Therapists in Saint Louis, MO

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Photo of Brittany A. Martin, Clinical Social Work/Therapist in Saint Louis, MO
Brittany A. Martin
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Saint Louis, MO 63101  (Online Only)
Taking the steps to locate and secure a therapist are not easy. You’ve probably been through some tough challenges that have brought you to this place today. However, you don’t have to navigate the hardships of life on your own. Allow me to help you build the skills you need to tap into your own resilience and create lasting changes!
Taking the steps to locate and secure a therapist are not easy. You’ve probably been through some tough challenges that have brought you to this place today. However, you don’t have to navigate the hardships of life on your own. Allow me to help you build the skills you need to tap into your own resilience and create lasting changes!
(314) 742-7182 View (314) 742-7182
Photo of Betsy Farrar, Pre-Licensed Professional in Saint Louis, MO
Betsy Farrar
Pre-Licensed Professional, MA, PLPC
Verified Verified
Saint Louis, MO 63104
Life can be chaotic and stressful. As a therapist, my passion is helping clients create more peace & presence in their stressful lives so that they can tap into their intuition and connect to their authentic selves. Through collaborative work and an emphasis on mind-body connection, I support clients as they explore their deepest pains, longings, & hopes. Through this reflective work, we can view our obstacles with new eyes, implement effective coping skills, cultivate mindfulness practices, & create change.
Life can be chaotic and stressful. As a therapist, my passion is helping clients create more peace & presence in their stressful lives so that they can tap into their intuition and connect to their authentic selves. Through collaborative work and an emphasis on mind-body connection, I support clients as they explore their deepest pains, longings, & hopes. Through this reflective work, we can view our obstacles with new eyes, implement effective coping skills, cultivate mindfulness practices, & create change.
(314) 794-5770 View (314) 794-5770
Photo of Matthew James Murtaugh in Saint Louis, MO
Matthew James Murtaugh
PLPC
Verified Verified
Saint Louis, MO 63139  (Online Only)
Hi! It is so nice to meet you! Are you struggling with emotional pain? Are you suffering from anxiety? Is it hard to get motivated in the morning? Do you find daily tasks difficult? Are your moods changing constantly? Maybe something happened years ago that is still weighing on you today? You have the right to be happy. You have the right to live your best life!
Hi! It is so nice to meet you! Are you struggling with emotional pain? Are you suffering from anxiety? Is it hard to get motivated in the morning? Do you find daily tasks difficult? Are your moods changing constantly? Maybe something happened years ago that is still weighing on you today? You have the right to be happy. You have the right to live your best life!
(314) 526-3746 View (314) 526-3746
Photo of Yasmira Emofor, Licensed Professional Counselor in Saint Louis, MO
Yasmira Emofor
Licensed Professional Counselor, LPC, CCDP-D
Verified Verified
Saint Louis, MO 63108
Have you felt like you are missing out on life? Have you felt like you are in a slump that you can’t dig yourself out off? Like you been struggling for so long without a break from the stress of it all? Whether your struggle is depression, anxiety, phobias or trauma, I am here to offer a safe space for you. What you want to feel is empowered, capable and resilient to handle the challenge; or ready to face down any fear. I've helped countless individuals! Let me help you reclaim your resiliency today!
Have you felt like you are missing out on life? Have you felt like you are in a slump that you can’t dig yourself out off? Like you been struggling for so long without a break from the stress of it all? Whether your struggle is depression, anxiety, phobias or trauma, I am here to offer a safe space for you. What you want to feel is empowered, capable and resilient to handle the challenge; or ready to face down any fear. I've helped countless individuals! Let me help you reclaim your resiliency today!
(314) 742-8208 View (314) 742-8208
Photo of Sharnita White, Counselor in Saint Louis, MO
Sharnita White
Counselor, LMHC, LPC
Verified Verified
Saint Louis, MO 63146
Are you unhappy with yourself? When alone your mind race, you question who you are & nothing makes you happy, ready to be healed from trauma. If you’re ready to find happiness within yourself, learn about how self care is connected & affects your self love, self esteem, self acceptance and self awareness, then you are in the right place.
Are you unhappy with yourself? When alone your mind race, you question who you are & nothing makes you happy, ready to be healed from trauma. If you’re ready to find happiness within yourself, learn about how self care is connected & affects your self love, self esteem, self acceptance and self awareness, then you are in the right place.
(314) 798-7989 View (314) 798-7989
Photo of Ashley Blake, Clinical Social Work/Therapist in Saint Louis, MO
Ashley Blake
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Saint Louis, MO 63117
Everyone thinks you have it all “all together,” but inside it feels like you're spinning out of control. You can’t stay focused. Simple tasks that should be easy feel totally overwhelming and you've started avoiding them completely. Your relationships are suffering, and you feel like it’s all your fault. You want to be easy-going and caring, but you're impatient and irritable. You want to be sociable and fun, but you're withdrawn and flat. The fear of being exposed as a fraud looms over you constantly. You’re not sure what to do but you know it's getting worse.
Everyone thinks you have it all “all together,” but inside it feels like you're spinning out of control. You can’t stay focused. Simple tasks that should be easy feel totally overwhelming and you've started avoiding them completely. Your relationships are suffering, and you feel like it’s all your fault. You want to be easy-going and caring, but you're impatient and irritable. You want to be sociable and fun, but you're withdrawn and flat. The fear of being exposed as a fraud looms over you constantly. You’re not sure what to do but you know it's getting worse.
(314) 501-6844 View (314) 501-6844
Photo of Krystal Skipper - Ellie Mental Health Concord Mo, Licensed Professional Counselor in Saint Louis, MO
Krystal Skipper - Ellie Mental Health Concord Mo
Licensed Professional Counselor, MA, LPC
Verified Verified
Saint Louis, MO 63128
WELCOME to Ellie Mental Health in South County STL. I'm so happy that you are here and are ready to start your or your loved ones mental health journey. I am the Clinic Director and would love to help you connect with one of my wonderfully, talented clinicians. We believe counseling can be a safe place to begin this healing. Myself and my clinicians aim to bring an authentic approach that includes humor, compassion, acceptance and creativity to the therapy room.
WELCOME to Ellie Mental Health in South County STL. I'm so happy that you are here and are ready to start your or your loved ones mental health journey. I am the Clinic Director and would love to help you connect with one of my wonderfully, talented clinicians. We believe counseling can be a safe place to begin this healing. Myself and my clinicians aim to bring an authentic approach that includes humor, compassion, acceptance and creativity to the therapy room.
(636) 202-1879 View (636) 202-1879
Photo of Laura McClure, Clinical Social Work/Therapist in Saint Louis, MO
Laura McClure
Clinical Social Work/Therapist, LCSW
Verified Verified
Saint Louis, MO 63122
Laura McClure is a Licensed Clinical Social Worker in Missouri who has been practicing since 2017. She has a Master of Social Work from Saint Louis University in 2017, clinical tract with specializations in Children, Youth, and Family, Trauma-Informed Care, and Individual and Family Therapy and a Bachelor of Science in Psychology and Child Family Development from Missouri State University in 2007. Laura believes that the client is the expert and works with the client to help define problem areas and develop attainable goals to work towards within the therapeutic environment.
Laura McClure is a Licensed Clinical Social Worker in Missouri who has been practicing since 2017. She has a Master of Social Work from Saint Louis University in 2017, clinical tract with specializations in Children, Youth, and Family, Trauma-Informed Care, and Individual and Family Therapy and a Bachelor of Science in Psychology and Child Family Development from Missouri State University in 2007. Laura believes that the client is the expert and works with the client to help define problem areas and develop attainable goals to work towards within the therapeutic environment.
(314) 742-8035 View (314) 742-8035
Photo of McKayla Kagie, Pre-Licensed Professional in Saint Louis, MO
McKayla Kagie
Pre-Licensed Professional, MA, SMFT
Verified Verified
1 Endorsed
Saint Louis, MO 63109  (Online Only)
The therapeutic relationship is one of healing and hope. Facilitating that relationship is very important because I understand the value of working with someone not pushing their usually well-intentioned agenda onto your situation. Someone outside our problems who has no investment in how we handle those problems can offer limitless perspective and an abundance of compassion. In addition to being a listening ear, therapists have many resources and tools to help us navigate whatever challenges and changes life throws at us. This is the type of therapist I strive to be.
The therapeutic relationship is one of healing and hope. Facilitating that relationship is very important because I understand the value of working with someone not pushing their usually well-intentioned agenda onto your situation. Someone outside our problems who has no investment in how we handle those problems can offer limitless perspective and an abundance of compassion. In addition to being a listening ear, therapists have many resources and tools to help us navigate whatever challenges and changes life throws at us. This is the type of therapist I strive to be.
(314) 207-9904 View (314) 207-9904
Photo of Coffee with Casey Counseling, Counselor in Saint Louis, MO
Coffee with Casey Counseling
Counselor, MA, LPC
Verified Verified
Saint Louis, MO 63119
If you're tired of being stuck in an unsatisfying rut in this messy world-- your comeback story can start here. One cup at a time, we will use a holistic approach to help you become your best self. We can work together to help you live the abundant, rewarding life that is in store for you. Learn more at coffeewithcaseycounseling.com
If you're tired of being stuck in an unsatisfying rut in this messy world-- your comeback story can start here. One cup at a time, we will use a holistic approach to help you become your best self. We can work together to help you live the abundant, rewarding life that is in store for you. Learn more at coffeewithcaseycounseling.com
(314) 310-2951 View (314) 310-2951
Photo of Sharper Vision Counseling Services, Licensed Professional Counselor in Saint Louis, MO
Sharper Vision Counseling Services
Licensed Professional Counselor, MEd, LPC, NCC
Verified Verified
1 Endorsed
Saint Louis, MO 63114
Waitlist for new clients
At this time we have a Counseling Intern and Associate Therapist Available Only. There are times in life when you feel stuck, sad, angry, or indifferent. In these times, it is helpful to have a non-bias party be a mirror on your journey to becoming the best version of you that you can be. There are also times when clients have identified that familial traditions have held them captive or even hindered their growth. Processing those things will help you to identify the best path for you as you move forward to your big picture. We would love to assist you on that journey of becoming a better you.
At this time we have a Counseling Intern and Associate Therapist Available Only. There are times in life when you feel stuck, sad, angry, or indifferent. In these times, it is helpful to have a non-bias party be a mirror on your journey to becoming the best version of you that you can be. There are also times when clients have identified that familial traditions have held them captive or even hindered their growth. Processing those things will help you to identify the best path for you as you move forward to your big picture. We would love to assist you on that journey of becoming a better you.
(314) 582-0810 View (314) 582-0810
Photo of L. Charlie Janski-Ogunfidodo, Clinical Social Work/Therapist in Saint Louis, MO
L. Charlie Janski-Ogunfidodo
Clinical Social Work/Therapist, LCSW
Verified Verified
2 Endorsed
Saint Louis, MO 63118  (Online Only)
During my career, I have worked with both individual and group settings, including adults with people living with HIV, veterans, incarcerated people and transgender/gender variant individuals. These populations included people with depression, bi-polar disorder, personality disorders, anxiety, PTSD and depression. I co-facilitated a group for trans youth and co-coordinated it for 6 years. As a proud bisexual, trans man, I love to work with my LGBT communities. I celebrate kinky and poly people. I strive to be an imperfect ally to non-binary trans people and people of color. I take private pay/in person through findingnormalstl.com
During my career, I have worked with both individual and group settings, including adults with people living with HIV, veterans, incarcerated people and transgender/gender variant individuals. These populations included people with depression, bi-polar disorder, personality disorders, anxiety, PTSD and depression. I co-facilitated a group for trans youth and co-coordinated it for 6 years. As a proud bisexual, trans man, I love to work with my LGBT communities. I celebrate kinky and poly people. I strive to be an imperfect ally to non-binary trans people and people of color. I take private pay/in person through findingnormalstl.com
(314) 350-4422 View (314) 350-4422
Photo of Mark Patrick, Licensed Professional Counselor in Saint Louis, MO
Mark Patrick
Licensed Professional Counselor, MA, LPC
Verified Verified
Saint Louis, MO 63122
Not accepting new clients
I provide compassionate, nonjudgmental counseling to individuals and families. I am particularly passionate about working with adolescents and their family systems. Learn more and contact me for a free consultation at www.markpatrickcounseling.com.
I provide compassionate, nonjudgmental counseling to individuals and families. I am particularly passionate about working with adolescents and their family systems. Learn more and contact me for a free consultation at www.markpatrickcounseling.com.
(314) 325-1691 View (314) 325-1691
Photo of Lauren Kamm, Licensed Professional Counselor in Saint Louis, MO
Lauren Kamm
Licensed Professional Counselor, LPC
Verified Verified
Saint Louis, MO 63132
Stuck? People-Pleasing? Burnt out by life? Almost like no matter what you try to change or improve, those wheels just keep spinning, and you are exhausted. My ideal client is someone who is just ready to feel better. You may not exactly know what is going on or why these feelings are coming up all of a sudden. That's okay! You deserve someone who will collaborate with you no matter what you are dealing with. I believe connection and authenticity is the most vital part of the therapy process. Therapy is not just for fears and tears, but laughter and smiles too :) Let's tackle this together! (I hope you enjoy analogies!)
Stuck? People-Pleasing? Burnt out by life? Almost like no matter what you try to change or improve, those wheels just keep spinning, and you are exhausted. My ideal client is someone who is just ready to feel better. You may not exactly know what is going on or why these feelings are coming up all of a sudden. That's okay! You deserve someone who will collaborate with you no matter what you are dealing with. I believe connection and authenticity is the most vital part of the therapy process. Therapy is not just for fears and tears, but laughter and smiles too :) Let's tackle this together! (I hope you enjoy analogies!)
(314) 937-6408 View (314) 937-6408
Photo of Erin McDyer - Sandhill Counseling, Pre-Licensed Professional in Saint Louis, MO
Erin McDyer - Sandhill Counseling
Pre-Licensed Professional, MA, PLPC
Verified Verified
Saint Louis, MO 63128
Everyone has different feelings about therapy. Some people are excited about it and jump at the opportunity to dive into the deepest parts of themselves, but some might find it nerve-racking, scary, or just straight up unpleasant. Maybe you’re nervous you’ll be told nothing is wrong with you or that you will be dismissed. Regardless of your feelings coming into therapy, my goal is the same: to create a space where you feel truly comfortable to express yourself, to be vulnerable, and where you feel heard and valued.
Everyone has different feelings about therapy. Some people are excited about it and jump at the opportunity to dive into the deepest parts of themselves, but some might find it nerve-racking, scary, or just straight up unpleasant. Maybe you’re nervous you’ll be told nothing is wrong with you or that you will be dismissed. Regardless of your feelings coming into therapy, my goal is the same: to create a space where you feel truly comfortable to express yourself, to be vulnerable, and where you feel heard and valued.
(636) 422-5791 x1029 View (636) 422-5791 x1029
Photo of Megan Robb, Licensed Professional Counselor in Saint Louis, MO
Megan Robb
Licensed Professional Counselor, LPC, ATR-BC, NCC
Verified Verified
Saint Louis, MO 63130
Hi, I'm Megan and I use she/her pronouns. I have 20 years experience working alongside people as they strengthen their inner knowledge and outward interactions. Therapy can bridge the gap between where you are and where you want to be. I think a lot about the brain and how we unconsciously replicate patterns. The work I do uses current brain-based therapy approaches to help integrate outdated patterns into newer, more helpful ones.
Hi, I'm Megan and I use she/her pronouns. I have 20 years experience working alongside people as they strengthen their inner knowledge and outward interactions. Therapy can bridge the gap between where you are and where you want to be. I think a lot about the brain and how we unconsciously replicate patterns. The work I do uses current brain-based therapy approaches to help integrate outdated patterns into newer, more helpful ones.
(314) 970-5890 View (314) 970-5890
Photo of Tracy M Schamburg, Licensed Professional Counselor in Saint Louis, MO
Tracy M Schamburg
Licensed Professional Counselor, M Ed, LPC
Verified Verified
Saint Louis, MO 63141
I have been in the counseling field for thirty years, private practice for twenty. I have an outstanding track record helping struggling couples. I am relatable and directive. I work well with men, women and adolescents. I have a book series on Amazon: The Common Sense Guide to Repairing Your Marriage; The Common Sense Guide to Landing on Your Feet; The Common Sense Guide to the 12 Days of Christmas. Check these out and you will definitely get an idea of my style and approach. People come in to counseling for results, and I work hard to provide them.
I have been in the counseling field for thirty years, private practice for twenty. I have an outstanding track record helping struggling couples. I am relatable and directive. I work well with men, women and adolescents. I have a book series on Amazon: The Common Sense Guide to Repairing Your Marriage; The Common Sense Guide to Landing on Your Feet; The Common Sense Guide to the 12 Days of Christmas. Check these out and you will definitely get an idea of my style and approach. People come in to counseling for results, and I work hard to provide them.
(314) 310-4127 View (314) 310-4127
Photo of Kit Lentini, Clinical Social Work/Therapist in Saint Louis, MO
Kit Lentini
Clinical Social Work/Therapist, LMSW
Verified Verified
Saint Louis, MO 63139
Throughout our lives, many of us adopt narratives that don’t align with our actual experiences — they may leave out important details about our families or our make-up, the ways we were hurt, or the ways in which we have succeeded. But in all cases, they don’t do justice to the depth of our experiences, and in fact, when we have been abused or mistreated, the very purpose of these false narratives may be to obscure the truth of who we are and what we’ve been through. My greatest hope is that our work together will allow you to come home to yourself as you learn to tell stories that honor the core of who you are.
Throughout our lives, many of us adopt narratives that don’t align with our actual experiences — they may leave out important details about our families or our make-up, the ways we were hurt, or the ways in which we have succeeded. But in all cases, they don’t do justice to the depth of our experiences, and in fact, when we have been abused or mistreated, the very purpose of these false narratives may be to obscure the truth of who we are and what we’ve been through. My greatest hope is that our work together will allow you to come home to yourself as you learn to tell stories that honor the core of who you are.
(314) 788-2805 View (314) 788-2805
Photo of Erin Hotz, Clinical Social Work/Therapist in Saint Louis, MO
Erin Hotz
Clinical Social Work/Therapist, LCSW
Verified Verified
Saint Louis, MO 63127
Life is not always easy. Transitions, such as becoming an adult or becoming a parent, can be welcome changes but can also be hard to manage. We also come across challenges in our day to day life that we may have a hard time coping with. Sometimes these things lead to issues like anxiety, depression, grief, struggles in relationships, or issues with school or work. My background in both Social Work and Child Development gives me a unique, holistic perspective that informs my practice. I particularly enjoy using my background to help both young adults and parents work through the challenges that come with their stages in life.
Life is not always easy. Transitions, such as becoming an adult or becoming a parent, can be welcome changes but can also be hard to manage. We also come across challenges in our day to day life that we may have a hard time coping with. Sometimes these things lead to issues like anxiety, depression, grief, struggles in relationships, or issues with school or work. My background in both Social Work and Child Development gives me a unique, holistic perspective that informs my practice. I particularly enjoy using my background to help both young adults and parents work through the challenges that come with their stages in life.
(314) 470-9816 View (314) 470-9816
Photo of Allison Cayne Counseling, LLC, Clinical Social Work/Therapist in Saint Louis, MO
Allison Cayne Counseling, LLC
Clinical Social Work/Therapist, LCSW, MEd
Verified Verified
Saint Louis, MO 63105
Not accepting new clients
Welcome! I offer counseling services for adolescents and young adults who are struggling with relationships (including IPV), life changes, identity, PTSD, anxiety, and depression. My approach to therapy is compassionate, client centered, and emphasizes the mutual development of goals for better emotional, physical, and relationship health. In our initial consultation, we can talk through where you’re at right now, where you’d like to be, and how we can get there in a way that feels comfortable for you. I like to spend time really getting to know you because a solid therapeutic relationship is built upon trust and understanding.
Welcome! I offer counseling services for adolescents and young adults who are struggling with relationships (including IPV), life changes, identity, PTSD, anxiety, and depression. My approach to therapy is compassionate, client centered, and emphasizes the mutual development of goals for better emotional, physical, and relationship health. In our initial consultation, we can talk through where you’re at right now, where you’d like to be, and how we can get there in a way that feels comfortable for you. I like to spend time really getting to know you because a solid therapeutic relationship is built upon trust and understanding.
(314) 697-2139 View (314) 697-2139

How does your Therapist compare?

Number of Therapists in Saint Louis, MO

1,000+

Average cost per session

$125

Therapists in Saint Louis, MO who prioritize treating:

91% Anxiety
86% Depression
77% Relationship Issues
74% Self Esteem
70% Trauma and PTSD
67% Stress
66% Coping Skills

Average years in practice

11 Years

Top 3 insurances accepted

74% UnitedHealthcare UHC | UBH
71% Aetna
71% Cigna and Evernorth

How Therapists in Saint Louis, MO see their clients

75% In Person and Online
25% Online Only

Gender breakdown

78% Female
20% Male
2% Non-Binary

FAQs - About Therapy and Counseling

How can I find a therapist in Saint Louis?

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.