Clear Water Lake


Compassionate Mental Health

& Couples Counseling

Offering online telehealth sessions for individuals & couples

Offering outdoor "walk and talk" sessions for individuals

January 2022 Update: I am currently full and not accepting new clients.


Hello & Welcome!

Maybe you are considering individual or couples counseling for the first time ever, or looking to return but with a new counselor. Perhaps you're feeling overwhelmed, stuck in negative patterns, or simply wanting to explore and grow.


As someone who's been in individual and couples counseling a few times, I know firsthand the fear and courage in asking for help, and slowly putting trust in a counselor and process. I hope this website helps you get to know me and my practice better to determine if I might be the right fit for you.

I believe we humans are designed for relationships. When we feel seen, heard, and cared for, even just by a few significant people in our lives, we tend to thrive. Depending on your needs and goals, I’d like to help you improve your relationship with yourself, and with the important people in your life. And I'd like to build a trusting, positive working relationship with you, as that's the key that makes counseling effective.


I believe you are the expert in the room, even if you feel lost right now. I use my training and experience to link you to your inner-expert, so that you may find more clarity, ease, connectedness, and freedom in your life. 


Clients have described me as down-to-earth, warm, and candid yet gentle. I appreciate playfulness and humor. I keep a small caseload and focus on the quality of my work -- making time for my own growth, consultation, and training -- not the quantity of clients I see. Being a clinical social worker is my true privilege and joy.




My areas of expertise are stress management, adjustment/life transitions, relationship issues, communication, self-esteem, parenting support, and foster care/adoption issues. I work with all personality types, but am especially skilled working with people who describe themselves as introverts or highly sensitive (read more about highly sensitive people here). I also love to work with parents and expectant parents.

Nature Explorer
Happy Couple

I welcome couples of all sexual identities and expressions. I work with folks feeling stuck in frequent conflict, those who don’t often feel they “click” anymore, and those who just experienced a major breach of trust or other stressful event. I also work with couples facing a milestone or life change, such as marriage or welcoming a new child, to help them prepare and adjust their relationship.



I'm a Licensed Independent Clinical Social Worker (Smith College School for Social Work, 2008) with over ten years of experience as a counselor, case manager, and Gottman workshop facilitator. I've worked as a counselor to couples, adults, and children/families in various settings in Seattle, including Seattle Therapy Group, Harborview Abuse and Trauma Center, and Catholic Community Services. I've also worked as a case manager at Amara, where I assessed and supported foster and adoptive parents. 


I identify as a white, cisgender, heterosexual woman. I aim to maintain a feminist, anti-racist, anti-bias lens in my work and life, and am continually learning and seeking to grow in these areas.


I grew up in Massachusetts, spent stints in North Carolina and South America for college and extended travel and volunteer work, and came to Seattle in 2006 when I met my now husband. We have two elementary school-age children who keep us on our toes. I love being in nature, exercise, yoga, art and writing.




If you (and your partner if you’re interested in couples counseling) have read my website and feel I might be a good fit, that’s the first step. The first 3-4 sessions (typically three sessions for individual counseling, four sessions for couples counseling) of our work together will be an assessment and goal setting phase, in which I’ll be getting to know you, assessing your needs, and ensuring I believe I have training and tools to help you meet your goals. Towards the end of this time, we will discuss and arrive at two or three top goals for our work together. If at the end of 3-4 sessions I do not feel I am a good fit for you, I will give you three referrals for therapists I believe would be a better fit.
There are a few indicators for both individuals and couples that I would NOT be a good fit. For individuals, these are self harming or suicidal thoughts or behaviors, a personality disorder, an active addiction, or an active eating disorder. For a more specially trained therapist, you can search for a therapist on Psychology Today by your city/zip code and then select the specific clinical issues you are facing to narrow the search. For couples, I am not a good fit for those folks seriously considering separating or divorce (learn more about Discernment Counseling here) or already separated. My training also falls short in working with couples who are practicing or considering polyamory or an open relationship (find a more skilled counselor here). Last, couples therapy is not indicated if there is a pattern of degradation, humiliation, sexual coercion, or violence in your relationship. You might be in a domestic violence situation. Often individual counseling, rather than couples counseling, is the best place to begin until these behaviors decline or cease. If you are unsafe right now, please call 911. To seek support and resources, please consider calling the WA State Domestic Violence Hotline, at 1-800-562-6025.


Individual counseling: 50 mins/$130, 80 mins/$208 Couples counseling: 50 mins/$160, 80 mins/$235


I accept cash, check, Visa, MasterCard, American Express, Discover, Health Savings Account (HSA) Cards, and Flexible Spending Account (FSA) Cards.


Yes, I have a a limited number of sliding scale spots available.


I find that although insurance can mitigate the cost of counseling, it can also bring major limitations around kind or duration of your care as well as your confidentiality. For these reasons I have chosen to not be listed as a preferred provider with any insurance carriers. However, I am considered an Out of Network provider, and some insurance plans offer considerable or full reimbursement for counseling with Out of Network providers, depending on your benefits. I can provide you with a monthly "superbill" (a kind of receipt) for you to submit to your insurance carrier or employer for possible reimbursement and/or flex spending purposes. Insurance carriers can ask/require that you meet criteria for a mental health disorder in order to reimburse.


I suggest calling the customer service # on the back of your insurance card and asking:
- What are my mental health benefits, if any?
- (If you are interested in couples therapy) Do I have coverage for marriage and family therapy services?
- Do I have out-of-network coverage?
- What is the coverage amount per session?
- How many therapy sessions does my plan cover?
- Do you only reimburse for certain diagnoses, procedure codes, and/or session lengths?
- How do I obtain insurance reimbursement?
- Is approval required from my primary care physician prior to receiving therapy services?
- Do I have coverage for telehealth ( video) appointments?


For the initial appointment, I recommend 80 minutes, in order to give us sufficient time for some beginning housekeeping and our initial getting to know each other. Particularly for couples, I find 80 minutes far more effective for our first session. From there, individual and couples counseling can be either 50 or 80 minutes depending on your preference. For couples counseling, I do recommend that we devote 80 minutes for our fourth session together, when we are have a more intensive conversation on your goals for counseling. Ideally, we will find a standing weekly time for our meetings. The length of counseling can really vary depending on your interest and needs. Individual counseling can be anywhere from five sessions to years of working together weekly, depending on what you’re looking for. Similarly, couples sometimes want to focus more briefly on a very specific change in their lives (such as a move, illness, etc) and how it’s impacting their relationship which can be done sometimes in 4-5 sessions, and other times couples want to work on one or more longer standing patterns in their communication or conflict which can take more like 8-12 sessions of focused work, or more. Prepare/Enrich premarital counseling can be about 5-10 sessions, and it can evolve into more long-term couples counseling if you desire.


Yes! Pre-crawling babies are always welcome.


I use SimplePractice, a HIPAA-compliant video platform that is free. You don't need to download anything. You will receive an e-mailed appointment reminder in advance of our appointment, with a link to the session. You will need a private space away from others, high speed wifi (this internet is generally more reliable than mobile data) and a device with a camera. Video sessions can be a little awkward at first, but I find people adjust to them and they can sometimes have added benefits of convenience or comfort. I'd like to help make video sessions as comfortable and effective for you as possible, and there are lots of ways we can make small adjustments, so let's be in conversation on this. Please note that by law you must be in WA state for our sessions, because I am only licensed to practice here.


Counseling is a broader term, meaning using any therapeutic technique that assists with someone's mental, emotional or behavioral problems. Psychotherapy is a more specific term that means diagnosing and treating a person with a mental health disorder. Although I can and do sometimes assess clients for disorders to gain clarity on your clinical picture and ensure I am providing you the best treatment or referring you to the appropriate provider, it's not integral to my approach. You may or may not meet "criteria" for a diagnosis, and I prefer to see you as a whole, complex person rather than summed up in any way by a diagnosis.


Sarah Crane O’Neill PLLC (206) 339-3641 NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. I. MY PLEDGE REGARDING HEALTH INFORMATION: I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to: Make sure that protected health information (“PHI”) that identifies you is kept private. Give you this notice of my legal duties and privacy practices with respect to health information. Follow the terms of the notice that is currently in effect. I can change the terms of this Notice, and such changes will apply to all information I have about you. I will notify you that I have changed the terms, provide you a copy of the new Notice, and request that you sign it. II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU: The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories. For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your person health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another. Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION: Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For my use in treating you. b. For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For my use in defending myself in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others. Marketing Purposes. As a clinical social worker, I will not use or disclose your PHI for marketing purposes. Sale of PHI. As a clinical social worker, I will not sell your PHI in the regular course of my business. IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons: When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety. For health oversight activities, including audits and investigations. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so. For law enforcement purposes, including reporting crimes occurring on my premises. To coroners or medical examiners, when such individuals are performing duties authorized by law. For research purposes, including studying and comparing the mental health of patients who received one form of counseling versus those who received another form of counseling for the same condition. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions. For workers' compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers' compensation laws. Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer. V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations. VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI: The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. The Right to Choose How I Send PHI to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost based fee for doing so. The Right to Get a List of the Disclosures I Have Made.You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it. EFFECTIVE DATE OF THIS NOTICE This notice went into effect on April 10, 2019. Acknowledgement of Receipt of Privacy Notice Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices. BY CLICKING ON THE CHECKBOX BELOW I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.


I require at least 48 hours notice (by email or phone) for session cancellation, unless it is due to illness in which case I waive the cost. If you give less than 48 hours notice and it is not due to illness, I charge the full session fee.


Concerns or Complaints - If you are unhappy with your counseling for any reason, please talk to me about your concerns as soon as possible so that I can respond to them appropriately. I assure you that I will take such criticism seriously, and that I will work to treat your concerns with care and respect. If you believe I have behaved in an unprofessional or unethical manner, please advise me so that the problem can be clarified or resolved. If such discussion proves to be ineffective, or if you feel that I’ve been unwilling to listen and respond, you can contact the Department of Health, Health Systems Quality Assurance, P.O. Box 47877, Olympia, WA 98504-7877, ph: (360) 236-4700.


For individuals (not couples) who are fully vaccinated (I too am fully vaccinated), I offer outdoor "walk-and-talk" sessions. We meet at the Washington Park Arboretum in the Montlake neighborood of Seattle, a beautiful wooded park with a paved loop path that typically takes about 40-50 minutes to circle. I match your pace, we can stop and pause as you need, we do not need to wear masks unless you'd like to, and we talk just as we would in a therapy office or by telehealth (video). There are tremendous upsides to walking sessions: movement stimulates creativity and positive mood, nature is soothing and inspiring to many, and being in physical proximity but not face to face can feel more relaxed and authentic for some. Among the downsides are distractions around us, the possibility that what you say could be overheard by a passer-by, as well as the possibility that you or I would run into someone we know. For some with mobility or health issues, walking sessions are also too challenging or risky to be worthwhile. It can also be wet! With good rain gear, I find sessions in light or moderate rain can work just fine, but everyone is different. We can tallk together in advance about your preferences, including the possibility that we check in a couple hours before the session and pivot to telehealth if it's forecast to pour. Also if it seems hazardous in any way, such as very windy or icy, we will make a plan to meet by telehealth instead. If you are curious about walking sessions, I suggest we first have a phone or video conversation about it. We can talk about the pros and cons together and any of your questions or concerns, and I can assess whether this might be a good format for you. I have a release form for you to sign should we agree to try walk-and-talk sessions.

Dandelion Parachute Seed

January 2022 Update: I am currently full and not accepting new clients.



Have you (and your partner if seeking couples counseling) both read my website and think I could be a good fit for you? Wonderful, I look forward to hearing from you. The best way to inquire about my availability is e-mail (below). If you are interested, we can schedule a 10-15 minute phone or video call so you can get a feel for my style and ask me any questions before we schedule a session.


I find that for me, having one or more sessions together is the best way for me to assess our goodness of "fit" for working together. At the end of our first session, or our first 3-4 session-long assessment phase, if I don't believe I can meet your needs, I will explain this to you and find you appropriate referrals.



I am available for sessions Mondays and Wednesdays during business hours. I make every effort to respond to emails and phone calls within 24-48 hours Monday - Friday.


Email (preferred):

Phone: (206) 339-3641