Therapists in 92131

Photo of Karen Mikolic, Psychologist, PhD, ABN
Karen Mikolic
Psychologist, PhD, ABN
2 Endorsed
San Diego, CA 92131
Is your child struggling in school? Are you seeking compensation after an injury? Are you experiencing memory problems? I am Board Certified Neuropsychologist with over 9 years of experience in hospital settings helping patients with neurological complications after stroke, heart attack, or brain injury. If your loved one struggles with memory problems and is no longer independent, an evaluation may help your family plan for their care. Attention Deficit/ADHD, Learning Disabilities, Autism, and being Gifted, qualify for school assistance to help students succeed. Let's meet to discuss if an evaluation may help!
Is your child struggling in school? Are you seeking compensation after an injury? Are you experiencing memory problems? I am Board Certified Neuropsychologist with over 9 years of experience in hospital settings helping patients with neurological complications after stroke, heart attack, or brain injury. If your loved one struggles with memory problems and is no longer independent, an evaluation may help your family plan for their care. Attention Deficit/ADHD, Learning Disabilities, Autism, and being Gifted, qualify for school assistance to help students succeed. Let's meet to discuss if an evaluation may help!
(619) 493-3526 View (619) 493-3526
Photo of Christina Thomas, Licensed Professional Clinical Counselor, LPCC
Christina Thomas
Licensed Professional Clinical Counselor, LPCC
San Diego, CA 92131
Welcome! My name is Christina Thomas. I am a licensed Professional Clinical Counselor (LPCC). I consider my role as a therapist as one who comes alongside couples, families, and individuals in the journey of self-discovery, personal growth, and healing. I work with individuals, couples, and families extensively in assisting through some of life’s most challenging seasons. I also work alongside those who are working through grief/loss, trauma, relationship dynamics, life transitions, illness, chronic illness, and parental and intra-personal challenges.
Welcome! My name is Christina Thomas. I am a licensed Professional Clinical Counselor (LPCC). I consider my role as a therapist as one who comes alongside couples, families, and individuals in the journey of self-discovery, personal growth, and healing. I work with individuals, couples, and families extensively in assisting through some of life’s most challenging seasons. I also work alongside those who are working through grief/loss, trauma, relationship dynamics, life transitions, illness, chronic illness, and parental and intra-personal challenges.
(747) 277-3104 View (747) 277-3104
Photo of Meg Kaufman, Marriage & Family Therapist, MFT
Meg Kaufman
Marriage & Family Therapist, MFT
1 Endorsed
San Diego, CA 92131
Hello and welcome to my profile. As a family therapist for over twenty-five years, I have learned what may work best for my clients, and I'm passionate about what I do. I often work with young people from age thirteen through their late- twenties, and anyone suffering loss, especially the loss of a pet. Perhaps because I still have vivid memories of my young self, and believe the animal-human bond is so strong these topics have special meaning for me. Subspecialties include trauma and stress management, parenting and support for caregivers.
Hello and welcome to my profile. As a family therapist for over twenty-five years, I have learned what may work best for my clients, and I'm passionate about what I do. I often work with young people from age thirteen through their late- twenties, and anyone suffering loss, especially the loss of a pet. Perhaps because I still have vivid memories of my young self, and believe the animal-human bond is so strong these topics have special meaning for me. Subspecialties include trauma and stress management, parenting and support for caregivers.
(858) 943-4698 View (858) 943-4698
Photo of Rachel Finch, Pre-Licensed Professional, MA, APCC, NCC
Rachel Finch
Pre-Licensed Professional, MA, APCC, NCC
1 Endorsed
San Diego, CA 92131
Your story matters, your resilience is powerful, and therapy can be the space where you rediscover both. Creating a path forward towards healing is possible, and you don't have to face your challenges alone. As an Associate Professional Clinical Counselor, I am here to walk alongside you! I am passionate and dedicated to supporting teens, families, and adults who are navigating the challenges of PTSD and complex trauma, ADHD, autism, dual diagnosis, family conflict and divorce/separation, grief and loss, attachment trauma, childhood sexual abuse, anxiety, and mood disorders.
Your story matters, your resilience is powerful, and therapy can be the space where you rediscover both. Creating a path forward towards healing is possible, and you don't have to face your challenges alone. As an Associate Professional Clinical Counselor, I am here to walk alongside you! I am passionate and dedicated to supporting teens, families, and adults who are navigating the challenges of PTSD and complex trauma, ADHD, autism, dual diagnosis, family conflict and divorce/separation, grief and loss, attachment trauma, childhood sexual abuse, anxiety, and mood disorders.
(619) 567-3827 View (619) 567-3827
Photo of Erica Kardonsky, Clinical Social Work/Therapist, BS, MSW, LCSW
Erica Kardonsky
Clinical Social Work/Therapist, BS, MSW, LCSW
3 Endorsed
San Diego, CA 92131
As a compassionate and empathic listener I provide a safe, non-judgmental environment in which your unique story can be told. Whether you're navigating a life transition, struggling with relationships and self-esteem, or feeling disconnected from your life, I can help. I've had the privilege of working with individuals from diverse backgrounds and I recognize and honor the unique experiences and perspectives you bring to therapy. In our work together, I will support you in identifying and letting go of what has been holding you back, so you can move toward the life you envision and step more fully into your authentic self.
As a compassionate and empathic listener I provide a safe, non-judgmental environment in which your unique story can be told. Whether you're navigating a life transition, struggling with relationships and self-esteem, or feeling disconnected from your life, I can help. I've had the privilege of working with individuals from diverse backgrounds and I recognize and honor the unique experiences and perspectives you bring to therapy. In our work together, I will support you in identifying and letting go of what has been holding you back, so you can move toward the life you envision and step more fully into your authentic self.
(858) 346-6423 View (858) 346-6423
Photo of Esther Krohner, Marriage & Family Therapist, LMFT
Esther Krohner
Marriage & Family Therapist, LMFT
San Diego, CA 92131
Whether you're a couple navigating conflict or a teenager dealing with stress, relationships, or big decisions, my goal is to help you move forward with tools that work, no guesswork or generic advice. I work with couples to improve communication, reduce conflict, and rebuild trust. I also work with teens and their families to address issues like anxiety, depression, school challenges, identity development, and family tension. My approach is direct, supportive, and tailored to the specific needs of each client. I offer couples therapy, individual therapy for teens, and parent guidance. I can help with ADHD, mood issues & anxiety.
Whether you're a couple navigating conflict or a teenager dealing with stress, relationships, or big decisions, my goal is to help you move forward with tools that work, no guesswork or generic advice. I work with couples to improve communication, reduce conflict, and rebuild trust. I also work with teens and their families to address issues like anxiety, depression, school challenges, identity development, and family tension. My approach is direct, supportive, and tailored to the specific needs of each client. I offer couples therapy, individual therapy for teens, and parent guidance. I can help with ADHD, mood issues & anxiety.
(510) 851-9411 x248797 View (510) 851-9411 x248797
Photo of Janet Rodriguez - Janet Rodriguez, LMFT, Marriage & Family Therapist, LMFT
Janet Rodriguez, LMFT
Marriage & Family Therapist, LMFT
1 Endorsed
San Diego, CA 92131
Welcome to viewing my profile! I have been in the mental health field for over 15 years. As a Marriage and Family Therapist, I received training and focused on the following modes of treatment: attachment theory, play therapy, strength-based, and trauma-informed, among other evidence-based models. Additionally, I have experience working in multidisciplinary settings providing collaborative quality care and psychotherapeutic treatment.
Welcome to viewing my profile! I have been in the mental health field for over 15 years. As a Marriage and Family Therapist, I received training and focused on the following modes of treatment: attachment theory, play therapy, strength-based, and trauma-informed, among other evidence-based models. Additionally, I have experience working in multidisciplinary settings providing collaborative quality care and psychotherapeutic treatment.
(858) 240-8176 View (858) 240-8176
Photo of Ida Fariba - Alliant Couple and Family Clinic, Marriage & Family Therapist, LMFT
Alliant Couple and Family Clinic
Marriage & Family Therapist, LMFT
1 Endorsed
San Diego, CA 92131
Welcome to Alliant Couple and Family Clinic! We offer mental health services to the community on a sliding fee scale. Services provided in-person in San Diego and Los Alamitos or virtually throughout California. Our team of pre-licensed therapists are available to treat mental health issues with individuals, couples, and families while receiving clinical supervision from highly experienced clinicians.
Welcome to Alliant Couple and Family Clinic! We offer mental health services to the community on a sliding fee scale. Services provided in-person in San Diego and Los Alamitos or virtually throughout California. Our team of pre-licensed therapists are available to treat mental health issues with individuals, couples, and families while receiving clinical supervision from highly experienced clinicians.
(858) 422-3618 View (858) 422-3618
Photo of Virginia Zarinebaf, Counselor, LPCC
Virginia Zarinebaf
Counselor, LPCC
San Diego, CA 92131
My approach to providing therapy is modeled through a strength-based approach, open communication and space for growth. I believe in connection, collaboration and goals for your therapy journey. I hope to create a comfortable pace with a sprinkle of humor. Growth is important as well as transparency, and I invite you to express your needs during this time to ensure your therapy goals are met with a sense of empowerment and hope. Therapy does not have to be hard.
My approach to providing therapy is modeled through a strength-based approach, open communication and space for growth. I believe in connection, collaboration and goals for your therapy journey. I hope to create a comfortable pace with a sprinkle of humor. Growth is important as well as transparency, and I invite you to express your needs during this time to ensure your therapy goals are met with a sense of empowerment and hope. Therapy does not have to be hard.
(858) 768-8127 View (858) 768-8127
Photo of Reut Landau, Marriage & Family Therapist, MS, LMFT
Reut Landau
Marriage & Family Therapist, MS, LMFT
2 Endorsed
San Diego, CA 92131
Hello and welcome! My name is Reut Landau and I am a licensed therapist with 13 years of experience helping individuals, couples, and families overcome life’s challenges. As a therapist I believe that everyone has the capacity for growth and change, and that therapy can provide the tools and support needed to achieve personal and interpersonal goals. I am committed to creating a safe, non-judgmental space where you can explore your thoughts and feelings, gain insight into patterns and behaviors, and develop strategies for moving forward.
Hello and welcome! My name is Reut Landau and I am a licensed therapist with 13 years of experience helping individuals, couples, and families overcome life’s challenges. As a therapist I believe that everyone has the capacity for growth and change, and that therapy can provide the tools and support needed to achieve personal and interpersonal goals. I am committed to creating a safe, non-judgmental space where you can explore your thoughts and feelings, gain insight into patterns and behaviors, and develop strategies for moving forward.
(858) 358-7377 View (858) 358-7377
Photo of Harvey Hyman, Licensed Professional Clinical Counselor, LPCC
Harvey Hyman
Licensed Professional Clinical Counselor, LPCC
San Diego, CA 92131
I'm a licensed professional clinical counselor in San Diego, CA, working solely with adults online. The clients I'm most able to help all suffered significant trauma wounds during their childhood or teen years, which they never fully felt, processed, grieved, and resolved. As adults, they are burdened by old survival strategies that no longer serve them and by coping mechanisms which blunt pain while blocking growth and change. If you're tired of self-criticism, pessimism, depression, social anxiety, social isolation, and being a people-pleasing chameleon not the real you, I will help you change your life
I'm a licensed professional clinical counselor in San Diego, CA, working solely with adults online. The clients I'm most able to help all suffered significant trauma wounds during their childhood or teen years, which they never fully felt, processed, grieved, and resolved. As adults, they are burdened by old survival strategies that no longer serve them and by coping mechanisms which blunt pain while blocking growth and change. If you're tired of self-criticism, pessimism, depression, social anxiety, social isolation, and being a people-pleasing chameleon not the real you, I will help you change your life
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Photo of Naomi Wahler, Psychologist, PhD
Naomi Wahler
Psychologist, PhD
2 Endorsed
San Diego, CA 92131
Sometimes life experiences leave us feeling overwhelmed or hopeless and we find that the ways we usually cope are not helping. Sometimes our personal journey involves difficult, seemingly impossible crises or losses. At times like these, we often try to manage emotions with activities that help us feel better for a short time but then the cost starts to outweigh the benefits. I believe we all go through times like this when we are tired of struggling. The path towards recovering from these experiences seems more doable when we are able to find a renewed motivation and clear goals towards healthy change.
Sometimes life experiences leave us feeling overwhelmed or hopeless and we find that the ways we usually cope are not helping. Sometimes our personal journey involves difficult, seemingly impossible crises or losses. At times like these, we often try to manage emotions with activities that help us feel better for a short time but then the cost starts to outweigh the benefits. I believe we all go through times like this when we are tired of struggling. The path towards recovering from these experiences seems more doable when we are able to find a renewed motivation and clear goals towards healthy change.
(858) 943-2658 View (858) 943-2658
Photo of Annaleis Giovanetti, Psychologist, PhD
Annaleis Giovanetti
Psychologist, PhD
San Diego, CA 92131
You’ve been trying to push through, but something still feels off. Maybe you’re constantly on edge, replaying the past, or stuck in patterns you can’t explain. Maybe anxiety, depression, or trauma has made it harder to sleep, focus, or feel connected to the people and activities you care about. My clients are often strong, thoughtful people who’ve spent a long time coping on their own. They’re capable and self-aware — but they’re tired of carrying everything internally and want tools that actually help them feel better. If that sounds familiar, you’re in the right place.
You’ve been trying to push through, but something still feels off. Maybe you’re constantly on edge, replaying the past, or stuck in patterns you can’t explain. Maybe anxiety, depression, or trauma has made it harder to sleep, focus, or feel connected to the people and activities you care about. My clients are often strong, thoughtful people who’ve spent a long time coping on their own. They’re capable and self-aware — but they’re tired of carrying everything internally and want tools that actually help them feel better. If that sounds familiar, you’re in the right place.
(858) 422-1922 View (858) 422-1922
Photo of Audrey Gehart - Audrey Gehart @ Grow Through Life Counseling, Marriage & Family Therapist Associate, AMFT
Audrey Gehart @ Grow Through Life Counseling
Marriage & Family Therapist Associate, AMFT
1 Endorsed
San Diego, CA 92131
I enjoy working with clients who want to better understand themselves and move through life with greater equanimity. Many of the individuals and families I support are navigating cultural identity, developmental challenges, or life transitions and are seeking clarity, connection, and growth. My goal is to help clients feel empowered, seen, and supported as they build insight into their experiences and strengths.
I enjoy working with clients who want to better understand themselves and move through life with greater equanimity. Many of the individuals and families I support are navigating cultural identity, developmental challenges, or life transitions and are seeking clarity, connection, and growth. My goal is to help clients feel empowered, seen, and supported as they build insight into their experiences and strengths.
(858) 567-0566 View (858) 567-0566
Photo of Kara Ann Kohnen - Grow Through Life Counseling Scripps Ranch, Marriage & Family Therapist, LMFT
Grow Through Life Counseling Scripps Ranch
Marriage & Family Therapist, LMFT
San Diego, CA 92131
Hello and welcome! Grow Through Life Counseling is a group private practice welcoming both in person clients in Scripps Ranch, CA and via Telehealth in CA. We have immediate openings and are accepting new clients. Our Mission is to provide quality counseling for all ages throughout life. We provide culturally sensitive and inclusive care for all children, teens, adults, couples and families. We respect each family member's unique identities, perspectives and experiences in life. With effective and creative psychotherapeutic interventions, we support emotional growth and the development during various stages of life to be healthier.
Hello and welcome! Grow Through Life Counseling is a group private practice welcoming both in person clients in Scripps Ranch, CA and via Telehealth in CA. We have immediate openings and are accepting new clients. Our Mission is to provide quality counseling for all ages throughout life. We provide culturally sensitive and inclusive care for all children, teens, adults, couples and families. We respect each family member's unique identities, perspectives and experiences in life. With effective and creative psychotherapeutic interventions, we support emotional growth and the development during various stages of life to be healthier.
(858) 223-9048 View (858) 223-9048
Photo of Stefano Casillo, Marriage & Family Therapist Associate, MA, AMFT
Stefano Casillo
Marriage & Family Therapist Associate, MA, AMFT
San Diego, CA 92131
Stefano’s professional experience in the field of psychology has involved working with individuals, couples, and families of various backgrounds throughout San Diego. As an advocate of strong mental health, he understands the importance of creating a safe environment for individuals of all ages where effective therapy can promote wellness.
Stefano’s professional experience in the field of psychology has involved working with individuals, couples, and families of various backgrounds throughout San Diego. As an advocate of strong mental health, he understands the importance of creating a safe environment for individuals of all ages where effective therapy can promote wellness.
(858) 652-4091 View (858) 652-4091
Photo of Sonja L Banks, Psychologist, PhD
Sonja L Banks
Psychologist, PhD
1 Endorsed
San Diego, CA 92131
I am a Licensed Clinical Psychologist and certified cognitive behavioral therapist who has been in private practice since 1999. Until 2014, I was the Senior Reproductive Psychologist in the Maternal Mental Health Division, Department of Psychiatry at UCSD. Educationally, I first earned Dual Bachelor Degrees in Psychology and Music from St. Olaf College. After earning a Ph.D. and M.A. in Clinical Psychology with a Health Psychology Emphasis from CSPP, I completed an internship at Scripps Clinic and a Fellowship at the Medical University of South Carolina.
I am a Licensed Clinical Psychologist and certified cognitive behavioral therapist who has been in private practice since 1999. Until 2014, I was the Senior Reproductive Psychologist in the Maternal Mental Health Division, Department of Psychiatry at UCSD. Educationally, I first earned Dual Bachelor Degrees in Psychology and Music from St. Olaf College. After earning a Ph.D. and M.A. in Clinical Psychology with a Health Psychology Emphasis from CSPP, I completed an internship at Scripps Clinic and a Fellowship at the Medical University of South Carolina.
(858) 914-2768 View (858) 914-2768
Photo of Debra Cha, Psychologist, PhD
Debra Cha
Psychologist, PhD
1 Endorsed
San Diego, CA 92131
I am a bilingual clinical psychologist offering in-person and virtual services to children and adults. I have a background in supervising the delivery of Applied Behavior Analysis (ABA), providing school based therapy, psychoeducational evaluations, and conducting pediatric evaluations at UCSD. I use evidence based treatment to assist in addressing concerns related to mood, behavior, and social skills and offer an environment for families, siblings, and caregivers who are wanting a space to process family members' mental health needs. Services are offered in Korean and English.
I am a bilingual clinical psychologist offering in-person and virtual services to children and adults. I have a background in supervising the delivery of Applied Behavior Analysis (ABA), providing school based therapy, psychoeducational evaluations, and conducting pediatric evaluations at UCSD. I use evidence based treatment to assist in addressing concerns related to mood, behavior, and social skills and offer an environment for families, siblings, and caregivers who are wanting a space to process family members' mental health needs. Services are offered in Korean and English.
(858) 260-3666 View (858) 260-3666
Photo of Heather Warren, Marriage & Family Therapist, MA, LMFT
Heather Warren
Marriage & Family Therapist, MA, LMFT
1 Endorsed
San Diego, CA 92131
I work with teens and adults navigating identity, relationships, anxiety, and the often-unspoken pressures that come from family, culture, and society. I have experience working with families, especially parent–teen relationships, as well as with female-identifying and gender-expansive individuals who are making sense of who they are within complex relational and social contexts.
I work with teens and adults navigating identity, relationships, anxiety, and the often-unspoken pressures that come from family, culture, and society. I have experience working with families, especially parent–teen relationships, as well as with female-identifying and gender-expansive individuals who are making sense of who they are within complex relational and social contexts.
(858) 943-2513 View (858) 943-2513
Photo of Nancy C Romig, RN, DNSc, PMHCNS, BC
Nancy C Romig
Verified Verified
2 Endorsed
San Diego, CA 92131
I bring over 40 years of experience in working with individual clients and families through life crisis and transitions. Areas of specialty are: loss, bereavement, chronic/acute illness, pregnancy/childbirth, parenting, and relationships. Health care professionals and nurses are an area of specialty with the unique challenges they face resulting in compassion fatigue, burnout and moral distress. Finding ways to achieve life work balance and self-care are essential to their well being and the ability to continue in their work as a helping profession.
I bring over 40 years of experience in working with individual clients and families through life crisis and transitions. Areas of specialty are: loss, bereavement, chronic/acute illness, pregnancy/childbirth, parenting, and relationships. Health care professionals and nurses are an area of specialty with the unique challenges they face resulting in compassion fatigue, burnout and moral distress. Finding ways to achieve life work balance and self-care are essential to their well being and the ability to continue in their work as a helping profession.
(619) 780-2267 View (619) 780-2267

See more therapy options for 92131

How does your Therapist compare?

Number of Therapists in 92131

200+

Average cost per session

$180

Therapists in 92131 who prioritize treating:

93% Anxiety
88% Depression
67% Relationship Issues
67% Trauma and PTSD
65% Grief
65% Life Transitions
62% Coping Skills

Average years in practice

13 Years

Top 3 insurances accepted

84% Aetna
76% Cigna and Evernorth
60% Other

How Therapists in 92131 see their clients

55% In Person and Online
45% Online Only

Gender breakdown

82% Female
18% Male
FAQs - About Therapy and Counseling

How can I find a therapist in 92131?

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.