Therapists in Portland, OR

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Photo of Sonali Patel, Marriage & Family Therapist in Portland, OR
Sonali Patel
Marriage & Family Therapist, MA, LMFT, CADC1
Verified Verified
3 Endorsed
Portland, OR 97239
As a family therapist, I believe that each family, couple and individual has the ability to heal using their own internal strengths. My focus is on restoring balance and building communication within families as they are integral in increasing the overall well-being of individuals, couples and families. I identify symptoms such as marital discord, addiction, behavioral issues among children and adolescents, mental and medical health issues as becoming an unhelpful part of the family system. My approach to reduce the impact of these symptoms and break harmful patterns is collaborative, encouraging members to be open and honest throughout the progression of therapy.
As a family therapist, I believe that each family, couple and individual has the ability to heal using their own internal strengths. My focus is on restoring balance and building communication within families as they are integral in increasing the overall well-being of individuals, couples and families. I identify symptoms such as marital discord, addiction, behavioral issues among children and adolescents, mental and medical health issues as becoming an unhelpful part of the family system. My approach to reduce the impact of these symptoms and break harmful patterns is collaborative, encouraging members to be open and honest throughout the progression of therapy.
(503) 894-5612 View (503) 894-5612
Photo of Jules Allison, Licensed Professional Counselor in Portland, OR
Jules Allison
Licensed Professional Counselor, MA, LPC, CADC II
Verified Verified
Portland, OR 97214
As a Queer and Non-binary supervisor I use feminist and strengths-based approaches to supervise from a social justice oriented lens. I also strive to help my supervisees in their own career development— especially as it concerns how to make a good living while keeping therapy accessible within the context of private practice.
As a Queer and Non-binary supervisor I use feminist and strengths-based approaches to supervise from a social justice oriented lens. I also strive to help my supervisees in their own career development— especially as it concerns how to make a good living while keeping therapy accessible within the context of private practice.
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Photo of David Keller, Pre-Licensed Professional in Portland, OR
David Keller
Pre-Licensed Professional, MS, NCC, LPCA
Verified Verified
1 Endorsed
Portland, OR 97202
Not accepting new clients
I believe that all people possess the desire for growth and development in their lives. When we encounter relationships or circumstances that overwhelm our ability to cope with them, we can begin to develop maladaptive patterns that make us feel stuck. Therapy can help clients develop insight into their behaviors, challenge patterns that aren’t working, and develop the resilience they need to continue seeking growth and development.
I believe that all people possess the desire for growth and development in their lives. When we encounter relationships or circumstances that overwhelm our ability to cope with them, we can begin to develop maladaptive patterns that make us feel stuck. Therapy can help clients develop insight into their behaviors, challenge patterns that aren’t working, and develop the resilience they need to continue seeking growth and development.
(503) 854-0079 View (503) 854-0079
Photo of Katheryn Rose Hayward, Clinical Social Work/Therapist in Portland, OR
Katheryn Rose Hayward
Clinical Social Work/Therapist, LCSW
Verified Verified
Portland, OR 97283  (Online Only)
Not accepting new clients
My name is Katheryn. I am a Licensed Clinical Social Worker who has an extensive history of working with children, adults, and older adults in a variety of community, inpatient and outpatient settings. I work under an eclectic framework and primarily support individuals who experience anxiety, phobias, depression, and trauma related symptoms. Using a strengths-based approach, I guide individuals in bringing change to their lives that is positive and constructive. I believe in creating safe, collaborative environments for individuals to take on their journey toward growth and healing. I am licensed in California and Oregon.
My name is Katheryn. I am a Licensed Clinical Social Worker who has an extensive history of working with children, adults, and older adults in a variety of community, inpatient and outpatient settings. I work under an eclectic framework and primarily support individuals who experience anxiety, phobias, depression, and trauma related symptoms. Using a strengths-based approach, I guide individuals in bringing change to their lives that is positive and constructive. I believe in creating safe, collaborative environments for individuals to take on their journey toward growth and healing. I am licensed in California and Oregon.
(971) 999-3177 View (971) 999-3177
Photo of Ryan T Samples, Professional Counselor Associate in Portland, OR
Ryan T Samples
Professional Counselor Associate, MA
Verified Verified
1 Endorsed
Portland, OR 97223
Have growing anxiety and stress that is becoming unmanageable? Feeling angry? Feeling stuck in the past or numb in the present? Having trouble sleeping? Find yourself being over critical of yourself? In a messy relationship and unsure what you can or want to do? Maybe frustrated with work and curious about a new career path but not sure where to start? It is not hard to find people around us who want to tell us what to think and how to act. What is hard to find is a space that is quiet and safe, that allows us the ability to recognize our own feelings and align them with our own thoughts.
Have growing anxiety and stress that is becoming unmanageable? Feeling angry? Feeling stuck in the past or numb in the present? Having trouble sleeping? Find yourself being over critical of yourself? In a messy relationship and unsure what you can or want to do? Maybe frustrated with work and curious about a new career path but not sure where to start? It is not hard to find people around us who want to tell us what to think and how to act. What is hard to find is a space that is quiet and safe, that allows us the ability to recognize our own feelings and align them with our own thoughts.
(503) 868-0513 View (503) 868-0513
Photo of Jessica Klein, Clinical Social Work/Therapist in Portland, OR
Jessica Klein
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Portland, OR 97219
In-Person Availability (Starting April 2024) I am an interactive therapist who will work to find unique tools and solutions for you. I specialize in couples therapy and adult individual therapy. I have advanced training in Emotionally Focused Therapy, an approach that helps couples increase closeness and heal through understanding each together, increasing empathy and interrupting destructive cycles. I also specialize in trauma and use EMDR (Eye Movement Desensitization & Reprocessing), somatic psychotherapy, polyvagal theory, and mindfulness tools to help clients stabilize their systems, process trauma and heal.
In-Person Availability (Starting April 2024) I am an interactive therapist who will work to find unique tools and solutions for you. I specialize in couples therapy and adult individual therapy. I have advanced training in Emotionally Focused Therapy, an approach that helps couples increase closeness and heal through understanding each together, increasing empathy and interrupting destructive cycles. I also specialize in trauma and use EMDR (Eye Movement Desensitization & Reprocessing), somatic psychotherapy, polyvagal theory, and mindfulness tools to help clients stabilize their systems, process trauma and heal.
(971) 545-4944 View (971) 545-4944
Photo of Jennifer Gray Counseling, Licensed Professional Counselor in Portland, OR
Jennifer Gray Counseling
Licensed Professional Counselor, LPC
Verified Verified
Portland, OR 97206  (Online Only)
Overwhelmed and exhausted with your business, you're now prepared to courageously reinvent a life you're absolutely passionate about! You aim to break free from the trap of comparison and perfectionism. You're eager to restore self-belief and break the chains of destructive cycles. You want authentic connections in every role. You wish to replace anxiety with strength and calm within. You aspire to be audacious and bold in a financially secure and liberating career. You're ready to revive your true essence: lively and inspired. You can go from Uncertain to Confident, Anxious to Calm, and Wanting to Fulfilled.
Overwhelmed and exhausted with your business, you're now prepared to courageously reinvent a life you're absolutely passionate about! You aim to break free from the trap of comparison and perfectionism. You're eager to restore self-belief and break the chains of destructive cycles. You want authentic connections in every role. You wish to replace anxiety with strength and calm within. You aspire to be audacious and bold in a financially secure and liberating career. You're ready to revive your true essence: lively and inspired. You can go from Uncertain to Confident, Anxious to Calm, and Wanting to Fulfilled.
(503) 461-1607 View (503) 461-1607
Photo of Nikki Humes, Marriage & Family Therapist in Portland, OR
Nikki Humes
Marriage & Family Therapist, LMFT
Verified Verified
Portland, OR 97215  (Online Only)
Clients typically reach out to me when some area of their life is not working well. This could be a new instance of something not working well, or it’s possible that something hasn’t been working well for a very long time. It could be a behavior, a relationship, a job, an attitude, a way of thinking or feeling, or it could be that the ways you used to cope are no longer working or serving you anymore. It’s a painful place to be when the old way doesn’t work anymore but you don’t yet know a new way. Therapy can be a powerful place to learn new tools for engaging in life and relationships that serve you and those around you better.
Clients typically reach out to me when some area of their life is not working well. This could be a new instance of something not working well, or it’s possible that something hasn’t been working well for a very long time. It could be a behavior, a relationship, a job, an attitude, a way of thinking or feeling, or it could be that the ways you used to cope are no longer working or serving you anymore. It’s a painful place to be when the old way doesn’t work anymore but you don’t yet know a new way. Therapy can be a powerful place to learn new tools for engaging in life and relationships that serve you and those around you better.
(503) 300-2907 View (503) 300-2907
Photo of Dr. Susan Stormer, Psychologist in Portland, OR
Dr. Susan Stormer
Psychologist, PhD
Verified Verified
Portland, OR 97205
Waitlist for new clients
Waitlist for clients. I work with individuals who struggle with feelings of anxiety, depression, and grief in many areas of life. Feeling overwhelmed is common in difficult times, and being misunderstood or judged by others can make things feel harder. I provide a warm and supportive environment while sharing information and skills to help you improve your relationship to yourself and others. All people need to feel like they have influence in their lives, healthy connections with others, and the ability to make effective changes when things aren't going well. Let's explore together to create goals that will develop your strengths.
Waitlist for clients. I work with individuals who struggle with feelings of anxiety, depression, and grief in many areas of life. Feeling overwhelmed is common in difficult times, and being misunderstood or judged by others can make things feel harder. I provide a warm and supportive environment while sharing information and skills to help you improve your relationship to yourself and others. All people need to feel like they have influence in their lives, healthy connections with others, and the ability to make effective changes when things aren't going well. Let's explore together to create goals that will develop your strengths.
(971) 645-4003 View (971) 645-4003
Photo of Jocelyn K Durant, Licensed Professional Counselor in Portland, OR
Jocelyn K Durant
Licensed Professional Counselor, MA, LPC
Verified Verified
2 Endorsed
Portland, OR 97232
Hello! I am a Play Therapist and Grief Counselor for children, tweens, adolescents and young adults. I have 20+ years of experience fostering individuals' self-expression, empowering growth and development, strengthening family dynamics, transforming traumatic events through play and other forms of creative expression, and compassionately addressing complex issues. I believe that with compassion and connection, individuals -from childhood to adulthood - can heal and grow, and find a renewed excitement in living.
Hello! I am a Play Therapist and Grief Counselor for children, tweens, adolescents and young adults. I have 20+ years of experience fostering individuals' self-expression, empowering growth and development, strengthening family dynamics, transforming traumatic events through play and other forms of creative expression, and compassionately addressing complex issues. I believe that with compassion and connection, individuals -from childhood to adulthood - can heal and grow, and find a renewed excitement in living.
(503) 210-9899 View (503) 210-9899
Photo of Mary Ann Russell, Counselor in Portland, OR
Mary Ann Russell
Counselor, LPC
Verified Verified
Portland, OR 97216
I believe every one of us is wired for healing and wholeness. My role as a counselor is to support you in removing the barriers to being your true self. I provide trauma-informed solution-focused therapy. We will focus on a specific goal until you feel you have progressed.
I believe every one of us is wired for healing and wholeness. My role as a counselor is to support you in removing the barriers to being your true self. I provide trauma-informed solution-focused therapy. We will focus on a specific goal until you feel you have progressed.
(503) 852-5267 View (503) 852-5267
Photo of Crystina Brazie, LCSW, Clinical Social Work/Therapist in Portland, OR
Crystina Brazie, LCSW
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Portland, OR 97225
My goal as a therapist and Clinical Supervisor is to increase your zest and vitality for life, to foster your ability to take action (empowerment), as well as to support you in having clarity (a clearer picture of yourself and others). Each of these goals, I believe, lead to an increased sense of self worth. In my time as a therapist, I have found that growth occurs both individually as well as in connection with others and that growth fostering relationships (of all kinds) that are created through mutual empathy and mutual empowerment are a key aspect of all of our lives.
My goal as a therapist and Clinical Supervisor is to increase your zest and vitality for life, to foster your ability to take action (empowerment), as well as to support you in having clarity (a clearer picture of yourself and others). Each of these goals, I believe, lead to an increased sense of self worth. In my time as a therapist, I have found that growth occurs both individually as well as in connection with others and that growth fostering relationships (of all kinds) that are created through mutual empathy and mutual empowerment are a key aspect of all of our lives.
(541) 488-8176 View (541) 488-8176
Photo of Julianna Waters, Clinical Social Work/Therapist in Portland, OR
Julianna Waters
Clinical Social Work/Therapist, LCSW
Verified Verified
Portland, OR 97206  (Online Only)
Finding the right therapist can be tricky business. It's all in the match. Honest, clearly communicated feedback, compassion for your difficulties, sound clinical skills and well over 20 years of clinical experience dealing with depression, anxiety, social isolation, grief/loss, relationship problems, work issues and co-occurring medical/emotional conditions are what I have to offer you. Our work will consist of exploring your therapeutic goals, working to understand how you're current and past experiences are impacting your life then practicing changes that will move you forward. We will be a team.
Finding the right therapist can be tricky business. It's all in the match. Honest, clearly communicated feedback, compassion for your difficulties, sound clinical skills and well over 20 years of clinical experience dealing with depression, anxiety, social isolation, grief/loss, relationship problems, work issues and co-occurring medical/emotional conditions are what I have to offer you. Our work will consist of exploring your therapeutic goals, working to understand how you're current and past experiences are impacting your life then practicing changes that will move you forward. We will be a team.
(458) 217-6118 View (458) 217-6118
Photo of Dr. Jason Jones, Psychologist in Portland, OR
Dr. Jason Jones
Psychologist, PhD
Verified Verified
Portland, OR 97205
I am currently accepting new patients! I have experience treating a broad range of mental health difficulties including anxiety, ADHD, and PTSD. I am thoughtful, and I listen with openness and compassion. I provide a non judgemental and compassionate approach to begin the healing process.
I am currently accepting new patients! I have experience treating a broad range of mental health difficulties including anxiety, ADHD, and PTSD. I am thoughtful, and I listen with openness and compassion. I provide a non judgemental and compassionate approach to begin the healing process.
(971) 298-8190 x1 View (971) 298-8190 x1
Photo of Misao Eliahim, Marriage & Family Therapist in Portland, OR
Misao Eliahim
Marriage & Family Therapist
Verified Verified
Portland, OR 97203  (Online Only)
I'm an African American mental health therapist who was born and raised in Portland, Oregon. As an African American person in Portland Oregon, I acutely recognize the health and safety risks associated with being a black person in a city where African Americans represent approximately 6% of the population.
I'm an African American mental health therapist who was born and raised in Portland, Oregon. As an African American person in Portland Oregon, I acutely recognize the health and safety risks associated with being a black person in a city where African Americans represent approximately 6% of the population.
(971) 231-1422 View (971) 231-1422
Photo of Barbara Eggenberger, Marriage & Family Therapist in Portland, OR
Barbara Eggenberger
Marriage & Family Therapist, MFT
Verified Verified
Portland, OR 97205  (Online Only)
I am a licensed Marriage Family Therapist serving clients via zoom in California and Oregon. If you struggle with chronic issues and have tried other therapists and are still struggling, I may be the therapist for you. I am a specialist in accessing early trauma and clearing it through the use of brain-based therapies such as EMDR and Brainspotting. I am certified in Brainspotting and Systemic Family Constellations and trained in EMDR I/II. I combine these three methods plus my natural empathic abilities to access blockages and clear them. You will feel immediately better!
I am a licensed Marriage Family Therapist serving clients via zoom in California and Oregon. If you struggle with chronic issues and have tried other therapists and are still struggling, I may be the therapist for you. I am a specialist in accessing early trauma and clearing it through the use of brain-based therapies such as EMDR and Brainspotting. I am certified in Brainspotting and Systemic Family Constellations and trained in EMDR I/II. I combine these three methods plus my natural empathic abilities to access blockages and clear them. You will feel immediately better!
(916) 571-9297 View (916) 571-9297
Photo of Christopher Lee Creaturo, Licensed Professional Counselor in Portland, OR
Christopher Lee Creaturo
Licensed Professional Counselor, MA, LPC
Verified Verified
1 Endorsed
Portland, OR 97205  (Online Only)
I work with clients to offer serious relief from the effects of trauma, depression and anxiety on their lives. Tools like EMDR and Internal Family Systems, as well the creation of a judgement-free space to talk can bring hope to the stuck parts of our worlds, and finally allow us to be present in our own lives again. Finding relief can feel like taking a first deep breath after being underwater for a long time, and that's an outcome worth fighting together for. Please email to learn more and find our if we make a good therapy team.
I work with clients to offer serious relief from the effects of trauma, depression and anxiety on their lives. Tools like EMDR and Internal Family Systems, as well the creation of a judgement-free space to talk can bring hope to the stuck parts of our worlds, and finally allow us to be present in our own lives again. Finding relief can feel like taking a first deep breath after being underwater for a long time, and that's an outcome worth fighting together for. Please email to learn more and find our if we make a good therapy team.
(458) 217-6034 View (458) 217-6034
Photo of Relationship Centered Counseling, Licensed Professional Counselor in Portland, OR
Relationship Centered Counseling
Licensed Professional Counselor, MA, LPC, LMHCA
Verified Verified
Portland, OR 97232
Are you feeling internally conflicted? Is that is making you feel stuck and anxious? Maybe that internal conflict is manifesting in conflicts with others? Maybe you are just going around in circles in or your head, or worse, on a downward spiral? Do you berate yourself and it doesn't help? Are you ready to be kinder to yourself? Are you ready to be curious about yourself? Are you ready to get along with yourself and others better? Do you want more freedom, choice, autonomy, even agency in your life, but are struggling with how to get it? I can help with a "yes" to any or all of these questions.
Are you feeling internally conflicted? Is that is making you feel stuck and anxious? Maybe that internal conflict is manifesting in conflicts with others? Maybe you are just going around in circles in or your head, or worse, on a downward spiral? Do you berate yourself and it doesn't help? Are you ready to be kinder to yourself? Are you ready to be curious about yourself? Are you ready to get along with yourself and others better? Do you want more freedom, choice, autonomy, even agency in your life, but are struggling with how to get it? I can help with a "yes" to any or all of these questions.
(503) 308-7860 View (503) 308-7860
Photo of Katherine Lindsay, Clinical Social Worker Associate in Portland, OR
Katherine Lindsay
Clinical Social Worker Associate, CSWA, CADCI
Verified Verified
1 Endorsed
Portland, OR 97223
In both my work and personal life, I am a firm believer in the benefits of therapy and the ability to integrate our challenges into our lives to create new and healthy dynamics. I am warm, creative, affirming, and direct as a therapist. I believe personal growth is a collaborative endeavor that requires caring, free from judgment. I work with individuals across the lifespan and have experience in a variety of mental health treatment settings.
In both my work and personal life, I am a firm believer in the benefits of therapy and the ability to integrate our challenges into our lives to create new and healthy dynamics. I am warm, creative, affirming, and direct as a therapist. I believe personal growth is a collaborative endeavor that requires caring, free from judgment. I work with individuals across the lifespan and have experience in a variety of mental health treatment settings.
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Photo of Caleb Abrams in Portland, OR
Caleb Abrams
CSAT, CCTP, CLC, MA
Verified Verified
1 Endorsed
Portland, OR 97232  (Online Only)
Caleb is Certified in the Treatment of Sexual Addiction, is a Certified Clinical Trauma Professional, Ordained Minister, Certified Life Coach, with a Masters of Psychology in Counseling and a Bachelors of Arts in Psychology. Caleb specializes in helping men work through sex addiction but provides counseling services for all kinds of addictions. He also works with clients that are struggling with anxiety, addictive behaviors, depression, PTSD, emotional abuse, mental abuse and trauma of various kinds. His passion is to provide a safe space for his clients and to walk hand-in-hand with them, guiding them through the healing process.
Caleb is Certified in the Treatment of Sexual Addiction, is a Certified Clinical Trauma Professional, Ordained Minister, Certified Life Coach, with a Masters of Psychology in Counseling and a Bachelors of Arts in Psychology. Caleb specializes in helping men work through sex addiction but provides counseling services for all kinds of addictions. He also works with clients that are struggling with anxiety, addictive behaviors, depression, PTSD, emotional abuse, mental abuse and trauma of various kinds. His passion is to provide a safe space for his clients and to walk hand-in-hand with them, guiding them through the healing process.
(207) 259-4977 View (207) 259-4977

How does your Therapist compare?

Number of Therapists in Portland, OR

3,000+

Average cost per session

$160

Therapists in Portland, OR who prioritize treating:

91% Anxiety
85% Depression
78% Relationship Issues
76% Self Esteem
74% Trauma and PTSD
71% Stress
68% Life Transitions

Average years in practice

10 Years

Top 3 insurances accepted

55% PacificSource
47% Aetna
38% BlueCross and BlueShield

How Therapists in Portland, OR see their clients

56% In Person and Online
44% Online Only

Gender breakdown

75% Female
21% Male
4% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Portland?

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.