Therapists in 17111
![Photo of Steven Lamar Johnson, LSW, MSW, MA](https://photos.psychologytoday.com/4b0e9717-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
Do you continue to fall short of your goals? Is the trauma you experienced preventing you from reaching your fullest potential? Do you suffer from social anxiety? depression? anger issues? ADHD? bipolar in adults? substance abuse? relationship issues, co-parenting? Etc... I have worked tirelessly for over 20 years helping families overcome their mental health issues and I would be honored to do the same for you.
Do you continue to fall short of your goals? Is the trauma you experienced preventing you from reaching your fullest potential? Do you suffer from social anxiety? depression? anger issues? ADHD? bipolar in adults? substance abuse? relationship issues, co-parenting? Etc... I have worked tirelessly for over 20 years helping families overcome their mental health issues and I would be honored to do the same for you.
![Photo of Maria Alpoyanis, LPC, LMHC, Licensed Professional Counselor](https://photos.psychologytoday.com/711daa76-2506-49cc-a40c-c2faba73a873/2/320x400.jpeg)
Maria Alpoyanis
Licensed Professional Counselor, LPC, LMHC
Verified Verified
1 Endorsed
Harrisburg, PA 17111 (Online Only)
My name is Maria (she/they) and I'm looking forward to getting started with you. I'm here to help you identify your goals for therapy, and work towards them with you - be it to reduce symptoms, process the past, or gain insight into current behaviors. I have experience working working with a spectrum of mental health needs, primarily anxiety/depression and LGBTQ+ identities.
My name is Maria (she/they) and I'm looking forward to getting started with you. I'm here to help you identify your goals for therapy, and work towards them with you - be it to reduce symptoms, process the past, or gain insight into current behaviors. I have experience working working with a spectrum of mental health needs, primarily anxiety/depression and LGBTQ+ identities.
![Photo of Tasha Medina, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/4faea146-83a0-463c-93f1-96bedf27ad99/1/320x400.jpeg)
Tasha Medina
Clinical Social Work/Therapist, LCSW
Verified Verified
Harrisburg, PA 17111 (Online Only)
I have always loved working with individuals who seek to enhance their lives and fight through difficult challenges that they face because I too have faced many of life's challenges and have overcome adversities. I want to be of support to others and help them to feel empowered to move through what they otherwise may feel they couldn't and see they succeed in life. It is a great honor to be part of one's healing journey.
I have always loved working with individuals who seek to enhance their lives and fight through difficult challenges that they face because I too have faced many of life's challenges and have overcome adversities. I want to be of support to others and help them to feel empowered to move through what they otherwise may feel they couldn't and see they succeed in life. It is a great honor to be part of one's healing journey.
![Photo of Maureen McCarthy, LSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/1375c30a-7b72-4093-af56-a172f1734994/1/320x400.jpeg)
Maureen McCarthy
Clinical Social Work/Therapist, LSW
Verified Verified
2 Endorsed
Harrisburg, PA 17111 (Online Only)
Hi! I am Maureen McCarthy, a Licensed Social Worker based in Central Pennsylvania. I have extensive experience working with gender expansive and sexually diverse individuals, including but not limited to the LGBTQIIA+, Polyam/CNM and BDSM/kink communities. In addition, to folks facing life transitions, stress, self-esteem issues, anxiety, depression, and trauma.
Hi! I am Maureen McCarthy, a Licensed Social Worker based in Central Pennsylvania. I have extensive experience working with gender expansive and sexually diverse individuals, including but not limited to the LGBTQIIA+, Polyam/CNM and BDSM/kink communities. In addition, to folks facing life transitions, stress, self-esteem issues, anxiety, depression, and trauma.
![Photo of Rafat Omar, PsyD, Psychologist](https://photos.psychologytoday.com/9d0ca0a9-0db5-4992-9b20-09c5a34e3abc/1/320x400.jpeg)
Hello, I'm Dr. Rafat Omar. I'm a licensed clinical psychologist in Pennsylvania. I work with clients of all ages, couples, and families.
Hello, I'm Dr. Rafat Omar. I'm a licensed clinical psychologist in Pennsylvania. I work with clients of all ages, couples, and families.
![Photo of Nicholas Pappas, PhD, Psychologist](https://photos.psychologytoday.com/bd1518a5-4785-42d1-b279-0c6908dbd618/2/320x400.jpeg)
Each client's psychological and spiritual needs are a focus addressing relational issues, behavioral issues, and mood-driven difficulties with consideration of individually-specified treatment goals. Overarching treatment outcome is healing and restoration and rehabilitation for clients to become healthy, happy and productive individuals.
Each client's psychological and spiritual needs are a focus addressing relational issues, behavioral issues, and mood-driven difficulties with consideration of individually-specified treatment goals. Overarching treatment outcome is healing and restoration and rehabilitation for clients to become healthy, happy and productive individuals.
![Photo of Mahmood Mohammad, MS, NCC, Pre-Licensed Professional](https://photos.psychologytoday.com/1ebd7c36-1d01-467e-9965-e5f0fef24821/1/320x400.jpeg)
Mahmood Mohammad
Pre-Licensed Professional, MS, NCC
Verified Verified
2 Endorsed
Harrisburg, PA 17111
Andy Warhol said, "Change doesn't happen by itself, you have to make it happen." I believe in guiding people to unlock their true potential and overcome obstacles through compassion and authenticity. Let's step outside our comfort zones and challenge our beliefs to make positive changes!
Andy Warhol said, "Change doesn't happen by itself, you have to make it happen." I believe in guiding people to unlock their true potential and overcome obstacles through compassion and authenticity. Let's step outside our comfort zones and challenge our beliefs to make positive changes!
![Photo of Tori Romberger, MA, NCC, LPC, CCTP, Licensed Professional Counselor](https://photos.psychologytoday.com/d0d984fc-e4fb-4c60-9aa4-3c393aa3a7d7/1/320x400.jpeg)
Tori Romberger
Licensed Professional Counselor, MA, NCC, LPC, CCTP
Verified Verified
2 Endorsed
Harrisburg, PA 17111 (Online Only)
You might be struggling with trauma, PTSD, or anxiety. Your mental health is important, and I'm here to support your journey. You are seeking relief from emotional burdens, and my goal is to provide a safe space for healing and growth. Let's work together to achieve the emotional health you desire.
You might be struggling with trauma, PTSD, or anxiety. Your mental health is important, and I'm here to support your journey. You are seeking relief from emotional burdens, and my goal is to provide a safe space for healing and growth. Let's work together to achieve the emotional health you desire.
![Photo of Teni Osundeko - Teni Counseling & Consulting Services, PhD, LCSW, SAP, Clinical Social Work/Therapist](https://photos.psychologytoday.com/3c0b0197-46cd-11ea-a6ad-06142c356176/8/320x400.jpeg)
Teni Counseling & Consulting Services
Clinical Social Work/Therapist, PhD, LCSW, SAP
Verified Verified
Swatara, PA 17111 (Online Only)
Are you going through a life transition or feeling depressed, anxious or stressed? You don't have to struggle anymore. I will come along side you to work through life's challenges. I provide therapy with compasssion, respect and integrity to help you improve your emotional well being. I am deeply commited to assisting individuals make positive changes and develop emotional wellness. Using a strengths perspective, I offer a safe and supportive environment for you to share your concerns and begin to develop new solutions. My approach to therapy is client centered, goal oriented and solution focused.
Are you going through a life transition or feeling depressed, anxious or stressed? You don't have to struggle anymore. I will come along side you to work through life's challenges. I provide therapy with compasssion, respect and integrity to help you improve your emotional well being. I am deeply commited to assisting individuals make positive changes and develop emotional wellness. Using a strengths perspective, I offer a safe and supportive environment for you to share your concerns and begin to develop new solutions. My approach to therapy is client centered, goal oriented and solution focused.
![Photo of Brett Bailey Kern, LPC, Licensed Professional Counselor](https://photos.psychologytoday.com/44e1c525-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
Brett Bailey Kern
Licensed Professional Counselor, LPC
Verified Verified
1 Endorsed
Harrisburg, PA 17111
What isn't talked about is repeated...In so many ways. We get stuck,whether this be specific behaviors, relationships, symptoms of anxiety or depression or substance abuse. Even, when we arrive at the awareness that we want to feel or be different. Our family experience and our experiences in our increasingly complex world, shape, without our permission, how we think and feel. Understanding the meaning we made of our experiences and the thinking and feeling habits that developed, can begin to bring relief and reduce or eliminate the symptoms that motivated us to seek help.
What isn't talked about is repeated...In so many ways. We get stuck,whether this be specific behaviors, relationships, symptoms of anxiety or depression or substance abuse. Even, when we arrive at the awareness that we want to feel or be different. Our family experience and our experiences in our increasingly complex world, shape, without our permission, how we think and feel. Understanding the meaning we made of our experiences and the thinking and feeling habits that developed, can begin to bring relief and reduce or eliminate the symptoms that motivated us to seek help.
![Photo of Vincent Rogers, MSW, LCSW, SAP, Clinical Social Work/Therapist](https://photos.psychologytoday.com/3d925dbc-46cd-11ea-a6ad-06142c356176/1/320x400.jpeg)
Vincent Rogers
Clinical Social Work/Therapist, MSW, LCSW, SAP
Verified Verified
1 Endorsed
Harrisburg, PA 17111
Are you experiencing life stressors? Are you feeling down and blue or having a hard time with work stress? If you are, then maybe I can help you get back on the right path to happiness. Is your marriage in trouble? Is your relationship facing problems and conflict? If so, my passion is to help couples reconnect to rediscover each other in a loving, caring manner. I can help you establish stronger communication patterns by providing couples with the tools to help them to have a healthy marriage/relationship.
Are you experiencing life stressors? Are you feeling down and blue or having a hard time with work stress? If you are, then maybe I can help you get back on the right path to happiness. Is your marriage in trouble? Is your relationship facing problems and conflict? If so, my passion is to help couples reconnect to rediscover each other in a loving, caring manner. I can help you establish stronger communication patterns by providing couples with the tools to help them to have a healthy marriage/relationship.
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![Photo of Merle Mullins, LCSW, LMFT, Marriage & Family Therapist](https://photos.psychologytoday.com/80338a0a-35b8-452d-b130-77c49aa7ac77/2/320x400.jpeg)
I help my clients overcome the issues that arise in family and work life: anxiety and depression, marital discord, healing after an affair, parenting strategies, anger management, addictions, step-family difficulties, or dealing with separation or divorce. I help people deal with behavior problems and relationship issues in the workplace, school, or community, including depression, anxiety, stress, substance abuse, obsessions and compulsions, grief and loss, and an inability to find meaning or purpose in life. I am also available for telecounseling sessions.
I help my clients overcome the issues that arise in family and work life: anxiety and depression, marital discord, healing after an affair, parenting strategies, anger management, addictions, step-family difficulties, or dealing with separation or divorce. I help people deal with behavior problems and relationship issues in the workplace, school, or community, including depression, anxiety, stress, substance abuse, obsessions and compulsions, grief and loss, and an inability to find meaning or purpose in life. I am also available for telecounseling sessions.
![Photo of Erin Waltz, MS, NCC, LPC, Licensed Professional Counselor](https://photos.psychologytoday.com/f5645281-b171-4760-9f28-145c6cce42e1/2/320x400.jpeg)
Erin Waltz
Licensed Professional Counselor, MS, NCC, LPC
Verified Verified
1 Endorsed
Harrisburg, PA 17111 (Online Only)
Not accepting new clients
I am a Licensed Professional Counselor who works with children, adolescents and adults facing difficult roadblocks and challenges. Whether it be behavioral, educational/workplace or other stressors impacting sucess, my experience can help you and/or your family take a solution focused approach to reaching your full potential.
I am a Licensed Professional Counselor who works with children, adolescents and adults facing difficult roadblocks and challenges. Whether it be behavioral, educational/workplace or other stressors impacting sucess, my experience can help you and/or your family take a solution focused approach to reaching your full potential.
![Photo of Christina E Miles, MA, LPC, CAADC, Licensed Professional Counselor](https://photos.psychologytoday.com/44eb59ab-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Christina E Miles
Licensed Professional Counselor, MA, LPC, CAADC
Verified Verified
Harrisburg, PA 17111
My areas of specialization include working with adolescents and adults with anxiety, depression, trauma, co-occurring disorders, addiction and personality disorders. I'm trained in E.M.D.R. which is the most researched treatment for trauma and P.T.S.D. I use Cognitive Behavioral Therapy (CBT) along with elements from other modalities of therapy to provide the best treatment approach for each individual client. Also, I incorporate natural and holistic interventions for those seeking an integrative approach.
My areas of specialization include working with adolescents and adults with anxiety, depression, trauma, co-occurring disorders, addiction and personality disorders. I'm trained in E.M.D.R. which is the most researched treatment for trauma and P.T.S.D. I use Cognitive Behavioral Therapy (CBT) along with elements from other modalities of therapy to provide the best treatment approach for each individual client. Also, I incorporate natural and holistic interventions for those seeking an integrative approach.
![Photo of McKenzie L. Walker - The Behavioral Health and Wellness Academy, LLC, PsyD, Psychologist](https://photos.psychologytoday.com/40cc37ef-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
The Behavioral Health and Wellness Academy, LLC
Psychologist, PsyD
Verified Verified
2 Endorsed
Harrisburg, PA 17111
My approach to treatment is based in the Cognitive Behavioral Therapy (CBT) model. I work to help you identify feelings that have an impact on your behaviors and attitudes. By identifying this string of thoughts, feelings and actions, we can work together to make changes that bring about positive outcomes in your life. At times, making changes can be difficult. Techniques of Motivational Interviewing are useful when struggling to determine what changes would be the most beneficial. I approach every session with a trauma informed attitude so events that leave an emotional imprint can be effectively explored.
My approach to treatment is based in the Cognitive Behavioral Therapy (CBT) model. I work to help you identify feelings that have an impact on your behaviors and attitudes. By identifying this string of thoughts, feelings and actions, we can work together to make changes that bring about positive outcomes in your life. At times, making changes can be difficult. Techniques of Motivational Interviewing are useful when struggling to determine what changes would be the most beneficial. I approach every session with a trauma informed attitude so events that leave an emotional imprint can be effectively explored.
![Photo of Joyce Brooks, MSW, LCSW, CCTP, Clinical Social Work/Therapist](https://photos.psychologytoday.com/395f3cde-cdd0-4f45-ad8e-76feab9ed531/1/320x400.jpeg)
Joyce Brooks
Clinical Social Work/Therapist, MSW, LCSW, CCTP
Verified Verified
Harrisburg, PA 17111 (Online Only)
Anxious? Stressed? How does Christianity intersect with anxiety? I can help you! I have over 20 years of experience working with adults addressing issues related to anxiety, stress, grief and loss, trauma and depression. I have worked in a variety of mental health settings (residential, in-home services, alternative education, partial hospitalization).
Anxious? Stressed? How does Christianity intersect with anxiety? I can help you! I have over 20 years of experience working with adults addressing issues related to anxiety, stress, grief and loss, trauma and depression. I have worked in a variety of mental health settings (residential, in-home services, alternative education, partial hospitalization).
![Photo of Andrew Charney, LPC, Clinical Social Work/Therapist](https://photos.psychologytoday.com/bfe4f96f-367a-4e57-8ad0-80e6e780325a/2/320x400.png)
Hello! My name is Andrew Charney and I am a Licensed Professional Counselor (LPC) in the state of Pennsylvania, a National Certified Counselor (NCC), am certified in Family Therapy, Level 1 Rational Living Therapy (Reality), and Gambling Addiction. I incorporate cognitive behavioral interventions, mindfulness with DBT, and motivational interviewing. I have 7 years of experience working with children, adolescents, and adults providing individual, couples, and family therapy, in addition to addiction counseling and group counseling.
Hello! My name is Andrew Charney and I am a Licensed Professional Counselor (LPC) in the state of Pennsylvania, a National Certified Counselor (NCC), am certified in Family Therapy, Level 1 Rational Living Therapy (Reality), and Gambling Addiction. I incorporate cognitive behavioral interventions, mindfulness with DBT, and motivational interviewing. I have 7 years of experience working with children, adolescents, and adults providing individual, couples, and family therapy, in addition to addiction counseling and group counseling.
![Photo of Shana Rivera, LCSW, C-DBT, Clinical Social Work/Therapist](https://photos.psychologytoday.com/747697ae-7607-4c51-9c17-76a9f05bf4f8/2/320x400.jpeg)
Hi, my name is Shana Rivera. I am a compassionate and experienced licensed clinical social worker (LCSW) and certified dialectical behavior therapist (C-DBT) with 15+ years of experience, dedicated to supporting adults in their journey towards improved wellbeing. My passion for helping others comes from a deep understanding of the challenges individuals face when navigating their mental health. I utilize evidence-based practice to help individuals heal in the areas of PTSD, anxiety and depressive disorders, personality disorders, and strained relationship dynamics.
Hi, my name is Shana Rivera. I am a compassionate and experienced licensed clinical social worker (LCSW) and certified dialectical behavior therapist (C-DBT) with 15+ years of experience, dedicated to supporting adults in their journey towards improved wellbeing. My passion for helping others comes from a deep understanding of the challenges individuals face when navigating their mental health. I utilize evidence-based practice to help individuals heal in the areas of PTSD, anxiety and depressive disorders, personality disorders, and strained relationship dynamics.
![Photo of Sarah A Kunkel, LPC, Licensed Professional Counselor](https://photos.psychologytoday.com/4eeae320-46cd-11ea-a6ad-06142c356176/3/320x400.jpeg)
Sarah is a Licenced Professional Counselor (LPC) and Certified Advanced Alcohol and Drug Counselor (CAADC) in the state of Pennsylvania. She completed her Masters degree in Mental Health Counseling/Clinical Psychology at the Philadelphia College of Osteopathic Medicine, with a specialized focus on Addiction and Offenders counseling. She then completed training in Cognitive Behavioral Therapy (CBT) through the Philadelphia Beck Community Initiative, under CBT founder Dr. Aaron Beck.
Sarah is a Licenced Professional Counselor (LPC) and Certified Advanced Alcohol and Drug Counselor (CAADC) in the state of Pennsylvania. She completed her Masters degree in Mental Health Counseling/Clinical Psychology at the Philadelphia College of Osteopathic Medicine, with a specialized focus on Addiction and Offenders counseling. She then completed training in Cognitive Behavioral Therapy (CBT) through the Philadelphia Beck Community Initiative, under CBT founder Dr. Aaron Beck.
![Photo of Jessica Hendrix, LPC, Clinical Social Work/Therapist](https://photos.psychologytoday.com/495a74f0-5a98-41ed-a0de-bd65d152d79f/1/320x400.jpeg)
Jessica is a Licensed Professional Counselor who earned her Master of Science degree in Community Counseling from Columbus State University in Georgia. Jessica works with adults who are experiencing problems with anxiety, depression, trauma, relationship concerns, and adjustment problems. She uses an eclectic style that includes Cognitive Behavioral Therapy (CBT). Her therapy focus is to aid her clients in recognizing and addressing unhelpful thinking styles so that they may find more effective means for working through problems.
Jessica is a Licensed Professional Counselor who earned her Master of Science degree in Community Counseling from Columbus State University in Georgia. Jessica works with adults who are experiencing problems with anxiety, depression, trauma, relationship concerns, and adjustment problems. She uses an eclectic style that includes Cognitive Behavioral Therapy (CBT). Her therapy focus is to aid her clients in recognizing and addressing unhelpful thinking styles so that they may find more effective means for working through problems.
See more therapy options for 17111
How does your Therapist compare?
Number of Therapists in 17111
40+
Average cost per session
$125
Therapists in 17111 who prioritize treating:
98% | Anxiety |
93% | Depression |
78% | Trauma and PTSD |
67% | Grief |
61% | Life Transitions |
59% | Coping Skills |
57% | Relationship Issues |
Average years in practice
11 Years
Top 3 insurances accepted
89% | Highmark |
84% | Optum |
75% | Aetna |
How Therapists in 17111 see their clients
70% | In Person and Online | |
30% | Online Only |
Gender breakdown
69% | Female | |
31% | Male |
FAQs - About Therapy and Counseling
How can I find a therapist in 17111?
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.