about refactor therapy

I'm Leif Nesse, a Licensed Mental Health Counselor Associate providing remote teletherapy to clients throughout Washington State.

Therapy often begins with a feeling that something isn't working, or a sense that the same difficulty keeps showing up in different forms. The work we do together is about understanding what's running underneath: the patterns that shape how you feel and choose, the stories you've been told or told yourself, the experiences that haven't yet had the chance to settle. What shifts in therapy isn't who you are. It's how clearly you can see your own life, and how freely you can move within it.

What I try to bring into the room is patience, careful attention, and a willingness to move at the pace the work actually needs. I don't believe in rushing people toward insight, and I don't believe in collecting symptoms to be managed. I believe in sitting with someone long enough to understand what they're carrying, finding language for things that haven't had language yet, and letting change happen in its own time. Some of the most important work we do together may look, from the outside, like nothing much at all. That's usually a sign it's working.

my approach

My approach is integrative. I draw on several traditions, and I choose tools in the room based on what a given moment calls for, not on a predetermined protocol.

Acceptance and Commitment Therapy offers the posture of mindful awareness and values-guided action. Internal Family Systems provides a way to meet the parts of you that have been doing their best under difficult assignments. Mindfulness-based approaches strengthen the capacity to observe experience without being swept into it. Narrative therapy helps us find the language for a truer story. Cognitive Behavioral Therapy offers structured, evidence-based tools when the work calls for them, particularly for anxiety, depression, and patterns that respond well to practice and repetition.

These aren't techniques I apply to you. They're tools we choose together, shaped by what the moment asks for. When a pattern finally gets named accurately, the recognition is often felt before it's understood...an exhale, a softening in the chest, a quiet sense that something long-carried has been set down.

who i work with

I work with adults who tend to think deeply about their lives, people drawn to therapy not just to manage symptoms but to understand what's underneath them. Many come for anxiety, depression, burnout, or grief. Others arrive at a threshold. A career shift, a loss, an empty house, a diagnosis, a relationship ending or beginning, and they find themselves asking larger questions about meaning, identity, and what comes next.

I have a particular affinity for existential concerns that don't always have a clean name, like mortality, purpose, regret, and the search for something that feels true, and for men learning to find language for an inner life they were never taught to name. I also welcome people navigating midlife and later-life transitions, and members of the LGBTQ+ community.

Whether you're sitting with something acute or something that's been running quietly in the background for years, I'd like to hear from you.

session information

Sessions are approximately 50 minutes and conducted via secure teletherapy. I currently operate on a cash-pay basis at $150 per session, with a limited number of reduced-fee spots available for those who need them. While I don't accept insurance directly, I can provide a superbill you may use for potential reimbursement through your HSA, FSA, or out-of-network benefits. I anticipate accepting several major insurance plans beginning in Fall 2026, so if you hope to use insurance, feel free to reach out now and I'll let you know as soon as your plan is available.

If any of this resonates, the next step is a free 15-minute consultation. No pressure, just a chance to see whether this feels like the right fit.