Therapists in Belle Fourche, SD

Photo of Jeri Fowler - Spruce Canyon Wellness, PLLC, Pre-Licensed Professional, MS, Pre-LPC, NCC
Spruce Canyon Wellness, PLLC
Pre-Licensed Professional, MS, Pre-LPC, NCC
Serves Area
I am Jeri Fowler with Spruce Canyon Wellness. Seeking therapy requires courage, and I understand the importance of finding a therapist you can trust. My approach is grounded in honesty, transparency, and a commitment to the clients wellbeing.
I am Jeri Fowler with Spruce Canyon Wellness. Seeking therapy requires courage, and I understand the importance of finding a therapist you can trust. My approach is grounded in honesty, transparency, and a commitment to the clients wellbeing.
(605) 467-8042 View (605) 467-8042
Photo of Jessica L Ruzicka - Enso Mental Health, LLC, Licensed Professional Counselor, MS, LPC-MH, QMHP, NCC
Enso Mental Health, LLC
Licensed Professional Counselor, MS, LPC-MH, QMHP, NCC
3 Endorsed
Serves Area
I'm Jessica Ruzicka at Ensō Mental Health. I value a diverse set of skills & believe being authentic & vulnerable can lead to the foundation within the therapeutic relationship. My approach to therapy is within the person-centered & humanistic approach, viewing the whole person, within their uniqueness, growth, & capabilities. I have worked extensively with families, children & adolescents within my career & seek out the importance of the child-parent relationship. Play therapy is a passion & set of skills I value while working with children & families. Focusing within Perinatal & Postpartum Mental Health is also a passion of mine.
I'm Jessica Ruzicka at Ensō Mental Health. I value a diverse set of skills & believe being authentic & vulnerable can lead to the foundation within the therapeutic relationship. My approach to therapy is within the person-centered & humanistic approach, viewing the whole person, within their uniqueness, growth, & capabilities. I have worked extensively with families, children & adolescents within my career & seek out the importance of the child-parent relationship. Play therapy is a passion & set of skills I value while working with children & families. Focusing within Perinatal & Postpartum Mental Health is also a passion of mine.
(605) 570-5094 View (605) 570-5094
Photo of David G May, Marriage & Family Therapist Associate, MFT
David G May
Marriage & Family Therapist Associate, MFT
Serves Area
It is time for you to spread your wings and fly. Children, teen, adult, couple, or family, my proven, unique, modern approach works through unresolved emotions of past relationships that affect who we are, the decisions we make, behaviors we have, reactions we have, relationships we seek and even relationships we avoid that keep us from being who we want to be. If you have been through other therapies or learning coping skills that no longer work, or are new and want to get to the root of healing, this is the place for you.
It is time for you to spread your wings and fly. Children, teen, adult, couple, or family, my proven, unique, modern approach works through unresolved emotions of past relationships that affect who we are, the decisions we make, behaviors we have, reactions we have, relationships we seek and even relationships we avoid that keep us from being who we want to be. If you have been through other therapies or learning coping skills that no longer work, or are new and want to get to the root of healing, this is the place for you.
(605) 580-7358 View (605) 580-7358
Photo of Tracy Candace Hunt, Licensed Professional Counselor, LPC, MH
Tracy Candace Hunt
Licensed Professional Counselor, LPC, MH
2 Endorsed
Serves Area
I believe in a holistic, person-centered approach to wellness, one that honors the complexity of each individual and takes into account the full spectrum of who you are—physical, mental, emotional, and spiritual. In my work, I strive to create a safe, collaborative space where we can explore your experiences and challenges together, tailoring strategies that evolve as you do. Every person is unique, and I’m committed to an approach that’s as individualized as you are. I strive to help clients achieve their goals and heal from issues that may be interfering with personal growth and fulfilling relationships with themselves and others
I believe in a holistic, person-centered approach to wellness, one that honors the complexity of each individual and takes into account the full spectrum of who you are—physical, mental, emotional, and spiritual. In my work, I strive to create a safe, collaborative space where we can explore your experiences and challenges together, tailoring strategies that evolve as you do. Every person is unique, and I’m committed to an approach that’s as individualized as you are. I strive to help clients achieve their goals and heal from issues that may be interfering with personal growth and fulfilling relationships with themselves and others
(605) 847-7145 View (605) 847-7145
Photo of Ashley Siebrasse - Enso Mental Health, LLC, Licensed Professional Counselor, MS, NCC, LPC-
Enso Mental Health, LLC
Licensed Professional Counselor, MS, NCC, LPC-
2 Endorsed
Serves Area
I'm Ashley Siebrasse at Ensō Mental Health, and I value a holistic approach to counseling and will consider all aspects of a person in our work together. I am committed to providing a safe and judgment free space to reflect and grow through all of life’s experiences.
I'm Ashley Siebrasse at Ensō Mental Health, and I value a holistic approach to counseling and will consider all aspects of a person in our work together. I am committed to providing a safe and judgment free space to reflect and grow through all of life’s experiences.
(605) 633-5079 View (605) 633-5079
Photo of Rachel Pettersen, Licensed Professional Counselor, LPC-MH, QMHP, LPC
Rachel Pettersen
Licensed Professional Counselor, LPC-MH, QMHP, LPC
1 Endorsed
Serves Area
Life is full of changes and challenges, some of which result in experiences with depression, anxiety, and grief. Other times, life just gets a little out of focus and off balance, leaving us feeling lost and unsure about where we're at and where we're headed. Getting support with these experiences can help to find our way back to a path that has us healing, meeting our goals, and feeling excited about our future again. As a therapist, I truly feel it's a privilege to help others find that path.
Life is full of changes and challenges, some of which result in experiences with depression, anxiety, and grief. Other times, life just gets a little out of focus and off balance, leaving us feeling lost and unsure about where we're at and where we're headed. Getting support with these experiences can help to find our way back to a path that has us healing, meeting our goals, and feeling excited about our future again. As a therapist, I truly feel it's a privilege to help others find that path.
(605) 316-5421 View (605) 316-5421
Photo of Julie Marie Birner - Addiction Recovery Centers of the Black Hills, Clinical Social Work/Therapist, LCSW, PIP, LAC
Addiction Recovery Centers of the Black Hills
Clinical Social Work/Therapist, LCSW, PIP, LAC
Serves Area
Have you been struggling with trauma and or substance use problems past or current in your life and find yourself stuck? We can help with sorting out these issues and give you tools to be able to live life to your fullest potential. I am trained in Motivational Interviewing, Cognitive Behavioral Therapy, and Accelerated Resolution Therapy (ART). ART is a technique that helps to restore mental health by changing the way distressing memories and images are stored in the brain. If we can change the images, we can eliminate the symptoms. It is just that simple.
Have you been struggling with trauma and or substance use problems past or current in your life and find yourself stuck? We can help with sorting out these issues and give you tools to be able to live life to your fullest potential. I am trained in Motivational Interviewing, Cognitive Behavioral Therapy, and Accelerated Resolution Therapy (ART). ART is a technique that helps to restore mental health by changing the way distressing memories and images are stored in the brain. If we can change the images, we can eliminate the symptoms. It is just that simple.
(605) 827-1273 View (605) 827-1273
Photo of Shannon Maxwell - Black Hills Psychology, Psychologist, PhD, CNP, LCSW
Black Hills Psychology
Psychologist, PhD, CNP, LCSW
Serves Area
Black Hills Psychology was formed to provide a comprehensive range of behavioral health services within one group practice. As a team of experienced and licensed psychologists, therapists, and medication providers, we offer a wide range of specialties and approaches to care for individuals of all ages. At Black Hills Psychology, you can be rest assured that you will be provided with the best care possible by a professional who is skilled to help you with the specific issues you are seeking to address. Each professional at our clinic has completed training and gained additional practical experience in their own areas of expertise.
Black Hills Psychology was formed to provide a comprehensive range of behavioral health services within one group practice. As a team of experienced and licensed psychologists, therapists, and medication providers, we offer a wide range of specialties and approaches to care for individuals of all ages. At Black Hills Psychology, you can be rest assured that you will be provided with the best care possible by a professional who is skilled to help you with the specific issues you are seeking to address. Each professional at our clinic has completed training and gained additional practical experience in their own areas of expertise.
(605) 657-4971 View (605) 657-4971
Photo of Patricia Aurand, Clinical Social Work/Therapist, CSW-PIP, MSW, MDiv
Patricia Aurand
Clinical Social Work/Therapist, CSW-PIP, MSW, MDiv
Serves Area
The word "therapist" has Greek origins that describe an individual who tends to the needs of others and assists in healing. When I imagine my ideal client, I imagine a person who is seeking a partner on their healing journey - one who is ready to be in the driver's seat with me serving as their GPS. My ideal client is willing to choose their destination (aka "goal") and provide feedback along the way to ensure that satisfactory progress is made. My favorite part of therapy is when a client is able to recognize their own healing and progress and announces they've reached their destination.
The word "therapist" has Greek origins that describe an individual who tends to the needs of others and assists in healing. When I imagine my ideal client, I imagine a person who is seeking a partner on their healing journey - one who is ready to be in the driver's seat with me serving as their GPS. My ideal client is willing to choose their destination (aka "goal") and provide feedback along the way to ensure that satisfactory progress is made. My favorite part of therapy is when a client is able to recognize their own healing and progress and announces they've reached their destination.
(605) 349-1694 View (605) 349-1694
Photo of Michele M Clodfelder, Licensed Professional Counselor, MS, LPC-MH, EAP
Michele M Clodfelder
Licensed Professional Counselor, MS, LPC-MH, EAP
1 Endorsed
Serves Area
I get it, being overwhelmed, worried about everything and just plain tired of life is an issue we will experience at some point in our lives. I can help. Anxiety pushing you to do more - then you realize no matter what you do it's not enough. I can help. Every phase of our life means we are relearning the same lesson, different situation. I can help. Feeling stuck and not seeing any way out of a situation can be paralyzing. I can help. Grief true deep grief, not understanding how to move through it. I can help. ANGER all the time, easily irritated? I can help. Give me a chance I can help.
I get it, being overwhelmed, worried about everything and just plain tired of life is an issue we will experience at some point in our lives. I can help. Anxiety pushing you to do more - then you realize no matter what you do it's not enough. I can help. Every phase of our life means we are relearning the same lesson, different situation. I can help. Feeling stuck and not seeing any way out of a situation can be paralyzing. I can help. Grief true deep grief, not understanding how to move through it. I can help. ANGER all the time, easily irritated? I can help. Give me a chance I can help.
(605) 534-8669 View (605) 534-8669

More Therapists Nearby

Photo of Autumne Good, Licensed Professional Counselor, MA, LPC-MH, NCC
Autumne Good
Licensed Professional Counselor, MA, LPC-MH, NCC
2 Endorsed
Spearfish, SD 57783
As a therapist, my goal is to assist you in finding the courage and direction to take the next steps in accomplishing the desired changes you want for your life. Change takes time and can be very difficult, especially without direction or a starting point. My role as your therapist is to assist you in finding a starting place, help you understand where you are on your journey, teach life skills, and encourage you to persevere to achieve the changes you desire in your life, within your family, and/or your relationships with others. I'm also part of All-Terrain Behavior Health Group. If I'm not available, a colleague may be.
As a therapist, my goal is to assist you in finding the courage and direction to take the next steps in accomplishing the desired changes you want for your life. Change takes time and can be very difficult, especially without direction or a starting point. My role as your therapist is to assist you in finding a starting place, help you understand where you are on your journey, teach life skills, and encourage you to persevere to achieve the changes you desire in your life, within your family, and/or your relationships with others. I'm also part of All-Terrain Behavior Health Group. If I'm not available, a colleague may be.
(605) 316-3691 View (605) 316-3691
Photo of Austin Nachtigall - Austin Nachtigall - Yellow Brick Road Counseling, Pre-Licensed Professional, MS, NCC
Austin Nachtigall - Yellow Brick Road Counseling
Pre-Licensed Professional, MS, NCC
1 Endorsed
Serves Area
Welcome to a space where your journey to understanding and improving your mental well-being takes the next step. I’m Austin, a dedicated mental health professional committed to assisting individuals in living up to their fullest potential. I specialize in helping individuals navigate stress, cultivate resilience, and achieve personal growth. Whether you’re grappling with anxiety, a major life challenge, relationship issues, or self-esteem concerns, my approach is rooted in empathy, respect, and collaboration.
Welcome to a space where your journey to understanding and improving your mental well-being takes the next step. I’m Austin, a dedicated mental health professional committed to assisting individuals in living up to their fullest potential. I specialize in helping individuals navigate stress, cultivate resilience, and achieve personal growth. Whether you’re grappling with anxiety, a major life challenge, relationship issues, or self-esteem concerns, my approach is rooted in empathy, respect, and collaboration.
(605) 627-8721 View (605) 627-8721
Photo of Norma Pansch - U Rock Counseling Services, Licensed Professional Counselor, MA, LPC-MH
U Rock Counseling Services
Licensed Professional Counselor, MA, LPC-MH
Serves Area
Not accepting new clients
Hi, my name is Norma, welcome to U Rock Counseling. I work with individuals ages 22-adulthood and specialize in trauma, grief, loss, loneliness, depression, anxiety, and issues unique to your stage of life. You will learn to connect to that joy that's been missing and feel the passion you once had. Your voice will not only be heard but also respected by me in a nonjudgmental and safe environment of empathy.
Hi, my name is Norma, welcome to U Rock Counseling. I work with individuals ages 22-adulthood and specialize in trauma, grief, loss, loneliness, depression, anxiety, and issues unique to your stage of life. You will learn to connect to that joy that's been missing and feel the passion you once had. Your voice will not only be heard but also respected by me in a nonjudgmental and safe environment of empathy.
(605) 349-2975 View (605) 349-2975
Photo of Kerri D Kinzell - Make It Happen Counseling, LLC, Clinical Social Work/Therapist, MSW, CSW-PIP, QMHP
Make It Happen Counseling, LLC
Clinical Social Work/Therapist, MSW, CSW-PIP, QMHP
Sturgis, SD 57785
I have been a social worker for 30 years. The basis of our profession is to start where the client is. No matter what the issue we can start the process together. I've also said that relating to my clients and establishing a therapeutic relationship is more important than anything else I know. I have a wide range of skills, am approachable and easy to talk with about anything. My passion is working with others who want to improve their life circumstances. I can offer support, guidance and another perspective in what you can control to make the necessary changes. I am strength based and build on what you already have going well.
I have been a social worker for 30 years. The basis of our profession is to start where the client is. No matter what the issue we can start the process together. I've also said that relating to my clients and establishing a therapeutic relationship is more important than anything else I know. I have a wide range of skills, am approachable and easy to talk with about anything. My passion is working with others who want to improve their life circumstances. I can offer support, guidance and another perspective in what you can control to make the necessary changes. I am strength based and build on what you already have going well.
(605) 307-5798 View (605) 307-5798
Photo of Dave Jetson, Licensed Professional Counselor, LCP-MH, LCPC
Dave Jetson
Licensed Professional Counselor, LCP-MH, LCPC
Serves Area
You feel stuck—dissatisfied, anxious, or lonely. Life’s challenges, like trauma, infidelity, depression, loneliness or grief, have left you overwhelmed and disconnected from your emotional truths. Denying these truths might feel safer, but it only deepens the struggle. You want to feel peace, rebuild trust in yourself and others, and find joy again. By reconnecting with your true emotions, you can uncover meaning, strengthen relationships, and create a life filled with purpose and authenticity. The journey starts with valuing yourself enough to take that first step.
You feel stuck—dissatisfied, anxious, or lonely. Life’s challenges, like trauma, infidelity, depression, loneliness or grief, have left you overwhelmed and disconnected from your emotional truths. Denying these truths might feel safer, but it only deepens the struggle. You want to feel peace, rebuild trust in yourself and others, and find joy again. By reconnecting with your true emotions, you can uncover meaning, strengthen relationships, and create a life filled with purpose and authenticity. The journey starts with valuing yourself enough to take that first step.
(605) 937-7636 View (605) 937-7636
Photo of Sarah M Johnson, Marriage & Family Therapist, MA, LMFT, CCTP
Sarah M Johnson
Marriage & Family Therapist, MA, LMFT, CCTP
1 Endorsed
Spearfish, SD 57783
Now accepting new clients. We are unhappy in our lives today because we have wounds from the past that have been left unhealed. These wounds generate from our basic needs not being met in childhood, abuse, loss of any kind (death of a loved one/friend, job, house, security, relationship, etc.), an unexpected accident, or any other traumas life may throw at you. These unhealed wounds are “jabbing” at you today through maladaptive and numbing behaviors, physical reactions, and emotional reactions.
Now accepting new clients. We are unhappy in our lives today because we have wounds from the past that have been left unhealed. These wounds generate from our basic needs not being met in childhood, abuse, loss of any kind (death of a loved one/friend, job, house, security, relationship, etc.), an unexpected accident, or any other traumas life may throw at you. These unhealed wounds are “jabbing” at you today through maladaptive and numbing behaviors, physical reactions, and emotional reactions.
(605) 315-7318 View (605) 315-7318
Photo of Anissa L Fuller, Clinical Social Work/Therapist, MSW, CSW-PIP
Anissa L Fuller
Clinical Social Work/Therapist, MSW, CSW-PIP
Spearfish, SD 57783
I have enjoyed counseling and mentoring others in their counseling skills for several years in a variety of settings. Whether you are young or older and experiencing depression, anxiety, loss, assault/violence, alcohol and other drug abuse issues, trauma, etc, I have proven ways to provide support towards your improved functioning. With my specialized trauma training and experience, I assure that any history of trauma is addressed as/if wanted and that support is uniquely addressed surrounding all aspects of pain. I accept many insurances as well as self-pay clients and welcome all ages, persons and questions.
I have enjoyed counseling and mentoring others in their counseling skills for several years in a variety of settings. Whether you are young or older and experiencing depression, anxiety, loss, assault/violence, alcohol and other drug abuse issues, trauma, etc, I have proven ways to provide support towards your improved functioning. With my specialized trauma training and experience, I assure that any history of trauma is addressed as/if wanted and that support is uniquely addressed surrounding all aspects of pain. I accept many insurances as well as self-pay clients and welcome all ages, persons and questions.
(605) 315-7099 View (605) 315-7099
Photo of Julie Maas, Licensed Professional Counselor, MS, LPC
Julie Maas
Licensed Professional Counselor, MS, LPC
Spearfish, SD 57783
Not accepting new clients
I enjoy getting to know my clients and learning about their lives. It is my goal to help people discover the best parts of themselves and tap into their strengths.
I enjoy getting to know my clients and learning about their lives. It is my goal to help people discover the best parts of themselves and tap into their strengths.
(605) 385-0459 View (605) 385-0459
Photo of Amanda Karlen - Center for Therapeutic Svcs & Psychodiagnostics, Counselor
At Center for Therapeutic Services and Psychodiagnostics, we are committed to helping you with the most comprehensive, holistic services that are established in evidence-based treatment. You are unique and your circumstances are unique! We will apply a broad range of dynamic assessments that are individualized and tailored to fit your unique needs. We take a creative approach to treating complex mental health problems both on an individual and group level.
At Center for Therapeutic Services and Psychodiagnostics, we are committed to helping you with the most comprehensive, holistic services that are established in evidence-based treatment. You are unique and your circumstances are unique! We will apply a broad range of dynamic assessments that are individualized and tailored to fit your unique needs. We take a creative approach to treating complex mental health problems both on an individual and group level.
(779) 704-4110 View (779) 704-4110
Photo of Triscell Evonne Knuppe - Knuppe Counseling, LLC, Clinical Social Work/Therapist, LCSW, PIP, MSW
Knuppe Counseling, LLC
Clinical Social Work/Therapist, LCSW, PIP, MSW
1 Endorsed
Serves Area
Not accepting new clients
I have worked with all ages, as well as individuals, couples and families with a variety of challenges. I have specialty training in family therapy, helping families dealing with challenging behaviors and communication. I am trauma focused, cognitive behavioral therapy trained. I am also EMDR trained. I have facilitated group therapy for parenting and will be doing more groups on other issues. I am solution focused and offer unconditional, positive regard for all. This is an LGBTQ+ safe space.
I have worked with all ages, as well as individuals, couples and families with a variety of challenges. I have specialty training in family therapy, helping families dealing with challenging behaviors and communication. I am trauma focused, cognitive behavioral therapy trained. I am also EMDR trained. I have facilitated group therapy for parenting and will be doing more groups on other issues. I am solution focused and offer unconditional, positive regard for all. This is an LGBTQ+ safe space.
(605) 413-4219 View (605) 413-4219

How does your Therapist compare?

Number of Therapists in Belle Fourche, SD

10+

Average cost per session

$200

Therapists in Belle Fourche, SD who prioritize treating:

90% Anxiety
90% Coping Skills
90% Stress
80% Grief
80% Trauma and PTSD
70% Relationship Issues
70% Depression

Average years in practice

10 Years

Top 3 insurances accepted

90% Medicaid
80% BlueCross and BlueShield
80% Wellmark BCBS

How Therapists in Belle Fourche, SD see their clients

100% In Person and Online

Gender breakdown

83% Female
17% Male
FAQs - About Therapy and Counseling

How can I find a therapist in Belle Fourche?

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.