Therapists in Lake Saint Louis, MO

Photo of Latonia Coates-Smith, Clinical Social Work/Therapist in Lake Saint Louis, MO
Latonia Coates-Smith
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
2 Endorsed
Lake Saint Louis, MO 63367
Embracing healing and wellness is key to maximizing your potential. Serving as a therapist and educator, I help clients understand the underlying factor(s) contributing to unresolved issues within their personal & professional lives. My goal is to provide a holistic approach to treatment by assessing the individual's environment as well as their mental, physical, and spiritual well being. The whelm of my practice has been demonstrated in both psychiatric and medical settings offering crisis intervention, intensive case management, and counseling to a diverse population.
Embracing healing and wellness is key to maximizing your potential. Serving as a therapist and educator, I help clients understand the underlying factor(s) contributing to unresolved issues within their personal & professional lives. My goal is to provide a holistic approach to treatment by assessing the individual's environment as well as their mental, physical, and spiritual well being. The whelm of my practice has been demonstrated in both psychiatric and medical settings offering crisis intervention, intensive case management, and counseling to a diverse population.
(636) 238-5944 View (636) 238-5944
Photo of Natalie Webb, Licensed Professional Counselor in Lake Saint Louis, MO
Natalie Webb
Licensed Professional Counselor, MA, LPC
Verified Verified
Lake Saint Louis, MO 63367
Life has a unique way of tossing us around with waves of confusion, frustration, and pain. In the midst of the chaos, it is hard to tell which way is which at times. Know that whatever situation you are facing, you are not alone and my hope is that we can navigate a way through together. As a counselor, my priority is you.The most important part of counseling is for you to feel safe, understood, and able to express yourself and what you are facing.
Life has a unique way of tossing us around with waves of confusion, frustration, and pain. In the midst of the chaos, it is hard to tell which way is which at times. Know that whatever situation you are facing, you are not alone and my hope is that we can navigate a way through together. As a counselor, my priority is you.The most important part of counseling is for you to feel safe, understood, and able to express yourself and what you are facing.
(636) 205-5264 View (636) 205-5264
Photo of Kristin Bemis, Counselor in Lake Saint Louis, MO
Kristin Bemis
Counselor, LPC, PMH-C
Verified Verified
Lake Saint Louis, MO 63367
I specialize in working with young children and adolescents navigating anxiety, depression, emotional regulation, and other challenges. My focus also includes counseling with prenatal/postpartum clients working through the challenges of becoming a new mother, including anxiety and depression. I am passionate about working with mothers who may be experiencing burnout or other challenges that come with the demands of motherhood. This includes helping to empower women to reach their fullest potential.
I specialize in working with young children and adolescents navigating anxiety, depression, emotional regulation, and other challenges. My focus also includes counseling with prenatal/postpartum clients working through the challenges of becoming a new mother, including anxiety and depression. I am passionate about working with mothers who may be experiencing burnout or other challenges that come with the demands of motherhood. This includes helping to empower women to reach their fullest potential.
(636) 535-2589 View (636) 535-2589
Photo of Ashley Avila, Licensed Professional Counselor in Lake Saint Louis, MO
Ashley Avila
Licensed Professional Counselor, EdS, LPC, NCC
Verified Verified
Lake Saint Louis, MO 63367
It can be easy to lose sight of hope, peace, and happiness when faced with the turmoils and challenges of this life. I believe every person's struggles are unique. I am passionate about understanding your story and offering support and practical solutions that restore hope and lead to healing. As a counselor, I believe that every interaction is an opportunity to reflect God’s love. Therefore, we will to start where you are, working in a safe, nonjudgmental atmosphere as we navigate through the storm or season of life that you are experiencing.
It can be easy to lose sight of hope, peace, and happiness when faced with the turmoils and challenges of this life. I believe every person's struggles are unique. I am passionate about understanding your story and offering support and practical solutions that restore hope and lead to healing. As a counselor, I believe that every interaction is an opportunity to reflect God’s love. Therefore, we will to start where you are, working in a safe, nonjudgmental atmosphere as we navigate through the storm or season of life that you are experiencing.
(636) 355-8149 View (636) 355-8149
Photo of Jennifer Moore-Santiago, Licensed Professional Counselor in Lake Saint Louis, MO
Jennifer Moore-Santiago
Licensed Professional Counselor, LPC, LMHC
Verified Verified
Lake Saint Louis, MO 63367  (Online Only)
I believe that mental wellness is vital and should be taken just as seriously as physical wellness. Every person, at some point in their life, will experience mental health needs. Life has ups and downs and learning how to navigate those downs is what mental wellness is about!
I believe that mental wellness is vital and should be taken just as seriously as physical wellness. Every person, at some point in their life, will experience mental health needs. Life has ups and downs and learning how to navigate those downs is what mental wellness is about!
(636) 791-6306 View (636) 791-6306
Photo of Blair Williams, Pre-Licensed Professional in Lake Saint Louis, MO
Blair Williams
Pre-Licensed Professional, MS, PLPC
Verified Verified
1 Endorsed
Lake Saint Louis, MO 63367
I believe the therapeutic process is a collaborative effort, and I am honored to have the opportunity to see life transformation happen with my clients. My goal is to work side by side with my clients to help them reach their life’s objective. I will do this through utilizing Cognitive Behavioral Therapy, Solution-focused therapy, and a Person-centered approach, as well as always leaning on God’s wisdom and direction.
I believe the therapeutic process is a collaborative effort, and I am honored to have the opportunity to see life transformation happen with my clients. My goal is to work side by side with my clients to help them reach their life’s objective. I will do this through utilizing Cognitive Behavioral Therapy, Solution-focused therapy, and a Person-centered approach, as well as always leaning on God’s wisdom and direction.
(636) 597-6078 View (636) 597-6078
Photo of Karla Pollock-Smith, Clinical Social Work/Therapist in Lake Saint Louis, MO
Karla Pollock-Smith
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Lake Saint Louis, MO 63367  (Online Only)
You are a successful career woman who is fighting anxiety every stinking day. You say “yes” without considering your schedule or your needs. You worry all of the time about what others think about you and you tend to act differently depending on who you are around. You are scared of being rejected or abandoned, and you spend way too much time in your head replaying conversations you’ve had, fearful that you said something wrong. You doubt yourself frequently and hate to make decisions! Your body has a lot of tension and you’ve been to your doctor or an ER because you thought you were having a heart attack. Time to invest in you.
You are a successful career woman who is fighting anxiety every stinking day. You say “yes” without considering your schedule or your needs. You worry all of the time about what others think about you and you tend to act differently depending on who you are around. You are scared of being rejected or abandoned, and you spend way too much time in your head replaying conversations you’ve had, fearful that you said something wrong. You doubt yourself frequently and hate to make decisions! Your body has a lot of tension and you’ve been to your doctor or an ER because you thought you were having a heart attack. Time to invest in you.
(636) 597-6290 View (636) 597-6290
Photo of Deanna Self, MA, LPC, Licensed Professional Counselor in Lake Saint Louis, MO
Deanna Self, MA, LPC
Licensed Professional Counselor, MA, LPC
Verified Verified
Lake Saint Louis, MO 63367
Counseling is about helping strong people become stronger. Sometimes, you just need a little peace, time, and a place to sort things out. When life is painful or hurts, get an objective viewpoint and tools to get back on track. My specialties include: Cognitive Behavior Therapy, Depression, Anxiety, Improving Communications and Relationships, Recovery from Body-Focused Repetitive Behaviors, Bereavement, Grief and Loss, and Christian Counseling . Regain your peace and improve your ability to better manage life stress. Call now, and through a relatively short time, get help to achieve your goals.
Counseling is about helping strong people become stronger. Sometimes, you just need a little peace, time, and a place to sort things out. When life is painful or hurts, get an objective viewpoint and tools to get back on track. My specialties include: Cognitive Behavior Therapy, Depression, Anxiety, Improving Communications and Relationships, Recovery from Body-Focused Repetitive Behaviors, Bereavement, Grief and Loss, and Christian Counseling . Regain your peace and improve your ability to better manage life stress. Call now, and through a relatively short time, get help to achieve your goals.
(314) 667-4569 View (314) 667-4569
Photo of Amy Ratican, Pre-Licensed Professional in Lake Saint Louis, MO
Amy Ratican
Pre-Licensed Professional, MA, PLPC
Verified Verified
Lake Saint Louis, MO 63367
My philosophy of counseling is to let others know they are not alone. Clients will always have someone to talk to about anything troublesome. I believe all people need someone to be there for them, to comfort them and give them tools to self-sooth and learn to succeed to the best of their ability. Through unconditional positive regard, creating a safe space which is nonjudgmental and confidential, and by using active listening and other techniques clients can continue to learn to improve themselves and their environment.
My philosophy of counseling is to let others know they are not alone. Clients will always have someone to talk to about anything troublesome. I believe all people need someone to be there for them, to comfort them and give them tools to self-sooth and learn to succeed to the best of their ability. Through unconditional positive regard, creating a safe space which is nonjudgmental and confidential, and by using active listening and other techniques clients can continue to learn to improve themselves and their environment.
(636) 251-3323 View (636) 251-3323
Photo of Karissa Curtis, Licensed Professional Counselor in Lake Saint Louis, MO
Karissa Curtis
Licensed Professional Counselor, MA, LPC, CST
Verified Verified
1 Endorsed
Lake Saint Louis, MO 63367
Waitlist for new clients
I believe people's pain is holy and sacred ground and that every individual's story has value. I work with individuals and couples, and I'm passionate about understanding my clients' struggles and giving them hope for healing and redemption. In coming to counseling, my clients can be assured that I'll provide a safe, non-judgmental space for them to grow and find healing. Of particular interest to me is helping people who struggle with relationship difficulties, sexual intimacy issues, vaginismus, sexual shame, religious and sexual identity conflicts, spirituality, and conflict and boundary issues.
I believe people's pain is holy and sacred ground and that every individual's story has value. I work with individuals and couples, and I'm passionate about understanding my clients' struggles and giving them hope for healing and redemption. In coming to counseling, my clients can be assured that I'll provide a safe, non-judgmental space for them to grow and find healing. Of particular interest to me is helping people who struggle with relationship difficulties, sexual intimacy issues, vaginismus, sexual shame, religious and sexual identity conflicts, spirituality, and conflict and boundary issues.
(636) 306-3471 View (636) 306-3471
Photo of Karen Gniadek- Ellie Mental Health Lake St. Louis, Licensed Professional Counselor in Lake Saint Louis, MO
Karen Gniadek- Ellie Mental Health Lake St. Louis
Licensed Professional Counselor, MA, LPC
Verified Verified
Lake Saint Louis, MO 63367
I believe everyone deserves to be genuinely heard and understood. Before joining Ellie as an LPC, my career was anchored within the public school system as a parent, substitute teacher, special education teacher, psychological examiner, and school-based therapist. Although children, teens, and young adults were my focus, I often found myself equally supporting guardians. My desire is to help clients of all ages use their strengths to find creative, practical, realistic ways to approach life's challenges.
I believe everyone deserves to be genuinely heard and understood. Before joining Ellie as an LPC, my career was anchored within the public school system as a parent, substitute teacher, special education teacher, psychological examiner, and school-based therapist. Although children, teens, and young adults were my focus, I often found myself equally supporting guardians. My desire is to help clients of all ages use their strengths to find creative, practical, realistic ways to approach life's challenges.
(636) 428-5174 View (636) 428-5174
Faith and Hope Counseling Services, LLC
Clinical Social Work/Therapist, MSW, LCSW, ACSW
Verified Verified
Lake Saint Louis, MO 63367
My name is Rebecca Turay, MSW, LCSW and I provide mental health counseling services for individuals ages 18 years and over: individuals, groups, couples, family, and those with marital or relationship issues for problems with: depression, anxiety, PTSD, panic, phobias/fears, grief and loss issues, death and dying, suicide, miscarriage, abortion, divorce, blended families, parenting, substance abuse, abuse, anger issues, low self-esteem, trauma, and adjustment or life changes. I also provide EMDR (Eye Movement Desensitization Reprocessing) therapy; and Hypnotherapy. Therapeutic approaches are individualized and provided with respect to client needs and preferences.
My name is Rebecca Turay, MSW, LCSW and I provide mental health counseling services for individuals ages 18 years and over: individuals, groups, couples, family, and those with marital or relationship issues for problems with: depression, anxiety, PTSD, panic, phobias/fears, grief and loss issues, death and dying, suicide, miscarriage, abortion, divorce, blended families, parenting, substance abuse, abuse, anger issues, low self-esteem, trauma, and adjustment or life changes. I also provide EMDR (Eye Movement Desensitization Reprocessing) therapy; and Hypnotherapy. Therapeutic approaches are individualized and provided with respect to client needs and preferences.
(636) 329-4003 View (636) 329-4003
Photo of Linda Duree, Licensed Professional Counselor in Lake Saint Louis, MO
Linda Duree
Licensed Professional Counselor, MA, LPC
Verified Verified
2 Endorsed
Lake Saint Louis, MO 63367
My name is Linda Duree with Crossroads Counseling & Mediation LLC. I am passionate about assisting individuals and families in achieving a state of wellness. It is my goal to provide the comprehensive tools and techniques necessary for you to navigate your journey. I provide counseling services to individuals, couples and families. I have specialized training in conflict resolution to help you find a middle ground through mediation and parent coordination. I am registered as a Domestic Relations Dispute Resolution Neutral & Parent Coordinator with the Missouri Bar.
My name is Linda Duree with Crossroads Counseling & Mediation LLC. I am passionate about assisting individuals and families in achieving a state of wellness. It is my goal to provide the comprehensive tools and techniques necessary for you to navigate your journey. I provide counseling services to individuals, couples and families. I have specialized training in conflict resolution to help you find a middle ground through mediation and parent coordination. I am registered as a Domestic Relations Dispute Resolution Neutral & Parent Coordinator with the Missouri Bar.
(636) 487-5718 View (636) 487-5718
Photo of Mary C O'Brien, Licensed Professional Counselor in Lake Saint Louis, MO
Mary C O'Brien
Licensed Professional Counselor, MA, LPC, NCC
Verified Verified
Lake Saint Louis, MO 63367
"I believe that change often involves new ways of thinking, understanding and constructively dealing with emotions, taking new actions, learning new patterns of relating and developing a hopeful attitude. I also believe in using a collaborative process directed toward working through a problem in effort to enhance one's ability to achieve enjoyment and satisfaction in life".
"I believe that change often involves new ways of thinking, understanding and constructively dealing with emotions, taking new actions, learning new patterns of relating and developing a hopeful attitude. I also believe in using a collaborative process directed toward working through a problem in effort to enhance one's ability to achieve enjoyment and satisfaction in life".
(314) 200-0516 View (314) 200-0516
Photo of Andy Anderson, Licensed Professional Counselor in Lake Saint Louis, MO
Andy Anderson
Licensed Professional Counselor, MA, LPC, KPMT
Verified Verified
6 Endorsed
Lake Saint Louis, MO 63367  (Online Only)
My ideal client would be parents or caregivers seeking treatment for their children with behavioral, emotional, and social problems, such as ODD, ADHD, anxiety, depression, and other typical childhood issues. These clients would be interested in a parent training format for the treatments, indicating a willingness to actively participate in the therapy process and work collaboratively with the therapist. Additionally, the ideal client would be open to utilizing technology for teletherapy sessions, as my services are presented in an online therapy platform.
My ideal client would be parents or caregivers seeking treatment for their children with behavioral, emotional, and social problems, such as ODD, ADHD, anxiety, depression, and other typical childhood issues. These clients would be interested in a parent training format for the treatments, indicating a willingness to actively participate in the therapy process and work collaboratively with the therapist. Additionally, the ideal client would be open to utilizing technology for teletherapy sessions, as my services are presented in an online therapy platform.
(636) 614-1673 View (636) 614-1673
Photo of Melissa Maer, Pre-Licensed Professional in Lake Saint Louis, MO
Melissa Maer
Pre-Licensed Professional, PLPC
Verified Verified
Lake Saint Louis, MO 63367  (Online Only)
Do you feel overwhelmed and experiencing anxiety as a result? Does anxiety and depression affect you in life? I believe that by empowering yourself while learning coping skills through therapy are important to improve your life. As someone who has experienced therapy herself, I believe that it's very important to experience the coping skills needed to learn different ways to handle difficult situations.
Do you feel overwhelmed and experiencing anxiety as a result? Does anxiety and depression affect you in life? I believe that by empowering yourself while learning coping skills through therapy are important to improve your life. As someone who has experienced therapy herself, I believe that it's very important to experience the coping skills needed to learn different ways to handle difficult situations.
(314) 804-0801 View (314) 804-0801
Photo of Heather Michelle Hampton, Licensed Professional Counselor in Lake Saint Louis, MO
Heather Michelle Hampton
Licensed Professional Counselor, MA, LPC
Verified Verified
Lake Saint Louis, MO 63367  (Online Only)
Is your marriage struggling, or a child having issues at home/school/bullying/anxiety or just need help? You might have some doubts about whether therapy can truly benefit your specific situation. Drawing from my personal life experiences and my educational background, I can provide assurance that therapy is indeed effective. We'll work together to gain a deep understanding of your current position, the journey that brought you here, and the direction you wish to move in the future. The path to improvement varies for each individual, which is why my counseling approach is not fixed but adaptable to meet you at your unique point.
Is your marriage struggling, or a child having issues at home/school/bullying/anxiety or just need help? You might have some doubts about whether therapy can truly benefit your specific situation. Drawing from my personal life experiences and my educational background, I can provide assurance that therapy is indeed effective. We'll work together to gain a deep understanding of your current position, the journey that brought you here, and the direction you wish to move in the future. The path to improvement varies for each individual, which is why my counseling approach is not fixed but adaptable to meet you at your unique point.
(636) 385-5378 View (636) 385-5378
Photo of Justin Cook, Licensed Professional Counselor in Lake Saint Louis, MO
Justin Cook
Licensed Professional Counselor, PhD, LPC, CCATP
Verified Verified
Lake Saint Louis, MO 63367
There are many reasons that we find ourselves in need of help. I believe that we all have a desire for our lives to be better, but many times we are unsure of how to reach those goals. Whether you are experiencing anxiety, depression, other mental health needs, or have experienced trauma in your life reaching out for help is the first step toward a better life.
There are many reasons that we find ourselves in need of help. I believe that we all have a desire for our lives to be better, but many times we are unsure of how to reach those goals. Whether you are experiencing anxiety, depression, other mental health needs, or have experienced trauma in your life reaching out for help is the first step toward a better life.
(636) 597-6067 View (636) 597-6067
Photo of Paige Enke, Clinical Social Work/Therapist in Lake Saint Louis, MO
Paige Enke
Clinical Social Work/Therapist, MSW, LMSW
Verified Verified
1 Endorsed
Lake Saint Louis, MO 63367
Hello! I'm a therapist with a passion for empowering people to embrace their authentic selves. I tailor my methods to your needs and primarily utilize CBT from a trauma informed perspective.
Hello! I'm a therapist with a passion for empowering people to embrace their authentic selves. I tailor my methods to your needs and primarily utilize CBT from a trauma informed perspective.
(636) 339-4475 View (636) 339-4475
Photo of Carolyn Tinker, Licensed Professional Counselor in Lake Saint Louis, MO
Carolyn Tinker
Licensed Professional Counselor, MA, NCC, LPC
Verified Verified
Lake Saint Louis, MO 63367
Waitlist for new clients
Carolyn operates from a systems way of thinking. I believe that there are many aspects that can affect each individual and exploring these aspects best helps the individual. I use therapies such as CBT, DBT, Solution-Focused Therapy, EFT with couples and other modalities. I work with children ages 10+, adolescents, individuals, couples and families. I have experience working with anxiety, depression, divorce, marital separation, premarital counseling, marriage counseling, sexual issues including addiction, affairs, pornography, abuse and LGBTQ+, grief and other situations that may arise.
Carolyn operates from a systems way of thinking. I believe that there are many aspects that can affect each individual and exploring these aspects best helps the individual. I use therapies such as CBT, DBT, Solution-Focused Therapy, EFT with couples and other modalities. I work with children ages 10+, adolescents, individuals, couples and families. I have experience working with anxiety, depression, divorce, marital separation, premarital counseling, marriage counseling, sexual issues including addiction, affairs, pornography, abuse and LGBTQ+, grief and other situations that may arise.
(636) 306-4196 View (636) 306-4196

See more therapy options for Lake Saint Louis

How does your Therapist compare?

Number of Therapists in Lake Saint Louis, MO

60+

Average cost per session

$122

Therapists in Lake Saint Louis, MO who prioritize treating:

95% Anxiety
86% Depression
79% Relationship Issues
78% Coping Skills
73% Self Esteem
68% Trauma and PTSD
68% Stress

Average years in practice

10 Years

Top 3 insurances accepted

83% Cigna and Evernorth
81% Aetna
74% Optum

How Therapists in Lake Saint Louis, MO see their clients

78% In Person and Online
22% Online Only

Gender breakdown

84% Female
15% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Lake Saint Louis?

Search for nearby therapists or counselors by inputting your city, town, or suburb; or zip code; or a provider’s name into the search bar. From there, you can filter providers by the issues they treat, cost, insurance, gender, and other factors to find providers who are well-suited to your needs. To navigate between locations within the same country, enter a new city or zip code into the search bar.

Learn more about how to find a therapist

Is everyone in the Psychology Today Therapy Directory a licensed therapist?

The Psychology Today directory lists providers who offer legitimate mental health services to the public, including psychologists, psychiatrists, social workers, and counselors.

Many have been licensed by the country or state where they practice; providers whose license or primary credential has been verified by Psychology Today are signified by a “Verified” symbol. Some clinicians or organizations provide services for which their state or country does not offer licenses, such as pastoral counseling. They may be selectively included without the “Verified” seal.

What’s the difference between a psychologist, a therapist, and a counselor?

Therapists, psychologists, and counselors are all licensed mental health professionals. In the US, psychologists have earned a doctoral degree. The terms “therapist” and “counselor” are used somewhat interchangeably, but generally therapists offer longer-term, mental health care, while counselors offer shorter-term care that may focus on one domain, such as marriage, career, or academic challenges.

Clients should consider factors such as insurance coverage and their primary reason(s) for seeking therapy to determine the type of professional best suited to their needs. Someone struggling with mental health challenges such as depression or anxiety, for example, may wish to seek out a clinical psychologist or therapist, while someone navigating career obstacles or marital upheaval may benefit from seeing a counselor who can offer short-term, targeted support.

What type of therapy is right for me?

The type of therapy best suited to a particular individual depends on several factors, including their primary reason for seeking therapy, their preferred timeline (some therapy types last for a set number of sessions, while others are open-ended), and their personality and preferences—some may prefer a more structured approach. For many individuals, multiple types of therapy could provide a good fit.

How much does therapy cost?

The cost of therapy depends on a number of variables, including location and the therapist’s experience and training. On average, a therapy session in the United States could cost between $100 and $200 or more. If you have insurance, the expense of mental health care is typically lower, but it varies based on your insurance plan details and whether you choose an in-network or out-of-network mental healthcare provider.

What are more affordable or low cost therapy solutions?

Many therapists offer sliding scale payments, usually on a limited number of slots, which consists in an agreement between the therapist and a client to pay a reduced rate. Therapists who provide such arrangements often consider the client's income or ability to pay, but the extent of the discount is ultimately at the therapist's discretion. Furthermore, while group therapy may have different goals and benefits compared to individual therapy, it can be a more affordable solution to address certain types of issues.

Is online therapy cheaper than in-person therapy?

Many therapists charge the same amount for online therapy as they do for in-person therapy—though clients may still find this cost-effective if it cuts down on their transportation costs. Health insurance plans often offer equivalent coverage for online and in-person therapy; indeed, in many places, they are legally required to do so. Text-based or on-demand therapy apps may be cheaper than traditional one-on-one psychotherapy; however, the practice may be less effective and is not likely to be covered by insurance.

Is online therapy a good option?

Therapy conducted online can be just as effective as in-person therapy, as long as there is a strong alliance between the client and the therapist. To find a therapist who provides telehealth services to clients in your area, click “Online Therapy” on the directory homepage and search by your city or town or your zip code.

Are therapy sessions confidential?

Confidentiality is a crucial part of the therapeutic relationship. Therapists in the United States are bound by the regulations set out by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which aims to protect sensitive health information. With very few exceptions, a therapist will only discuss their client with others when the client has given their written permission. The instances in which a therapist would be required to disclose personal information are: if a client poses a danger to themselves or others, if the therapist suspects the abuse of a child or an elderly or otherwise dependent adult, or if they are legally forced to by court order. These exceptions to the confidentiality agreement are usually discussed with a client before their first session.