Therapists in Vancouver, WA

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Photo of Tucker Douglas Gerhardt, Pre-Licensed Professional, MA, LMHC-A
Tucker Douglas Gerhardt
Pre-Licensed Professional, MA, LMHC-A
Vancouver, WA 98663
Do you sometimes feel like you are not enough? Are you carrying a heavy burden? Do you feel like you're not living a life that is in line with your true self? I can help! I truly believe in the healing power of shining light on the parts of ourselves that we normally keep hidden. As a therapist I strive to develop a nurturing and honest alliance where you can explore your thoughts, emotions, and experiences, free from judgement.
Do you sometimes feel like you are not enough? Are you carrying a heavy burden? Do you feel like you're not living a life that is in line with your true self? I can help! I truly believe in the healing power of shining light on the parts of ourselves that we normally keep hidden. As a therapist I strive to develop a nurturing and honest alliance where you can explore your thoughts, emotions, and experiences, free from judgement.
(360) 657-9361 View (360) 657-9361
Photo of Nathan Morales, Clinical Social Work/Therapist, LSWAIC
Nathan Morales
Clinical Social Work/Therapist, LSWAIC
Vancouver, WA 98661
Hi! I'm Nathan Morales, and I am a Therapist at Wild Heart Society. My role as a clinician is to help support you on your journey as a guide who listens to you. I believe that people do the best when they can, and therefore, we need to focus on what they are doing well, highlight their successes, and strengthen areas where we feel they can grow. Through a queer theoretical lens, I believe it is important to create an affirming space so we can explore the spectrum of relationships, identity, and gender within Western systems. My full profile is located at Wild Heart Society in the Meet the Team section.
Hi! I'm Nathan Morales, and I am a Therapist at Wild Heart Society. My role as a clinician is to help support you on your journey as a guide who listens to you. I believe that people do the best when they can, and therefore, we need to focus on what they are doing well, highlight their successes, and strengthen areas where we feel they can grow. Through a queer theoretical lens, I believe it is important to create an affirming space so we can explore the spectrum of relationships, identity, and gender within Western systems. My full profile is located at Wild Heart Society in the Meet the Team section.
(360) 777-6725 View (360) 777-6725
Photo of Sherese Cordova, Counselor, MA, LMHCA
Sherese Cordova
Counselor, MA, LMHCA
Online Only
I’m a trauma therapist specializing in EMDR. I work with clients navigating complex trauma, PTSD, ADHD, autism, OCD, anxiety, and depression. At the core of my work is the relationship we build together. Therapy should be a place where you can show up exactly as you are and be met with warmth, honesty and humor when it helps. Healing isn’t about forcing yourself to move on, it’s about finally allowing your mind and body to process what they’ve been holding on to. My role as your therapist is to meet you where you are, sit with you in your pain, and help guide you along your path toward growth and healing.
I’m a trauma therapist specializing in EMDR. I work with clients navigating complex trauma, PTSD, ADHD, autism, OCD, anxiety, and depression. At the core of my work is the relationship we build together. Therapy should be a place where you can show up exactly as you are and be met with warmth, honesty and humor when it helps. Healing isn’t about forcing yourself to move on, it’s about finally allowing your mind and body to process what they’ve been holding on to. My role as your therapist is to meet you where you are, sit with you in your pain, and help guide you along your path toward growth and healing.
(360) 585-4887 View (360) 585-4887
Photo of Craig Griffin, Counselor, MA, LMHC
Craig Griffin
Counselor, MA, LMHC
1 Endorsed
Vancouver, WA 98665
I treat mood disorders, depression, anxiety, Anger, OCD, trauma and addictions with Eye Movement Desensitization and Reprocessing (EMDR), Image Transformation Therapy (ImTT) and Cognitive Behavioral Therapy (CBT) I integrate faith in therapy and consider myself a Christian Counselor. I respect those that would not like faith to be a part of treatment, and I will not impose my faith or values upon you.
I treat mood disorders, depression, anxiety, Anger, OCD, trauma and addictions with Eye Movement Desensitization and Reprocessing (EMDR), Image Transformation Therapy (ImTT) and Cognitive Behavioral Therapy (CBT) I integrate faith in therapy and consider myself a Christian Counselor. I respect those that would not like faith to be a part of treatment, and I will not impose my faith or values upon you.
(360) 523-7182 View (360) 523-7182
Photo of Marla Carman, Counselor, MA, LMHC
Marla Carman
Counselor, MA, LMHC
Vancouver, WA 98683
Joy Carman is a Licensed Mental Health Counselor who has been practicing since 2005. She earned her Master of Arts in Professional Counseling (MAPC) and her Bachelor of Arts in Psychology (BA) from Ottawa University, along with two Certification of Advanced Degrees in Clinical Counseling and Trauma, Abuse and Deprivation (CAGS). She has credentials from the National Board of Certified Counselors as a National Certified Counselor (NCC) and a Board Certified-Telemental Health Provider (BC-TMHP). She is trained in EMDR therapy since 2008, ART therapy (accelerated resolution therapy) and Flash Technique for trauma processing.
Joy Carman is a Licensed Mental Health Counselor who has been practicing since 2005. She earned her Master of Arts in Professional Counseling (MAPC) and her Bachelor of Arts in Psychology (BA) from Ottawa University, along with two Certification of Advanced Degrees in Clinical Counseling and Trauma, Abuse and Deprivation (CAGS). She has credentials from the National Board of Certified Counselors as a National Certified Counselor (NCC) and a Board Certified-Telemental Health Provider (BC-TMHP). She is trained in EMDR therapy since 2008, ART therapy (accelerated resolution therapy) and Flash Technique for trauma processing.
(360) 323-9080 View (360) 323-9080
Photo of Dr. Richard Shaw, Counselor, DMFT, LMHC, LMFT
Dr. Richard Shaw
Counselor, DMFT, LMHC, LMFT
4 Endorsed
Vancouver, WA 98664
Hi, my name is Richard Shaw and I am a Licensed Mental Health Counselor in Washington State and a Licensed Marriage and Family Therapist in Oregon, providing Professional Counseling Services for more than 25 years, currently offering in office and zoom appointments. I am also an Associate Professor of over 25 years in the Graduate School of Counseling at George Fox University. I have been married for over 30 years and have two adult children. I am originally from Nebraska and in my free time, I enjoy movies, the Oregon coast and college and professional football.
Hi, my name is Richard Shaw and I am a Licensed Mental Health Counselor in Washington State and a Licensed Marriage and Family Therapist in Oregon, providing Professional Counseling Services for more than 25 years, currently offering in office and zoom appointments. I am also an Associate Professor of over 25 years in the Graduate School of Counseling at George Fox University. I have been married for over 30 years and have two adult children. I am originally from Nebraska and in my free time, I enjoy movies, the Oregon coast and college and professional football.
(360) 215-3925 View (360) 215-3925
Photo of Joy Wilson - Joy Wilson, Counselor, LMHC, LPC
Joy Wilson
Counselor, LMHC, LPC
2 Endorsed
Online Only
Our life stories do not always have the fairy tale endings that we hoped for, but we are not mere puppets. We are active agents in pursuit of meaningful moments and positive outcomes. I will help you identify your strengths and collaborate with you to find solutions to challenges in your story. I strive to provide a counseling relationship in which you can feel safe, heard, and supported as you explore or process whatever you choose.
Our life stories do not always have the fairy tale endings that we hoped for, but we are not mere puppets. We are active agents in pursuit of meaningful moments and positive outcomes. I will help you identify your strengths and collaborate with you to find solutions to challenges in your story. I strive to provide a counseling relationship in which you can feel safe, heard, and supported as you explore or process whatever you choose.
(503) 850-8088 View (503) 850-8088
Photo of Sara Giza, Clinical Social Work/Therapist, MSW
Sara Giza
Clinical Social Work/Therapist, MSW
1 Endorsed
Online Only
Growing up in Flint, Michigan, with a single mom of three, we lived in government housing. Exposed at a young age to poverty, substance abuse, domestic violence and witnessing oppression and privilege firsthand, I knew that I wanted to be part of the solution one day. That led me to social work and becoming a therapist, who has now worked with countless teens and adults on their mental health challenges in both nonprofit organizations and private practice. My areas of expertise include working heavily with trauma, sexual assault, domestic violence, grief, chronic illness and LGBTQ+ issues, as well as the neurodivergent community.
Growing up in Flint, Michigan, with a single mom of three, we lived in government housing. Exposed at a young age to poverty, substance abuse, domestic violence and witnessing oppression and privilege firsthand, I knew that I wanted to be part of the solution one day. That led me to social work and becoming a therapist, who has now worked with countless teens and adults on their mental health challenges in both nonprofit organizations and private practice. My areas of expertise include working heavily with trauma, sexual assault, domestic violence, grief, chronic illness and LGBTQ+ issues, as well as the neurodivergent community.
(360) 996-1270 View (360) 996-1270
Photo of Stacy Cotteleer, Clinical Social Work/Therapist, LICSW
Stacy Cotteleer
Clinical Social Work/Therapist, LICSW
Vancouver, WA 98663
Feeling overwhelmed? Not sure where to start in order to feel better? I have been working in the mental health sector for nearly twenty years providing crisis intervention, psychoeducation, and outpatient support. My greatest passion is supporting people in all walks of life to find emotional, physical, and spiritual BALANCE. Whether you are struggling with day-to-day stressors, a challenging life transition, or difficulty in relationships, I am here to support you in finding your way back to center. My promise to you is to listen well and work collaboratively in pursuing your goals in order to feel better and thrive.
Feeling overwhelmed? Not sure where to start in order to feel better? I have been working in the mental health sector for nearly twenty years providing crisis intervention, psychoeducation, and outpatient support. My greatest passion is supporting people in all walks of life to find emotional, physical, and spiritual BALANCE. Whether you are struggling with day-to-day stressors, a challenging life transition, or difficulty in relationships, I am here to support you in finding your way back to center. My promise to you is to listen well and work collaboratively in pursuing your goals in order to feel better and thrive.
(360) 345-3670 View (360) 345-3670
Photo of Elizabeth Dammarell, Counselor, LMHC, CDP, NCC, MA
Elizabeth Dammarell
Counselor, LMHC, CDP, NCC, MA
4 Endorsed
Vancouver, WA 98685
Creating a safe space for individuals to thrive, grow, and find courage to tell their story, is what I believe my role to be as a counselor. Often times we run from our pain and avoid facing what has been hurting us all these years. It is my belief that counseling provides a neutral and compassionate environment to process through this pain, and finally discover the relief we have been looking for. My hope as your counselor is to help you develop a deeper awareness and personal insight so that you may live a more fulfilling and authentic life.
Creating a safe space for individuals to thrive, grow, and find courage to tell their story, is what I believe my role to be as a counselor. Often times we run from our pain and avoid facing what has been hurting us all these years. It is my belief that counseling provides a neutral and compassionate environment to process through this pain, and finally discover the relief we have been looking for. My hope as your counselor is to help you develop a deeper awareness and personal insight so that you may live a more fulfilling and authentic life.
(360) 763-0549 View (360) 763-0549
Photo of Alyssa Weller, Marriage & Family Therapist, LMFT
Alyssa Weller
Marriage & Family Therapist, LMFT
Online Only
Life can be challenging when trauma-related experiences, anxiety, or attachment disorders interfere with your sense of peace and security. You may feel overwhelmed by fear, stress, or emotional pain, often unsure of how to move forward. I understand how deeply these struggles can impact your day-to-day life and relationships. My goal is to provide you with a supportive space where we can work together to process these experiences, helping you gain a sense of control, safety, and emotional well-being.
Life can be challenging when trauma-related experiences, anxiety, or attachment disorders interfere with your sense of peace and security. You may feel overwhelmed by fear, stress, or emotional pain, often unsure of how to move forward. I understand how deeply these struggles can impact your day-to-day life and relationships. My goal is to provide you with a supportive space where we can work together to process these experiences, helping you gain a sense of control, safety, and emotional well-being.
(360) 926-9268 View (360) 926-9268
Photo of Serene Singharaj, Pre-Licensed Professional, LMHCA, LPCA
Serene Singharaj
Pre-Licensed Professional, LMHCA, LPCA
Online Only
My primary goal as a therapist is to help my clients align with their most authentic selves, which often gets silenced or pushed aside by past wounds. I offer a warm and welcoming space where you can explore how your lived experiences have shaped who you are, cultivate a sense of safety within your body and relationships, and build resilience and inner strength to navigate the ebbs and flows of life. My ideal clients are young adults and BIPOC individuals experiencing anxiety, depression, trauma, self-esteem challenges, identity concerns, relationship dysfunction, and life transitions.
My primary goal as a therapist is to help my clients align with their most authentic selves, which often gets silenced or pushed aside by past wounds. I offer a warm and welcoming space where you can explore how your lived experiences have shaped who you are, cultivate a sense of safety within your body and relationships, and build resilience and inner strength to navigate the ebbs and flows of life. My ideal clients are young adults and BIPOC individuals experiencing anxiety, depression, trauma, self-esteem challenges, identity concerns, relationship dysfunction, and life transitions.
(360) 502-2058 x500 View (360) 502-2058 x500
Photo of Dr. Savanna Parker, Licensed Mental Health Counselor, PsyD, LMHC
Dr. Savanna Parker
Licensed Mental Health Counselor, PsyD, LMHC
6 Endorsed
Online Only
I help people who have learned to ignore their feelings reconnect with their inner voice and live more authentically. My approach is deeply attuned to your real-time emotional experience, helping you to understand what your nervous system is communicating and why change feels so difficult.
I help people who have learned to ignore their feelings reconnect with their inner voice and live more authentically. My approach is deeply attuned to your real-time emotional experience, helping you to understand what your nervous system is communicating and why change feels so difficult.
(360) 468-7880 View (360) 468-7880
Photo of MacDonald Dunbar, Marriage & Family Therapist, MA, LMFT
MacDonald Dunbar
Marriage & Family Therapist, MA, LMFT
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 Daphne Eck Coppock, Clinical Social Work/Therapist, LICSW
Daphne Eck Coppock
Clinical Social Work/Therapist, LICSW
1 Endorsed
Online Only
You’ve been hurt by the church, a spiritual leader, religious institution, or what someone once told you is a cult. Ouch. It was supposed to offer you safety and meaning, but it ultimately became an affront to your conscience and everything you hold dear. Now, you’re dealing with guilt, fear, anger, and shame. Maybe you were labeled “bitter,” pressured to forgive before you were ready, or told your pain was a failure of faith. You may still hold spiritual beliefs while feeling conflicted, guarded, or deeply confused. What happened wasn’t harmless. Spiritual abuse leaves real wounds, and carrying them alone only deepens the impact.
You’ve been hurt by the church, a spiritual leader, religious institution, or what someone once told you is a cult. Ouch. It was supposed to offer you safety and meaning, but it ultimately became an affront to your conscience and everything you hold dear. Now, you’re dealing with guilt, fear, anger, and shame. Maybe you were labeled “bitter,” pressured to forgive before you were ready, or told your pain was a failure of faith. You may still hold spiritual beliefs while feeling conflicted, guarded, or deeply confused. What happened wasn’t harmless. Spiritual abuse leaves real wounds, and carrying them alone only deepens the impact.
(509) 591-9290 View (509) 591-9290
Photo of Tracy LeBlanc - Playful Healing Counseling, LLC, Clinical Social Work/Therapist, LICSW, RPT-S
Playful Healing Counseling, LLC
Clinical Social Work/Therapist, LICSW, RPT-S
Vancouver, WA 98661
I enjoy supporting children and families through play therapy, art therapy (and sometimes talk therapy too)! I believe in the resilience and strength of children and their families. I believe that children process the world through play, art and movement as much as, if not more than, they do through words. I believe in the power of play to help children make sense of their experiences and struggles and move toward positive change. I believe in the power of play to help families reconnect and build strong alliances with one another.
I enjoy supporting children and families through play therapy, art therapy (and sometimes talk therapy too)! I believe in the resilience and strength of children and their families. I believe that children process the world through play, art and movement as much as, if not more than, they do through words. I believe in the power of play to help children make sense of their experiences and struggles and move toward positive change. I believe in the power of play to help families reconnect and build strong alliances with one another.
(360) 328-7196 View (360) 328-7196
Photo of Leslie Collord, Counselor, LMHC
Leslie Collord
Counselor, LMHC
3 Endorsed
Vancouver, WA 98661
I work with adults seeking support for anxiety, depression, relationship issues, life transitions, and trauma and stress-related problems. I also work with teens, ages 13+ who are struggling with school, relationships, and the pressure to succeed in their transition into adulthood. I provide a supportive yet challenging space that supports working through obstacles and developing more effective coping skills along the way. I value a collaborative working relationship using evidence based practices to guide sessions and work to facilitate openness through remaining curious, engaged, and empathic.
I work with adults seeking support for anxiety, depression, relationship issues, life transitions, and trauma and stress-related problems. I also work with teens, ages 13+ who are struggling with school, relationships, and the pressure to succeed in their transition into adulthood. I provide a supportive yet challenging space that supports working through obstacles and developing more effective coping skills along the way. I value a collaborative working relationship using evidence based practices to guide sessions and work to facilitate openness through remaining curious, engaged, and empathic.
(360) 516-1383 View (360) 516-1383
Photo of Iris Le, Licensed Mental Health Counselor, LMHC
Iris Le
Licensed Mental Health Counselor, LMHC
Online Only
If you're feeling overwhelmed by anxiety, haunted by past trauma, or burdened by depression, you're the client I'm here to support. Through a holistic and collaborative approach, I help my clients to untangle complex emotions and develop practical tools for lasting change. My passion is to help clients discover a renewed sense of peace, clarity, and the internal strength to live more fully and joyfully, reclaiming their well-being.
If you're feeling overwhelmed by anxiety, haunted by past trauma, or burdened by depression, you're the client I'm here to support. Through a holistic and collaborative approach, I help my clients to untangle complex emotions and develop practical tools for lasting change. My passion is to help clients discover a renewed sense of peace, clarity, and the internal strength to live more fully and joyfully, reclaiming their well-being.
(360) 309-0354 View (360) 309-0354
Photo of Casey Claypool, Counselor, MA, LMHC
Casey Claypool
Counselor, MA, LMHC
Vancouver, WA 98683
My primary focus is to guide individuals towards a greater sense of freedom through the awareness of one's emotional and behavioral patterns which is accessed through mind/body/soul connection and to heal the wounds that have accumulated throughout our lives.
My primary focus is to guide individuals towards a greater sense of freedom through the awareness of one's emotional and behavioral patterns which is accessed through mind/body/soul connection and to heal the wounds that have accumulated throughout our lives.
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Photo of Jessica Piziali, Counselor, MAC, LMHC
Jessica Piziali
Counselor, MAC, LMHC
Vancouver, WA 98686
Jessica Piziali, LMHC, serves patients throughout Washington at LifeStance Health, offering specialized support through an eclectic and neurodivergent-affirming lens tailored to individual needs. Jessica's clinical focus includes helping clients manage ADHD, anxiety, and depression, providing a compassionate and personalized approach to mental health care. By incorporating mindfulness-based cognitive behavioral therapy (CBT), somatic practices, and insight therapy, she effectively supports clients in managing their symptoms and achieving emotional well-being.
Jessica Piziali, LMHC, serves patients throughout Washington at LifeStance Health, offering specialized support through an eclectic and neurodivergent-affirming lens tailored to individual needs. Jessica's clinical focus includes helping clients manage ADHD, anxiety, and depression, providing a compassionate and personalized approach to mental health care. By incorporating mindfulness-based cognitive behavioral therapy (CBT), somatic practices, and insight therapy, she effectively supports clients in managing their symptoms and achieving emotional well-being.
(360) 226-8496 View (360) 226-8496

See more therapy options for Vancouver

How does your Therapist compare?

Number of Therapists in Vancouver, WA

1,000+

Average cost per session

$160

Therapists in Vancouver, WA who prioritize treating:

93% Anxiety
86% Depression
76% Trauma and PTSD
71% Relationship Issues
69% Self Esteem
68% Stress
64% Grief

Average years in practice

10 Years

Top 3 insurances accepted

81% Aetna
71% Regence
59% BlueCross and BlueShield

How Therapists in Vancouver, WA see their clients

54% In Person and Online
46% Online Only

Gender breakdown

77% Female
20% Male
3% 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.