Photo of Nathaniel Eckland, PhD, Psychologist
Nathaniel Eckland
Psychologist, PhD
Verified Verified
Bethesda, MD 20817  (Online Only)
Problems like depression and anxiety can hold us back from living the life we want. Therapy can be challenging but the rewards are often worth the investment. Through therapy we can learn to change habits (thinking and behavioral) that no longer serve us and learn to accept and face life’s difficulties rather than avoid them. My role is supporting you in envisioning and working towards a fulfilling life. I work to create a warm, collaborative, nonjudgmental environment where you can be comfortable expressing and challenging yourself.
Problems like depression and anxiety can hold us back from living the life we want. Therapy can be challenging but the rewards are often worth the investment. Through therapy we can learn to change habits (thinking and behavioral) that no longer serve us and learn to accept and face life’s difficulties rather than avoid them. My role is supporting you in envisioning and working towards a fulfilling life. I work to create a warm, collaborative, nonjudgmental environment where you can be comfortable expressing and challenging yourself.
(240) 366-2339 View (240) 366-2339
Photo of Robert Anthony Binger - Comeback Counseling: Trauma-Informed Therapy, LCPC, CCTP-II, ASDCS
Comeback Counseling: Trauma-Informed Therapy
Licensed Clinical Professional Counselor, LCPC, CCTP-II, ASDCS
Verified Verified
Bethesda, MD 20817
Certified trauma-informed therapist with training in EMDR, IFS, DBT, and CPT. I specialize in work with adult/adolescent clients with a history of trauma, whether single incident or complex and/or autism. These clients may present with PTSD, cPTSD, depression, anxiety, substance use disorders, personality disorders, and more. My goal is to assist my clients with not only recovering after trauma, but enabling growth toward the person they want to be. I see survival as a strength, and the adaptations that allowed for that survival should be recognized as such to increase self-compassion and facilitate the next step.
Certified trauma-informed therapist with training in EMDR, IFS, DBT, and CPT. I specialize in work with adult/adolescent clients with a history of trauma, whether single incident or complex and/or autism. These clients may present with PTSD, cPTSD, depression, anxiety, substance use disorders, personality disorders, and more. My goal is to assist my clients with not only recovering after trauma, but enabling growth toward the person they want to be. I see survival as a strength, and the adaptations that allowed for that survival should be recognized as such to increase self-compassion and facilitate the next step.
(240) 474-9205 View (240) 474-9205
Photo of Lilian Gunawan, LMSW, PMH-C, Clinical Social Work/Therapist
Lilian Gunawan
Clinical Social Work/Therapist, LMSW, PMH-C
Verified Verified
Bethesda, MD 20817
I am a clinical social worker and therapist at the Washington Center for Women’s and Children’s Wellness in Bethesda, Maryland, caring for women and birthing people throughout Montgomery County and the Greater Washington area. I provide both tele-health and in-person appointments to clients. I am specialized in perinatal and women's mental health working with individuals who are struggling in their transition to parenthood, during pregnancy, fertility treatment, and in the postpartum period as well as with those who have experienced a pregnancy loss.
I am a clinical social worker and therapist at the Washington Center for Women’s and Children’s Wellness in Bethesda, Maryland, caring for women and birthing people throughout Montgomery County and the Greater Washington area. I provide both tele-health and in-person appointments to clients. I am specialized in perinatal and women's mental health working with individuals who are struggling in their transition to parenthood, during pregnancy, fertility treatment, and in the postpartum period as well as with those who have experienced a pregnancy loss.
(301) 381-2443 View (301) 381-2443
Photo of Kari Ayoroa, LCPC, LPC, CCTP, CIMHP, Counselor
Kari Ayoroa
Counselor, LCPC, LPC, CCTP, CIMHP
Verified Verified
Bethesda, MD 20817
I work with adults and adolescents treating anxiety, OCD, trauma, and depression. Using Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure and Response Prevention Therapy (ERP), Mindfulness, Solution Focused Therapy, Integrative Mental Health and as a Certified Clinical Trauma Professional. I utilize my experience working with adults, college and high school transitions concerns, social media impacts, life transitions, management of stress and many more. I treat based on my experience and willingness to meet all my clients where they are in their journey.
I work with adults and adolescents treating anxiety, OCD, trauma, and depression. Using Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Exposure and Response Prevention Therapy (ERP), Mindfulness, Solution Focused Therapy, Integrative Mental Health and as a Certified Clinical Trauma Professional. I utilize my experience working with adults, college and high school transitions concerns, social media impacts, life transitions, management of stress and many more. I treat based on my experience and willingness to meet all my clients where they are in their journey.
(301) 889-9395 View (301) 889-9395
Photo of Melanie Eisman Garber, LCSW-C, Clinical Social Work/Therapist
Melanie Eisman Garber
Clinical Social Work/Therapist, LCSW-C
Verified Verified
3 Endorsed
Bethesda, MD 20817  (Online Only)
I am an individual and family therapist that works primarily with adolescents, young adults and adults. My practice integrates traditional psychotherapy with a myriad of techniques to help clients channel their inner strength and make positive and desired changes in their lives. I am trained in cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) while also utilizing mindfulness, strengths-based and eclectic approaches to therapy. I am extremely passionate about working with adolescents, young adults and adults dealing with life transitions, relationship, peer issues and failure to launch.
I am an individual and family therapist that works primarily with adolescents, young adults and adults. My practice integrates traditional psychotherapy with a myriad of techniques to help clients channel their inner strength and make positive and desired changes in their lives. I am trained in cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) while also utilizing mindfulness, strengths-based and eclectic approaches to therapy. I am extremely passionate about working with adolescents, young adults and adults dealing with life transitions, relationship, peer issues and failure to launch.
(240) 594-8645 View (240) 594-8645
Photo of Joselyn Brown, LCPC
Joselyn Brown
Licensed Clinical Professional Counselor, LCPC
Verified Verified
Bethesda, MD 20817
My ideal client presents depressive symptoms related to trauma & grief. They express that they want to process unresolved childhood issues. They express that the issues have prevented close relationships with their adult children. They want forgiveness and help in creating better ties. The goal may be to explore & resolve issues related to traumatic events and improve overall mood. Interventions may include sharing details of the event and how it has affected their relationships, using positive self-talk, developing positive coping skills, and identifying effective strategies to communicate thoughts and feelings.
My ideal client presents depressive symptoms related to trauma & grief. They express that they want to process unresolved childhood issues. They express that the issues have prevented close relationships with their adult children. They want forgiveness and help in creating better ties. The goal may be to explore & resolve issues related to traumatic events and improve overall mood. Interventions may include sharing details of the event and how it has affected their relationships, using positive self-talk, developing positive coping skills, and identifying effective strategies to communicate thoughts and feelings.
(240) 262-3432 View (240) 262-3432
Photo of Hope Heller, LCSW-C, LICSW, LCSW, Clinical Social Work/Therapist
Hope Heller
Clinical Social Work/Therapist, LCSW-C, LICSW, LCSW
Verified Verified
1 Endorsed
Bethesda, MD 20817
Are you or someone in your life impacted by a chronic or terminal illness? Are you struggling with decisions around risk for a genetic illness? Are you struggling with relationships, family boundaries, or life transitions?
Are you or someone in your life impacted by a chronic or terminal illness? Are you struggling with decisions around risk for a genetic illness? Are you struggling with relationships, family boundaries, or life transitions?
(301) 205-5236 View (301) 205-5236
Photo of Mamata Das Hotha - Thrive! Executive Functioning Center, NCC, LCSW-C, MEd, Clinical Social Work/Therapist
Thrive! Executive Functioning Center
Clinical Social Work/Therapist, NCC, LCSW-C, MEd
Verified Verified
Bethesda, MD 20817
Our center works with teens and adults that are struggling to meet their goals. We have providers licensed in school counseling and therapy specializing in ADHD to help our clients realize their barriers and help them improve efficiency. We partner with community resources to provide the needed services to our clients to address their limitations and make improvements. Contact us today so we can help you thrive!
Our center works with teens and adults that are struggling to meet their goals. We have providers licensed in school counseling and therapy specializing in ADHD to help our clients realize their barriers and help them improve efficiency. We partner with community resources to provide the needed services to our clients to address their limitations and make improvements. Contact us today so we can help you thrive!
(240) 734-2662 View (240) 734-2662
Photo of Martina Alvarado, LCPC, MS, NCC, Counselor
Martina Alvarado
Counselor, LCPC, MS, NCC
Verified Verified
Bethesda, MD 20817  (Online Only)
I have a profound commitment to understanding and nurturing each client's unique goals, My intention is to create a safe and compassionate space where healing can flourish. My current areas of specialty include: adult ADHD, mood disorders, multicultural issues, sexual disorders, and women's health.
I have a profound commitment to understanding and nurturing each client's unique goals, My intention is to create a safe and compassionate space where healing can flourish. My current areas of specialty include: adult ADHD, mood disorders, multicultural issues, sexual disorders, and women's health.
(240) 363-2567 View (240) 363-2567
Photo of Todd Handelman, MSW, LCSW-C, Clinical Social Work/Therapist
Todd Handelman
Clinical Social Work/Therapist, MSW, LCSW-C
Verified Verified
Bethesda, MD 20817
Since 1992 I have helped clients age 13-73 respond to challenges facing them throughout their life cycles. Throughout my career I have facilitated my clients in developing skills and learning to ways to cope with the demands of school, socialization challenges, relationship dynamics, depression, anxiety, ADHD, sexuality, professional/career development and sports performance enhancement.
Since 1992 I have helped clients age 13-73 respond to challenges facing them throughout their life cycles. Throughout my career I have facilitated my clients in developing skills and learning to ways to cope with the demands of school, socialization challenges, relationship dynamics, depression, anxiety, ADHD, sexuality, professional/career development and sports performance enhancement.
(301) 859-7251 View (301) 859-7251
Photo of Brenden Stinson, LMSW, Clinical Social Work/Therapist
Brenden Stinson
Clinical Social Work/Therapist, LMSW
Verified Verified
Bethesda, MD 20817
For me, there is no ideal client. To some extent, everyone is on a spectrum of depression and anxiety, and I seek to work with clients who need assistance becoming oriented toward improvement. I have personal and professional experience and understand how difficult it is to find someone patient enough to grow alongside a client through the therapeutic process. I want to work alongside you to help you live a happy, meaningful life with these conditions.
For me, there is no ideal client. To some extent, everyone is on a spectrum of depression and anxiety, and I seek to work with clients who need assistance becoming oriented toward improvement. I have personal and professional experience and understand how difficult it is to find someone patient enough to grow alongside a client through the therapeutic process. I want to work alongside you to help you live a happy, meaningful life with these conditions.
(240) 266-9948 View (240) 266-9948
Photo of Antoinette Fobbs, LCSW-C, Clinical Social Work/Therapist
Antoinette Fobbs
Clinical Social Work/Therapist, LCSW-C
Verified Verified
Bethesda, MD 20817
My ideal client would be a mom or wife, an individual who does not have any coping skills and blames themselves for things that are out of their control, such as anxiety, depression, unstable mood, low self-esteem, lack of confidence, lack of motivation, & no insight in their situation. Their needs would be support, empathy, understanding, and active listening. They have goals to work on themselves, improve communication skills, increase coping skills, and alleviate anxiety and depressive symptoms. The client would want to change and work on themselves to become better and stronger individuals for themselves & their families.
My ideal client would be a mom or wife, an individual who does not have any coping skills and blames themselves for things that are out of their control, such as anxiety, depression, unstable mood, low self-esteem, lack of confidence, lack of motivation, & no insight in their situation. Their needs would be support, empathy, understanding, and active listening. They have goals to work on themselves, improve communication skills, increase coping skills, and alleviate anxiety and depressive symptoms. The client would want to change and work on themselves to become better and stronger individuals for themselves & their families.
(301) 381-6907 View (301) 381-6907
Photo of Dr. Carlos J. Carmona-Goyena, PhD
Dr. Carlos J. Carmona-Goyena
Licensed Clinical Professional Counselor, PhD
Verified Verified
Bethesda, MD 20817
Welcome! With over 18 years of experience and a Doctorate in Counseling Psychology granted at the Interamerican University of Puerto Rico, I am eager to start working together... You desire more than just relief from your symptoms; you seek understanding, connection, and lasting change. You want to rebuild your relationships, find peace within yourself, and develop the resilience to face life's challenges. You would be motivated by a deep desire for personal growth and a commitment to building a healthier, more fulfilling life.
Welcome! With over 18 years of experience and a Doctorate in Counseling Psychology granted at the Interamerican University of Puerto Rico, I am eager to start working together... You desire more than just relief from your symptoms; you seek understanding, connection, and lasting change. You want to rebuild your relationships, find peace within yourself, and develop the resilience to face life's challenges. You would be motivated by a deep desire for personal growth and a commitment to building a healthier, more fulfilling life.
(240) 670-1843 View (240) 670-1843
Photo of Leah E. Chiaverini, LCSW-C, Clinical Social Work/Therapist
Leah E. Chiaverini
Clinical Social Work/Therapist, LCSW-C
Verified Verified
1 Endorsed
Bethesda, MD 20817
I work with clients of all ages and issues/needs. I have a particular interest in those who are grieving, an experience that is difficult for anyone, particularly a young person who is just beginning to grasp language and how language relates to feelings. I am also well accommodated to help clients manage and process trauma/traumatic experiences with knowledge and guidance regarding the sympathetic nervous system/mind and body connectivity.
I work with clients of all ages and issues/needs. I have a particular interest in those who are grieving, an experience that is difficult for anyone, particularly a young person who is just beginning to grasp language and how language relates to feelings. I am also well accommodated to help clients manage and process trauma/traumatic experiences with knowledge and guidance regarding the sympathetic nervous system/mind and body connectivity.
(301) 691-2376 View (301) 691-2376
Photo of Mamata Hotha - Women's Wellness and Counseling Center (WWCC), LCSW-C, RYT200, RN, Clinical Social Work/Therapist
Women's Wellness and Counseling Center (WWCC)
Clinical Social Work/Therapist, LCSW-C, RYT200, RN
Verified Verified
Bethesda, MD 20817  (Online Only)
Maximizing wellness and functionality is our approach at WWCC. Life happens - chronic illness and pain, infertility, divorce, etc. Our goal is to help you adjust to your new 'normal' and to restore your mental health to a place where you can cope and function effectively regardless of circumstances. Our yoga instructors and therapists have a wide range of experience some with nursing backgrounds that help clients understand underlying medical issues that may be their impacting chronic pain, depression, anxiety, insomnia, and other issues.
Maximizing wellness and functionality is our approach at WWCC. Life happens - chronic illness and pain, infertility, divorce, etc. Our goal is to help you adjust to your new 'normal' and to restore your mental health to a place where you can cope and function effectively regardless of circumstances. Our yoga instructors and therapists have a wide range of experience some with nursing backgrounds that help clients understand underlying medical issues that may be their impacting chronic pain, depression, anxiety, insomnia, and other issues.
(301) 985-2621 View (301) 985-2621
Photo of Jonathon Ross Carrington, LCPC, Counselor
Jonathon Ross Carrington
Counselor, LCPC
Verified Verified
1 Endorsed
Bethesda, MD 20817  (Online Only)
Are you a professional navigating the challenges of an abusive relationship? You may feel isolated and powerless, struggling to maintain boundaries. You might be struggling with asking for what you need, saying no, and standing up for yourself. Your goal might be to reclaim your voice, learn how to set healthy boundaries, and be present in your relationships and work. You might be seeking out a therapist right now to help you sort out these issues and learn new strategies in your life.
Are you a professional navigating the challenges of an abusive relationship? You may feel isolated and powerless, struggling to maintain boundaries. You might be struggling with asking for what you need, saying no, and standing up for yourself. Your goal might be to reclaim your voice, learn how to set healthy boundaries, and be present in your relationships and work. You might be seeking out a therapist right now to help you sort out these issues and learn new strategies in your life.
(301) 918-5433 View (301) 918-5433
Photo of Rachel A. Dack, LCPC, MS, NCC
Rachel A. Dack
Licensed Clinical Professional Counselor, LCPC, MS, NCC
Verified Verified
7 Endorsed
Bethesda, MD 20817  (Online Only)
I am a passionate psychotherapist, specializing in relationship, dating, intimacy and marital issues, anxiety, depression, breakups and low self-esteem. My practice centers on supporting clients throughout life transitions and relationship stages/challenges. I am committed to working together to address issues interfering with life satisfaction and to help you achieve healthier, more rewarding relationships and greater awareness. I believe you possess what it takes to create the life you want and my role is to help you find, utilize and enhance your strengths and gain healthy coping skills to live an authentic and meaningful life.
I am a passionate psychotherapist, specializing in relationship, dating, intimacy and marital issues, anxiety, depression, breakups and low self-esteem. My practice centers on supporting clients throughout life transitions and relationship stages/challenges. I am committed to working together to address issues interfering with life satisfaction and to help you achieve healthier, more rewarding relationships and greater awareness. I believe you possess what it takes to create the life you want and my role is to help you find, utilize and enhance your strengths and gain healthy coping skills to live an authentic and meaningful life.
(301) 655-8462 View (301) 655-8462
Photo of Marjorie Jean, LICSW, LCSW-C, Clinical Social Work/Therapist
Marjorie Jean
Clinical Social Work/Therapist, LICSW, LCSW-C
Verified Verified
2 Endorsed
Bethesda, MD 20817  (Online Only)
Thriving takes commitment as it requires a mindset and body shift that can feel daunting at times. The weight of this world is already so disorienting and when we add our experiences with trauma, we can easily fall and live in a cycle of self-betrayal and neglect. Sometimes what we are holding onto needs to be fully disintegrated before we can move to a growth cycle. Much of my work is centered on trauma and stress recovery, shared empowerment, movement, and decolonizing practices. As a trauma healing practitioner, I am invested in facilitating your access to your whole self moving you beyond the traditional therapeutic activities.
Thriving takes commitment as it requires a mindset and body shift that can feel daunting at times. The weight of this world is already so disorienting and when we add our experiences with trauma, we can easily fall and live in a cycle of self-betrayal and neglect. Sometimes what we are holding onto needs to be fully disintegrated before we can move to a growth cycle. Much of my work is centered on trauma and stress recovery, shared empowerment, movement, and decolonizing practices. As a trauma healing practitioner, I am invested in facilitating your access to your whole self moving you beyond the traditional therapeutic activities.
(240) 724-8062 View (240) 724-8062
Photo of Mariel Farhi, Marriage & Family Therapist Associate
Mariel Farhi
Marriage & Family Therapist Associate
Verified Verified
Bethesda, MD 20817
Life is a journey and therapy works best a meeting fellow travelers on the road. We can walk together for a while and through our conversations create a warm, genuine, and engaged space where you can be curious, explore, and uncover insights that are already within you. I specialize in working with adult individuals, teens, and couples facing internal and external challenges that throw up roadblocks to living a whole, authentic life. I have a particular affinity for working with artists, activists, other healing professionals, and intercultural and premarital couples.
Life is a journey and therapy works best a meeting fellow travelers on the road. We can walk together for a while and through our conversations create a warm, genuine, and engaged space where you can be curious, explore, and uncover insights that are already within you. I specialize in working with adult individuals, teens, and couples facing internal and external challenges that throw up roadblocks to living a whole, authentic life. I have a particular affinity for working with artists, activists, other healing professionals, and intercultural and premarital couples.
(301) 825-9609 x44 View (301) 825-9609 x44
Photo of Michelle D Greenberg, LCSW, Clinical Social Work/Therapist
Michelle D Greenberg
Clinical Social Work/Therapist, LCSW
Verified Verified
Bethesda, MD 20817  (Online Only)
I currently have daytime availability. As an experienced therapist, I begin with where you are. My initial goal is to build a trusting relationship and create space to explore the challenges you are experiencing. I view myself as a scientist—listening, examining, observing, and asking the questions needed to create a plan. I work collaboratively with my clients to help them meet their goals and live their best lives.
I currently have daytime availability. As an experienced therapist, I begin with where you are. My initial goal is to build a trusting relationship and create space to explore the challenges you are experiencing. I view myself as a scientist—listening, examining, observing, and asking the questions needed to create a plan. I work collaboratively with my clients to help them meet their goals and live their best lives.
(410) 824-5617 View (410) 824-5617
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How does your Therapist compare?

Number of Therapists in 20817

300+

Average cost per session

$185

Therapists in 20817 who prioritize treating:

95% Anxiety
90% Depression
76% Relationship Issues
69% Self Esteem
65% Stress
64% Life Transitions
62% Coping Skills

Average years in practice

14 Years

Top 3 insurances accepted

68% BlueCross and BlueShield
62% Cigna and Evernorth
61% CareFirst

How Therapists in 20817 see their clients

61% In Person and Online
39% Online Only

Gender breakdown

80% Female
19% Male
1% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in 20817?

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.