Photo of Leah M. Manders, Clinical Social Work/Therapist, LCSW
Leah M. Manders
Clinical Social Work/Therapist, LCSW
Verified Verified
Online Only
My name is Leah Manders, I'm a Licensed Clinical Social Worker. I provide virtual short and long-term talk therapy for adolescents, adults, and older individuals facing a range of behavioral, self-esteem, interpersonal, trauma, and addiction challenges. I use a generalist approach- which means I draw from a variety of therapy frameworks, including strength-based, dialectical therapy, and parts work; I try to tailor my approach to each, unique person I work with, depending on their individual needs. My aim is to create a safe, comfortable space to explore and learn useful tools that reduce and resolve emotional/psychological pain.
My name is Leah Manders, I'm a Licensed Clinical Social Worker. I provide virtual short and long-term talk therapy for adolescents, adults, and older individuals facing a range of behavioral, self-esteem, interpersonal, trauma, and addiction challenges. I use a generalist approach- which means I draw from a variety of therapy frameworks, including strength-based, dialectical therapy, and parts work; I try to tailor my approach to each, unique person I work with, depending on their individual needs. My aim is to create a safe, comfortable space to explore and learn useful tools that reduce and resolve emotional/psychological pain.
(716) 354-3133 View (716) 354-3133
Photo of Lauren Conley, Clinical Social Work/Therapist, LCSW-R, LCSW, CCTP
Lauren Conley
Clinical Social Work/Therapist, LCSW-R, LCSW, CCTP
Verified Verified
Online Only
Waitlist for new clients
Welcome! I have been a clinical therapist for 20 years and specialize in trauma, anxiety and relationship issues, with licensure in Washington DC, New York, and North Carolina. I have experience in various treatment approaches to ensure that your goals are being prioritized at your pace. In my professional career, I have been privileged to work with many people to achieve a level of stability, progress, and peace of mind that they never thought possible.
Welcome! I have been a clinical therapist for 20 years and specialize in trauma, anxiety and relationship issues, with licensure in Washington DC, New York, and North Carolina. I have experience in various treatment approaches to ensure that your goals are being prioritized at your pace. In my professional career, I have been privileged to work with many people to achieve a level of stability, progress, and peace of mind that they never thought possible.
(716) 671-3365 View (716) 671-3365
Photo of Nora McNally, Counselor, LMHC
Nora McNally
Counselor, LMHC
Verified Verified
Online Only
My ideal clients are people who are experiencing patterns of what they consider failure in their relationships, behaviors, potential or self-esteem; who see themselves as frozen, trapped, isolated or hopeless about their ability to create a positive future. Such people generally benefit from increased self-esteem and insight, as well as a healthier perspective around self-defeating behavior cycles and belief systems. I find that clients are looking for genuine connections and the feeling that they are a loved, respected, and contributing human being.
My ideal clients are people who are experiencing patterns of what they consider failure in their relationships, behaviors, potential or self-esteem; who see themselves as frozen, trapped, isolated or hopeless about their ability to create a positive future. Such people generally benefit from increased self-esteem and insight, as well as a healthier perspective around self-defeating behavior cycles and belief systems. I find that clients are looking for genuine connections and the feeling that they are a loved, respected, and contributing human being.
(716) 396-6531 View (716) 396-6531
Photo of Bridget E. Hillery, Counselor, LMHC, CASAC
Bridget E. Hillery
Counselor, LMHC, CASAC
Verified Verified
Online Only
Waitlist for new clients
Life’s challenges and pressures can leave us feeling exhausted and overwhelmed, but with the right support, we can emerge stronger and more resilient than before. Resilience isn’t something we’re born with—it’s something we can build and strengthen over time, which is pretty amazing!
Life’s challenges and pressures can leave us feeling exhausted and overwhelmed, but with the right support, we can emerge stronger and more resilient than before. Resilience isn’t something we’re born with—it’s something we can build and strengthen over time, which is pretty amazing!
(716) 320-7959 View (716) 320-7959
Photo of Amanda Zepeda, Mental Health Counselor, LMHC
Amanda Zepeda
Mental Health Counselor, LMHC
Verified Verified
Online Only
Waitlist for new clients
As a therapist, I believe that people are not defined by their problems, but by their potential to create meaningful change. My approach is rooted in Solution-Focused Brief Therapy (SFBT), a model that empowers clients to identify strengths, build on what is already working, and move toward practical solutions. Rather than dwelling on past struggles, I help individuals and families focus on the future they want to create and the small steps that will get them there. I recognize that each person who walks into my practice already possesses skills, experiences, and resilience that can serve as building blocks for progress.
As a therapist, I believe that people are not defined by their problems, but by their potential to create meaningful change. My approach is rooted in Solution-Focused Brief Therapy (SFBT), a model that empowers clients to identify strengths, build on what is already working, and move toward practical solutions. Rather than dwelling on past struggles, I help individuals and families focus on the future they want to create and the small steps that will get them there. I recognize that each person who walks into my practice already possesses skills, experiences, and resilience that can serve as building blocks for progress.
(716) 431-3860 View (716) 431-3860
Photo of Melissa Babiarz, Counselor, MA, LMHC
Melissa Babiarz
Counselor, MA, LMHC
Verified Verified
Online Only
I have been providing addiction and mental health services in the WNY community since 1999. I've worked in a variety of settings starting at local agencies eventually advancing into administration. In 2010 I made the decision to step out of that role and into Private Practice. I am an educator and community trainer. I've had the privilege of working with countless individuals and their families as they address their struggles and reached their triumphs battling various addictions and healing their Trauma. I am insightful, direct and never judgmental.
I have been providing addiction and mental health services in the WNY community since 1999. I've worked in a variety of settings starting at local agencies eventually advancing into administration. In 2010 I made the decision to step out of that role and into Private Practice. I am an educator and community trainer. I've had the privilege of working with countless individuals and their families as they address their struggles and reached their triumphs battling various addictions and healing their Trauma. I am insightful, direct and never judgmental.
(716) 557-7945 View (716) 557-7945
Photo of Juanita L Green-Johnson, Counselor, MS, LMHC
Juanita L Green-Johnson
Counselor, MS, LMHC
Verified Verified
Buffalo, NY 14216
Not accepting new clients
The beautiful anomaly of therapy is it is something that everyone can use yet what one needs and finds beneficial is different for everyone. As a provider, I utilize a person-centered approach because I believe counseling should be individualized. The working relationship between client and therapist is something that can be transformative both inside and outside of the office.
The beautiful anomaly of therapy is it is something that everyone can use yet what one needs and finds beneficial is different for everyone. As a provider, I utilize a person-centered approach because I believe counseling should be individualized. The working relationship between client and therapist is something that can be transformative both inside and outside of the office.
(716) 296-6494 View (716) 296-6494
Photo of Thea Fouskaris, Clinical Social Work/Therapist, LCSW-R
Thea Fouskaris
Clinical Social Work/Therapist, LCSW-R
Verified Verified
1 Endorsed
Online Only
If you’ve been feeling overwhelmed by emotions or disconnected from yourself or your life, you’re not alone. The good news is that everything you need to heal is already within you. Therapy offers a chance to explore your life from a holistic perspective—looking both inward and outward, reflecting on your past and present—to foster healing and growth. I’m here to listen and provide the tools and guidance you need to navigate this journey.
If you’ve been feeling overwhelmed by emotions or disconnected from yourself or your life, you’re not alone. The good news is that everything you need to heal is already within you. Therapy offers a chance to explore your life from a holistic perspective—looking both inward and outward, reflecting on your past and present—to foster healing and growth. I’m here to listen and provide the tools and guidance you need to navigate this journey.
(716) 217-6925 View (716) 217-6925
Photo of Nicole L Jordan, Clinical Social Work/Therapist, LCSW
Nicole L Jordan
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Online Only
Hello! I'm Nicole Jordan, proprietor of Kaleidoscope Living. I am a dedicated and compassionate therapist, committed to creating a safe, genuine, and non-judgmental space to explore individual's thoughts, feelings, reactions, and behaviors. Acceptance, kindness, and respect forms the foundation of my practice. I have been providing therapy for over a decade, working with many diverse and amazing individuals. People choose therapy for many reasons, managing life transitions, dealing with relationship issues, or overcoming anxiety and depression. I'm here to guide and support you as you navigate through these challenging paths.
Hello! I'm Nicole Jordan, proprietor of Kaleidoscope Living. I am a dedicated and compassionate therapist, committed to creating a safe, genuine, and non-judgmental space to explore individual's thoughts, feelings, reactions, and behaviors. Acceptance, kindness, and respect forms the foundation of my practice. I have been providing therapy for over a decade, working with many diverse and amazing individuals. People choose therapy for many reasons, managing life transitions, dealing with relationship issues, or overcoming anxiety and depression. I'm here to guide and support you as you navigate through these challenging paths.
(716) 321-0925 View (716) 321-0925
Photo of Jen Kilpatrick, Counselor, LMHC
Jen Kilpatrick
Counselor, LMHC
Verified Verified
2 Endorsed
Online Only
Not accepting new clients
Hi! I'm Jen! I am a queer, neurodivergent (ADHD) therapist. I am sex/kink affirming, sex-work positive, cannabis friendly, gender affirming, & ND affirming. I'm an Integrative psychotherapist with focus in attachment & C-PTSD and it's impact on our relationships with ourselves & the world around us. I use inner child work, brain based & emotion focused skills with my clients. My focus at first though is building a safe space with you- free of judgment and filled with unconditional positive regard. My clients typically suffer with shame so being someone you trust is important to me.
Hi! I'm Jen! I am a queer, neurodivergent (ADHD) therapist. I am sex/kink affirming, sex-work positive, cannabis friendly, gender affirming, & ND affirming. I'm an Integrative psychotherapist with focus in attachment & C-PTSD and it's impact on our relationships with ourselves & the world around us. I use inner child work, brain based & emotion focused skills with my clients. My focus at first though is building a safe space with you- free of judgment and filled with unconditional positive regard. My clients typically suffer with shame so being someone you trust is important to me.
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Photo of Chelsey M. Canfield, Clinical Social Work/Therapist, LCSW
Chelsey M. Canfield
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Buffalo, NY 14216
We find ourselves at times stuck, reliving our worst moments or struggling to make sense of how we feel. No matter your age, healing from trauma requires compassion and a person centered perspective. With a specialty in adolescent, young adult and family therapy, I am here to guide the healing process and provide the support necessary to build a more positive future for you or your family.
We find ourselves at times stuck, reliving our worst moments or struggling to make sense of how we feel. No matter your age, healing from trauma requires compassion and a person centered perspective. With a specialty in adolescent, young adult and family therapy, I am here to guide the healing process and provide the support necessary to build a more positive future for you or your family.
(716) 588-4563 View (716) 588-4563
Photo of Tracy Welch, Counselor, LMHC
Tracy Welch
Counselor, LMHC
Verified Verified
1 Endorsed
Online Only
It’s morning and your alarm is going off. You think, "no, I just fell asleep!". Then your thoughts start to race, your heart is beating really fast and it is hard to breathe. You don't want to get out of bed, but if you don’t you know you will feel worse, as if that is even possible! Somewhere, at some point, something happened and your world started feeling chaotic and overwhelming, and since then, you've been surviving on auto pilot and doing your best not to fall apart. If this is you and you want to feel better, allow me to help.
It’s morning and your alarm is going off. You think, "no, I just fell asleep!". Then your thoughts start to race, your heart is beating really fast and it is hard to breathe. You don't want to get out of bed, but if you don’t you know you will feel worse, as if that is even possible! Somewhere, at some point, something happened and your world started feeling chaotic and overwhelming, and since then, you've been surviving on auto pilot and doing your best not to fall apart. If this is you and you want to feel better, allow me to help.
(716) 321-5198 View (716) 321-5198
Photo of Melissa Anne Muldoon, Clinical Social Work/Therapist, LCSW
Melissa Anne Muldoon
Clinical Social Work/Therapist, LCSW
Verified Verified
Online Only
I value a non-judgemental approach over all else and will offer you unconditional positive regard. My treatment modality focus is on motivational interviewing & a client-centered approach. As your therapist it's my job to guide you while remembering that you are the expert in your own life. I can offer advice on coping strategies, mindfulness, and guide you through cognitive-behavioral therapy techniques. No matter what you have experienced, survived, or done, you are worthy & valuable. I believe in encouraging clients to work through feelings of shame that can be pervasive and devastating to their lives.
I value a non-judgemental approach over all else and will offer you unconditional positive regard. My treatment modality focus is on motivational interviewing & a client-centered approach. As your therapist it's my job to guide you while remembering that you are the expert in your own life. I can offer advice on coping strategies, mindfulness, and guide you through cognitive-behavioral therapy techniques. No matter what you have experienced, survived, or done, you are worthy & valuable. I believe in encouraging clients to work through feelings of shame that can be pervasive and devastating to their lives.
(716) 303-4093 View (716) 303-4093
Photo of Emily Ets-Hokin, Psychologist, PhD, ABPP
Emily Ets-Hokin
Psychologist, PhD, ABPP
Verified Verified
Buffalo, NY 14216
I am a licensed clinical psychologist and psychoanalyst with over 30 years of experience in solo private practice, teaching and service in the community. Having a relationship with my patients and taking care of them are central in my work. Perhaps because of my background in the arts (dance), I also deeply value the creative yet disciplined use of self and an active authentic engagement in the therapeutic process. I specialize in the treatment of adolescents and young adults (18-25). I also treat individuals, couples, and families who struggle with transitional issues throughout the life cycle.
I am a licensed clinical psychologist and psychoanalyst with over 30 years of experience in solo private practice, teaching and service in the community. Having a relationship with my patients and taking care of them are central in my work. Perhaps because of my background in the arts (dance), I also deeply value the creative yet disciplined use of self and an active authentic engagement in the therapeutic process. I specialize in the treatment of adolescents and young adults (18-25). I also treat individuals, couples, and families who struggle with transitional issues throughout the life cycle.
(716) 514-9113 View (716) 514-9113
Photo of Mary Sandner, Clinical Social Work/Therapist, LCSW
Mary Sandner
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Online Only
You only get to live your life once, and I believe that it should be one that you feel is 100% worth living for. This simple thought guides my approach to therapy. Pain and suffering are part of the human experience, and while we may not be able to avoid these all the time, we can surely build a meaningful life around these things. A life that has purpose, direction, and is guided by your deeply held values. My goal is to empower individuals to discover ways to reduce their overall suffering, align with personal values, learn healthy ways to cope with pain, and create a life that feels abundantly worth living for every day
You only get to live your life once, and I believe that it should be one that you feel is 100% worth living for. This simple thought guides my approach to therapy. Pain and suffering are part of the human experience, and while we may not be able to avoid these all the time, we can surely build a meaningful life around these things. A life that has purpose, direction, and is guided by your deeply held values. My goal is to empower individuals to discover ways to reduce their overall suffering, align with personal values, learn healthy ways to cope with pain, and create a life that feels abundantly worth living for every day
(716) 320-7816 View (716) 320-7816
Photo of Nancy Marie Kells - Nancy M. Kells, LCSW, Clinical Social Work/Therapist, LCSW, MEd
Nancy M. Kells, LCSW
Clinical Social Work/Therapist, LCSW, MEd
Verified Verified
Online Only
Before being a therapist, I was a patient struggling with an eating disorder, depression and a history of trauma. I've been in your shoes. Therapy transformed my life, and it can do the same for you. It is an exciting and challenging opportunity; a springboard into a meaningful, confident and fulfilling life. The goals you set for therapy will be met as long as you stay in treatment. You can change your life. The secrets: 1. Resolve the causes of your struggles for permanent change and never give up! Best of luck!
Before being a therapist, I was a patient struggling with an eating disorder, depression and a history of trauma. I've been in your shoes. Therapy transformed my life, and it can do the same for you. It is an exciting and challenging opportunity; a springboard into a meaningful, confident and fulfilling life. The goals you set for therapy will be met as long as you stay in treatment. You can change your life. The secrets: 1. Resolve the causes of your struggles for permanent change and never give up! Best of luck!
(716) 354-1983 View (716) 354-1983
Photo of Alia Healy Cross, Counselor, MS, LMHC
Alia Healy Cross
Counselor, MS, LMHC
Verified Verified
1 Endorsed
Buffalo, NY 14216
Due to licensing rules, I can only see New York clients! I am empathetic when working with diverse, adult populations facing situational & mental health challenges. I've been on both sides of "the therapy couch" as a Survivor with Bipolar I Disorder & as a counselor. I completed my internship assisting Survivors of Domestic Violence & have a great deal of knowledge about Healthy Relationships vs Unhealthy ones. I'm comfortable helping folks facing anxiety, depression, psychosis & trauma. I can assist in clarifying achievable goals & I can build trust. It's an honor to be able to help others navigate the curveballs life will throw!
Due to licensing rules, I can only see New York clients! I am empathetic when working with diverse, adult populations facing situational & mental health challenges. I've been on both sides of "the therapy couch" as a Survivor with Bipolar I Disorder & as a counselor. I completed my internship assisting Survivors of Domestic Violence & have a great deal of knowledge about Healthy Relationships vs Unhealthy ones. I'm comfortable helping folks facing anxiety, depression, psychosis & trauma. I can assist in clarifying achievable goals & I can build trust. It's an honor to be able to help others navigate the curveballs life will throw!
(716) 458-7887 View (716) 458-7887
Photo of Mary-Lucinda Palmieri, Clinical Social Work/Therapist, LCSW
Mary-Lucinda Palmieri
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Buffalo, NY 14216
Hello! I am a Licensed Clinical Social Worker (LCSW). I have worked with many individuals with a wide range of unique presenting problems. I like to call myself an eclectic therapist in the sense that I incorporate multiple models during our time together. I am open to working with clients and/or couples who are ready and willing to do the work! Although it may be hard, it will soon be worth it. I would be a good fit for you if you want to be challenged and gain new insight about yourself. I emphasize and value the therapeutic relationship and work with clients to establish rapport and a clear sense of goals!
Hello! I am a Licensed Clinical Social Worker (LCSW). I have worked with many individuals with a wide range of unique presenting problems. I like to call myself an eclectic therapist in the sense that I incorporate multiple models during our time together. I am open to working with clients and/or couples who are ready and willing to do the work! Although it may be hard, it will soon be worth it. I would be a good fit for you if you want to be challenged and gain new insight about yourself. I emphasize and value the therapeutic relationship and work with clients to establish rapport and a clear sense of goals!
(716) 296-4313 View (716) 296-4313
Photo of Samantha Jakubowski, Counselor, LMHC, M-CASAC
Samantha Jakubowski
Counselor, LMHC, M-CASAC
Verified Verified
Online Only
Hi! I have been practicing addiction counseling for over 15 years, working with individuals, young adults and families. I expanded my practice to include mental health for the last 10 years and most recently began focusing on law enforcement/first responders. I work with individuals to determine what their goals are and help them achieve them. Individuals who are serious about their recovery and goals would be a great fit. Only you can change your future!
Hi! I have been practicing addiction counseling for over 15 years, working with individuals, young adults and families. I expanded my practice to include mental health for the last 10 years and most recently began focusing on law enforcement/first responders. I work with individuals to determine what their goals are and help them achieve them. Individuals who are serious about their recovery and goals would be a great fit. Only you can change your future!
(585) 728-1937 View (585) 728-1937
Photo of Amanda Polino, Clinical Social Work/Therapist, LCSW-R
Amanda Polino
Clinical Social Work/Therapist, LCSW-R
Verified Verified
1 Endorsed
Buffalo, NY 14216
Not accepting new clients
* I am not accepting new clients at this time * Are you are a young woman struggling with daily anxiety? As a result you’re having problems in your relationships, work/school, or even daily tasks? If the stress you’re carrying is taking away today’s peace, you may benefit from learning specific tools to better manage each day. I treat woman dealing with anxiety, depression, low self-worth, life changes/stressors and relationship problems.
* I am not accepting new clients at this time * Are you are a young woman struggling with daily anxiety? As a result you’re having problems in your relationships, work/school, or even daily tasks? If the stress you’re carrying is taking away today’s peace, you may benefit from learning specific tools to better manage each day. I treat woman dealing with anxiety, depression, low self-worth, life changes/stressors and relationship problems.
(716) 650-5819 View (716) 650-5819
1

See more therapy options for 14216

How does your Therapist compare?

Number of Therapists in 14216

60+

Average cost per session

$135

Therapists in 14216 who prioritize treating:

97% Anxiety
94% Depression
85% Relationship Issues
83% Self Esteem
82% Coping Skills
78% Stress
69% Trauma and PTSD

Average years in practice

12 Years

Top 3 insurances accepted

64% Independent Health
58% Aetna
55% UnitedHealthcare UHC | UBH

How Therapists in 14216 see their clients

68% In Person and Online
32% Online Only

Gender breakdown

80% Female
19% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in 14216?

Search for nearby therapists or counselors by inputting your city, town, or suburb; or zip code; or a provider’s name into the search bar. From there, you can filter providers by the issues they treat, cost, insurance, gender, and other factors to find providers who are well-suited to your needs. To navigate between locations within the same country, enter a new city or zip code into the search bar.

Learn more about how to find a therapist

Is everyone in the Psychology Today Therapy Directory a licensed therapist?

The Psychology Today directory lists providers who offer legitimate mental health services to the public, including psychologists, psychiatrists, social workers, and counselors.

Many have been licensed by the country or state where they practice; providers whose license or primary credential has been verified by Psychology Today are signified by a “Verified” symbol. Some clinicians or organizations provide services for which their state or country does not offer licenses, such as pastoral counseling. They may be selectively included without the “Verified” seal.

What’s the difference between a psychologist, a therapist, and a counselor?

Therapists, psychologists, and counselors are all licensed mental health professionals. In the US, psychologists have earned a doctoral degree. The terms “therapist” and “counselor” are used somewhat interchangeably, but generally therapists offer longer-term, mental health care, while counselors offer shorter-term care that may focus on one domain, such as marriage, career, or academic challenges.

Clients should consider factors such as insurance coverage and their primary reason(s) for seeking therapy to determine the type of professional best suited to their needs. Someone struggling with mental health challenges such as depression or anxiety, for example, may wish to seek out a clinical psychologist or therapist, while someone navigating career obstacles or marital upheaval may benefit from seeing a counselor who can offer short-term, targeted support.

What type of therapy is right for me?

The type of therapy best suited to a particular individual depends on several factors, including their primary reason for seeking therapy, their preferred timeline (some therapy types last for a set number of sessions, while others are open-ended), and their personality and preferences—some may prefer a more structured approach. For many individuals, multiple types of therapy could provide a good fit.

How much does therapy cost?

The cost of therapy depends on a number of variables, including location and the therapist’s experience and training. On average, a therapy session in the United States could cost between $100 and $200 or more. If you have insurance, the expense of mental health care is typically lower, but it varies based on your insurance plan details and whether you choose an in-network or out-of-network mental healthcare provider.

What are more affordable or low cost therapy solutions?

Many therapists offer sliding scale payments, usually on a limited number of slots, which consists in an agreement between the therapist and a client to pay a reduced rate. Therapists who provide such arrangements often consider the client's income or ability to pay, but the extent of the discount is ultimately at the therapist's discretion. Furthermore, while group therapy may have different goals and benefits compared to individual therapy, it can be a more affordable solution to address certain types of issues.

Is online therapy cheaper than in-person therapy?

Many therapists charge the same amount for online therapy as they do for in-person therapy—though clients may still find this cost-effective if it cuts down on their transportation costs. Health insurance plans often offer equivalent coverage for online and in-person therapy; indeed, in many places, they are legally required to do so. Text-based or on-demand therapy apps may be cheaper than traditional one-on-one psychotherapy; however, the practice may be less effective and is not likely to be covered by insurance.

Is online therapy a good option?

Therapy conducted online can be just as effective as in-person therapy, as long as there is a strong alliance between the client and the therapist. To find a therapist who provides telehealth services to clients in your area, click “Online Therapy” on the directory homepage and search by your city or town or your zip code.

Are therapy sessions confidential?

Confidentiality is a crucial part of the therapeutic relationship. Therapists in the United States are bound by the regulations set out by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which aims to protect sensitive health information. With very few exceptions, a therapist will only discuss their client with others when the client has given their written permission. The instances in which a therapist would be required to disclose personal information are: if a client poses a danger to themselves or others, if the therapist suspects the abuse of a child or an elderly or otherwise dependent adult, or if they are legally forced to by court order. These exceptions to the confidentiality agreement are usually discussed with a client before their first session.