Therapists in Spokane, WA

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Photo of Sean P O'Brien, Clinical Social Work/Therapist in Spokane, WA
Sean P O'Brien
Clinical Social Work/Therapist, LICSW
Verified Verified
Spokane, WA 99208
Do you feel stuck in patterns that are no longer serving you? Do you want to be more fulfilled at work and home? Do you have a history of trauma or abuse that is impacting your daily life? Wherever you are in your journey, I am here to support you with a safe, supportive and non-judgmental space. My goal is to help you understand yourself and to develop practical skills that align with your values and empower you to live a more gratifying life.
Do you feel stuck in patterns that are no longer serving you? Do you want to be more fulfilled at work and home? Do you have a history of trauma or abuse that is impacting your daily life? Wherever you are in your journey, I am here to support you with a safe, supportive and non-judgmental space. My goal is to help you understand yourself and to develop practical skills that align with your values and empower you to live a more gratifying life.
(509) 587-1734 View (509) 587-1734
Photo of Ilana Skarling, Clinical Social Work/Therapist in Spokane, WA
Ilana Skarling
Clinical Social Work/Therapist, MSW, LICSW
Verified Verified
1 Endorsed
Spokane, WA 99201  (Online Only)
You are not too much. Nor is what you have been through too much. If you struggle with gender or sexual identity, sexual or domestic violence, or other forms of lasting trauma, I can help. Just know that I believe you to be, at this moment, exactly who you need to be in order to survive. I also believe that things can get better.
You are not too much. Nor is what you have been through too much. If you struggle with gender or sexual identity, sexual or domestic violence, or other forms of lasting trauma, I can help. Just know that I believe you to be, at this moment, exactly who you need to be in order to survive. I also believe that things can get better.
(206) 752-5508 View (206) 752-5508
Photo of Talk With Mel, PLLC, Clinical Social Work/Therapist in Spokane, WA
Talk With Mel, PLLC
Clinical Social Work/Therapist, LICSW
Verified Verified
Spokane, WA 99201  (Online Only)
I’m glad you’re here. I’d like to think I provide a welcoming atmosphere and warmth to the people I meet and work with. Hence, Talk With Mel, PLLC was created and built to provide a space where you and I can come together, and what else? - talk.
I’m glad you’re here. I’d like to think I provide a welcoming atmosphere and warmth to the people I meet and work with. Hence, Talk With Mel, PLLC was created and built to provide a space where you and I can come together, and what else? - talk.
(206) 558-5783 View (206) 558-5783
Photo of Olivia Hope Morgaine in Spokane, WA
Olivia Hope Morgaine
MA, LMHCA
Verified Verified
Spokane, WA 99201  (Online Only)
Generally, we react to suffering and what we struggle with by trying to fix perceived problems, our selves, or others. It is natural to not want to suffer, but often our very resistance to suffering, or the habits we develop to avoid discomfort and pain work against us. I provide an integrative, soul-nourishing approach to therapy rooted in embodied depth psychology, health coaching, and mindfulness practices that encourages fully accepting ourselves: our bodies, feelings, and thoughts as they are.
Generally, we react to suffering and what we struggle with by trying to fix perceived problems, our selves, or others. It is natural to not want to suffer, but often our very resistance to suffering, or the habits we develop to avoid discomfort and pain work against us. I provide an integrative, soul-nourishing approach to therapy rooted in embodied depth psychology, health coaching, and mindfulness practices that encourages fully accepting ourselves: our bodies, feelings, and thoughts as they are.
(808) 707-7540 View (808) 707-7540
Photo of Tiffany London Riddle, Marriage & Family Therapist Associate in Spokane, WA
Tiffany London Riddle
Marriage & Family Therapist Associate, MA, LMFTA, MBA
Verified Verified
Spokane, WA 99204
I am confident people can experience and live within healthy relationships showing up self-assured of who they are and how they communicate with the ability to create change and heal within themselves. My psychotherapy practice focuses on relationships. I enjoy helping people understand the complexities of their human interactions using simple words. I like to help people feel understood, look at their joys and pains, and be motivated to change which all leads to a life experiencing Jagged Joy.
I am confident people can experience and live within healthy relationships showing up self-assured of who they are and how they communicate with the ability to create change and heal within themselves. My psychotherapy practice focuses on relationships. I enjoy helping people understand the complexities of their human interactions using simple words. I like to help people feel understood, look at their joys and pains, and be motivated to change which all leads to a life experiencing Jagged Joy.
(509) 204-1796 View (509) 204-1796
Photo of Family Essentials Counseling North, Counselor in Spokane, WA
Family Essentials Counseling North
Counselor, PhD, LMHC, LMFT, LICSW
Verified Verified
1 Endorsed
Spokane, WA 99208
At Family Essentials Counseling we work with you to select the right counselor for you and your needs. On our website you'll find detailed information on providers available - FamilyEssentialsCounseling.com We also have our own ARNP who can help you with medication management.
At Family Essentials Counseling we work with you to select the right counselor for you and your needs. On our website you'll find detailed information on providers available - FamilyEssentialsCounseling.com We also have our own ARNP who can help you with medication management.
(509) 253-1984 View (509) 253-1984
Photo of Kendra Corey, Counselor in Spokane, WA
Kendra Corey
Counselor, LMHC
Verified Verified
5 Endorsed
Spokane, WA 99224
Counseling is a sacred experience in which a client and therapist venture into hidden pains, untold stories, and the darkness of sin together. As a Christian, I believe that the healing journey cannot happen apart from the Holy Spirit, the Great Counselor. But as a trained, Clinical Mental Health Counselor, I know that faith communities, Christian family members, and other close Christian relationships often fail to authentically meet us in the depths of our despair and sorrow. With me as your counselor, I hope you will find a spaciousness to be your full imperfect self without fear of judgement or shame.
Counseling is a sacred experience in which a client and therapist venture into hidden pains, untold stories, and the darkness of sin together. As a Christian, I believe that the healing journey cannot happen apart from the Holy Spirit, the Great Counselor. But as a trained, Clinical Mental Health Counselor, I know that faith communities, Christian family members, and other close Christian relationships often fail to authentically meet us in the depths of our despair and sorrow. With me as your counselor, I hope you will find a spaciousness to be your full imperfect self without fear of judgement or shame.
(509) 236-8382 View (509) 236-8382
Photo of Sarah Harrison, Licensed Professional Counselor in Spokane, WA
Sarah Harrison
Licensed Professional Counselor, LPC, MHCA
Verified Verified
4 Endorsed
Spokane, WA 99204  (Online Only)
My approach involves empathically engaging with your past, present, and future to increase self-empowerment and identify new paths toward thriving. The process of therapy is a collaboration between the client and clinician, but you will be the ultimate agent of change in your life. At the heart of my process, I use sensitive-inquiry and mindfulness-based practices to nudge you toward an integrated relationship with yourself. I will encourage you to feel deeply, tune into the physical sensations of your emotions, and find meaning-making systems. Self-compassion is a primary emphasis in my work.
My approach involves empathically engaging with your past, present, and future to increase self-empowerment and identify new paths toward thriving. The process of therapy is a collaboration between the client and clinician, but you will be the ultimate agent of change in your life. At the heart of my process, I use sensitive-inquiry and mindfulness-based practices to nudge you toward an integrated relationship with yourself. I will encourage you to feel deeply, tune into the physical sensations of your emotions, and find meaning-making systems. Self-compassion is a primary emphasis in my work.
(503) 751-8597 View (503) 751-8597
Photo of Ruby Moon, Counselor in Spokane, WA
Ruby Moon
Counselor, EdS, NCSP, LMHCA
Verified Verified
Spokane, WA 99201
As a metaphysical psychotherapist and holistic healer, my work lies in the intersection of spirituality and the embodied human experience. I offer a loving space for high-vibrational healing – healing that honors your lived human experience, as well as your divine, intuitive knowing. I help clients get back into their bodies to reconnect with their innate wisdom and intuition, and attune to their own inner guidance system. When we cultivate an awareness of both our divinity and humanity, we become who we intended to be: whole, authentic, embodied. We gift our unique beauty to ourselves and the world.
As a metaphysical psychotherapist and holistic healer, my work lies in the intersection of spirituality and the embodied human experience. I offer a loving space for high-vibrational healing – healing that honors your lived human experience, as well as your divine, intuitive knowing. I help clients get back into their bodies to reconnect with their innate wisdom and intuition, and attune to their own inner guidance system. When we cultivate an awareness of both our divinity and humanity, we become who we intended to be: whole, authentic, embodied. We gift our unique beauty to ourselves and the world.
(509) 712-3070 View (509) 712-3070
Photo of Laura Alvarez, Counselor in Spokane, WA
Laura Alvarez
Counselor, LMHC
Verified Verified
Spokane, WA 99201
Years ago I grew increasingly aware of how anxiety affects our behaviors that are not representative of who we are. I studied mindfulness interventions that came from Positive Psychology and Dialectical Behavior Therapy. After personal practice and assistance to my clients in group and individual settings we experienced and witnessed decreased stress, improved self-regulation, and a quicker way to access joy, acceptance, and peace with ourselves and others.
Years ago I grew increasingly aware of how anxiety affects our behaviors that are not representative of who we are. I studied mindfulness interventions that came from Positive Psychology and Dialectical Behavior Therapy. After personal practice and assistance to my clients in group and individual settings we experienced and witnessed decreased stress, improved self-regulation, and a quicker way to access joy, acceptance, and peace with ourselves and others.
(509) 361-6654 View (509) 361-6654
Photo of Allie Zachariades, Counselor in Spokane, WA
Allie Zachariades
Counselor, MA, LMHC, RYT
Verified Verified
4 Endorsed
Spokane, WA 99204
I enjoy working with clients who are experiencing difficult life transitions, adoption, sexual trauma, mood and anxiety disorders, and those who aren't quite sure what category they would fall into. Once you walk into the room it is up to the therapist & the client to figure out how the therapist can facilitate personal life growth.In session we will learn to Express ourselves through art, nature, our bodies and minds. We may take a walk, create something abstract or sit and talk; the therapy adventure is yours and I am simply a therapist to guide you towards stability, growth and your highest potential.
I enjoy working with clients who are experiencing difficult life transitions, adoption, sexual trauma, mood and anxiety disorders, and those who aren't quite sure what category they would fall into. Once you walk into the room it is up to the therapist & the client to figure out how the therapist can facilitate personal life growth.In session we will learn to Express ourselves through art, nature, our bodies and minds. We may take a walk, create something abstract or sit and talk; the therapy adventure is yours and I am simply a therapist to guide you towards stability, growth and your highest potential.
(509) 550-0608 View (509) 550-0608
Photo of Amber Pitre, Pre-Licensed Professional in Spokane, WA
Amber Pitre
Pre-Licensed Professional, LMHCA
Verified Verified
Spokane, WA 99201  (Online Only)
I am deeply passionate about assisting individuals in understanding and overcoming their unique challenges. Each of us has encountered experiences that have shaped our identities and perspectives. My objective is to establish a secure environment for clients to delve into their emotions, recognize the correlation between their experiences and behaviors, and cultivate effective coping mechanisms. I specialize in working with individuals who have faced trauma, depression, anxiety, grief, and relationship difficulties.
I am deeply passionate about assisting individuals in understanding and overcoming their unique challenges. Each of us has encountered experiences that have shaped our identities and perspectives. My objective is to establish a secure environment for clients to delve into their emotions, recognize the correlation between their experiences and behaviors, and cultivate effective coping mechanisms. I specialize in working with individuals who have faced trauma, depression, anxiety, grief, and relationship difficulties.
(509) 512-1869 View (509) 512-1869
Photo of Yelena Sedgwick, Counselor in Spokane, WA
Yelena Sedgwick
Counselor, MA, LMHC
Verified Verified
Spokane, WA 99218
Insurance not accepted; Cash pay only. Do you excel as a student, wife, mom or professional, yet find yourself silently struggling with deep-seated anger, frustration, disappointment, anxiety, insecurity or other challenging emotions? You've tried changing your mindset, perhaps even other therapies, but nothing has reached the core of your struggle and pain. I work with women like you, who are desperate for real change and ready to heal from the inside out. When you truly understand how trauma wounds people, you can begin to learn how to break free from the painful cycles that prevent you from living a full and abundant life.
Insurance not accepted; Cash pay only. Do you excel as a student, wife, mom or professional, yet find yourself silently struggling with deep-seated anger, frustration, disappointment, anxiety, insecurity or other challenging emotions? You've tried changing your mindset, perhaps even other therapies, but nothing has reached the core of your struggle and pain. I work with women like you, who are desperate for real change and ready to heal from the inside out. When you truly understand how trauma wounds people, you can begin to learn how to break free from the painful cycles that prevent you from living a full and abundant life.
(509) 632-7696 View (509) 632-7696
Photo of Jessica Campbell, Counselor in Spokane, WA
Jessica Campbell
Counselor, LMHC, IATP, QEEG-D
Verified Verified
Spokane, WA 99201
I work with an eclectic approach to therapy. By forming a strong, therapeutic alliance the client and counselor embark on a journey toward shared treatment goals. My theoretical approach to counseling enlists pieces of cognitive behavioral therapy, mindfulness, and interpersonal psychotherapy. With evidence-based treatment practices, the client can learn new methods of coping with mental health distress. One main area of focus is the treatment of trauma. Too often, clients have attended counseling with no relief of symptoms and have revealed that the trauma they experienced was unaddressed. As a Certified Trauma Specialist, I am passionate about helping clients heal from traumatic experiences.
I work with an eclectic approach to therapy. By forming a strong, therapeutic alliance the client and counselor embark on a journey toward shared treatment goals. My theoretical approach to counseling enlists pieces of cognitive behavioral therapy, mindfulness, and interpersonal psychotherapy. With evidence-based treatment practices, the client can learn new methods of coping with mental health distress. One main area of focus is the treatment of trauma. Too often, clients have attended counseling with no relief of symptoms and have revealed that the trauma they experienced was unaddressed. As a Certified Trauma Specialist, I am passionate about helping clients heal from traumatic experiences.
(509) 822-2376 View (509) 822-2376
Photo of Kathryn Bradford, Marriage & Family Therapist Associate in Spokane, WA
Kathryn Bradford
Marriage & Family Therapist Associate, MA, LMHCA, LMFTA, NCC
Verified Verified
2 Endorsed
Spokane, WA 99202
You are worthy of being seen, known and deeply understood—my hope is that beginning in our first meeting together, you, your relationship or your child will experience that. Offering ourselves grace, holding ourselves with compassion, and tuning into our own needs can be challenging. Especially when we are experiencing anxiety, depression, a difficult life transition, or a conflict in relationship. You don't have to do it alone.
You are worthy of being seen, known and deeply understood—my hope is that beginning in our first meeting together, you, your relationship or your child will experience that. Offering ourselves grace, holding ourselves with compassion, and tuning into our own needs can be challenging. Especially when we are experiencing anxiety, depression, a difficult life transition, or a conflict in relationship. You don't have to do it alone.
(509) 285-9632 View (509) 285-9632
Photo of Jocelyn Ribar, Marriage & Family Therapist in Spokane, WA
Jocelyn Ribar
Marriage & Family Therapist, LMFT, LMHC, RYT
Verified Verified
2 Endorsed
Spokane, WA 99203
People are motivated by fulfilling needs, including the deep rooted need for connection. We are all hardwired for connection and love. In each and every one of us lies strength and resilience. We all have moments where we get off track and might need guidance and help. As your counselor, it is my role to help you feel heard and accepted, able to share your story. My goal is to meet you where you are, in your own process. I am here to walk this journey with you and help you discover a deeper awareness of your internal processes.
People are motivated by fulfilling needs, including the deep rooted need for connection. We are all hardwired for connection and love. In each and every one of us lies strength and resilience. We all have moments where we get off track and might need guidance and help. As your counselor, it is my role to help you feel heard and accepted, able to share your story. My goal is to meet you where you are, in your own process. I am here to walk this journey with you and help you discover a deeper awareness of your internal processes.
(509) 792-3530 View (509) 792-3530
Photo of Dana Fuller, Marriage & Family Therapist in Spokane, WA
Dana Fuller
Marriage & Family Therapist, MA, LMFT
Verified Verified
Spokane, WA 99217
You have your own personal journey that has brought you too today. Each individual, couple, and family have unique circumstances and personal aspects to bring to the therapy process. You are recognizing it would be helpful to talk with someone that can help sort out the thoughts, emotions, and life situations that led you here. Working together we can determine what is significant to your journey. We will build a relationship that is safe and open to explore vulnerable aspects of your life that will lead to personal insights, improve coping skills, and create lasting change.
You have your own personal journey that has brought you too today. Each individual, couple, and family have unique circumstances and personal aspects to bring to the therapy process. You are recognizing it would be helpful to talk with someone that can help sort out the thoughts, emotions, and life situations that led you here. Working together we can determine what is significant to your journey. We will build a relationship that is safe and open to explore vulnerable aspects of your life that will lead to personal insights, improve coping skills, and create lasting change.
(509) 253-7986 View (509) 253-7986
Photo of Marina Connor, Counselor in Spokane, WA
Marina Connor
Counselor, LMHC, NCC
Verified Verified
Spokane, WA 99205  (Online Only)
Hi, I'm Marina. With me, no topic, feeling, or situation is off-limits in the counseling space – I will treat you with respect to help you overcome what's hurting you. I work with individuals, couples/poly relationships, and families between the ages of preteen and elder. As a sex therapist, I have extensive experience working with kink and BDSM, polyamory, LGBTQ issues, gender therapy, sexual pleasure and dysfunction, pain with sex, negative body image, high or low libido, sex work, sex abuse, sexual trauma, and/or sexual shame, among other topics.
Hi, I'm Marina. With me, no topic, feeling, or situation is off-limits in the counseling space – I will treat you with respect to help you overcome what's hurting you. I work with individuals, couples/poly relationships, and families between the ages of preteen and elder. As a sex therapist, I have extensive experience working with kink and BDSM, polyamory, LGBTQ issues, gender therapy, sexual pleasure and dysfunction, pain with sex, negative body image, high or low libido, sex work, sex abuse, sexual trauma, and/or sexual shame, among other topics.
(509) 260-7465 View (509) 260-7465
Photo of RIM Holistic Health (Stephanie Tumba), Counselor in Spokane, WA
RIM Holistic Health (Stephanie Tumba)
Counselor, MACP, LMHC
Verified Verified
Spokane, WA 99201  (Online Only)
My speciality is working with those who want to improve their overall wellbeing. Do you feel stuck in stress, sadness, trauma, numbness, or isolation? Perhaps you struggle to maintain relationships, or find yourself in a cycle of unhealthy boundaries. You may question your own worth and struggle to communicate your thoughts and feelings with those in your life. Whatever your struggles, you are most likely hoping for more peace of mind, connection, confidence, and compassion. Just like our bodies heal from scrapes and bruises, we are also built and meant to heal emotionally and mentally. Counseling is a great way to gain life skills.
My speciality is working with those who want to improve their overall wellbeing. Do you feel stuck in stress, sadness, trauma, numbness, or isolation? Perhaps you struggle to maintain relationships, or find yourself in a cycle of unhealthy boundaries. You may question your own worth and struggle to communicate your thoughts and feelings with those in your life. Whatever your struggles, you are most likely hoping for more peace of mind, connection, confidence, and compassion. Just like our bodies heal from scrapes and bruises, we are also built and meant to heal emotionally and mentally. Counseling is a great way to gain life skills.
(509) 408-0108 View (509) 408-0108
Photo of Kurt Michael Leonard, Clinical Social Work/Therapist in Spokane, WA
Kurt Michael Leonard
Clinical Social Work/Therapist, MSW, LICSW, MHP
Verified Verified
Spokane, WA 99208
Welcome to my mental health counseling profile. I want you to feel very encouraged by what you are about to read. I want you to know that hope, restoration, recovery, healing, and durable personal growth are available to you in your current trauma, crisis, adjustment or loss through the counseling and therapy that I can provide for you and with you. When we experience adversity and face troubling challenges, we need compassionate support that teaches highly effective skills and techniques to best moderate or eliminate the impending symptoms of stress. We also need support that helps to access our strengths and build resilience.
Welcome to my mental health counseling profile. I want you to feel very encouraged by what you are about to read. I want you to know that hope, restoration, recovery, healing, and durable personal growth are available to you in your current trauma, crisis, adjustment or loss through the counseling and therapy that I can provide for you and with you. When we experience adversity and face troubling challenges, we need compassionate support that teaches highly effective skills and techniques to best moderate or eliminate the impending symptoms of stress. We also need support that helps to access our strengths and build resilience.
(509) 236-1813 x1 View (509) 236-1813 x1

How does your Therapist compare?

Number of Therapists in Spokane, WA

1,000+

Average cost per session

$135

Therapists in Spokane, WA who prioritize treating:

92% Anxiety
87% Depression
76% Self Esteem
74% Trauma and PTSD
73% Relationship Issues
73% Stress
71% Coping Skills

Average years in practice

8 Years

Top 3 insurances accepted

73% Premera
72% Aetna
58% Regence

How Therapists in Spokane, WA see their clients

52% In Person and Online
48% Online Only

Gender breakdown

80% Female
18% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Spokane?

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.