Therapists in San Francisco, CA

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Photo of Gregory Desierto, Psychologist in San Francisco, CA
Gregory Desierto
Psychologist, PsyD
Verified Verified
1 Endorsed
San Francisco, CA 94102
Growing up did you experience painful or confusing boundary violations? Did someone whom you trusted, respected, or even loved touch you or fondle you in a way that made you feel uncomfortable, scared, or perhaps even made you feel confused and pleasured? Do you feel embarrassed and bothered by your experience, and worry that others will not understand how you have been sexually violated and abused? Do you struggle with managing your romantic relationships, your friendships, as well as your emotions and thoughts because your past uncomfortable experience with sex have made sex and your sexuality confusing, uncomfortable or even overstimulating? You are not alone.
Growing up did you experience painful or confusing boundary violations? Did someone whom you trusted, respected, or even loved touch you or fondle you in a way that made you feel uncomfortable, scared, or perhaps even made you feel confused and pleasured? Do you feel embarrassed and bothered by your experience, and worry that others will not understand how you have been sexually violated and abused? Do you struggle with managing your romantic relationships, your friendships, as well as your emotions and thoughts because your past uncomfortable experience with sex have made sex and your sexuality confusing, uncomfortable or even overstimulating? You are not alone.
(415) 569-1434 View (415) 569-1434
Photo of Jill E Hartman, Marriage & Family Therapist in San Francisco, CA
Jill E Hartman
Marriage & Family Therapist, LMFT, MA
Verified Verified
San Francisco, CA 94110
When life feels overwhelming, finding meaning and connection can feel elusive. Layer on the struggles inherent in our current world—family dynamics, life transitions, climate anxiety—you name it, and it’s no wonder it can feel impossible. In my work, I help people navigate life’s murky waters, and the feelings of inertia that can come with the territory. Helping people connect with, and stay true to, their authentic selves is what makes my work meaningful. I work particularly well with clients who struggle in relationships (including with adult family members), as well as adults with ADHD or those who suspect they might have ADHD.
When life feels overwhelming, finding meaning and connection can feel elusive. Layer on the struggles inherent in our current world—family dynamics, life transitions, climate anxiety—you name it, and it’s no wonder it can feel impossible. In my work, I help people navigate life’s murky waters, and the feelings of inertia that can come with the territory. Helping people connect with, and stay true to, their authentic selves is what makes my work meaningful. I work particularly well with clients who struggle in relationships (including with adult family members), as well as adults with ADHD or those who suspect they might have ADHD.
(510) 913-9384 View (510) 913-9384
Photo of Jessica Claire Lief, Clinical Social Work/Therapist in San Francisco, CA
Jessica Claire Lief
Clinical Social Work/Therapist, LCSW, MSW
Verified Verified
San Francisco, CA 94115
My name is Jessica Lief. I have been practicing social work and working as a psychotherapist since 2014. I support individuals who are recovering from eating disorders, body image issues, substance use issues, trauma, self harm, prenatal and postpartum issues, miscarriage and fertility issues. I work with adults of all ages. My style has been described as nurturing, empathic, and empowering. I am direct and authentic; I will never blame you for your suffering. My approach is primarily psychodynamic but combines aspects of self-psychology, mindful self-compassion, dialectical behavior therapy, Seeking Safety, and mindfulness.
My name is Jessica Lief. I have been practicing social work and working as a psychotherapist since 2014. I support individuals who are recovering from eating disorders, body image issues, substance use issues, trauma, self harm, prenatal and postpartum issues, miscarriage and fertility issues. I work with adults of all ages. My style has been described as nurturing, empathic, and empowering. I am direct and authentic; I will never blame you for your suffering. My approach is primarily psychodynamic but combines aspects of self-psychology, mindful self-compassion, dialectical behavior therapy, Seeking Safety, and mindfulness.
(628) 265-8809 View (628) 265-8809
Photo of Emily Semow, Psychologist in San Francisco, CA
Emily Semow
Psychologist, PsyD, CEDS
Verified Verified
1 Endorsed
San Francisco, CA 94123
Adults and teens come to see me when there is something in their lives they want to change. This may be relief from a harsh inner critic, self doubt, sadness, and/or emptiness. It could be distress from work, school, family, relationships, or social situations. Some people are dealing with the impacts of one or more traumas. Others want help getting to the roots of body image distress or an eating disorder. Whatever the issue may be, my clients seek meaningful, lasting change. They look for both understanding and acceptance as well as the specific tools and insights that will facilitate a more satisfying life.
Adults and teens come to see me when there is something in their lives they want to change. This may be relief from a harsh inner critic, self doubt, sadness, and/or emptiness. It could be distress from work, school, family, relationships, or social situations. Some people are dealing with the impacts of one or more traumas. Others want help getting to the roots of body image distress or an eating disorder. Whatever the issue may be, my clients seek meaningful, lasting change. They look for both understanding and acceptance as well as the specific tools and insights that will facilitate a more satisfying life.
(628) 313-3746 View (628) 313-3746
Photo of Atheena Matcham, Marriage & Family Therapist in San Francisco, CA
Atheena Matcham
Marriage & Family Therapist, MA, LMFT
Verified Verified
San Francisco, CA 94118  (Online Only)
Not accepting new clients
Finding the right therapist can be scary. It takes a lot of courage to begin the search and build trust. I value this process and am honored to be a part of this sacred therapeutic relationship. I believe every individual has the strength within to grow and change. Having a safe space to reflect, learn, and explore can be helpful in the journey. I offer a safe space to work with individuals through life stress, transitions, painful experiences, & overall wellness.
Finding the right therapist can be scary. It takes a lot of courage to begin the search and build trust. I value this process and am honored to be a part of this sacred therapeutic relationship. I believe every individual has the strength within to grow and change. Having a safe space to reflect, learn, and explore can be helpful in the journey. I offer a safe space to work with individuals through life stress, transitions, painful experiences, & overall wellness.
(628) 227-6420 View (628) 227-6420
Photo of Austin Heafey, Psychologist in San Francisco, CA
Austin Heafey
Psychologist, MFT, Psy D
Verified Verified
San Francisco, CA 94123
Everyone deserves support– life can be overwhelming. Our sessions provide a safe, encouraging space for you to slow down and focus on what’s important. As an advocate for you, your family, or your child, we create solutions that help you find healing.
Everyone deserves support– life can be overwhelming. Our sessions provide a safe, encouraging space for you to slow down and focus on what’s important. As an advocate for you, your family, or your child, we create solutions that help you find healing.
(415) 594-4159 View (415) 594-4159
Photo of Navie Sandhu, Psychologist in San Francisco, CA
Navie Sandhu
Psychologist, PsyD, MPH
Verified Verified
San Francisco, CA 94109  (Online Only)
Life has a funny way of throwing us off balance, am I right? I’m Navie (Navneet) Sandhu, PsyD, MPH, a licensed Clinical Psychologist and I'm here to help you navigate those bumps in the road. With a wealth of experience gained during my tenure at Kaiser Permanente and my postdoctoral fellowship in the Health Psychology program at California Pacific Medical Center in San Francisco, I am well-equipped to assist you in your story.
Life has a funny way of throwing us off balance, am I right? I’m Navie (Navneet) Sandhu, PsyD, MPH, a licensed Clinical Psychologist and I'm here to help you navigate those bumps in the road. With a wealth of experience gained during my tenure at Kaiser Permanente and my postdoctoral fellowship in the Health Psychology program at California Pacific Medical Center in San Francisco, I am well-equipped to assist you in your story.
(628) 240-0367 View (628) 240-0367
Photo of Marlana Pierson, Marriage & Family Therapist in San Francisco, CA
Marlana Pierson
Marriage & Family Therapist, LMFT
Verified Verified
San Francisco, CA 94105  (Online Only)
I am passionate about helping individuals better understand how their thoughts and emotions impact behavior to make positive changes. I specialize in working with adults experiencing depression, anxiety, self-harm, trauma, life transitions, and relationship issues. I use an empathetic yet direct approach to help increase self-awareness to look inward at yourself, and relationships, and dive into the past to discover unwanted patterns with the goal of creating a life worth living. Additionally, I have experience supporting parents of teens who are struggling to balance child care, work responsibilities, and self-care.
I am passionate about helping individuals better understand how their thoughts and emotions impact behavior to make positive changes. I specialize in working with adults experiencing depression, anxiety, self-harm, trauma, life transitions, and relationship issues. I use an empathetic yet direct approach to help increase self-awareness to look inward at yourself, and relationships, and dive into the past to discover unwanted patterns with the goal of creating a life worth living. Additionally, I have experience supporting parents of teens who are struggling to balance child care, work responsibilities, and self-care.
(415) 949-2198 View (415) 949-2198
Photo of Joanna Keller, Psychologist in San Francisco, CA
Joanna Keller
Psychologist, PsyD, PMH-C
Verified Verified
San Francisco, CA 94115  (Online Only)
I am a licensed clinical psychologist working with adults of all ages. I have significant experience supporting adults in the tech industry through my role as the Mental Health Manager at the onsite wellness center at Meta/Facebook for 7+ years. Additionally, I am certified in perinatal mental health and specialize in supporting individuals through the complicated journey of parenthood, including fertility challenges, fetal loss, and perinatal mood and anxiety disorders. Other areas of expertise include depression, anxiety, substance use/addiction, life transitions, personal/professional growth, and relationships/dating.
I am a licensed clinical psychologist working with adults of all ages. I have significant experience supporting adults in the tech industry through my role as the Mental Health Manager at the onsite wellness center at Meta/Facebook for 7+ years. Additionally, I am certified in perinatal mental health and specialize in supporting individuals through the complicated journey of parenthood, including fertility challenges, fetal loss, and perinatal mood and anxiety disorders. Other areas of expertise include depression, anxiety, substance use/addiction, life transitions, personal/professional growth, and relationships/dating.
(415) 801-3703 View (415) 801-3703
Photo of Johnny Morataya, Clinical Social Work/Therapist in San Francisco, CA
Johnny Morataya
Clinical Social Work/Therapist, LCSW
Verified Verified
San Francisco, CA 94105  (Online Only)
My approach to therapy is to create a secure and comfortable space for anyone to address their mental health needs and concerns; I am not here to judge but to understand and help. My goal is to meet you where you are and collaboratively work towards the goals that you set. I use Cognitive Behavioral Therapy as a treatment modality to aid in processing thoughts and feelings with regard to certain stressors and identify helpful coping skills.
My approach to therapy is to create a secure and comfortable space for anyone to address their mental health needs and concerns; I am not here to judge but to understand and help. My goal is to meet you where you are and collaboratively work towards the goals that you set. I use Cognitive Behavioral Therapy as a treatment modality to aid in processing thoughts and feelings with regard to certain stressors and identify helpful coping skills.
(510) 804-2497 View (510) 804-2497
Photo of Amy Rattazzi, Clinical Social Work/Therapist in San Francisco, CA
Amy Rattazzi
Clinical Social Work/Therapist, LCSW
Verified Verified
San Francisco, CA 94109
Specializing in life stressors, grief, self-esteem, and cultural identities, I provide compassionate support for individuals facing challenges. We'll work together to cultivate understanding, heal, and develop coping strategies. I create a safe, inclusive space where all aspects of yourself are embraced. You're the expert of your experience, and I'm here to listen and guide you.
Specializing in life stressors, grief, self-esteem, and cultural identities, I provide compassionate support for individuals facing challenges. We'll work together to cultivate understanding, heal, and develop coping strategies. I create a safe, inclusive space where all aspects of yourself are embraced. You're the expert of your experience, and I'm here to listen and guide you.
(415) 582-4209 View (415) 582-4209
Photo of Sandra Berger Psychotherapy, Marriage & Family Therapist in San Francisco, CA
Sandra Berger Psychotherapy
Marriage & Family Therapist, LMFT
Verified Verified
4 Endorsed
San Francisco, CA 94123  (Online Only)
Not accepting new clients
Therapy with me will help you to gain better understanding of yourself and hopefully will affect positively in your family and your relationships. I work well with adults and adolescents who experience difficult childhood/family relationships, anxiety/depression, single parenting, life transitions and co-dependence/addiction issues. I can help you with coping tools you can use in the first session.
Therapy with me will help you to gain better understanding of yourself and hopefully will affect positively in your family and your relationships. I work well with adults and adolescents who experience difficult childhood/family relationships, anxiety/depression, single parenting, life transitions and co-dependence/addiction issues. I can help you with coping tools you can use in the first session.
(415) 650-1025 View (415) 650-1025
Photo of Christine Mark-Griffin, Clinical Social Work/Therapist in San Francisco, CA
Christine Mark-Griffin
Clinical Social Work/Therapist, LCSW
Verified Verified
San Francisco, CA 94115
If you have been struggling with a difficult life situation, managing your role as a parent or helping your child through a traumatic experience, I understand how lost you can feel. I made it my mission to help people get the healing they need – kids and adults alike – to let their best self shine.
If you have been struggling with a difficult life situation, managing your role as a parent or helping your child through a traumatic experience, I understand how lost you can feel. I made it my mission to help people get the healing they need – kids and adults alike – to let their best self shine.
(415) 360-7231 View (415) 360-7231
Photo of Maria Burch, Clinical Social Work/Therapist in San Francisco, CA
Maria Burch
Clinical Social Work/Therapist, LCSW, PMH-C
Verified Verified
San Francisco, CA 94117  (Online Only)
Are anxiety (constant worry), depression, and imposter syndrome getting in the way of having clarity, peace of mind, and a sense of direction? As you go through life transitions such as the birth of a child, experienced a miscarriage, have marital stress, work stress and/or relationship concerns (friend and/or family), imposter syndrome, and social anxiety — it is essential to have someone who can provide you with solid and impartial support. I’m a warm, interactive, directive and solution focused therapist. My mission is to provide you with life-changing & actionable tools to help you move forward.
Are anxiety (constant worry), depression, and imposter syndrome getting in the way of having clarity, peace of mind, and a sense of direction? As you go through life transitions such as the birth of a child, experienced a miscarriage, have marital stress, work stress and/or relationship concerns (friend and/or family), imposter syndrome, and social anxiety — it is essential to have someone who can provide you with solid and impartial support. I’m a warm, interactive, directive and solution focused therapist. My mission is to provide you with life-changing & actionable tools to help you move forward.
(415) 799-1379 View (415) 799-1379
Photo of Jeff Taylor, Psychologist in San Francisco, CA
Jeff Taylor
Psychologist, PsyD
Verified Verified
San Francisco, CA 94114
Many of my patients are adults and older adolescents struggling with anxiety, depression, post-traumatic stress, grief/loss, life transitions, and relationship challenges. My therapeutic approach is warm, genuine, and engaging and often combines interpersonal, cognitive-behavioral, and attachment perspectives within a safe and collaborative therapeutic relationship. I am passionate about helping my patients to identify their inherent strengths and motivations for change while also bringing awareness to obstacles that may be blocking them from experiencing lives that feel fulfilling and meaningful.
Many of my patients are adults and older adolescents struggling with anxiety, depression, post-traumatic stress, grief/loss, life transitions, and relationship challenges. My therapeutic approach is warm, genuine, and engaging and often combines interpersonal, cognitive-behavioral, and attachment perspectives within a safe and collaborative therapeutic relationship. I am passionate about helping my patients to identify their inherent strengths and motivations for change while also bringing awareness to obstacles that may be blocking them from experiencing lives that feel fulfilling and meaningful.
(415) 524-0406 View (415) 524-0406
Photo of The Conscious Partnership™, Marriage & Family Therapist in San Francisco, CA
The Conscious Partnership™
Marriage & Family Therapist
Verified Verified
San Francisco, CA 94115  (Online Only)
I specialize in relationship issues, marital and premartial couples therapy, and support anxiety and financial stress. Chronic disconnection with your partner or close relationships or struggles in managing anxious feelings can really upset the peace in your world. When struggling and worried about your future, change can feel overwhelming and confusing. I can help you sort out how to better manage your relationships and mood. If you're longing to learn how to love or cope with anxiety, going inward with skilled guidance can really help. I'm here to support you to heal and change. Let's schedule a call and talk about what you need.
I specialize in relationship issues, marital and premartial couples therapy, and support anxiety and financial stress. Chronic disconnection with your partner or close relationships or struggles in managing anxious feelings can really upset the peace in your world. When struggling and worried about your future, change can feel overwhelming and confusing. I can help you sort out how to better manage your relationships and mood. If you're longing to learn how to love or cope with anxiety, going inward with skilled guidance can really help. I'm here to support you to heal and change. Let's schedule a call and talk about what you need.
(628) 888-1206 View (628) 888-1206
Photo of Maria Lentzou, Marriage & Family Therapist in San Francisco, CA
Maria Lentzou
Marriage & Family Therapist, MA, LMFT
Verified Verified
5 Endorsed
San Francisco, CA 94115
I work with children, teens and adults, in individual sessions and groups. Adults and teens: I see you as creative, resourceful, and whole on your own. I am here to help you heal wounds that keep you stuck and don't let you believe in your own strengths and intuition. I can offer curious questions, valuable resources and tools to add to your own toolbelt, new perspectives, and challenges that honor your goals and what you need to live your best life. I also provide Authentic Movement groups and experiential creative workshops.
I work with children, teens and adults, in individual sessions and groups. Adults and teens: I see you as creative, resourceful, and whole on your own. I am here to help you heal wounds that keep you stuck and don't let you believe in your own strengths and intuition. I can offer curious questions, valuable resources and tools to add to your own toolbelt, new perspectives, and challenges that honor your goals and what you need to live your best life. I also provide Authentic Movement groups and experiential creative workshops.
(415) 862-1656 View (415) 862-1656
Photo of Para Ambardar, Psychologist in San Francisco, CA
Para Ambardar
Psychologist, PhD
Verified Verified
San Francisco, CA 94118
My approach to psychotherapy focuses on deepening your working knowledge of human behavior in order to foster more autonomous, better informed decisions in both your professional and personal life. Psychotherapy provides a space where one is encouraged to be oneself, directly experience what is happening, and reflect upon one's complex and, at times, conflicting thoughts, emotions and behavioral patterns. Success is measured not only by relief from current symptoms but also by an increasing capacity to know yourself more fully, to find greater satisfaction in what you do and to feel more fulfilled in your relationships.
My approach to psychotherapy focuses on deepening your working knowledge of human behavior in order to foster more autonomous, better informed decisions in both your professional and personal life. Psychotherapy provides a space where one is encouraged to be oneself, directly experience what is happening, and reflect upon one's complex and, at times, conflicting thoughts, emotions and behavioral patterns. Success is measured not only by relief from current symptoms but also by an increasing capacity to know yourself more fully, to find greater satisfaction in what you do and to feel more fulfilled in your relationships.
(415) 612-1363 View (415) 612-1363
Photo of Dr. Sasha Avanesov, Psychologist in San Francisco, CA
Dr. Sasha Avanesov
Psychologist, PhD
Verified Verified
2 Endorsed
San Francisco, CA 94115
Whether you are experiencing anxiety, stress, relationship issues, coping with trauma, screaming at the world gone mad, seeking answers to spiritual or existential questions, or pursuing personal growth, I will work hard to empower you. Together, we will explore, clarify, and address issues at the root of your concerns, clearing a path towards inner peace.
Whether you are experiencing anxiety, stress, relationship issues, coping with trauma, screaming at the world gone mad, seeking answers to spiritual or existential questions, or pursuing personal growth, I will work hard to empower you. Together, we will explore, clarify, and address issues at the root of your concerns, clearing a path towards inner peace.
(510) 405-7319 View (510) 405-7319
Photo of Janine Darwin, Marriage & Family Therapist in San Francisco, CA
Janine Darwin
Marriage & Family Therapist, MA, LMFT
Verified Verified
3 Endorsed
San Francisco, CA 94115
Are you anxious, emotionally overwhelmed, struggling with feelings of inadequacy, not able to make decisions, engaging in self destructive behaviors or just plain confused about why things (or people) are so difficult? Contact me. If you are struggling with poor relationships at work, with your partner, with your kids; contact me. If you just want a better understanding of how you think, feel and behave; contact me. Together we will uncover your internal healing abilities to achieve freedom and relief.
Are you anxious, emotionally overwhelmed, struggling with feelings of inadequacy, not able to make decisions, engaging in self destructive behaviors or just plain confused about why things (or people) are so difficult? Contact me. If you are struggling with poor relationships at work, with your partner, with your kids; contact me. If you just want a better understanding of how you think, feel and behave; contact me. Together we will uncover your internal healing abilities to achieve freedom and relief.
(415) 578-3944 View (415) 578-3944

See more therapy options for San Francisco

How does your Therapist compare?

Number of Therapists in San Francisco, CA

3,000+

Average cost per session

$189

Therapists in San Francisco, CA who prioritize treating:

93% Anxiety
87% Depression
81% Relationship Issues
75% Self Esteem
70% Trauma and PTSD
68% Stress
66% Life Transitions

Average years in practice

12 Years

Top 3 insurances accepted

69% Aetna
55% UnitedHealthcare UHC | UBH
54% Cigna and Evernorth

How Therapists in San Francisco, CA see their clients

55% In Person and Online
45% Online Only

Gender breakdown

75% Female
23% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in San Francisco?

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.