Therapists in 89128

Photo of Jessica Walden, Marriage & Family Therapist, NCC
Jessica Walden
Marriage & Family Therapist, NCC
2 Endorsed
Las Vegas, NV 89128
Accepting new clients. I am a marriage and family therapist that works with individuals, couples, and families. I believe everyone has the ability to improve and be the best version of themselves. Every individual and family is unique and I believe in adapting my approach to the client's needs and working collaboratively to reach their goals.
Accepting new clients. I am a marriage and family therapist that works with individuals, couples, and families. I believe everyone has the ability to improve and be the best version of themselves. Every individual and family is unique and I believe in adapting my approach to the client's needs and working collaboratively to reach their goals.
(702) 765-4669 View (702) 765-4669
Photo of Mignon Ramsey, Marriage & Family Therapist Intern, LMFT
Mignon Ramsey
Marriage & Family Therapist Intern, LMFT
Las Vegas, NV 89128
My ideal client is someone who carries the weight of their struggles with depression, anxiety, grief, trauma, and relational issues, yet still holds onto a glimmer of hope for brighter days. They long for a compassionate ear to listen, a guiding hand to navigate the unpredictable currents of life, and a safe space to explore their innermost thoughts and emotions.
My ideal client is someone who carries the weight of their struggles with depression, anxiety, grief, trauma, and relational issues, yet still holds onto a glimmer of hope for brighter days. They long for a compassionate ear to listen, a guiding hand to navigate the unpredictable currents of life, and a safe space to explore their innermost thoughts and emotions.
(725) 302-3460 View (725) 302-3460
Photo of Daniela Leon, Marriage & Family Therapist, MS, LMFT, LCADC
Daniela Leon
Marriage & Family Therapist, MS, LMFT, LCADC
Las Vegas, NV 89128
Now Accepting New Clients – Saturday Appointments Available Are you suffering or feeling stuck? You’re not alone—and you don’t have to face it alone. I believe every person has the ability to heal, grow, and make meaningful changes in their life. My role as your therapist is to provide a safe, compassionate, and nonjudgmental space where we can explore the deeper roots of your struggles and work together toward healing and resilience. I take a collaborative approach to therapy, where your voice, goals, and values are central.
Now Accepting New Clients – Saturday Appointments Available Are you suffering or feeling stuck? You’re not alone—and you don’t have to face it alone. I believe every person has the ability to heal, grow, and make meaningful changes in their life. My role as your therapist is to provide a safe, compassionate, and nonjudgmental space where we can explore the deeper roots of your struggles and work together toward healing and resilience. I take a collaborative approach to therapy, where your voice, goals, and values are central.
(702) 903-1215 View (702) 903-1215
Photo of Jeffrey D Strain - Guava Psychological Centre, Psychologist, PhD
Guava Psychological Centre
Psychologist, PhD
Las Vegas, NV 89128
Guava Psychological Centre (GPC) is an integrative mental health practice in Las Vegas, Nevada. Psychological services for individuals, couples, groups, and organizations include insight-oriented psychotherapy, psychological testing, forensic and public service evaluations, clinical supervision and training, and consultation. The handicapped-accessible office is located near Desert Shores, on the west side of Las Vegas.
Guava Psychological Centre (GPC) is an integrative mental health practice in Las Vegas, Nevada. Psychological services for individuals, couples, groups, and organizations include insight-oriented psychotherapy, psychological testing, forensic and public service evaluations, clinical supervision and training, and consultation. The handicapped-accessible office is located near Desert Shores, on the west side of Las Vegas.
(702) 447-0165 View (702) 447-0165
Photo of Kerry McCarthy, Licensed Professional Counselor, LPC, LAC, LMHC, CPC
Kerry McCarthy
Licensed Professional Counselor, LPC, LAC, LMHC, CPC
3 Endorsed
Las Vegas, NV 89128
You’ve been holding it together for everyone else, but inside you feel worn out, disconnected, or anxious. Maybe you’re replaying painful memories or trying to manage the weight of stress that never seems to lift. You want to feel more grounded, present, and able to enjoy your life and relationships again but you’re not sure where to start. You just know you can’t keep doing it this way. Together, we’ll uncover what’s been driving your pain and create real, sustainable change so you can move from surviving to living with intention and calm.
You’ve been holding it together for everyone else, but inside you feel worn out, disconnected, or anxious. Maybe you’re replaying painful memories or trying to manage the weight of stress that never seems to lift. You want to feel more grounded, present, and able to enjoy your life and relationships again but you’re not sure where to start. You just know you can’t keep doing it this way. Together, we’ll uncover what’s been driving your pain and create real, sustainable change so you can move from surviving to living with intention and calm.
(720) 770-4481 View (720) 770-4481
Photo of Milagros Severin-Ruiz, Marriage & Family Therapist, MS, LMFT, LCADC
Milagros Severin-Ruiz
Marriage & Family Therapist, MS, LMFT, LCADC
Las Vegas, NV 89128
With over 20 years of clinical experience, I provide thoughtful, personalized therapy for adults and couples seeking meaningful, lasting change beyond quick fixes or surface-level solutions. My work supports clients navigating anxiety, depression, relationship challenges, and unresolved trauma, including patterns rooted in growing up in alcohol-affected families.
With over 20 years of clinical experience, I provide thoughtful, personalized therapy for adults and couples seeking meaningful, lasting change beyond quick fixes or surface-level solutions. My work supports clients navigating anxiety, depression, relationship challenges, and unresolved trauma, including patterns rooted in growing up in alcohol-affected families.
(702) 602-6427 View (702) 602-6427
Photo of Christie Fielding, Clinical Social Work/Therapist, LCSW
Christie Fielding
Clinical Social Work/Therapist, LCSW
1 Endorsed
Las Vegas, NV 89128
If you are ready to have a life changing experience, then you have come to the right place. Therapy can take many forms. I view therapy through a collaborative lense. I want you to feel empowered to make the changes that will make your life more fulfilling. I recognize that you are unique because of the experiences you have had and that therapy is not a one size fits all. Change comes through small and simple steps. Finding joy and happiness comes through taking these small and simple steps.
If you are ready to have a life changing experience, then you have come to the right place. Therapy can take many forms. I view therapy through a collaborative lense. I want you to feel empowered to make the changes that will make your life more fulfilling. I recognize that you are unique because of the experiences you have had and that therapy is not a one size fits all. Change comes through small and simple steps. Finding joy and happiness comes through taking these small and simple steps.
(702) 508-6103 View (702) 508-6103
Photo of Tonja Vallin, Marriage & Family Therapist, LMFT, ICST
Tonja Vallin
Marriage & Family Therapist, LMFT, ICST
2 Endorsed
Las Vegas, NV 89128
Are you ready to make 2026 your best year ever? If you have been struggling with anxiety, trauma, or relationship issues it's time to stop the insanity. I have helped hundreds of people reconnect with themselves and others through the powerful tools of EMDR and Sand Tray Therapy. My approach is grounded, compassionate, and tailored to each individual’s unique journey. As a trauma-informed therapist, I believe in your inner capacity to heal — even if you don’t feel it yet. Whether you’re facing current life challenges, or seeking to improve your relationships, I can help.
Are you ready to make 2026 your best year ever? If you have been struggling with anxiety, trauma, or relationship issues it's time to stop the insanity. I have helped hundreds of people reconnect with themselves and others through the powerful tools of EMDR and Sand Tray Therapy. My approach is grounded, compassionate, and tailored to each individual’s unique journey. As a trauma-informed therapist, I believe in your inner capacity to heal — even if you don’t feel it yet. Whether you’re facing current life challenges, or seeking to improve your relationships, I can help.
(702) 745-5575 View (702) 745-5575
Photo of Leah Gardner - Calm Gardens Therapy, Licensed Professional Counselor, MA, NCC, LCPC, ACS, AAMFT
Calm Gardens Therapy
Licensed Professional Counselor, MA, NCC, LCPC, ACS, AAMFT
Las Vegas, NV 89128
At Calm Gardens Therapy, our clinicians have extensive experience working with a wide range of individuals, from children with selective mutism & behavioral concerns to adults managing anxiety, depression, bipolar disorder, & more. We are dedicated to supporting our clients in improving their overall well-being & mental health. Our Clinical Director, Leah Gardner, brings a deep background in trauma & behaviorism, specializing in individuals with moderate to severe behaviors. Leah, an ACS & AAMFT Supervisor Candidate, also supervises others, enhancing our facility's expertise.
At Calm Gardens Therapy, our clinicians have extensive experience working with a wide range of individuals, from children with selective mutism & behavioral concerns to adults managing anxiety, depression, bipolar disorder, & more. We are dedicated to supporting our clients in improving their overall well-being & mental health. Our Clinical Director, Leah Gardner, brings a deep background in trauma & behaviorism, specializing in individuals with moderate to severe behaviors. Leah, an ACS & AAMFT Supervisor Candidate, also supervises others, enhancing our facility's expertise.
(702) 842-0426 View (702) 842-0426
Photo of Terry F Bunker - Bunker Counseling, Marriage & Family Therapist, MS, LMFT
Bunker Counseling
Marriage & Family Therapist, MS, LMFT
1 Endorsed
Las Vegas, NV 89128
Helping you find solutions to your challenges is a joy for me. I have enjoyed 30 yrs of working with individuals, couples and families and hope to have an opportunity to meet with you. I have deep respect for the courage it takes to face challenges and to work through them. I believe in people and the resiliency each person can find within. Finding peace of mind and spirit is a journey worth taking. I look forward to meeting you.
Helping you find solutions to your challenges is a joy for me. I have enjoyed 30 yrs of working with individuals, couples and families and hope to have an opportunity to meet with you. I have deep respect for the courage it takes to face challenges and to work through them. I believe in people and the resiliency each person can find within. Finding peace of mind and spirit is a journey worth taking. I look forward to meeting you.
(702) 728-4610 View (702) 728-4610
Photo of Jennifer C Moore, Clinical Social Work/Therapist, MSW, LCSW
Jennifer C Moore
Clinical Social Work/Therapist, MSW, LCSW
Las Vegas, NV 89128
There are times in our lives when we feel stuck, sometimes hopeless. We face problems in living that seem impossible to overcome. Sometimes these problems are internal struggles within ourselves. Other times, these problems are interpersonal struggles with others such as our spouses or significant others, our children, and other loved ones. Whatever the presenting issue may be, my goal is to assist you in finding hope and confidence within yourself to choose and apply positive, effective solutions to the problems that lie in your path.
There are times in our lives when we feel stuck, sometimes hopeless. We face problems in living that seem impossible to overcome. Sometimes these problems are internal struggles within ourselves. Other times, these problems are interpersonal struggles with others such as our spouses or significant others, our children, and other loved ones. Whatever the presenting issue may be, my goal is to assist you in finding hope and confidence within yourself to choose and apply positive, effective solutions to the problems that lie in your path.
(702) 879-5867 View (702) 879-5867
Photo of Vanessa Humphrey - Ascension Therapy-Vanessa Humphrey, LCPC, LLC, Licensed Professional Counselor, MS, LCPC, NCC
Ascension Therapy-Vanessa Humphrey, LCPC, LLC
Licensed Professional Counselor, MS, LCPC, NCC
Las Vegas, NV 89128
Ms. Humphrey strives to educate through clinical practice, fight against mental health stigma, decrease lack of connectedness and help restore balance to self, family, and community. Kindly, visit my website and submit "contact us" inquiry information for direct access to Ascension Therapy, LLC.
Ms. Humphrey strives to educate through clinical practice, fight against mental health stigma, decrease lack of connectedness and help restore balance to self, family, and community. Kindly, visit my website and submit "contact us" inquiry information for direct access to Ascension Therapy, LLC.
(725) 677-6962 View (725) 677-6962
Photo of Emily Halverson - Emily Halverson, Cardinal Pines Family Therapy LLC, Marriage & Family Therapist, LMFT, MS
Emily Halverson, Cardinal Pines Family Therapy LLC
Marriage & Family Therapist, LMFT, MS
Las Vegas, NV 89128
Hello! My name is Emily. I am a licensed couple, family and child therapist. I have a lot of toys and games in my office for my kiddo clients so I always get asked if I see adults too. Yes, I see people of all ages! My background is in human development and the ways in which attachment, traumas, and other significant life experiences shape how our automatic nervous systems respond to environmental triggers, brain structure, and behaviors at each different life cycle stage. Anxiety, anger, mood shifts, loneliness, loss, detachment, fear of trust, chronic illness, people with higher sensitivities- these are some of my top areas.
Hello! My name is Emily. I am a licensed couple, family and child therapist. I have a lot of toys and games in my office for my kiddo clients so I always get asked if I see adults too. Yes, I see people of all ages! My background is in human development and the ways in which attachment, traumas, and other significant life experiences shape how our automatic nervous systems respond to environmental triggers, brain structure, and behaviors at each different life cycle stage. Anxiety, anger, mood shifts, loneliness, loss, detachment, fear of trust, chronic illness, people with higher sensitivities- these are some of my top areas.
(725) 502-1525 View (725) 502-1525
Photo of Myrna L Toledo, Pre-Licensed Professional, CPC-I
Myrna L Toledo
Pre-Licensed Professional, CPC-I
1 Endorsed
Las Vegas, NV 89128
As an adult going through the bumps life put on the road for me, I was able to understand and appreciate the importance of a strong and peaceful mindset, which comes with proper mental health. Let me guide you through your roadway to successful and peaceful mental health.
As an adult going through the bumps life put on the road for me, I was able to understand and appreciate the importance of a strong and peaceful mindset, which comes with proper mental health. Let me guide you through your roadway to successful and peaceful mental health.
(702) 508-7901 View (702) 508-7901
Photo of Steph Guice, LPC Intern, MA, CPC-I
Steph Guice
LPC Intern, MA, CPC-I
Las Vegas, NV 89128
Hi there! Working with a therapist can be scary and overwhelming. You may wonder what therapy will look like, how you should act, and what you should say. In our time together, I will strive to help you feel comfortable to be yourself and ease those worries. As an attachment-based therapist, I believe it is the relationship between you and I that matters the most. My goal is to create an environment that will suit your personality and the goals you have for yourself.
Hi there! Working with a therapist can be scary and overwhelming. You may wonder what therapy will look like, how you should act, and what you should say. In our time together, I will strive to help you feel comfortable to be yourself and ease those worries. As an attachment-based therapist, I believe it is the relationship between you and I that matters the most. My goal is to create an environment that will suit your personality and the goals you have for yourself.
(702) 299-6502 View (702) 299-6502
Photo of Deidre Jenkins - Relationship Dynamics, Marriage & Family Therapist, MS, LMFT, CIMHP, FNTP, SAP
Relationship Dynamics
Marriage & Family Therapist, MS, LMFT, CIMHP, FNTP, SAP
3 Endorsed
Las Vegas, NV 89128
Life's challenges are only the beginning. Allow me to help you through them. I am an empathetic, good-hearted, and insightful therapist. As a solution-focused therapist, my approach is direct and enhances your communication to others while helping you to focus on what you determine is important. Together we can improve your self confidence and guiding you to a life that is worth celebrating . While we will be unable to change difficult situation of the past; we can explore events or thoughts that keep you and your relationships in a rut and improve transitioning through your life's challenges.
Life's challenges are only the beginning. Allow me to help you through them. I am an empathetic, good-hearted, and insightful therapist. As a solution-focused therapist, my approach is direct and enhances your communication to others while helping you to focus on what you determine is important. Together we can improve your self confidence and guiding you to a life that is worth celebrating . While we will be unable to change difficult situation of the past; we can explore events or thoughts that keep you and your relationships in a rut and improve transitioning through your life's challenges.
(702) 800-3956 View (702) 800-3956
Photo of Alvin James Kenon, Clinical Social Work/Therapist, LCSW
Alvin James Kenon
Clinical Social Work/Therapist, LCSW
1 Endorsed
Las Vegas, NV 89128
I am an Army veteran and a retired Corrections Sergeant with over 17 years of service in the Las Vegas community and more than ten years of experience providing therapy and mental health support. My background in public safety allows me to work effectively with adults, teens, and young adults facing anxiety, depression, trauma, anger, grief and loss, self-harm behaviors, and significant life transitions. I have a strong interest in helping teens and young adults navigate life challenges, build emotional awareness, and develop confidence, resilience, and leadership skills during critical stages of growth.
I am an Army veteran and a retired Corrections Sergeant with over 17 years of service in the Las Vegas community and more than ten years of experience providing therapy and mental health support. My background in public safety allows me to work effectively with adults, teens, and young adults facing anxiety, depression, trauma, anger, grief and loss, self-harm behaviors, and significant life transitions. I have a strong interest in helping teens and young adults navigate life challenges, build emotional awareness, and develop confidence, resilience, and leadership skills during critical stages of growth.
(702) 605-6681 View (702) 605-6681
Photo of Avi Anderson, Clinical Social Work/Therapist, CSW-I, LMSW
Avi Anderson
Clinical Social Work/Therapist, CSW-I, LMSW
2 Endorsed
Las Vegas, NV 89128
OCD. Obsessive Compulsive Disorder. Marriage counseling. Couples therapy. Sex addiction. Porn addiction. Sexual compulsivity. This is my core work in Las Vegas & Henderson, w/ telehealth across Nevada. Clients seek me out for focused, high-level care. I treat OCD, sex & porn addiction, intimacy challenges, & troubled relationships. As an IOCDF member & one of the few specialists in NV who do all of this combined, I bring expertise & a direct, evidence-based approach. I’m out of network w/ insurance, & my fees remain clear & accessible for clients who want top-quality treatment. Clients leave ready for a future built on hope & love!
OCD. Obsessive Compulsive Disorder. Marriage counseling. Couples therapy. Sex addiction. Porn addiction. Sexual compulsivity. This is my core work in Las Vegas & Henderson, w/ telehealth across Nevada. Clients seek me out for focused, high-level care. I treat OCD, sex & porn addiction, intimacy challenges, & troubled relationships. As an IOCDF member & one of the few specialists in NV who do all of this combined, I bring expertise & a direct, evidence-based approach. I’m out of network w/ insurance, & my fees remain clear & accessible for clients who want top-quality treatment. Clients leave ready for a future built on hope & love!
(725) 234-6612 View (725) 234-6612
Photo of Jim R Eells - Restoration Neurology, MD
Restoration Neurology
Verified Verified
Las Vegas, NV 89128
I specialize in treating a whole host of disorders that stem from low neurotransmitter levels, namely serotonin and dopamine. Such disorders include depression, anxiety, insomnia, chronic fatigue, fibromyalgia, migraines, cognitive impairment, Alzheimer's, Parkinson's, IBS, Crohn's disease, tremor, restless leg syndrome and more. Treatment is very holistic, it involves scientifically administering precursors such as 5-htp, tyrosine, cysteine and l-dopa which the brain uses to produce serotonin and dopamine naturally. It is extremely effective with none of the downside of prescription medication.
I specialize in treating a whole host of disorders that stem from low neurotransmitter levels, namely serotonin and dopamine. Such disorders include depression, anxiety, insomnia, chronic fatigue, fibromyalgia, migraines, cognitive impairment, Alzheimer's, Parkinson's, IBS, Crohn's disease, tremor, restless leg syndrome and more. Treatment is very holistic, it involves scientifically administering precursors such as 5-htp, tyrosine, cysteine and l-dopa which the brain uses to produce serotonin and dopamine naturally. It is extremely effective with none of the downside of prescription medication.
(702) 832-2957 View (702) 832-2957
Photo of Mika Perkins, Licensed Professional Counselor, CPC, NCC
Mika Perkins
Licensed Professional Counselor, CPC, NCC
4 Endorsed
Las Vegas, NV 89128
As a therapist, I strive to create a supportive and empathetic environment for my clients. I believe in the power of validation, active listening, and collaboration in the therapeutic process. I work to establish a strong therapeutic alliance with my clients, where they feel heard, understood, and respected. I aim to provide a safe space for clients to explore their emotions, thoughts, and challenges without fear of judgment. My approach is client-centered, meaning that I tailor my therapy techniques to meet the individual needs and goals of each client. I am committed to supporting my clients on their journey towards healing.
As a therapist, I strive to create a supportive and empathetic environment for my clients. I believe in the power of validation, active listening, and collaboration in the therapeutic process. I work to establish a strong therapeutic alliance with my clients, where they feel heard, understood, and respected. I aim to provide a safe space for clients to explore their emotions, thoughts, and challenges without fear of judgment. My approach is client-centered, meaning that I tailor my therapy techniques to meet the individual needs and goals of each client. I am committed to supporting my clients on their journey towards healing.
(725) 208-5664 View (725) 208-5664

See more therapy options for 89128

How does your Therapist compare?

Number of Therapists in 89128

200+

Average cost per session

$135

Therapists in 89128 who prioritize treating:

93% Anxiety
88% Depression
79% Trauma and PTSD
76% Self Esteem
74% Relationship Issues
73% Coping Skills
73% Stress

Average years in practice

9 Years

Top 3 insurances accepted

80% Aetna
62% Cigna and Evernorth
57% BlueCross and BlueShield

How Therapists in 89128 see their clients

74% In Person and Online
26% Online Only

Gender breakdown

85% Female
14% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in 89128?

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.