Therapists in San Francisco County, CA

Photo of Marisol Cendejas, Clinical Social Work/Therapist, LCSW
Marisol Cendejas
Clinical Social Work/Therapist, LCSW
Online Only
I am a bilingual therapist who cares about creating safer spaces to empower mental health and wellness in BIPOC (Black, Indigenous, and people of color). I take a holistic and trauma-informed approach.
I am a bilingual therapist who cares about creating safer spaces to empower mental health and wellness in BIPOC (Black, Indigenous, and people of color). I take a holistic and trauma-informed approach.
(415) 949-2397 View (415) 949-2397
Photo of Skye Nashelsky, Marriage & Family Therapist, MA, LMFT
Skye Nashelsky
Marriage & Family Therapist, MA, LMFT
5 Endorsed
San Francisco, CA 94110
You have the capacity to lead a fulfilling and meaningful life! There are multiple forms and layers of oppression that impact our daily lives and self worth. I support clients in acknowledging and addressing shame, grief, trauma, and anxiety. I specialize in issues concerning gender, sexuality, intimacy, relationships, and identity. As your therapist, I act as a support working collaboratively alongside you to identify goals, action steps and interventions tailored specifically to your individual needs and identity.
You have the capacity to lead a fulfilling and meaningful life! There are multiple forms and layers of oppression that impact our daily lives and self worth. I support clients in acknowledging and addressing shame, grief, trauma, and anxiety. I specialize in issues concerning gender, sexuality, intimacy, relationships, and identity. As your therapist, I act as a support working collaboratively alongside you to identify goals, action steps and interventions tailored specifically to your individual needs and identity.
(510) 395-8008 View (510) 395-8008
Photo of Chloe Rowshani, Marriage & Family Therapist Associate, AMFT, JD
Chloe Rowshani
Marriage & Family Therapist Associate, AMFT, JD
6 Endorsed
San Francisco, CA 94107
Preparing for marriage or parenthood can bring both excitement and anxiety. I currently have slots available for values-based premarital and pre-baby counseling to help couples strengthen communication, deepen emotional connection, and navigate change with confidence. As a former attorney turned integrative therapist, I also provide non-legal support with premarital agreements, helping you discuss sensitive topics with clarity and care. My approach is emotionally focused, compassionate, and culturally attuned, supporting couples and families through meaningful transitions.
Preparing for marriage or parenthood can bring both excitement and anxiety. I currently have slots available for values-based premarital and pre-baby counseling to help couples strengthen communication, deepen emotional connection, and navigate change with confidence. As a former attorney turned integrative therapist, I also provide non-legal support with premarital agreements, helping you discuss sensitive topics with clarity and care. My approach is emotionally focused, compassionate, and culturally attuned, supporting couples and families through meaningful transitions.
(415) 358-7954 View (415) 358-7954
Photo of Joe Mutow, Licensed Professional Clinical Counselor, LPCC
Joe Mutow
Licensed Professional Clinical Counselor, LPCC
Online Only
I have provided therapy for individuals (children K-12 and adults), families, groups, and couple sessions for over ten years. My modality is Cognitive Behavioral which means we believe it is not the event itself but how we perceive and react to the circumstance that may cause a problem. We will explore different possibilities through our session and discover what may serve us the best in pursuing happiness.
I have provided therapy for individuals (children K-12 and adults), families, groups, and couple sessions for over ten years. My modality is Cognitive Behavioral which means we believe it is not the event itself but how we perceive and react to the circumstance that may cause a problem. We will explore different possibilities through our session and discover what may serve us the best in pursuing happiness.
(818) 715-6005 View (818) 715-6005
Photo of Suresh Chacko, Psychologist, PsyD
Suresh Chacko
Psychologist, PsyD
1 Endorsed
San Francisco, CA 94102
If you're feeling stuck or overwhelmed, I would like to provide a place to think about what's troubling you and find new ways forward. We can work to understand the deeper patterns that shape your experiences and relationships. Your history, relationships, and internal conflicts all matter in making sense of current struggles. In our work together, we’ll consider what drives your reactions and choices in ways that may not be immediately obvious. My aim is to help you develop greater self-understanding, find more satisfying ways to navigate life’s challenges, and to provide an attentive, supportive environment for this work.
If you're feeling stuck or overwhelmed, I would like to provide a place to think about what's troubling you and find new ways forward. We can work to understand the deeper patterns that shape your experiences and relationships. Your history, relationships, and internal conflicts all matter in making sense of current struggles. In our work together, we’ll consider what drives your reactions and choices in ways that may not be immediately obvious. My aim is to help you develop greater self-understanding, find more satisfying ways to navigate life’s challenges, and to provide an attentive, supportive environment for this work.
View
Photo of Maia Taub, Marriage & Family Therapist, LMFT
Maia Taub
Marriage & Family Therapist, LMFT
San Francisco, CA 94131
Are you tired of feeling stuck? Sick of encountering the same problems/ issues/ struggles over and over again. You are not alone. Change is very hard; we naturally fear it. I can help. In my work, I am actively engaged, interested, curious, thoughtful and direct. I will work with you to get beneath the surface, sort through the layers and come to a place of deeper understanding and greater ability to make conscious choices. In both my professional and personal experience, I have come to believe in the transformative power of therapy.
Are you tired of feeling stuck? Sick of encountering the same problems/ issues/ struggles over and over again. You are not alone. Change is very hard; we naturally fear it. I can help. In my work, I am actively engaged, interested, curious, thoughtful and direct. I will work with you to get beneath the surface, sort through the layers and come to a place of deeper understanding and greater ability to make conscious choices. In both my professional and personal experience, I have come to believe in the transformative power of therapy.
(415) 799-9163 View (415) 799-9163
Photo of Alison L Saylor, Marriage & Family Therapist, MA, MFT
Alison L Saylor
Marriage & Family Therapist, MA, MFT
1 Endorsed
San Francisco, CA 94117
Do you find that you and your partner have fierce fights over seemingly trivial matters? Do you argue over the same thing repeatedly without progress? Do you find that one of you is often chasing after the other for connection and commitment while the other pulls away? Have you been stuck in patterns of self-sabotage? Having trouble keeping yourself out of relationships and situations that are unhealthy or even dangerous? There is hope. I provide short-term, intensive couples therapy, individual therapy and hypnotherapy that has helped hundreds overcome these patterns to find true connection and happiness.
Do you find that you and your partner have fierce fights over seemingly trivial matters? Do you argue over the same thing repeatedly without progress? Do you find that one of you is often chasing after the other for connection and commitment while the other pulls away? Have you been stuck in patterns of self-sabotage? Having trouble keeping yourself out of relationships and situations that are unhealthy or even dangerous? There is hope. I provide short-term, intensive couples therapy, individual therapy and hypnotherapy that has helped hundreds overcome these patterns to find true connection and happiness.
(415) 799-4153 View (415) 799-4153
Photo of Karyn Mendoza, Clinical Social Work/Therapist, LCSW
Karyn Mendoza
Clinical Social Work/Therapist, LCSW
2 Endorsed
Online Only
I’ve worked with people of all ages facing trauma, anxiety, depression, relationship conflicts, work issues, self-esteem, substance abuse, and daily stressors. I bring a deep desire to support others on their journey toward healing and wholehearted living. Using a trauma-informed lens, I affirm each client’s culture, gender identity, and strengths. I strive to create a safe, inclusive, and warm environment that uplifts while addressing challenges that hinder living your best life. I believe our work is most effective when it is authentic, collaborative, and tailored to your unique needs.
I’ve worked with people of all ages facing trauma, anxiety, depression, relationship conflicts, work issues, self-esteem, substance abuse, and daily stressors. I bring a deep desire to support others on their journey toward healing and wholehearted living. Using a trauma-informed lens, I affirm each client’s culture, gender identity, and strengths. I strive to create a safe, inclusive, and warm environment that uplifts while addressing challenges that hinder living your best life. I believe our work is most effective when it is authentic, collaborative, and tailored to your unique needs.
(415) 687-5672 View (415) 687-5672
Photo of Brandi Bell, Marriage & Family Therapist, MS, LMFT
Brandi Bell
Marriage & Family Therapist, MS, LMFT
Online Only
As a Licensed Marriage and Family Therapist, I am committed to creating a supportive, client-centered space where individuals can explore personal growth and emotional well-being. Whether you are seeking skills for personal development, support through grief and loss, managing depression, anxiety, or a safe space to celebrate joy and process life transitions, therapy offers an opportunity to deepen your relationship with yourself and embrace change. My goal is to empower you with the tools and insights needed to foster healing, self-awareness, and meaningful transformation.
As a Licensed Marriage and Family Therapist, I am committed to creating a supportive, client-centered space where individuals can explore personal growth and emotional well-being. Whether you are seeking skills for personal development, support through grief and loss, managing depression, anxiety, or a safe space to celebrate joy and process life transitions, therapy offers an opportunity to deepen your relationship with yourself and embrace change. My goal is to empower you with the tools and insights needed to foster healing, self-awareness, and meaningful transformation.
(707) 394-3776 View (707) 394-3776
Photo of Jason Tong - Hypnotic Mind Coaching - Certified Hypnosis, CHT
My name is Jason and I am a Board Certified Hypnotist. I specialize using Hypnosis and scientifically-backed strategies to overcome Anxiety and Bad Habits (Overeating, Smoking). As a result, people have been able to lose weight, quit smoking/other addictions, recover from grief/loss and have increased confidence in their personal and work life.
My name is Jason and I am a Board Certified Hypnotist. I specialize using Hypnosis and scientifically-backed strategies to overcome Anxiety and Bad Habits (Overeating, Smoking). As a result, people have been able to lose weight, quit smoking/other addictions, recover from grief/loss and have increased confidence in their personal and work life.
(415) 851-7463 View (415) 851-7463
Photo of Leora Fulvio, Marriage & Family Therapist, MA, MFT, CCHT
Leora Fulvio
Marriage & Family Therapist, MA, MFT, CCHT
5 Endorsed
San Francisco, CA 94123
If you are suffering with food & body image issues, issues of self-esteem & self-worth, relationship issues or dealing with trauma, I can help you. There are so many women who feel as though they are not enough. They believe that they somehow have to be better, look different, lose weight, be a whole different person to have a good relationship and a happy life. They beat themselves up constantly and are always trying to change. Do you understand this feeling? If so, I can help you have a loving relationship with yourself and settle into who you really are.
If you are suffering with food & body image issues, issues of self-esteem & self-worth, relationship issues or dealing with trauma, I can help you. There are so many women who feel as though they are not enough. They believe that they somehow have to be better, look different, lose weight, be a whole different person to have a good relationship and a happy life. They beat themselves up constantly and are always trying to change. Do you understand this feeling? If so, I can help you have a loving relationship with yourself and settle into who you really are.
(415) 649-8964 View (415) 649-8964
Photo of Cherise Arzaga, Clinical Social Work/Therapist, LCSW, 74795
Cherise Arzaga
Clinical Social Work/Therapist, LCSW, 74795
1 Endorsed
Online Only
Are you a driven person yet having difficulties managing your relationships, work stress, and family life? Are you feeling like you’ve exhausted all your coping skills and nothing seems to work? From a trauma informed and attachment-based lens we will explore your core issues and help you improve your mental health and emotional well-being. You can heal from past trauma, learn how to manage intrusive or obsessional thoughts, regulate your emotions, lift your mood, and communicate effectively. Together we'll work through unresolved feelings and patterns to live a more authentic life now.
Are you a driven person yet having difficulties managing your relationships, work stress, and family life? Are you feeling like you’ve exhausted all your coping skills and nothing seems to work? From a trauma informed and attachment-based lens we will explore your core issues and help you improve your mental health and emotional well-being. You can heal from past trauma, learn how to manage intrusive or obsessional thoughts, regulate your emotions, lift your mood, and communicate effectively. Together we'll work through unresolved feelings and patterns to live a more authentic life now.
(415) 619-5433 View (415) 619-5433
Photo of Stacy Lavino, Marriage & Family Therapist, MS, LMFT
Stacy Lavino
Marriage & Family Therapist, MS, LMFT
Online Only
Are you struggling or feeling stuck? Everyone will face challenges sometimes in their lives. There's nothing wrong with seeking out extra support. Therapy is for people who have the self-awareness to realize they need help, and that is something to be admired. I strive to create a safe, non-judgmental space where individuals can feel seen, heard, and respected. We work together as a team to help you reach your goals and become more fulfilled in your life. Therapy provides long-lasting benefits & support, giving you tools to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face.
Are you struggling or feeling stuck? Everyone will face challenges sometimes in their lives. There's nothing wrong with seeking out extra support. Therapy is for people who have the self-awareness to realize they need help, and that is something to be admired. I strive to create a safe, non-judgmental space where individuals can feel seen, heard, and respected. We work together as a team to help you reach your goals and become more fulfilled in your life. Therapy provides long-lasting benefits & support, giving you tools to avoid triggers, re-direct damaging patterns, and overcome whatever challenges you face.
(415) 697-1193 View (415) 697-1193
Photo of Lisa A Murphy, Clinical Social Work/Therapist, LCSW
Lisa A Murphy
Clinical Social Work/Therapist, LCSW
Online Only
Are you are you struggling with anxiety, stress, weight control/obesity, emotional eating, unhealthy/excessive behaviors or a chronic illness/family member's chronic illness? You may have tried to change many times in the past without the results you want. If you are ready to break the cycle, therapy can help you make changes...for life. My approach is to welcome your whole self in therapy, including your mind, body and spirit. We'll develop specific strategies to help you get better faster. Help for Wellness provides psychotherapy by telehealth in California, Utah, Washington and Idaho.
Are you are you struggling with anxiety, stress, weight control/obesity, emotional eating, unhealthy/excessive behaviors or a chronic illness/family member's chronic illness? You may have tried to change many times in the past without the results you want. If you are ready to break the cycle, therapy can help you make changes...for life. My approach is to welcome your whole self in therapy, including your mind, body and spirit. We'll develop specific strategies to help you get better faster. Help for Wellness provides psychotherapy by telehealth in California, Utah, Washington and Idaho.
(415) 878-1835 View (415) 878-1835
Photo of Lindsay Repko, Marriage & Family Therapist, MA, MFT
Lindsay Repko
Marriage & Family Therapist, MA, MFT
4 Endorsed
Online Only
Your experience is worthy of exploration and I believe that we all benefit from a protected space to journey through our history, needs, thoughts, and wishes around who we've been and who we want to be. I'm also familiar with the many ways that we can feel prohibited from giving ourselves such a space.
Your experience is worthy of exploration and I believe that we all benefit from a protected space to journey through our history, needs, thoughts, and wishes around who we've been and who we want to be. I'm also familiar with the many ways that we can feel prohibited from giving ourselves such a space.
(415) 630-6296 View (415) 630-6296
Photo of Alisha Borges - Alisha Borges - Expansive Therapy, Licensed Professional Clinical Counselor, APCC
Alisha Borges - Expansive Therapy
Licensed Professional Clinical Counselor, APCC
7 Endorsed
San Francisco, CA 94107
My approach to therapy is rooted in the power of healing-in-relationship and the engagement of our whole selves in that process. For those interested, my background as a Registered Dance/Movement Therapist allows for utilizing the body, art, and play as a few of the key instruments in the healing journey, alongside traditional talk therapy practices. My theoretical orientation is also integrative of psychodynamic theories, existential theory, mindfulness, interpersonal neurobiology, attachment theory, and internal family systems.
My approach to therapy is rooted in the power of healing-in-relationship and the engagement of our whole selves in that process. For those interested, my background as a Registered Dance/Movement Therapist allows for utilizing the body, art, and play as a few of the key instruments in the healing journey, alongside traditional talk therapy practices. My theoretical orientation is also integrative of psychodynamic theories, existential theory, mindfulness, interpersonal neurobiology, attachment theory, and internal family systems.
(628) 277-5830 View (628) 277-5830
Photo of Kelly Wild - Wild Wellness Psychotherapy Center, Psychologist, PsyD
Wild Wellness Psychotherapy Center
Psychologist, PsyD
1 Endorsed
Online Only
Do you feel trapped in worry, panic, or racing thoughts? Anxiety is a natural part of being human—our built-in alarm system, meant to keep us safe. But when worry, perfectionism, panic, or intrusive thoughts take over, it can feel less like a guide and more like a predator you can't outrun. Your mind may race like a stampede, your body locked in fight-or-flight, or feel your spirit seeking shelter. I teach science-based strategies that calm the body and help you stop battling your own mind. Together, we'll learn to read the terrain of your inner landscape so you can move through it with confidence and build new patterns for living.
Do you feel trapped in worry, panic, or racing thoughts? Anxiety is a natural part of being human—our built-in alarm system, meant to keep us safe. But when worry, perfectionism, panic, or intrusive thoughts take over, it can feel less like a guide and more like a predator you can't outrun. Your mind may race like a stampede, your body locked in fight-or-flight, or feel your spirit seeking shelter. I teach science-based strategies that calm the body and help you stop battling your own mind. Together, we'll learn to read the terrain of your inner landscape so you can move through it with confidence and build new patterns for living.
(415) 390-6739 View (415) 390-6739
Photo of Justin Kram, Marriage & Family Therapist, LMFT
Justin Kram
Marriage & Family Therapist, LMFT
4 Endorsed
Online Only
You may identify as "highly sensitive" or feel "misunderstood" by those around you. You may not have a clear idea how to address the distress in your life. You may feel confused or exasperated by clashes you are experiencing in relationships. Maybe you are facing a life transition, including but not limited to: a move to a new place, a new or worsening illness, work problems, spiritual questioning, transitions into the workforce or retirement. Regardless, painful feelings such as longing, numbness or despair make it hard to step into your life. You are ready and open for a new collaboration in this "laboratory" of therapy. Welcome.
You may identify as "highly sensitive" or feel "misunderstood" by those around you. You may not have a clear idea how to address the distress in your life. You may feel confused or exasperated by clashes you are experiencing in relationships. Maybe you are facing a life transition, including but not limited to: a move to a new place, a new or worsening illness, work problems, spiritual questioning, transitions into the workforce or retirement. Regardless, painful feelings such as longing, numbness or despair make it hard to step into your life. You are ready and open for a new collaboration in this "laboratory" of therapy. Welcome.
(415) 625-0210 View (415) 625-0210
Photo of Lindsey Brooks, Psychologist, PhD
Lindsey Brooks
Psychologist, PhD
6 Endorsed
San Francisco, CA 94115
Are you a person of color, LGBTQ, or woman-identified professional in a high demand field? Have you been wearing that superhero cape for far too long? Ready to feel more peace in your life? You’ve come to the right place. I’m Dr. Lindsey Brooks and I work with underrepresented achievers. I’ll help you feel more grounded, balanced, and resilient. You might be thinking to yourself: "I need to keep it all together”, “If I just work harder and push myself more, then everything will be okay”, or “I have to stay strong for my family”. Everyone around you sees you as a success, yet something still feels like it’s missing.
Are you a person of color, LGBTQ, or woman-identified professional in a high demand field? Have you been wearing that superhero cape for far too long? Ready to feel more peace in your life? You’ve come to the right place. I’m Dr. Lindsey Brooks and I work with underrepresented achievers. I’ll help you feel more grounded, balanced, and resilient. You might be thinking to yourself: "I need to keep it all together”, “If I just work harder and push myself more, then everything will be okay”, or “I have to stay strong for my family”. Everyone around you sees you as a success, yet something still feels like it’s missing.
(415) 592-6568 View (415) 592-6568
Photo of Katy Wray - Katy Wray, Psychotherapist & Jungian Psychoanalyst, Marriage & Family Therapist, LMFT
Katy Wray, Psychotherapist & Jungian Psychoanalyst
Marriage & Family Therapist, LMFT
San Francisco, CA 94115
Not accepting new clients
Psychotherapy can help when you are struggling with something specific, or when you are feeling concerned about where your life is going in general. There may be patterns that you tend to repeat and wish to change. Common concerns include relationships, work, anxiety, depression, grief, and childhood trauma. Depth therapy and Jungian psychoanalysis aim to go beyond symptom relief to unblock your capacity to grow into who you are uniquely meant to be.
Psychotherapy can help when you are struggling with something specific, or when you are feeling concerned about where your life is going in general. There may be patterns that you tend to repeat and wish to change. Common concerns include relationships, work, anxiety, depression, grief, and childhood trauma. Depth therapy and Jungian psychoanalysis aim to go beyond symptom relief to unblock your capacity to grow into who you are uniquely meant to be.
(415) 800-2661 View (415) 800-2661

See more therapy options for San Francisco County

How does your Therapist compare?

Number of Therapists in San Francisco County, CA

3,000+

Average cost per session

$187

Therapists in San Francisco County, CA who prioritize treating:

92% Anxiety
85% Depression
75% Relationship Issues
73% Self Esteem
69% Trauma and PTSD
65% Life Transitions
63% Stress

Average years in practice

11 Years

Top 3 insurances accepted

77% Aetna
55% Cigna and Evernorth
53% Other

How Therapists in San Francisco County, CA see their clients

57% Online Only
43% In Person and Online

Gender breakdown

76% Female
21% Male
3% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in San Francisco County?

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.