Therapists in Springfield, MO

Photo of Angela K Coulter, Clinical Social Work/Therapist in Springfield, MO
Angela K Coulter
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Springfield, MO 65807
Not accepting new clients
My practice is client centered, directed at meeting a person exactly where they are at on their current journey. It is a strength based approach and I am committed to cultivating and highlighting the resources one has within themselves to increase resiliency, balance, and joy.
My practice is client centered, directed at meeting a person exactly where they are at on their current journey. It is a strength based approach and I am committed to cultivating and highlighting the resources one has within themselves to increase resiliency, balance, and joy.
(417) 222-3172 View (417) 222-3172
Photo of Amanda DiMartini, Licensed Professional Counselor in Springfield, MO
Amanda DiMartini
Licensed Professional Counselor, MA, LPC
Verified Verified
2 Endorsed
Springfield, MO 65806
Anxiety Specialist: Anxiety Relief: Free yourself from racing thoughts, worry, fear, and restlessness. Anxiety can decrease your self- esteem and create difficulty with decision making. There are life-changing strategies I will teach and support you through. Learn to utilize your strengths and overcome debilitating stress responses. Ketamine-Assisted Psychotherapy/Integration sessions available. Ketamine-Assisted Psychotherapy is a powerful psychedelic treatment that can help heal trauma, reset your perspective, and improve motivation for positive change.
Anxiety Specialist: Anxiety Relief: Free yourself from racing thoughts, worry, fear, and restlessness. Anxiety can decrease your self- esteem and create difficulty with decision making. There are life-changing strategies I will teach and support you through. Learn to utilize your strengths and overcome debilitating stress responses. Ketamine-Assisted Psychotherapy/Integration sessions available. Ketamine-Assisted Psychotherapy is a powerful psychedelic treatment that can help heal trauma, reset your perspective, and improve motivation for positive change.
(417) 595-0166 View (417) 595-0166
Photo of Stacie Viele, Pre-Licensed Professional in Springfield, MO
Stacie Viele
Pre-Licensed Professional, PLPC
Verified Verified
Springfield, MO 65804
As a therapist I hope to create a space in which clients feel comfortable to explore what is holding them back from living a life that feels fulfilling. I believe that it is possible to live a life of balance in which stress and distress feel like something to cope with rather than something that overwhelms or overshadows the possibilities in life. I want to support learning and discovery as well as an integration of this new awareness into life so that clients leave with both self-knowledge and empowerment to maintain change.
As a therapist I hope to create a space in which clients feel comfortable to explore what is holding them back from living a life that feels fulfilling. I believe that it is possible to live a life of balance in which stress and distress feel like something to cope with rather than something that overwhelms or overshadows the possibilities in life. I want to support learning and discovery as well as an integration of this new awareness into life so that clients leave with both self-knowledge and empowerment to maintain change.
(417) 453-2892 View (417) 453-2892
Photo of Caitlyn Hill, Clinical Social Work/Therapist in Springfield, MO
Caitlyn Hill
Clinical Social Work/Therapist, LMSW
Verified Verified
Springfield, MO 65804
As a therapist, my goal is to provide an empowering structure so that my clients can flourish and heal.
As a therapist, my goal is to provide an empowering structure so that my clients can flourish and heal.
(417) 302-3454 View (417) 302-3454
Photo of Silvia Espinosa Ed.s, Licensed Professional Counselor in Springfield, MO
Silvia Espinosa Ed.s
Licensed Professional Counselor, NCC
Verified Verified
Springfield, MO 65804
Have you been suffering in silence or struggling with relationships? Know that hope is near. We all have experienced pain that if left untreated, can keep us trapped, inhibiting our ability to enjoy life. There are three main areas that are dear to my heart: play therapy for children who’ve gone through adverse life experiences, marriage counseling for couples experiencing difficulty, and survivors of betrayal trauma: psychological/emotional, physical or sexual abuse. Know that it will take time to heal, courage to face the reality of your experience, and a steady commitment to your own healing.
Have you been suffering in silence or struggling with relationships? Know that hope is near. We all have experienced pain that if left untreated, can keep us trapped, inhibiting our ability to enjoy life. There are three main areas that are dear to my heart: play therapy for children who’ve gone through adverse life experiences, marriage counseling for couples experiencing difficulty, and survivors of betrayal trauma: psychological/emotional, physical or sexual abuse. Know that it will take time to heal, courage to face the reality of your experience, and a steady commitment to your own healing.
(417) 453-2767 View (417) 453-2767
Photo of The Candid Counselor, Licensed Professional Counselor in Springfield, MO
The Candid Counselor
Licensed Professional Counselor
Verified Verified
Springfield, MO 65807  (Online Only)
Change is hard and we are only motivated to change when we become uncomfortable with our current situation. Change also requires risk, commitment and hard work; I am looking for clients who are ready to take tangible steps towards change, personal growth, and mental health improvement using a telehealth platform that allows you to remain in the safety and comfort of your own environment, with no time wasted for travel. I’m accepting clients who reside in Missouri and flexible scheduling is offered. Call or email me for a free consultation to see if I’d be a good fit for you and your mental health goals.
Change is hard and we are only motivated to change when we become uncomfortable with our current situation. Change also requires risk, commitment and hard work; I am looking for clients who are ready to take tangible steps towards change, personal growth, and mental health improvement using a telehealth platform that allows you to remain in the safety and comfort of your own environment, with no time wasted for travel. I’m accepting clients who reside in Missouri and flexible scheduling is offered. Call or email me for a free consultation to see if I’d be a good fit for you and your mental health goals.
(417) 302-3004 View (417) 302-3004
Photo of Maribeth Primm, Licensed Professional Counselor in Springfield, MO
Maribeth Primm
Licensed Professional Counselor, LPC, NCC
Verified Verified
1 Endorsed
Springfield, MO 65802
Waitlist for new clients
Hi! I'm Maribeth, an EMDR Certified Therapist, and I'm glad you've found me! It's so important to feel a sense of connection with a therapist. My philosophy is simple - I believe that we are all born as divine lights of the universe, but that through the course of our lives we are given messages through the words or acts of others, or sometimes even ourselves, that impact how we see ourselves and the world. My style of therapy focuses on helping people change those messages to reflect the true nature of each of us - one of wholeness. Therapy, to me, is the act of holding space for someone as they journey towards their awakening.
Hi! I'm Maribeth, an EMDR Certified Therapist, and I'm glad you've found me! It's so important to feel a sense of connection with a therapist. My philosophy is simple - I believe that we are all born as divine lights of the universe, but that through the course of our lives we are given messages through the words or acts of others, or sometimes even ourselves, that impact how we see ourselves and the world. My style of therapy focuses on helping people change those messages to reflect the true nature of each of us - one of wholeness. Therapy, to me, is the act of holding space for someone as they journey towards their awakening.
(417) 280-3386 View (417) 280-3386
Photo of Jennifer Byrd, Pre-Licensed Professional in Springfield, MO
Jennifer Byrd
Pre-Licensed Professional, MS, PLPC
Verified Verified
1 Endorsed
Springfield, MO 65804
I believe humans all have the potential to develop, grow, and heal. As a Provisionally Licensed Professional Counselor, I work with individuals (teens and adults) and couples on issues related to depression, anxiety, relationship issues, career struggles, self-esteem, women’s issues, LGBTQ+ issues, life transitions, trauma, and grief.
I believe humans all have the potential to develop, grow, and heal. As a Provisionally Licensed Professional Counselor, I work with individuals (teens and adults) and couples on issues related to depression, anxiety, relationship issues, career struggles, self-esteem, women’s issues, LGBTQ+ issues, life transitions, trauma, and grief.
(417) 216-6636 View (417) 216-6636
Photo of Mending Hearts Counseling, Counselor in Springfield, MO
Mending Hearts Counseling
Counselor, LPC, LCPC
Verified Verified
2 Endorsed
Springfield, MO 65804  (Online Only)
Are you looking for a safe space to explore sexuality and/or gender identity? Are you looking for a professional who is affirmative, empathetic, and well-trained with the LBGTQIA+ community? Look no further than Mending Hearts Counseling. My name is Marissa Moore, and I believe that every person deserves an empathetic and non-judgmental space to explore their sexuality and/or gender identity. Through our therapeutic relationship, we identify goals for managing stress, learning new coping methods, and improving relationships.
Are you looking for a safe space to explore sexuality and/or gender identity? Are you looking for a professional who is affirmative, empathetic, and well-trained with the LBGTQIA+ community? Look no further than Mending Hearts Counseling. My name is Marissa Moore, and I believe that every person deserves an empathetic and non-judgmental space to explore their sexuality and/or gender identity. Through our therapeutic relationship, we identify goals for managing stress, learning new coping methods, and improving relationships.
(417) 228-2480 View (417) 228-2480
Photo of Counseling Group of the Ozarks, Clinical Social Work/Therapist in Springfield, MO
Counseling Group of the Ozarks
Clinical Social Work/Therapist, MA, LPC
Verified Verified
1 Endorsed
Springfield, MO 65804
Waitlist for new clients
You even checking out this site shows how much strength and bravery you have. Just know that you don’t have to go through things alone. We believe people seek out help when the things they do to deal with life no longer work. A lot of people think counseling is only for those who need “professional help,” but it’s really about talking to someone who is safe and not biased about what you should think or feel. You make think “there must be better out there,” — a better life, a way to feel less stressed, a happier marriage, a job you love… but you are just trying to survive this day.
You even checking out this site shows how much strength and bravery you have. Just know that you don’t have to go through things alone. We believe people seek out help when the things they do to deal with life no longer work. A lot of people think counseling is only for those who need “professional help,” but it’s really about talking to someone who is safe and not biased about what you should think or feel. You make think “there must be better out there,” — a better life, a way to feel less stressed, a happier marriage, a job you love… but you are just trying to survive this day.
(417) 212-5724 View (417) 212-5724
Photo of Leah N Musacchio, Pre-Licensed Professional in Springfield, MO
Leah N Musacchio
Pre-Licensed Professional, MSW, Intern
Verified Verified
1 Endorsed
Springfield, MO 65807
Have you ever lived abroad and returned to your home country with frustrations and experiences that others don’t quite understand. Have you ever felt stuck in those experiences and have a hard time moving forward. Or maybe you have just moved to another country and you’re having a difficult time adjusting to your new culture. If this is you, Leah would love to sit and process those thoughts with you.
Have you ever lived abroad and returned to your home country with frustrations and experiences that others don’t quite understand. Have you ever felt stuck in those experiences and have a hard time moving forward. Or maybe you have just moved to another country and you’re having a difficult time adjusting to your new culture. If this is you, Leah would love to sit and process those thoughts with you.
(417) 557-3571 View (417) 557-3571
Photo of Dr. C Steven Shaffer Phd, Licensed Professional Counselor in Springfield, MO
Dr. C Steven Shaffer Phd
Licensed Professional Counselor, PhD, LPC, NBCC
Verified Verified
Springfield, MO 65810  (Online Only)
Most of my clients are facing relational challenges due to areas that are out of balance in their lives. At the present time, I have about 100 clients. I spend much time working with people with high levels of stress, anxiety and depression. My greatest strengths are in Marriage & Family and Youth Counseling due to the fact that I look for root problems in the lives of people and find ways to retrain them so that they can be much more functional. I am also very effective with self-esteem issues. With additional counselors we can address substance abuse, weight management, child custody issues, divorce mediation, etc.
Most of my clients are facing relational challenges due to areas that are out of balance in their lives. At the present time, I have about 100 clients. I spend much time working with people with high levels of stress, anxiety and depression. My greatest strengths are in Marriage & Family and Youth Counseling due to the fact that I look for root problems in the lives of people and find ways to retrain them so that they can be much more functional. I am also very effective with self-esteem issues. With additional counselors we can address substance abuse, weight management, child custody issues, divorce mediation, etc.
(417) 620-0416 View (417) 620-0416
Photo of Krystle Robinson Eckhart, Psychologist in Springfield, MO
Krystle Robinson Eckhart
Psychologist, PsyD, LP, HSP
Verified Verified
Springfield, MO 65804  (Online Only)
I work with individuals with a wide range of concerns. My clinical specialties and interests include disordered eating, body image, obesity and weight loss, LGBTQ, gender identity, phase of life transitions, grief/loss, relationships, assertive communication, issues related to trauma/adverse life experiences, holistic health and wellness, self-compassion, and promoting self-awareness and insight. My background includes significant experience in the delivery of behavioral health care including individual psychotherapy and inpatient, intensive-outpatient, and outpatient groups. In addition to my experience with psychotherapy services, I also complete psychological assessments, provide supervision to pre-doctoral psychology interns, and consultation services.
I work with individuals with a wide range of concerns. My clinical specialties and interests include disordered eating, body image, obesity and weight loss, LGBTQ, gender identity, phase of life transitions, grief/loss, relationships, assertive communication, issues related to trauma/adverse life experiences, holistic health and wellness, self-compassion, and promoting self-awareness and insight. My background includes significant experience in the delivery of behavioral health care including individual psychotherapy and inpatient, intensive-outpatient, and outpatient groups. In addition to my experience with psychotherapy services, I also complete psychological assessments, provide supervision to pre-doctoral psychology interns, and consultation services.
(417) 238-0530 View (417) 238-0530
Photo of Genevieve Nelson, Licensed Professional Counselor in Springfield, MO
Genevieve Nelson
Licensed Professional Counselor, MS, LPC, NCC
Verified Verified
Springfield, MO 65804
Gen is a licensed professional counselor with extensive experience in grief work (all ages) and counseling teens. Regardless of age or specific concern, Gen will provide you with a safe & supportive space to navigate your journey. With empathy and compassion, she will help you process your emotions, honor your unique experience, & find healing along the way.
Gen is a licensed professional counselor with extensive experience in grief work (all ages) and counseling teens. Regardless of age or specific concern, Gen will provide you with a safe & supportive space to navigate your journey. With empathy and compassion, she will help you process your emotions, honor your unique experience, & find healing along the way.
(417) 387-3329 View (417) 387-3329
Photo of Dr. Jonnie Mae Middletonlotte, Licensed Professional Counselor in Springfield, MO
Dr. Jonnie Mae Middletonlotte
Licensed Professional Counselor, PhD,, MS,, LPC
Verified Verified
1 Endorsed
Springfield, MO 65804
Personal conflict can cause chaos in your life, but the appropriate resolution can nurture healthy relationships and personal growth. If you are ready to dig in and do the hard work, together we can work towards the more peaceful and happy life you desire. We offer Substance use groups for adults and adolescents. We are Christian centered and use a variety of research-based therapeutic methods of counseling to find what works best for our clients. I believe therapy should be started with the end in mind, so our goal is to bring about peace and balance in a timely manner.
Personal conflict can cause chaos in your life, but the appropriate resolution can nurture healthy relationships and personal growth. If you are ready to dig in and do the hard work, together we can work towards the more peaceful and happy life you desire. We offer Substance use groups for adults and adolescents. We are Christian centered and use a variety of research-based therapeutic methods of counseling to find what works best for our clients. I believe therapy should be started with the end in mind, so our goal is to bring about peace and balance in a timely manner.
(417) 283-4940 View (417) 283-4940
Photo of Lacey Kinzer, Licensed Professional Counselor in Springfield, MO
Lacey Kinzer
Licensed Professional Counselor, MS, LPC
Verified Verified
1 Endorsed
Springfield, MO 65804
If you are an adult or teenager struggling with anxiety, relationship issues, trauma issues, self-esteem, or setting boundaries, I would love to help you. Couples who are struggling with relationship issues are also welcome as I have a passion and experience in marital/couples therapy and helping relationships succeed. I have also been trained in EMDR which assists clients in rapid reduction of trauma-related symptoms resulting in overall healing. I have had specialized training in DBT and have assisted clients in learning and implementing these skills as well.
If you are an adult or teenager struggling with anxiety, relationship issues, trauma issues, self-esteem, or setting boundaries, I would love to help you. Couples who are struggling with relationship issues are also welcome as I have a passion and experience in marital/couples therapy and helping relationships succeed. I have also been trained in EMDR which assists clients in rapid reduction of trauma-related symptoms resulting in overall healing. I have had specialized training in DBT and have assisted clients in learning and implementing these skills as well.
(417) 275-2688 View (417) 275-2688
Photo of Cassandra Eskoff, Licensed Professional Counselor in Springfield, MO
Cassandra Eskoff
Licensed Professional Counselor, MS, LPC
Verified Verified
Springfield, MO 65807  (Online Only)
I know how life changing it can be to have someone in your corner. I bring a genuine energy to sessions as I help clients navigate human experiences and difficult emotions. I have experience working with people struggling with mood disorders, ADHD, OCD, intrusive thoughts, relationship issues, and trauma. Some of my approaches include person-centered, cognitive behavioral therapy (CBT), psychoanalysis, and solution-focused brief therapy (SFBT). It is my privilege as your therapist to meet you where you’re at and help you get where you’re trying to go without judgement. I’d be honored to be the person in your corner!
I know how life changing it can be to have someone in your corner. I bring a genuine energy to sessions as I help clients navigate human experiences and difficult emotions. I have experience working with people struggling with mood disorders, ADHD, OCD, intrusive thoughts, relationship issues, and trauma. Some of my approaches include person-centered, cognitive behavioral therapy (CBT), psychoanalysis, and solution-focused brief therapy (SFBT). It is my privilege as your therapist to meet you where you’re at and help you get where you’re trying to go without judgement. I’d be honored to be the person in your corner!
(417) 510-4585 View (417) 510-4585
Photo of Andrea Frey Metzger, Licensed Professional Counselor in Springfield, MO
Andrea Frey Metzger
Licensed Professional Counselor, MS, LPC, NCC
Verified Verified
Springfield, MO 65809  (Online Only)
Whether you are struggling in your relationship, dealing with loneliness from the multiple issues we've dealt with the past year (pandemic, grief, trauma), or simply needing to process some things with someone objectively, I believe the therapeutic relationship can be a platform for deep transformation and continued growth.
Whether you are struggling in your relationship, dealing with loneliness from the multiple issues we've dealt with the past year (pandemic, grief, trauma), or simply needing to process some things with someone objectively, I believe the therapeutic relationship can be a platform for deep transformation and continued growth.
(417) 212-5297 View (417) 212-5297
Photo of Rita Windle, Clinical Social Work/Therapist in Springfield, MO
Rita Windle
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Springfield, MO 65804
Hello, I'm Rita, a Licensed Clinical Social Worker, and I hold a master's degree in social work from the University of Missouri-Columbia. With over three decades of experience in the field, I have had the privilege of providing individual, couples, family, group, and substance abuse counseling. I enjoy providing play therapy, and I have developed a specialization in women's mental health care. Throughout my career, I've had the honor of assisting clients facing various challenges such as depression, anxiety, trauma, job stress, relationship issues, grief, codependency, and major life changes, including divorce.
Hello, I'm Rita, a Licensed Clinical Social Worker, and I hold a master's degree in social work from the University of Missouri-Columbia. With over three decades of experience in the field, I have had the privilege of providing individual, couples, family, group, and substance abuse counseling. I enjoy providing play therapy, and I have developed a specialization in women's mental health care. Throughout my career, I've had the honor of assisting clients facing various challenges such as depression, anxiety, trauma, job stress, relationship issues, grief, codependency, and major life changes, including divorce.
(417) 665-5747 View (417) 665-5747
Photo of Gayle Robertson, Marriage & Family Therapist in Springfield, MO
Gayle Robertson
Marriage & Family Therapist, MA, LMFT, LPC
Verified Verified
Springfield, MO 65804
That elephant in the room – it just continues to stand there staring at you. Days pass and you keep noticing, but don’t do anything about it. You know you need to make some changes, but it’s really a lot easier to just ignore what’s right in front of you. Until, your partner complains again that you’re not listening, you’re always on your phone, you don’t spend time together. While the memories of your past blowups stare you in the face, and sadness overcomes you, you decide you can’t keep living with the sense of disconnect that has grown between you. You need someone else’s help to solve your problems.
That elephant in the room – it just continues to stand there staring at you. Days pass and you keep noticing, but don’t do anything about it. You know you need to make some changes, but it’s really a lot easier to just ignore what’s right in front of you. Until, your partner complains again that you’re not listening, you’re always on your phone, you don’t spend time together. While the memories of your past blowups stare you in the face, and sadness overcomes you, you decide you can’t keep living with the sense of disconnect that has grown between you. You need someone else’s help to solve your problems.
(417) 815-4892 View (417) 815-4892

How does your Therapist compare?

Number of Therapists in Springfield, MO

300+

Average cost per session

$110

Therapists in Springfield, MO who prioritize treating:

90% Anxiety
84% Depression
75% Trauma and PTSD
74% Self Esteem
72% Relationship Issues
69% Coping Skills
68% Stress

Average years in practice

9 Years

Top 3 insurances accepted

72% Aetna
64% Cigna and Evernorth
64% UnitedHealthcare UHC | UBH

How Therapists in Springfield, MO see their clients

76% In Person and Online
24% Online Only

Gender breakdown

81% Female
18% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Springfield?

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.