Therapists in Central, Fresno, CA

Photo of Tiffany Richards, Pre-Licensed Professional in Central, Fresno, CA
Tiffany Richards
Pre-Licensed Professional, APCC
Verified
Central, Fresno, CA 93720  (Online Only)
Do you feel like you are surviving and not living? Do you feel stuck in an endless loop of anxiety and depression? Is it hard for you to find the words to describe your experiences? Therapy can provide a powerful space to build insight, process openly, and learn to effectively address and manage difficult emotions in order to make positive changes. One of my favorite parts of my job is providing an affirming trusting and non judgmental environment so we can work collaboratively to create a treatment plan unique to your needs.
Do you feel like you are surviving and not living? Do you feel stuck in an endless loop of anxiety and depression? Is it hard for you to find the words to describe your experiences? Therapy can provide a powerful space to build insight, process openly, and learn to effectively address and manage difficult emotions in order to make positive changes. One of my favorite parts of my job is providing an affirming trusting and non judgmental environment so we can work collaboratively to create a treatment plan unique to your needs.
(657) 571-4330 View (657) 571-4330
Photo of Onyx Trauma & Healing Center, Marriage & Family Therapist in Central, Fresno, CA
Onyx Trauma & Healing Center
Marriage & Family Therapist, MS, MA, LMFT
Verified
2 Endorsed
Central, Fresno, CA 93721
There are seasons in life that are very unpredictable, 2020 for example! If you are finding that the last few months, weeks, maybe even years have been full of overwhelming amounts of change, transition and uncertainty, your are not alone. I understand the uncertainty of life can cause depression, anxiety, and unresolved traumas to arise. In every client I have ever seen, trauma has been experienced and expressed in different ways. My goal is to assist you with getting to the heart of the issues you are enduring, while embracing the resiliency and strength it took for you to make it this far. Emotional healing and relief is near.
There are seasons in life that are very unpredictable, 2020 for example! If you are finding that the last few months, weeks, maybe even years have been full of overwhelming amounts of change, transition and uncertainty, your are not alone. I understand the uncertainty of life can cause depression, anxiety, and unresolved traumas to arise. In every client I have ever seen, trauma has been experienced and expressed in different ways. My goal is to assist you with getting to the heart of the issues you are enduring, while embracing the resiliency and strength it took for you to make it this far. Emotional healing and relief is near.
(209) 391-2420 View (209) 391-2420
Photo of Margot Tepperman, Clinical Social Work/Therapist in Central, Fresno, CA
Margot Tepperman
Clinical Social Work/Therapist, MA, MSW, LCSW, ACC
Verified
Central, Fresno, CA 93701
I provide a holistic counseling approach providing rapid, positive changes in areas of depression, anxiety, trauma, stress management, relationship, pain management and grief work with adults and children. My resources include the powerful technique of EMDR, Eye Movement Desensitization and Reprocessing, as well as HYPNOSIS, visual imagery and new thought. Hypnosis is a powerful, effective and immediate tool to bring about profound change. It is useful for eliminating addictive behaviors, improving sports performance, reducing anxiety while giving presentations, taking tests and also used for post surgery healing.
I provide a holistic counseling approach providing rapid, positive changes in areas of depression, anxiety, trauma, stress management, relationship, pain management and grief work with adults and children. My resources include the powerful technique of EMDR, Eye Movement Desensitization and Reprocessing, as well as HYPNOSIS, visual imagery and new thought. Hypnosis is a powerful, effective and immediate tool to bring about profound change. It is useful for eliminating addictive behaviors, improving sports performance, reducing anxiety while giving presentations, taking tests and also used for post surgery healing.
(559) 472-0863 View (559) 472-0863
Photo of Shadaria Rene Prince, Clinical Social Work/Therapist in Central, Fresno, CA
Shadaria Rene Prince
Clinical Social Work/Therapist, MSW, LCSW
Verified
1 Endorsed
Central, Fresno, CA 93721
Hello and Welcome! My name is Shadaria Prince, LCSW, and I'm here to foster Healing, Empowerment, and Resilience in your journey. Life's unpredictable twists and turns can often leave us disoriented, questioning our path and searching for solid ground. This uncertainty can manifest as heightened anxiety, persistent stress, and overthinking, making life's challenges seem insurmountable. In these moments, I come alongside you, offering a nurturing, non-judgmental space where you can rediscover your inner strength and find your voice.
Hello and Welcome! My name is Shadaria Prince, LCSW, and I'm here to foster Healing, Empowerment, and Resilience in your journey. Life's unpredictable twists and turns can often leave us disoriented, questioning our path and searching for solid ground. This uncertainty can manifest as heightened anxiety, persistent stress, and overthinking, making life's challenges seem insurmountable. In these moments, I come alongside you, offering a nurturing, non-judgmental space where you can rediscover your inner strength and find your voice.
(209) 260-6720 View (209) 260-6720
Photo of Obed Romero, Marriage & Family Therapist in Central, Fresno, CA
Obed Romero
Marriage & Family Therapist, LMFT
Verified
Central, Fresno, CA 93711  (Online Only)
Waitlist for new clients
Hi! I am a Licensed Marriage and Family Therapist (LMFT) & Associate Professional Clinical Counselor (APCC). I am specialized in & have years of experience of working with adults diagnosed with anxiety disorders, depressive disorders, & anger-related disorders. My therapeutic approaches include: Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), & self-compassion focused interventions. I have also been trained in Emotion Focused Couple’s Therapy (EFT), Motivational Interviewing (MI), suicide assessment & providing sleep therapy skills through the UC Berkley sleep team.
Hi! I am a Licensed Marriage and Family Therapist (LMFT) & Associate Professional Clinical Counselor (APCC). I am specialized in & have years of experience of working with adults diagnosed with anxiety disorders, depressive disorders, & anger-related disorders. My therapeutic approaches include: Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), & self-compassion focused interventions. I have also been trained in Emotion Focused Couple’s Therapy (EFT), Motivational Interviewing (MI), suicide assessment & providing sleep therapy skills through the UC Berkley sleep team.
(559) 242-1551 View (559) 242-1551
Photo of Elizabeth Rose Galadjian, Associate Professional Clinical Counselor in Central, Fresno, CA
Elizabeth Rose Galadjian
Associate Professional Clinical Counselor, MS, APCC
Verified
Central, Fresno, CA 93650  (Online Only)
My journey into the mental health field was ignited by witnessing the struggles faced by my loved ones, which were exacerbated due to a lack of adequate support. I strive to be that missing support and foster an environment where individuals can leverage their strengths and tap into newly developed coping skills. I've also been motivated by the noticeable absence of Armenian-speaking clinicians. These experiences have granted me valuable insights into supporting individuals grappling with significant life transitions, anxiety, depression, trauma, and various other challenges. I aim to have a meaningful impact on diverse communities.
My journey into the mental health field was ignited by witnessing the struggles faced by my loved ones, which were exacerbated due to a lack of adequate support. I strive to be that missing support and foster an environment where individuals can leverage their strengths and tap into newly developed coping skills. I've also been motivated by the noticeable absence of Armenian-speaking clinicians. These experiences have granted me valuable insights into supporting individuals grappling with significant life transitions, anxiety, depression, trauma, and various other challenges. I aim to have a meaningful impact on diverse communities.
(323) 417-5432 View (323) 417-5432
Photo of Jetena McGhee, Clinical Social Work/Therapist in Central, Fresno, CA
Jetena McGhee
Clinical Social Work/Therapist, LCSW
Verified
Central, Fresno, CA 93721  (Online Only)
Are you a young lady or adult woman who is having difficulty navigating life? Do you have a daughter who needs help? Difficulties in life can cause crisis, guilt, shame, depression, anxiety, relationship problems, a lack of faith and hope, and a lack of understanding who you are and what you stand for. If you are interested in straightening you path, gaining clarity and building faith, please consider reaching out. I have a total of 15 years of experience helping children/adolescents and adults with challenging life issues. I got my start in the helping field as a therapist for children/adolescents with autism.
Are you a young lady or adult woman who is having difficulty navigating life? Do you have a daughter who needs help? Difficulties in life can cause crisis, guilt, shame, depression, anxiety, relationship problems, a lack of faith and hope, and a lack of understanding who you are and what you stand for. If you are interested in straightening you path, gaining clarity and building faith, please consider reaching out. I have a total of 15 years of experience helping children/adolescents and adults with challenging life issues. I got my start in the helping field as a therapist for children/adolescents with autism.
(626) 209-8340 View (626) 209-8340
Photo of Rebecca Reynolds, Marriage & Family Therapist in Central, Fresno, CA
Rebecca Reynolds
Marriage & Family Therapist, MS, LMFT
Verified
Central, Fresno, CA 93721
As a human and as a therapist, I understand that making sense of life and its impact can sometimes be overwhelming and traumatic in ways that can leave us feeling helpless, anxious, depressed, or simply stuck. It takes courage to seek help to find relief. That relief is possible in the safety of the space I provide where you know you and your story matter. I will hold your vulnerability and pain with compassion and authenticity while the process of finding new or renewed hope, healing, strength, wholeness, and vitality for life begin to unfold as the difficulty you are facing is shared and your journey supported.
As a human and as a therapist, I understand that making sense of life and its impact can sometimes be overwhelming and traumatic in ways that can leave us feeling helpless, anxious, depressed, or simply stuck. It takes courage to seek help to find relief. That relief is possible in the safety of the space I provide where you know you and your story matter. I will hold your vulnerability and pain with compassion and authenticity while the process of finding new or renewed hope, healing, strength, wholeness, and vitality for life begin to unfold as the difficulty you are facing is shared and your journey supported.
(559) 272-9286 View (559) 272-9286
Photo of Dr. Soliman, Psychologist in Central, Fresno, CA
Dr. Soliman
Psychologist, PsyD
Verified
Central, Fresno, CA 93721
I believe in the process of change and will help my clients to move in a positive direction. I believe that change is a process and depends on an individual's needs and where an individual is with relation to the stages of change. I believe that I can help you overcome your obstacles. I have received my Postpartum Support International Certificate Training in Perinatal Mood and Anxiety Disorder with hopes to help this particular population. In addition, I am a member of Postpartum Support International (PSI).
I believe in the process of change and will help my clients to move in a positive direction. I believe that change is a process and depends on an individual's needs and where an individual is with relation to the stages of change. I believe that I can help you overcome your obstacles. I have received my Postpartum Support International Certificate Training in Perinatal Mood and Anxiety Disorder with hopes to help this particular population. In addition, I am a member of Postpartum Support International (PSI).
(559) 549-9615 View (559) 549-9615
Photo of Maxim Kramer, Psychologist in Central, Fresno, CA
Maxim Kramer
Psychologist, PhD
Verified
Central, Fresno, CA 93701
Greetings: I have made changes to my private practice such that I am accepting private clients for treatment of PTSD utilizing EMDR, as well as other approaches for depression and anxiety. I am also prepared to assist people with other life-issues. We can discuss these by phone before an appointment is made. Please note that I cannot accept military veterans as clients/patients because of conflict of interest.
Greetings: I have made changes to my private practice such that I am accepting private clients for treatment of PTSD utilizing EMDR, as well as other approaches for depression and anxiety. I am also prepared to assist people with other life-issues. We can discuss these by phone before an appointment is made. Please note that I cannot accept military veterans as clients/patients because of conflict of interest.
(201) 977-2656 View (201) 977-2656
Photo of Lori Pontious, Marriage & Family Therapist in Central, Fresno, CA
Lori Pontious
Marriage & Family Therapist, MS, LMFT
Verified
2 Endorsed
Central, Fresno, CA 93701
You may have been feeling as though you've been given a life without an instruction manual. Relationships might be more challenging for you than not, and in comparing yourself to other people, you feel like something is missing, that might explain how you end up with the "same person" over and over - the disrespectful, distant, controlling or dismissive person that the previously-ideal partner became, after a while. This is a pattern that can occur with Complex PTSD, a common situation with many of the clients I speak to, which can be resolved with psychoeducation and trauma therapy.
You may have been feeling as though you've been given a life without an instruction manual. Relationships might be more challenging for you than not, and in comparing yourself to other people, you feel like something is missing, that might explain how you end up with the "same person" over and over - the disrespectful, distant, controlling or dismissive person that the previously-ideal partner became, after a while. This is a pattern that can occur with Complex PTSD, a common situation with many of the clients I speak to, which can be resolved with psychoeducation and trauma therapy.
(559) 545-0753 View (559) 545-0753
Photo of Guadalupe Vasquez, Psychologist in Central, Fresno, CA
Guadalupe Vasquez
Psychologist, PsyD
Verified
3 Endorsed
Central, Fresno, CA 93701
Psicologia para evaluaciones de inmigracion...Especializada en evaluaciones de inmigración*Dificultád Extrema *VAWA (Violencia Doméstica) *Visa U (Víctimas de Crimen) *Asilo Político. Se habla Español. Llame hoy para una consulta gratis.
Psicologia para evaluaciones de inmigracion...Especializada en evaluaciones de inmigración*Dificultád Extrema *VAWA (Violencia Doméstica) *Visa U (Víctimas de Crimen) *Asilo Político. Se habla Español. Llame hoy para una consulta gratis.
(559) 412-5675 View (559) 412-5675
Photo of Jessica Rice, Marriage & Family Therapist in Central, Fresno, CA
Jessica Rice
Marriage & Family Therapist, MS, LMFT
Verified
Central, Fresno, CA 93701
Every person has their own reasons for seeking therapy. Some choose it during a period of major life transitions or hardships, while others may seek out therapy in order to deepen their understanding of themselves. By using a psychodynamic and object relations model I am able to consider the whole person rather than pure symptom reduction. I believe there is both conscious and unconscious meaning to symptoms.
Every person has their own reasons for seeking therapy. Some choose it during a period of major life transitions or hardships, while others may seek out therapy in order to deepen their understanding of themselves. By using a psychodynamic and object relations model I am able to consider the whole person rather than pure symptom reduction. I believe there is both conscious and unconscious meaning to symptoms.
(559) 366-6522 View (559) 366-6522
Photo of Rachelle (Shelly) Clement-Gilpin, Marriage & Family Therapist in Central, Fresno, CA
Rachelle (Shelly) Clement-Gilpin
Marriage & Family Therapist, MS, LMFT
Verified
Central, Fresno, CA 93701
As a LMFT and TBRI Pracitioner, I have learned that many children, families, and individuals suffer from trauma. Often client's diagnosis of PTSD, Anxiety, Depression, Bi-Polar, and ADHD are related to early childhood and adult trauma, as well as a lack of early secure attachment to their primary caregiver. Recent studies in Neuroscience confirm that Neuropathways in the brain develop based on these traumas.
As a LMFT and TBRI Pracitioner, I have learned that many children, families, and individuals suffer from trauma. Often client's diagnosis of PTSD, Anxiety, Depression, Bi-Polar, and ADHD are related to early childhood and adult trauma, as well as a lack of early secure attachment to their primary caregiver. Recent studies in Neuroscience confirm that Neuropathways in the brain develop based on these traumas.
(559) 540-8528 View (559) 540-8528
Photo of Valente Orozco, Clinical Social Work/Therapist in Central, Fresno, CA
Valente Orozco
Clinical Social Work/Therapist, LCSW, RPT-S, PPS
Verified
4 Endorsed
Central, Fresno, CA 93701
The relationship you have with your therapist is the biggest factor contributing to positive outcomes in therapy. Establishing a relationship built on mutual trust and respect is the first step in the journey towards health. I work with children and adults to establish this relationship from the very beginning. My goal is to create an experience for children and adults that allows you to connect with your sense of self and who you are, express those feelings and needs that are often hidden away, and realize the potential for growth inside each of us.
The relationship you have with your therapist is the biggest factor contributing to positive outcomes in therapy. Establishing a relationship built on mutual trust and respect is the first step in the journey towards health. I work with children and adults to establish this relationship from the very beginning. My goal is to create an experience for children and adults that allows you to connect with your sense of self and who you are, express those feelings and needs that are often hidden away, and realize the potential for growth inside each of us.
(559) 340-4922 View (559) 340-4922
Photo of Mark Barnes, Psychologist in Central, Fresno, CA
Mark Barnes
Psychologist, PhD
Verified
1 Endorsed
Central, Fresno, CA 93701
I am a child psychologist who has worked with children and adolescents and their families since 1984. I hold a doctorate in Clinical Psychology and am a licensed psychologist. I also hold a Master's degree in Marriage, Family, and Child Counseling. I work with children adolescents and their families as I believe with early treatment, children and adolescents can develop healthy and adaptive coping techniques that can improve their prognosis for a happier and healthier adulthood.
I am a child psychologist who has worked with children and adolescents and their families since 1984. I hold a doctorate in Clinical Psychology and am a licensed psychologist. I also hold a Master's degree in Marriage, Family, and Child Counseling. I work with children adolescents and their families as I believe with early treatment, children and adolescents can develop healthy and adaptive coping techniques that can improve their prognosis for a happier and healthier adulthood.
(559) 377-7152 View (559) 377-7152
Photo of Ron Steele, Clinical Social Work/Therapist in Central, Fresno, CA
Ron Steele
Clinical Social Work/Therapist, LCSW, MSW, MA
Verified
2 Endorsed
Central, Fresno, CA 93721
Hello and welcome my name is Ron and I am licensed Clinical Social Worker with over 20 years of providing counseling and therapeutic services. My goal has been to help those overcome life-changing events that have affected us in some way. My experience includes working with adolescents, families, and couples. My passion and goals are to help provide you tools, that will help you overcome significant events that have set you back in moving forward to a positive outlook in life.
Hello and welcome my name is Ron and I am licensed Clinical Social Worker with over 20 years of providing counseling and therapeutic services. My goal has been to help those overcome life-changing events that have affected us in some way. My experience includes working with adolescents, families, and couples. My passion and goals are to help provide you tools, that will help you overcome significant events that have set you back in moving forward to a positive outlook in life.
(559) 574-5444 View (559) 574-5444
Photo of Psychological Immigration Evaluation, LMFT , Marriage & Family Therapist in Central, Fresno, CA
Psychological Immigration Evaluation, LMFT
Marriage & Family Therapist, LMFT
Verified
Central, Fresno, CA 93701  (Online Only)
What is an immigration psychological evaluation? It's a conversation with a licensed mental health professional. Where we discuss your history and gather information about how your mental health is being impacted, due to the specifics of your immigration case. The evaluation will last about 120 minutes. A written report summarizing the evaluation will be provided to your attorney to be include with your immigration petition.
What is an immigration psychological evaluation? It's a conversation with a licensed mental health professional. Where we discuss your history and gather information about how your mental health is being impacted, due to the specifics of your immigration case. The evaluation will last about 120 minutes. A written report summarizing the evaluation will be provided to your attorney to be include with your immigration petition.
(408) 665-7640 View (408) 665-7640
Photo of Tirian Ann Klein, Marriage & Family Therapist in Central, Fresno, CA
Tirian Ann Klein
Marriage & Family Therapist, LMFT
Verified
Central, Fresno, CA 93701
I believe in the hope and possibilities for change in every individual. Profound change and transformation in our lives takes place when we lean into our vulnerability in an environment which is safe, full of genuine concern, empathy, compassion and connection. I work to provide this for every client.
I believe in the hope and possibilities for change in every individual. Profound change and transformation in our lives takes place when we lean into our vulnerability in an environment which is safe, full of genuine concern, empathy, compassion and connection. I work to provide this for every client.
(559) 634-3154 View (559) 634-3154
Photo of Steven Oppenheimer, Marriage & Family Therapist in Central, Fresno, CA
Steven Oppenheimer
Marriage & Family Therapist, MA, MFT, MBA
Verified
Central, Fresno, CA 93701
I help Individuals to manage stress & to get unstuck from the life circumstances holding them back in life, career & relationships. I have a diverse professional and personal background, which helps me to connect with others. In addition to my role as a licensed therapist, I bring to my practice over 30 years of business leadership experience. I am goal oriented, solution focused and non-judgemental. Most important, I am easy to talk to.
I help Individuals to manage stress & to get unstuck from the life circumstances holding them back in life, career & relationships. I have a diverse professional and personal background, which helps me to connect with others. In addition to my role as a licensed therapist, I bring to my practice over 30 years of business leadership experience. I am goal oriented, solution focused and non-judgemental. Most important, I am easy to talk to.
(760) 333-9890 View (760) 333-9890

How does your Therapist compare?

Number of Therapists in Central, Fresno, CA

30+

Average cost per session

$127

Therapists in Central, Fresno, CA who prioritize treating:

86% Anxiety
80% Depression
77% Relationship Issues
69% Trauma and PTSD
66% Self Esteem
57% Grief
51% Family Conflict

Average years in practice

10 Years

Top 3 insurances accepted

58% Aetna
50% Other
46% UnitedHealthcare UHC | UBH

How Therapists in Central, Fresno, CA see their clients

60% In Person and Online
40% Online Only

Gender breakdown

75% Female
25% Male

FAQs - About Therapy and Counseling

How can I find a therapist in Central, Fresno?

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.