That said, if you have out-of-network benefits as part of your health insurance plan, you may be able to get a significant portion of your session fees reimbursed by your insurance company (I cannot guarantee this, of course). It is up to you to determine your health insurance coverage on your own, and you will also need to submit documentation on your own as well, though I can provide that documentation in the form of a superbill for you to submit. I’m happy to discuss this if you have any questions about it.

What is your cancellation policy?

I have a 48 hour cancellation policy, meaning if you cancel an appointment within 48 hours of its scheduled time, you may be responsible for a late cancellation fee. Once we pick a day and time to meet, that spot is reserved for you and I cannot offer it to anyone else. I take our work together seriously, and while some ambivalence is expected in therapy, I expect you to take your commitment to therapy (and your investment in yourself!) seriously, too. That said, if you’re sick, I want you to stay home and take care of yourself, and I understand other things come up, too. If possible, I’ll always try to offer a time for rescheduling our appointment within the week. If we aren’t able to find a time, I reserve the right to charge a late cancellation fee of $75. No-shows without prior notification are always subject to the full fee for the appointment.

How do I get to your office?

Great question! I was previously located in Bethesda, but due to health-related concerns around COVID-19, I’m only offering virtual services via telehealth right now. This may change in 2021—we’ll see.

What is telehealth? Is it safe, and effective?

Telehealth refers to virtual therapy sessions where you (the client) and I (the therapist) are not physically located in the same space. Most often this occurs via secure video platform, like the one offered through my electronic health record, Simple Practice (phone sessions are also an option, but video offers more of a personal feel and is the medium I prefer). Telehealth has many advantages, including increased accessibility, and most people enjoy the comfort and safety that can be found in attending therapy from your own home. Scientific research has also shown that telehealth can be just as effective as in-person therapy, for a variety of concerns. That said, it isn’t for everyone. If you have questions or concerns about telehealth, please don’t hesitate to bring them up! Also, as a note, therapists can only offer services in states where they are fully licensed. I can see clients all around Maryland, DC and VA at this time. If you go to college in another state, or take an extended vacation, we cannot work together while you’re away.

I’m ready to learn more—how do I set up a first appointment?

I’m so glad you’re feeling ready to explore working together! Our first step will be to schedule our initial phone call. This is a free 15-20 minute phone call during which I’ll ask a few questions about your decision to seek therapy now, as well as any current symptoms and your history, and I’ll go over a few policies specific to my practice. After this phone call, if we both feel the fit is right, we can schedule a first session together. 

To get started, feel free to reach out to me via email (alexaltmantherapy@gmail.com) or phone (301-241-8664) to find a time to talk. If you don’t reach me immediately, please offer a few times you’re free to talk soon. I look forward to connecting with you!

HIPAA Private Practice Information: if you’re interested in accessing a copy of my Notice of Privacy Practices regarding Protected Health Information, or PHI, please click here.