Therapists in Downtown, San Diego, CA

Photo of Desiree Aspiras, Clinical Social Work/Therapist, MA, LMFT
Desiree Aspiras
Clinical Social Work/Therapist, MA, LMFT
1 Endorsed
Online Only
I work alongside my clients to help them move towards their goals and reconnect with what matters most to them. Compassion, creativity, and a social-justice lens are important to me and informs my practice. I want for you to feel heard, understood, and validated. At the same time, know that I will challenge you when it is appropriate, and encourage you to experiment with doing things differently than you may have done before. Relief and healing is possible, change and flourishing is possible, but not without effort on your part. Therapy is about getting the support you need, while learning ways to cope, recover, grow, and thrive.
I work alongside my clients to help them move towards their goals and reconnect with what matters most to them. Compassion, creativity, and a social-justice lens are important to me and informs my practice. I want for you to feel heard, understood, and validated. At the same time, know that I will challenge you when it is appropriate, and encourage you to experiment with doing things differently than you may have done before. Relief and healing is possible, change and flourishing is possible, but not without effort on your part. Therapy is about getting the support you need, while learning ways to cope, recover, grow, and thrive.
(619) 658-4041 View (619) 658-4041
Photo of Tanya Arreguin, Marriage & Family Therapist, LMFT
Tanya Arreguin
Marriage & Family Therapist, LMFT
Online Only
I have experience in working at Community-Based outpatient clinics providing individual and group counseling services to children, adolescents, adults, and older adults. I also have worked with the LGBTQ+ community, families, and survivors of abuse. I am a culturally sensitive therapist who acts as an ally and advocate for my clients. I look forward to working alongside you to help you reach your goals through adaptive coping skills/strategies, problem solving skills, mindfulness tools, reframing negative thinking, and shifting maladaptive patterns that no longer serve a purpose.
I have experience in working at Community-Based outpatient clinics providing individual and group counseling services to children, adolescents, adults, and older adults. I also have worked with the LGBTQ+ community, families, and survivors of abuse. I am a culturally sensitive therapist who acts as an ally and advocate for my clients. I look forward to working alongside you to help you reach your goals through adaptive coping skills/strategies, problem solving skills, mindfulness tools, reframing negative thinking, and shifting maladaptive patterns that no longer serve a purpose.
(619) 848-3756 View (619) 848-3756
Photo of Alexander Walters, Marriage & Family Therapist, LMFT
Alexander Walters
Marriage & Family Therapist, LMFT
3 Endorsed
Online Only
My experience includes working with adult addicts for an outpatient treatment center, couples and families through the school-based and special education programs at a family services agency, and one-on-one therapeutic sessions with adults utilizing both in-person and virtual modes of service. My style is client-centered and focused on affirming the client's strengths, reframing negative or challenging thoughts, and guidance of the client towards goal achievement.
My experience includes working with adult addicts for an outpatient treatment center, couples and families through the school-based and special education programs at a family services agency, and one-on-one therapeutic sessions with adults utilizing both in-person and virtual modes of service. My style is client-centered and focused on affirming the client's strengths, reframing negative or challenging thoughts, and guidance of the client towards goal achievement.
(510) 871-8253 View (510) 871-8253
Photo of Domenique LaBeau, Marriage & Family Therapist, LMFT
Domenique LaBeau
Marriage & Family Therapist, LMFT
Online Only
I support individuals, couples, and families navigating identity, intimacy, communication, and life transitions. My approach integrates CBT, ACT, and mindfulness, enriched by sex therapy-informed care, somatic practices, and attachment-based work. I create a nonjudgmental space for clients to explore gender, sexuality, and relationship dynamics with openness and clarity. Together, we build tools to reduce distress, strengthen connection, and support long-term emotional growth.
I support individuals, couples, and families navigating identity, intimacy, communication, and life transitions. My approach integrates CBT, ACT, and mindfulness, enriched by sex therapy-informed care, somatic practices, and attachment-based work. I create a nonjudgmental space for clients to explore gender, sexuality, and relationship dynamics with openness and clarity. Together, we build tools to reduce distress, strengthen connection, and support long-term emotional growth.
(510) 338-4727 View (510) 338-4727
Photo of Lideth Ortega-Villalobos, Psychologist, PhD
Lideth Ortega-Villalobos
Psychologist, PhD
Online Only
I have an integrative approach that is culturally responsive and attends to intersecting identities. I take into account the client's presenting concerns, preferences, and familiarity with therapy and introduce empirically supported interventions to match goals and treatment plans.
I have an integrative approach that is culturally responsive and attends to intersecting identities. I take into account the client's presenting concerns, preferences, and familiarity with therapy and introduce empirically supported interventions to match goals and treatment plans.
(510) 544-3946 View (510) 544-3946
Photo of Michael Bjornson, Psychologist, LCP
Michael Bjornson
Psychologist, LCP
Online Only
Hello, my name is Dr. Michael Bjornson. Most of my clients simply refer to me as Dr. "B". I have been a licensed clinical psychologist for over 26 years, with active licenses in California, Utah, and Wyoming. I am honored that you are considering me to help you in whatever life challenges have led you to seek help. Whether this may be your first-time seeking help or not, I recognize starting therapy is a big decision requiring courage and trust in another human being, to be there for you in a professional, caring capacity, to facilitate and guide you through important and difficult concerns.
Hello, my name is Dr. Michael Bjornson. Most of my clients simply refer to me as Dr. "B". I have been a licensed clinical psychologist for over 26 years, with active licenses in California, Utah, and Wyoming. I am honored that you are considering me to help you in whatever life challenges have led you to seek help. Whether this may be your first-time seeking help or not, I recognize starting therapy is a big decision requiring courage and trust in another human being, to be there for you in a professional, caring capacity, to facilitate and guide you through important and difficult concerns.
(424) 396-5080 View (424) 396-5080
Photo of Amber Roper, Marriage & Family Therapist, LMFT
Amber Roper
Marriage & Family Therapist, LMFT
2 Endorsed
Online Only
I believe that my job as a therapist is to meet each individual where they are to get them to where they want to go. I am passionate about working with people who make the brave choice to enter into therapy and take the healing journey. I believe therapy is very personal, and should be individualized and tailored to the needs of the client.
I believe that my job as a therapist is to meet each individual where they are to get them to where they want to go. I am passionate about working with people who make the brave choice to enter into therapy and take the healing journey. I believe therapy is very personal, and should be individualized and tailored to the needs of the client.
(424) 799-2157 View (424) 799-2157
Photo of Rebecca Paushter, Clinical Social Work/Therapist, LCSW
Rebecca Paushter
Clinical Social Work/Therapist, LCSW
Online Only
In choosing me as your therapist, we'll work together for you to discover your identity and core values, form radical acceptance and self-love, create new ways of coping and problem-solving, gain insight and understanding, strengthen relationships and communication, among other profound matters of life. I’ll provide a warm, supportive, safe, and professional space for you to feel comfortable delving into difficult past and present situations, in order to pave a new, happier, and healthier way forward. It is my ambition that you (re)gain a sense of empowerment in your life. If this is what you're looking for, then let's get started.
In choosing me as your therapist, we'll work together for you to discover your identity and core values, form radical acceptance and self-love, create new ways of coping and problem-solving, gain insight and understanding, strengthen relationships and communication, among other profound matters of life. I’ll provide a warm, supportive, safe, and professional space for you to feel comfortable delving into difficult past and present situations, in order to pave a new, happier, and healthier way forward. It is my ambition that you (re)gain a sense of empowerment in your life. If this is what you're looking for, then let's get started.
(619) 903-6393 View (619) 903-6393
Photo of Tibebe Worku, Marriage & Family Therapist, LMFT
Tibebe Worku
Marriage & Family Therapist, LMFT
Online Only
I specialize in working with individuals, families, and couples who are negotiating complex issues around identity or life transitions, but can also help clients focus on and work through more specific relational challenges that have arisen in their lives. My therapy style is warm and direct. I help clients understand and articulate the challenges they face in a way that is meaningful and useful so that they are better equipped to make real choices that are equally satisfying and sustainable. I provide a space where clients can be truly heard, some for the first time. Let's work together to create lasting change.
I specialize in working with individuals, families, and couples who are negotiating complex issues around identity or life transitions, but can also help clients focus on and work through more specific relational challenges that have arisen in their lives. My therapy style is warm and direct. I help clients understand and articulate the challenges they face in a way that is meaningful and useful so that they are better equipped to make real choices that are equally satisfying and sustainable. I provide a space where clients can be truly heard, some for the first time. Let's work together to create lasting change.
(619) 344-9108 View (619) 344-9108
Photo of Kecia Lynann Woods, Marriage & Family Therapist, LMFT
Kecia Lynann Woods
Marriage & Family Therapist, LMFT
Online Only
Are you a teen, adult, or child, struggling with anxiety, depression, or relationship challenges? Feeling overwhelmed by low self-esteem or autism-related issues? You're not alone. Whether you seek faith-based or secular support, I'm here to help you navigate challenges and build strengths. Together, we'll develop practical strategies for growth. You're the expert in your life—I’ll guide you toward positive change. Let’s unlock your potential.
Are you a teen, adult, or child, struggling with anxiety, depression, or relationship challenges? Feeling overwhelmed by low self-esteem or autism-related issues? You're not alone. Whether you seek faith-based or secular support, I'm here to help you navigate challenges and build strengths. Together, we'll develop practical strategies for growth. You're the expert in your life—I’ll guide you toward positive change. Let’s unlock your potential.
(619) 480-0187 View (619) 480-0187
Photo of Jeffrey Mann, Psychologist, PsyD
Jeffrey Mann
Psychologist, PsyD
Downtown, San Diego, CA 92101
Welcome! I am a Psychologist offering psychotherapy through secure videochat, or Telehealth in CA, VA, MD, DC. This is a convenient and effective way to get the help you need on your schedule where you're comfortable. For more information, see my web page (https://drjeffreymann.com/telehealth/). Frequently the events of our lives get to the point where we feel like so much of our energy is being wasted simply trying to "keep it together". I'm not a believer in magic cures, but there is A LOT than can be done to address the ways we think and behave in our everyday lives that can have a profound impact on our satisfaction with life.
Welcome! I am a Psychologist offering psychotherapy through secure videochat, or Telehealth in CA, VA, MD, DC. This is a convenient and effective way to get the help you need on your schedule where you're comfortable. For more information, see my web page (https://drjeffreymann.com/telehealth/). Frequently the events of our lives get to the point where we feel like so much of our energy is being wasted simply trying to "keep it together". I'm not a believer in magic cures, but there is A LOT than can be done to address the ways we think and behave in our everyday lives that can have a profound impact on our satisfaction with life.
(619) 618-1908 View (619) 618-1908
Photo of Jay Alarcon, Marriage & Family Therapist, LMFT
Jay Alarcon
Marriage & Family Therapist, LMFT
Downtown, San Diego, CA 92120
Coming to therapy can feel vulnerable and scary, but it is a brave step towards the life you want and deserve. I am guided by evidence based techniques, educated insight, and genuine curiosity. I work to nurture my clients’ sensitivities, strengths, hopes, and desires for a meaningful and fulfilling existence. I help individuals tap into their inner strength and thrive, to connect to their passions, couples seeking effective communication techniques and highly sensitive people understand their trait and harness their superpower! I support individuals from diverse backgrounds and sexual orientations, navigate cultural challenges
Coming to therapy can feel vulnerable and scary, but it is a brave step towards the life you want and deserve. I am guided by evidence based techniques, educated insight, and genuine curiosity. I work to nurture my clients’ sensitivities, strengths, hopes, and desires for a meaningful and fulfilling existence. I help individuals tap into their inner strength and thrive, to connect to their passions, couples seeking effective communication techniques and highly sensitive people understand their trait and harness their superpower! I support individuals from diverse backgrounds and sexual orientations, navigate cultural challenges
(858) 360-8251 View (858) 360-8251
Photo of Stephanie Byrd, Psychologist, PsyD
Stephanie Byrd
Psychologist, PsyD
3 Endorsed
Downtown, San Diego, CA 92101
Getting praised for being so "together", when inside you feel like you're crumbling to pieces? Feeling pressured to change, but don't know where to start? I'd like to help. If you're feeling confused, overwhelmed, anxious or sad and know you need to make some changes, Im here to help. If you and your partner are stuck in negative cycles and get frustrated trying to work through it couples therapy can help. I teach couples like you how to negotiate your needs and how to strengthen and rebuild your bond.
Getting praised for being so "together", when inside you feel like you're crumbling to pieces? Feeling pressured to change, but don't know where to start? I'd like to help. If you're feeling confused, overwhelmed, anxious or sad and know you need to make some changes, Im here to help. If you and your partner are stuck in negative cycles and get frustrated trying to work through it couples therapy can help. I teach couples like you how to negotiate your needs and how to strengthen and rebuild your bond.
(727) 498-5874 View (727) 498-5874
Photo of Jason Astorga, Licensed Professional Clinical Counselor, LPCC
Jason Astorga
Licensed Professional Clinical Counselor, LPCC
1 Endorsed
Online Only
I specialize in working with adults on building self-worth and forming meaningful relationships—both with themselves and others. I have had experience in working with trauma including military trauma, sexual and physical abuse, abandonment and neglect. Using an integrative approach that includes Cognitive Behavioral Therapy and attachment-based practices I have helped clients process these experiences. My goal is to guide healing and encourage growth with compassion, helping clients build secure connections and a stronger sense of self.
I specialize in working with adults on building self-worth and forming meaningful relationships—both with themselves and others. I have had experience in working with trauma including military trauma, sexual and physical abuse, abandonment and neglect. Using an integrative approach that includes Cognitive Behavioral Therapy and attachment-based practices I have helped clients process these experiences. My goal is to guide healing and encourage growth with compassion, helping clients build secure connections and a stronger sense of self.
(619) 848-3810 View (619) 848-3810
Photo of Jessica Ayala, Clinical Social Work/Therapist, LCSW
Jessica Ayala
Clinical Social Work/Therapist, LCSW
1 Endorsed
Online Only
How do you envision your life? Are you struggling with co-parenting, relationship issues, anxiety or depression? It takes courage to envision and seek a more fulfilling and happier life and to take the first steps towards change. If you are ready to take that step, I am here to support and empower you. I am a Licensed Clinical Social Worker with over 20 years of experience working with adults, children, and families. My therapeutic style is straightforward, honest, and goal-oriented, and more often than not, there is room for humor and laughter in a therapy session.
How do you envision your life? Are you struggling with co-parenting, relationship issues, anxiety or depression? It takes courage to envision and seek a more fulfilling and happier life and to take the first steps towards change. If you are ready to take that step, I am here to support and empower you. I am a Licensed Clinical Social Worker with over 20 years of experience working with adults, children, and families. My therapeutic style is straightforward, honest, and goal-oriented, and more often than not, there is room for humor and laughter in a therapy session.
(619) 586-5968 View (619) 586-5968
Photo of Dr. Margo Sawires, Psychologist, PsyD
Dr. Margo Sawires
Psychologist, PsyD
1 Endorsed
Downtown, San Diego, CA 92101
I have over 16 years of experience in the mental health field. My clinical background has been extensive, working in a wide variety of clinical settings & with rather diverse populations. I received both my masters & doctorate from the California School of Professional Psychology at Alliant International University. Beyond that, I have earned a post-doctoral specialization in Psychoanalytic Psychotherapy through the San Diego Psychoanalytic Institute. I offer Concierge Psychological Services to patient who want top pier care, prompt scheduling & 100% discretion. I also offer Professional Consulting & Clinical Consultation Services.
I have over 16 years of experience in the mental health field. My clinical background has been extensive, working in a wide variety of clinical settings & with rather diverse populations. I received both my masters & doctorate from the California School of Professional Psychology at Alliant International University. Beyond that, I have earned a post-doctoral specialization in Psychoanalytic Psychotherapy through the San Diego Psychoanalytic Institute. I offer Concierge Psychological Services to patient who want top pier care, prompt scheduling & 100% discretion. I also offer Professional Consulting & Clinical Consultation Services.
(619) 800-6060 View (619) 800-6060
Photo of Stacy Kim Johnston, Psychologist, PhD
Stacy Kim Johnston
Psychologist, PhD
Online Only
I work well with people who are seeking improvement on the following issues: relationship issues whether it be husband-wife, cohabitants, mother-daughter/son, father-son/daughter, co-parenting, or divorce mediation. I also have experience with substance abuse issues and dual diagnosis as well as co-dependency. Self-esteem is often a struggle with many teens and young women and this is another area of expertise. Anger issues are commonly found in men and this too is an area in which I can offer professional help. I welcome you to contact me to see if we are a good fit.
I work well with people who are seeking improvement on the following issues: relationship issues whether it be husband-wife, cohabitants, mother-daughter/son, father-son/daughter, co-parenting, or divorce mediation. I also have experience with substance abuse issues and dual diagnosis as well as co-dependency. Self-esteem is often a struggle with many teens and young women and this is another area of expertise. Anger issues are commonly found in men and this too is an area in which I can offer professional help. I welcome you to contact me to see if we are a good fit.
(619) 778-7215 View (619) 778-7215
Photo of Dion Kirkland, Associate Professional Clinical Counselor, APCC
Dion Kirkland
Associate Professional Clinical Counselor, APCC
Online Only
Do you feel overwhelmed by anxiety, depression, and self-doubt, often trapped in cycles of self-criticism and emotional exhaustion? You might be navigating the heartbreak of miscarriage or the weight of postpartum depression, feeling isolated and uncertain. Your emotions can feel intense—waves of agitation, guilt, or sadness that seem impossible to escape. What you truly long for is clarity, relief, and a sense of balance. Deep down, you want to feel at peace within yourself, heal from past wounds, and regain control and hope for the future. I’m here to support you on that journey.
Do you feel overwhelmed by anxiety, depression, and self-doubt, often trapped in cycles of self-criticism and emotional exhaustion? You might be navigating the heartbreak of miscarriage or the weight of postpartum depression, feeling isolated and uncertain. Your emotions can feel intense—waves of agitation, guilt, or sadness that seem impossible to escape. What you truly long for is clarity, relief, and a sense of balance. Deep down, you want to feel at peace within yourself, heal from past wounds, and regain control and hope for the future. I’m here to support you on that journey.
(619) 393-3443 x803 View (619) 393-3443 x803
Photo of Sara Roldan, Psychological Associate, PsyD
Sara Roldan
Psychological Associate, PsyD
1 Endorsed
Downtown, San Diego, CA 92112
I am a bilingual clinician (Spanish/English) with a multicultural background and extensive expertise in trauma therapy. With experience spanning hospitals, intensive outpatient programs (IOP), community mental health settings, and private practice, I have cultivated a unique ability to address the most complex cases of trauma, including career-related trauma, hospital trauma, and the challenges faced by active-duty military personnel and first responders. I offer a safe and empathetic environment where clients can process their experiences, calm their nervous systems, and regain control of their lives.
I am a bilingual clinician (Spanish/English) with a multicultural background and extensive expertise in trauma therapy. With experience spanning hospitals, intensive outpatient programs (IOP), community mental health settings, and private practice, I have cultivated a unique ability to address the most complex cases of trauma, including career-related trauma, hospital trauma, and the challenges faced by active-duty military personnel and first responders. I offer a safe and empathetic environment where clients can process their experiences, calm their nervous systems, and regain control of their lives.
(619) 859-4800 View (619) 859-4800
Photo of Andrea Sartor, Marriage & Family Therapist, LMFT
Andrea Sartor
Marriage & Family Therapist, LMFT
1 Endorsed
Online Only
Hi, I’m Andrea Sartor, a licensed Marriage and Family Therapist (LMFT) in California with over 15 years of experience. Most importantly, I am someone who can help and support change during the toughest times in your life. I use humor and positive thinking to create a supportive environment where you can explore your authentic self. I have had the opportunity to work In the United Kingdom and in California as a therapist and I have worked with many different cultures and alternative lifestyles. It's not always easy to express our personal thoughts and emotions but I will commit to create an empathetic safe space for your inner world.
Hi, I’m Andrea Sartor, a licensed Marriage and Family Therapist (LMFT) in California with over 15 years of experience. Most importantly, I am someone who can help and support change during the toughest times in your life. I use humor and positive thinking to create a supportive environment where you can explore your authentic self. I have had the opportunity to work In the United Kingdom and in California as a therapist and I have worked with many different cultures and alternative lifestyles. It's not always easy to express our personal thoughts and emotions but I will commit to create an empathetic safe space for your inner world.
(619) 492-5950 View (619) 492-5950

See more therapy options for Downtown, San Diego

How does your Therapist compare?

Number of Therapists in Downtown, San Diego, CA

900+

Average cost per session

$160

Therapists in Downtown, San Diego, CA who prioritize treating:

92% Anxiety
85% Depression
70% Coping Skills
68% Trauma and PTSD
67% Relationship Issues
67% Self Esteem
66% Stress

Average years in practice

11 Years

Top 3 insurances accepted

82% Aetna
65% Cigna and Evernorth
47% Other

How Therapists in Downtown, San Diego, CA see their clients

69% Online Only
31% In Person and Online

Gender breakdown

78% Female
21% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Downtown, San Diego?

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.