Therapists in Littleton, MA

Photo of Steven Chapin, Psychologist in Littleton, MA
Steven Chapin
Psychologist, PhD
Verified Verified
Littleton, MA 01460
In my work as a therapist, my first priority is to establish a comfortable, respectful working relationship that will allow my clients to begin to focus on the often difficult, painful and complex feelings, issues and situations that have brought them to counseling. My role is to listen carefully and thoughtfully, and to help guide and facilitate discussions that will help my clients to grow and change in beneficial ways, to resolve important conflicts and issues, and to reduce the severity of symptoms such as anxiety, depressed mood and difficulty managing anger.
In my work as a therapist, my first priority is to establish a comfortable, respectful working relationship that will allow my clients to begin to focus on the often difficult, painful and complex feelings, issues and situations that have brought them to counseling. My role is to listen carefully and thoughtfully, and to help guide and facilitate discussions that will help my clients to grow and change in beneficial ways, to resolve important conflicts and issues, and to reduce the severity of symptoms such as anxiety, depressed mood and difficulty managing anger.
(978) 496-3135 View (978) 496-3135
Photo of Shanna R Kraai, Clinical Social Work/Therapist in Littleton, MA
Shanna R Kraai
Clinical Social Work/Therapist, LICSW
Verified Verified
Littleton, MA 01460
Waitlist for new clients
I received my Masters of Social Work from the Graduate School of Social Work at the University of Denver with a clinical specialization in families, high-risk youth, and trauma. I have over 15 years of experience as a social worker, with experience in the areas of research, child welfare, juvenile justice, domestic and international school systems, and private practice therapy and assessment. I am passionate about mental health and aspire to create a climate of empathy, creativity, and understanding with families. I am a skilled clinician who strives to build resilience and adaptability.
I received my Masters of Social Work from the Graduate School of Social Work at the University of Denver with a clinical specialization in families, high-risk youth, and trauma. I have over 15 years of experience as a social worker, with experience in the areas of research, child welfare, juvenile justice, domestic and international school systems, and private practice therapy and assessment. I am passionate about mental health and aspire to create a climate of empathy, creativity, and understanding with families. I am a skilled clinician who strives to build resilience and adaptability.
(978) 295-2967 View (978) 295-2967
Photo of Cheryl Nelson, Counselor in Littleton, MA
Cheryl Nelson
Counselor, MS, LMHC
Verified Verified
Littleton, MA 01460  (Online Only)
Not accepting new clients
Life is difficult and we were not made to go through it alone. Whether this is your first time reaching out or you are seeking a fresh perspective on issues/concerns that have prevented you from living your best life, you are already making a good decision. Some of those concerns may be related to unsatisfactory relationships, and issues related to trauma, anxiety, depression, or life transitions.
Life is difficult and we were not made to go through it alone. Whether this is your first time reaching out or you are seeking a fresh perspective on issues/concerns that have prevented you from living your best life, you are already making a good decision. Some of those concerns may be related to unsatisfactory relationships, and issues related to trauma, anxiety, depression, or life transitions.
(978) 404-8153 View (978) 404-8153
Photo of Julie B. Russell, Clinical Social Work/Therapist in Littleton, MA
Julie B. Russell
Clinical Social Work/Therapist, LICSW
Verified Verified
Littleton, MA 01460
Not accepting new clients
It takes great courage to engage in psychotherapy. I appreciate how intimidating the process of finding and meeting a new therapist can be. I will work with you to establish safety and trust in this therapeutic relationship so that you can learn more about the concerns that trouble you and how to care for them. We will work together to understand the impact of relationships and life events on you. This understanding may then allow you to speak for these experiences in a way that leaves you feeling calmer and more empowered.
It takes great courage to engage in psychotherapy. I appreciate how intimidating the process of finding and meeting a new therapist can be. I will work with you to establish safety and trust in this therapeutic relationship so that you can learn more about the concerns that trouble you and how to care for them. We will work together to understand the impact of relationships and life events on you. This understanding may then allow you to speak for these experiences in a way that leaves you feeling calmer and more empowered.
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Photo of Bonnie Atkin Hellman, Clinical Social Work/Therapist in Littleton, MA
Bonnie Atkin Hellman
Clinical Social Work/Therapist, LICSW, MEd
Verified Verified
Littleton, MA 01460
It is never easy to make that initial phone call even when you are dealing with a personal or relationship problem, managing depression, anxiety, parenting, or going through a divorce. My practical and positive approach has helped many people for over the 25 years. In addition, I like to use humor whenever possible.I have a compassionate and gentle manner, listen carefully to the issues and decide with you, goals for therapy. While I draw on a range of approaches, including cognitive-behavioral, psychodynamic and psycho-educational, it is the strength of the relationship that leads to success in reaching your goals.
It is never easy to make that initial phone call even when you are dealing with a personal or relationship problem, managing depression, anxiety, parenting, or going through a divorce. My practical and positive approach has helped many people for over the 25 years. In addition, I like to use humor whenever possible.I have a compassionate and gentle manner, listen carefully to the issues and decide with you, goals for therapy. While I draw on a range of approaches, including cognitive-behavioral, psychodynamic and psycho-educational, it is the strength of the relationship that leads to success in reaching your goals.
(781) 718-1916 View (781) 718-1916
Photo of James Hannon, Drug & Alcohol Counselor in Littleton, MA
James Hannon
Drug & Alcohol Counselor, PhD, LADC-I
Verified Verified
1 Endorsed
Littleton, MA 01460
Waitlist for new clients
Many of my patients are recovering from addictions of various sorts. Many of them, as well as other patients, have mood disorders (anxiety, depression and bipolar disorder). I also work with individuals and families struggling with problems in work and career, marriage and similar relationships, and what are often described as existential or spiritual crises--the lack of a sense of meaning and purpose in life. I involve families in therapy when possible--people don't live and learn as isolated individuals.
Many of my patients are recovering from addictions of various sorts. Many of them, as well as other patients, have mood disorders (anxiety, depression and bipolar disorder). I also work with individuals and families struggling with problems in work and career, marriage and similar relationships, and what are often described as existential or spiritual crises--the lack of a sense of meaning and purpose in life. I involve families in therapy when possible--people don't live and learn as isolated individuals.
(508) 374-9560 View (508) 374-9560
Photo of Kristin Bornstein, Counselor in Littleton, MA
Kristin Bornstein
Counselor, LMHC
Verified Verified
Littleton, MA 01604
My warmth and compassion helps build a healing environment to support internal growth. I collaborate with clients to be empowered to fulfill their personal goals and live their best life. My use of cognitive behavioral therapy, mindfulness as well as an eclectic approach offers a tailor-fit approach for each person to strategize and resolve challenges and conflict in their life. I offer guidance and support for each person to make empowered choices to create renewal, balance and freedom in life. I offer insight, and a non-judgmental environment to support, and teach skills necessary for growth.
My warmth and compassion helps build a healing environment to support internal growth. I collaborate with clients to be empowered to fulfill their personal goals and live their best life. My use of cognitive behavioral therapy, mindfulness as well as an eclectic approach offers a tailor-fit approach for each person to strategize and resolve challenges and conflict in their life. I offer guidance and support for each person to make empowered choices to create renewal, balance and freedom in life. I offer insight, and a non-judgmental environment to support, and teach skills necessary for growth.
(508) 915-3775 x1 View (508) 915-3775 x1
Photo of Gabrielle Arias, Counselor in Littleton, MA
Gabrielle Arias
Counselor, LMHC, RDT, MA
Verified Verified
Littleton, MA 01460  (Online Only)
Are you an adolescent or adult seeking support for mood, anxiety, or identity struggles? Do you need extra guidance on ways to manage symptoms that are getting in the way of school, work, home, or relationships? Have you been questioning your sexuality, gender, or romantic orientation and are looking for a queer competent provider to help you navigate those complicated dynamics? Are you managing difficult life transitions? If any of this sounds like you or your loved one, know that you're not alone and you've come to the right place!
Are you an adolescent or adult seeking support for mood, anxiety, or identity struggles? Do you need extra guidance on ways to manage symptoms that are getting in the way of school, work, home, or relationships? Have you been questioning your sexuality, gender, or romantic orientation and are looking for a queer competent provider to help you navigate those complicated dynamics? Are you managing difficult life transitions? If any of this sounds like you or your loved one, know that you're not alone and you've come to the right place!
(978) 945-3812 View (978) 945-3812
Photo of Lisa Ann Yoshida, Counselor in Littleton, MA
Lisa Ann Yoshida
Counselor
Verified Verified
1 Endorsed
Littleton, MA 01460  (Online Only)
My background is in both mainstream mental health counseling and alternative healing practices. I specialize in an integrative approach to wellbeing, incorporating both mainstream and alternative modalities and practices.
My background is in both mainstream mental health counseling and alternative healing practices. I specialize in an integrative approach to wellbeing, incorporating both mainstream and alternative modalities and practices.
(978) 464-3446 View (978) 464-3446
Photo of Smita Chaddha, Counselor in Littleton, MA
Smita Chaddha
Counselor, MA, MS, LMHC
Verified Verified
Littleton, MA 01460
I am a Trauma and EMDR specialist/consultant and Mindfulness-based therapist, who will help identify past/current distress, Anxiety & Trauma using EMDR, Sensorimotor Psychotherapy, and Internal Family Systems. My focus is to help change thinking patterns and unhealthy coping techniques based on current research in Neuroscience, Positive Neuroplasticity, DBT and Mindfulness-Based Cognitive Therapy. This helps clients with PTSD, High Anxiety, Phobia, Grief, Depression or Impulsivity. My goal is to increase mindfulness in thought and action, to effectively increase Emotional Regulation, Distress Tolerance & better Communication.
I am a Trauma and EMDR specialist/consultant and Mindfulness-based therapist, who will help identify past/current distress, Anxiety & Trauma using EMDR, Sensorimotor Psychotherapy, and Internal Family Systems. My focus is to help change thinking patterns and unhealthy coping techniques based on current research in Neuroscience, Positive Neuroplasticity, DBT and Mindfulness-Based Cognitive Therapy. This helps clients with PTSD, High Anxiety, Phobia, Grief, Depression or Impulsivity. My goal is to increase mindfulness in thought and action, to effectively increase Emotional Regulation, Distress Tolerance & better Communication.
(978) 808-7269 View (978) 808-7269
Photo of Mona Tye, Clinical Social Work/Therapist in Littleton, MA
Mona Tye
Clinical Social Work/Therapist, LICSW
Verified Verified
Littleton, MA 01460
If you have tried everything to make yourself happy without lasting success, I invite you to work with me in a comfortable, nurturing environment on making the changes you may have been avoiding. You want someone safe to walk the path with you, a Social Worker with more than 25 years of experience in helping clients just like you. Together, we will map out a strategy that fits your lifestyle while we take time to consider your personal struggles. If you have been languishing for too long with depression, stress or anxiety, let me guide you toward understanding and living life more fully.
If you have tried everything to make yourself happy without lasting success, I invite you to work with me in a comfortable, nurturing environment on making the changes you may have been avoiding. You want someone safe to walk the path with you, a Social Worker with more than 25 years of experience in helping clients just like you. Together, we will map out a strategy that fits your lifestyle while we take time to consider your personal struggles. If you have been languishing for too long with depression, stress or anxiety, let me guide you toward understanding and living life more fully.
(978) 319-4179 View (978) 319-4179
Photo of Denise Dellasanta, Counselor in Littleton, MA
Denise Dellasanta
Counselor, LMHC
Verified Verified
Littleton, MA 01460  (Online Only)
Accepting new clients. Hello! I am a Licensed Mental Health Counselor with over 20 years of clinical experience helping adults and adolescents overcome depression, anxiety and trauma. I use evidence based practices that help you overcome negative thoughts and feelings that can impact your ability to enjoy life or sustain fulfilling relationships. I can help you or your teen develop coping skills, build self esteem and feel in control of life again.
Accepting new clients. Hello! I am a Licensed Mental Health Counselor with over 20 years of clinical experience helping adults and adolescents overcome depression, anxiety and trauma. I use evidence based practices that help you overcome negative thoughts and feelings that can impact your ability to enjoy life or sustain fulfilling relationships. I can help you or your teen develop coping skills, build self esteem and feel in control of life again.
(978) 295-2050 View (978) 295-2050
Photo of Michael S. Birnkrant, Counselor in Littleton, MA
Michael S. Birnkrant
Counselor, PsyaD, LMHC
Verified Verified
3 Endorsed
Littleton, MA 01460
Everyone can benefit from better self-understanding. Sometimes our anxiety, depression, and internal conflicts can affect our relationships with others and the world in which we live. By creating a safe environment for expressing thoughts and feelings, I am able to help those who enter into a therapeutic alliance with me improve general satisfaction in interpersonal relationships and life.
Everyone can benefit from better self-understanding. Sometimes our anxiety, depression, and internal conflicts can affect our relationships with others and the world in which we live. By creating a safe environment for expressing thoughts and feelings, I am able to help those who enter into a therapeutic alliance with me improve general satisfaction in interpersonal relationships and life.
(617) 936-8316 View (617) 936-8316
Photo of Caroline Rosa, Clinical Social Work/Therapist in Littleton, MA
Caroline Rosa
Clinical Social Work/Therapist
Verified Verified
Littleton, MA 01460  (Online Only)
Have you been struggling to figure out your next steps? Feeling lost or like your life is “a hot mess”? Struggling to focus on what matters most to you? Feeling as if you can’t figure out who you are and what you want? Are you in the midst of trying to make sense of your career path, identity, friendships and/or romantic relationships? Together, we can work together to better define your values, focus on the things that really matter to you and let go of the rest. I can work with you to help hone and build on your strengths, consider different paths forward, and become more confident and comfortable with yourself.
Have you been struggling to figure out your next steps? Feeling lost or like your life is “a hot mess”? Struggling to focus on what matters most to you? Feeling as if you can’t figure out who you are and what you want? Are you in the midst of trying to make sense of your career path, identity, friendships and/or romantic relationships? Together, we can work together to better define your values, focus on the things that really matter to you and let go of the rest. I can work with you to help hone and build on your strengths, consider different paths forward, and become more confident and comfortable with yourself.
(978) 579-1094 View (978) 579-1094
Photo of Suzanne Dirstine, Clinical Social Work/Therapist in Littleton, MA
Suzanne Dirstine
Clinical Social Work/Therapist, MSW, LICSW
Verified Verified
Littleton, MA 01460
Waitlist for new clients
Welcome. I believe that your experience of the therapeutic relationship should be comfortable and feel secure. I utilize an attachment based approach and believe that once feelings of safety are established in therapy that real changes in thoughts, feelings and relationships are possible. I have a warm and interested style of interacting with others and it is always important to me that you feel heard and valued in our time together. Please don't hesitate to get in touch if you'd like to know more or have any questions.
Welcome. I believe that your experience of the therapeutic relationship should be comfortable and feel secure. I utilize an attachment based approach and believe that once feelings of safety are established in therapy that real changes in thoughts, feelings and relationships are possible. I have a warm and interested style of interacting with others and it is always important to me that you feel heard and valued in our time together. Please don't hesitate to get in touch if you'd like to know more or have any questions.
(978) 598-3355 View (978) 598-3355
Photo of Fred Gerhard, Psychologist in Littleton, MA
Fred Gerhard
Psychologist, PsyD
Verified Verified
Littleton, MA 01460
Online Webcam counseling, or In-Office counseling, my approach to helping people is to clearly understand each person's way of thinking, feeling, understanding, and living - their unique personal psychology - and to tailor an effective method of helping to the individual, their strengths and their needs. Much of my life's enjoyment comes from helping people live happier, more fulfilling lives. In working with me as your counselor or life coach, you can expect someone who listens with a caring and empathic attitude - someone who will provide expert and effective feedback to help you reach your goals for a satisfying and joyful life!
Online Webcam counseling, or In-Office counseling, my approach to helping people is to clearly understand each person's way of thinking, feeling, understanding, and living - their unique personal psychology - and to tailor an effective method of helping to the individual, their strengths and their needs. Much of my life's enjoyment comes from helping people live happier, more fulfilling lives. In working with me as your counselor or life coach, you can expect someone who listens with a caring and empathic attitude - someone who will provide expert and effective feedback to help you reach your goals for a satisfying and joyful life!
(978) 384-0996 View (978) 384-0996
Photo of Ellen Maiman, Clinical Social Work/Therapist in Littleton, MA
Ellen Maiman
Clinical Social Work/Therapist, LICSW
Verified Verified
Littleton, MA 01460
My first priority as your therapist is to provide an environment in which you can speak freely about your concerns while I listen and reflect back to you in a non-judgemental and compassionate way. You may need new coping skills, new perspectives or a way to heal beyond old difficulties that remain unresolved. I will help you clarify what your intentions are and help you to be more compassionate with yourself during the process. One of the goals is to be more content and more at peace with yourself and in your relationships with others.
My first priority as your therapist is to provide an environment in which you can speak freely about your concerns while I listen and reflect back to you in a non-judgemental and compassionate way. You may need new coping skills, new perspectives or a way to heal beyond old difficulties that remain unresolved. I will help you clarify what your intentions are and help you to be more compassionate with yourself during the process. One of the goals is to be more content and more at peace with yourself and in your relationships with others.
(978) 894-1626 View (978) 894-1626
Photo of Christine Musello, Psy.D., Psychologist in Littleton, MA
Christine Musello, Psy.D.
Psychologist, PsyD, MEd
Verified Verified
4 Endorsed
Littleton, MA 01460
Waitlist for new clients
Update November 2020: If you viewed this profile recently, please note that I've moved! In addition, currently most meetings are remote and openings are rare. I currently work with teens, young adults, and adults. Mood disorders, parent guidance, veterans, family relationships, trauma and PTSD are areas of clinical interest. Those who seek to be responsible for their own happiness, whether through acceptance or through efforts to change and grow, are the people I hope to meet.
Update November 2020: If you viewed this profile recently, please note that I've moved! In addition, currently most meetings are remote and openings are rare. I currently work with teens, young adults, and adults. Mood disorders, parent guidance, veterans, family relationships, trauma and PTSD are areas of clinical interest. Those who seek to be responsible for their own happiness, whether through acceptance or through efforts to change and grow, are the people I hope to meet.
(978) 290-4977 View (978) 290-4977
Photo of Laura K Kincaid, Clinical Social Work/Therapist in Littleton, MA
Laura K Kincaid
Clinical Social Work/Therapist, LICSW
Verified Verified
2 Endorsed
Littleton, MA 01460
Not accepting new clients
Finding a therapist that is the right fit can be an overwhelming task. I believe that the connection and comfort level you have with your therapist is essential to success in therapy. I encourage you to ask questions, as we begin working to help you reach your full potential. I have extensive experience working with all age groups, and a specialty in adapting treatment to the needs of children and teens. I am a cognitive behavioral therapist who specializes in dealing with anxiety and traumatic disorders, as well as various other mood, adjustment, attention and family difficulties.
Finding a therapist that is the right fit can be an overwhelming task. I believe that the connection and comfort level you have with your therapist is essential to success in therapy. I encourage you to ask questions, as we begin working to help you reach your full potential. I have extensive experience working with all age groups, and a specialty in adapting treatment to the needs of children and teens. I am a cognitive behavioral therapist who specializes in dealing with anxiety and traumatic disorders, as well as various other mood, adjustment, attention and family difficulties.
(978) 290-4857 View (978) 290-4857
Photo of Hilary Curtis, Counselor in Littleton, MA
Hilary Curtis
Counselor, PhD, LMHC, CCATP, CAIMHP
Verified Verified
2 Endorsed
Littleton, MA 01460
Waitlist for new clients
Co-Founder of Maxant & Curtis Mental Health. Finding a therapist is about the "match" as much as about the skill and experience of the clinician. I find that clients who feel the "match" with my work are looking for a practical dialogue about active problem solving, as well as feelings of trust and connection. The journey to find a matching therapist can be frustrating, and I work with clients to identify that early in the process. In therapy, some of our most difficult thoughts and feelings need a safe and supportive place to be heard, and ensuring that our work will be safe and respectful to your needs is goal number one.
Co-Founder of Maxant & Curtis Mental Health. Finding a therapist is about the "match" as much as about the skill and experience of the clinician. I find that clients who feel the "match" with my work are looking for a practical dialogue about active problem solving, as well as feelings of trust and connection. The journey to find a matching therapist can be frustrating, and I work with clients to identify that early in the process. In therapy, some of our most difficult thoughts and feelings need a safe and supportive place to be heard, and ensuring that our work will be safe and respectful to your needs is goal number one.
(978) 796-5054 View (978) 796-5054

See more therapy options for Littleton

How does your Therapist compare?

Number of Therapists in Littleton, MA

50+

Average cost per session

$150

Therapists in Littleton, MA who prioritize treating:

93% Depression
93% Anxiety
76% Grief
71% Relationship Issues
71% Self Esteem
65% Trauma and PTSD
64% Coping Skills

Average years in practice

20 Years

Top 3 insurances accepted

93% BlueCross and BlueShield
68% Tufts
63% UnitedHealthcare UHC | UBH

How Therapists in Littleton, MA see their clients

73% In Person and Online
27% Online Only

Gender breakdown

86% Female
10% Male
4% Non-Binary

FAQs - About Therapy and Counseling

How can I find a therapist in Littleton?

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.