Therapists in Vancouver, WA

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Photo of Trish Carder, Counselor in Vancouver, WA
Trish Carder
Counselor, LMHCA, LICSWA
Verified Verified
1 Endorsed
Vancouver, WA 98662
Currently, I have a limited number of late afternoon/early evening openings for clients seeking either in-person or telehealth appointments. I work with adults, age 18 and over, who have histories of trauma, including physical, sexual, or verbal abuse, and abandonment or neglect, and those going through difficult life transitions, such as divorce or loss of a loved one. Symptoms we address include depression, anxiety, anger, low self-esteem, and feeling disconnected from yourself or others.
Currently, I have a limited number of late afternoon/early evening openings for clients seeking either in-person or telehealth appointments. I work with adults, age 18 and over, who have histories of trauma, including physical, sexual, or verbal abuse, and abandonment or neglect, and those going through difficult life transitions, such as divorce or loss of a loved one. Symptoms we address include depression, anxiety, anger, low self-esteem, and feeling disconnected from yourself or others.
(360) 523-1283 View (360) 523-1283
Photo of Lauren Earle, Counselor in Vancouver, WA
Lauren Earle
Counselor, MA, LMHC, NCC
Verified Verified
4 Endorsed
Vancouver, WA 98684
You may have been dealing with anxious or distressing thoughts and feelings for a while now, but are finally noticing that they are unmanageable. This may look like loops in your thoughts and feelings, reliving past trauma, broken relationships, or feeling like your needs are never met. Rather than participating in life, it may feel like you’re just going through the motions. This can feel hopeless and exhausting. Through safety built on honesty and openness, I will work with you to become attuned to your internal world, identify your values, develop healthy relationships, and heal from past trauma. I am an EMDR trained therapist.
You may have been dealing with anxious or distressing thoughts and feelings for a while now, but are finally noticing that they are unmanageable. This may look like loops in your thoughts and feelings, reliving past trauma, broken relationships, or feeling like your needs are never met. Rather than participating in life, it may feel like you’re just going through the motions. This can feel hopeless and exhausting. Through safety built on honesty and openness, I will work with you to become attuned to your internal world, identify your values, develop healthy relationships, and heal from past trauma. I am an EMDR trained therapist.
(360) 226-7781 View (360) 226-7781
Photo of Nimuë, PLLC - Conscious Collaborative Counseling , Counselor in Vancouver, WA
Nimuë, PLLC - Conscious Collaborative Counseling
Counselor, LMHC
Verified Verified
Vancouver, WA 98662
I am an LGBTQIA+ provider and love working with adults who are ready to dig deep and make healthy changes to live their best lives. Whether you are LGBTQIA+, BIPOC, a Highly Sensitive Person (HSP) or Empath, or label yourself as "outside the box" I am ready to help you see your beautiful strengths and empower you with the tools to help change unhealthy patterns in order to create your best life. Clients that have sought my services have reported that I was helpful in processing their trauma, identifying self-sabotaging behaviors, moving thru grief, re-inventing themselves post divorce or in simply learning how to live in the Now.
I am an LGBTQIA+ provider and love working with adults who are ready to dig deep and make healthy changes to live their best lives. Whether you are LGBTQIA+, BIPOC, a Highly Sensitive Person (HSP) or Empath, or label yourself as "outside the box" I am ready to help you see your beautiful strengths and empower you with the tools to help change unhealthy patterns in order to create your best life. Clients that have sought my services have reported that I was helpful in processing their trauma, identifying self-sabotaging behaviors, moving thru grief, re-inventing themselves post divorce or in simply learning how to live in the Now.
(360) 531-7607 View (360) 531-7607
Photo of Davina Karpstein, Counselor in Vancouver, WA
Davina Karpstein
Counselor, MA, LMHCA
Verified Verified
2 Endorsed
Vancouver, WA 98683
If you are seeking guidance, it takes courage and strength. Whether you are struggling to adjust to a life transition, finding it hard to make changes last, or just ready to face your past, you do not have to find your way alone. Your thoughts, feelings and behaviors may feel overwhelming and impossible to understand or connect but I can work with you to create a space for change and help you find relief from the suffering.
If you are seeking guidance, it takes courage and strength. Whether you are struggling to adjust to a life transition, finding it hard to make changes last, or just ready to face your past, you do not have to find your way alone. Your thoughts, feelings and behaviors may feel overwhelming and impossible to understand or connect but I can work with you to create a space for change and help you find relief from the suffering.
(360) 732-8993 View (360) 732-8993
Photo of Justin S. Schultz, Counselor in Vancouver, WA
Justin S. Schultz
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98661
Are you struggling with feeling overwhelmed, depressed, or anxious with your current situation or recent life transition? Maybe you feel like life is an uphill battle. Well, I am here to help. I am a licensed mental health counselor in Vancouver, Washington. My approach to counseling is to provide you with a safe, nonjudgmental, and comfortable space to explore what you would like your life to look like and how we can get you moving in that direction.
Are you struggling with feeling overwhelmed, depressed, or anxious with your current situation or recent life transition? Maybe you feel like life is an uphill battle. Well, I am here to help. I am a licensed mental health counselor in Vancouver, Washington. My approach to counseling is to provide you with a safe, nonjudgmental, and comfortable space to explore what you would like your life to look like and how we can get you moving in that direction.
(360) 205-9536 View (360) 205-9536
Photo of Preston Brennan, Counselor in Vancouver, WA
Preston Brennan
Counselor, MA, LMHCA
Verified Verified
1 Endorsed
Vancouver, WA 98684
You’ve seen enough videos, listened to enough podcasts, and read enough articles to know what you should do to fix your problems. Yet, you always seem to find yourself back in the same patterns you wanted out of. Whether it’s porn, substance use, procrastination, stress, or anger, you can’t shake the feeling that you're stuck with them. You may have even started to wonder if change is possible. Often, we feel this way because we are so focused on the symptoms, that we cannot address the deeper pain that is causing them.
You’ve seen enough videos, listened to enough podcasts, and read enough articles to know what you should do to fix your problems. Yet, you always seem to find yourself back in the same patterns you wanted out of. Whether it’s porn, substance use, procrastination, stress, or anger, you can’t shake the feeling that you're stuck with them. You may have even started to wonder if change is possible. Often, we feel this way because we are so focused on the symptoms, that we cannot address the deeper pain that is causing them.
(360) 215-5905 View (360) 215-5905
Photo of Christine Yoshida Counseling, Counselor in Vancouver, WA
Christine Yoshida Counseling
Counselor, MS, NCC, LMHC, LPC, NBPT
Verified Verified
1 Endorsed
Vancouver, WA 98685
I help clients who are struggling with disordered eating, eating disorders, chronic dieting, over exercising, orthorexia, poor body image and muscle dysmorphia. Focusing on body respect, intuitive eating and joyful movement!. Whether you are actively struggling with an eating disorder or simply sick and tired of dealing with the stress, anxiety, obsession, depression and annoyance of dieting, I am here to help. I would love the opportunity to work with you and guide you in developing a healthy relationship with food and fitness.
I help clients who are struggling with disordered eating, eating disorders, chronic dieting, over exercising, orthorexia, poor body image and muscle dysmorphia. Focusing on body respect, intuitive eating and joyful movement!. Whether you are actively struggling with an eating disorder or simply sick and tired of dealing with the stress, anxiety, obsession, depression and annoyance of dieting, I am here to help. I would love the opportunity to work with you and guide you in developing a healthy relationship with food and fitness.
(360) 979-1150 View (360) 979-1150
Photo of Hannah Grabhorn, Counselor in Vancouver, WA
Hannah Grabhorn
Counselor, MA, LMHCA
Verified Verified
2 Endorsed
Vancouver, WA 98684
Waitlist for new clients
I enjoy working with people who are ready to make a change, are willing to be curious, an are open to talking about hard things. I work with individuals, couples, teens, and children in a variety of settings. I enjoy working with recovering “people pleasers”, individuals with depression, anxiety, and people seeking ADHD management, and grief counseling. For couples, it is my goal to get you from a cycle of fighting to greater understanding and intimacy.
I enjoy working with people who are ready to make a change, are willing to be curious, an are open to talking about hard things. I work with individuals, couples, teens, and children in a variety of settings. I enjoy working with recovering “people pleasers”, individuals with depression, anxiety, and people seeking ADHD management, and grief counseling. For couples, it is my goal to get you from a cycle of fighting to greater understanding and intimacy.
(360) 634-0389 View (360) 634-0389
Photo of Corrina Lowe, Marriage & Family Therapist in Vancouver, WA
Corrina Lowe
Marriage & Family Therapist, LMFT
Verified Verified
Vancouver, WA 98662
Corrina Lowe has been practicing since 2005. She graduated from California Baptist University with a Masters in Marriage and Family therapy. Corrina believes in the importance of treating the whole person through using an eclectic therapeutic approach that supports the needs of individual person. Her primary areas of focus include ADHD, Autism, and Mood disorders.
Corrina Lowe has been practicing since 2005. She graduated from California Baptist University with a Masters in Marriage and Family therapy. Corrina believes in the importance of treating the whole person through using an eclectic therapeutic approach that supports the needs of individual person. Her primary areas of focus include ADHD, Autism, and Mood disorders.
(360) 226-4853 View (360) 226-4853
Photo of Mandy Miller, Counselor in Vancouver, WA
Mandy Miller
Counselor, MA, LMHC, LPC
Verified Verified
Vancouver, WA 98683  (Online Only)
UPDATE: currently have availability for telehealth sessions! Limited open spots Mondays and Tuesdays! Seeking therapy can be an exciting, scary, and/or overwhelming decision. I am here to help make that decision a positive one of personal empowerment. With respect and compassion, I work to create a comfortable and safe environment in which we can develop a therapeutic alliance and share in the journey of personal growth. Helping each client work through specific life challenges, goals, and transitions is both a privilege and a passion for me and I welcome the opportunity to be a part of your journey!
UPDATE: currently have availability for telehealth sessions! Limited open spots Mondays and Tuesdays! Seeking therapy can be an exciting, scary, and/or overwhelming decision. I am here to help make that decision a positive one of personal empowerment. With respect and compassion, I work to create a comfortable and safe environment in which we can develop a therapeutic alliance and share in the journey of personal growth. Helping each client work through specific life challenges, goals, and transitions is both a privilege and a passion for me and I welcome the opportunity to be a part of your journey!
(360) 492-4933 View (360) 492-4933
Photo of Shannon Manuszewski, Counselor in Vancouver, WA
Shannon Manuszewski
Counselor, MS, NCC, LMHC, LPC
Verified Verified
Vancouver, WA 98686
Not accepting new clients
My approach is to accept you regardless of your religion, race, ethical background, sexual orientation, or gender. This is also what I practice in my personal life. Regardless of what you say or do, I provide the comfort and acceptance for you to express your thoughts and feelings without judgment. I develop a personal plan of focus geared specifically to what you want out of counseling. I also believe by building a strong therapeutic relationship with my client, it allows meaningful and effective therapy - this is the foundation for the healing process.
My approach is to accept you regardless of your religion, race, ethical background, sexual orientation, or gender. This is also what I practice in my personal life. Regardless of what you say or do, I provide the comfort and acceptance for you to express your thoughts and feelings without judgment. I develop a personal plan of focus geared specifically to what you want out of counseling. I also believe by building a strong therapeutic relationship with my client, it allows meaningful and effective therapy - this is the foundation for the healing process.
(210) 361-1255 View (210) 361-1255
Photo of Matthew Beeble, MA, LMHC , Counselor in Vancouver, WA
Matthew Beeble, MA, LMHC
Counselor, MA, LMHC, LPC
Verified Verified
5 Endorsed
Vancouver, WA 98660  (Online Only)
You already have what you need within yourself to experience fulfillment in your life. Unfortunately, there are many internal and external influences that can prevent this resulting in a feeling of falling short of who you should be. This can lead to a sense of being out of balance, feeling stuck and many of the symptoms that bring you to therapy. I believe that the most important task is to make meaning of your life by increasing awareness of your experience resulting in a new understanding and a feeling of peace and of being at home in your skin.
You already have what you need within yourself to experience fulfillment in your life. Unfortunately, there are many internal and external influences that can prevent this resulting in a feeling of falling short of who you should be. This can lead to a sense of being out of balance, feeling stuck and many of the symptoms that bring you to therapy. I believe that the most important task is to make meaning of your life by increasing awareness of your experience resulting in a new understanding and a feeling of peace and of being at home in your skin.
(360) 200-7192 View (360) 200-7192
Photo of Nicole Kennedy, Counselor in Vancouver, WA
Nicole Kennedy
Counselor, LMHC
Verified Verified
Vancouver, WA 98660
Welcome. I'm so glad you're here. If you're seeking therapy, you're likely looking for some sort of change, which requires hope. I believe hope is gritty and requires courage. I believe the magic is found right in that liminal space where we start to open the door to new possibilities. I currently serve adult women-identifying clients in my private practice who desire to work through grief, trauma, anxiety, depression, and relational conflict. Informed by relational psychodynamic theory and existential psychotherapy, my therapeutic orientation is relationship centered.
Welcome. I'm so glad you're here. If you're seeking therapy, you're likely looking for some sort of change, which requires hope. I believe hope is gritty and requires courage. I believe the magic is found right in that liminal space where we start to open the door to new possibilities. I currently serve adult women-identifying clients in my private practice who desire to work through grief, trauma, anxiety, depression, and relational conflict. Informed by relational psychodynamic theory and existential psychotherapy, my therapeutic orientation is relationship centered.
(360) 559-6373 View (360) 559-6373
Photo of Devon Rose Davis, Clinical Social Work/Therapist in Vancouver, WA
Devon Rose Davis
Clinical Social Work/Therapist, MSW, LICSWA
Verified Verified
Vancouver, WA 98682  (Online Only)
Not accepting new clients
I am not currently taking new clients! My clients seek a therapist who is anti-racist, body-positive, kink and identity-affirming. I specialize in working with survivors of abuse, folks with complex trauma, and queer & trans folks. Often the work is around self-awareness, life patterns, identity development, stress responses, self-image, trauma release and around trans identity. I work primarily within the IFS model of therapy, incorporating attachment, and DBT therapies where approproate. I approach the work with an anti-pathologizing, harm-reduction and gate-opening lens. I offer Telehealth only, and I do not take insurance.
I am not currently taking new clients! My clients seek a therapist who is anti-racist, body-positive, kink and identity-affirming. I specialize in working with survivors of abuse, folks with complex trauma, and queer & trans folks. Often the work is around self-awareness, life patterns, identity development, stress responses, self-image, trauma release and around trans identity. I work primarily within the IFS model of therapy, incorporating attachment, and DBT therapies where approproate. I approach the work with an anti-pathologizing, harm-reduction and gate-opening lens. I offer Telehealth only, and I do not take insurance.
Photo of JKD Counseling, LLC Janine DeBacker, LMHC, Counselor in Vancouver, WA
JKD Counseling, LLC Janine DeBacker, LMHC
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98660
Not accepting new clients
Are you stuck? Are your relationships unhealthy? Are you just unhappy with yourself and life? Life is full of challenges and transitions. I'm glad you are wanting to find help and feel better. Much of my work is helping you in 3 areas: developing clarity of what is important to you, recognizing choices that are around you, and finding the courage to move forward.
Are you stuck? Are your relationships unhealthy? Are you just unhappy with yourself and life? Life is full of challenges and transitions. I'm glad you are wanting to find help and feel better. Much of my work is helping you in 3 areas: developing clarity of what is important to you, recognizing choices that are around you, and finding the courage to move forward.
(971) 801-6291 View (971) 801-6291
Photo of Renee Thompson, Counselor in Vancouver, WA
Renee Thompson
Counselor, MA, LMHC, CPC
Verified Verified
6 Endorsed
Vancouver, WA 98683
New Client Openings! Whether you’re at the end of your rope or looking for a tune up, I’m here as a judgment-free, supportive guide to help you on your path to feeling better, faster. I'm trained to work with a wide range of issues including anxiety and depression, parenting concerns, life transitions, grief, job related concerns, or relationship dissatisfaction. I specialize in helping people overcome chronic or traumatic stress and burnout, and those wanting to heal from childhood wounds. By examining not just your behaviors or problems, but the experiences and attachments that formed them, we'll get to the root of your concerns.
New Client Openings! Whether you’re at the end of your rope or looking for a tune up, I’m here as a judgment-free, supportive guide to help you on your path to feeling better, faster. I'm trained to work with a wide range of issues including anxiety and depression, parenting concerns, life transitions, grief, job related concerns, or relationship dissatisfaction. I specialize in helping people overcome chronic or traumatic stress and burnout, and those wanting to heal from childhood wounds. By examining not just your behaviors or problems, but the experiences and attachments that formed them, we'll get to the root of your concerns.
(360) 342-9336 View (360) 342-9336
Photo of Cherry Foultner, Marriage & Family Therapist in Vancouver, WA
Cherry Foultner
Marriage & Family Therapist, LMFT
Verified Verified
1 Endorsed
Vancouver, WA 98662
Pursuing a better self is a challenging journey. At times, you can feel lost and unsure how to break yourself out of the never-ending cycle. Do you often feel weighed down by challenging life situations, relationship difficulties, mental health, or stress? I can help you work on strategies and inner resources that will allow you to address the root cause of your difficulties and find healing.
Pursuing a better self is a challenging journey. At times, you can feel lost and unsure how to break yourself out of the never-ending cycle. Do you often feel weighed down by challenging life situations, relationship difficulties, mental health, or stress? I can help you work on strategies and inner resources that will allow you to address the root cause of your difficulties and find healing.
(360) 860-5303 View (360) 860-5303
Photo of Rachel Storm, Counselor in Vancouver, WA
Rachel Storm
Counselor, MA, LMHCA
Verified Verified
Vancouver, WA 98686
Not accepting new clients
Healing is possible. There have been times in my own life when it felt impossible to experience the life I was meant to live, the joy we are meant to experience, spiritual, mental, emotional, and physical health. If you are there right now, or you feel like you are chained to your past and patterns that keep you from moving forward into hope, peace, and joy, you can overcome. I would love to partner with you on your journey forward.
Healing is possible. There have been times in my own life when it felt impossible to experience the life I was meant to live, the joy we are meant to experience, spiritual, mental, emotional, and physical health. If you are there right now, or you feel like you are chained to your past and patterns that keep you from moving forward into hope, peace, and joy, you can overcome. I would love to partner with you on your journey forward.
(360) 276-9425 View (360) 276-9425
Photo of Meghann Smith, Marriage & Family Therapist in Vancouver, WA
Meghann Smith
Marriage & Family Therapist, MA, LMFT
Verified Verified
Vancouver, WA 98683  (Online Only)
Are you struggling with feeling alone, or having difficulty connecting with others? Do you feel yourself sinking into increasingly negative feelings? Is your family experiencing sudden, new challenges, with no way to successfully navigate them? I can help! I am an empathic, gentle, nerdy therapist that can help you feel more present in the moment, better connected with others, and actually enjoy life! I accept people with an extraordinary amount of compassion, just as they are, without judgment. It's important to me that the process is collaborative, and our sessions will be tailored to fit your specific needs, concerns, and goals.
Are you struggling with feeling alone, or having difficulty connecting with others? Do you feel yourself sinking into increasingly negative feelings? Is your family experiencing sudden, new challenges, with no way to successfully navigate them? I can help! I am an empathic, gentle, nerdy therapist that can help you feel more present in the moment, better connected with others, and actually enjoy life! I accept people with an extraordinary amount of compassion, just as they are, without judgment. It's important to me that the process is collaborative, and our sessions will be tailored to fit your specific needs, concerns, and goals.
(541) 264-5141 View (541) 264-5141
Photo of Kathie Ray-Annis, MSW, P.,S., Inc, Clinical Social Work/Therapist in Vancouver, WA
Kathie Ray-Annis, MSW, P.,S., Inc
Clinical Social Work/Therapist, LICSW, CRT, CMHP
Verified Verified
Vancouver, WA 98662
Do you feel lost and out of control of your life? Making the decision to seek counseling takes courage. If you are reading this then I know that you are a courageous person. I know that you are seeking skills to overcome something in your life that is emotionally painful. Let me help you create a relationship with the life you want.
Do you feel lost and out of control of your life? Making the decision to seek counseling takes courage. If you are reading this then I know that you are a courageous person. I know that you are seeking skills to overcome something in your life that is emotionally painful. Let me help you create a relationship with the life you want.
(360) 663-4491 View (360) 663-4491

How does your Therapist compare?

Number of Therapists in Vancouver, WA

800+

Average cost per session

$150

Therapists in Vancouver, WA who prioritize treating:

93% Anxiety
87% Depression
76% Trauma and PTSD
71% Relationship Issues
69% Self Esteem
68% Stress
67% Grief

Average years in practice

10 Years

Top 3 insurances accepted

71% Aetna
54% Cigna and Evernorth
51% UnitedHealthcare UHC | UBH

How Therapists in Vancouver, WA see their clients

66% In Person and Online
34% Online Only

Gender breakdown

79% Female
19% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Vancouver?

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.