Therapists in San Francisco, CA

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Photo of Minda Streamer, Associate Clinical Social Worker in San Francisco, CA
Minda Streamer
Associate Clinical Social Worker, ACSW
Not Verified Not Verified
San Francisco, CA 94114  (Online Only)
I am an Associate Clinical Social Worker with three years of experience providing individual and group therapy to a wide variety of people through various settings. I earned my Bachelors in American Indian Studies at UCLA and my Masters in Clinical Social Work through a Trauma Responsive program of study at the University of Chicago Crown Family School of Social Work, Policy, and Practice. I am also an enrolled member of the Los Coyotes Band of Cahuilla and Cupeño Indians.
I am an Associate Clinical Social Worker with three years of experience providing individual and group therapy to a wide variety of people through various settings. I earned my Bachelors in American Indian Studies at UCLA and my Masters in Clinical Social Work through a Trauma Responsive program of study at the University of Chicago Crown Family School of Social Work, Policy, and Practice. I am also an enrolled member of the Los Coyotes Band of Cahuilla and Cupeño Indians.
(347) 658-1393 View (347) 658-1393
Photo of www.raquelgarciapsychotherapy.com, Marriage & Family Therapist in San Francisco, CA
www.raquelgarciapsychotherapy.com
Marriage & Family Therapist, LMFT
Verified Verified
4 Endorsed
San Francisco, CA 94109
I offer Individual, Couples and Family Psychotherapy, in English and Spanish. I honor the principles of compassion, openness, acceptance, non judgment, equality for all. I use inquiry and mindfulness of emotions, thoughts and body to welcome and receive what wants to be seen; consider the multigenerational, biological, psychosocial and internal aspects of the human being as a way to better understand ourselves. I use Mindfulness, Attachment Focused therapy, (EFT) Dialectical Behavioral Therapy, Somatics, EMDR, transpersonal modalities. I offer EFT intensives for couples and families, and workshops for couples
I offer Individual, Couples and Family Psychotherapy, in English and Spanish. I honor the principles of compassion, openness, acceptance, non judgment, equality for all. I use inquiry and mindfulness of emotions, thoughts and body to welcome and receive what wants to be seen; consider the multigenerational, biological, psychosocial and internal aspects of the human being as a way to better understand ourselves. I use Mindfulness, Attachment Focused therapy, (EFT) Dialectical Behavioral Therapy, Somatics, EMDR, transpersonal modalities. I offer EFT intensives for couples and families, and workshops for couples
(415) 234-4692 View (415) 234-4692
Photo of Garett Weinstein - Expansive Therapy, Licensed Professional Clinical Counselor in San Francisco, CA
Garett Weinstein - Expansive Therapy
Licensed Professional Clinical Counselor, AMFT
Verified Verified
San Francisco, CA 94110
I believe in the transformative power of genuine connection, acknowledging the unique intersections of each person's journey and creating an affirming environment where diverse identities are celebrated. Together we will navigate the intricacies of relationships, identity, and personal growth in a holistic and affirming manner.
I believe in the transformative power of genuine connection, acknowledging the unique intersections of each person's journey and creating an affirming environment where diverse identities are celebrated. Together we will navigate the intricacies of relationships, identity, and personal growth in a holistic and affirming manner.
(628) 265-3610 View (628) 265-3610
Photo of Daniel Jin Blum, Psychologist in San Francisco, CA
Daniel Jin Blum
Psychologist, PhD, DBSM
Verified Verified
San Francisco, CA 94140  (Online Only)
Having difficulties sleeping? Lacking the energy to perform at your best? As a Stanford trained sleep psychologist and Diplomate in Behavioral Sleep Medicine, I provide evidenced-based treatment for individuals coping with a wide range of concerns including trouble sleeping, anxiety and performance. I am passionate about helping people optimize their physical, mental and emotional health and take a collaborative and practical approach. I am committed to making sure we are a good fit, so please feel free to call me for a complimentary phone consultation.
Having difficulties sleeping? Lacking the energy to perform at your best? As a Stanford trained sleep psychologist and Diplomate in Behavioral Sleep Medicine, I provide evidenced-based treatment for individuals coping with a wide range of concerns including trouble sleeping, anxiety and performance. I am passionate about helping people optimize their physical, mental and emotional health and take a collaborative and practical approach. I am committed to making sure we are a good fit, so please feel free to call me for a complimentary phone consultation.
(415) 801-3612 View (415) 801-3612
Photo of Eliot M. Lev, Associate Clinical Social Worker in San Francisco, CA
Eliot M. Lev
Associate Clinical Social Worker, ACSW, MS
Verified Verified
1 Endorsed
San Francisco, CA 94103  (Online Only)
Waitlist for new clients
In the journey towards healing and self-discovery, finding a therapist who truly understands the intersectionality of your experiences is key. As a therapist and part of the trans, queer, ethnic minority, multicultural, immigrant, trauma survivor, and (dis)ability communities, I'm dedicated to honoring all that makes you - you. The uniqueness of your journey, recognition of your experiences, and collaboration will be at the core of our work.
In the journey towards healing and self-discovery, finding a therapist who truly understands the intersectionality of your experiences is key. As a therapist and part of the trans, queer, ethnic minority, multicultural, immigrant, trauma survivor, and (dis)ability communities, I'm dedicated to honoring all that makes you - you. The uniqueness of your journey, recognition of your experiences, and collaboration will be at the core of our work.
(415) 498-1860 View (415) 498-1860
Photo of J. Marc Wallis, LCSW, Psychotherapy, Clinical Social Work/Therapist in San Francisco, CA
J. Marc Wallis, LCSW, Psychotherapy
Clinical Social Work/Therapist, LCSW, BCD
Verified Verified
San Francisco, CA 94115
My approach is warm, collaborative and effective. With 30 years of clinical experience, I help adults, adolescents, couples and teams address a variety of concerns, including: emotional turmoil, unsatisyfing relationships, and ways you may unwittingly be doing things that get in your own way. The collaborative work of therapy helps people feel more alive, satisfied and engaged in work, relationships and their other pursuits.
My approach is warm, collaborative and effective. With 30 years of clinical experience, I help adults, adolescents, couples and teams address a variety of concerns, including: emotional turmoil, unsatisyfing relationships, and ways you may unwittingly be doing things that get in your own way. The collaborative work of therapy helps people feel more alive, satisfied and engaged in work, relationships and their other pursuits.
(650) 209-7826 View (650) 209-7826
Photo of Rob Nganga, Marriage & Family Therapist in San Francisco, CA
Rob Nganga
Marriage & Family Therapist, LMFT
Verified Verified
San Francisco, CA 94105  (Online Only)
I'm a firm believer in the saying "You know your body best" and will never minimize or deny your pain. I view the therapist-client relationship as a car we are in together. In that car, you are in the driver's seat and you decide where we are going and when we get there. If you want to stop or slow down along the way, that's completely up to you. As your therapist, I'm in the passenger seat with my experience and compassion serving as the GPS. I can help you avoid getting lost or getting stuck, but you are always in control of how fast we move and where we are going.
I'm a firm believer in the saying "You know your body best" and will never minimize or deny your pain. I view the therapist-client relationship as a car we are in together. In that car, you are in the driver's seat and you decide where we are going and when we get there. If you want to stop or slow down along the way, that's completely up to you. As your therapist, I'm in the passenger seat with my experience and compassion serving as the GPS. I can help you avoid getting lost or getting stuck, but you are always in control of how fast we move and where we are going.
(415) 639-5202 View (415) 639-5202
Photo of Leah Eisbart, Psychologist in San Francisco, CA
Leah Eisbart
Psychologist, PsyD
Verified Verified
San Francisco, CA 94118
I work with children, adolescents, and adults seeking support to improve social and emotional well-being and alleviate distress. I support children struggling at home or at school due to academic or environmental stressors, mood and behavioral challenges, attention and concentration difficulties, and those with learning differences. I also provide supportive parent consultation in which we work together towards a better understanding of your child’s experience and behavior to increase social-emotional functioning and academic success.
I work with children, adolescents, and adults seeking support to improve social and emotional well-being and alleviate distress. I support children struggling at home or at school due to academic or environmental stressors, mood and behavioral challenges, attention and concentration difficulties, and those with learning differences. I also provide supportive parent consultation in which we work together towards a better understanding of your child’s experience and behavior to increase social-emotional functioning and academic success.
(628) 203-1132 View (628) 203-1132
Photo of Rachel Claflin, Marriage & Family Therapist Associate in San Francisco, CA
Rachel Claflin
Marriage & Family Therapist Associate, MA, AMFT
Verified Verified
San Francisco, CA 94110  (Online Only)
Do you have a voice in your head constantly telling you that you aren't good enough? Do you feel like you're hiding your true self? Are you struggling with burnout and lack of purpose? Do you isolate to cope with anxiety? Are you longing to change but don't know how? Therapy can help! I am passionate about supporting clients in lessening anxiety, improving self-esteem, establishing boundaries, deepening communication in relationships, and identifying purpose and values to live a more authentic life.
Do you have a voice in your head constantly telling you that you aren't good enough? Do you feel like you're hiding your true self? Are you struggling with burnout and lack of purpose? Do you isolate to cope with anxiety? Are you longing to change but don't know how? Therapy can help! I am passionate about supporting clients in lessening anxiety, improving self-esteem, establishing boundaries, deepening communication in relationships, and identifying purpose and values to live a more authentic life.
(415) 813-6514 View (415) 813-6514
Photo of Dr. Alisha Saxena, Psychologist in San Francisco, CA
Dr. Alisha Saxena
Psychologist, PsyD, MS, MA
Verified Verified
1 Endorsed
San Francisco, CA 94114  (Online Only)
We all have moments of feeling isolated and “stuck.” This can stem from the difference between what your life looks like now and how you would like it to be. The stress of this disconnection can seep into all aspects of your world: socially withdrawing or getting into more arguments can lead to depression and relationship conflict. You might feel like what you do is never “good enough,” increasing anxiety. You might hide your stress by focusing on what you can control, particularly after traumatic events. Therapy can help bring back joy and spontaneity into your life, helping you feel more fulfilled and energized.
We all have moments of feeling isolated and “stuck.” This can stem from the difference between what your life looks like now and how you would like it to be. The stress of this disconnection can seep into all aspects of your world: socially withdrawing or getting into more arguments can lead to depression and relationship conflict. You might feel like what you do is never “good enough,” increasing anxiety. You might hide your stress by focusing on what you can control, particularly after traumatic events. Therapy can help bring back joy and spontaneity into your life, helping you feel more fulfilled and energized.
(415) 449-9588 View (415) 449-9588
Photo of Nicole Therese Muller, Clinical Social Work/Therapist in San Francisco, CA
Nicole Therese Muller
Clinical Social Work/Therapist, LCSW
Verified Verified
San Francisco, CA 94122
Talking with a therapist provides a safe place to talk about painful thoughts, feelings and stressors. You may be feeling sad, angry, anxious or stuck. You may be unable to control negative thoughts, unhealthy behaviors, engaging in unhealthy relationships or repeating destructive patterns. You may be distressed from memories related to traumatic events. It takes courage to talk to another person about these undesirable and distressing parts of your life. I offer a safe space to talk and be listened to. When you are ready, I’d like to help you feel better about yourself, your relationships and your life.
Talking with a therapist provides a safe place to talk about painful thoughts, feelings and stressors. You may be feeling sad, angry, anxious or stuck. You may be unable to control negative thoughts, unhealthy behaviors, engaging in unhealthy relationships or repeating destructive patterns. You may be distressed from memories related to traumatic events. It takes courage to talk to another person about these undesirable and distressing parts of your life. I offer a safe space to talk and be listened to. When you are ready, I’d like to help you feel better about yourself, your relationships and your life.
(415) 592-6500 View (415) 592-6500
Photo of Arlene Bermann, Clinical Social Work/Therapist in San Francisco, CA
Arlene Bermann
Clinical Social Work/Therapist, LCSW
Verified Verified
San Francisco, CA 94114
I think of therapy as like sanctuary - a place where there aren't distractions, where there is an opportunity to pay attention to what is important, in a spirit of kindness. Because of this, many individuals and couples find it to be enjoyable, and very relieving. Of course, since people do therapy to work on painful things, therapy itself isn't always easy. But at least things can be approached thoughtfully and skillfully, in a safe context, and this itself brings great benefits.
I think of therapy as like sanctuary - a place where there aren't distractions, where there is an opportunity to pay attention to what is important, in a spirit of kindness. Because of this, many individuals and couples find it to be enjoyable, and very relieving. Of course, since people do therapy to work on painful things, therapy itself isn't always easy. But at least things can be approached thoughtfully and skillfully, in a safe context, and this itself brings great benefits.
(415) 574-0962 View (415) 574-0962
Photo of Yvonne Guertin, Marriage & Family Therapist in San Francisco, CA
Yvonne Guertin
Marriage & Family Therapist, LMFT, RMBP, SEP
Verified Verified
7 Endorsed
San Francisco, CA 94109
Coming from a holistic, mind-body, humanistic, compassionate perspective, I work with clients who desire to improve the quality of their lives, reducing stress and emotional pain. Clients may suffer from loneliness, depression, low self-esteem, anxiety or loss. They may need help with communication awareness, grounding methods, self-care, sexual fulfillment or life purpose. These conditions are more normal than abnormal, while sometimes feeling overwhelming. I invite clients to listen to and trust their innate wisdom, guiding them to identify and move through the obstacles preventing them from living their life to the fullest.
Coming from a holistic, mind-body, humanistic, compassionate perspective, I work with clients who desire to improve the quality of their lives, reducing stress and emotional pain. Clients may suffer from loneliness, depression, low self-esteem, anxiety or loss. They may need help with communication awareness, grounding methods, self-care, sexual fulfillment or life purpose. These conditions are more normal than abnormal, while sometimes feeling overwhelming. I invite clients to listen to and trust their innate wisdom, guiding them to identify and move through the obstacles preventing them from living their life to the fullest.
(415) 800-4671 View (415) 800-4671
Photo of Dima Dashevsky, Marriage & Family Therapist in San Francisco, CA
Dima Dashevsky
Marriage & Family Therapist, LMFT
Verified Verified
San Francisco, CA 94102  (Online Only)
Starting therapy for the first time or returning after a long break can feel intimidating. You might have even had bad experiences before. I'm here to help. We will go at your pace because your experience is important to me. I believe that lasting change and healing can only happen when our whole selves are seen and welcomed. I provide a safe healing space and bring a strong, grounded presence so that you can begin to cultivate more love and compassion for yourself, connect with your inner wisdom and become more whole and authentic in your relationship with others.
Starting therapy for the first time or returning after a long break can feel intimidating. You might have even had bad experiences before. I'm here to help. We will go at your pace because your experience is important to me. I believe that lasting change and healing can only happen when our whole selves are seen and welcomed. I provide a safe healing space and bring a strong, grounded presence so that you can begin to cultivate more love and compassion for yourself, connect with your inner wisdom and become more whole and authentic in your relationship with others.
(831) 900-4916 View (831) 900-4916
Photo of Unfold Psychology Men's Group, Marriage & Family Therapist Associate in San Francisco, CA
Unfold Psychology Men's Group
Marriage & Family Therapist Associate
Verified Verified
San Francisco, CA 94123
Our men's group provides a supportive space where we gather to understand the unique challenges men face, discussing men's issues openly and constructively.
Our men's group provides a supportive space where we gather to understand the unique challenges men face, discussing men's issues openly and constructively.
(650) 993-9321 View (650) 993-9321
Photo of Justin D'Avella, Psychologist in San Francisco, CA
Justin D'Avella
Psychologist, PsyD
Verified Verified
1 Endorsed
San Francisco, CA 94105  (Online Only)
Are you ready to slow down? To get unstuck? To discover a deeper sense of well-being? Transformational change is possible but healing is not a solo journey. I am passionate about supporting my clients to unlock a more genuine experience of themselves. Together, we will work to cultivate awareness, courage, confidence and steadiness in your life. I work with people who want to find clarity, a sense of aliveness, and to heal from both the bruises and scars that life sometimes creates. I can help you discover a deeper understanding of yourself, your relationships, and your purpose in the world.
Are you ready to slow down? To get unstuck? To discover a deeper sense of well-being? Transformational change is possible but healing is not a solo journey. I am passionate about supporting my clients to unlock a more genuine experience of themselves. Together, we will work to cultivate awareness, courage, confidence and steadiness in your life. I work with people who want to find clarity, a sense of aliveness, and to heal from both the bruises and scars that life sometimes creates. I can help you discover a deeper understanding of yourself, your relationships, and your purpose in the world.
(415) 707-0434 View (415) 707-0434
Photo of Debra Miller, Marriage & Family Therapist in San Francisco, CA
Debra Miller
Marriage & Family Therapist, RN, MFT, LPCC
Verified Verified
2 Endorsed
San Francisco, CA 94115  (Online Only)
"The more aspects of myself I am given the freedom to know and live without reacting to as right or wrong, good or bad, the more I can witness all the elements of who I am and the healthier I am" ---Diane Shainberg. As a psychotherapist, I practice with the belief that therapy can be a rich and vital exploration into understanding the deepest parts of ourselves.The parts we cherish as well as the parts we want to change.
"The more aspects of myself I am given the freedom to know and live without reacting to as right or wrong, good or bad, the more I can witness all the elements of who I am and the healthier I am" ---Diane Shainberg. As a psychotherapist, I practice with the belief that therapy can be a rich and vital exploration into understanding the deepest parts of ourselves.The parts we cherish as well as the parts we want to change.
(415) 347-5972 View (415) 347-5972
Photo of Managing Perfectionism Overwhelm Burnout Trauma Recovery Heather Ayers-Cluff, Clinical Social Work/Therapist in San Francisco, CA
Managing Perfectionism Overwhelm Burnout Trauma Recovery Heather Ayers-Cluff
Clinical Social Work/Therapist, LCSW, PPSC, EMDR
Verified Verified
San Francisco, CA 94102
Hello! I am Heather and I am currently accepting new clients, offering both in-person and telehealth services. Are you overworked, constantly doing things for others, and feeling like there is no time left for YOU? Feeling completely burnt out and exhausted, but finding it hard to fall or stay asleep? Or maybe you're feeling completely alone, like it's you against the world and nobody is looking out for you? I'm here to tell you that you are NOT alone. Contact me for a free 20-minute consultation.
Hello! I am Heather and I am currently accepting new clients, offering both in-person and telehealth services. Are you overworked, constantly doing things for others, and feeling like there is no time left for YOU? Feeling completely burnt out and exhausted, but finding it hard to fall or stay asleep? Or maybe you're feeling completely alone, like it's you against the world and nobody is looking out for you? I'm here to tell you that you are NOT alone. Contact me for a free 20-minute consultation.
(628) 266-2265 View (628) 266-2265
Photo of Lisa Quach, Clinical Social Work/Therapist in San Francisco, CA
Lisa Quach
Clinical Social Work/Therapist
Verified Verified
2 Endorsed
San Francisco, CA 94115  (Online Only)
Welcome to a transformative journey towards healing & self-discovery. I am Lisa, a psychotherapist licensed in CA & NY. My therapeutic toolkit includes CBT, DBT, Emotionally Focused Therapy (EFT), and Eye Movement Desensitization and Reprocessing (EMDR). With a profound commitment to supporting individuals & relationships on their path to mental well-being, I bring forth an integrative, culturally attuned, & compassionate approach. Tailoring evidence-based techniques to suit your unique needs, we collaboratively establish a nurturing therapeutic alliance that fosters healing & personal growth.
Welcome to a transformative journey towards healing & self-discovery. I am Lisa, a psychotherapist licensed in CA & NY. My therapeutic toolkit includes CBT, DBT, Emotionally Focused Therapy (EFT), and Eye Movement Desensitization and Reprocessing (EMDR). With a profound commitment to supporting individuals & relationships on their path to mental well-being, I bring forth an integrative, culturally attuned, & compassionate approach. Tailoring evidence-based techniques to suit your unique needs, we collaboratively establish a nurturing therapeutic alliance that fosters healing & personal growth.
(415) 779-7963 View (415) 779-7963
Photo of Barbara C Maresca, Psychologist in San Francisco, CA
Barbara C Maresca
Psychologist, PsyD
Verified Verified
San Francisco, CA 94103
People come to see me for help with a wide range mental health and relational struggles. I view the difficulties people face not as simply disorders, but as learned behavior that serve important purposes.
People come to see me for help with a wide range mental health and relational struggles. I view the difficulties people face not as simply disorders, but as learned behavior that serve important purposes.
(415) 792-0554 View (415) 792-0554

See more therapy options for San Francisco

How does your Therapist compare?

Number of Therapists in San Francisco, CA

3,000+

Average cost per session

$189

Therapists in San Francisco, CA who prioritize treating:

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

Average years in practice

12 Years

Top 3 insurances accepted

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

How Therapists in San Francisco, CA see their clients

55% In Person and Online
45% Online Only

Gender breakdown

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

How can I find a therapist in San Francisco?

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

Learn more about how to find a therapist

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

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

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

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

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

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

What type of therapy is right for me?

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

How much does therapy cost?

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

What are more affordable or low cost therapy solutions?

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

Is online therapy cheaper than in-person therapy?

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

Is online therapy a good option?

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

Are therapy sessions confidential?

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