Photo of Jasmine Alvarado, Counselor in 49006, MI
Jasmine Alvarado
Counselor, MA, LLC
Verified Verified
1 Endorsed
Kalamazoo, MI 49006
I utilize varying approaches to make connections with children, teens, and adults. For children, I primarily used play-based approaches and see their play as their communication and understanding of the world around them. Working with teenagers, I used a mixed approach to allow communication and processing of their experiences. With adults I focus on what they hope to gain from working together and help them navigate their stressors in their life. I work to intentionally consider how we collaborate and connect to ensure your needs are being met. Call (269) 350-4143 to get started!
I utilize varying approaches to make connections with children, teens, and adults. For children, I primarily used play-based approaches and see their play as their communication and understanding of the world around them. Working with teenagers, I used a mixed approach to allow communication and processing of their experiences. With adults I focus on what they hope to gain from working together and help them navigate their stressors in their life. I work to intentionally consider how we collaborate and connect to ensure your needs are being met. Call (269) 350-4143 to get started!
(269) 256-1981 View (269) 256-1981
Photo of Curt G Bitman, Limited Licensed Psychologist in 49006, MI
Curt G Bitman
Limited Licensed Psychologist, MA, LLP
Verified Verified
2 Endorsed
Kalamazoo, MI 49006
My goal is for you to see the restoration of hope. It is my firm belief that your answers and truths are all within you. It is my desire to make sure that you discover those answers with clarity. Unleashing you potential is vital. Helping to open-up avenues of self-discovery and giving you resources to face life challenges is key. I would want to make sure that you navigate your challenges with a keen sense of focus and determination. Providing you with a sense of safety in getting you there without shame or guilt can be accomplished.
My goal is for you to see the restoration of hope. It is my firm belief that your answers and truths are all within you. It is my desire to make sure that you discover those answers with clarity. Unleashing you potential is vital. Helping to open-up avenues of self-discovery and giving you resources to face life challenges is key. I would want to make sure that you navigate your challenges with a keen sense of focus and determination. Providing you with a sense of safety in getting you there without shame or guilt can be accomplished.
(269) 281-5272 View (269) 281-5272
Photo of Mallory Bitzer, Clinical Social Work/Therapist in 49006, MI
Mallory Bitzer
Clinical Social Work/Therapist, LMSW, CAADC
Verified Verified
Kalamazoo, MI 49006
Brene Brown stated, “Authenticity is a collection of choices that we have to make every day. It’s about the choice to show up and be real. The choice to be honest. The choice to let our true selves be seen.” Being our authentic self is easier said than done, but it is totally worth it. To develop this, we need to embrace our strengths, explore our values, pay attention to our self-talk, notice our emotions, practice mindfulness, build a solid social support network, and face our fears. When we live authentically, we generate trust within ourselves and with others. This process can be difficult but is worth it.
Brene Brown stated, “Authenticity is a collection of choices that we have to make every day. It’s about the choice to show up and be real. The choice to be honest. The choice to let our true selves be seen.” Being our authentic self is easier said than done, but it is totally worth it. To develop this, we need to embrace our strengths, explore our values, pay attention to our self-talk, notice our emotions, practice mindfulness, build a solid social support network, and face our fears. When we live authentically, we generate trust within ourselves and with others. This process can be difficult but is worth it.
(269) 215-4029 View (269) 215-4029
Photo of Kim Powers, Counselor in 49006, MI
Kim Powers
Counselor, MA, LPC, CAADC, ADS, MITS
Verified Verified
3 Endorsed
Kalamazoo, MI 49006
Waitlist for new clients
Be proud of yourself for reaching out for help. Are you in need of a safe space to feel feelings, process hurt, and challenge yourself to grow? Do you have specific goals you want to address? Or not sure where to start? I believe sometimes the hardest things to talk about are the best things to talk about. I am honored to be featured in Voyage Magazine in the "Hidden Gems Series: Local Businesses and Creatives you should know." I want to help you identify, process, and express your thoughts, feelings, and concerns in a healthy way. You, too, can heal, grow, & learn. Let's work together to help you feel better & experience wellness.
Be proud of yourself for reaching out for help. Are you in need of a safe space to feel feelings, process hurt, and challenge yourself to grow? Do you have specific goals you want to address? Or not sure where to start? I believe sometimes the hardest things to talk about are the best things to talk about. I am honored to be featured in Voyage Magazine in the "Hidden Gems Series: Local Businesses and Creatives you should know." I want to help you identify, process, and express your thoughts, feelings, and concerns in a healthy way. You, too, can heal, grow, & learn. Let's work together to help you feel better & experience wellness.
(269) 355-6296 View (269) 355-6296
Photo of Gilbert R Paivarinta, Clinical Social Work/Therapist in 49006, MI
Gilbert R Paivarinta
Clinical Social Work/Therapist, LMSW, CAADC
Verified Verified
2 Endorsed
Kalamazoo, MI 49006
Hi there! Are you interested in learning how to effectively live your life the way you want to live it? You likely already have some of these skills. I can help you to identify these skills and maximize their benefits while offering you the individualized support you need at being successful in living how you want to live.  Managing stress, anxiety, depression and many other challenges that life can throw at you is my specialty. Learning to understand the ineffective processes of your negative patterns and reactions will offer you a new perspective.
Hi there! Are you interested in learning how to effectively live your life the way you want to live it? You likely already have some of these skills. I can help you to identify these skills and maximize their benefits while offering you the individualized support you need at being successful in living how you want to live.  Managing stress, anxiety, depression and many other challenges that life can throw at you is my specialty. Learning to understand the ineffective processes of your negative patterns and reactions will offer you a new perspective.
(269) 371-5690 View (269) 371-5690
Photo of Brandy Burnham, Limited Licensed Psychologist in 49006, MI
Brandy Burnham
Limited Licensed Psychologist, MA, LLP, LPC, NCC
Verified Verified
9 Endorsed
Kalamazoo, MI 49006
Even in the darkest of times hope can be found. There is always a reason to keep going! When your world is falling apart, and you feel that everything is stacked against you, a glimmer of hope can change your whole perspective. You are meant for more!
Even in the darkest of times hope can be found. There is always a reason to keep going! When your world is falling apart, and you feel that everything is stacked against you, a glimmer of hope can change your whole perspective. You are meant for more!
(269) 682-1043 View (269) 682-1043
Photo of Julia Erity, Clinical Social Work/Therapist in 49006, MI
Julia Erity
Clinical Social Work/Therapist, LLMSW
Verified Verified
1 Endorsed
Kalamazoo, MI 49006
Accepting the journey we've been on and the need for change can feel overwhelming. Often therapy is seen as a one sided conversation, let's change that narrative together. As your therapist, it is important to me to create a relationship where you feel safe and supported. We can explore what acceptance, healing, and growth means to you and create a plan to achieve those goals.
Accepting the journey we've been on and the need for change can feel overwhelming. Often therapy is seen as a one sided conversation, let's change that narrative together. As your therapist, it is important to me to create a relationship where you feel safe and supported. We can explore what acceptance, healing, and growth means to you and create a plan to achieve those goals.
(269) 557-0361 View (269) 557-0361
Photo of Jessica A Kerby, Psychologist in 49006, MI
Jessica A Kerby
Psychologist, PhD
Verified Verified
1 Endorsed
Kalamazoo, MI 49006
I enjoy working with individuals of all different backgrounds, but with a particular interest in women's issues, addictions, and family conflict. As your psychologist, I will seek to understand the challenges that you face and I will join you in developing and implementing a plan for personal growth.
I enjoy working with individuals of all different backgrounds, but with a particular interest in women's issues, addictions, and family conflict. As your psychologist, I will seek to understand the challenges that you face and I will join you in developing and implementing a plan for personal growth.
(269) 205-6339 View (269) 205-6339
Photo of Kristi Merrills, Clinical Social Work/Therapist in 49006, MI
Kristi Merrills
Clinical Social Work/Therapist, LCSW
Verified Verified
Kalamazoo, MI 49006  (Online Only)
Waitlist for new clients
I have a deep passion for community development, culture diversity and human connection. In my experience my clients know themselves better than anyone, they are their own best resource when it comes to choosing the right treatment for them. I see our time together as a joint venture, our knowledge combined creates the solutions and tools needed to uncover patterns and emotions they may not even be aware of. I know that no single approach is the right one for every individual. My role as a therapist is to support you to make choices that empower you, and help you explore and resolve your current predicaments, or diagnosis.
I have a deep passion for community development, culture diversity and human connection. In my experience my clients know themselves better than anyone, they are their own best resource when it comes to choosing the right treatment for them. I see our time together as a joint venture, our knowledge combined creates the solutions and tools needed to uncover patterns and emotions they may not even be aware of. I know that no single approach is the right one for every individual. My role as a therapist is to support you to make choices that empower you, and help you explore and resolve your current predicaments, or diagnosis.
(269) 231-4075 View (269) 231-4075
Photo of Kalamazoo Evidence Based Therapy in 49006, MI
Kalamazoo Evidence Based Therapy
PhD, LP
Verified Verified
Kalamazoo, MI 49006  (Online Only)
Kalamazoo Evidence Based Therapy (KEBT) is an individually owned practice bringing together therapists trained in and practicing evidence based therapy including cognitive behavior therapy (CBT), dialectical behavior therapy, (DBT), behavioral activation for depression, exposure-based therapies for anxiety, acceptance and commitment therapy (ACT), and radically open DBT (RODBT) for issues of over-control. KEBT is founded by psychologist, Victoria Cane, who specializes in the treatment of emotion dysregulation disorder (a more accurate name for borderline personality disorder), eating disorders, and LGBTQIA-affirmative therapy.
Kalamazoo Evidence Based Therapy (KEBT) is an individually owned practice bringing together therapists trained in and practicing evidence based therapy including cognitive behavior therapy (CBT), dialectical behavior therapy, (DBT), behavioral activation for depression, exposure-based therapies for anxiety, acceptance and commitment therapy (ACT), and radically open DBT (RODBT) for issues of over-control. KEBT is founded by psychologist, Victoria Cane, who specializes in the treatment of emotion dysregulation disorder (a more accurate name for borderline personality disorder), eating disorders, and LGBTQIA-affirmative therapy.
(269) 430-2037 View (269) 430-2037
Photo of Rachel Johnson, Licensed Professional Counselor in 49006, MI
Rachel Johnson
Licensed Professional Counselor, MA, NCC, LPC, MITS
Verified Verified
5 Endorsed
Kalamazoo, MI 49006
As counselor, I see therapy involving a very individual, 'person centered' approach. "I believe that every person has the internal resources they need for growth & healing, and to find their direction and progress in the therapy process." I support the client on their path to success, providing empathy, acceptance for who they are and where they are, while offering a non-judgmental orientation. I encourage the client with the freedom to explore thoughts, feelings, and life experiences in our time together.
As counselor, I see therapy involving a very individual, 'person centered' approach. "I believe that every person has the internal resources they need for growth & healing, and to find their direction and progress in the therapy process." I support the client on their path to success, providing empathy, acceptance for who they are and where they are, while offering a non-judgmental orientation. I encourage the client with the freedom to explore thoughts, feelings, and life experiences in our time together.
(269) 815-4213 View (269) 815-4213
Photo of Mal L Horein, Clinical Social Work/Therapist in 49006, MI
Mal L Horein
Clinical Social Work/Therapist, LMSW
Verified Verified
2 Endorsed
Kalamazoo, MI 49006  (Online Only)
Everyone faces challenges in life and, at times, it is helpful to have extra support to work through those challenges. It is my hope that you will reach out for that support. As a licensed social worker, I have worked in the field for 6 years, working alongside adults as they navigate anxiety, depression, mood disorders, identity and many other concerns. I firmly believe that therapy is a collaborative process between the individual and the therapist. I value shared decision making and encourage open communication.
Everyone faces challenges in life and, at times, it is helpful to have extra support to work through those challenges. It is my hope that you will reach out for that support. As a licensed social worker, I have worked in the field for 6 years, working alongside adults as they navigate anxiety, depression, mood disorders, identity and many other concerns. I firmly believe that therapy is a collaborative process between the individual and the therapist. I value shared decision making and encourage open communication.
(269) 248-5039 View (269) 248-5039
Photo of Jay Tompkins, Counselor in 49006, MI
Jay Tompkins
Counselor, MA, LPC, NCC
Verified Verified
2 Endorsed
Kalamazoo, MI 49006
Are you feeling stuck, and unsure how to move forward? Its hard figuring out where to start, whether it be one big event or many smaller things piling up over time. Everyone could use some extra support at times, and it takes a lot of courage to talk about the struggles in your life. My specialty is creating a supportive environment to process troubling areas and provide opportunities to improve desired skills and achieve your goals. I provide counseling for adolescents and adults to improve functioning and self-satisfaction. Counseling is a collaborative process, and I look forward to working alongside you to achieve your goals!
Are you feeling stuck, and unsure how to move forward? Its hard figuring out where to start, whether it be one big event or many smaller things piling up over time. Everyone could use some extra support at times, and it takes a lot of courage to talk about the struggles in your life. My specialty is creating a supportive environment to process troubling areas and provide opportunities to improve desired skills and achieve your goals. I provide counseling for adolescents and adults to improve functioning and self-satisfaction. Counseling is a collaborative process, and I look forward to working alongside you to achieve your goals!
(269) 241-8369 View (269) 241-8369
Photo of Rinehart Institute, Counselor in 49006, MI
Rinehart Institute
Counselor, MA, LPC, NCC
Verified Verified
Kalamazoo, MI 49006
Please visit our website (http://www.rinehartinstitute.com) for more information regarding the services we provide, individual practitioner's biographies, and the specialties of each clinician.
Please visit our website (http://www.rinehartinstitute.com) for more information regarding the services we provide, individual practitioner's biographies, and the specialties of each clinician.
(269) 466-6503 View (269) 466-6503
Photo of Mandala Counseling and Consulting PLC, Limited Licensed Psychologist in 49006, MI
Mandala Counseling and Consulting PLC
Limited Licensed Psychologist, MA, LLP
Verified Verified
2 Endorsed
Kalamazoo, MI 49006
Mandala Counseling and Consulting PLC offers something different from the "treatment as usual" therapies. We help you target and understand problems that get in your way. We give you concrete, usable, effective tools to use in the everyday. And we don't just focus on problems. We help you move toward a greater sense of wellbeing, empowerment and joy. Approaches used are backed by research and are evidenced based. You CAN make tangible changes in life without spending years of therapy. If you struggle with balance or the "normal hard problems of life" to severe emotional dysregulation, we can help.
Mandala Counseling and Consulting PLC offers something different from the "treatment as usual" therapies. We help you target and understand problems that get in your way. We give you concrete, usable, effective tools to use in the everyday. And we don't just focus on problems. We help you move toward a greater sense of wellbeing, empowerment and joy. Approaches used are backed by research and are evidenced based. You CAN make tangible changes in life without spending years of therapy. If you struggle with balance or the "normal hard problems of life" to severe emotional dysregulation, we can help.
(269) 763-5130 View (269) 763-5130
Photo of Victoria Cane, Psychologist in 49006, MI
Victoria Cane
Psychologist, PhD, LP
Verified Verified
5 Endorsed
Kalamazoo, MI 49006
I am a licensed psychologist with a background in community mental health and university counseling practicing privately since 2011. I take a holistic approach to therapeutic work, using the context of culture, personal development, and multiple dimensions of identity. I also specialize in evidence-based therapies including dialectical behavior therapy (DBT), behavioral activation for depression, radically open dbt (RODBT) for issues of over-control, and prolonged exposure for PTSD. I am board certified as a DBT therapist through the Linehan Institute and infuse elements of DBT like mindfulness practice into my general work.
I am a licensed psychologist with a background in community mental health and university counseling practicing privately since 2011. I take a holistic approach to therapeutic work, using the context of culture, personal development, and multiple dimensions of identity. I also specialize in evidence-based therapies including dialectical behavior therapy (DBT), behavioral activation for depression, radically open dbt (RODBT) for issues of over-control, and prolonged exposure for PTSD. I am board certified as a DBT therapist through the Linehan Institute and infuse elements of DBT like mindfulness practice into my general work.
(269) 795-6542 View (269) 795-6542
Photo of Patricia Hilliard, Limited Licensed Psychologist in 49006, MI
Patricia Hilliard
Limited Licensed Psychologist, MA, TLLP
Verified Verified
Kalamazoo, MI 49006
Life can present many challenges and talking with someone can help you to process and release emotions, learn new skills, and gain new perspectives. I work with each person as a unique individual, creating a trusting partnership where we can work together to help you achieve your goals.
Life can present many challenges and talking with someone can help you to process and release emotions, learn new skills, and gain new perspectives. I work with each person as a unique individual, creating a trusting partnership where we can work together to help you achieve your goals.
(269) 359-0559 View (269) 359-0559
Photo of Rebecca Layton, Clinical Social Work/Therapist in 49006, MI
Rebecca Layton
Clinical Social Work/Therapist, LLMSW
Verified Verified
2 Endorsed
Kalamazoo, MI 49006
Waitlist for new clients
Similarly to many of you, the pandemic created an opportunity for me to re-evaluate my choices and to step out of that comfort zone and move towards something new. Exploring new paths can be intimidating but it is also exciting. What I hope to provide for each of my clients as we work together: a place where it is safe to be both vulnerable and brave as you work towards healing and towards your own goals. My professional mission is to help each person determine their goals and needs, then build on their strengths to reach them. This is never a linear process but I can provide an open, safe, and judgment free environment.
Similarly to many of you, the pandemic created an opportunity for me to re-evaluate my choices and to step out of that comfort zone and move towards something new. Exploring new paths can be intimidating but it is also exciting. What I hope to provide for each of my clients as we work together: a place where it is safe to be both vulnerable and brave as you work towards healing and towards your own goals. My professional mission is to help each person determine their goals and needs, then build on their strengths to reach them. This is never a linear process but I can provide an open, safe, and judgment free environment.
(269) 256-2775 View (269) 256-2775
Photo of Lisa Schafer, Licensed Professional Counselor in 49006, MI
Lisa Schafer
Licensed Professional Counselor, MA, LPC, CAADC
Verified Verified
1 Endorsed
Kalamazoo, MI 49006
I'm listening. We all have times in our lives where we need that additional support. I am here to help you pull yourself out of your rut and into a life with more fulfillment and purpose. I enjoy helping people find that inspiration by incorporating a wide range of interventions based on your unique needs. I am here to inspire you as a Mental health professional by helping you rewrite your story. I am honored to walk with you in your journey as you take those next steps fully empowered. I have direct approach and won't just sit and nod at you. You deserve to feel better in your life.
I'm listening. We all have times in our lives where we need that additional support. I am here to help you pull yourself out of your rut and into a life with more fulfillment and purpose. I enjoy helping people find that inspiration by incorporating a wide range of interventions based on your unique needs. I am here to inspire you as a Mental health professional by helping you rewrite your story. I am honored to walk with you in your journey as you take those next steps fully empowered. I have direct approach and won't just sit and nod at you. You deserve to feel better in your life.
(269) 256-2865 View (269) 256-2865
Photo of Beth E Jones, Clinical Social Work/Therapist in 49006, MI
Beth E Jones
Clinical Social Work/Therapist, LMSW, MA, CDC
Verified Verified
Kalamazoo, MI 49006
Welcome! I have 2 core therapy philosophies: First, your thoughts will mislead you, if unexamined. Second: "Live Your Best Life" - not your diagnoses or issues. You're here because: 1. You're suffering from painful thoughts and overwhelming feelings; 2. Self-destructive habits are harming your progress and relationships; 3. You want to Safely collaborate with a warm, dynamic expert to solve confusing issues. I can help! I'm a Seasoned, Clinically-Licensed Therapist employing: CBT (Cognitive Behavior Therapy); DBT (Dialectical Behavior Therapy); S/A (Substance Abuse Therapy); MAT (Mindfulness Awareness Training) and TIP (Thought Inquiry Power).
Welcome! I have 2 core therapy philosophies: First, your thoughts will mislead you, if unexamined. Second: "Live Your Best Life" - not your diagnoses or issues. You're here because: 1. You're suffering from painful thoughts and overwhelming feelings; 2. Self-destructive habits are harming your progress and relationships; 3. You want to Safely collaborate with a warm, dynamic expert to solve confusing issues. I can help! I'm a Seasoned, Clinically-Licensed Therapist employing: CBT (Cognitive Behavior Therapy); DBT (Dialectical Behavior Therapy); S/A (Substance Abuse Therapy); MAT (Mindfulness Awareness Training) and TIP (Thought Inquiry Power).
(269) 743-3571 View (269) 743-3571

See more therapy options for 49006

How does your Therapist compare?

Number of Therapists in 49006

70+

Average cost per session

$150

Therapists in 49006 who prioritize treating:

97% Anxiety
96% Depression
83% Coping Skills
81% Self Esteem
75% Stress
73% Relationship Issues
69% Trauma and PTSD

Average years in practice

9 Years

Top 3 insurances accepted

96% BlueCross and BlueShield
80% UnitedHealthcare UHC | UBH
72% Priority Health

How Therapists in 49006 see their clients

78% In Person and Online
22% Online Only

Gender breakdown

76% Female
24% Male
FAQs - About Therapy and Counseling

How can I find a therapist in 49006?

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.