Dr. Kara HokesClinical Psychologist · she, herWhen each day feels like a roller coaster, therapy can help you get off the ride.
I'm Dr. Kara Hokes, a clinical psychologist in Tacoma, Washington, with almost ten years of experience helping people adapt to hard circumstances: trauma, emotion dysregulation, anxiety, anger, and perinatal mental health. I work with veterans, first responders, survivors of sexual and domestic violence, and people of all backgrounds and cultures, over secure video.
Secure video across Washington State and PSYPACT states · $150 per session with a free 15-minute intro call · Most major insurance accepted
In crisis right now? Call or text 988, veterans press 1. This site isn't watched around the clock.
What to expect
The first session is 50 minutes by video and mostly listening. You share what you're comfortable sharing, I ask questions to understand the full picture, and by the end I'll tell you plainly whether I think I can help. If I'm not the right fit, I'll help you find someone who is.
Evidence-based treatment, culturally responsive care, and a partnership aimed at your goals.
I'm Kara. I'm a clinical psychologist with almost ten years of experience helping individuals adapt to challenging life circumstances. My specializations are trauma, emotion dysregulation, anxiety, anger, and perinatal mental health, and I work with first responders, healthcare workers, veterans, and individuals of all backgrounds and cultures.
I'm trained in evidence-based practices, meaning treatments with real research behind them: ACT, CBT, CPT, and DBT. And I believe culturally responsive care matters as much as the research, so every client I work with feels seen, respected, and heard. Therapy here is a partnership: you bring the goals, I bring the tools, and we work on both.
If you feel like each day is a roller coaster and you would like to get off of the ride, I'm here to help.
Credentials & Training
- PhD, Clinical Psychology
- Licensed Psychologist, Washington State (#61681733)
- PSYPACT Certified: telehealth across participating states
- Trained in ACT, CBT, CPT, and DBT
- Trauma-focused, strength-based, and feminist approaches
- Clinical supervision and consultation for other clinicians
You can verify license #61681733 yourself at the Washington State Department of Health license search.
Feel free to ask about qualifications and training experience; the 15-minute call is a good place for that.
The communities this practice is built around.
I see individuals and groups, ages teen to elder. Some communities come to me again and again, so I built the practice for them on purpose.
Veterans
Combat and non-combat trauma, military sexual trauma, and the transition home. Service habits like staying switched on and handling it alone can follow you long after the uniform comes off. You set the pace here, and you don't have to prove anything to belong.
Survivors of sexual violence
Whether it happened recently or years ago, whether you reported it or never told a soul. We go at your pace and in your words; you will never be pushed to tell more of the story than you're ready to tell.
Survivors of domestic violence
For people rebuilding after violence or control in a relationship, including those still untangling from it. Together we work on safety, the beliefs that relationship left behind, and what you want next. I can coordinate with advocates and hotlines if that would help.
People who have caused harm
If you've used violence or harmed a partner, and you want to stop, you're welcome here. This is honest, accountable work: understanding what drove the harm, then building relationships that are safe for everyone in them. Choosing to change is serious, and it's possible.
Queer and trans communities
Queer allied, trans-affirming care: for questioning, coming out, transitioning, or the ordinary reasons anyone comes to therapy. You shouldn't have to educate your own therapist about your life before the real work can start.
People of color and under-represented groups
Racial-justice allied and culturally responsive, with respect for what your communities have carried. Immigrants, refugees, people of color, elders, and anyone whose experience keeps getting misread in a therapy room: you belong here.
Every group above is welcome to the same free 15-minute consultation. If you don't see yourself here, ask anyway.
The treatments I practice, and what each one actually involves.
These are the approaches listed on my profile, and the first four carry serious research behind them. That doesn't make any of them a default. In our first sessions we'll look at your history and what you want out of therapy, then choose together. If something isn't working after a fair trial, we change course. You'll always know why we're doing what we're doing.
A structured protocol for PTSD, and the one with the strongest evidence in veterans and survivors of assault. We examine the beliefs trauma leaves behind about safety, trust, control, and intimacy. Writing is part of the work, and most people finish in about twelve sessions.
Skills for emotions that arrive at full volume: distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness. DBT is the standard treatment for emotion dysregulation and borderline personality disorder, and its skills reach well past that diagnosis.
Rather than fighting painful thoughts, ACT teaches you to notice them, make room for them, and put your energy into what you actually value. The aim is a life that carries its hard feelings and still moves toward what matters to you.
Thoughts, feelings, and behaviors feed each other. CBT maps the loops, tests the predictions behind them, and builds practical skills you keep for life. Structured, active, and usually time-limited.
Trauma-focused means the treatment faces the trauma directly instead of circling it. Depending on your history that can mean telling the story, working with memories in smaller doses, or processing beliefs one at a time, always at a pace your nervous system agrees to.
Your culture, language, faith, and community shape what healing means and what help should look like. I practice culturally responsive care, where every client feels seen, respected, and heard, and I stay curious about what I don't know.
Feminist therapy names the real forces that shape your life: gender, power, and the messages you were handed about both. The relationship is collaborative and the goals are yours. It suits survivors of violence especially well, because it treats you as the expert on your own life.
You've survived everything that has happened so far, and that took skill, whether anyone ever named it or not. Strength-based work starts from what already works in you and builds from there, instead of treating you like a list of problems.
What people bring me, named plainly.
These match the concerns I treat most. This list is only a starting point: if what you're carrying isn't on it, reach out anyway.
Feeling on edge? Start here.
This is the first skill I teach most people who start with me over video. A slow, even exhale is the clearest signal you can send a revved-up nervous system that the emergency is over.
The widget carries the three breathing patterns I hand out most. Box breathing for steadying a jumpy system. 4-7-8 when the problem is falling asleep. An even five-in, five-out pace if the holds make you antsy. Below it sits a second tool, 5-4-3-2-1, for the times when breathing alone doesn't reach. There's no wrong way to do any of this: if the counts feel tight, make them smaller and work up.
One honest note: breathing exercises don't replace therapy, and they work best as practice, not rescue. If you're in crisis, call or text 988. This tool is for the hard minutes in between.
Even and symmetrical. My default for steadying a jumpy system.
Four counts in. Hold four. Four counts out. Hold again.
Most people notice a shift within two to four rounds.
5-4-3-2-1 senses
Step 1 of 5The other tool I teach. Name what your senses pick up, one sense at a time. It pulls attention out of the past and into the room.
Name five things you can see.
Look around slowly. Colors, edges, and small details all count.
What working together actually looks like.
Most people have never done therapy before, so here's the usual path from start to finish. We'll adjust it as we learn more about you.
Every session happens over secure video: the same evidence-based care, wherever in Washington you are.
Sessions and groups
I see individuals and groups. $150 per session, most weekdays, 9am to 5pm Pacific. If you don't see an open spot on the calendar, reach out anyway; schedules shift.
- Step 01
Free Consultation
A free 15-minute phone call. You tell me what's going on in a sentence or two, I tell you how I work, and we both get a feel for whether this is the right match. No fee, no obligation.
- Step 02
Collaborative Assessment
The first few sessions are for understanding, not diagnosing. We map your history, your goals, and what safety feels like for you. If a formal diagnosis would help (some insurance plans require one), I'll explain exactly what it means before anything goes in your file.
- Step 03
Active Treatment
We pick the approach that fits: CPT, DBT, ACT, CBT, or a blend. Before any deep processing, we build stabilization, which means real skills for grounding, sleep, and getting through the hard days. Then we work at a pace you can actually handle.
- Step 04
Integration & Growth
Therapy should end. When symptoms quiet down, we space out sessions, review what you've learned, and make a plan for the triggers that might still show up. Most people finish somewhere between six months and two years.
Books I find myself recommending.
No book replaces therapy, but the right one can help you feel understood between sessions. These are the four I reach for most, plus free resources I trust for veterans, survivors, and queer and trans folks.
The Body Keeps the Score
Bessel van der Kolk
The classic on how trauma lives in the body. Dense in places, and worth the effort.
Find it on Bookshop.org
Transforming the Living Legacy of Trauma
Janina Fisher
A workbook, not a lecture. Gentle exercises for the days when therapy feels like too much.
Find it on Bookshop.org
What My Bones Know
Stephanie Foo
A memoir of complex PTSD. Clients tell me it's the first time they saw themselves on the page.
Find it on Bookshop.org
It Didn't Start with You
Mark Wolynn
On how family pain echoes forward. I suggest it when the history predates you.
Find it on Bookshop.orgFree, reliable online resources
- ptsd.va.govVA National Center for PTSD
Treatment explanations, self-help tools, and a treatment decision aid. Built for veterans, useful to anyone with PTSD.
- nimh.nih.govNational Institute of Mental Health
Plain-language fact sheets on PTSD, anxiety, and depression, reviewed by researchers.
- rainn.orgRAINN: National Sexual Assault Hotline
24/7 phone and chat support for survivors of sexual violence, plus practical guides on safety, reporting, and recovery.
- thehotline.orgNational Domestic Violence Hotline
24/7 phone, chat, and text support for anyone affected by domestic violence, with quiet, judgment-free safety-planning tools.
- thetrevorproject.orgThe Trevor Project
Crisis support and community for LGBTQ+ young people, staffed around the clock by counselors who get it.
The book links open Bookshop.org, which supports independent bookstores. I don't receive anything for recommending any of this. They're on the list because they've helped people I've worked with.
What care costs, and who helps pay for it.
Money questions deserve straight answers, especially when you're already carrying a lot. Here is every plan I accept, what sessions cost if you're paying yourself, and the honest limits, so nothing about cost catches you by surprise.
Plans I accept16
Listed exactly as they appear in my practice profile. Cigna EAP stands for Employee Assistance Program; if your employer offers one, sessions may be covered. I'm licensed in Washington State, so insurance covers clients who live here, and before we start I'll check your benefits with you so nothing about cost comes as a surprise.
If you don't use insurance
Sessions & sliding scale
Sessions are $150 per 50-minute session. If you're uninsured and money is what's keeping you from care, email me and we'll talk about sliding-scale options (a lower fee based on what you can afford); that's a door I keep open on purpose.
Good Faith Estimate
If you're paying without insurance, federal law gives you the right to a Good Faith Estimate of what care is expected to cost. Ask me any time and I'll write one for you.
TriCare, VA, or CHAMPVA?
I'm not in-network with any of them, so I won't be the right billing fit there. If you also carry a civilian plan from the list above, I can take that. Vet Centers provide free counseling to veterans and their families, and ptsd.va.gov can help you find one.
The longer answer is in the questions belowSorting out cost shouldn't be the hard part. Bring your benefits questions to the free 15-minute consultation and we'll sort out what makes sense. Book one below.
Prefer email? karahokes@gmail.com. A sentence is plenty; I read every message myself.
Start with a free 15-minute phone call.
Tell me a little about what's going on. You don't need the right words; a sentence or two is enough. I read every message myself and reply within two business days.
Immediate availability most weeks. First openings usually come up within the next one to two weeks; reach out by email or phone to schedule.
Reach the practice
- Emailkarahokes@gmail.com
- Phone(253) 893-3585
- LocationAvailable online only
Based in Tacoma, WA 98498 - HoursMost weekdays, 9am to 5pm Pacific
Video sessions and replies - Fees$150 per session · Free 15-minute intro call
Most major insurance accepted · Sliding scale by email - Keep these detailsSave a contact card to your phone
The contact card carries the phone number, email, and hours. Insurance details are in their own section above, and I'm glad to talk any of it through on the intro call.
Where I can see you
The short version: every session is video, and geography is mostly a licensing question.
- Washington State: I'm licensed here, so clients living anywhere in WA, Seattle to Spokane, can use the insurance plans I accept.
- Beyond Washington: I'm PSYPACT certified, which lets me see private-pay clients in 40-plus participating states at the same $150 per session. Check the list:
PSYPACT participating states
Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.
The authoritative, current list lives at psypact.org.
If we meet by video
Every session happens this way, so here's exactly what the setup looks like.
- The link: a private video address I send the morning of your session. It opens in your browser; no account, no download.
- What helps: a room where you can close the door, headphones if you have them, and a connection steady enough for video. A phone works in a pinch.
- Privacy: the platform is HIPAA-compliant, the call is encrypted, and nothing is recorded, either side.
- Backup plan: if video drops, we finish the session on the phone. We agree on the number before the first session, so a bad connection never costs you the hour.
If you're in crisis
If you're in immediate danger, please call 988 (Suicide & Crisis Lifeline) or 911, or go to your nearest emergency room.
Veterans: call 988 and press 1 for the Veterans Crisis Line. If someone is hurting you at home: 1-800-799-7233 (National Domestic Violence Hotline). For sexual assault support, any hour: 1-800-656-4673 (RAINN).
This form isn't monitored around the clock, so please don't use it for emergencies.
A few basics, then anything you'd like me to know. Take your time.
$150 per 50-minute session. The 15-minute intro call is free, most major insurance is accepted, and sliding-scale options exist if you're paying without insurance.
What you write here goes to my practice email only. It's not added to any list and it's not shared. Please leave out anything you'd rather say out loud first; a sentence or two is plenty to start.
After you send this
The whole path, so nothing about it is a surprise.
It comes straight to me.
Your note lands in my practice inbox. I read every message myself; there is no assistant in between.
I reply within two business days.
The reply comes from karahokes@gmail.com. If nothing has arrived by then, check spam, then call the practice.
We talk for 15 minutes, free.
You ask what you want; I explain how I work and what treatment could look like. If I'm not the right fit, I'll say so and suggest someone who is.
Before the intro call
You don't need to prepare anything for a 15-minute phone call. If a little structure helps you feel steady, this is the whole list.
Nothing needed yet.
Referring a patient to me.
You know the referral only works if the patient actually lands. Here's the whole picture so you can decide quickly whether I'm the right place, and what happens after you send someone.
Who lands well with me
Teens, adults, and elders 65+ by secure video, as individuals or in groups. The core of my practice is trauma and PTSD, emotion dysregulation, sexual abuse recovery, and domestic violence, with CPT, DBT, ACT, and CBT as the main tools. Veterans and first responders, survivors of violence, and people who have caused harm and want to stop are groups I work with often.
Who I refer elsewhere
Young children: I'll point you to colleagues who specialize in child and adolescent work. Anyone in immediate danger: 988 or 911 first, therapy after things are stable. Medication-first needs: psychologists don't prescribe in Washington, so I coordinate with a prescriber rather than replace one.
The practical part
Online-only across Washington State, plus PSYPACT states for private-pay clients. 16 insurance plans including Aetna, Premera, Medicare, and Regence; the full list is in the Insurance & Fees section above. $150 per session with sliding-scale options. Immediate availability most weeks, so first openings usually land within a week.
Making the handoff warm
The fastest path is the patient calling (253) 893-3585 or using the form below; a warm handoff from you still beats a cold directory listing. If you'd rather brief me first, email me and put "referral" in the subject line. Include a release of information with your paperwork and I'll take it from there.
Closed loop, on purpose. With your patient's written consent, I'll send you a short update after the first session and again at milestones, so the referral doesn't just vanish after the handoff. Include a release of information with your paperwork and that part runs itself.