Therapists in San Francisco, CA

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Photo of Lyle Smith, Marriage & Family Therapist Associate in San Francisco, CA
Lyle Smith
Marriage & Family Therapist Associate, AMFT
Verified Verified
1 Endorsed
San Francisco, CA 94110  (Online Only)
Waitlist for new clients
You wake up in the morning and immediately want to go back to sleep. You feel overwhelmed and exhausted by everyday microaggressions and outright bigotry. You want acceptance and understanding, but it just seems like nothing will ever change. You feel isolated, anxious, and afraid for the future. If this sounds familiar, I want you to know that you are not alone. Help is available. I specialize in working with clients across the LGBTQAI+ spectrum on issues such as being true to oneself, managing anger, self-harming behaviors, trauma, and neurodiversity.
You wake up in the morning and immediately want to go back to sleep. You feel overwhelmed and exhausted by everyday microaggressions and outright bigotry. You want acceptance and understanding, but it just seems like nothing will ever change. You feel isolated, anxious, and afraid for the future. If this sounds familiar, I want you to know that you are not alone. Help is available. I specialize in working with clients across the LGBTQAI+ spectrum on issues such as being true to oneself, managing anger, self-harming behaviors, trauma, and neurodiversity.
(415) 853-9264 View (415) 853-9264
Photo of Thomas Masat, Marriage & Family Therapist in San Francisco, CA
Thomas Masat
Marriage & Family Therapist, LMFT, CGP
Verified Verified
4 Endorsed
San Francisco, CA 94114  (Online Only)
I work with patients seeking greater intimacy and connection, sex and desire. Often, patients are exploring their relationship to sexual orientation, problematic sexual behaviors including porn, and compulsive behaviors. Finding a middle path can be challenging...and profoundly rewarding as you create new ways of relating to yourself and others.
I work with patients seeking greater intimacy and connection, sex and desire. Often, patients are exploring their relationship to sexual orientation, problematic sexual behaviors including porn, and compulsive behaviors. Finding a middle path can be challenging...and profoundly rewarding as you create new ways of relating to yourself and others.
(415) 969-3984 View (415) 969-3984
Photo of Dr. Catherine Ciano, Psychologist in San Francisco, CA
Dr. Catherine Ciano
Psychologist, PhD, MBA
Verified Verified
San Francisco, CA 94114  (Online Only)
Waitlist for new clients
I help motivated people develop the skills and ability to create the change they want in their lives. As a Primary Care Psychologist at UC Berkeley and One Medical, I have helped many people with stress, anxiety, depression, perfectionism, panic, sleep issues, burnout, and relationship challenges. My style is highly collaborative, with the goal of increasing your sense of confidence and feeling of control over your life.
I help motivated people develop the skills and ability to create the change they want in their lives. As a Primary Care Psychologist at UC Berkeley and One Medical, I have helped many people with stress, anxiety, depression, perfectionism, panic, sleep issues, burnout, and relationship challenges. My style is highly collaborative, with the goal of increasing your sense of confidence and feeling of control over your life.
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Photo of Sandra Hall, Clinical Social Work/Therapist in San Francisco, CA
Sandra Hall
Clinical Social Work/Therapist, LCSW, LICSW, QCSW
Verified Verified
2 Endorsed
San Francisco, CA 94122
Not accepting new clients
Are you seeking an experienced provider who can assist you in your gender-affirming surgeries goals? I would love to help! I have years of experience navigating many different insurance companies' and surgeons' requirements for mental health assessments for a variety of different procedures. I work to make you as comfortable as possible and informed every step of the way. (Sliding scale available.)
Are you seeking an experienced provider who can assist you in your gender-affirming surgeries goals? I would love to help! I have years of experience navigating many different insurance companies' and surgeons' requirements for mental health assessments for a variety of different procedures. I work to make you as comfortable as possible and informed every step of the way. (Sliding scale available.)
(971) 351-2449 View (971) 351-2449
Photo of Veronica Ghabour, Counselor in San Francisco, CA
Veronica Ghabour
Counselor, APCC
Verified Verified
San Francisco, CA 94114
Mental health challenges are due to the aftereffects of traumatic experiences. Trauma can place a strain on your family, work, relationships, and even cause issues with self-worth. I specialize in trauma therapy along with treating personality disorders, depression, anxiety, ADHD, and addiction. All these disorders can look different from person to person, and that is where our therapeutic journey of empowerment and self-exploration begins. I concentrate on creating a safe space of growth and self-discovery through unconditional positive regard, emotional regulation, and guided activities.
Mental health challenges are due to the aftereffects of traumatic experiences. Trauma can place a strain on your family, work, relationships, and even cause issues with self-worth. I specialize in trauma therapy along with treating personality disorders, depression, anxiety, ADHD, and addiction. All these disorders can look different from person to person, and that is where our therapeutic journey of empowerment and self-exploration begins. I concentrate on creating a safe space of growth and self-discovery through unconditional positive regard, emotional regulation, and guided activities.
(415) 936-8843 View (415) 936-8843
Photo of Daniel J. Kugler, Marriage & Family Therapist in San Francisco, CA
Daniel J. Kugler
Marriage & Family Therapist, STD, MFT
Verified Verified
San Francisco, CA 94109
Not accepting new clients
I am a compassionate and practical therapist with many years of experience. I work with people having relationship problems, anxiety, depression, job difficulties or life transitions. My treatment focuses on problem-solving in the here and now, short term or long term. I offer reasonable fees and evening appointments.
I am a compassionate and practical therapist with many years of experience. I work with people having relationship problems, anxiety, depression, job difficulties or life transitions. My treatment focuses on problem-solving in the here and now, short term or long term. I offer reasonable fees and evening appointments.
(650) 385-8227 View (650) 385-8227
Photo of Shawna Brevik, Marriage & Family Therapist in San Francisco, CA
Shawna Brevik
Marriage & Family Therapist, MA, LMFT
Verified Verified
San Francisco, CA 94109  (Online Only)
Do you have trouble identifying why patterns keep repeating themselves in your life? Maybe you are someone who is longing for a deeper connection to self and the world around you. Perhaps you are a couple reading this looking for support in navigating some of human relationships most challenging conflicts, or it could be you're just looking to strengthen the relationship. Wherever your inquiry lies I am confident our work together can facilitate meaningful change.
Do you have trouble identifying why patterns keep repeating themselves in your life? Maybe you are someone who is longing for a deeper connection to self and the world around you. Perhaps you are a couple reading this looking for support in navigating some of human relationships most challenging conflicts, or it could be you're just looking to strengthen the relationship. Wherever your inquiry lies I am confident our work together can facilitate meaningful change.
(341) 766-0669 View (341) 766-0669
Photo of Samantha Ludin, Psychologist in San Francisco, CA
Samantha Ludin
Psychologist, PhD
Verified Verified
San Francisco, CA 94117
These are really tough times, aren't they? Existing issues feel bigger and it can be that much harder to cope. Therapy can heIp. I approach therapy in a warm and collaborative manner to help couples, individuals, and families identify new and adaptive ways to deal with life's challenges. In couples therapy, I use Emotion-Focused and Gottman approaches to help partners learn to manage and repair conflict, rebuild trust and intimacy, and build emotional connections. In family treatment, I'll work with your family to develop adaptive and healthy communication patterns, as well as address parenting concerns and behavioral issues.
These are really tough times, aren't they? Existing issues feel bigger and it can be that much harder to cope. Therapy can heIp. I approach therapy in a warm and collaborative manner to help couples, individuals, and families identify new and adaptive ways to deal with life's challenges. In couples therapy, I use Emotion-Focused and Gottman approaches to help partners learn to manage and repair conflict, rebuild trust and intimacy, and build emotional connections. In family treatment, I'll work with your family to develop adaptive and healthy communication patterns, as well as address parenting concerns and behavioral issues.
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Photo of Lauren LaPointe - Ketamine Assisted Psychotherapy, Marriage & Family Therapist in San Francisco, CA
Lauren LaPointe - Ketamine Assisted Psychotherapy
Marriage & Family Therapist, BA, MA
Verified Verified
San Francisco, CA 94118
Have you tried talk therapy before and eventually came to a place of feeling stuck or like it wasn't helping anymore? Are you struggling with feelings of depression, anxiety and chronic pain? Are you a part of the LGBTQ+ community and looking for a therapist who is knowledgeable about the struggles faced in this community? Do you need help navigating life transitions? Do you want to explore and better understand the dynamics of your family and friends? Do you need help processing challenging experiences or trauma? Are you curious about psychedelic assisted therapy? Or maybe you just want to deepen your understanding of yourself.
Have you tried talk therapy before and eventually came to a place of feeling stuck or like it wasn't helping anymore? Are you struggling with feelings of depression, anxiety and chronic pain? Are you a part of the LGBTQ+ community and looking for a therapist who is knowledgeable about the struggles faced in this community? Do you need help navigating life transitions? Do you want to explore and better understand the dynamics of your family and friends? Do you need help processing challenging experiences or trauma? Are you curious about psychedelic assisted therapy? Or maybe you just want to deepen your understanding of yourself.
(510) 345-1832 View (510) 345-1832
Photo of Margaret Flynn, Psychologist in San Francisco, CA
Margaret Flynn
Psychologist, PsyD
Verified Verified
San Francisco, CA 94109  (Online Only)
Are you are stuck in unhelpful patterns in your life or relationships? Do you want to feel differently about yourself or your partner? Is conflict or distance in your romantic relationship causing stress? Is there a sexual health concern you are not sure where to start to address? Let’s talk! In my practice with couples, I work from an Emotionally Focused Therapy framework, an evidence-based treatment facilitating change from distress to a secure bond. With increased security in your relationship, you can more productively navigate conflict and feel more confident in the world knowing your partner has your back.
Are you are stuck in unhelpful patterns in your life or relationships? Do you want to feel differently about yourself or your partner? Is conflict or distance in your romantic relationship causing stress? Is there a sexual health concern you are not sure where to start to address? Let’s talk! In my practice with couples, I work from an Emotionally Focused Therapy framework, an evidence-based treatment facilitating change from distress to a secure bond. With increased security in your relationship, you can more productively navigate conflict and feel more confident in the world knowing your partner has your back.
(628) 200-4308 View (628) 200-4308
Photo of Suzanne Klein, Psychologist in San Francisco, CA
Suzanne Klein
Psychologist, PhD
Verified Verified
1 Endorsed
San Francisco, CA 94118
If you are curious about your life and want to resolve troubling aspects of your relationships and feelings about yourself, I can help. Just like many others, you may have long-standing issues and current life struggles that cause you to feel sad or anxious and make it difficult for you to enjoy yourself and your loved ones to the fullest. Together we will sort through and understand how you've become the person you are now and how to help you heal from past traumas to gain greater perspective and happiness in your life and relationships going forward.
If you are curious about your life and want to resolve troubling aspects of your relationships and feelings about yourself, I can help. Just like many others, you may have long-standing issues and current life struggles that cause you to feel sad or anxious and make it difficult for you to enjoy yourself and your loved ones to the fullest. Together we will sort through and understand how you've become the person you are now and how to help you heal from past traumas to gain greater perspective and happiness in your life and relationships going forward.
(415) 630-5054 View (415) 630-5054
Photo of Dr. Josie Valderrama, Psychologist in San Francisco, CA
Dr. Josie Valderrama
Psychologist, PsyD, MA
Verified Verified
2 Endorsed
San Francisco, CA 94110
Life is a cycle of learning, healing, growth. Feeling stymied or creatively blocked? I am a psychologist & creative coach who may be able to help. Do you know what you want & can't seem to get there? I know what it feels like to be frustrated, bogged down or confused. Take that courageous and momentum-building first step! Support greater insight, fulfillment & peace of mind via expert counseling for your heroic journey. An energized collaboration involving compassionate psychoeducation, talk therapy & experiential processes. Say yes to mindfulness, transcending self-limiting beliefs, and transforming challenges into breakthroughs.
Life is a cycle of learning, healing, growth. Feeling stymied or creatively blocked? I am a psychologist & creative coach who may be able to help. Do you know what you want & can't seem to get there? I know what it feels like to be frustrated, bogged down or confused. Take that courageous and momentum-building first step! Support greater insight, fulfillment & peace of mind via expert counseling for your heroic journey. An energized collaboration involving compassionate psychoeducation, talk therapy & experiential processes. Say yes to mindfulness, transcending self-limiting beliefs, and transforming challenges into breakthroughs.
(415) 549-1773 View (415) 549-1773
Photo of Yu-Shan Huang, Marriage & Family Therapist in San Francisco, CA
Yu-Shan Huang
Marriage & Family Therapist, MA, LMFT
Verified Verified
4 Endorsed
San Francisco, CA 94115
I'm a San Francisco based therapist licensed in California. My bi-cultural background helped me expand my awareness and develop skills around the intersection of cross-cultural issues and relational trauma. I work well with adults who grew up from emotionally unavailable caregivers, couples who struggles with communication/ connection/ intimacy and cross-cultural conflicts. I support clients in connecting with their feelings and authentic selves to build a more balanced and healthier relationship with others and oneself. ​Together we will aim to transfer your therapeutic progress into any aspect of your life.
I'm a San Francisco based therapist licensed in California. My bi-cultural background helped me expand my awareness and develop skills around the intersection of cross-cultural issues and relational trauma. I work well with adults who grew up from emotionally unavailable caregivers, couples who struggles with communication/ connection/ intimacy and cross-cultural conflicts. I support clients in connecting with their feelings and authentic selves to build a more balanced and healthier relationship with others and oneself. ​Together we will aim to transfer your therapeutic progress into any aspect of your life.
(415) 325-2650 View (415) 325-2650
Photo of Silver Lake Psychology--San Francisco location, Psychologist in San Francisco, CA
Silver Lake Psychology--San Francisco location
Psychologist, PsyD
Verified Verified
San Francisco, CA 94109  (Online Only)
Learn how to feel more connected to yourself, others and the world around you. Therapy provides all the elements of intimacy: honest communication, vulnerability and trust. Good therapy is challenging yet warm, providing both structure and empathy for your unique experience. We are a collective of therapists with a wide range of specialties. Our intake professionals will help connect you with the right therapist for your needs. We make appointments easy, offering evenings and weekends and flexibility for creative professionals who can't make the same time each week.
Learn how to feel more connected to yourself, others and the world around you. Therapy provides all the elements of intimacy: honest communication, vulnerability and trust. Good therapy is challenging yet warm, providing both structure and empathy for your unique experience. We are a collective of therapists with a wide range of specialties. Our intake professionals will help connect you with the right therapist for your needs. We make appointments easy, offering evenings and weekends and flexibility for creative professionals who can't make the same time each week.
(415) 268-8735 View (415) 268-8735
Photo of Silvia MacAllister Voermanek, Marriage & Family Therapist in San Francisco, CA
Silvia MacAllister Voermanek
Marriage & Family Therapist, LMFT, PCC, MA
Verified Verified
4 Endorsed
San Francisco, CA 94114
I'm here to support your personal growth journey. With nearly 20 years of experience as a psychotherapist and life & executive coach, my approach empowers you to conquer mental health challenges and find your purpose. Whether you're facing anxiety, depression, addiction, anger, self-doubt, or life's challenges, I'm here to help you embrace change. Get ready to embark on this transformative journey, and together, we'll unlock your full potential!
I'm here to support your personal growth journey. With nearly 20 years of experience as a psychotherapist and life & executive coach, my approach empowers you to conquer mental health challenges and find your purpose. Whether you're facing anxiety, depression, addiction, anger, self-doubt, or life's challenges, I'm here to help you embrace change. Get ready to embark on this transformative journey, and together, we'll unlock your full potential!
(415) 965-2414 View (415) 965-2414
Photo of Anna H McDonald, Marriage & Family Therapist in San Francisco, CA
Anna H McDonald
Marriage & Family Therapist, LMFT
Verified Verified
1 Endorsed
San Francisco, CA 94110
If you're doing mostly well, but have recently discovered that something is off, you might work well with me. I am passionate about carefully excavating til we find what's causing the disruption under the surface. If you have things that happened in your childhood or earlier adult life that you don't talk about, we might work well together. I am passionate about helping people who have experienced deep wounding from difficult experiences. I understand that healing is not linear, and that you might need a guide to find your way.
If you're doing mostly well, but have recently discovered that something is off, you might work well with me. I am passionate about carefully excavating til we find what's causing the disruption under the surface. If you have things that happened in your childhood or earlier adult life that you don't talk about, we might work well together. I am passionate about helping people who have experienced deep wounding from difficult experiences. I understand that healing is not linear, and that you might need a guide to find your way.
(628) 218-7767 View (628) 218-7767
Amanda L Cotten
Marriage & Family Therapist Associate, AMFT, APCC
Verified Verified
San Francisco, CA 94133
I use a combination of Cognitive Behavioral Therapy and psychoanalysis in order to help you get from where you are to where you want to be. CBT can be a concrete road map for daily activities and psychoanalysis will help you gain the insight into yourself and find the deep strength that will give you resiliency for everything that comes your way."
I use a combination of Cognitive Behavioral Therapy and psychoanalysis in order to help you get from where you are to where you want to be. CBT can be a concrete road map for daily activities and psychoanalysis will help you gain the insight into yourself and find the deep strength that will give you resiliency for everything that comes your way."
(628) 277-4577 View (628) 277-4577
Photo of Megan Sullivan-Tuba, Marriage & Family Therapist Associate in San Francisco, CA
Megan Sullivan-Tuba
Marriage & Family Therapist Associate, AMFT
Verified Verified
San Francisco, CA 94115  (Online Only)
Therapy isn’t easy — but that doesn't mean it has to be joyless. If you’re looking for a therapist who can delve into the dark stuff with both the compassionate support and the sense of humor that it deserves, you’ve come to the right place. I'm an Associate Marriage and Family therapist who works with individuals and couples of all genders and orientations to improve their relationships. I love working with clients to improve communication and increasing intimacy, especially when partners come from different cultural backgrounds and hold different values.
Therapy isn’t easy — but that doesn't mean it has to be joyless. If you’re looking for a therapist who can delve into the dark stuff with both the compassionate support and the sense of humor that it deserves, you’ve come to the right place. I'm an Associate Marriage and Family therapist who works with individuals and couples of all genders and orientations to improve their relationships. I love working with clients to improve communication and increasing intimacy, especially when partners come from different cultural backgrounds and hold different values.
(415) 741-5533 View (415) 741-5533
Photo of Ron Burg, Psychologist in San Francisco, CA
Ron Burg
Psychologist, PhD
Verified Verified
San Francisco, CA 94102  (Online Only)
I work with men, regardless of sexual orientation, who feel stuck in their lives in one way or another. My approach is individualized and varies depending upon who you are and what you want to work on. As a rule, however, my sessions are very active and directed. Men who have been in talk therapy before typically tell me that working with me is different. They say that we are breaking new ground rather than rehashing familiar territory. Things move and they start to see changes rather quickly. Check out at my website for more information.
I work with men, regardless of sexual orientation, who feel stuck in their lives in one way or another. My approach is individualized and varies depending upon who you are and what you want to work on. As a rule, however, my sessions are very active and directed. Men who have been in talk therapy before typically tell me that working with me is different. They say that we are breaking new ground rather than rehashing familiar territory. Things move and they start to see changes rather quickly. Check out at my website for more information.
(415) 858-6856 View (415) 858-6856
Photo of Margaret F Burkle, Marriage & Family Therapist in San Francisco, CA
Margaret F Burkle
Marriage & Family Therapist, MA, LMFT
Verified Verified
San Francisco, CA 94131  (Online Only)
Are you looking to explore a part of yourself that’s been hidden or silenced? Have you come up against circumstances or emotions you’re having difficulty navigating? I’m a therapist with 13 years of experience working with depression, psychosis, trauma, grief, major life transitions, gender exploration, queer identity affirmation, and self-worth/assertiveness. You’ll have options to utilize different modalities from an eclectic style that utilizes narrative approaches, drama therapy, family systems, and liberatory practice. My priority is a flexible, person- centered environment that considers intersections of identity, oppression,
Are you looking to explore a part of yourself that’s been hidden or silenced? Have you come up against circumstances or emotions you’re having difficulty navigating? I’m a therapist with 13 years of experience working with depression, psychosis, trauma, grief, major life transitions, gender exploration, queer identity affirmation, and self-worth/assertiveness. You’ll have options to utilize different modalities from an eclectic style that utilizes narrative approaches, drama therapy, family systems, and liberatory practice. My priority is a flexible, person- centered environment that considers intersections of identity, oppression,
(415) 914-8810 View (415) 914-8810

See more therapy options for San Francisco

How does your Therapist compare?

Number of Therapists in San Francisco, CA

3,000+

Average cost per session

$189

Therapists in San Francisco, CA who prioritize treating:

93% Anxiety
87% Depression
81% Relationship Issues
75% Self Esteem
70% Trauma and PTSD
68% Stress
66% Life Transitions

Average years in practice

12 Years

Top 3 insurances accepted

69% Aetna
55% UnitedHealthcare UHC | UBH
54% Cigna and Evernorth

How Therapists in San Francisco, CA see their clients

55% In Person and Online
45% Online Only

Gender breakdown

75% Female
23% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in San Francisco?

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.