Therapists in Des Moines, IA

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Photo of Ali Simpson, Counselor in Des Moines, IA
Ali Simpson
Counselor, LMHC, MA
Verified Verified
Des Moines, IA 50309
Starting counseling can be overwhelming and can leave you feeling vulnerable. My name is Ali Simpson and I strive to provide a comfortable, nonjudgmental, supportive environment to help you reach your goals. I use a collaborative approach which helps individuals feel comfortable openly sharing their thoughts and feelings. There are no concerns that can be viewed as too big or too small. Counseling is a place for all individuals seeking a more fulfilling life.
Starting counseling can be overwhelming and can leave you feeling vulnerable. My name is Ali Simpson and I strive to provide a comfortable, nonjudgmental, supportive environment to help you reach your goals. I use a collaborative approach which helps individuals feel comfortable openly sharing their thoughts and feelings. There are no concerns that can be viewed as too big or too small. Counseling is a place for all individuals seeking a more fulfilling life.
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Photo of Jamie L. Nelson-Kirby, Marriage & Family Therapist in Des Moines, IA
Jamie L. Nelson-Kirby
Marriage & Family Therapist, MA, LMFT, RYT-500
Verified Verified
1 Endorsed
Des Moines, IA 50312
Not accepting new clients
I strive to help individuals, couples and families work through a variety of issues and facilitate the change they desire. I provide a safe and comfortable environment to explore patterns and relational dynamics, while fostering personal insight and change.
I strive to help individuals, couples and families work through a variety of issues and facilitate the change they desire. I provide a safe and comfortable environment to explore patterns and relational dynamics, while fostering personal insight and change.
(515) 200-1058 View (515) 200-1058
Photo of Megan Jackson, Marriage & Family Therapist in Des Moines, IA
Megan Jackson
Marriage & Family Therapist, MS, LMFT
Verified Verified
Des Moines, IA 50322
Waitlist for new clients
Megan's hope is that therapy will be a safe and non-judgmental space for her clients to engage with their deepest emotions and experience transformational healing and growth. She desires to offer a supportive and peaceful environment for clients to share in a unique and powerful therapeutic relationship. Megan admires any person who chooses to enter the therapy process and hopes to come alongside of her clients in a collaborative process so that they can experience the fullness of what therapy has to offer. Megan is deeply passionate about walking with her clients on their healing journeys.
Megan's hope is that therapy will be a safe and non-judgmental space for her clients to engage with their deepest emotions and experience transformational healing and growth. She desires to offer a supportive and peaceful environment for clients to share in a unique and powerful therapeutic relationship. Megan admires any person who chooses to enter the therapy process and hopes to come alongside of her clients in a collaborative process so that they can experience the fullness of what therapy has to offer. Megan is deeply passionate about walking with her clients on their healing journeys.
(515) 854-3596 View (515) 854-3596
Photo of Ryan McClure, Clinical Social Work/Therapist in Des Moines, IA
Ryan McClure
Clinical Social Work/Therapist, LISW
Verified Verified
1 Endorsed
Des Moines, IA 50310
Waitlist for new clients
I have been providing therapy support within the Des Moines area for over 24 years and the co-founder of the counseling agency Lifeworks Inc. My primary areas of interest include helping individuals overcome challenges with depression, anxiety, social phobias, low self-esteem, anger issues and overall learning how to effectively manage challenging emotions that often present themselves. Typically, I serve clients older than 12 and younger than 99. I love my profession and take pride in assisting and supporting clients that I see each week. Therapy is a good thing. It will surprise you.
I have been providing therapy support within the Des Moines area for over 24 years and the co-founder of the counseling agency Lifeworks Inc. My primary areas of interest include helping individuals overcome challenges with depression, anxiety, social phobias, low self-esteem, anger issues and overall learning how to effectively manage challenging emotions that often present themselves. Typically, I serve clients older than 12 and younger than 99. I love my profession and take pride in assisting and supporting clients that I see each week. Therapy is a good thing. It will surprise you.
(515) 368-8229 View (515) 368-8229
Photo of Ashley Parker, Licensed Master Social Worker in Des Moines, IA
Ashley Parker
Licensed Master Social Worker, LMSW
Verified Verified
3 Endorsed
Des Moines, IA 50309
Let's face it, you've been in survival mode for far too long. You're tired of letting intense emotions and past hurts get in the way of moving forward, and you’re ready to take action to build a life worth living. I can help! I'm passionate about working with clients struggling with anxiety, big life changes, emotional intensity, relational trauma, and self acceptance. I'm a neurodivergent affirming provider with both lived and professional experience and a One Iowa LGBTQ+ inclusive therapist. My goal is to help you discover your own power to learn, heal, and grow from adversity in order to find peace, connection, and purpose.
Let's face it, you've been in survival mode for far too long. You're tired of letting intense emotions and past hurts get in the way of moving forward, and you’re ready to take action to build a life worth living. I can help! I'm passionate about working with clients struggling with anxiety, big life changes, emotional intensity, relational trauma, and self acceptance. I'm a neurodivergent affirming provider with both lived and professional experience and a One Iowa LGBTQ+ inclusive therapist. My goal is to help you discover your own power to learn, heal, and grow from adversity in order to find peace, connection, and purpose.
(515) 303-3392 View (515) 303-3392
Photo of Andrea Vignovich, Counselor in Des Moines, IA
Andrea Vignovich
Counselor, MA, LMHC, RPT
Verified Verified
1 Endorsed
Des Moines, IA 50309
Hello! My name is Andrea Vignovich (she/her) and I am a Licensed Mental Health Counselor (LMHC). An important part of my therapeutic role is to meet you where you are on your journey toward emotional wellness and stability. I believe empathy, empowerment, and connection can help lead you toward your personal goals. In counseling, it is pivotal to create a safe and open space for you to foster growth and learning in yourself and your goals. Seeking counseling can be scary and challenging, however, it can also be rewarding and its effects are long-lasting. I hope to join you on your journey of growth and emotional wellbeing.
Hello! My name is Andrea Vignovich (she/her) and I am a Licensed Mental Health Counselor (LMHC). An important part of my therapeutic role is to meet you where you are on your journey toward emotional wellness and stability. I believe empathy, empowerment, and connection can help lead you toward your personal goals. In counseling, it is pivotal to create a safe and open space for you to foster growth and learning in yourself and your goals. Seeking counseling can be scary and challenging, however, it can also be rewarding and its effects are long-lasting. I hope to join you on your journey of growth and emotional wellbeing.
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Photo of Nancy K Miller, Clinical Social Work/Therapist in Des Moines, IA
Nancy K Miller
Clinical Social Work/Therapist, LMSW
Verified Verified
Des Moines, IA 50322
You’re stronger than you think. My passion for helping others has been fueled by the adversity in my own life and the strength I’ve witnessed in others. Your struggles and concerns are valid, and I want to help you learn to manage them in the healthiest way possible. You’ll be surprised by your own resilience! I enjoy working with young adults and adults who are motivated to find a solution to alleviate their depression, anxiety, ADHD, PTSD, and self-harming behaviors. I have experience working with BPD, substance and pornography issues, betrayal trauma, and general life transitions.
You’re stronger than you think. My passion for helping others has been fueled by the adversity in my own life and the strength I’ve witnessed in others. Your struggles and concerns are valid, and I want to help you learn to manage them in the healthiest way possible. You’ll be surprised by your own resilience! I enjoy working with young adults and adults who are motivated to find a solution to alleviate their depression, anxiety, ADHD, PTSD, and self-harming behaviors. I have experience working with BPD, substance and pornography issues, betrayal trauma, and general life transitions.
(515) 575-2540 View (515) 575-2540
Photo of Matthew Becker, Clinical Social Work/Therapist in Des Moines, IA
Matthew Becker
Clinical Social Work/Therapist, LMSW
Verified Verified
Des Moines, IA 50309
I have worked with individuals and couples for eight years and utilize Cognitive Behavioral Therapy, Motivational Interviewing, and Acceptance and Commitment Therapy. I enjoy helping adults learn new skills to deal with anxiety, codependency, romantic relationships, depression, grief and loss, life transitions, peer relationships, personal growth, low self-esteem, spirituality, stress, trauma & PTSD, and work-life balance.
I have worked with individuals and couples for eight years and utilize Cognitive Behavioral Therapy, Motivational Interviewing, and Acceptance and Commitment Therapy. I enjoy helping adults learn new skills to deal with anxiety, codependency, romantic relationships, depression, grief and loss, life transitions, peer relationships, personal growth, low self-esteem, spirituality, stress, trauma & PTSD, and work-life balance.
(515) 827-2237 View (515) 827-2237
Photo of Nicole Schrader, Clinical Social Work/Therapist in Des Moines, IA
Nicole Schrader
Clinical Social Work/Therapist, MSW, LMSW
Verified Verified
2 Endorsed
Des Moines, IA 50310
Waitlist for new clients
Thank you for taking the first step toward your healing! Walking with clients on the path toward better wellness is truly an honor. My core values are the love of learning, honesty, growth, kindness, and respect, which all show up in my work with clients. I pride myself in co-creating a safe space for clients to be fully seen, heard, and supported. My approach is inclusive, compassionate, direct, innovative, and non-judgmental, with some humor thrown in the mix. With over 16 years of experience in wellness, my philosophy integrates mindfulness, somatics, breathwork, and holistic practices.
Thank you for taking the first step toward your healing! Walking with clients on the path toward better wellness is truly an honor. My core values are the love of learning, honesty, growth, kindness, and respect, which all show up in my work with clients. I pride myself in co-creating a safe space for clients to be fully seen, heard, and supported. My approach is inclusive, compassionate, direct, innovative, and non-judgmental, with some humor thrown in the mix. With over 16 years of experience in wellness, my philosophy integrates mindfulness, somatics, breathwork, and holistic practices.
(515) 972-9048 View (515) 972-9048
Photo of Amy Beth Lapham, Clinical Social Work/Therapist in Des Moines, IA
Amy Beth Lapham
Clinical Social Work/Therapist, LICSW, LISW
Verified Verified
Des Moines, IA 50312
I have been providing therapy for children (age 8 and up), adolescents and adults since 1995 in a variety of therapeutic settings. I have specialize in the area of trauma and other forms of abuse causing emotional distress/ negative impact on many levels of a person and their families life.
I have been providing therapy for children (age 8 and up), adolescents and adults since 1995 in a variety of therapeutic settings. I have specialize in the area of trauma and other forms of abuse causing emotional distress/ negative impact on many levels of a person and their families life.
(218) 451-5035 View (218) 451-5035
Photo of Lauren Wright Therapy, Counselor in Des Moines, IA
Lauren Wright Therapy
Counselor, MS, LMHC
Verified Verified
Des Moines, IA 50324
I support people seeking more meaningful and connected relationships with themselves and others. Experienced in areas of anxiety, depression, developmental/relational trauma, life transitions, academic/career related concerns and interpersonal relationships, I help my clients deepen their understanding of themselves, navigate difficult life experiences and develop helpful strategies in order to lead more fulfilling lives. I assist my clients in learning about how the past informs the present in order to establish a new future for themselves. I welcome you and affirm all your identities.
I support people seeking more meaningful and connected relationships with themselves and others. Experienced in areas of anxiety, depression, developmental/relational trauma, life transitions, academic/career related concerns and interpersonal relationships, I help my clients deepen their understanding of themselves, navigate difficult life experiences and develop helpful strategies in order to lead more fulfilling lives. I assist my clients in learning about how the past informs the present in order to establish a new future for themselves. I welcome you and affirm all your identities.
(515) 523-6379 View (515) 523-6379
Photo of Karla Mracek-Knight, Clinical Social Work/Therapist in Des Moines, IA
Karla Mracek-Knight
Clinical Social Work/Therapist, MSW, LISW, RD
Verified Verified
Des Moines, IA 50309
Not accepting new clients
When someone asks me what I love about being a therapist, my answer is, "Everything." I love meeting new people, understanding their stories, being present for the vulnerable moments and witnessing the hope and change. I provide a warm and inviting space for clients to share their struggles and find their strength. My approach is client-centered, driven by your goals, navigated with compassion and humor.
When someone asks me what I love about being a therapist, my answer is, "Everything." I love meeting new people, understanding their stories, being present for the vulnerable moments and witnessing the hope and change. I provide a warm and inviting space for clients to share their struggles and find their strength. My approach is client-centered, driven by your goals, navigated with compassion and humor.
(515) 575-2053 View (515) 575-2053
Photo of Sean Abramowitz, Counselor in Des Moines, IA
Sean Abramowitz
Counselor, tLMHC
Verified Verified
1 Endorsed
Des Moines, IA 50324
Sean Abramowitz, MA tLMHC is a Licensed Mental Health Counselor working out of Des Moines, Iowa with 12 years of human services experience, and one year of experience as a therapist. He specializes in couples counseling and trauma therapy. Drawing from his training in EMDR, and his experience as a meditation teacher, Sean incorporates somatic and body-based approaches to personal change and transformation, and growth within relationships. Utilizing techniques such as mindfulness and EMDR to help clients understand and reprocess trauma, he advocates for a trauma-informed approach to individual therapy, as well as relationships.
Sean Abramowitz, MA tLMHC is a Licensed Mental Health Counselor working out of Des Moines, Iowa with 12 years of human services experience, and one year of experience as a therapist. He specializes in couples counseling and trauma therapy. Drawing from his training in EMDR, and his experience as a meditation teacher, Sean incorporates somatic and body-based approaches to personal change and transformation, and growth within relationships. Utilizing techniques such as mindfulness and EMDR to help clients understand and reprocess trauma, he advocates for a trauma-informed approach to individual therapy, as well as relationships.
(515) 949-4862 View (515) 949-4862
Photo of Katherine Donahue, Clinical Social Work/Therapist in Des Moines, IA
Katherine Donahue
Clinical Social Work/Therapist, LISW
Verified Verified
Des Moines, IA 50312
Not accepting new clients
Finding a good fit in a therapist is important. If you feel comfortable and at ease in the therapist’s presence, feel understood and affirmed, even “click” interpersonally on some level, you’re building a good foundation for getting what you want out of counseling. By nature, my personality style is welcoming, genuine and straightforward, calming, and supportive. I see the strengths in people and provide a compassionate, affirming presence. I think hope and humor are critically important aspects of therapy and in life.
Finding a good fit in a therapist is important. If you feel comfortable and at ease in the therapist’s presence, feel understood and affirmed, even “click” interpersonally on some level, you’re building a good foundation for getting what you want out of counseling. By nature, my personality style is welcoming, genuine and straightforward, calming, and supportive. I see the strengths in people and provide a compassionate, affirming presence. I think hope and humor are critically important aspects of therapy and in life.
(319) 670-2127 View (319) 670-2127
Photo of Nan King, Counselor in Des Moines, IA
Nan King
Counselor, LMHC, CADC
Verified Verified
Des Moines, IA 50309
I provide a personalized approach tailored to each persons needs to help you attain the personal growth you desire. Most people experience difficulties at some point in their lives. If you are experiencing problems, there is hope. Counseling provides a safe, warm, supportive relationship where you can openly share your thoughts and feelings, find support, and learn new strategies for coping with situations and emotions. My desire is to work with you to develop new patterns in your life that can lead to healthier coping skills, increased confidence, and a greater sense of purpose and meaning in your life.
I provide a personalized approach tailored to each persons needs to help you attain the personal growth you desire. Most people experience difficulties at some point in their lives. If you are experiencing problems, there is hope. Counseling provides a safe, warm, supportive relationship where you can openly share your thoughts and feelings, find support, and learn new strategies for coping with situations and emotions. My desire is to work with you to develop new patterns in your life that can lead to healthier coping skills, increased confidence, and a greater sense of purpose and meaning in your life.
(515) 778-4440 View (515) 778-4440
Photo of Megan Wych, Counselor in Des Moines, IA
Megan Wych
Counselor, MS, LMHC
Verified Verified
1 Endorsed
Des Moines, IA 50309
Do you feel like you've tried everything, and it is just not 'clicking' for whatever reason? Has your child's personality shifted? Do you recognize struggles where there have not been any? Are you uncertain about what to do next and afraid that whatever this is, it might get worse? You might not have the words to describe what's happening, or maybe you're left second-guessing your thoughts, feelings, or purpose.
Do you feel like you've tried everything, and it is just not 'clicking' for whatever reason? Has your child's personality shifted? Do you recognize struggles where there have not been any? Are you uncertain about what to do next and afraid that whatever this is, it might get worse? You might not have the words to describe what's happening, or maybe you're left second-guessing your thoughts, feelings, or purpose.
(515) 303-4119 View (515) 303-4119
Photo of Shelly Stewart-Sandusky, Marriage & Family Therapist in Des Moines, IA
Shelly Stewart-Sandusky
Marriage & Family Therapist, MS, LMFT
Verified Verified
Des Moines, IA 50322
Hello. I am a Licensed Marriage and Family Therapist who works with couples and individuals needing help with relationship issues. I thrive on working with couples struggling with infidelity, rebuilding trust or communication/fair fighting and high conflict. The dynamic of a couple is unique and should be approached as such. I believe that every relationship can work and be healthy for both partners if both partners are willing to do the work and make changes. I am also certifified in treatment of personality disorders and am able to help in both individual and couples dynamics.
Hello. I am a Licensed Marriage and Family Therapist who works with couples and individuals needing help with relationship issues. I thrive on working with couples struggling with infidelity, rebuilding trust or communication/fair fighting and high conflict. The dynamic of a couple is unique and should be approached as such. I believe that every relationship can work and be healthy for both partners if both partners are willing to do the work and make changes. I am also certifified in treatment of personality disorders and am able to help in both individual and couples dynamics.
(515) 346-6974 View (515) 346-6974
Photo of Elijah James Evans, Counselor in Des Moines, IA
Elijah James Evans
Counselor, LMHC, NCC
Verified Verified
1 Endorsed
Des Moines, IA 50322
Waitlist for new clients
I enjoy working with clients who want to improve the way they approach their relationships with themselves, others, or the world. These clients may have recognized their current way of doing things is hurting themselves or others, or they may have simply identified they are not feeling their best. I am passionate about helping people understand and enact more effective patterns of being.
I enjoy working with clients who want to improve the way they approach their relationships with themselves, others, or the world. These clients may have recognized their current way of doing things is hurting themselves or others, or they may have simply identified they are not feeling their best. I am passionate about helping people understand and enact more effective patterns of being.
(515) 209-3680 View (515) 209-3680
Photo of Rena Olsen, Marriage & Family Therapist in Des Moines, IA
Rena Olsen
Marriage & Family Therapist, MA, LMFT-S
Verified Verified
2 Endorsed
Des Moines, IA 50309
Not accepting new clients
I am passionate about coming alongside individuals, families, and couples from all walks of life to work through difficult feelings and life situations. I believe that clients are the experts on themselves, and approaches therapy as a learner and a partner. I strive to work with clients to help them gain new insights and skills to resolve concerns and instill hope for the future. I am willing to work as hard as my clients to help them achieve whatever goals they set for themselves and believe that a positive relationship between therapist and client is key to reaching those goals successfully.
I am passionate about coming alongside individuals, families, and couples from all walks of life to work through difficult feelings and life situations. I believe that clients are the experts on themselves, and approaches therapy as a learner and a partner. I strive to work with clients to help them gain new insights and skills to resolve concerns and instill hope for the future. I am willing to work as hard as my clients to help them achieve whatever goals they set for themselves and believe that a positive relationship between therapist and client is key to reaching those goals successfully.
(515) 454-1319 View (515) 454-1319
Photo of Tonya Jansen, Counselor in Des Moines, IA
Tonya Jansen
Counselor, LMHC
Verified Verified
Des Moines, IA 50312
Not accepting new clients
Provider focused on long-term treatment of Borderline Personality Disorder, Complex PTSD, and PTSD. "You're not stuck. You're just committed to certain patterns of behavior because they helped you in the past. Now those behaviors have become more harmful than helpful. The reason you can't move forward is because you keep applying an old formula to a new level in your life." - Emily Maroutian. Are you stuck in a pattern? Change can be hard, but it starts with empathy for the reasons the patterns developed in the first place.
Provider focused on long-term treatment of Borderline Personality Disorder, Complex PTSD, and PTSD. "You're not stuck. You're just committed to certain patterns of behavior because they helped you in the past. Now those behaviors have become more harmful than helpful. The reason you can't move forward is because you keep applying an old formula to a new level in your life." - Emily Maroutian. Are you stuck in a pattern? Change can be hard, but it starts with empathy for the reasons the patterns developed in the first place.
(515) 729-1710 View (515) 729-1710

How does your Therapist compare?

Number of Therapists in Des Moines, IA

400+

Average cost per session

$155

Therapists in Des Moines, IA who prioritize treating:

95% Anxiety
90% Depression
80% Relationship Issues
80% Self Esteem
77% Stress
76% Trauma and PTSD
72% Coping Skills

Average years in practice

10 Years

Top 3 insurances accepted

84% BlueCross and BlueShield
75% Wellmark BCBS
51% UnitedHealthcare UHC | UBH

How Therapists in Des Moines, IA see their clients

78% In Person and Online
22% Online Only

Gender breakdown

83% Female
16% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Des Moines?

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.