Therapists in Vancouver, WA

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Photo of Pasternak Counseling, Psychologist in Vancouver, WA
Pasternak Counseling
Psychologist, Alan Pasternak
Verified Verified
Vancouver, WA 98685
As a semiretired Psychologist, I do not have an office and visit my client(s) in their home or office anywhere in Clark county. I am married to a Marriage and Family Therapist and understand the difficulties that couples have even with our level of knowledge. I help each member of the couple rise above the conflict and participate in healing their relationship by encouraging personal responsibility and self-disclosure and by getting in touch with the goodness in each person and the love they are missing.
As a semiretired Psychologist, I do not have an office and visit my client(s) in their home or office anywhere in Clark county. I am married to a Marriage and Family Therapist and understand the difficulties that couples have even with our level of knowledge. I help each member of the couple rise above the conflict and participate in healing their relationship by encouraging personal responsibility and self-disclosure and by getting in touch with the goodness in each person and the love they are missing.
(360) 227-5356 View (360) 227-5356
Photo of Wayne Allen Smith, Clinical Social Work/Therapist in Vancouver, WA
Wayne Allen Smith
Clinical Social Work/Therapist, LCSW, LICSW
Verified Verified
1 Endorsed
Vancouver, WA 98683  (Online Only)
Often times we face struggles and hardship without any support or guidance. Sometimes we suffer through anger, grief and loss, or going through a big life change alone. I specialize in working with issues around trauma, identity, self esteem, depression, anxiety, relationships concerns, and boundary setting.
Often times we face struggles and hardship without any support or guidance. Sometimes we suffer through anger, grief and loss, or going through a big life change alone. I specialize in working with issues around trauma, identity, self esteem, depression, anxiety, relationships concerns, and boundary setting.
(360) 506-6313 View (360) 506-6313
Photo of Rachelle Tau-Stewart, Counselor in Vancouver, WA
Rachelle Tau-Stewart
Counselor, MA, LMHCA
Verified Verified
1 Endorsed
Vancouver, WA 98684
I have a passion to help individuals, children and teens that are struggling with present and past life challenges. Oftentimes we let traumatic experiences and negative thoughts and behaviors shape our lives and how we cope. I believe through empathy, understanding and a warm presence I can help adjust these things hindering life from actively moving forward. Resulting in a client feeling safe and vulnerable enough in the space and process to express oneself and be true to who they are and what they are really feeling.
I have a passion to help individuals, children and teens that are struggling with present and past life challenges. Oftentimes we let traumatic experiences and negative thoughts and behaviors shape our lives and how we cope. I believe through empathy, understanding and a warm presence I can help adjust these things hindering life from actively moving forward. Resulting in a client feeling safe and vulnerable enough in the space and process to express oneself and be true to who they are and what they are really feeling.
(360) 295-9556 View (360) 295-9556
Photo of Allison Chambers-Dixon, Psychologist in Vancouver, WA
Allison Chambers-Dixon
Psychologist, PsyD
Verified Verified
Vancouver, WA 98662
Allison is a licensed psychologist in Oregon and Washington. She has worked in private practice and university counseling settings and has extensive experience assisting adults with trauma reconciliation, disability and chronic illness, grief and loss, multicultural counseling, anxiety, depression, identity exploration, and building healthy and satisfying relationships. In addition, she has experience conducting psychological assessment.
Allison is a licensed psychologist in Oregon and Washington. She has worked in private practice and university counseling settings and has extensive experience assisting adults with trauma reconciliation, disability and chronic illness, grief and loss, multicultural counseling, anxiety, depression, identity exploration, and building healthy and satisfying relationships. In addition, she has experience conducting psychological assessment.
(360) 361-8410 View (360) 361-8410
Photo of Natalie Schwartz, Counselor in Vancouver, WA
Natalie Schwartz
Counselor
Verified Verified
Vancouver, WA 98686
Natalie's education includes a Bachelor of Arts degree in Psychology from Chapman University and a Master of Arts degree in Counseling Psychology from Lewis and Clark College. Her major graduate coursework included Individual, Group and Family Counseling, Lifespan Development, Theories in Counseling and Behavior Change in Children, Treatment and Diagnosis of Mental Health Disorders, Clinical Work in Diverse Populations, Ethical and Legal Issues in Mental Health Counseling, Play Therapy, Sand Tray and Assessment. Natalie has worked in Residential, Therapeutic School, Clinic Based, school and client home settings.
Natalie's education includes a Bachelor of Arts degree in Psychology from Chapman University and a Master of Arts degree in Counseling Psychology from Lewis and Clark College. Her major graduate coursework included Individual, Group and Family Counseling, Lifespan Development, Theories in Counseling and Behavior Change in Children, Treatment and Diagnosis of Mental Health Disorders, Clinical Work in Diverse Populations, Ethical and Legal Issues in Mental Health Counseling, Play Therapy, Sand Tray and Assessment. Natalie has worked in Residential, Therapeutic School, Clinic Based, school and client home settings.
(360) 361-8427 View (360) 361-8427
Photo of Susan (Sue) M Bernt, Clinical Social Work/Therapist in Vancouver, WA
Susan (Sue) M Bernt
Clinical Social Work/Therapist, LICSW, LCSW
Verified Verified
1 Endorsed
Vancouver, WA 98682  (Online Only)
I am telehealth only at this time. I specialize working with adults, teens, and children (6 + ) and their families. Together we can work on relationships, behavior challenges, depression, stress and anxiety problems, self worth, and trauma. I have a great interactive internet based/HIPPA safe video platform to use with children. Play in therapy allows children to communicate and learn to solve problems and change their negative behaviors. I work with adults to assist in processing unexpected life situations. Theories used in treatment: Developmental Psychotherapy, Psychoeducation, Attachment, Person-Centered,
I am telehealth only at this time. I specialize working with adults, teens, and children (6 + ) and their families. Together we can work on relationships, behavior challenges, depression, stress and anxiety problems, self worth, and trauma. I have a great interactive internet based/HIPPA safe video platform to use with children. Play in therapy allows children to communicate and learn to solve problems and change their negative behaviors. I work with adults to assist in processing unexpected life situations. Theories used in treatment: Developmental Psychotherapy, Psychoeducation, Attachment, Person-Centered,
(503) 822-6579 View (503) 822-6579
Photo of Active Path Mental Health, Clinical Social Work/Therapist in Vancouver, WA
Active Path Mental Health
Clinical Social Work/Therapist, LCSW
Verified Verified
Vancouver, WA 98683
Not accepting new clients
Are you looking for a safe space to discuss your mental health? My counseling style is calm and interactive. I believe in treating everyone with respect, sensitivity, individuality, and compassion. I work with clients who experience depression, anxiety, and postpartum. I believe the therapeutic relationship can be a rewarding and remarkable experience. I take great care in the work I do to understand your needs and am honored to witness and walk with you on your journey.
Are you looking for a safe space to discuss your mental health? My counseling style is calm and interactive. I believe in treating everyone with respect, sensitivity, individuality, and compassion. I work with clients who experience depression, anxiety, and postpartum. I believe the therapeutic relationship can be a rewarding and remarkable experience. I take great care in the work I do to understand your needs and am honored to witness and walk with you on your journey.
(360) 564-0822 View (360) 564-0822
Photo of Ashley Grace Gunderson, Counselor in Vancouver, WA
Ashley Grace Gunderson
Counselor, MA, LMHC, LPC
Verified Verified
Vancouver, WA 98660
Welcome. It takes a lot of courage to share your story. One of my goals as a therapist is to create a warm and safe space. Creating a therapeutic alliance based on safety and trust is foundational for change and healing. I stand in openness and empathy towards my clients and encourage compassion and honesty as they look within and work at getting to know themselves and grow their capacity to think about their inner life.
Welcome. It takes a lot of courage to share your story. One of my goals as a therapist is to create a warm and safe space. Creating a therapeutic alliance based on safety and trust is foundational for change and healing. I stand in openness and empathy towards my clients and encourage compassion and honesty as they look within and work at getting to know themselves and grow their capacity to think about their inner life.
(360) 515-4623 View (360) 515-4623
Photo of Rebecca Bradley, Clinical Social Work/Therapist in Vancouver, WA
Rebecca Bradley
Clinical Social Work/Therapist
Verified Verified
Vancouver, WA 98660
Welcome to a therapeutic space where healing is holistic, and the mind-body connection is at the core of transformation. My practice is a sanctuary for those navigating the complexities of life, offering support for a range of challenges including trauma, depression, anxiety, grief, psychosis and existential crisis. In our collaborative journey, I see myself as a partner and guide, empowering you to explore the depths of your own potential for healing. My practice is rooted in the belief that each individual possesses innate ability to heal themselves. Together, we navigate the path towards unlocking the transformative power within
Welcome to a therapeutic space where healing is holistic, and the mind-body connection is at the core of transformation. My practice is a sanctuary for those navigating the complexities of life, offering support for a range of challenges including trauma, depression, anxiety, grief, psychosis and existential crisis. In our collaborative journey, I see myself as a partner and guide, empowering you to explore the depths of your own potential for healing. My practice is rooted in the belief that each individual possesses innate ability to heal themselves. Together, we navigate the path towards unlocking the transformative power within
(360) 938-4293 View (360) 938-4293
Photo of Sara Giza, Clinical Social Work/Therapist in Vancouver, WA
Sara Giza
Clinical Social Work/Therapist, MSW, LSWAIC
Verified Verified
Vancouver, WA 98662  (Online Only)
After receiving my master’s degree in Social Work from the University of Louisville and obtaining a certification on executive leadership strategy for violence and abuse prevention from the University of Pennsylvania, I moved to Vancouver in June 2021. I spent ten years working in various nonprofits and community organizations’ before going to graduate school. My professional background involves working with both teens and adults on their mental health challenges. My areas of expertise include working heavily with trauma, sexual assault, domestic violence, grief, chronic illness and LGBTQ+ issues.
After receiving my master’s degree in Social Work from the University of Louisville and obtaining a certification on executive leadership strategy for violence and abuse prevention from the University of Pennsylvania, I moved to Vancouver in June 2021. I spent ten years working in various nonprofits and community organizations’ before going to graduate school. My professional background involves working with both teens and adults on their mental health challenges. My areas of expertise include working heavily with trauma, sexual assault, domestic violence, grief, chronic illness and LGBTQ+ issues.
(360) 209-7507 View (360) 209-7507
Photo of Cheryl A Hamilton-Jefferson, Counselor in Vancouver, WA
Cheryl A Hamilton-Jefferson
Counselor, MA, QMHP, LMHC
Verified Verified
1 Endorsed
Vancouver, WA 98665
Not accepting new clients
Limited space available. Welcome! Are you feeling weathered by the storms of life? Storms are a great metaphor for life’s adversities, challenges, failures, and disappointments. Storms are something we don’t want to see or experience in our lives or nature. Storms put our faith and ability to survive to the test. We must remind ourselves, within the heart of the storm also lies the transformation.
Limited space available. Welcome! Are you feeling weathered by the storms of life? Storms are a great metaphor for life’s adversities, challenges, failures, and disappointments. Storms are something we don’t want to see or experience in our lives or nature. Storms put our faith and ability to survive to the test. We must remind ourselves, within the heart of the storm also lies the transformation.
(360) 345-3587 View (360) 345-3587
Photo of Jonathan Rabon, Psychologist in Vancouver, WA
Jonathan Rabon
Psychologist, PsyD
Verified Verified
Vancouver, WA 98662
Education/Experience: Jonathan is a licensed Psychologist in the State of Washington. He earned his Bachelor of Arts (BA) in Psychology from the University of Alabama in 2002, Master of Arts (MA) in Clinical Psychology in 2006 and Doctor of Clinical Psychology (PsyD) from George Fox University in Newberg, Oregon. Jonathan has worked with male and female adults and adolescents in the following settings: community mental health centers, college counseling center, mental health court, youth corrections, outpatient private practice, and adult corrections.
Education/Experience: Jonathan is a licensed Psychologist in the State of Washington. He earned his Bachelor of Arts (BA) in Psychology from the University of Alabama in 2002, Master of Arts (MA) in Clinical Psychology in 2006 and Doctor of Clinical Psychology (PsyD) from George Fox University in Newberg, Oregon. Jonathan has worked with male and female adults and adolescents in the following settings: community mental health centers, college counseling center, mental health court, youth corrections, outpatient private practice, and adult corrections.
(360) 938-4216 View (360) 938-4216
Photo of Sophia Claudson, Pre-Licensed Professional in Vancouver, WA
Sophia Claudson
Pre-Licensed Professional
Verified Verified
2 Endorsed
Vancouver, WA 98684
Are you struggling to cope with the transitions you are facing? Do you have difficulty connecting in your relationships? Do you find yourself unable to heal from loss? Life is often a series of gains and losses that can be difficult to navigate. I am passionate about coming alongside clients as they seek emotional, mental, relational and spiritual wellness. My goal is to provide a safe, therapeutic space where my clients feel seen and heard. I am convinced that clients are the experts in their own lives. I want to help you understand yourself better, and help you achieve your goals in a way that works the best for you!
Are you struggling to cope with the transitions you are facing? Do you have difficulty connecting in your relationships? Do you find yourself unable to heal from loss? Life is often a series of gains and losses that can be difficult to navigate. I am passionate about coming alongside clients as they seek emotional, mental, relational and spiritual wellness. My goal is to provide a safe, therapeutic space where my clients feel seen and heard. I am convinced that clients are the experts in their own lives. I want to help you understand yourself better, and help you achieve your goals in a way that works the best for you!
(360) 347-2136 View (360) 347-2136
Photo of Northwest Telemental Health, Counselor in Vancouver, WA
Northwest Telemental Health
Counselor, LMHC, LPC
Verified Verified
Vancouver, WA 98660
I see life as a series of journeys, some you choose, some are chosen for you. Some journeys are gifts, full of lushness and beauty and pass by too quickly, others try us and appear as barren landscapes - trips that seem like they'll never end. The gift of counseling is you get a fresh perspective on what is happening around you. I see my job as preparing you for the ride by offering a tune up when you need one and adding your toolbox so that the trip is as smooth and enjoyable as possible. The trip can be beautiful and it can be bumpy but by working together we'll get you to where you want to be.
I see life as a series of journeys, some you choose, some are chosen for you. Some journeys are gifts, full of lushness and beauty and pass by too quickly, others try us and appear as barren landscapes - trips that seem like they'll never end. The gift of counseling is you get a fresh perspective on what is happening around you. I see my job as preparing you for the ride by offering a tune up when you need one and adding your toolbox so that the trip is as smooth and enjoyable as possible. The trip can be beautiful and it can be bumpy but by working together we'll get you to where you want to be.
(360) 230-7941 View (360) 230-7941
Photo of LaVonna Kofstad, Mental Health Counselor in Vancouver, WA
LaVonna Kofstad
Mental Health Counselor
Verified Verified
Vancouver, WA 98686
I have a Master of Education degree in Counseling from Heritage University with advance courses in Multicultural counseling, Counseling Theory, Testing and Evaluation, Group counseling, Ethics, Research, Developmental counseling and Mental Health Community Services. I also have an undergraduate degree in Psychology from the University of Oregon (Go ducks! ) I have served a wide range of clients of diverse populations from various backgrounds, ethnicities and cultures.
I have a Master of Education degree in Counseling from Heritage University with advance courses in Multicultural counseling, Counseling Theory, Testing and Evaluation, Group counseling, Ethics, Research, Developmental counseling and Mental Health Community Services. I also have an undergraduate degree in Psychology from the University of Oregon (Go ducks! ) I have served a wide range of clients of diverse populations from various backgrounds, ethnicities and cultures.
(360) 345-3289 View (360) 345-3289
Photo of Lacey Kelley, Counselor in Vancouver, WA
Lacey Kelley
Counselor, M Ed, LMHCA, NBCC
Verified Verified
Vancouver, WA 98662
I believe counseling is more than just for tough times; it's a key tool for building strength and feeling good overall. Whether you're dealing with feeling sad, anxious, or struggling in relationships, I'm here to help. We'll work together to find solutions and make you feel better.
I believe counseling is more than just for tough times; it's a key tool for building strength and feeling good overall. Whether you're dealing with feeling sad, anxious, or struggling in relationships, I'm here to help. We'll work together to find solutions and make you feel better.
(360) 997-5592 x1 View (360) 997-5592 x1
Photo of Terry Turner James, Counselor in Vancouver, WA
Terry Turner James
Counselor, LMHC
Verified Verified
Vancouver, WA 98662  (Online Only)
Navigating through life's ever-changing landscape can be a complex journey, often marked by waves of anxiety, shades of depression, and the challenges of adjustment disorder. These experiences, though unique, share a common thread: they reflect our response to the world around us and the transitions we face. In my practice, I focus on understanding these emotional landscapes, creating a supportive space where you can explore and process these feelings. We'll work together to acknowledge the impact of life's shifts and the emotions they stir, fostering resilience and a deeper understanding of your personal journey.
Navigating through life's ever-changing landscape can be a complex journey, often marked by waves of anxiety, shades of depression, and the challenges of adjustment disorder. These experiences, though unique, share a common thread: they reflect our response to the world around us and the transitions we face. In my practice, I focus on understanding these emotional landscapes, creating a supportive space where you can explore and process these feelings. We'll work together to acknowledge the impact of life's shifts and the emotions they stir, fostering resilience and a deeper understanding of your personal journey.
(360) 262-1911 View (360) 262-1911
Photo of Nancy Warren, MA LMHC, Counselor in Vancouver, WA
Nancy Warren, MA LMHC
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98660
For the past 25 years, I have worked with individuals with a wide range of concerns including anxiety, depression, grief and bereavement, post traumatic stress disorder (PTSD), sleep difficulties, troubled relationships, marital distress, chronic illness, and life transitions. My practice currently focuses on working with clients who have been diagnosed with Parkinson’s disease and other neurological disorders. I also see patients with cancer across the cancer continuum, from diagnosis, treatment, to survivorship or recurrence and end of life. I am passionate about working with both of these patient groups.
For the past 25 years, I have worked with individuals with a wide range of concerns including anxiety, depression, grief and bereavement, post traumatic stress disorder (PTSD), sleep difficulties, troubled relationships, marital distress, chronic illness, and life transitions. My practice currently focuses on working with clients who have been diagnosed with Parkinson’s disease and other neurological disorders. I also see patients with cancer across the cancer continuum, from diagnosis, treatment, to survivorship or recurrence and end of life. I am passionate about working with both of these patient groups.
(360) 680-1693 View (360) 680-1693
Photo of Macdonald Dunbar, Marriage & Family Therapist in Vancouver, WA
Macdonald Dunbar
Marriage & Family Therapist, LMFT
Verified Verified
Vancouver, WA 98686
When working individually, Mac offers strength based humanistic therapy drawing from theoretical orientations including cognitive behavioral therapy, solution focus brief therapy, motivational interviewing, and narrative therapy. This approach is implemented in support of those experiencing anxiety, depression, trauma responses, loss and grief, and other symptoms. Family therapy is grounded in family system theory addressing various forms of conflict and stabilizing family dynamics as family members move through various life cycle challenges.
When working individually, Mac offers strength based humanistic therapy drawing from theoretical orientations including cognitive behavioral therapy, solution focus brief therapy, motivational interviewing, and narrative therapy. This approach is implemented in support of those experiencing anxiety, depression, trauma responses, loss and grief, and other symptoms. Family therapy is grounded in family system theory addressing various forms of conflict and stabilizing family dynamics as family members move through various life cycle challenges.
(360) 361-8381 View (360) 361-8381
Photo of Jessalyn Jackson, Counselor in Vancouver, WA
Jessalyn Jackson
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98660  (Online Only)
I have a special interest in helping you discover what is truly possible for yourself and your life. Maybe you've found yourself in a cycle that you can't seem to get out of, missing out on what makes your life truly vital. I work closely with individuals who are struggling with life transitions, work-related stress, relationship issues, depression and anxiety. My goal is to walk alongside you as you reflect and make connections that propel your life forward in the direction that you want while gaining the tools to sustain it.
I have a special interest in helping you discover what is truly possible for yourself and your life. Maybe you've found yourself in a cycle that you can't seem to get out of, missing out on what makes your life truly vital. I work closely with individuals who are struggling with life transitions, work-related stress, relationship issues, depression and anxiety. My goal is to walk alongside you as you reflect and make connections that propel your life forward in the direction that you want while gaining the tools to sustain it.
(206) 752-4354 View (206) 752-4354

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.