Performance anxiety & pressure
Performance anxiety and pressure in competitive or high-stakes environments, with an emphasis on turning nerves into usable focus.
Counseling Services
Clinical care for high-demand lives
Licensed mental health counseling for people whose environments reward pushing through. Confidential, structured, and built to fit a real training, duty, or deployment schedule. Available in person at our office in Spokane, WA, and via secure telehealth anywhere in Washington State.
Approach
Concerns we help with
Paul works from a Solution-Focused Brief Therapy lens. The work is goal-oriented and present- and future-focused: building solutions and a plan you can act on, rather than dwelling on the past.
Identity & transition stress
Leaving sport, leaving service, career transitions, and the question of who you are without the role.
Clarity & decision-making
Major life or career crossroads where the next step feels unclear and the stakes feel high.
Goal-setting & follow-through
Turning vague intentions into concrete action, building accountability, and closing the gap between plan and execution.
Relationship & family strain
The wear that military, first-responder, and athletic demands place on partners, parents, and family systems.
Team & family dynamics
Communication breakdowns, role conflict, and rebuilding trust so the system performs under stress.
Stress & burnout
The cumulative toll of high-operational-tempo careers, including exhaustion, cynicism, and the erosion that follows years at capacity.
Sleep, recovery & routine disruption
Rebuilding sustainable sleep, recovery, and daily routines when travel, training, or operational tempo keeps pulling them apart.
Anger & emotional regulation
When pressure turns short-fused at home, on duty, or in competition, and you want steadier control of how you respond in the moments that matter.
Confidence & self-doubt
Working through harsh self-criticism, hesitation, and the mental patterns that get in the way of purposeful action.
Ages 13 and up
Teens & families
Counseling is available for clients ages 13 and up. Under Washington State law, adolescents ages 13 to 17 can consent to their own outpatient mental health care and have a say in how involved a parent or guardian is. Many families choose to involve parents, and we'll talk through what that looks like during the free consultation. We also work with parents and families who are supporting a young athlete, service member, or first responder through a demanding season.
What to expect
The process
- 01
Free 15-minute consultation
A short, confidential call about what's happening and what you want to change. No cost and no obligation to continue.
- 02
Assessment
An initial session to map history, current stressors, and goals, then determine whether counseling, performance work, or a referral fits best.
- 03
Ongoing work
Regular sessions with clear objectives, practical between-session work, and periodic review of progress.
Do simple, better.
Lasting change usually comes from small, repeatable actions done consistently, not from dramatic overhauls. The work is to find the simple next step and build from there.
Credentials & supervision
Paul Swanson, LMHCA
Credential #MHCA.MC.70147923
Verified by Psychology TodayPaul Swanson is a Licensed Mental Health Counselor Associate (LMHCA) in Washington State and practices as an associate counselor under the clinical supervision of Jonathan Douglas, MS, LMHC, NCC, Psychotherapist and Clinical Supervisor. As an associate, he is not independently licensed; all counseling services are provided under this supervisory relationship.
Paul is pursuing Certified Mental Performance Consultant® (CMPC) certification through the Association for Applied Sport Psychology (AASP). Mental performance consulting is educational and skill-based; it is not psychotherapy or mental health counseling.
Formats
Individual & group counseling
Individual counseling
One-to-one sessions offered via secure telehealth and in person. Session length and frequency are set collaboratively during assessment.
Group counseling
Small, closed groups for people navigating similar pressures, such as athletes in transition, first responders, or partners and family members affected by high-demand careers. Groups are formed around shared themes, meet on a set schedule, and are structured with clear confidentiality agreements so members can speak safely. Availability depends on enrollment and is discussed during your consultation.
Logistics
Practical details
- Service area
- In-person sessions are held at our office in Spokane, WA. Telehealth is available to clients physically located anywhere in Washington State at the time of each session, including Spokane and the Inland Northwest. Licensing requires that you be in Washington for every appointment, including telehealth.
- Confidentiality
- Counseling is confidential and protected by law, with narrow exceptions required by state statute and professional ethics (such as imminent risk of harm or suspected abuse). Those limits are reviewed with you before work begins.
- Fees & payment
Free 15-minute consultation to see if we're a good fit.
Individual counseling: $150 per session.
Cause & Effect Institute is a private-pay practice and is not in-network with insurance plans. A superbill can be provided on request for clients who want to seek out-of-network reimbursement; reimbursement depends on your plan and is not guaranteed.
A limited number of sliding-scale spots are available based on financial need. Ask about them during your free consultation.
Late cancellations (less than 24 hours' notice) and missed appointments are billed at $75.
- Good Faith Estimate
- You have the right to receive a Good Faith Estimate explaining how much your care will cost. Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including related costs like tests, prescription drugs, equipment, and hospital fees. Make sure your provider gives you a Good Faith Estimate in writing at least one business day before your service. You can also ask your provider for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Practical questions
Before you begin
Clear answers about cost, approach, location, and counseling for teens and families.
Take the first step
A free 15-minute consultation is the first step. No commitment required.