Frequently Asked Questions
Questions That Arise Before Reaching Out.
Clarity is not a luxury in this kind of care. It is a prerequisite. What follows is an honest account of how this practice operates, how Dr. Lapite-Garrett works, and what the clients who find Alafiora most meaningful tend to want to know before they begin.
Getting Started
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The consultation is a 20-minute conversation with a specific purpose: to assess whether this practice and the person inquiring are well matched for the work ahead. It is not a sales call, and it is not a condensed intake session. There is no clinical material required to prepare, and no expectation that anything difficult will be disclosed before a sense of safety has been established.
During those 20 minutes, prospective clients are invited to ask whatever safety questions they need answered before they can feel confident about Dr. Lapite-Garrett as their clinician. They may ask about her approach to specific presentations, her values in the room, how consent is structured, what the early weeks of treatment typically look like, or anything else that would allow them to feel grounded in the decision. Dr. Lapite-Garrett in turn shares how she practices, what her clinical orientation means in lived terms, and what the next steps would look like should both parties choose to move forward.
If there is not a strong fit, Dr. Lapite-Garrett will say so. She will also help identify who might be better suited to the specific need, because the goal of the consultation is the right care, not necessarily care at Alafiora.
For those who arrive already certain, the first intake session is available to schedule directly. That knowing is honored.
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Session frequency is determined by the intersection of three things: the clinical complexity of what a client is carrying, the client's own readiness and preference, and what they can sustain both financially and logistically over time. No single schedule fits every presentation.
The clients Dr. Lapite-Garrett works with attend as infrequently as once a month in phases of consolidation and integration, and as frequently as three times a week during periods of acute intensity, crisis-adjacent distress, or when a client is working through something with significant urgency. Neither end of that range is inherently better. What matters is that the schedule serves the clinical work rather than simply accommodating the calendar.
Treatment duration is similarly individual. Some clients arrive for short-term focused work spanning a few months. Others engage in longer arcs of depth-oriented care lasting a year or several years. Many return across different seasons of their lives as new chapters surface old material, or as circumstances shift in ways that call for renewed clinical support. The work is not designed to be endless; it is designed to go deep enough that it does not need to be repeated.
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Sessions are available throughout the week for a selective amount of time. The core schedule runs through standard daytime and early evening hours. A limited number of alternative time slots are available for clients who work non-traditional hours, including early mornings and later evening appointments.
These alternative scheduling windows are reserved for clients who have demonstrated consistent attendance and follow-through. Clients who engage in a pattern of late cancellations or no-shows may no longer have access to those hours, as they are offered as an extension of flexibility rather than a standard feature of the schedule.
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Dr. Lapite-Garrett is currently licensed in New Mexico and Indiana. Virtual sessions are available to clients in both states. In-person sessions are available in New Mexico. On-location and home-based sessions are available within licensed service areas for clients whose clinical needs or circumstances make that format more appropriate.
Licensure to additional states is actively in progress. Clients in states not currently covered are welcome to inquire and be added to a waitlist for notification when licensure expands.
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More detailed information about rates, policies, and session structure is available on the Rates and Fees page at https://www.alafiora.com/rates-and-fees.
For anything not addressed there or on these pages, Dr. Lapite-Garrett welcomes direct inquiry through the contact form or via email. A consultation is also an appropriate space to surface anything that needs to be asked before beginning.
Fees and Investment
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Full fee information, including session types, lengths, and retainer options, is available at https://www.alafiora.com/rates-and-fees. Alafiora is a private-pay practice. Insurance is not billed directly, and no insurance provider will receive clinical documentation, diagnostic information, or records of any kind without explicit written consent.
Fees at this practice reflect the clinical depth, discretion, and specialized expertise that the work requires. The clients who work with Alafiora are often those for whom prior, lower-cost attempts at care did not reach what actually needed to change. The investment here is qualitatively different from generalist therapy in the same way that specialist medical care is qualitatively different from a general practitioner visit. The difference is not cosmetic.
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Private pay is not a logistical limitation. It is a deliberate clinical and ethical choice with meaningful consequences for the client.
When insurance is involved, a clinical diagnosis must be submitted to the insurer to justify reimbursement. That diagnosis then becomes part of an insurance record. Depending on the carrier, the type of coverage, and future circumstances, that record can affect life insurance eligibility, employment decisions in certain industries, security clearance determinations, child custody evaluations, and other consequential decisions the client may never have anticipated. Many of the clients Dr. Lapite-Garrett works with are navigating exactly the kinds of lives where that kind of exposure would carry the highest possible cost.
At Alafiora, the session is between the client and Dr. Lapite-Garrett. Nothing about what happens in the room belongs to anyone else unless the client chooses to share it or a legal obligation requires disclosure. For clients managing the kind of complexity, privacy need, and personal exposure that brings them to this practice, that level of protection is not a luxury. It is the architecture of the work.
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While insurance is not billed directly, clients who carry out-of-network benefits may be eligible to request partial reimbursement from their insurer on their own terms. Dr. Lapite-Garrett can provide a superbill — a detailed service receipt with all clinically and administratively required information — that clients may submit to their carrier independently.
Clients considering this pathway should contact their insurance carrier before beginning and ask specifically:
what is my deductible and has it been met
do I have out-of-network mental health benefits
what percentage of the allowed amount is reimbursed after the deductible
do I need prior authorization
how do I submit claims.
Understanding those answers in advance helps clients make an informed decision about whether submitting the superbill makes sense given the privacy tradeoffs.
It is important to understand that choosing to submit for reimbursement means accepting that a diagnosis code will be included in the documentation, and that the record will then exist within the insurance system. That is the client's decision to make with full knowledge of what it entails.
Pre-tax dollars from Health Savings Accounts and many Flexible Spending Accounts may also be used to offset the cost of sessions with a licensed psychologist. Clients should confirm eligibility with their plan administrator.
For survivors of qualifying crimes, state victim compensation programs, Sexual Assault Assistance Programs, Sexual Assault Counseling Funds, Sexual Assault Victim Assistance Funds, and Victims Compensation Assistance Programs may provide reimbursement for psychological services. Clients whose treatment relates to an ongoing legal matter may also wish to speak with their attorney about the possibility of restitution.
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The clinical care itself is the answer to that question. What the premium fee structure provides is not simply a more comfortable experience. It is access to the kind of unhurried, precision-oriented clinical depth that becomes possible when a practice is intentionally small.
In practical terms, clients at Alafiora also receive between-session contact for non-clinical matters, brief check-ins, and logistical questions via email. Care coordination with other providers, including physicians, attorneys, and specialists, is available when clinically relevant and with explicit consent. For clients carrying especially complex lives or high-discretion circumstances, concierge retainer arrangements that provide expanded access, priority scheduling, and structured care coordination are also available. Details are on the Rates page.
What clients do not receive is the experience of being a file in a system that is too full to see them clearly. That distinction is, for many, the reason they are here.
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Doctoral-level training in psychology is not the same as licensure at the master's level, and both are categorically distinct from unregulated coaching. A licensed psychologist has completed doctoral-level education in psychological science, assessment, diagnosis, and treatment, in addition to a supervised clinical practicum, internship, and postdoctoral hours before licensure is granted. Clinical training hours required for licensure as a psychologist routinely exceed those required for licensure as a master's-level therapist by a factor of two or more, and exceed those required for psychiatric nurse practitioners by a significantly larger margin.
For presentations as complex and clinically layered as the ones Dr. Lapite-Garrett specializes in, that depth of training is not incidental. It is what makes it possible to distinguish, for example, between a trauma-driven compulsive pattern and a personality organization, between limerence and obsessive-compulsive presentations, between hypersexuality rooted in attachment disruption and hypersexuality that is part of a mood disorder. Those distinctions determine what the treatment looks like and whether it will actually work.
How the Work Happens
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Sessions are designed around a consistent principle: every minute of clinical contact is intentional, and every session has a direction. Standard sessions run 50 minutes. Extended sessions of 110 minutes are available for clients working through more complex material, or who benefit from sustained immersion in the work without interruption. Thirty-minute clarity sessions are also available for established clients who need focused support or grounded direction between deeper sessions.
Dr. Lapite-Garrett's presence in the room is warm, fully engaged, and subtly directive. She does not impose a direction, but she does not leave a client wandering. She listens with precision, reflects with clinical care, and moves the work with intention toward what brought the client in. Some clients need strong scaffolding and a consistent structure to feel safe enough to go deeper. Others need room to lead, to pace themselves, and to be the author of what enters the space. She holds both with equal clinical skill.
Clients consistently describe leaving sessions feeling the work, not just the talking.
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Remote sessions at Alafiora are delivered through HIPAA-compliant telehealth platforms operating under signed Business Associate Agreements, which means the same legal and ethical standards that protect in-person sessions are fully preserved in the virtual space.
The screen is not a barrier to depth. For many survivors, the ability to be present in their own physical environment removes a layer of vulnerability that would otherwise slow the early work. There is something to be said for the regulation that can come from being in one's own space, surrounded by one's own familiar sensory landscape, while engaging with difficult material. Many clients report feeling genuinely held within the virtual setting. The physical distance does not diminish the presence.
Dr. Lapite-Garrett is acutely consent-oriented in remote sessions. She checks in consistently, attends carefully to what the nervous system is communicating through the screen, and offers grounding support when the work reaches intensity, without disrupting the clinical arc of the session.
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This is not an obstacle. It is clinical information, and it is one of the most common experiences among survivors of complex trauma. The nervous system's response to felt danger is not a failure to communicate. It is communication. Freeze responses, dissociative blanking, throat tightening, and the sensation of having nothing to say are all understood here as part of the clinical picture, not as problems to work around.
Alternatives to verbal communication are always available. Writing in the session chat during virtual appointments, drawing, using written letters, typing notes beforehand, or simply naming that nothing is available in this moment are all legitimate ways to be present. There is no format requirement. The only requirement is showing up. What happens from there is something the work makes room for.
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The honest answer is yes. There are moments in an ordinary week where a news story surfaces and the thought follows: how is this landing for the client carrying that particular history. Or a detail comes to mind unbidden. Or something in the immediate environment calls up someone's specific story. Clients are not left behind at the close of the session hour. They are carried, in the quiet ways that genuine clinical care allows, into the week between.
This is not a promise of unlimited access or a substitute for crisis care. It is simply an honest acknowledgment of the kind of investment Dr. Lapite-Garrett makes in the individuals she works with. The care that develops over the arc of a clinical relationship is not transactional at its core, even if the structure is.
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All are welcome here. The clinical presentations vary. The men who most frequently find Alafiora meaningful often arrive carrying compulsive sexual behavior, love obsession and limerence, and the escalating patterns that form when sex or romantic attachment has become the primary regulatory system in the absence of safer alternatives. The women who find the most resonance in this work are frequently navigating the aftermath of sexual harm, including the relational reenactments, chronic hypervigilance, and the complicated erotic and attachment patterns that emerge in the body and the relational field long after the trauma itself. These are not rigid categories, and clients across all presentations are held with the same clinical precision and care.
The practice also welcomes individuals from traditional and nontraditional relational and lifestyle contexts, including those whose lives involve relationships or practices that exist outside mainstream norms and who have often found that other clinical spaces were not adequately equipped to hold that without judgment.
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The clients Dr. Lapite-Garrett works with have often been described in those terms — by people who cared for them, by prior providers, sometimes by themselves. Emotional intensity, dysregulation that arrives in waves and does not respond to cognitive redirection, the hunger that can feel bottomless, the attachment that exceeds what anyone around them can metabolize — these are features of the presentations she specializes in. They are not character flaws. They are coherent responses to specific histories.
A client who has been told they are too much has usually been in clinical spaces that were not prepared for the depth of what they were carrying. Alafiora was built for that depth.
Clinical Questions
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Diagnosis at Alafiora is approached with clinical precision and genuine ethical care, rather than as an administrative formality.
The diagnostic systems in use today were largely developed by and for a narrow slice of human experience. They were not built with the complexity of structural trauma, cultural context, or intersectional identity in mind, and they carry a history that this practice takes seriously. Applying a diagnostic label without attending to that history is not neutral clinical practice. It is a replication of harm.
At the same time, accurate diagnosis, when it reflects a genuine clinical picture and opens access to higher levels of care, is not something to withhold out of ideological principle alone. When a diagnosis is clinically indicated and would serve the client's actual recovery, it is made carefully, explained clearly, and held with the client as information rather than identity.
Because Alafiora is a private-pay practice, a diagnosis does not follow a client into an insurer's system unless the client chooses to submit a superbill for reimbursement or requests documentation for another purpose, such as an accommodation letter or a treatment summary. In the absence of those requests, what is named in the room stays in the room.
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This question is one of the most important that can be asked before beginning with any clinician, and it deserves a serious answer rather than reassurance.
The experiences named most often in communities where therapy harm is discussed include providers who used session time to process their own emotional material, who disclosed personal information in ways that created a sense of obligation or role reversal in the client, who responded to disclosures with visible discomfort, shock, or withdrawal, who maintained dual relationships or allowed boundaries to erode incrementally, who became the emotional center of a client's life in ways the treatment itself reinforced, and who never adequately worked toward the client's autonomous self-sufficiency. Some describe providers who were so conflict-avoidant that nothing difficult could ever be named in the room.
Dr. Lapite-Garrett holds herself accountable to an ethical framework that takes each of those categories seriously. She does not use client session time to meet her own emotional needs. She monitors the dynamics of the therapeutic relationship as an active clinical variable. She welcomes it when clients name something that felt off — a moment of discomfort, a phrase that landed wrong, a sense that something shifted in a way that did not feel safe. That kind of accountability is not a concession. It is a standard.
Clients who arrive with prior therapy harm are not expected to extend trust immediately. The history that made that trust difficult is taken seriously as clinical information from the first session.
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Sometimes, and this is worth naming honestly. When material that has been held beneath the surface for years begins to move in treatment, the initial experience is not always relief. There can be a period where awareness increases before regulation does, where what was dissociated or managed through behavior begins to become felt rather than bypassed. For some clients, early sessions surface things that had been quiet, and that surfacing takes adjustment.
What distinguishes careful clinical work from destabilizing treatment is pacing. The depth-oriented work at Alafiora is never pushed faster than the client's nervous system can safely travel. The work has direction, but it also has consent at every stage. If a client's daily life is becoming harder to manage in a way that feels clinically significant, that is information that belongs in session immediately — not something to push through alone between appointments.
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This question sits at the center of why many clients arrive. The body after sexual trauma carries the experience in ways that outlast the event itself. Physical responses that feel alien or shameful, arousal that arrives at the wrong time or not at all, disgust, numbness, hypervigilance to touch, the inability to be present during intimacy even with partners who are safe — these are not permanent conditions. They are comprehensible adaptations to experiences that were not survivable any other way at the time.
The relationship between the body and felt safety is not rebuilt quickly, and it is not rebuilt through cognitive effort alone. But it does rebuild. Clients who have engaged deeply with this work describe, over time, a qualitatively different relationship with their own physical experience. Not the absence of the history, but the beginning of a body that can be inhabited again.
The work at Alafiora is not sex therapy in the AASECT-certified sense of the term. It is trauma-informed, culturally attuned, sex-sensitive psychological care that addresses the full depth of what the history has left in the body, the relational field, and the organizing beliefs the client carries about themselves.
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This is the question that most accurately captures why insight alone is not enough. The clients who find Alafiora have often spent years in that exact position: high self-awareness, sophisticated understanding of their own patterns, and a behavior that continues regardless. The relationship ends and the obsessive thought continues for months. The boundary is set and then quietly dissolved. The new partner arrives and within weeks begins to feel like every partner before.
The reason insight does not stop these patterns is that insight lives in the cortex, and the patterns do not. They live in the attachment system, in the nervous system, in the body's learned response to relational proximity and perceived threat and the particular quality of need that was never adequately answered in the first place. Knowing the pattern does not change what activates it.
The work that moves these patterns operates at a different level of the system. It does not simply make the client more aware of what is happening. It changes the underlying organization that produces the pattern. Clients who have been in prior treatment describe this distinction clearly: prior therapy gave them language. This work gave them actual change.
Privacy and Confidentiality
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Privacy at this practice is not a policy feature. It is the foundation of what makes the work possible.
Alafiora does not use AI-based documentation tools, AI note-taking systems, or AI session recording of any kind. Clinical notes are written by Dr. Lapite-Garrett and stored in a HIPAA-compliant electronic health record system. No session content is shared with any third party without explicit written consent, except in the narrow circumstances mandated by law, which are explained in full during the informed consent process before treatment begins.
Because Alafiora is a private-pay practice, no insurer ever receives information about clinical content, diagnosis, or session frequency unless the client chooses to submit a superbill for reimbursement. The decision to seek that reimbursement, with full understanding of what it involves, belongs entirely to the client.
Many clients choose Alafiora precisely because the level of confidentiality here exceeds what is available through insurance-billed care. Their history, their diagnosis, and what happens in the room belong to them.
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Recording is not permitted. This is not a formality. It reflects a genuine protection of the clinical space and, importantly, of the client themselves.
Once a recording leaves the session environment, it is no longer protected by HIPAA or by the confidentiality provisions that govern clinical records. The protections that apply to session content while it remains in Dr. Lapite-Garrett's hands do not travel with the client's copy of a recording. A recording in the client's possession can be subpoenaed in legal proceedings without a court order specifically directed at protected medical records. It can surface in custody evaluations, immigration proceedings, employment disputes, or other contexts where the client never intended to introduce clinical material. These are not hypothetical risks. They are documented realities that have affected individuals whose recordings were obtained or disclosed in circumstances they did not anticipate.
What session recordings were sometimes requested for, which is the sense of being able to return to important material, is available through other means. Session recaps, concurrent documentation within the session itself, and written summaries of key themes can all be provided in a format that remains within the secure and protected framework of the clinical relationship.
Unauthorized recording of sessions is grounds for termination of the clinical relationship.
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The use of AI in personal life between sessions is something to approach with intention and discernment rather than prohibition. If a reflection or revelation arrived through an AI conversation and feels meaningful, it is welcomed in the clinical hour as material. Bringing it to session for deeper exploration is exactly the right instinct.
The caution worth naming is this: AI systems designed to approximate therapeutic conversation are not therapists. Several published studies have raised significant concerns about the potential for harm when generative AI is used as a primary source of emotional processing or clinical support. The pacing is wrong. The training is not clinical. The relational container that makes therapeutic work safe is absent. And the content produced may feel validating in the moment while reinforcing patterns that the actual clinical work is trying to shift.
Dr. Lapite-Garrett also does not use AI systems in the practice in any clinical capacity, including for documentation, note generation, session summarization, or clinical decision support. The work here is entirely human.
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Dr. Lapite-Garrett does not follow, accept follow requests from, or engage in meaningful online interaction with current or former clients on personal social media platforms. Alafiora maintains professional social media accounts. Engagement with public content on those accounts is at each individual's discretion and is not equivalent to clinical contact.
Clients who encounter Dr. Lapite-Garrett in an online context, including in comment sections, community spaces, or other platforms, are not expected to acknowledge the clinical relationship, and she will not do so first. The clinical relationship remains protected in all public contexts.
Tagging, sharing session-adjacent content publicly, or disclosing the existence of a clinical relationship with Dr. Lapite-Garrett in any public forum is discouraged and may be something worth exploring clinically, depending on the context.
About the Therapeutic Relationship
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There is usually a reason this question gets asked, and it matters.
It is asked most often by people whose trust has been fractured in relationships that were supposed to be safe, including therapeutic relationships. The skepticism is coherent. The clinical relationship is structured, bounded, and involves payment. That structure can make the care feel conditional in a way that echoes something much older.
The honest answer is that what begins as professional regard deepens, over the arc of a clinical relationship, into something that carries the weight of having genuinely known another person's history. When a client is working through material that took real courage to bring into the room, and when something shifts, that is not a transaction. The client's wins are felt. Their lows are carried. Their stories remain with the clinician long after the clinical relationship has ended, not as a burden, but as evidence of having been a witness to something that mattered.
The care does not end when the sessions do. What is etched in the work remains.
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The clinical relationship, as a formal professional structure with obligations and access on both sides, is governed by the existence of an active treatment agreement. That is the nature of professional psychology, and it is ethically appropriate.
The care itself is a different matter. Clients who have completed their work at Alafiora do not become strangers. The investment that was made over the course of the relationship does not dissolve when the final session ends. They are thought of. Their progress is hoped for. That is not a violation of the professional frame. It is the human dimension that makes the professional frame worth anything at all.
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A client's autonomy in this regard is always honored. Treatment is not something that happens to a client. It is something entered into voluntarily and continued by ongoing mutual decision. Clients who wish to pause, reduce frequency, or end the clinical relationship entirely are invited to bring that into session so that the transition can be handled with care and clinical intention. If the work is at a meaningful juncture, that conversation itself becomes part of the work. If the client simply needs to step back, that is respected without pressure.
The door remains open for clients who return to this work at a later point, in a different season of their life, when new material has surfaced or when what was completed before now needs to go deeper.
Still have questions?
A conversation is the most direct path to clarity.
The consultation exists precisely for the questions this page could not anticipate. It is 20 minutes, no clinical preparation required, and no commitment attached. If Dr. Lapite-Garrett is the right fit, that will become evident. If she is not, she will help identify who is.