Therapists in San Francisco, CA

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Photo of Norma Luna, Clinical Social Work/Therapist in San Francisco, CA
Norma Luna
Clinical Social Work/Therapist, LCSW
Verified Verified
San Francisco, CA 94121
I'm Norma Luna, a Licensed Clinical Social Worker and I invite you to call and schedule an appointment. I offer a warm and safe space where you can fully express yourself. I take a person centered, compassionate and integrative approach to therapy, incorporating mind, body and spirit. Along with understanding how culture and societal issues influence an individual.
I'm Norma Luna, a Licensed Clinical Social Worker and I invite you to call and schedule an appointment. I offer a warm and safe space where you can fully express yourself. I take a person centered, compassionate and integrative approach to therapy, incorporating mind, body and spirit. Along with understanding how culture and societal issues influence an individual.
(628) 277-8598 View (628) 277-8598
Photo of Samuel Khanukayev, Marriage & Family Therapist in San Francisco, CA
Samuel Khanukayev
Marriage & Family Therapist, MFT
Verified Verified
San Francisco, CA 94102
I strive to facilitate a reflective and explorative environment where the unbearable can be held and truth can be spoken. Multicultural and bilingual elements of my identity, and a history of enduring ethnic discrimination and immigration, significantly inform how I listen to my clients, think through trauma and fragmentation with them. Unconscious repetitions of aversion, clinging, and reenactments of familiar/familial ways of being bind us in suffering. Through psychotherapy, rigid frames of being can be deconstructed and psychological space can be reclaimed for creativity, desire and becoming.
I strive to facilitate a reflective and explorative environment where the unbearable can be held and truth can be spoken. Multicultural and bilingual elements of my identity, and a history of enduring ethnic discrimination and immigration, significantly inform how I listen to my clients, think through trauma and fragmentation with them. Unconscious repetitions of aversion, clinging, and reenactments of familiar/familial ways of being bind us in suffering. Through psychotherapy, rigid frames of being can be deconstructed and psychological space can be reclaimed for creativity, desire and becoming.
(510) 982-6497 View (510) 982-6497
Photo of Garett Weinstein - Expansive Therapy, Counselor in San Francisco, CA
Garett Weinstein - Expansive Therapy
Counselor, AMFT
Verified Verified
San Francisco, CA 94109
I believe in the transformative power of genuine connection, acknowledging the unique intersections of each person's journey and creating an affirming environment where diverse identities are celebrated. Together we will navigate the intricacies of relationships, identity, and personal growth in a holistic and affirming manner.
I believe in the transformative power of genuine connection, acknowledging the unique intersections of each person's journey and creating an affirming environment where diverse identities are celebrated. Together we will navigate the intricacies of relationships, identity, and personal growth in a holistic and affirming manner.
(213) 693-3394 View (213) 693-3394
Photo of Anya Rome, Marriage & Family Therapist Associate in San Francisco, CA
Anya Rome
Marriage & Family Therapist Associate, AMFT
Verified Verified
San Francisco, CA 94110
There are important reasons why you are struggling, and they deserve attention and understanding. I work with people who find themselves overwhelmed by the demands of everyday life and demoralized by the struggle just to keep up. People who have ever felt defective, or like there is something wrong with the way that they are. These feelings may be due to, or manifest as: anxiety, depression, relationship problems, substance-use issues, or ADHD-related issues like difficulty with time management, organization, and motivation.
There are important reasons why you are struggling, and they deserve attention and understanding. I work with people who find themselves overwhelmed by the demands of everyday life and demoralized by the struggle just to keep up. People who have ever felt defective, or like there is something wrong with the way that they are. These feelings may be due to, or manifest as: anxiety, depression, relationship problems, substance-use issues, or ADHD-related issues like difficulty with time management, organization, and motivation.
(510) 851-9836 View (510) 851-9836
Photo of Brittany M Ramirez, Marriage & Family Therapist in San Francisco, CA
Brittany M Ramirez
Marriage & Family Therapist, LMFT
Verified Verified
San Francisco, CA 94102
Brittany M. Ramirez is a Licensed Marriage and Family Therapist in California who has been practicing since 2013. Brittany helps people figure this "thing" out we call life. As she became a therapist working with clients, it became apparent that what Brittany does is help people with what she believes to be the human experience. So, that's what Brittany unofficially calls herself now: "the human experience therapist. " We all go through challenges, and they look different as we get older, but they never stop.
Brittany M. Ramirez is a Licensed Marriage and Family Therapist in California who has been practicing since 2013. Brittany helps people figure this "thing" out we call life. As she became a therapist working with clients, it became apparent that what Brittany does is help people with what she believes to be the human experience. So, that's what Brittany unofficially calls herself now: "the human experience therapist. " We all go through challenges, and they look different as we get older, but they never stop.
(628) 200-3209 View (628) 200-3209
Photo of Dr. Sasha Avanesov, Psychologist in San Francisco, CA
Dr. Sasha Avanesov
Psychologist, PhD
Verified Verified
2 Endorsed
San Francisco, CA 94115
Whether you are experiencing anxiety, stress, relationship issues, coping with trauma, screaming at the world gone mad, seeking answers to spiritual or existential questions, or pursuing personal growth, I will work hard to empower you. Together, we will explore, clarify, and address issues at the root of your concerns, clearing a path towards inner peace.
Whether you are experiencing anxiety, stress, relationship issues, coping with trauma, screaming at the world gone mad, seeking answers to spiritual or existential questions, or pursuing personal growth, I will work hard to empower you. Together, we will explore, clarify, and address issues at the root of your concerns, clearing a path towards inner peace.
(510) 405-7319 View (510) 405-7319
Photo of Jessica L Davis, Marriage & Family Therapist in San Francisco, CA
Jessica L Davis
Marriage & Family Therapist, MA, LMFT
Verified Verified
San Francisco, CA 94114  (Online Only)
I work with couples, groups, and individuals that feel ready to examine their inner world and outer relationships, perhaps feeling stuck in low self-esteem, anxiety, depression, or confusion. Clients who wish to explore issues around stress, overwhelm, relationships, identity, sexuality, spirituality, psychedelics, or trauma often resonate with my style of psychotherapy. I offer couples and individuals a warm environment that is supportive, collaborative, and direct. Building a relationship that has a safe space for tough and untouchable topics is essential to my work.
I work with couples, groups, and individuals that feel ready to examine their inner world and outer relationships, perhaps feeling stuck in low self-esteem, anxiety, depression, or confusion. Clients who wish to explore issues around stress, overwhelm, relationships, identity, sexuality, spirituality, psychedelics, or trauma often resonate with my style of psychotherapy. I offer couples and individuals a warm environment that is supportive, collaborative, and direct. Building a relationship that has a safe space for tough and untouchable topics is essential to my work.
(341) 999-7319 View (341) 999-7319
Photo of Adilia E Torres, Marriage & Family Therapist in San Francisco, CA
Adilia E Torres
Marriage & Family Therapist, MA, LMFT
Verified Verified
San Francisco, CA 94120  (Online Only)
Healing is a gift that emerges from seeds cultivated by struggle, broken borders, and bold dreams. I am a queer mental health practitioner in the Bay Area. My daily practice as a mental health clinician is guided and shaped by culturally relevant services imbued with an Indigenous approach to healing and medicine. My work is focused on trauma-trauma-informed care and recovery services for children, youth, adults, and families impacted by (im)migration, displacement, and other forms of oppression. We individualize and collaborate with the creation of your treatment plan of care tailored to the needs of each person. English & Spanish
Healing is a gift that emerges from seeds cultivated by struggle, broken borders, and bold dreams. I am a queer mental health practitioner in the Bay Area. My daily practice as a mental health clinician is guided and shaped by culturally relevant services imbued with an Indigenous approach to healing and medicine. My work is focused on trauma-trauma-informed care and recovery services for children, youth, adults, and families impacted by (im)migration, displacement, and other forms of oppression. We individualize and collaborate with the creation of your treatment plan of care tailored to the needs of each person. English & Spanish
(415) 639-3276 View (415) 639-3276
Photo of Silvia Escobar, Clinical Social Work/Therapist in San Francisco, CA
Silvia Escobar
Clinical Social Work/Therapist, LCSW
Verified Verified
San Francisco, CA 94114
My name is Silvia Escobar and I am a Licensed Clinical Social Worker (LCSW) based in Southern California. I work with adolescents and adults specializing in depression, anxiety, life transitions, and stress using Cognitive Behavioral Therapy and Solution Focused Therapy, and Dialectical Behavioral Therapy to help my clients make progress and start feeling better. I find that my style and approach is a good fit for teenagers and adults who may be dealing with the challenges of life transitions, relationship issues, social pressures, grief and loss. This often takes the form of anxiety, depression, and stress.
My name is Silvia Escobar and I am a Licensed Clinical Social Worker (LCSW) based in Southern California. I work with adolescents and adults specializing in depression, anxiety, life transitions, and stress using Cognitive Behavioral Therapy and Solution Focused Therapy, and Dialectical Behavioral Therapy to help my clients make progress and start feeling better. I find that my style and approach is a good fit for teenagers and adults who may be dealing with the challenges of life transitions, relationship issues, social pressures, grief and loss. This often takes the form of anxiety, depression, and stress.
(415) 878-6144 View (415) 878-6144
Photo of Buddhist Based Cognitive Behavioral Therapy, Psychologist in San Francisco, CA
Buddhist Based Cognitive Behavioral Therapy
Psychologist, PsyD
Verified Verified
1 Endorsed
San Francisco, CA 94115
The type of therapy that I specialize in would likely be a good match for you if you're interested in integrating practices like meditation, mindfulness, self-compassion, and loving-kindness with contemporary psychotherapy to address current issues in your life. In the past I have successfully worked with individuals struggling with anxiety disorders, depression, trauma, anger, addiction, chronic pain, marital and other relational issues including LGBT relationships. My specialty is working with anxiety and stress related disorders.
The type of therapy that I specialize in would likely be a good match for you if you're interested in integrating practices like meditation, mindfulness, self-compassion, and loving-kindness with contemporary psychotherapy to address current issues in your life. In the past I have successfully worked with individuals struggling with anxiety disorders, depression, trauma, anger, addiction, chronic pain, marital and other relational issues including LGBT relationships. My specialty is working with anxiety and stress related disorders.
(415) 849-0064 View (415) 849-0064
Photo of Matt McKeithan, Psychologist in San Francisco, CA
Matt McKeithan
Psychologist, PsyD, MA, LPC-A
Verified Verified
San Francisco, CA 94121  (Online Only)
I specialize in treating those with various mental disorders and behavioral issues to include: ADHD, PTSD, Anxiety, and Personality Disorders. I utilize detailed Psychological Assessment, and empirically supported treatments such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Mindfulness. I am certified as a DBT practitioner and a life coach. Lastly, I integrate a holistic mindset into my practice, where emphasis is placed on gut/brain health, sleep quality, lifestyle, and diet.
I specialize in treating those with various mental disorders and behavioral issues to include: ADHD, PTSD, Anxiety, and Personality Disorders. I utilize detailed Psychological Assessment, and empirically supported treatments such as Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and Mindfulness. I am certified as a DBT practitioner and a life coach. Lastly, I integrate a holistic mindset into my practice, where emphasis is placed on gut/brain health, sleep quality, lifestyle, and diet.
(628) 214-2794 View (628) 214-2794
Photo of Christina Davis, Psychologist in San Francisco, CA
Christina Davis
Psychologist, PsyD
Verified Verified
San Francisco, CA 94133
My education, training and professional experience are from a humanistic, person-centered orientation. What this means is that I practice from a strength-based perspective, which emphasizes first identifying the skills and abilities you already possess. What are your existing resources?
My education, training and professional experience are from a humanistic, person-centered orientation. What this means is that I practice from a strength-based perspective, which emphasizes first identifying the skills and abilities you already possess. What are your existing resources?
(628) 232-5054 View (628) 232-5054
Photo of Tiffany Loggins, Psychologist in San Francisco, CA
Tiffany Loggins
Psychologist, PsyD
Verified Verified
San Francisco, CA 94116  (Online Only)
Waitlist for new clients
I am a culturally sensitive psychologist, author, and mental wellness public speaker in San Francisco, who will create a safe space that distinctively fits your needs to help on your journey toward healing and growth. I understand we often find ourselves feeling lost, overwhelmed, abandoned, or may be at a loss of how we feel, because we’ve arrived at that familiar place of despair and ruminating self doubt. My hope is to provide an opportunity to disentangle from suffering, which may lead to improved quality of life, greater satisfaction within relationships, increased productivity, and enhanced self-worth and compassion.
I am a culturally sensitive psychologist, author, and mental wellness public speaker in San Francisco, who will create a safe space that distinctively fits your needs to help on your journey toward healing and growth. I understand we often find ourselves feeling lost, overwhelmed, abandoned, or may be at a loss of how we feel, because we’ve arrived at that familiar place of despair and ruminating self doubt. My hope is to provide an opportunity to disentangle from suffering, which may lead to improved quality of life, greater satisfaction within relationships, increased productivity, and enhanced self-worth and compassion.
(628) 265-8377 View (628) 265-8377
Photo of Sandra L Goozée, Marriage & Family Therapist in San Francisco, CA
Sandra L Goozée
Marriage & Family Therapist, PhD
Verified Verified
1 Endorsed
San Francisco, CA 94104
Most therapists will say they specialize in what you’re dealing with. Given my decades of experience, I have become fairly scrupulous about the clients I choose to work with. I see therapy as collaborative. If you’re ready to put in the work necessary for change, you’ve come to the right place. If the following sounds like you, feel free to reach out to me now: You know what you want to change in your life; you realize that a commitment to change means that most of the work is going to be on your end; and you're ready to trust in someone to partner with you.
Most therapists will say they specialize in what you’re dealing with. Given my decades of experience, I have become fairly scrupulous about the clients I choose to work with. I see therapy as collaborative. If you’re ready to put in the work necessary for change, you’ve come to the right place. If the following sounds like you, feel free to reach out to me now: You know what you want to change in your life; you realize that a commitment to change means that most of the work is going to be on your end; and you're ready to trust in someone to partner with you.
(415) 236-3193 View (415) 236-3193
Photo of Audrey Redfield, Psychologist in San Francisco, CA
Audrey Redfield
Psychologist, PhD
Verified Verified
1 Endorsed
San Francisco, CA 94114
I believe that we all have an inner healing intelligence that is a source of wisdom and guidance toward the expression of our unique gifts and fulfillment of our aspirations. The light of our inner healer is often clouded by various stressors, trauma, conditioning, and roles we took on as children to survive that we continue to enact as adults. I hold a safe, non-judgmental space of compassion and curiosity to support you with accessing this light and feel the self-love and self-acceptance that radiate from it. I am trained in and utilize Internal Family Systems and Ketamine-Assisted Psychotherapy to help facilitate healing.
I believe that we all have an inner healing intelligence that is a source of wisdom and guidance toward the expression of our unique gifts and fulfillment of our aspirations. The light of our inner healer is often clouded by various stressors, trauma, conditioning, and roles we took on as children to survive that we continue to enact as adults. I hold a safe, non-judgmental space of compassion and curiosity to support you with accessing this light and feel the self-love and self-acceptance that radiate from it. I am trained in and utilize Internal Family Systems and Ketamine-Assisted Psychotherapy to help facilitate healing.
(415) 663-5517 View (415) 663-5517
Photo of Taylor Isaacson, Marriage & Family Therapist Associate in San Francisco, CA
Taylor Isaacson
Marriage & Family Therapist Associate, AMFT
Verified Verified
1 Endorsed
San Francisco, CA 94114  (Online Only)
We all deserve space to be our full selves. I view my role as therapist as a co-explorer – I walk alongside you as you navigate your authentic experience of this world. In session, we follow what feels present for you in the moment and approach what arises with curiosity. This mindful awareness helps us meet and build relationship with more “parts” of you. I aim to allow all of you in. Eventually, this process of being “more you” can lead to a more grounded and connected existence, one in which you find yourself with more choice, agency, and fulfillment in life.
We all deserve space to be our full selves. I view my role as therapist as a co-explorer – I walk alongside you as you navigate your authentic experience of this world. In session, we follow what feels present for you in the moment and approach what arises with curiosity. This mindful awareness helps us meet and build relationship with more “parts” of you. I aim to allow all of you in. Eventually, this process of being “more you” can lead to a more grounded and connected existence, one in which you find yourself with more choice, agency, and fulfillment in life.
(415) 326-9895 View (415) 326-9895
Photo of Stephen Gundlach, Marriage & Family Therapist Associate in San Francisco, CA
Stephen Gundlach
Marriage & Family Therapist Associate, MA
Verified Verified
San Francisco, CA 94114
Thank you for taking this important step on your journey of healing and well being. My name is Stephen Gundlach. I am a psychotherapist working with individuals, couples, and teens. I see therapy as a process in which the therapist walks alongside you as a mirror and a guide to your own unfolding understanding of yourself and your unique story. In this process inner strengths and resiliencies are identified, habitual patterns that are no longer helping come to light, and desired growth and change become possible.
Thank you for taking this important step on your journey of healing and well being. My name is Stephen Gundlach. I am a psychotherapist working with individuals, couples, and teens. I see therapy as a process in which the therapist walks alongside you as a mirror and a guide to your own unfolding understanding of yourself and your unique story. In this process inner strengths and resiliencies are identified, habitual patterns that are no longer helping come to light, and desired growth and change become possible.
(415) 915-7224 View (415) 915-7224
Photo of Stacey Mcguirl, Marriage & Family Therapist in San Francisco, CA
Stacey Mcguirl
Marriage & Family Therapist, MFT
Verified Verified
3 Endorsed
San Francisco, CA 94114
Therapy provides a space to speak freely and be heard with care that can provide a person with more internal space for lived experience, emotion, thought and desire. In psychotherapy, you can express your thoughts and feelings and gain insight into the unconscious sources of your conflicts. With warmth and curiosity, I will provide an attentive ear and a thoughtful mind.
Therapy provides a space to speak freely and be heard with care that can provide a person with more internal space for lived experience, emotion, thought and desire. In psychotherapy, you can express your thoughts and feelings and gain insight into the unconscious sources of your conflicts. With warmth and curiosity, I will provide an attentive ear and a thoughtful mind.
(415) 742-2915 View (415) 742-2915
Photo of Meagan Holden, Marriage & Family Therapist Associate in San Francisco, CA
Meagan Holden
Marriage & Family Therapist Associate, MD, AMFT
Verified Verified
1 Endorsed
San Francisco, CA 94123
Do you feel stuck or overwhelmed? Do you feel like something is missing and you want more from your life? I am here to help. I deeply believe that healing is possible and have spent my life dedicated to it. In my first career as an anesthesiologist and critical care physician, that healing was focused on the health of the body. Now as a psychotherapist, I bring that experience to how I practice therapy and work with a deep appreciation for the mind-body connection. I believe that our overall wellness and health is deeply rooted in our psychological health.
Do you feel stuck or overwhelmed? Do you feel like something is missing and you want more from your life? I am here to help. I deeply believe that healing is possible and have spent my life dedicated to it. In my first career as an anesthesiologist and critical care physician, that healing was focused on the health of the body. Now as a psychotherapist, I bring that experience to how I practice therapy and work with a deep appreciation for the mind-body connection. I believe that our overall wellness and health is deeply rooted in our psychological health.
(415) 366-1365 View (415) 366-1365
Jessica Selvin
Psychologist, PsyD
Verified Verified
San Francisco, CA 94131
My approach is to provide a warm supportive environment so you can feel comfortable and able to speak about whatever is distressing you. I like to work collaboratively, exploring both the past and the present, to figure out what is preventing you from feeling more fulfilled. The work involves clarifying and questioning your assumptions, suspending judgment, and closely considering your feelings and experiences. Engaging in psychotherapy promotes awareness, reflection, and change; you can learn to live in a creative manner while developing the capacity to know and realistically meet your own needs. While we can't change difficult s
My approach is to provide a warm supportive environment so you can feel comfortable and able to speak about whatever is distressing you. I like to work collaboratively, exploring both the past and the present, to figure out what is preventing you from feeling more fulfilled. The work involves clarifying and questioning your assumptions, suspending judgment, and closely considering your feelings and experiences. Engaging in psychotherapy promotes awareness, reflection, and change; you can learn to live in a creative manner while developing the capacity to know and realistically meet your own needs. While we can't change difficult s
(415) 687-5639 View (415) 687-5639

See more therapy options for San Francisco

How does your Therapist compare?

Number of Therapists in San Francisco, CA

3,000+

Average cost per session

$189

Therapists in San Francisco, CA who prioritize treating:

93% Anxiety
87% Depression
81% Relationship Issues
75% Self Esteem
70% Trauma and PTSD
68% Stress
66% Life Transitions

Average years in practice

12 Years

Top 3 insurances accepted

69% Aetna
55% UnitedHealthcare UHC | UBH
54% Cigna and Evernorth

How Therapists in San Francisco, CA see their clients

55% In Person and Online
45% Online Only

Gender breakdown

75% Female
23% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in San Francisco?

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.