Therapists in Madison, SD

Photo of Scott Wiley, Licensed Professional Counselor, LPC
Scott Wiley
Licensed Professional Counselor, LPC
Online Only
Scott Wiley is a Licensed Professional Counselor in the state of South Dakota and nationally certified by the National Board for Certified Counselors, Inc. He is also an ordained minister of The Wesleyan Church denomination and has over 30 years of pastoral experience. Scott has been trained from both secular and Christian perspectives and has nearly 20 years of clinical experience in both realms. Based on the goals you to the table, I draw heavily from Cognitive Behavioral Therapy, including its offshoots, Dialectical Behavioral Therapy, and Acceptance and Commitment Therapy.
Scott Wiley is a Licensed Professional Counselor in the state of South Dakota and nationally certified by the National Board for Certified Counselors, Inc. He is also an ordained minister of The Wesleyan Church denomination and has over 30 years of pastoral experience. Scott has been trained from both secular and Christian perspectives and has nearly 20 years of clinical experience in both realms. Based on the goals you to the table, I draw heavily from Cognitive Behavioral Therapy, including its offshoots, Dialectical Behavioral Therapy, and Acceptance and Commitment Therapy.
(605) 315-5904 View (605) 315-5904
Photo of Jennifer Walker, Clinical Social Work/Therapist, MSW, LCSWPIP, NADD-CC, QMHP
Jennifer Walker
Clinical Social Work/Therapist, MSW, LCSWPIP, NADD-CC, QMHP
3 Endorsed
Serves Area
It can be hard and intimidating to reach out for help. Finding a therapist, you feel comfortable with is the key to beginning a journey of healing. Nobody deserves to feel overlooked, forgotten or left out at any stage of life. At times we all need support to help us find our purpose in life and a sense of community and belonging. I am here to walk that journey to wellness with you by using a non-judgmental, gentle demeanor, and compassionate approach through individualized treatment planning to meet your unique needs.
It can be hard and intimidating to reach out for help. Finding a therapist, you feel comfortable with is the key to beginning a journey of healing. Nobody deserves to feel overlooked, forgotten or left out at any stage of life. At times we all need support to help us find our purpose in life and a sense of community and belonging. I am here to walk that journey to wellness with you by using a non-judgmental, gentle demeanor, and compassionate approach through individualized treatment planning to meet your unique needs.
(605) 205-8956 View (605) 205-8956
Photo of Alla Anatoly Jones, Counselor, MS, LPC-MH, LAC
Alla Anatoly Jones
Counselor, MS, LPC-MH, LAC
1 Endorsed
Serves Area
I am a licensed mental health and substance abuse therapist with over 20 years of professional experience, specializing in trauma recovery therapy and couple's therapy. I am committed to provide healing and restoration for those experiencing personal, relational, and psychological issues as the result of traumatic experience. The modalities I am trained on will help you to release the stored pain and free yourself to be a person you are meant to be.
I am a licensed mental health and substance abuse therapist with over 20 years of professional experience, specializing in trauma recovery therapy and couple's therapy. I am committed to provide healing and restoration for those experiencing personal, relational, and psychological issues as the result of traumatic experience. The modalities I am trained on will help you to release the stored pain and free yourself to be a person you are meant to be.
(605) 307-3631 View (605) 307-3631
Photo of Andrea Uckert, Licensed Professional Counselor, MS, LPC-MH, QMHP
Andrea Uckert
Licensed Professional Counselor, MS, LPC-MH, QMHP
Serves Area
My goal as a therapist is to walk alongside you in your journey of counseling. At times, it means providing hope, problem solving, developing new skills, or healing from trauma. I strive to provide a safe and comfortable environment in which we are able to build a strong therapeutic relationship from which we can clarify and set goals, resolve or manage issues, and find increased inner strength. I take a client-centered approach to help you best meet your goals. My private practice is located in Brookings, SD.
My goal as a therapist is to walk alongside you in your journey of counseling. At times, it means providing hope, problem solving, developing new skills, or healing from trauma. I strive to provide a safe and comfortable environment in which we are able to build a strong therapeutic relationship from which we can clarify and set goals, resolve or manage issues, and find increased inner strength. I take a client-centered approach to help you best meet your goals. My private practice is located in Brookings, SD.
(605) 250-4894 View (605) 250-4894

More Therapists Nearby

Photo of Ashley Day, Pre-Licensed Professional, MS, NCC
Ashley Day
Pre-Licensed Professional, MS, NCC
Brookings, SD 57006
My goal as a therapist is to offer a nonjudgmental space where you can feel safe to show up as your authentic self, knowing you’ll be met with compassion and respect. I see therapy as a collaborative journey, and I’m committed to walking alongside you every step of the way.
My goal as a therapist is to offer a nonjudgmental space where you can feel safe to show up as your authentic self, knowing you’ll be met with compassion and respect. I see therapy as a collaborative journey, and I’m committed to walking alongside you every step of the way.
(605) 467-5462 View (605) 467-5462
Photo of Amanda R DeVries, Licensed Professional Counselor, MA, LPC, LPC-MH, QMHP, NCC
Amanda R DeVries
Licensed Professional Counselor, MA, LPC, LPC-MH, QMHP, NCC
3 Endorsed
Serves Area
“I can’t imagine a future where things ever improve, no matter how much I push myself.” “My thoughts are constantly racing, and even the smallest challenges feel like they could unravel at any second.” “I can be in a room full of people and still feel completely unseen.” If any of this resonates, you’re not alone. Anxiety, depression, and the lingering effects of past trauma can make life feel heavy, but healing is possible. Together, we can face life’s difficult and sometimes frightening emotions, and I would be honored to walk with you through this process.
“I can’t imagine a future where things ever improve, no matter how much I push myself.” “My thoughts are constantly racing, and even the smallest challenges feel like they could unravel at any second.” “I can be in a room full of people and still feel completely unseen.” If any of this resonates, you’re not alone. Anxiety, depression, and the lingering effects of past trauma can make life feel heavy, but healing is possible. Together, we can face life’s difficult and sometimes frightening emotions, and I would be honored to walk with you through this process.
(605) 800-7112 View (605) 800-7112
Photo of Irina Nicholas Goubanova, Licensed Professional Counselor, MS, LPC, QMHP
Irina Nicholas Goubanova
Licensed Professional Counselor, MS, LPC, QMHP
Serves Area
Life is a journey, not a destination.We need strength & resiliency during that journey. We all occasionally stumble and face pitfalls. I am an experienced and intuitive mental health professional, who will help you heal during the times of emotional distress and life crises. My training and professional experience focus on helping clients during the time of transition.I have been successful in the treatment of Anxiety, Depression, Trauma, Chronic pain. I include therapeutic hypnosis Do not face your struggles alone. Help is within reach. You will know after your first visit, if you made the right choice.
Life is a journey, not a destination.We need strength & resiliency during that journey. We all occasionally stumble and face pitfalls. I am an experienced and intuitive mental health professional, who will help you heal during the times of emotional distress and life crises. My training and professional experience focus on helping clients during the time of transition.I have been successful in the treatment of Anxiety, Depression, Trauma, Chronic pain. I include therapeutic hypnosis Do not face your struggles alone. Help is within reach. You will know after your first visit, if you made the right choice.
(605) 250-3971 View (605) 250-3971
Photo of Michelle Ruesink, Licensed Professional Counselor, LPC, LPC-MH, QMHP
Michelle Ruesink
Licensed Professional Counselor, LPC, LPC-MH, QMHP
Brookings, SD 57006
My goal as a therapist is to help you find the very best aspects of yourself. I work to help you create healthy and dynamic relationships and to generate meaningful change. I offer specialized mental health services for adults, couples, children, and families. My practice combines a client-centered approach with effective psychotherapy interventions to treat a wide range of issues. Building a strong therapeutic relationship is key to each client's therapeutic journey, and I make this a priority to ensure a trusting and warm experience for my clients. My private practice office is located in Brookings, South Dakota.
My goal as a therapist is to help you find the very best aspects of yourself. I work to help you create healthy and dynamic relationships and to generate meaningful change. I offer specialized mental health services for adults, couples, children, and families. My practice combines a client-centered approach with effective psychotherapy interventions to treat a wide range of issues. Building a strong therapeutic relationship is key to each client's therapeutic journey, and I make this a priority to ensure a trusting and warm experience for my clients. My private practice office is located in Brookings, South Dakota.
(605) 250-3745 View (605) 250-3745
Photo of Amanda Briggs Davis, Clinical Social Work/Therapist, CSW-PIP, QMHP, EMDR-C, ACS
Amanda Briggs Davis
Clinical Social Work/Therapist, CSW-PIP, QMHP, EMDR-C, ACS
2 Endorsed
Serves Area
I know life can be painful and complicated. This may be one of those seasons. Breathe. Life is filled with hard things, and emotions can rise to become very intense, and they calm. I'm here to support you through this. I accept you for who you are, just as you are, and I'm here for you. Counseling is an effective way to learn skills to more effectively manage thoughts and emotions, work to desensitize unprocessed traumatic memories with EMDR, or navigate any challenges you may be facing - mood, relationship issues, life transitions, grief and loss.
I know life can be painful and complicated. This may be one of those seasons. Breathe. Life is filled with hard things, and emotions can rise to become very intense, and they calm. I'm here to support you through this. I accept you for who you are, just as you are, and I'm here for you. Counseling is an effective way to learn skills to more effectively manage thoughts and emotions, work to desensitize unprocessed traumatic memories with EMDR, or navigate any challenges you may be facing - mood, relationship issues, life transitions, grief and loss.
(605) 316-3252 View (605) 316-3252
Photo of Brianna Heppler, Marriage & Family Therapist, MS, LMFT, CSTIP
Brianna Heppler
Marriage & Family Therapist, MS, LMFT, CSTIP
Serves Area
Having a therapist who understands your lived experience can help break down barriers and take away the burden of education. I love working with neurodivergent and/or queer adolescents, adults, and families. Building a life that works for you and your relationships in a world that isn't designed for us, is no small task, but can make all the difference in the world. Honing skills to help keep yourself regulated while dealing with daily stress is an integral part of my practice.
Having a therapist who understands your lived experience can help break down barriers and take away the burden of education. I love working with neurodivergent and/or queer adolescents, adults, and families. Building a life that works for you and your relationships in a world that isn't designed for us, is no small task, but can make all the difference in the world. Honing skills to help keep yourself regulated while dealing with daily stress is an integral part of my practice.
(605) 626-8981 View (605) 626-8981
Photo of Jill Walerius, Clinical Social Work/Therapist, MSW, CSW-PIP, LAC
Jill Walerius
Clinical Social Work/Therapist, MSW, CSW-PIP, LAC
1 Endorsed
Serves Area
Therapy is a personal journey toward self-understanding and self-acceptance. My goal is to provide a safe, supportive space where you feel heard, respected, and empowered to make lasting changes. Together, we’ll explore your goals, identify patterns that may be holding you back, and create healthier, more authentic ways of navigating life. I specialize in working with those healing from trauma, PTSD, abuse/neglect histories, and sexual health concerns. As a Certified EMDR Therapist and Certified Sex Therapy Informed Professional, I use evidence-based approaches including EMDR, IFS and DBT to help you move forward with confidence.
Therapy is a personal journey toward self-understanding and self-acceptance. My goal is to provide a safe, supportive space where you feel heard, respected, and empowered to make lasting changes. Together, we’ll explore your goals, identify patterns that may be holding you back, and create healthier, more authentic ways of navigating life. I specialize in working with those healing from trauma, PTSD, abuse/neglect histories, and sexual health concerns. As a Certified EMDR Therapist and Certified Sex Therapy Informed Professional, I use evidence-based approaches including EMDR, IFS and DBT to help you move forward with confidence.
(605) 210-6027 View (605) 210-6027
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 Renata Bosek, Counselor, PhD, MN-LPCC, MN-LADC, LPC-MH, SD-LAC
Renata Bosek
Counselor, PhD, MN-LPCC, MN-LADC, LPC-MH, SD-LAC
Brookings, SD 57006
There are a great number of hurdles and challenges facing people dealing with psychological disorders. There is also a social stigma when referring to mental health and mental health diagnoses. Having worked in many different types of mental health environments I have interacted with people who have bipolar disorder to disassociate disorder. I create a safe and effective environment for communicating and working through the many challenges faced by individuals. I strive to make a difference in people’s lives by focusing on the individual and the individual’s needs.
There are a great number of hurdles and challenges facing people dealing with psychological disorders. There is also a social stigma when referring to mental health and mental health diagnoses. Having worked in many different types of mental health environments I have interacted with people who have bipolar disorder to disassociate disorder. I create a safe and effective environment for communicating and working through the many challenges faced by individuals. I strive to make a difference in people’s lives by focusing on the individual and the individual’s needs.
(605) 605-1096 View (605) 605-1096
Photo of Michelle Novak, Licensed Professional Counselor, MS, LPC-MH, QMHP
Michelle Novak
Licensed Professional Counselor, MS, LPC-MH, QMHP
1 Endorsed
Serves Area
I have immediate openings! I provide compassionate, trauma-informed individual therapy. My goal is to meet clients where they are with compassion and understanding. I have been providing counseling services for 15+ years.
I have immediate openings! I provide compassionate, trauma-informed individual therapy. My goal is to meet clients where they are with compassion and understanding. I have been providing counseling services for 15+ years.
(605) 674-6601 View (605) 674-6601
Photo of Clint Sperle, Licensed Professional Counselor, MA, LPC-MH, QMHP
Clint Sperle
Licensed Professional Counselor, MA, LPC-MH, QMHP
Serves Area
I received my degree in Counseling and Psychology in Education and am a Licensed Professional Counselor-MH. I have worked with children and adolescents in individual, group and family settings for the past 24+ years. Special areas of interest include working with children and adolescents in areas related to: abuse issues, trauma, evaluations and therapy for children with sexualized behaviors, grief and loss, depression, anxiety, divorce issues, behavioral issues and adjustment issues. I also work with children, adolescents and adults with developmental disabilities.
I received my degree in Counseling and Psychology in Education and am a Licensed Professional Counselor-MH. I have worked with children and adolescents in individual, group and family settings for the past 24+ years. Special areas of interest include working with children and adolescents in areas related to: abuse issues, trauma, evaluations and therapy for children with sexualized behaviors, grief and loss, depression, anxiety, divorce issues, behavioral issues and adjustment issues. I also work with children, adolescents and adults with developmental disabilities.
(605) 303-6587 View (605) 303-6587
Photo of Geoff Faustman, Marriage & Family Therapist, MA, LMFT
Geoff Faustman
Marriage & Family Therapist, MA, LMFT
Online Only
I offer a direct, active, goal-oriented approach in helping you find relief from the anxiety, anger, depression, shame, or whatever it is that leaves you feeling stuck. By taking a look at 1) What are you trying to achieve? 2) What are you trying to preserve? 3) What are you trying to avoid? and 4) What are you trying to eliminate? we can highlight the sometimes-complex interaction among your thoughts, decisions, actions and outcomes. Knowing yourself, making use of your personal strengths & your tools at hand while allowing your values guide you, you can propel yourself toward becoming the best, most fulfilled version of yourself.
I offer a direct, active, goal-oriented approach in helping you find relief from the anxiety, anger, depression, shame, or whatever it is that leaves you feeling stuck. By taking a look at 1) What are you trying to achieve? 2) What are you trying to preserve? 3) What are you trying to avoid? and 4) What are you trying to eliminate? we can highlight the sometimes-complex interaction among your thoughts, decisions, actions and outcomes. Knowing yourself, making use of your personal strengths & your tools at hand while allowing your values guide you, you can propel yourself toward becoming the best, most fulfilled version of yourself.
(605) 349-1370 View (605) 349-1370
Photo of Rachel Anderson, Pre-Licensed Professional, MS
Rachel Anderson
Pre-Licensed Professional, MS
1 Endorsed
Serves Area
I am passionate about providing a safe and supportive therapeutic space where clients can work towards their personal goals. I have experience working with adolescents, young adults, and adults who have struggled with anxiety, depression, adjustment disorders, OCD, and oppositional-defiant disorder. I am committed to helping clients navigate challenges and achieve meaningful progress to their mental health journey.
I am passionate about providing a safe and supportive therapeutic space where clients can work towards their personal goals. I have experience working with adolescents, young adults, and adults who have struggled with anxiety, depression, adjustment disorders, OCD, and oppositional-defiant disorder. I am committed to helping clients navigate challenges and achieve meaningful progress to their mental health journey.
(605) 952-5521 View (605) 952-5521
Photo of Regina Dumansky, Marriage & Family Therapist, MA, LMFT
Regina Dumansky
Marriage & Family Therapist, MA, LMFT
Serves Area
If you’ve tried everything but still feel stuck in cycles of frustration, exhaustion, overwhelm, depression, loss of self, lashing out, withdrawing, or numbing…its time to go beyond talking and into depth work that moves you out of repeating cycles and stepping back into Your life.
If you’ve tried everything but still feel stuck in cycles of frustration, exhaustion, overwhelm, depression, loss of self, lashing out, withdrawing, or numbing…its time to go beyond talking and into depth work that moves you out of repeating cycles and stepping back into Your life.
(605) 307-5077 View (605) 307-5077
Photo of Nikki Gorman, Licensed Professional Counselor, MA, LPC-MH, LPCC, LMHC
Nikki Gorman
Licensed Professional Counselor, MA, LPC-MH, LPCC, LMHC
Online Only
Support for Intense Emotions, Trauma & Relationship Patterns If you’re feeling overwhelmed, stuck in patterns you can’t seem to break, or exhausted from holding everything together, you’re not alone. Many of the clients I work with struggle with anxiety, intense emotions, relationship challenges, trauma, or feeling disconnected from themselves. I offer a warm, nonjudgmental space where you can slow down, feel understood, and begin to make sense of what’s going on beneath the surface. Together, we’ll work to reduce distress, build practical coping skills, and help you feel more grounded, confident, and in control of your life.
Support for Intense Emotions, Trauma & Relationship Patterns If you’re feeling overwhelmed, stuck in patterns you can’t seem to break, or exhausted from holding everything together, you’re not alone. Many of the clients I work with struggle with anxiety, intense emotions, relationship challenges, trauma, or feeling disconnected from themselves. I offer a warm, nonjudgmental space where you can slow down, feel understood, and begin to make sense of what’s going on beneath the surface. Together, we’ll work to reduce distress, build practical coping skills, and help you feel more grounded, confident, and in control of your life.
(605) 250-7340 View (605) 250-7340
Photo of Katy Millington, Pre-Licensed Professional, MSc, MS, NCC
Katy Millington
Pre-Licensed Professional, MSc, MS, NCC
1 Endorsed
Brookings, SD 57006
You’re tired of feeling anxious, stuck, or weighed down by past experiences. Maybe you’ve tried therapy before and felt like the therapist didn’t quite “get” you. You’re looking for real relief from painful memories, practical skills for daily life, and a therapist who is authentic, down-to-earth, and able to sit with humor, honesty, and hard topics without judgment. Here, you can expect a space that feels grounded and genuine, where you don’t have to perform or filter yourself to be understood.
You’re tired of feeling anxious, stuck, or weighed down by past experiences. Maybe you’ve tried therapy before and felt like the therapist didn’t quite “get” you. You’re looking for real relief from painful memories, practical skills for daily life, and a therapist who is authentic, down-to-earth, and able to sit with humor, honesty, and hard topics without judgment. Here, you can expect a space that feels grounded and genuine, where you don’t have to perform or filter yourself to be understood.
(605) 808-0626 View (605) 808-0626

How does your Therapist compare?

Number of Therapists in Madison, SD

< 10

Therapists in Madison, SD who prioritize treating:

100% Depression
100% Anxiety
75% Relationship Issues
75% Grief
75% Obsessive-Compulsive (OCD)
75% Trauma and PTSD
75% Self Esteem

Average years in practice

15 Years

Top 3 insurances accepted

75% BlueCross and BlueShield
75% Avera Health Plans
75% Sanford Health Plan

How Therapists in Madison, SD see their clients

75% In Person and Online
25% Online Only

Gender breakdown

67% Female
33% Male
FAQs - About Therapy and Counseling

How can I find a therapist in Madison?

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.