Therapists in Puyallup, WA

Photo of Jim Robinson, Counselor in Puyallup, WA
Jim Robinson
Counselor, MA, LMHC
Verified Verified
Puyallup, WA 98373
Hi, I have worked with hurting people for a long time and my hope is to support you through this difficult, possibly overwhelming time in your life. Your struggle is unique and personal and I respect your need to feel understood. During our first visit, I will simply listen and seek to understand what is causing you sorrow, anxiety, hurt, or anger. Together we will work towards wholeness and my firm hope is that I can help you find that place in life again where you are at peace with yourself and your situation.
Hi, I have worked with hurting people for a long time and my hope is to support you through this difficult, possibly overwhelming time in your life. Your struggle is unique and personal and I respect your need to feel understood. During our first visit, I will simply listen and seek to understand what is causing you sorrow, anxiety, hurt, or anger. Together we will work towards wholeness and my firm hope is that I can help you find that place in life again where you are at peace with yourself and your situation.
(253) 243-3832 View (253) 243-3832
Photo of Karis Bjerke, Clinical Social Work/Therapist in Puyallup, WA
Karis Bjerke
Clinical Social Work/Therapist, MSW, LSWAIC, SUDP
Verified Verified
Puyallup, WA 98372  (Online Only)
Not accepting new clients
I am here to meet you where you are in your desire to effect positive changes in your life. I am an experienced clinician working with individuals who are co-occurring having mental health symptoms and substance use. Together we can make a plan and help navigate you towards recovery. I specialize in helping you to develop healthy coping skills, prevention of use, exploring root causes and helping individuals be the best person they desire to become. I provide professional and skilled assessments, group and individual sessions.
I am here to meet you where you are in your desire to effect positive changes in your life. I am an experienced clinician working with individuals who are co-occurring having mental health symptoms and substance use. Together we can make a plan and help navigate you towards recovery. I specialize in helping you to develop healthy coping skills, prevention of use, exploring root causes and helping individuals be the best person they desire to become. I provide professional and skilled assessments, group and individual sessions.
(360) 227-5939 View (360) 227-5939
Photo of Amy M Plumb, Counselor in Puyallup, WA
Amy M Plumb
Counselor, MA, LMHC, SUDP, CPC, CWP
Verified Verified
1 Endorsed
Puyallup, WA 98371  (Online Only)
Talk therapy is great, but what many of the people I work with have missed in past therapy experiences is how to implement what they have learned about themselves into their real life. Self-regulation is key and after establishing a solid foundation using skills training for increasing distress tolerance and emotion regulation, I work with people to get at the root of the problems they are experiencing by using EMDR therapy and other interventions that address the core stuff, which is often the stuff that has kept us stuck in patterns that hurt. From there, we can work on improving your relationships and personal development.
Talk therapy is great, but what many of the people I work with have missed in past therapy experiences is how to implement what they have learned about themselves into their real life. Self-regulation is key and after establishing a solid foundation using skills training for increasing distress tolerance and emotion regulation, I work with people to get at the root of the problems they are experiencing by using EMDR therapy and other interventions that address the core stuff, which is often the stuff that has kept us stuck in patterns that hurt. From there, we can work on improving your relationships and personal development.
(206) 734-3718 View (206) 734-3718
Photo of Karen Beth Acheson, Psychologist in Puyallup, WA
Karen Beth Acheson
Psychologist, PhD
Verified Verified
Puyallup, WA 98374  (Online Only)
Waitlist for new clients
Greetings and welcome. I'm Dr. Karen Beth Acheson, Ph.D., and I have over 20 years of experience bringing warmth, compassion, and a sense of humor to help empower people to make healthy changes in their lives. My primary focus is adult psychotherapy. My style is down-to-earth; I draw from humanistic, psychodynamic, cognitive-behavioral & mindfulness-based therapies. My specialty areas include: Depression; Bipolar (manic) Depression; Anxiety; Trauma (including Post-Traumatic Stress Disorder); and Emotional/Sexual/physical Abuse. Also, I am now blending my lifelong passion for animals, including a B.S. in Animal Science, with
Greetings and welcome. I'm Dr. Karen Beth Acheson, Ph.D., and I have over 20 years of experience bringing warmth, compassion, and a sense of humor to help empower people to make healthy changes in their lives. My primary focus is adult psychotherapy. My style is down-to-earth; I draw from humanistic, psychodynamic, cognitive-behavioral & mindfulness-based therapies. My specialty areas include: Depression; Bipolar (manic) Depression; Anxiety; Trauma (including Post-Traumatic Stress Disorder); and Emotional/Sexual/physical Abuse. Also, I am now blending my lifelong passion for animals, including a B.S. in Animal Science, with
(253) 215-6726 View (253) 215-6726
Photo of Russell E Peters, Counselor in Puyallup, WA
Russell E Peters
Counselor, DMin, MDiv, LMHC
Verified Verified
Puyallup, WA 98373
You have served your community, patients, and faith groups, for many years. The excellent care that you provide you deserve. I have 25 years experience serving first responders, military, and faith group leaders. My focus is on individuals exposed to repetitive traumatic experiences in service focus occupations and faith group leadership. Providing tools to cope with various traumas, I am client centered, trained in EMDR and skilled in experiences that provoke trauma. My therapeutic approach is to journey with clients during dark times and support them as they discover the life they deserve.
You have served your community, patients, and faith groups, for many years. The excellent care that you provide you deserve. I have 25 years experience serving first responders, military, and faith group leaders. My focus is on individuals exposed to repetitive traumatic experiences in service focus occupations and faith group leadership. Providing tools to cope with various traumas, I am client centered, trained in EMDR and skilled in experiences that provoke trauma. My therapeutic approach is to journey with clients during dark times and support them as they discover the life they deserve.
(253) 393-9337 View (253) 393-9337
Photo of Ana-Lisa Davidson, Counselor in Puyallup, WA
Ana-Lisa Davidson
Counselor, LMHCA
Verified Verified
Puyallup, WA 98372
Utilizing Emotion-focused therapy (EFT), we will create an open and honest partnership to improve your mental health and explore who you are and what you would like to achieve. My style of therapy is a collaborative approach between myself and my clients as we strive to reach your goals. I believe counseling provides a safe place for clients to be able to heal and grow. As Humans, we are emotionally bonding creatures, and it is crucial to recognize and support the emotional, physical, and spiritual dimensions of our beings.
Utilizing Emotion-focused therapy (EFT), we will create an open and honest partnership to improve your mental health and explore who you are and what you would like to achieve. My style of therapy is a collaborative approach between myself and my clients as we strive to reach your goals. I believe counseling provides a safe place for clients to be able to heal and grow. As Humans, we are emotionally bonding creatures, and it is crucial to recognize and support the emotional, physical, and spiritual dimensions of our beings.
(253) 563-1883 View (253) 563-1883
Photo of Jay Brooksby, Psychologist in Puyallup, WA
Jay Brooksby
Psychologist, PhD, LP
Verified Verified
2 Endorsed
Puyallup, WA 98375
Therapy Rocks! This is what I was meant to do. I specialize in treating men's trauma, all types of addiction, ADHD, relationships, and career satisfaction. My main tools consist of my own personality, CBT (Cognitive Behavioral Therapy), EMDR (eye movement desensitization and reprocessing), and interpersonal process. I want my clients to know me, know that they have an advocate, and see themselves get traction.
Therapy Rocks! This is what I was meant to do. I specialize in treating men's trauma, all types of addiction, ADHD, relationships, and career satisfaction. My main tools consist of my own personality, CBT (Cognitive Behavioral Therapy), EMDR (eye movement desensitization and reprocessing), and interpersonal process. I want my clients to know me, know that they have an advocate, and see themselves get traction.
(253) 204-2186 View (253) 204-2186
Photo of Nik Conroy, Counselor in Puyallup, WA
Nik Conroy
Counselor, MA, LMHC, CSAT
Verified Verified
4 Endorsed
Puyallup, WA 98371
I specialize in working with clients struggling with porn, sex, and masturbation addiction, chronic infidelity, and OCD. I also have a passion for assisting individuals as they navigate through challenges and doubts regarding their Christian faith. I am currently a Ph.D. student in Clinical Sexology and Behavioral Addictions at the International Institute of Clinical Sexology (IICS). I am also a Certified Sex Addiction Therapist (CSAT) and member of the International Institute for Trauma and Addiction Professionals (IITAP).
I specialize in working with clients struggling with porn, sex, and masturbation addiction, chronic infidelity, and OCD. I also have a passion for assisting individuals as they navigate through challenges and doubts regarding their Christian faith. I am currently a Ph.D. student in Clinical Sexology and Behavioral Addictions at the International Institute of Clinical Sexology (IICS). I am also a Certified Sex Addiction Therapist (CSAT) and member of the International Institute for Trauma and Addiction Professionals (IITAP).
(253) 544-5743 View (253) 544-5743
Photo of The Joy and Wellness Center, Psychologist in Puyallup, WA
The Joy and Wellness Center
Psychologist
Verified Verified
2 Endorsed
Puyallup, WA 98372
Even with the current situation, we are still accepting new clients. However, please email us rather than call. Our goal is to focus on mental wellness. We do this through a variety of treatment methods tailored for your specific needs. Our providers will work with you to determine whether CBT, DBT, Mindfulness, Art therapy, or other treatment methods are best in helping you overcome your current challenges. We’ll work together to develop an action plan to gain the skills and insight that help you get back on track to happiness and success.
Even with the current situation, we are still accepting new clients. However, please email us rather than call. Our goal is to focus on mental wellness. We do this through a variety of treatment methods tailored for your specific needs. Our providers will work with you to determine whether CBT, DBT, Mindfulness, Art therapy, or other treatment methods are best in helping you overcome your current challenges. We’ll work together to develop an action plan to gain the skills and insight that help you get back on track to happiness and success.
(253) 329-5745 View (253) 329-5745
Photo of Live Life Healed, PLLC - Tabitha Kuria, Counselor in Puyallup, WA
Live Life Healed, PLLC - Tabitha Kuria
Counselor, EdS, CMHS, LMHC
Verified Verified
3 Endorsed
Puyallup, WA 98373  (Online Only)
To say that life is hard is an understatement; what a time to be alive and to be human! Life has an interesting way of "just" happening when we least expect it. Everyone has a story or a burden to bear, some heavier than others. Regardless, seeking a therapist midst those things can add another layer of hardness or stress. My goal as your therapist is to help you find healing. Whether I am the right fit or not, you will leave our consultation one or two ways; ready to dive in together and do the work or help with finding the right therapist.
To say that life is hard is an understatement; what a time to be alive and to be human! Life has an interesting way of "just" happening when we least expect it. Everyone has a story or a burden to bear, some heavier than others. Regardless, seeking a therapist midst those things can add another layer of hardness or stress. My goal as your therapist is to help you find healing. Whether I am the right fit or not, you will leave our consultation one or two ways; ready to dive in together and do the work or help with finding the right therapist.
(253) 867-8475 View (253) 867-8475
Photo of Amy E Pruitt, Marriage & Family Therapist in Puyallup, WA
Amy E Pruitt
Marriage & Family Therapist, LMFT
Verified Verified
Puyallup, WA 98373
Would it surprise you to know that nearly every client I have ever worked with has asked me the same question? It's true. "Am I crazy?" I tell them all the same thing: "No. Crazy is a feeling--not a diagnosis. You can feel crazy, act crazy, look crazy, do something crazy--but you cannot BE crazy. Maybe you have been wondering if you are crazy? Or if perhaps you are "losing your mind"? I would like to be the therapist who gets to know you, and helps reassure you that you are not crazy or losing your mind, and to help you feel better in general.
Would it surprise you to know that nearly every client I have ever worked with has asked me the same question? It's true. "Am I crazy?" I tell them all the same thing: "No. Crazy is a feeling--not a diagnosis. You can feel crazy, act crazy, look crazy, do something crazy--but you cannot BE crazy. Maybe you have been wondering if you are crazy? Or if perhaps you are "losing your mind"? I would like to be the therapist who gets to know you, and helps reassure you that you are not crazy or losing your mind, and to help you feel better in general.
(253) 262-0423 View (253) 262-0423
Photo of Andrea Tuliao, Clinical Social Work/Therapist in Puyallup, WA
Andrea Tuliao
Clinical Social Work/Therapist, MS, LICSW
Verified Verified
1 Endorsed
Puyallup, WA 98372
Andrea is experienced working with individuals (adolescents and adults), couples, groups, and families who are navigating: adjustment issues, low self-esteem, family relationships, compassion fatigue, work stressors, relationship conflicts, trauma (sexual, physical, and emotional), suicidal thoughts, grief and loss, substance use stressors, medical diagnoses/health concerns impacting mental health & well-being, and feeling anxious/down/unsure of how you are feeling. As a clinical social worker, she has 13 years of experience in community mental health, primary care settings, teletherapy, and management clinical social worker.
Andrea is experienced working with individuals (adolescents and adults), couples, groups, and families who are navigating: adjustment issues, low self-esteem, family relationships, compassion fatigue, work stressors, relationship conflicts, trauma (sexual, physical, and emotional), suicidal thoughts, grief and loss, substance use stressors, medical diagnoses/health concerns impacting mental health & well-being, and feeling anxious/down/unsure of how you are feeling. As a clinical social worker, she has 13 years of experience in community mental health, primary care settings, teletherapy, and management clinical social worker.
(253) 465-4502 View (253) 465-4502
Photo of Mariah White, Counselor in Puyallup, WA
Mariah White
Counselor, AAC, BS
Verified Verified
1 Endorsed
Puyallup, WA 98372
Not accepting new clients
Hi, I am Mariah and I enjoy working with children and teens, guiding them through the difficult challenges they face. I have a background working as a certified behavior technician with children on the autism spectrum. I believe that each individual has the strength to persevere through the challenges in life. I am here to support and guide you towards your goals in counseling. I use an integrative approach using person centered, cognitive behavioral therapy and other approaches. I specialize in working with individuals with anxiety and depression as well as an array of concerns.
Hi, I am Mariah and I enjoy working with children and teens, guiding them through the difficult challenges they face. I have a background working as a certified behavior technician with children on the autism spectrum. I believe that each individual has the strength to persevere through the challenges in life. I am here to support and guide you towards your goals in counseling. I use an integrative approach using person centered, cognitive behavioral therapy and other approaches. I specialize in working with individuals with anxiety and depression as well as an array of concerns.
(253) 243-0169 View (253) 243-0169
Photo of Erika St Peter, Counselor in Puyallup, WA
Erika St Peter
Counselor, MA, LMHC
Verified Verified
Puyallup, WA 98374  (Online Only)
No longer taking new clients at this time.
No longer taking new clients at this time.
(206) 430-1810 View (206) 430-1810
Photo of Jonathan Clarke Goodman, Counselor in Puyallup, WA
Jonathan Clarke Goodman
Counselor, LMHC, NCC
Verified Verified
1 Endorsed
Puyallup, WA 98373
Not accepting new clients
I am a counselor who has served clients with a wide range of issues from anxiety, depression, personality issues, and trauma for 8 years. Before this, I worked serving individuals with traumatic stress for 6 years as a victim advocate in Pierce County. I'm interested in helping motivated adults and teens who are seeking new coping skills to help themselves rediscover their power to heal and grow.
I am a counselor who has served clients with a wide range of issues from anxiety, depression, personality issues, and trauma for 8 years. Before this, I worked serving individuals with traumatic stress for 6 years as a victim advocate in Pierce County. I'm interested in helping motivated adults and teens who are seeking new coping skills to help themselves rediscover their power to heal and grow.
(253) 242-8605 View (253) 242-8605
Photo of Caren Osborn, Marriage & Family Therapist in Puyallup, WA
Caren Osborn
Marriage & Family Therapist, MA, LMFT
Verified Verified
Puyallup, WA 98373
You can heal by recognizing how important your thoughts and feelings are in navigating this world. We often use our minds to solve everything and sometimes we "solve" ourselves into trouble. We become fragmented when we problem solve without taking the time to tend to our whole self. Use all of you to integrate what has been fragmented by trauma, be it divorce, depression, anxiety, family issues, grief, etc. In a Christian setting I will be guide you to access your thoughts, feelings, and spirituality to help you become more authentically yourself, allowing you to use your strengths and create more peace in your life.
You can heal by recognizing how important your thoughts and feelings are in navigating this world. We often use our minds to solve everything and sometimes we "solve" ourselves into trouble. We become fragmented when we problem solve without taking the time to tend to our whole self. Use all of you to integrate what has been fragmented by trauma, be it divorce, depression, anxiety, family issues, grief, etc. In a Christian setting I will be guide you to access your thoughts, feelings, and spirituality to help you become more authentically yourself, allowing you to use your strengths and create more peace in your life.
(253) 200-6391 View (253) 200-6391
Photo of Emily Vannoy, Marriage & Family Therapist in Puyallup, WA
Emily Vannoy
Marriage & Family Therapist, LMFTA
Verified Verified
Puyallup, WA 98373
Dealing with issues on your own can be difficult. Coming to therapy, creating goals, and making a plan to help achieve them is a rewarding experience that someone doesn't have to do alone. Whether the issue is trauma based or just dealing with everyday life, no goal is too big to achieve.
Dealing with issues on your own can be difficult. Coming to therapy, creating goals, and making a plan to help achieve them is a rewarding experience that someone doesn't have to do alone. Whether the issue is trauma based or just dealing with everyday life, no goal is too big to achieve.
View
Photo of Maloy Morgan Moore, Marriage & Family Therapist Associate in Puyallup, WA
Maloy Morgan Moore
Marriage & Family Therapist Associate, LMFTA
Verified Verified
Puyallup, WA 98372
I acknowledge the larger systems of oppression that disproportionately affect minoritized folks such as people of color, LGBTQ+ people, polyamorous relationships, non-traditional family structures, and anyone else whose existence threatens the capitalist patriarchy in which we exist. My dream is to create a space in therapy where people can bring their whole, authentic selves. Together, we can explore narratives of self, family, and the world that impact your health. My philosophy is that healing cannot happen in isolation, and so I work systemically with families to promote wellness.
I acknowledge the larger systems of oppression that disproportionately affect minoritized folks such as people of color, LGBTQ+ people, polyamorous relationships, non-traditional family structures, and anyone else whose existence threatens the capitalist patriarchy in which we exist. My dream is to create a space in therapy where people can bring their whole, authentic selves. Together, we can explore narratives of self, family, and the world that impact your health. My philosophy is that healing cannot happen in isolation, and so I work systemically with families to promote wellness.
(253) 487-0438 View (253) 487-0438
Photo of Lorien J Newsome, Psychologist in Puyallup, WA
Lorien J Newsome
Psychologist, PhD
Verified Verified
Puyallup, WA 98371
Not accepting new clients
Most people can benefit from counseling at some point in their lives – regarding work, family, relationships, or specific life events. I specialize in working with individuals who are experiencing stress, anxiety, emotional and/or relational issues. Frequently, they have endured traumas. Some of them are grieving losses. Some have managed to closely guard their painful pasts, until recent stressors overcame those barriers, and old feelings and thoughts have crept in. If this sounds like you, I can help.
Most people can benefit from counseling at some point in their lives – regarding work, family, relationships, or specific life events. I specialize in working with individuals who are experiencing stress, anxiety, emotional and/or relational issues. Frequently, they have endured traumas. Some of them are grieving losses. Some have managed to closely guard their painful pasts, until recent stressors overcame those barriers, and old feelings and thoughts have crept in. If this sounds like you, I can help.
(253) 447-6799 View (253) 447-6799
Photo of Laura M Schulz, Counselor in Puyallup, WA
Laura M Schulz
Counselor, PhD, MA, LMHC
Verified Verified
7 Endorsed
Puyallup, WA 98374  (Online Only)
Life can be hard; therapy can help you remove roadblocks & work toward a happier you. Many people have answers to their challenges within them but are blocked by overwhelm & self-doubt. For many, our childhood wasn't perfect. Examining that foundation, deciding what parts of it you want to continue carrying, and what parts you want to let go of can help you toward a calmer and happier life. If you're feeling stressed out or stuck, let's find out what's at the root of those emotions so you can get to a happier & healthier life.
Life can be hard; therapy can help you remove roadblocks & work toward a happier you. Many people have answers to their challenges within them but are blocked by overwhelm & self-doubt. For many, our childhood wasn't perfect. Examining that foundation, deciding what parts of it you want to continue carrying, and what parts you want to let go of can help you toward a calmer and happier life. If you're feeling stressed out or stuck, let's find out what's at the root of those emotions so you can get to a happier & healthier life.
(425) 276-6479 View (425) 276-6479

How does your Therapist compare?

Number of Therapists in Puyallup, WA

200+

Average cost per session

$150

Therapists in Puyallup, WA who prioritize treating:

91% Anxiety
88% Depression
80% Self Esteem
79% Trauma and PTSD
75% Coping Skills
73% Stress
72% Relationship Issues

Average years in practice

9 Years

Top 3 insurances accepted

77% Premera
75% Regence
74% First Choice Health | FCH

How Therapists in Puyallup, WA see their clients

69% In Person and Online
31% Online Only

Gender breakdown

79% Female
20% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Puyallup?

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.