Therapists in Germantown, MD

Photo of Christopher Cofone, Clinical Social Work/Therapist, LCSW-C
Christopher Cofone
Clinical Social Work/Therapist, LCSW-C
1 Endorsed
Online Only
Is this a time for a new start? A reset in life? I welcome the change to meet with you and support a new beginning for you . I am friendly and open and welcome the change to understand your needs as well as connecting as people.
Is this a time for a new start? A reset in life? I welcome the change to meet with you and support a new beginning for you . I am friendly and open and welcome the change to understand your needs as well as connecting as people.
(301) 710-6564 x101 View (301) 710-6564 x101
Photo of Nina Anagnostopoulos, Counselor, MA, LCPC
Nina Anagnostopoulos
Counselor, MA, LCPC
8 Endorsed
Online Only
Welcome! I specialize in working with adults who experience persistent anxiety, relationship concerns, trauma, family conflict, multicultural issues, and difficulty around life transitions. More specifically, I support clients with challenges around mood, assertiveness, self-esteem, boundary-setting, “people pleasing”, frequent guilt, neglect, or just not feeling good enough. I work especially well with those who have experienced unhealthy relationship dynamics, such as emotional abuse or manipulation. My background as a first-generation Greek-American has also contributed to my knowledge of and interest in cross-cultural concerns.
Welcome! I specialize in working with adults who experience persistent anxiety, relationship concerns, trauma, family conflict, multicultural issues, and difficulty around life transitions. More specifically, I support clients with challenges around mood, assertiveness, self-esteem, boundary-setting, “people pleasing”, frequent guilt, neglect, or just not feeling good enough. I work especially well with those who have experienced unhealthy relationship dynamics, such as emotional abuse or manipulation. My background as a first-generation Greek-American has also contributed to my knowledge of and interest in cross-cultural concerns.
(301) 321-8787 View (301) 321-8787
Photo of David Wyner, Clinical Social Work/Therapist, LCSW, MA
David Wyner
Clinical Social Work/Therapist, LCSW, MA
Germantown, MD 20876
You don't have to continue feeling overwhelmed by anxiety, depression, relationship or self issues. Effective psychotherapy helps most people deal with these problems and in many cases provides a life altering experience. I have an extensive background treating a wide variety of problems in a safe and congenial atmosphere.
You don't have to continue feeling overwhelmed by anxiety, depression, relationship or self issues. Effective psychotherapy helps most people deal with these problems and in many cases provides a life altering experience. I have an extensive background treating a wide variety of problems in a safe and congenial atmosphere.
(718) 618-5909 View (718) 618-5909
Photo of Marie Deyro, Psychologist, PsyD
Marie Deyro
Psychologist, PsyD
Online Only
I am a licensed clinical psychologist with 20 years of experience within the mental health industry. I am the founder of Empower & Elevate Psychotherapy, a virtual outpatient private practice providing quality mental health care to individuals and families across 43 states. I specialize in the assessment and treatment of pediatric, child, adolescent, and adult populations with symptoms related to autism, ADHD, disruptive behavior, intellectual and developmental disabilities, anxiety, depression, mood dysregulation, stress, life transitions, challenges with identity development, hardship in attachments, and family discord.
I am a licensed clinical psychologist with 20 years of experience within the mental health industry. I am the founder of Empower & Elevate Psychotherapy, a virtual outpatient private practice providing quality mental health care to individuals and families across 43 states. I specialize in the assessment and treatment of pediatric, child, adolescent, and adult populations with symptoms related to autism, ADHD, disruptive behavior, intellectual and developmental disabilities, anxiety, depression, mood dysregulation, stress, life transitions, challenges with identity development, hardship in attachments, and family discord.
(667) 239-8189 View (667) 239-8189
Photo of Lolita Ramsey - Dream Counseling, Counselor, LCPC
Dream Counseling
Counselor, LCPC
Online Only
Living with anxiety, depression, or another mood disorder can cause you to feel crippled or stuck. It seems like you have no control over your life and struggle to manage relationships with your friends, family, and peers. Emotional distress may make it hard to complete simple task and achieve goals. Many times you probably feel misunderstood. Imagine what it would be like to feel understood and to be able to better understand you own emotions, thoughts, and symptoms. You would feel like you are finally being heard and gain confidence in your ability to solve your problems, manage your mood, and overcome past experiences.
Living with anxiety, depression, or another mood disorder can cause you to feel crippled or stuck. It seems like you have no control over your life and struggle to manage relationships with your friends, family, and peers. Emotional distress may make it hard to complete simple task and achieve goals. Many times you probably feel misunderstood. Imagine what it would be like to feel understood and to be able to better understand you own emotions, thoughts, and symptoms. You would feel like you are finally being heard and gain confidence in your ability to solve your problems, manage your mood, and overcome past experiences.
(301) 685-0506 View (301) 685-0506
Photo of Taysue Morris, Licensed Clinical Professional Counselor, LCPC, NCC
Taysue Morris
Licensed Clinical Professional Counselor, LCPC, NCC
Germantown, MD 20874
Currently taking new clients! Welcome to ReNEW You counseling. Do you often feel I holds a unique and diverse lived reality that has allowed her to see value in both painful and joyful life events. I use my various identities and experiences from multiple settings I have worked within to help advocate and serve my clients. I take a holistic approach in therapy, focusing on the whole person. Utilizing this therapeutic modality, I integrate spiritual, physical, mental, and emotional forms of well-being, to help clients develop a deeper understanding of themselves on all these levels.
Currently taking new clients! Welcome to ReNEW You counseling. Do you often feel I holds a unique and diverse lived reality that has allowed her to see value in both painful and joyful life events. I use my various identities and experiences from multiple settings I have worked within to help advocate and serve my clients. I take a holistic approach in therapy, focusing on the whole person. Utilizing this therapeutic modality, I integrate spiritual, physical, mental, and emotional forms of well-being, to help clients develop a deeper understanding of themselves on all these levels.
(240) 213-9431 View (240) 213-9431
Photo of Diana Andrea Gayle, Counselor, LGPC
Diana Andrea Gayle
Counselor, LGPC
Online Only
Life is filled with issues whether it is dealing with past adult or childhood traumas, the loss of a loved one, or battling with anxiety or depression we all need support and guidance with the most difficult of our circumstances. I am a Clinical Mental Health therapist with over 10 years of experience in counseling and crisis/ behavioral interventions to address the diverse needs of my clients. My treatment foundation is in Applied Behavioral Analytic therapy which involves behavioral interventions w/ CBT to use to address the needs of my mental health clients specifically to manage traumas and substance abuse.
Life is filled with issues whether it is dealing with past adult or childhood traumas, the loss of a loved one, or battling with anxiety or depression we all need support and guidance with the most difficult of our circumstances. I am a Clinical Mental Health therapist with over 10 years of experience in counseling and crisis/ behavioral interventions to address the diverse needs of my clients. My treatment foundation is in Applied Behavioral Analytic therapy which involves behavioral interventions w/ CBT to use to address the needs of my mental health clients specifically to manage traumas and substance abuse.
(240) 816-4452 View (240) 816-4452
Photo of Susan Aziz, Licensed Professional Counselor, LCPC
Susan Aziz
Licensed Professional Counselor, LCPC
Online Only
Hi, my name is Susan Aziz! I am a Licensed Professional Clinical Counselor who is passionate about connecting with individuals to support them in identifying and achieving their goals. I work primarily with adults and adolescents experiencing anxiety disorders. This includes generalized anxiety disorders, postpartum anxiety, obsessive compulsive disorder, panic disorder, social anxiety, and more. At the core of my methodology lies a person-centered approach. I am deeply committed to cultivating a robust therapeutic alliance founded on empathy and unwavering support.
Hi, my name is Susan Aziz! I am a Licensed Professional Clinical Counselor who is passionate about connecting with individuals to support them in identifying and achieving their goals. I work primarily with adults and adolescents experiencing anxiety disorders. This includes generalized anxiety disorders, postpartum anxiety, obsessive compulsive disorder, panic disorder, social anxiety, and more. At the core of my methodology lies a person-centered approach. I am deeply committed to cultivating a robust therapeutic alliance founded on empathy and unwavering support.
(240) 414-4328 View (240) 414-4328
Photo of Sara Mitchell, Clinical Social Work/Therapist, LMSW
Sara Mitchell
Clinical Social Work/Therapist, LMSW
Germantown, MD 20874
With my advocacy and social work background, I take a "systems" approach to therapy. So our work together will not just be based on your symptoms or life stressors, but also acknowledging your personal identities, values, and environment. Every client has a different comfort level with conventional talk therapy, so I encourage you to incorporate tools that can help you more comfortably communicate, process, and reflect - your journal entries or art, relevant movie clips or songs, tarot cards, etc. I am an affirming and safe therapist option for clients who identify as disabled, chronically ill, neurodivergent, and/or LGBTQ+.
With my advocacy and social work background, I take a "systems" approach to therapy. So our work together will not just be based on your symptoms or life stressors, but also acknowledging your personal identities, values, and environment. Every client has a different comfort level with conventional talk therapy, so I encourage you to incorporate tools that can help you more comfortably communicate, process, and reflect - your journal entries or art, relevant movie clips or songs, tarot cards, etc. I am an affirming and safe therapist option for clients who identify as disabled, chronically ill, neurodivergent, and/or LGBTQ+.
(240) 262-4217 View (240) 262-4217
Photo of Shannon Barrett, Clinical Social Work/Therapist, LCSW-C
Shannon Barrett
Clinical Social Work/Therapist, LCSW-C
Online Only
Waitlist for new clients
Are you looking for a warm and compassionate teammate to help you navigate a difficult life situation, mental health issue, or painful stressor? If you have reached the point where you realize you can't keep feeling this way, I'm here to listen, help you better define the issue and work with you at your pace to create a solution. I use empathy and humor to help individuals and families recognize their strengths and understand the barriers that may be in the way of change.
Are you looking for a warm and compassionate teammate to help you navigate a difficult life situation, mental health issue, or painful stressor? If you have reached the point where you realize you can't keep feeling this way, I'm here to listen, help you better define the issue and work with you at your pace to create a solution. I use empathy and humor to help individuals and families recognize their strengths and understand the barriers that may be in the way of change.
(301) 970-3804 View (301) 970-3804
Photo of Laurie Mombay, Licensed Clinical Professional Counselor
Laurie Mombay
Licensed Clinical Professional Counselor
Online Only
Hello, I'm Laurie. Have you struggled with making sense of your story and wonder how to move forward with your life as it is today? As a Licensed Clinical Professional Counselor in Maryland with 20 years of experience, I have had the privilege of listening to people's stories with compassion, kindness, and support. I enjoy helping my clients gain understanding into how their past impacts the present and then use that insight to move toward a better future by choosing healthier thoughts, emotions, and behaviors.
Hello, I'm Laurie. Have you struggled with making sense of your story and wonder how to move forward with your life as it is today? As a Licensed Clinical Professional Counselor in Maryland with 20 years of experience, I have had the privilege of listening to people's stories with compassion, kindness, and support. I enjoy helping my clients gain understanding into how their past impacts the present and then use that insight to move toward a better future by choosing healthier thoughts, emotions, and behaviors.
(301) 610-3961 View (301) 610-3961
Photo of Katrina Williams - Insightful Minds Clinical Services, LLC. , Psychologist, PsyD
Insightful Minds Clinical Services, LLC.
Psychologist, PsyD
Online Only
Welcome! I’m Dr. Katrina Williams. Life can feel overwhelming, leaving you frustrated and uncertain about change. It takes courage to face challenges in relationships, career, and finding your path. Using evidence-based approaches, I help you build self-compassion, balance, and empowerment. Together, we’ll create a personalized therapy book—your guide to daily growth and becoming the person you aspire to be. Let’s work together to help you gain clarity, build self-compassion, and take confident steps toward the life you truly desire. Your path to healing and fulfillment starts here.
Welcome! I’m Dr. Katrina Williams. Life can feel overwhelming, leaving you frustrated and uncertain about change. It takes courage to face challenges in relationships, career, and finding your path. Using evidence-based approaches, I help you build self-compassion, balance, and empowerment. Together, we’ll create a personalized therapy book—your guide to daily growth and becoming the person you aspire to be. Let’s work together to help you gain clarity, build self-compassion, and take confident steps toward the life you truly desire. Your path to healing and fulfillment starts here.
(240) 571-3003 View (240) 571-3003
Photo of Katie Bajekal, Clinical Social Work/Therapist, LMSW, MSW
Katie Bajekal
Clinical Social Work/Therapist, LMSW, MSW
Online Only
Every individual has their own unique experiences and reasons for stepping into the therapy room. I am passionate about working with clients to create a supportive therapy environment that works with you to help you achieve your goals. I believe it is important to create a therapy experience that honors your full self and takes your environment—social, physical, and mental—into consideration. I am passionate about working with adolescents, young adults, and adults and have experience working with LGBTQ+ and neurodivergent individuals as well as folks living with anxiety disorders, depression, stress, and HSP.
Every individual has their own unique experiences and reasons for stepping into the therapy room. I am passionate about working with clients to create a supportive therapy environment that works with you to help you achieve your goals. I believe it is important to create a therapy experience that honors your full self and takes your environment—social, physical, and mental—into consideration. I am passionate about working with adolescents, young adults, and adults and have experience working with LGBTQ+ and neurodivergent individuals as well as folks living with anxiety disorders, depression, stress, and HSP.
(240) 908-5928 View (240) 908-5928
Photo of Matthew Elliott Fishleder - Matthew Fishleder, LCMFT, LMFT, Marriage & Family Therapist, MA, LCMFT, LMFT
Matthew Fishleder, LCMFT, LMFT
Marriage & Family Therapist, MA, LCMFT, LMFT
7 Endorsed
Online Only
Life feels overwhelming lately. You’re juggling anxiety, identity questions, relationships, and the nonstop emotional churn of work, family, and being human. Some days you stay steady; some days you lose it; some days you wonder who you’re becoming. I help adults and parents move from autopilot to awareness by slowing down, clarifying what matters, and creating momentum toward a life that feels grounded and real.
Life feels overwhelming lately. You’re juggling anxiety, identity questions, relationships, and the nonstop emotional churn of work, family, and being human. Some days you stay steady; some days you lose it; some days you wonder who you’re becoming. I help adults and parents move from autopilot to awareness by slowing down, clarifying what matters, and creating momentum toward a life that feels grounded and real.
(240) 916-2204 View (240) 916-2204
Photo of Tobi B Goldfus, Clinical Social Work/Therapist, LCSW-C, BCD
Tobi B Goldfus
Clinical Social Work/Therapist, LCSW-C, BCD
Germantown, MD 20876
Are you stuck in unhelpful mind or behavior patterns, difficult times in a relationship or stressed in a way that is affecting all of the above? I believe that we all possess the resources to experience ourselves "new and improved" and move toward being the best that we can be. We know what has worked for us and what hasn't. Finding ways to make lasting changes and experience relief that is tailored to who YOU are, is my commitment to you. It will be an exciting journey into self-discovery, relief of unwanted symptoms and new confidence.
Are you stuck in unhelpful mind or behavior patterns, difficult times in a relationship or stressed in a way that is affecting all of the above? I believe that we all possess the resources to experience ourselves "new and improved" and move toward being the best that we can be. We know what has worked for us and what hasn't. Finding ways to make lasting changes and experience relief that is tailored to who YOU are, is my commitment to you. It will be an exciting journey into self-discovery, relief of unwanted symptoms and new confidence.
(301) 842-4351 View (301) 842-4351
Photo of Adrienne Gardner, Clinical Social Work/Therapist, LCSW -C
Adrienne Gardner
Clinical Social Work/Therapist, LCSW -C
Germantown, MD 20876
Hello all! I’m a mental health professional with over 15 years of experience. I’m from Washington, DC area and graduated from Howard University and The University of Maryland School of Social Work. I gained my experience working in Mental/Behavioral Health with positions with the State of Maryland, the Department of Veterans Affairs, Recovery Centers of America, and the Department of Defense/Department of the Army to name the most impactful. My specialties include treating individuals plagued with issues related to trauma/PTSD, depression, anxiety, and related disorders.
Hello all! I’m a mental health professional with over 15 years of experience. I’m from Washington, DC area and graduated from Howard University and The University of Maryland School of Social Work. I gained my experience working in Mental/Behavioral Health with positions with the State of Maryland, the Department of Veterans Affairs, Recovery Centers of America, and the Department of Defense/Department of the Army to name the most impactful. My specialties include treating individuals plagued with issues related to trauma/PTSD, depression, anxiety, and related disorders.
(240) 820-3863 View (240) 820-3863
Photo of Erica Moran Etter, Psychologist
Erica Moran Etter
Psychologist
Online Only
I offer individual therapy, family therapy, and parent consultations. To treat anxiety and mood disorders, I primarily use Acceptance and Commitment (ACT) and Cognitive Behavioral Therapy (CBT) approaches, incorporating gradual exposure therapy when appropriate. I also have extensive experience utilizing Exposure and Response Prevention (E/RP) to treat obsessive compulsive disorder (OCD) as well as using Trauma-Focused CBT (TF-CBT) to treat post-traumatic stress disorder (PTSD). I integrate elements of family systems, motivational interviewing, and Dialectical Behavior Therapy (DBT) as needed for each client.
I offer individual therapy, family therapy, and parent consultations. To treat anxiety and mood disorders, I primarily use Acceptance and Commitment (ACT) and Cognitive Behavioral Therapy (CBT) approaches, incorporating gradual exposure therapy when appropriate. I also have extensive experience utilizing Exposure and Response Prevention (E/RP) to treat obsessive compulsive disorder (OCD) as well as using Trauma-Focused CBT (TF-CBT) to treat post-traumatic stress disorder (PTSD). I integrate elements of family systems, motivational interviewing, and Dialectical Behavior Therapy (DBT) as needed for each client.
(240) 213-8434 View (240) 213-8434
Photo of Mónica María Grey, Licensed Clinical Professional Counselor, CBT-I
Mónica María Grey
Licensed Clinical Professional Counselor, CBT-I
Online Only
If insomnia or restless nights are taking over your life, I can help. I specialize in treating insomnia and chronic sleep problems using Cognitive Behavioral Therapy for Insomnia (CBT-I), the gold-standard, evidence-based treatment to retrain your mind and body for deeper, more restorative sleep—often in 6–8 weeks.
If insomnia or restless nights are taking over your life, I can help. I specialize in treating insomnia and chronic sleep problems using Cognitive Behavioral Therapy for Insomnia (CBT-I), the gold-standard, evidence-based treatment to retrain your mind and body for deeper, more restorative sleep—often in 6–8 weeks.
(240) 534-1577 View (240) 534-1577
Photo of Carl V Coleman - CVC Consulting, Licensed Clinical Professional Counselor, LCPC
CVC Consulting
Licensed Clinical Professional Counselor, LCPC
6 Endorsed
Germantown, MD 20874
"What's going on? Why is this happening? I feel stuck! I feel angry! Where is my confidence? How hard must this be? What's it all about?" Can you relate to any of these feelings? I believe you are taking steps to greater emotional and mental health just by exploring this site. As a licensed clinical professional counselor and your consultant, we can work together to explore your situation and concerns. Let's evaluate approaches to better manage and help improve your quality of life. Together you and I will establish goals and objectives that move you forward!
"What's going on? Why is this happening? I feel stuck! I feel angry! Where is my confidence? How hard must this be? What's it all about?" Can you relate to any of these feelings? I believe you are taking steps to greater emotional and mental health just by exploring this site. As a licensed clinical professional counselor and your consultant, we can work together to explore your situation and concerns. Let's evaluate approaches to better manage and help improve your quality of life. Together you and I will establish goals and objectives that move you forward!
(240) 442-1587 View (240) 442-1587
Photo of Gabrielle Hadorn, Marriage & Family Therapist, LCMFT
Gabrielle Hadorn
Marriage & Family Therapist, LCMFT
Online Only
Whether you are seeking support through a life transition, needing guidance as you navigate relationships, or looking for relief from depression and anxiety, I am here to provide you with an affirming and empowering therapy experience. I strive to meet each client and family system where they are and to create a therapeutic environment that is best suited to their needs. As your therapist, I will work with you to explore and utilize your own unique strengths to overcome life's challenges.
Whether you are seeking support through a life transition, needing guidance as you navigate relationships, or looking for relief from depression and anxiety, I am here to provide you with an affirming and empowering therapy experience. I strive to meet each client and family system where they are and to create a therapeutic environment that is best suited to their needs. As your therapist, I will work with you to explore and utilize your own unique strengths to overcome life's challenges.
(240) 628-7743 View (240) 628-7743

See more therapy options for Germantown

How does your Therapist compare?

Number of Therapists in Germantown, MD

200+

Average cost per session

$156

Therapists in Germantown, MD who prioritize treating:

93% Anxiety
89% Depression
75% Relationship Issues
75% Self Esteem
71% Coping Skills
69% Stress
64% Trauma and PTSD

Average years in practice

12 Years

Top 3 insurances accepted

79% Cigna and Evernorth
76% BlueCross and BlueShield
75% CareFirst

How Therapists in Germantown, MD see their clients

52% Online Only
48% In Person and Online

Gender breakdown

81% Female
19% Male
FAQs - About Therapy and Counseling

How can I find a therapist in Germantown?

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.