Therapists in Puyallup, WA

Photo of John Carlsen, Counselor in Puyallup, WA
John Carlsen
Counselor, MA, NCC, LMHC
Verified Verified
12 Endorsed
Puyallup, WA 98373
You're someone who is looking to find just the right fit in a counselor. Maybe you are experiencing grief, or having difficulty adjusting to life changes. Perhaps you have a general sense of dissatisfaction with life, or have specific things you want to work through. Or, maybe you're feeling trapped by anxiety, or past trauma, and you want to feel a sense of hope; to be seen, heard, and understood. There is no "one-size-fits-all" approach to therapy, and the things you may want to work on are important and unique.
You're someone who is looking to find just the right fit in a counselor. Maybe you are experiencing grief, or having difficulty adjusting to life changes. Perhaps you have a general sense of dissatisfaction with life, or have specific things you want to work through. Or, maybe you're feeling trapped by anxiety, or past trauma, and you want to feel a sense of hope; to be seen, heard, and understood. There is no "one-size-fits-all" approach to therapy, and the things you may want to work on are important and unique.
(253) 201-0431 View (253) 201-0431
Photo of Deanna Brown, Counselor in Puyallup, WA
Deanna Brown
Counselor, MA, LMHC
Verified Verified
Puyallup, WA 98372
Accepting New Patients with for Ketamine Guided Therapy in my practice with evening, weekend, day, morning slots available Telehealth and In person. I specialize in Psychedelic Ketamine and THC Guided Therapy which is billed at private pay Only all other treatments cam be billed with insurances using therapists at our practice. I am a proud Army Veteran working in the field of counseling since 2015. I have experience working with combat veterans, CPS, couples, children, teens, adults, families, first responders, LGBTQ community, Licensed Approved Supervisor to Supervise Therapists, and a prior Director of a Psychiatric Hospital.
Accepting New Patients with for Ketamine Guided Therapy in my practice with evening, weekend, day, morning slots available Telehealth and In person. I specialize in Psychedelic Ketamine and THC Guided Therapy which is billed at private pay Only all other treatments cam be billed with insurances using therapists at our practice. I am a proud Army Veteran working in the field of counseling since 2015. I have experience working with combat veterans, CPS, couples, children, teens, adults, families, first responders, LGBTQ community, Licensed Approved Supervisor to Supervise Therapists, and a prior Director of a Psychiatric Hospital.
(206) 717-8722 View (206) 717-8722
Photo of Jeanglee Tracer, Clinical Social Work/Therapist in Puyallup, WA
Jeanglee Tracer
Clinical Social Work/Therapist, LICSW
Verified Verified
Puyallup, WA 98374  (Online Only)
Not accepting new clients
While being human is the greatest adventure one can have, it is always filled with peaks and valleys. I am going to go out on a limb here and say that at this moment in time, it is not the peaks you are struggling with. You may have heard the cliches “without the rain there would be no rainbows,” or “it’s always darkest before the dawn.” While these may be inspiring words when you are in a small dip in the road, but chances are they may only serve to irritate you when you are crawling on your hands and knees through the valleys.
While being human is the greatest adventure one can have, it is always filled with peaks and valleys. I am going to go out on a limb here and say that at this moment in time, it is not the peaks you are struggling with. You may have heard the cliches “without the rain there would be no rainbows,” or “it’s always darkest before the dawn.” While these may be inspiring words when you are in a small dip in the road, but chances are they may only serve to irritate you when you are crawling on your hands and knees through the valleys.
(360) 526-8186 View (360) 526-8186
Photo of Caren Osborn, Marriage & Family Therapist in Puyallup, WA
Caren Osborn
Marriage & Family Therapist, MA, LMFT
Verified Verified
Puyallup, WA 98373
You can heal by recognizing how important your thoughts and feelings are in navigating this world. We often use our minds to solve everything and sometimes we "solve" ourselves into trouble. We become fragmented when we problem solve without taking the time to tend to our whole self. Use all of you to integrate what has been fragmented by trauma, be it divorce, depression, anxiety, family issues, grief, etc. In a Christian setting I will be guide you to access your thoughts, feelings, and spirituality to help you become more authentically yourself, allowing you to use your strengths and create more peace in your life.
You can heal by recognizing how important your thoughts and feelings are in navigating this world. We often use our minds to solve everything and sometimes we "solve" ourselves into trouble. We become fragmented when we problem solve without taking the time to tend to our whole self. Use all of you to integrate what has been fragmented by trauma, be it divorce, depression, anxiety, family issues, grief, etc. In a Christian setting I will be guide you to access your thoughts, feelings, and spirituality to help you become more authentically yourself, allowing you to use your strengths and create more peace in your life.
(253) 200-6391 View (253) 200-6391
Photo of Jonathan Clarke Goodman, Counselor in Puyallup, WA
Jonathan Clarke Goodman
Counselor, LMHC, NCC
Verified Verified
1 Endorsed
Puyallup, WA 98373
Not accepting new clients
I am a counselor who has served clients with a wide range of issues from anxiety, depression, personality issues, and trauma for 8 years. Before this, I worked serving individuals with traumatic stress for 6 years as a victim advocate in Pierce County. I'm interested in helping motivated adults and teens who are seeking new coping skills to help themselves rediscover their power to heal and grow.
I am a counselor who has served clients with a wide range of issues from anxiety, depression, personality issues, and trauma for 8 years. Before this, I worked serving individuals with traumatic stress for 6 years as a victim advocate in Pierce County. I'm interested in helping motivated adults and teens who are seeking new coping skills to help themselves rediscover their power to heal and grow.
(253) 242-8605 View (253) 242-8605
Photo of Katie Kimball, Clinical Social Work/Therapist in Puyallup, WA
Katie Kimball
Clinical Social Work/Therapist, MSW, LICSW
Verified Verified
Puyallup, WA 98371
As a Licensed Independent Clinical Social Worker I specialize in providing individual therapy to adolescents and adults experiencing challenges in the various domains of their life. This may include concerns such as depression, anxiety, trauma, substance use, adjustment, parent/child dynamics and school. I believe that it is an honor and a privilege to be a part of your life. My hope is that through the collaborative therapeutic process we can identify and utilize your inner strengths and resources to gain deeper insight and awareness into self and others.
As a Licensed Independent Clinical Social Worker I specialize in providing individual therapy to adolescents and adults experiencing challenges in the various domains of their life. This may include concerns such as depression, anxiety, trauma, substance use, adjustment, parent/child dynamics and school. I believe that it is an honor and a privilege to be a part of your life. My hope is that through the collaborative therapeutic process we can identify and utilize your inner strengths and resources to gain deeper insight and awareness into self and others.
(253) 600-2161 View (253) 600-2161
Photo of Nick Etherington, Counselor in Puyallup, WA
Nick Etherington
Counselor, LMHC, MS
Verified Verified
1 Endorsed
Puyallup, WA 98373
“There is no greater agony than bearing an untold story inside you”-Maya Angelou. It can be difficult taking the first step to seek out help when life seems unmanageable. However, it is often more difficult to work through the issues causing this disruption alone. Whether this is due to limited support in your life, or feeling that you have to take care of it yourself, you do not have to work through it alone.
“There is no greater agony than bearing an untold story inside you”-Maya Angelou. It can be difficult taking the first step to seek out help when life seems unmanageable. However, it is often more difficult to work through the issues causing this disruption alone. Whether this is due to limited support in your life, or feeling that you have to take care of it yourself, you do not have to work through it alone.
(253) 262-0631 View (253) 262-0631
Photo of Shawnda Brese, Marriage & Family Therapist in Puyallup, WA
Shawnda Brese
Marriage & Family Therapist, MA, LMFT
Verified Verified
4 Endorsed
Puyallup, WA 98372
Current openings: Monday 11am or 2pm, Tuesday 9am or 3:30pm; Wednesday 3:30pm; Thursday 11am, 1pm, 2pm. People see counselors for many different reasons. Some folks have mental health struggles such as anxiety or depression and therefore come to therapy for treatment and help. Others come to therapy for other life problems such as relationship problems, stressful work environments, worries about their future or their kids, struggles with their faith and spirituality, or grief and loss, etc. Counseling is an investment in the betterment of your life.
Current openings: Monday 11am or 2pm, Tuesday 9am or 3:30pm; Wednesday 3:30pm; Thursday 11am, 1pm, 2pm. People see counselors for many different reasons. Some folks have mental health struggles such as anxiety or depression and therefore come to therapy for treatment and help. Others come to therapy for other life problems such as relationship problems, stressful work environments, worries about their future or their kids, struggles with their faith and spirituality, or grief and loss, etc. Counseling is an investment in the betterment of your life.
(253) 231-3581 View (253) 231-3581
Photo of Jessie Waiamau-Ariota, Counselor in Puyallup, WA
Jessie Waiamau-Ariota
Counselor, MA, LMHC
Verified Verified
Puyallup, WA 98373
Not accepting new clients
HOPE is the only thing stronger than fear. Are you looking for a therapist to hope with you? I will. At the heart of all of my work as a therapist is a passion and desire to support and connect with you on your life journey. I will meet you where you are and help you get to where you want to go. You're reading this because you are ready for CHANGE! Learn how to apply LASTING SOLUTIONS to the issues in your life. I'll help you envision, fall in love with, and then create your best future. Aim for change. Hope with me. Let's get started!
HOPE is the only thing stronger than fear. Are you looking for a therapist to hope with you? I will. At the heart of all of my work as a therapist is a passion and desire to support and connect with you on your life journey. I will meet you where you are and help you get to where you want to go. You're reading this because you are ready for CHANGE! Learn how to apply LASTING SOLUTIONS to the issues in your life. I'll help you envision, fall in love with, and then create your best future. Aim for change. Hope with me. Let's get started!
(253) 256-3713 View (253) 256-3713
Photo of Marie Rule, Clinical Social Work/Therapist in Puyallup, WA
Marie Rule
Clinical Social Work/Therapist, LSWAIC, MSW , MHP
Verified Verified
Puyallup, WA 98375
I work with clients who are dealing with depression, anxiety, grief and loss, challenges with self-worth and unhelpful thinking, trauma, PTSD, relationships and feeling stuck. I help clients realize their innate wisdom, achieve their goals - whatever they may be, and find new ways of being in a world that is constantly full of challenges. I also work with parents who are struggling with their roles as parents, dealing with guilt and shame that oftentimes comes with parenting and help to find positive solutions with childrearing.
I work with clients who are dealing with depression, anxiety, grief and loss, challenges with self-worth and unhelpful thinking, trauma, PTSD, relationships and feeling stuck. I help clients realize their innate wisdom, achieve their goals - whatever they may be, and find new ways of being in a world that is constantly full of challenges. I also work with parents who are struggling with their roles as parents, dealing with guilt and shame that oftentimes comes with parenting and help to find positive solutions with childrearing.
(253) 243-3930 View (253) 243-3930
Photo of Heather Adaro, Counselor in Puyallup, WA
Heather Adaro
Counselor, LMHC, SUDP
Verified Verified
1 Endorsed
Puyallup, WA 98372  (Online Only)
Not accepting new clients
It takes a lot of courage to reach out when we're struggling. Life gets hard, relationships are complicated, work is demanding, and sometimes it's hard to know which way is up. Things like anxiousness, feelings of sadness, or experiences of trauma can complicate all this. It's difficult to feel on the cusp of needing to do something, wanting something different, and feeling stuck. Maybe you're feeling overwhelmed, or caught in patterns that aren't serving you anymore, whether it's eating, codependency, or substances. Let's talk about how to make meaningful change, and connection to yourself, your needs and values.
It takes a lot of courage to reach out when we're struggling. Life gets hard, relationships are complicated, work is demanding, and sometimes it's hard to know which way is up. Things like anxiousness, feelings of sadness, or experiences of trauma can complicate all this. It's difficult to feel on the cusp of needing to do something, wanting something different, and feeling stuck. Maybe you're feeling overwhelmed, or caught in patterns that aren't serving you anymore, whether it's eating, codependency, or substances. Let's talk about how to make meaningful change, and connection to yourself, your needs and values.
(253) 364-0127 View (253) 364-0127
Photo of Healing Space Therapy PLLC, Counselor in Puyallup, WA
Healing Space Therapy PLLC
Counselor, MA, LMHC
Verified Verified
2 Endorsed
Puyallup, WA 98372
Accepting new clients! I believe that people can seek therapy for many reasons. As your therapist my approach is to meet you where you are and help you reach your therapy goals. Whether you are struggling with a major life change, a traumatic moment or have day to day challenges, I am here to align with you and guide you to become your best self. My approach is to look at the whole person and together create therapy goals that will empower and heal from within.
Accepting new clients! I believe that people can seek therapy for many reasons. As your therapist my approach is to meet you where you are and help you reach your therapy goals. Whether you are struggling with a major life change, a traumatic moment or have day to day challenges, I am here to align with you and guide you to become your best self. My approach is to look at the whole person and together create therapy goals that will empower and heal from within.
(253) 400-1796 View (253) 400-1796
Photo of Gianna Young, Counselor in Puyallup, WA
Gianna Young
Counselor, MA, LMHCA
Verified Verified
3 Endorsed
Puyallup, WA 98371
I am passionate about meeting clients in their toughest seasons and fostering healing together. I approach the counseling relationship with empathy and a holistic framework that we are complex individuals who require complex treatment. I understand that it takes time to heal. My goal is to walk alongside you and help you develop skills that will lead you toward the person God created you to be. Together with God’s help, we can experience a life filled with His peace and joy.
I am passionate about meeting clients in their toughest seasons and fostering healing together. I approach the counseling relationship with empathy and a holistic framework that we are complex individuals who require complex treatment. I understand that it takes time to heal. My goal is to walk alongside you and help you develop skills that will lead you toward the person God created you to be. Together with God’s help, we can experience a life filled with His peace and joy.
(253) 366-6751 View (253) 366-6751
Photo of Gennevieve M Luff, Counselor in Puyallup, WA
Gennevieve M Luff
Counselor, MA, MHP, LMHC
Verified Verified
1 Endorsed
Puyallup, WA 98372
In the journey of life, challenges and obstacles will arise which can leave one feeling unbalanced and emotionally depleted. These feelings can make you feel like your self-esteem has taken a hit and leave you feeling unworthy of love and belonging. I feel everyone has the potential to find balance and healing in rewriting their own future story. My goal in working with you would be to provide a safe place to explore and effectively express emotions, set goals to increase quality of life and improve communication skills while rebuilding your self-worth and self-esteem.
In the journey of life, challenges and obstacles will arise which can leave one feeling unbalanced and emotionally depleted. These feelings can make you feel like your self-esteem has taken a hit and leave you feeling unworthy of love and belonging. I feel everyone has the potential to find balance and healing in rewriting their own future story. My goal in working with you would be to provide a safe place to explore and effectively express emotions, set goals to increase quality of life and improve communication skills while rebuilding your self-worth and self-esteem.
(253) 252-8813 View (253) 252-8813
Photo of Laura M Schulz, Counselor in Puyallup, WA
Laura M Schulz
Counselor, PhD, MA, LMHC
Verified Verified
7 Endorsed
Puyallup, WA 98374  (Online Only)
Life can be hard; therapy can help you remove roadblocks & work toward a happier you. Many people have answers to their challenges within them but are blocked by overwhelm & self-doubt. For many, our childhood wasn't perfect. Examining that foundation, deciding what parts of it you want to continue carrying, and what parts you want to let go of can help you toward a calmer and happier life. If you're feeling stressed out or stuck, let's find out what's at the root of those emotions so you can get to a happier & healthier life.
Life can be hard; therapy can help you remove roadblocks & work toward a happier you. Many people have answers to their challenges within them but are blocked by overwhelm & self-doubt. For many, our childhood wasn't perfect. Examining that foundation, deciding what parts of it you want to continue carrying, and what parts you want to let go of can help you toward a calmer and happier life. If you're feeling stressed out or stuck, let's find out what's at the root of those emotions so you can get to a happier & healthier life.
(425) 276-6479 View (425) 276-6479
Photo of HorizonView Health, Licensed Professional Counselor in Puyallup, WA
HorizonView Health
Licensed Professional Counselor
Verified Verified
Puyallup, WA 98371
Counseling is a brave and wonderful step and finding a positive therapeutic relationship without judgement is necessary for change and growth. Our counselors believe in a client centered, strength-based approach. They have training and experience in several modalities including cognitive behavioral therapy, solutions focused treatment and are experienced in the emotional, physical, and spiritual impacts of trauma.
Counseling is a brave and wonderful step and finding a positive therapeutic relationship without judgement is necessary for change and growth. Our counselors believe in a client centered, strength-based approach. They have training and experience in several modalities including cognitive behavioral therapy, solutions focused treatment and are experienced in the emotional, physical, and spiritual impacts of trauma.
(253) 331-2547 View (253) 331-2547
Photo of Jennifer McDonald, Marriage & Family Therapist Associate in Puyallup, WA
Jennifer McDonald
Marriage & Family Therapist Associate, LMFTA
Verified Verified
Puyallup, WA 98373  (Online Only)
I serve children (6+), teens, and adults (up to 40) for individual therapy. I also conduct couples therapy, family therapy and i offer parent sessions. I use a mixture of models to meet each client where they are currently at in their mental health journey.
I serve children (6+), teens, and adults (up to 40) for individual therapy. I also conduct couples therapy, family therapy and i offer parent sessions. I use a mixture of models to meet each client where they are currently at in their mental health journey.
(206) 222-6701 View (206) 222-6701
Photo of Ana-Lisa Davidson, Counselor in Puyallup, WA
Ana-Lisa Davidson
Counselor, LMHCA
Verified Verified
Puyallup, WA 98372
Utilizing Emotion-focused therapy (EFT), we will create an open and honest partnership to improve your mental health and explore who you are and what you would like to achieve. My style of therapy is a collaborative approach between myself and my clients as we strive to reach your goals. I believe counseling provides a safe place for clients to be able to heal and grow. As Humans, we are emotionally bonding creatures, and it is crucial to recognize and support the emotional, physical, and spiritual dimensions of our beings.
Utilizing Emotion-focused therapy (EFT), we will create an open and honest partnership to improve your mental health and explore who you are and what you would like to achieve. My style of therapy is a collaborative approach between myself and my clients as we strive to reach your goals. I believe counseling provides a safe place for clients to be able to heal and grow. As Humans, we are emotionally bonding creatures, and it is crucial to recognize and support the emotional, physical, and spiritual dimensions of our beings.
(253) 563-1883 View (253) 563-1883
Photo of Charnei Washington, Marriage & Family Therapist Associate in Puyallup, WA
Charnei Washington
Marriage & Family Therapist Associate
Verified Verified
Puyallup, WA 98373  (Online Only)
Not accepting new clients
I specialize in helping adults of all walks of life, navigate significant life changes, cope with mild mood challenges, & provide support in sex therapy. Yes, I'm a sex therapist! My goal is to create a welcoming online space where you can openly share your thoughts & feelings, gain valuable insights, & develop the skills to empower yourself, whether related to your sexual journey or not. My passion is breaking the stigma around sex and sexual expression, especially in the context of mental health, with a focus on supporting people of color (POC). I believe mental health and sexual well-being are vital for overall wellness.
I specialize in helping adults of all walks of life, navigate significant life changes, cope with mild mood challenges, & provide support in sex therapy. Yes, I'm a sex therapist! My goal is to create a welcoming online space where you can openly share your thoughts & feelings, gain valuable insights, & develop the skills to empower yourself, whether related to your sexual journey or not. My passion is breaking the stigma around sex and sexual expression, especially in the context of mental health, with a focus on supporting people of color (POC). I believe mental health and sexual well-being are vital for overall wellness.
(253) 263-1262 View (253) 263-1262
Photo of Resolve & Recover Counseling , Clinical Social Work/Therapist in Puyallup, WA
Resolve & Recover Counseling
Clinical Social Work/Therapist, LICSW , SUDP, MHP, LCSW
Verified Verified
Puyallup, WA 98373
Not accepting new clients
I am certified in trauma and complex trauma related disorders. My focus in therapy is to start where you are and identify what brings you to therapy. We will create a treatment plan specific to your needs and goals. I understand that working through trauma and recovery can be complex and challenging for many, but I believe in recovery using the mind body and spirit so you can fully heal and become the best version of yourself that you can be.
I am certified in trauma and complex trauma related disorders. My focus in therapy is to start where you are and identify what brings you to therapy. We will create a treatment plan specific to your needs and goals. I understand that working through trauma and recovery can be complex and challenging for many, but I believe in recovery using the mind body and spirit so you can fully heal and become the best version of yourself that you can be.
(253) 785-0688 View (253) 785-0688

How does your Therapist compare?

Number of Therapists in Puyallup, WA

200+

Average cost per session

$150

Therapists in Puyallup, WA who prioritize treating:

91% Anxiety
88% Depression
80% Self Esteem
79% Trauma and PTSD
75% Coping Skills
73% Stress
72% Relationship Issues

Average years in practice

9 Years

Top 3 insurances accepted

77% Premera
74% Regence
73% First Choice Health | FCH

How Therapists in Puyallup, WA see their clients

69% In Person and Online
31% Online Only

Gender breakdown

79% Female
20% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Puyallup?

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.