What Accessible, Affirming Care Actually Looks Like at Our Practice

A few times a year, someone writes to us and opens the email with an apology. They are sorry for the length of their message. They are sorry they are not sure what to call themselves yet. They are sorry they have been looking for a therapist for months and this is the fourth practice they have reached out to. The apologies sit inside the first paragraph like they came with the body.

We read those emails slowly. Something in us wants to reach through the screen and say, please, you do not owe us an apology for how you arrived.

This post is about what we actually do to try to meet people where they are. Not in values-language, not in percentages, not as a pitch. In the details. Vancouver-based, online across Canada, our practice is small — three clinicians at the moment, Clayre, Laura, and Laith — and we are still working on most of what we name below. We name it anyway, because vagueness about accessibility is one of the ways accessibility gets lost.

What lowering the barrier actually means here

Accessibility is not a claim we make on an about page. It is a set of small choices that repeat over time. Some of those choices are structural, like how our fees work. Most of them are smaller and harder to see: how a form is worded, how fast a session moves, what happens when someone falls silent, how we respond when a client names something we missed.

The scholar and somatic psychologist Rae Johnson writes about the way power moves through bodies in the room — through posture, pacing, gaze, tone. In a therapy room, that is not incidental. It is the room. A therapist's body carries the history of their training, their identity, their own unhealed places. A client's body reads all of it in the first few minutes. If accessibility only lives in our intake form and not in how we actually sit with someone, it is not there.

The first email

Before anyone books anything, they usually write to us. The first email is part of the work.

We aim to read carefully and write back in real language. We try not to use more words than the person used. We ask what name and pronouns to use before the first session, and we use them. If someone tells us they are worried about cost, we name the options we have, including the free 15-minute consult and reduced-fee sessions with Laith, our clinical practicum student. If we cannot take them on, we say so, and we try to suggest somewhere that might.

None of that is unusual. It is the basics. We name it because the basics do not happen everywhere, and because people who have been turned away before sometimes need to hear that they will not be turned away here for the shape of their question.

Cost, named plainly

We have three ways of holding the cost question.

• Full-fee sessions with Clayre, Laura, or Laith, at our standard rates. Most insurance plans cover a portion of this, depending on your coverage. We provide receipts.
• Low-cost counselling with Laith, who is completing a clinical practicum with us. These sessions are available at a reduced rate and are open to adults across Canada.
• Sliding-scale spots with Clayre or Laura. These are limited and usually have a waitlist. When a spot opens, we prioritise people whose access to affirming care is most constrained by cost.

We do not ask anyone to prove their income. We ask what is possible for them and we try to make the numbers meet somewhere.

Cost is one barrier among several. The others are less tidy, and this is where most of the actual work sits.

Power in the room, including ours

Clayre is a white, disabled, trans and queer therapist. Laura is a white, queer therapist. Laith is working through their own route into clinical practice. None of that is neutral. When a Black client, an Indigenous client, or a client of colour walks into a room with a mostly-white team, that room already contains a history, whether or not any of us name it.

We try to name it. We ask, early on, whether the way we are working is meeting the person in front of us. We do not assume silence is consent. When someone tells us something is not working, we try to take it in without collapsing into apology or getting defensive on our own behalf. That part is a practice, not a finished skill. Some days we do it better than others.

Johnson describes what she calls embodied microaggressions — the small, often unintentional ways that the body of a person with more power can shrink, dismiss, or talk over the body of a person with less. In a conversation with Amber McZeal, they talk about the work of building what they call somatic bandwidth: the capacity to stay present in hard conversations across difference, rather than reaching for the exit. We keep coming back to that language. It describes something we need to keep building, individually and together, if we are going to do this work with any integrity.

What we are still working on

A short, honest list.

• Our practicum program. We want to grow it so that more reduced-fee spots are available. This takes time because we are committed to training slowly and well, not quickly.
• Physical accessibility of any in-person offerings. Right now, most of our work is online across Canada, which lowers some barriers and raises others. Community sound baths we are planning in Vancouver later in 2026 will be held at community centres with elevator access and accessible washrooms. Other accessibility needs, we will keep asking about and adjusting.
• Language. We write in English. We know that shuts doors. If you need care in another language, we will do our best to point you toward therapists who can offer that.
• Repair. When we get something wrong, we want to hear it. Sometimes clients stop coming and we never know why. We are trying to get better at making it possible for people to tell us, if they want to, without feeling responsible for our feelings.

Accessibility is not a destination. It is a set of practices a practice keeps at, with the understanding that no practice finishes this work. We would rather tell you what we are doing and what we are still figuring out than offer you a polished version of either.

If you are looking for accessible therapy and want to understand what that actually looks like from the inside, this is what ours looks like today. Next year, the list will have shifted. If you are considering reaching out, the first email does not have to come with an apology. Write to us in whatever form shows up. We will read carefully, and we will write back.