Therapists in Ann Arbor, MI

Photo of Melissa Butler, Limited Licensed Psychologist in Ann Arbor, MI
Melissa Butler
Limited Licensed Psychologist, MS, LLP
Verified Verified
2 Endorsed
Ann Arbor, MI 48104
The therapy I offer is most effective for people who have already spent time working on themselves in therapy, spiritual practice, or by other means. My main treatment focus is developmental trauma, which means the harm caused in relationships growing up. As adults that can look like high functioning depression, anxiety, relationship problems, creative blocks, numbness/dissociation, lack of progress, and other expressions. We work with mindfulness based somatic therapy in an compassionate, supportive, and non-judgmental environment using a wide array of methods. Together we will uncover the healing your body is striving to access.
The therapy I offer is most effective for people who have already spent time working on themselves in therapy, spiritual practice, or by other means. My main treatment focus is developmental trauma, which means the harm caused in relationships growing up. As adults that can look like high functioning depression, anxiety, relationship problems, creative blocks, numbness/dissociation, lack of progress, and other expressions. We work with mindfulness based somatic therapy in an compassionate, supportive, and non-judgmental environment using a wide array of methods. Together we will uncover the healing your body is striving to access.
(734) 519-6667 View (734) 519-6667
Photo of Ann Arbor Psychological Services, Psychologist in Ann Arbor, MI
Ann Arbor Psychological Services
Psychologist, PhD
Verified Verified
Ann Arbor, MI 48104
For over 20 years, Dr. Stephen Purcell has been helping adults, adolescents, couples and families improve their relationships; cope with stress, anxiety and depression; work through trauma, grief, and loss; overcome addictions; and navigate major life transitions like divorce and career change. Whether you are currently facing a crisis or simply want to improve the way you function in everyday life, Dr. Purcell has the training, skills and experience to assist you.
For over 20 years, Dr. Stephen Purcell has been helping adults, adolescents, couples and families improve their relationships; cope with stress, anxiety and depression; work through trauma, grief, and loss; overcome addictions; and navigate major life transitions like divorce and career change. Whether you are currently facing a crisis or simply want to improve the way you function in everyday life, Dr. Purcell has the training, skills and experience to assist you.
(734) 619-8125 View (734) 619-8125
Photo of Katie Fox, Clinical Social Work/Therapist in Ann Arbor, MI
Katie Fox
Clinical Social Work/Therapist, LMSW
Verified Verified
Ann Arbor, MI 48104
Life can be hard. Sometimes we struggle with feelings of anxiety that have us so lost in the future or the past that we can barely function in the present. Other times we may feel so depressed that we don't want to get out of bed and everything seems to take an enormous effort. Or maybe we've lost someone important and we have to figure out how to live when it feels like a piece of us is missing. Or maybe we're facing a difficult life transition, like a new diagnosis or retirement, and we just need help moving forward. Regardless of what you are struggling with, I know it can be hard to ask for help.
Life can be hard. Sometimes we struggle with feelings of anxiety that have us so lost in the future or the past that we can barely function in the present. Other times we may feel so depressed that we don't want to get out of bed and everything seems to take an enormous effort. Or maybe we've lost someone important and we have to figure out how to live when it feels like a piece of us is missing. Or maybe we're facing a difficult life transition, like a new diagnosis or retirement, and we just need help moving forward. Regardless of what you are struggling with, I know it can be hard to ask for help.
(734) 294-0284 View (734) 294-0284
Photo of Community Elevation, Clinical Social Work/Therapist in Ann Arbor, MI
Community Elevation
Clinical Social Work/Therapist, LCSW
Verified Verified
Ann Arbor, MI 48103  (Online Only)
Admitting you can’t do everything alone is the first step toward achieving wellness in a fast-paced, demanding world. Therefore, we provide mental health therapists who support the growth of people, organizations, and communities by providing culturally-sensitive mental health services. As experienced therapists, we are honored to assist you in exploring your core issues and moving toward a healthy, fulfilling life. We have worked with clients who have experienced trauma/depression/anxiety; we have worked in athletics, college/school systems, hospital settings, private practice, and mental health systems.
Admitting you can’t do everything alone is the first step toward achieving wellness in a fast-paced, demanding world. Therefore, we provide mental health therapists who support the growth of people, organizations, and communities by providing culturally-sensitive mental health services. As experienced therapists, we are honored to assist you in exploring your core issues and moving toward a healthy, fulfilling life. We have worked with clients who have experienced trauma/depression/anxiety; we have worked in athletics, college/school systems, hospital settings, private practice, and mental health systems.
(734) 562-0799 View (734) 562-0799
Photo of Ashley Magers, Clinical Social Work/Therapist in Ann Arbor, MI
Ashley Magers
Clinical Social Work/Therapist, LMSW, PMH-C
Verified Verified
Ann Arbor, MI 48103
Are you frequently feeling irritated or overwhelmed and finding it difficult to accept yourself and your limitations? Are you noticing feelings of resentment towards others in your life? Are you adjusting to a life transition, such as pregnancy or parenthood? If you would like to deepen your clarity and self-compassion as you explore what choices you have to change how you connect with yourself and in your relationships, Ashley would love the opportunity to come alongside you at this point in your journey!
Are you frequently feeling irritated or overwhelmed and finding it difficult to accept yourself and your limitations? Are you noticing feelings of resentment towards others in your life? Are you adjusting to a life transition, such as pregnancy or parenthood? If you would like to deepen your clarity and self-compassion as you explore what choices you have to change how you connect with yourself and in your relationships, Ashley would love the opportunity to come alongside you at this point in your journey!
(734) 294-0731 View (734) 294-0731
Photo of Susie Thompson-Doering, Clinical Social Work/Therapist in Ann Arbor, MI
Susie Thompson-Doering
Clinical Social Work/Therapist, LMSW
Verified Verified
Ann Arbor, MI 48104
Do you find yourself overwhelmed with midlife struggles no matter what you do? Maybe this season of life isn’t quite what you expected. The challenges in midlife can leave you feeling stressed, depleted, lonely & lost. You might feel unsettled or realize that the strategies you used to use to get through your days aren’t working for you anymore. Anxiety and depression are creeping in. You’re distracted, frustrated, tired and irritable and just want to be heard, seen and understood. You’re dealing with empty nest changes, menopause changes, relationship changes, even changes due to loss and grief. That’s a lot of change to navigate.
Do you find yourself overwhelmed with midlife struggles no matter what you do? Maybe this season of life isn’t quite what you expected. The challenges in midlife can leave you feeling stressed, depleted, lonely & lost. You might feel unsettled or realize that the strategies you used to use to get through your days aren’t working for you anymore. Anxiety and depression are creeping in. You’re distracted, frustrated, tired and irritable and just want to be heard, seen and understood. You’re dealing with empty nest changes, menopause changes, relationship changes, even changes due to loss and grief. That’s a lot of change to navigate.
(734) 404-7679 View (734) 404-7679
Photo of Brianna Jackson, Clinical Social Work/Therapist in Ann Arbor, MI
Brianna Jackson
Clinical Social Work/Therapist, LLMSW
Verified Verified
Ann Arbor, MI 48104
I appreciate your willingness to be vulnerable and seek a partner in change. I welcome you as you are and will create a safe, judgement-free space for you to share your thoughts and feelings. My top priority is to empower you to reach your full potential by highlighting your own inner-strength and wisdom. I use an eclectic approach with my clients, meaning I work with you to identify which tools and skills may be most helpful based on your unique experiences and preferences.
I appreciate your willingness to be vulnerable and seek a partner in change. I welcome you as you are and will create a safe, judgement-free space for you to share your thoughts and feelings. My top priority is to empower you to reach your full potential by highlighting your own inner-strength and wisdom. I use an eclectic approach with my clients, meaning I work with you to identify which tools and skills may be most helpful based on your unique experiences and preferences.
(734) 339-2693 View (734) 339-2693
Photo of Pacific Wellness, LLC, Clinical Social Work/Therapist in Ann Arbor, MI
Pacific Wellness, LLC
Clinical Social Work/Therapist, LMSW
Verified Verified
Ann Arbor, MI 48103
My clients tend to be experiencing stress and want to find connections between past experiences, patterns of response, strong emotions and current life circumstances. Life transitions can feel overwhelming and loss can become a catalyst for change. This is often the beginning of an opportunity to gain greater understanding of our selves and the meaning we make in our lives.
My clients tend to be experiencing stress and want to find connections between past experiences, patterns of response, strong emotions and current life circumstances. Life transitions can feel overwhelming and loss can become a catalyst for change. This is often the beginning of an opportunity to gain greater understanding of our selves and the meaning we make in our lives.
(734) 212-8742 View (734) 212-8742
Photo of Alicia Kitsuse, Pre-Licensed Professional in Ann Arbor, MI
Alicia Kitsuse
Pre-Licensed Professional, MA, LLC
Verified Verified
1 Endorsed
Ann Arbor, MI 48105
Whatever has brought you to therapy, take heart that you have arrived. Therapy provides a unique opportunity to unpack your burdens in an environment of warmth, compassion, and care. Whether you seek to improve your relationship with yourself or with others, my aim is to meet you where you are and help you unlock your own natural wisdom and capacity for growth, repair, and healing.
Whatever has brought you to therapy, take heart that you have arrived. Therapy provides a unique opportunity to unpack your burdens in an environment of warmth, compassion, and care. Whether you seek to improve your relationship with yourself or with others, my aim is to meet you where you are and help you unlock your own natural wisdom and capacity for growth, repair, and healing.
(734) 789-6489 View (734) 789-6489
Photo of Brittany Lewis, Clinical Social Work/Therapist in Ann Arbor, MI
Brittany Lewis
Clinical Social Work/Therapist, LMSW
Verified Verified
Ann Arbor, MI 48105
Brittany Lewis is a Licensed Master Social Worker in Michigan who has been practicing since 2017. Brittany provides resources and therapy to individuals, families, and couples who find themselves struggling with communication, anxiety, emotional abuse, difficulty trusting others, family dynamics, difficulty disclosing feelings/emotions, and depression and intimacy issues. Outside of work, Brittany enjoys traveling, theater, music, and fine dining.
Brittany Lewis is a Licensed Master Social Worker in Michigan who has been practicing since 2017. Brittany provides resources and therapy to individuals, families, and couples who find themselves struggling with communication, anxiety, emotional abuse, difficulty trusting others, family dynamics, difficulty disclosing feelings/emotions, and depression and intimacy issues. Outside of work, Brittany enjoys traveling, theater, music, and fine dining.
(734) 415-6894 View (734) 415-6894
Photo of Alaina Provenzano, Clinical Social Work/Therapist in Ann Arbor, MI
Alaina Provenzano
Clinical Social Work/Therapist, LMSW
Verified Verified
2 Endorsed
Ann Arbor, MI 48104
If you experience a pattern of disappointment and hurt in your relationships, you might begin to wonder what you're doing wrong. You may feel anxious around others and read into what they do and say to determine how they feel about you. Conflict might bring up feelings of unworthiness and self-blame. Others seem to have such ease with relationships, and you don’t understand why it feels like such a struggle to find and keep connections that feel secure. As hard as you've tried, you've not been able to interrupt this pattern and you worry you’ll feel this way forever.
If you experience a pattern of disappointment and hurt in your relationships, you might begin to wonder what you're doing wrong. You may feel anxious around others and read into what they do and say to determine how they feel about you. Conflict might bring up feelings of unworthiness and self-blame. Others seem to have such ease with relationships, and you don’t understand why it feels like such a struggle to find and keep connections that feel secure. As hard as you've tried, you've not been able to interrupt this pattern and you worry you’ll feel this way forever.
(248) 965-0158 View (248) 965-0158
Photo of Pyramid Counseling & Consultation LLC, Clinical Social Work/Therapist in Ann Arbor, MI
Pyramid Counseling & Consultation LLC
Clinical Social Work/Therapist
Verified Verified
Ann Arbor, MI 48108  (Online Only)
Our agency provides psychotherapy for adults, couples, families, and teens. Our mission is to enhance your quality of life by developing your strengths and providing life coaching in dealing with life's challenges in the following areas and more:
Our agency provides psychotherapy for adults, couples, families, and teens. Our mission is to enhance your quality of life by developing your strengths and providing life coaching in dealing with life's challenges in the following areas and more:
(734) 259-4063 View (734) 259-4063
Photo of Rheanna Graver, Clinical Social Work/Therapist in Ann Arbor, MI
Rheanna Graver
Clinical Social Work/Therapist, LLMSW
Verified Verified
2 Endorsed
Ann Arbor, MI 48104
4/10/2024 - I currently have immediate in person and virtual openings! I enjoy working with adolescents, young adults, and adults. I have provided individual and group care to individuals struggling with various concerns, including life transitions, eating disorders, self-esteem, depression, and anxiety. I integrate evidence-based treatment approaches, including CBT skills and DBT skills, with passion, empathy, and support to assist my clients in reaching their goals and being their best possible selves.
4/10/2024 - I currently have immediate in person and virtual openings! I enjoy working with adolescents, young adults, and adults. I have provided individual and group care to individuals struggling with various concerns, including life transitions, eating disorders, self-esteem, depression, and anxiety. I integrate evidence-based treatment approaches, including CBT skills and DBT skills, with passion, empathy, and support to assist my clients in reaching their goals and being their best possible selves.
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Photo of Joseph Forrest, Clinical Social Work/Therapist in Ann Arbor, MI
Joseph Forrest
Clinical Social Work/Therapist, LMSW
Verified Verified
Ann Arbor, MI 48103
I take an individual and strengths-based approach to therapy, and specialize in working with adults who deal with trauma, insomnia, depression, substance use disorders, and anxiety. I hope to cultivate an accepting and empowering environment where you can feel supported and challenged to progress. I hope to give you practical help in getting to your goals, and provide feedback and exercises to work on outside of our time together, increasing the size of your tool kit to deal with life stressors and mental health challenges.
I take an individual and strengths-based approach to therapy, and specialize in working with adults who deal with trauma, insomnia, depression, substance use disorders, and anxiety. I hope to cultivate an accepting and empowering environment where you can feel supported and challenged to progress. I hope to give you practical help in getting to your goals, and provide feedback and exercises to work on outside of our time together, increasing the size of your tool kit to deal with life stressors and mental health challenges.
(734) 802-2124 View (734) 802-2124
Photo of Tasha Ball, Clinical Social Work/Therapist in Ann Arbor, MI
Tasha Ball
Clinical Social Work/Therapist, LLMSW
Verified Verified
2 Endorsed
Ann Arbor, MI 48105  (Online Only)
Finding a therapist can be overwhelming and taxing! My hope is that I can make that process smooth and comforting for you as you begin on your healing journey. I specialize in working with individuals who identify as LGBTQIA+, people with a history of emotional abuse, anxiety, depression, self-harm, trauma, and relationship/family conflict. I will provide you with the space to learn and grow as well as be vulnerable and have hard conversations. You CAN do hard things and I am here to be a support for you to feel more confident and conquer your fears.
Finding a therapist can be overwhelming and taxing! My hope is that I can make that process smooth and comforting for you as you begin on your healing journey. I specialize in working with individuals who identify as LGBTQIA+, people with a history of emotional abuse, anxiety, depression, self-harm, trauma, and relationship/family conflict. I will provide you with the space to learn and grow as well as be vulnerable and have hard conversations. You CAN do hard things and I am here to be a support for you to feel more confident and conquer your fears.
(734) 849-2131 View (734) 849-2131
Photo of Kiera Dressler-Reed, Clinical Social Work/Therapist in Ann Arbor, MI
Kiera Dressler-Reed
Clinical Social Work/Therapist, LLMSW
Verified Verified
2 Endorsed
Ann Arbor, MI 48104
Hello and welcome! My name is Kiera, and I am a therapist specializing in the treatment of anxiety, depression, trauma, addiction, and life transitions in teens and adults. My own journey of healing deeply impacts my work and allows me to come alongside my clients in a way that is honest, authentic, and hopeful. More than anything, I hope my clients know that they are never alone, and they are never past the point of being able to benefit from mental health treatment. I believe in our abundant ability to grow and change, and it is an honor to be part of someone’s journey towards healing and fulfillment.
Hello and welcome! My name is Kiera, and I am a therapist specializing in the treatment of anxiety, depression, trauma, addiction, and life transitions in teens and adults. My own journey of healing deeply impacts my work and allows me to come alongside my clients in a way that is honest, authentic, and hopeful. More than anything, I hope my clients know that they are never alone, and they are never past the point of being able to benefit from mental health treatment. I believe in our abundant ability to grow and change, and it is an honor to be part of someone’s journey towards healing and fulfillment.
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Photo of Karen Christine Nicholson-Muth, Clinical Social Work/Therapist in Ann Arbor, MI
Karen Christine Nicholson-Muth
Clinical Social Work/Therapist, LMSW
Verified Verified
Ann Arbor, MI 48104
I've been in practice for over 10 years and have seen patients from three-ninety years old. Many transitions occur throughout the lifespan and during these transitions; some can be more difficult than expected and need examining for better understanding and practices. To do this I facilitate an environment free of judgement and help my patients understand their feelings and thoughts, as well as how to improve their behaviors to better their lives and futures. I enjoy my work and very much and strive to help people find their own voice, achieve their greatest accomplishments and successes in life, love, and work.
I've been in practice for over 10 years and have seen patients from three-ninety years old. Many transitions occur throughout the lifespan and during these transitions; some can be more difficult than expected and need examining for better understanding and practices. To do this I facilitate an environment free of judgement and help my patients understand their feelings and thoughts, as well as how to improve their behaviors to better their lives and futures. I enjoy my work and very much and strive to help people find their own voice, achieve their greatest accomplishments and successes in life, love, and work.
(734) 418-6954 View (734) 418-6954
Photo of Samantha Hughes, Clinical Social Work/Therapist in Ann Arbor, MI
Samantha Hughes
Clinical Social Work/Therapist, LLMSW
Verified Verified
2 Endorsed
Ann Arbor, MI 48108
My background in various human services settings has allowed me space to develop skills and understand people in a different way than most. My goal is to help you attain the skills to be who you want to be and have a place to let your feelings be heard. I love to help people start from where they are now and grow into who they want to be. My passion is working with children and young adults, focusing on becoming more independent through aquiring knowledge and skills for success and to better manage life stressors, anxiety, depression, transition, divorce, family changes, behavioral problems and school related issues.
My background in various human services settings has allowed me space to develop skills and understand people in a different way than most. My goal is to help you attain the skills to be who you want to be and have a place to let your feelings be heard. I love to help people start from where they are now and grow into who they want to be. My passion is working with children and young adults, focusing on becoming more independent through aquiring knowledge and skills for success and to better manage life stressors, anxiety, depression, transition, divorce, family changes, behavioral problems and school related issues.
(734) 865-2766 View (734) 865-2766
Photo of Manuela Uribe, Clinical Social Work/Therapist in Ann Arbor, MI
Manuela Uribe
Clinical Social Work/Therapist, LMSW
Verified Verified
4 Endorsed
Ann Arbor, MI 48104
Waitlist for new clients
My goal is to help human beings enhance their well-being and make positive changes in order to live a life worth living. I have experience working with individuals who struggle with conditions such as depression, anxiety, bipolar disorder, post-traumatic stress disorder, substance abuse, borderline personality disorder, and schizophrenia. I enjoy working with individuals of all ages and backgrounds.
My goal is to help human beings enhance their well-being and make positive changes in order to live a life worth living. I have experience working with individuals who struggle with conditions such as depression, anxiety, bipolar disorder, post-traumatic stress disorder, substance abuse, borderline personality disorder, and schizophrenia. I enjoy working with individuals of all ages and backgrounds.
(231) 613-3053 View (231) 613-3053
Photo of Anne L Crawford, Limited Licensed Psychologist in Ann Arbor, MI
Anne L Crawford
Limited Licensed Psychologist, MA, LLP
Verified Verified
1 Endorsed
Ann Arbor, MI 48108  (Online Only)
What's getting in the way of your living the life you want? Is it depression? Anxiety? Explosive anger? Whatever brings you to therapy, I would love to help you find a way forward. Offering a safe, confidential, judgement-free environment in which you can freely air your concerns, I will collaborate with you to explore what's not working for you, how it got that way, and how you might chart a path through and beyond it.
What's getting in the way of your living the life you want? Is it depression? Anxiety? Explosive anger? Whatever brings you to therapy, I would love to help you find a way forward. Offering a safe, confidential, judgement-free environment in which you can freely air your concerns, I will collaborate with you to explore what's not working for you, how it got that way, and how you might chart a path through and beyond it.
(734) 436-3859 View (734) 436-3859

How does your Therapist compare?

Number of Therapists in Ann Arbor, MI

1,000+

Average cost per session

$150

Therapists in Ann Arbor, MI who prioritize treating:

93% Anxiety
87% Depression
77% Self Esteem
75% Relationship Issues
70% Trauma and PTSD
69% Coping Skills
69% Stress

Average years in practice

11 Years

Top 3 insurances accepted

93% BlueCross and BlueShield
55% Blue Care Network
48% Aetna

How Therapists in Ann Arbor, MI see their clients

62% In Person and Online
38% Online Only

Gender breakdown

79% Female
19% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Ann Arbor?

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.