Therapists in Pittsburgh, PA
Shawnekquia Stribling
Licensed Professional Counselor, LPC
Verified Verified
1 Endorsed
Pittsburgh, PA 15213 (Online Only)
Waitlist for new clients
Hi, my name is Shawnekquia Stribling and I am a dedicated Licensed Professional Counselor, whom specializes in providing compassionate support and guidance to individuals facing a range of challenges. With a deep understanding of racial identity, social injustice issues, anxiety, depression, mood disorders, workplace burnout, relationship struggles, and autism spectrum disorder. I offer a safe and nurturing space for healing and growth.
Hi, my name is Shawnekquia Stribling and I am a dedicated Licensed Professional Counselor, whom specializes in providing compassionate support and guidance to individuals facing a range of challenges. With a deep understanding of racial identity, social injustice issues, anxiety, depression, mood disorders, workplace burnout, relationship struggles, and autism spectrum disorder. I offer a safe and nurturing space for healing and growth.
Rachel E Noderer
Licensed Professional Counselor, MSEd, LPC
Verified Verified
3 Endorsed
Pittsburgh, PA 15226
Not accepting new clients
Would you like to feel more grounded and confident in your life? Perhaps you're feeling trapped by your thoughts and you're looking to gain skills to interrupt unhelpful thinking spirals? Or possibly you're feeling disconnected from your sense of self and would like a safe place to explore what makes you you? There are all sorts of reasons why you might be needing support right now and therapy can be a wonderful tool to help you build self compassion, manage overwhelming feelings, and build upon your existing strengths to accomplish your goals.
Would you like to feel more grounded and confident in your life? Perhaps you're feeling trapped by your thoughts and you're looking to gain skills to interrupt unhelpful thinking spirals? Or possibly you're feeling disconnected from your sense of self and would like a safe place to explore what makes you you? There are all sorts of reasons why you might be needing support right now and therapy can be a wonderful tool to help you build self compassion, manage overwhelming feelings, and build upon your existing strengths to accomplish your goals.
Christian Counseling Associates of Western PA
Counselor, PhD
Verified Verified
1 Endorsed
Pittsburgh, PA 15206
Christian Counseling Associates (CCA) provides individual, marriage, and family counseling. We serve Christians who want their faith integrated into the counseling process and those holding any beliefs or attitudes toward spirituality. Our counselors will help you identify the core issues that have caused your emotional and personal problems, and immediately develop strategies to resolve these issues. CCA is able to provide a full range of clinical services. Please visit our website at www.ccawpa.com for a complete description of our faith based counseling services, locations, and counseling staff.
Christian Counseling Associates (CCA) provides individual, marriage, and family counseling. We serve Christians who want their faith integrated into the counseling process and those holding any beliefs or attitudes toward spirituality. Our counselors will help you identify the core issues that have caused your emotional and personal problems, and immediately develop strategies to resolve these issues. CCA is able to provide a full range of clinical services. Please visit our website at www.ccawpa.com for a complete description of our faith based counseling services, locations, and counseling staff.
Vanessa Royse
Clinical Social Work/Therapist, LCSW
Verified Verified
Pittsburgh, PA 15228
Not accepting new clients
I work with individuals who have a wide range of concerns from depression and anxiety to issues in relationships, grief, loneliness, chronic pain, and stress. Clients get results with me because my approach is practical, creative, and empowering, and I work hard to help clients gain new tools to overcome their challenges. Together we will find ways to better understand the road blocks that are preventing you from moving forward, and to develop healthier coping strategies and behaviors that will improve your life and well-being.
I work with individuals who have a wide range of concerns from depression and anxiety to issues in relationships, grief, loneliness, chronic pain, and stress. Clients get results with me because my approach is practical, creative, and empowering, and I work hard to help clients gain new tools to overcome their challenges. Together we will find ways to better understand the road blocks that are preventing you from moving forward, and to develop healthier coping strategies and behaviors that will improve your life and well-being.
Pat Brosseau
Clinical Social Work/Therapist, MSW, LSW
Verified Verified
1 Endorsed
Pittsburgh, PA 15232
Accepting new clients! The world is just... really hard right now. It's difficult to imagine how therapy would even help when the world is on fire. You constantly feel "other", in so many ways, which makes maintaining social and romantic relationships nearly impossible. You know you have a long list of things to process, but have never felt like you've had a truly safe, nonjudgmental space to do that. In order to heal, you know on a visceral level that you need to feel fully accepted, not just tolerated. You are starting to drown from the overwhelming stress, anxiety, neurodiversity, perfectionism, low self-worth, and isolation.
Accepting new clients! The world is just... really hard right now. It's difficult to imagine how therapy would even help when the world is on fire. You constantly feel "other", in so many ways, which makes maintaining social and romantic relationships nearly impossible. You know you have a long list of things to process, but have never felt like you've had a truly safe, nonjudgmental space to do that. In order to heal, you know on a visceral level that you need to feel fully accepted, not just tolerated. You are starting to drown from the overwhelming stress, anxiety, neurodiversity, perfectionism, low self-worth, and isolation.
Sarah London
Clinical Social Work/Therapist, LSW
Verified Verified
1 Endorsed
Pittsburgh, PA 15236
Our mental wellness defines how we experience life and is crucial to over all well being. Through therapeutic support you can gain new perspectives, skills, and opportunities towards improving your mental wellness so you can experience a healthy, balanced life.
Our mental wellness defines how we experience life and is crucial to over all well being. Through therapeutic support you can gain new perspectives, skills, and opportunities towards improving your mental wellness so you can experience a healthy, balanced life.
Liz McBride
Licensed Professional Counselor, M Ed, LPC
Verified Verified
1 Endorsed
Pittsburgh, PA 15232 (Online Only)
I earned my Bachelor’s degree in Art History from Saint Mary’s College in South Bend, Indiana, graduating in May of 2014. In the Fall of 2012, I received training as a victims’ advocate and crisis line operator at the Family Justice Center in South Bend. For the rest of my time as an undergraduate, I continued volunteering for the FJC, focusing on taking crisis calls, yet unaware of the skills I was building in attending to each caller’s concerns. I utilized my training again during grad school to volunteer for Crisis Text Line, where I honed my skills in crisis management and planning.
I earned my Bachelor’s degree in Art History from Saint Mary’s College in South Bend, Indiana, graduating in May of 2014. In the Fall of 2012, I received training as a victims’ advocate and crisis line operator at the Family Justice Center in South Bend. For the rest of my time as an undergraduate, I continued volunteering for the FJC, focusing on taking crisis calls, yet unaware of the skills I was building in attending to each caller’s concerns. I utilized my training again during grad school to volunteer for Crisis Text Line, where I honed my skills in crisis management and planning.
The Children's Home & Lemieux Family Center
Clinical Social Work/Therapist, MSW, LSW
Verified Verified
Pittsburgh, PA 15224
Are you looking for support in the areas of adoption, foster care, infertility, assisted reproductive technology, donor conception, pregnancy loss, pregnancy decision making, or a related area? You may feel alone, but you are not. We’re here to help. The Children’s Home of Pittsburgh provides specialized counseling services to individuals, families, couples, and children. We work with all individuals and family types, without discrimination.
Are you looking for support in the areas of adoption, foster care, infertility, assisted reproductive technology, donor conception, pregnancy loss, pregnancy decision making, or a related area? You may feel alone, but you are not. We’re here to help. The Children’s Home of Pittsburgh provides specialized counseling services to individuals, families, couples, and children. We work with all individuals and family types, without discrimination.
Joe Trecki - Sense Of Direction Counseling Services
Licensed Professional Counselor, MSEd, LPC
Verified Verified
Pittsburgh, PA 15220
Sometimes life can feel a little overwhelming. This holds true for young kids, teens, and adults. In my therapy, I use a variety of techniques and approaches to meet my clients where they are and utilize their strengths in order to get them to achieve their goals regardless of their age, gender, or orientation. Together, we will identify strengths, skills, and resources that you will turn into opportunity and growth. We will focus on the solution and not the problem. Greatness is just being better than you were yesterday!
Sometimes life can feel a little overwhelming. This holds true for young kids, teens, and adults. In my therapy, I use a variety of techniques and approaches to meet my clients where they are and utilize their strengths in order to get them to achieve their goals regardless of their age, gender, or orientation. Together, we will identify strengths, skills, and resources that you will turn into opportunity and growth. We will focus on the solution and not the problem. Greatness is just being better than you were yesterday!
David Prybock
Psychologist, PhD
Verified Verified
Pittsburgh, PA 15206
Do you want to improve your relationship, have less stress, or simply gain insight about yourself so that you can be happier and live a more fulfilling life? Change is difficult, especially when we try to do it alone. I am a Licensed Psychologist who offers individual and group therapy that are designed to help you be happier. My aim is to provide you with the knowledge and skills that will help you achieve change. Working together, we will utilize the strengths you already have and target those aspects of yourself that you want to change the most.
Do you want to improve your relationship, have less stress, or simply gain insight about yourself so that you can be happier and live a more fulfilling life? Change is difficult, especially when we try to do it alone. I am a Licensed Psychologist who offers individual and group therapy that are designed to help you be happier. My aim is to provide you with the knowledge and skills that will help you achieve change. Working together, we will utilize the strengths you already have and target those aspects of yourself that you want to change the most.
Emma Shannon
Licensed Professional Counselor, LPC
Verified Verified
4 Endorsed
Pittsburgh, PA 15218 (Online Only)
Not accepting new clients
Healing from trauma, processing shame, and building self-confidence is a journey I'd be honored to join you on. I view therapy as a collaborative, relational process. My job is to facilitate the co-creation of a safe space together, in which I help you to connect with yourself in new ways. Who you are, your history, and your week-to-week needs inform the pacing, flow, and style of our sessions while I offer structure and information as needed. Our process will likely include connecting with internal resources to stabilize daily life, engaging in deep processing of traumas and wounding, and integrating new learning into self-concept.
Healing from trauma, processing shame, and building self-confidence is a journey I'd be honored to join you on. I view therapy as a collaborative, relational process. My job is to facilitate the co-creation of a safe space together, in which I help you to connect with yourself in new ways. Who you are, your history, and your week-to-week needs inform the pacing, flow, and style of our sessions while I offer structure and information as needed. Our process will likely include connecting with internal resources to stabilize daily life, engaging in deep processing of traumas and wounding, and integrating new learning into self-concept.
15 Second Videos
Rachel E Noderer
Christian Counseling Associates of Western PA
Norman Philosophical Consulting
Avellar Warden Psychological Associates
Sharna Olfman
Brian J. Ferraccio
Danielle Turk
Kim Saft
Erin Kilpatrick
Amanda Ludwig -Becoming Whole Counseling Consulting
Makin Wellness | Online Therapy & Counseling
Dominique Dove
The Counseling and Wellness Center of Pittsburgh
Emily Zeller
Debbie Wilkinson
Amy Commander
Madison Rice
Randy Potter
Rachael Dittmar
Abbie Quinby
Tanja Soto
Alison Grabell
Kaitlyn Bonham
Liz Chaney
Natalie McCormick
Mikayla Weston
Diane L Winter
Katie Hido
Carolyn Weimer
Stanton Marlan
Christian Counseling Associates of Western PA
Cody McConnell
Madison Krull
Chelsie Musisko
Alexander Noel
Loving Me Solutions
Amber Lynn Blue
Casey McFarland
Elizabeth A Turak
Leigh Montgomery
Vanessa Pappal
Michelle Wygant
Makin Wellness
Michael Balsan
Aiesha Lee
Robert D Feragotti
Alaina Schrader
Christian Counseling Associates of Western PA
Maddison Fyffe
Casey Watkins
Claire Fior
Psychologist, PsyD
Verified Verified
Pittsburgh, PA 15206
Not accepting new clients
I believe how humans experience growth and how they change are the big themes of psychology. We grow and change through our relationships with others, but sometimes we can get stuck in certain relationship patterns that cause distress. Uncovering the dynamics of these patterns, how they affect our self-concept, our feelings, our understanding of others, and our nervous systems can be healing. Practicing new patterns of emotion, thought, and behavior, whether through talk- therapy, mindfulness practices, or a combination of both, can assist growth and change toward more compassion and connection in our lives.
I believe how humans experience growth and how they change are the big themes of psychology. We grow and change through our relationships with others, but sometimes we can get stuck in certain relationship patterns that cause distress. Uncovering the dynamics of these patterns, how they affect our self-concept, our feelings, our understanding of others, and our nervous systems can be healing. Practicing new patterns of emotion, thought, and behavior, whether through talk- therapy, mindfulness practices, or a combination of both, can assist growth and change toward more compassion and connection in our lives.
Anne Barbabella
Clinical Social Work/Therapist, LCSW
Verified Verified
2 Endorsed
Pittsburgh, PA 15236 (Online Only)
Waitlist for new clients
For over 20 years, I have worked in the field of mental health and addiction. I have extensive experience working with all disorders from mild to severe and specialize in working with the dual diagnosed (mental health and addiction) population; especially those suffering with mood disorders, anxiety and trauma related issues. I am able to offer support to not only the client who is suffering but their family and support system as well. I believe that all people are capable of improving their life with hard work, openness and a desire for change.
For over 20 years, I have worked in the field of mental health and addiction. I have extensive experience working with all disorders from mild to severe and specialize in working with the dual diagnosed (mental health and addiction) population; especially those suffering with mood disorders, anxiety and trauma related issues. I am able to offer support to not only the client who is suffering but their family and support system as well. I believe that all people are capable of improving their life with hard work, openness and a desire for change.
Anita Cilia
Clinical Social Work/Therapist, LCSW , BA
Verified Verified
Pittsburgh, PA 15236
Have you been feeling overwhelmed, like you are drowning and not able to catch your breath? Are you having trouble managing your thoughts and feelings? Are you having difficulty dealing with the loss of a loved one? Are you sad and unsure why or what to do about it? Do you ever find yourself talking and no matter how loudly you talk it seems like nobody is listening? Do you feel irritated and angry or are having trouble controlling your temper and it’s causing you difficulties at home or work?
Have you been feeling overwhelmed, like you are drowning and not able to catch your breath? Are you having trouble managing your thoughts and feelings? Are you having difficulty dealing with the loss of a loved one? Are you sad and unsure why or what to do about it? Do you ever find yourself talking and no matter how loudly you talk it seems like nobody is listening? Do you feel irritated and angry or are having trouble controlling your temper and it’s causing you difficulties at home or work?
Thrive Counseling Center LLC
Licensed Professional Counselor, LPC, NCC
Verified Verified
1 Endorsed
Pittsburgh, PA 15201
Our lives tend to be multi-faceted works of art, made up of many roles, relationships, and responsibilities. Oftentimes, we are able to adapt to changes in these roles and responsibilities with little or no difficulty; however there are times in our lives when change can cause distraction, negative feelings, and overall dissatisfaction with our lives. These times are when we can be empowered to discover our true authentic lives, within ourselves and our relationships, by engaging in therapy. During sessions, we will explore ineffective behavior patterns and perceptions to move forward into a better state of mind and lead a more fulfilling life.
Our lives tend to be multi-faceted works of art, made up of many roles, relationships, and responsibilities. Oftentimes, we are able to adapt to changes in these roles and responsibilities with little or no difficulty; however there are times in our lives when change can cause distraction, negative feelings, and overall dissatisfaction with our lives. These times are when we can be empowered to discover our true authentic lives, within ourselves and our relationships, by engaging in therapy. During sessions, we will explore ineffective behavior patterns and perceptions to move forward into a better state of mind and lead a more fulfilling life.
Monica Waitkus
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Pittsburgh, PA 15237
I believe everyone can make positive changes in their life and therapy is a safe, supportive experience to help navigate through the change process. I provide treatment that is tailored to your needs and is focused on promoting your unique strengths while also addressing any barriers to progress. Whether dealing with a major life crisis or just wanting to improve the overall quality of your life or relationships, my focus is on helping you find the skills and strength to make meaningful change. Emphasizing individual goals and personal autonomy, I create a therapeutic environment that is positive, open-minded and non-judgmental.
I believe everyone can make positive changes in their life and therapy is a safe, supportive experience to help navigate through the change process. I provide treatment that is tailored to your needs and is focused on promoting your unique strengths while also addressing any barriers to progress. Whether dealing with a major life crisis or just wanting to improve the overall quality of your life or relationships, my focus is on helping you find the skills and strength to make meaningful change. Emphasizing individual goals and personal autonomy, I create a therapeutic environment that is positive, open-minded and non-judgmental.
Lauren Caraotta
Art Therapist, MS, ATR
Verified Verified
Pittsburgh, PA 15216 (Online Only)
Not accepting new clients
I believe we as humans are highly adaptable, even under the most challenging conditions. As a therapist, my approach builds upon the strength of this adaptive ability while remaining responsive to the fear, anger, and shame that can accompany it. I work with my clients to foster deeper self-compassion.
I believe we as humans are highly adaptable, even under the most challenging conditions. As a therapist, my approach builds upon the strength of this adaptive ability while remaining responsive to the fear, anger, and shame that can accompany it. I work with my clients to foster deeper self-compassion.
Rachel Kolman
Clinical Social Work/Therapist, LMSW
Verified Verified
Pittsburgh, PA 15203
It can be overwhelming to grapple with anxiety, depression, relationship struggles, and the countless stressors that come with everyday life. If you're yearning for relief, clarity, and empowerment, I'm here to walk alongside you on your journey. My practice is founded on the principles of compassion, understanding, and respect for your unique experiences and perspectives. Together, we can explore the underlying factors contributing to your distress, develop coping strategies tailored to your needs, and work towards creating positive changes in your life.
It can be overwhelming to grapple with anxiety, depression, relationship struggles, and the countless stressors that come with everyday life. If you're yearning for relief, clarity, and empowerment, I'm here to walk alongside you on your journey. My practice is founded on the principles of compassion, understanding, and respect for your unique experiences and perspectives. Together, we can explore the underlying factors contributing to your distress, develop coping strategies tailored to your needs, and work towards creating positive changes in your life.
Katherine Hammond Holtz
Psychologist, PsyD
Verified Verified
Pittsburgh, PA 15206 (Online Only)
I enjoy working with individuals who are interested in promoting well-being in themselves and in relation to others. Mindfulness instruction is available as a key component of my therapy should this focus be desired. Studies have shown that a regular practice of mindfulness supports an enriched experience of life, feelings of well being, better ability to cope with stress and pain, reduced panic, anxiety, and fear and better concentration. I currently only offer tele-health, accessible from the comfort of your own home or office.
I enjoy working with individuals who are interested in promoting well-being in themselves and in relation to others. Mindfulness instruction is available as a key component of my therapy should this focus be desired. Studies have shown that a regular practice of mindfulness supports an enriched experience of life, feelings of well being, better ability to cope with stress and pain, reduced panic, anxiety, and fear and better concentration. I currently only offer tele-health, accessible from the comfort of your own home or office.
Heather Walker
Licensed Professional Counselor, LPC, NCC, MA
Verified Verified
Pittsburgh, PA 15212
Not accepting new clients
As a therapist, I strive to collaborate with my clients to create an environment that offers the support and safety necessary to explore life’s complexity. It is my belief that in order to meaningfully move through the our challenges, we first must understand ourselves and how we got here. I work with individuals and couples dealing with a wide variety a challenges, including anxiety, depression, eating disorders, identity issues, difficult transitions, self-esteem, relationship issues, self-harm and substance abuse.
As a therapist, I strive to collaborate with my clients to create an environment that offers the support and safety necessary to explore life’s complexity. It is my belief that in order to meaningfully move through the our challenges, we first must understand ourselves and how we got here. I work with individuals and couples dealing with a wide variety a challenges, including anxiety, depression, eating disorders, identity issues, difficult transitions, self-esteem, relationship issues, self-harm and substance abuse.
See more therapy options for Pittsburgh
How does your Therapist compare?
Number of Therapists in Pittsburgh, PA
1,000+
Average cost per session
$125
Therapists in Pittsburgh, PA who prioritize treating:
93% | Anxiety |
88% | Depression |
77% | Self Esteem |
71% | Relationship Issues |
69% | Trauma and PTSD |
69% | Coping Skills |
66% | Stress |
Average years in practice
10 Years
Top 3 insurances accepted
81% | Highmark |
74% | Aetna |
68% | UnitedHealthcare UHC | UBH |
How Therapists in Pittsburgh, PA see their clients
60% | In Person and Online | |
40% | Online Only |
Gender breakdown
78% | Female | |
19% | Male | |
3% | Non-Binary |
FAQs - About Therapy and Counseling
How can I find a therapist in Pittsburgh?
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
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.
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.
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.