What does therapy at Onward Healing look like?

At Onward Healing, we specialize in evidence-based treatments for OCD, anxiety, BFRBs, tics, and trauma. Sessions are typically 50 minutes long and conducted via secure telehealth video. Treatment is collaborative — we work together to understand what's keeping you stuck and build skills to help you move forward. Depending on your goals, we may use Exposure and Response Prevention (ERP), Habit Reversal Training (HRT), the ComB model, EMDR, or other structured approaches.

Do you accept insurance?

We are currently out-of-network with all insurance providers. This means we do not bill insurance directly. However, many clients are able to use out-of-network benefits to get partial reimbursement. We can provide a superbill (an itemized receipt) that you can submit to your insurance company. We recommend calling your insurance provider before starting to understand your out-of-network mental health benefits.

How does telehealth therapy work?

All sessions at Onward Healing are conducted via secure, HIPAA-compliant video platform. Once you're scheduled, you'll receive a link to join the session from wherever you are — your home, office, or anywhere private. Telehealth is just as effective as in-person therapy for the conditions we treat, and many clients find it more convenient and accessible.

What states do you serve?

We are currently licensed to provide therapy in Pennsylvania (PA), Vermont (VT), and Florida (FL). You must be physically located in one of these states at the time of your session.

How long will I need therapy?

This varies widely depending on your goals, the severity of your symptoms, and your engagement with treatment. Some clients see significant improvement in 12-16 sessions; others prefer ongoing support over a longer period. We'll discuss your goals at the outset and check in regularly on your progress.

What is ERP therapy, and is it right for me?

Exposure and Response Prevention (ERP) is the gold-standard treatment for OCD and certain anxiety disorders. It involves gradually facing feared situations or thoughts (exposure) while resisting compulsions or avoidance behaviors (response prevention). It sounds challenging — and it can be — but it's also highly effective. We move at a pace that feels manageable, and you're never pushed into anything you're not ready for.

What are BFRBs, and can therapy help?

Body-Focused Repetitive Behaviors (BFRBs) are repetitive, self-directed behaviors like hair pulling (trichotillomania), skin picking (excoriation disorder), nail biting, and cheek chewing. These behaviors are often automatic and can cause significant distress or physical harm. Evidence-based treatments like Habit Reversal Training (HRT) and the Comprehensive Behavioral (ComB) model have strong research support and can lead to meaningful reduction in urges and behaviors.

How do I get started?

The easiest first step is to schedule a free 15-minute consultation. This call gives us a chance to learn about what you're struggling with, answer any questions you have, and see if we're a good fit. There's no pressure and no commitment. You can book directly through our website or reach out by email.

Is HRT the same as just trying harder or stopping?

No. Willpower-based attempts to stop pulling or picking almost always fail. HRT is a specific behavioral protocol: you map the exact moments when urges occur, build a physically incompatible competing response, and practice it repeatedly until it overrides the BFRB. It's a skill, not a battle of will.

Why is BFRB treatment not the same as OCD treatment?

BFRBs and OCD look similar on the surface but have different underlying mechanisms. OCD is driven by intrusive thoughts and anxiety-reduction compulsions. BFRBs are urge-and-sensation driven, often without an associated obsession. That's why OCD is treated with ERP and BFRBs are treated with HRT ? different conditions, different treatments.

Will I have to shave my head or look at my pulled hair?

No. HRT does not require shaving, exposure to pulled hair, or any aversive procedures. Treatment is focused on what you do during the urge ? not on confronting the consequences of past pulling.

How long does HRT take to work for trichotillomania?

Most people see a noticeable reduction in pulling or picking within 4?6 weeks of consistent HRT practice, and meaningful long-term change in 8?16 sessions. BFRB treatment is most effective when paired with consistent between-session practice.

What if I pull or pick without realizing it?

Automatic pulling or picking ? where you find yourself doing it without remembering starting ? is extremely common. HRT addresses automatic BFRB by building awareness skills first, then layering on competing responses. You don't need to start out aware; you build that as part of treatment.

Will my hair or skin recover after BFRB treatment?

In most cases, yes ? hair regrows once pulling stops, and skin heals once picking is interrupted. Recovery timelines vary. Some clients see scalp regrowth in 8?12 weeks of reduced pulling; some scarring may be permanent. The goal of treatment is to stop ongoing damage so healing can happen.

Can children and teens do HRT?

Yes ? HRT is well-validated for children and adolescents. Nina works with teens specifically for tic disorders and is open to discussing BFRB cases on a case-by-case basis. The free consultation is the right place to ask about age appropriateness.

What's the difference between automatic and focused pulling?

Focused pulling is intentional ? usually triggered by an emotional state and done with full awareness. Automatic pulling happens outside conscious attention ? you wake up with a pile of hair you didn't realize you'd pulled. Most people with BFRBs have some of each, and HRT is tailored to match your specific blend.

Is BFRB treatment covered by insurance?

Onward Healing Therapy is private-pay. A superbill is provided after each session for out-of-network reimbursement (many PPO plans cover 40?80%). Trichotillomania (ICD-10: F63.3) and excoriation disorder (F42.4) are diagnosable conditions, so superbills are valid for reimbursement claims.

What if I've already tried hypnosis, supplements, or willpower programs for BFRBs?

Many BFRB clients have tried multiple non-evidence-based approaches first. None of those have research support equivalent to HRT. Starting HRT now doesn't mean you failed at the others; it means you're finally trying the treatment that's actually designed for BFRBs.