Therapists in 40391
![Photo of Megan Manns, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/67021dbb-4dac-4619-8936-143b733d01a7/2/320x400.jpeg)
Megan Manns
Clinical Social Work/Therapist, LCSW
Verified Verified
Winchester, KY 40391 (Online Only)
I can help clients by providing a safe place for client's to process trauma and create healthy coping skills to manage stress, anxiety, triggers, and depression.
I can help clients by providing a safe place for client's to process trauma and create healthy coping skills to manage stress, anxiety, triggers, and depression.
![Photo of Vicci Phillips, MS, LPCC](https://photos.psychologytoday.com/48d49f5a-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Vicci Phillips
Licensed Professional Clinical Counselor, MS, LPCC
Verified Verified
Winchester, KY 40391
We all encounter problems in life, and seeking help to overcome these difficulties is smart, healthy, and courageous. As a counselor, I am passionate about helping people discover how to navigate life's obstacles. Together, we will work toward helping you achieve your goals, all in a confidential, accepting, and non-judgmental environment. We will explore the areas in your life that are not working as well as you would like and find avenues toward hope, health, and healing.
We all encounter problems in life, and seeking help to overcome these difficulties is smart, healthy, and courageous. As a counselor, I am passionate about helping people discover how to navigate life's obstacles. Together, we will work toward helping you achieve your goals, all in a confidential, accepting, and non-judgmental environment. We will explore the areas in your life that are not working as well as you would like and find avenues toward hope, health, and healing.
![Photo of Joshua Johnston, MS, LMFT, Marriage & Family Therapist](https://photos.psychologytoday.com/3ef2297f-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Joshua Johnston
Marriage & Family Therapist, MS, LMFT
Verified Verified
2 Endorsed
Winchester, KY 40391 (Online Only)
Therapy is about connecting with another person in such a way that you feel understood and valued, while trusting that your best interest is being served. There are many different ways to achieve this goal. My approach centers on working with people to understand their unique values and beliefs, which ultimately guides their experiences, and developing goals and strategies together to work toward their desired outcome. By asking the question, "what does better look like?", you are already on your way.
Therapy is about connecting with another person in such a way that you feel understood and valued, while trusting that your best interest is being served. There are many different ways to achieve this goal. My approach centers on working with people to understand their unique values and beliefs, which ultimately guides their experiences, and developing goals and strategies together to work toward their desired outcome. By asking the question, "what does better look like?", you are already on your way.
![Photo of Kendra O Poe, LPCC, NCCE-A](https://photos.psychologytoday.com/3c4feaf0-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Kendra O Poe
Licensed Professional Clinical Counselor, LPCC, NCCE-A
Verified Verified
Winchester, KY 40391
Thank you for taking the first step and considering counseling services. At Thrive Counseling & Consultation, we strive to help clients not only survive, but to thrive. Our environment is nonjudgmental in nature, and a safe place to explore life's difficulties. We have a team of therapists, and our aim is to place you with the therapist who is the best fit for your particular issues. Call today for help from a caring professional!
Thank you for taking the first step and considering counseling services. At Thrive Counseling & Consultation, we strive to help clients not only survive, but to thrive. Our environment is nonjudgmental in nature, and a safe place to explore life's difficulties. We have a team of therapists, and our aim is to place you with the therapist who is the best fit for your particular issues. Call today for help from a caring professional!
![Photo of Christina Chaney, LCSW, CTRS, Clinical Social Work/Therapist](https://photos.psychologytoday.com/112ab689-78f3-4aff-b427-9259f334a1b5/1/320x400.jpeg)
Discover the power of positive energy in life. By using a holistic approach to treat Mind, Body, and Spirit, I can help you concentrate on finding solutions, identify your strengths, increase your confidence, and overcome emotional barriers that keep you from moving forward. I understand the unique challenges adolescents are facing and welcome the opportunity to empower them to make positive changes. I have experience in successfully helping couples and families learn how to repair and rebuild their relationships. I encourage you to explore yourself and your goals in a safe, validating, and non-judgmental environment.
Discover the power of positive energy in life. By using a holistic approach to treat Mind, Body, and Spirit, I can help you concentrate on finding solutions, identify your strengths, increase your confidence, and overcome emotional barriers that keep you from moving forward. I understand the unique challenges adolescents are facing and welcome the opportunity to empower them to make positive changes. I have experience in successfully helping couples and families learn how to repair and rebuild their relationships. I encourage you to explore yourself and your goals in a safe, validating, and non-judgmental environment.
![Photo of Marianne Williams - Central Kentucky DUI and Counseling, LPCC-S](https://photos.psychologytoday.com/f40e07a3-24c2-4c1d-8a95-b339f721518d/2/320x400.jpeg)
Central Kentucky DUI and Counseling
Licensed Professional Clinical Counselor, LPCC-S
Verified Verified
Winchester, KY 40391
Do you ever feel alone or that no one understands how you feel? Do you need someone who is objective, honest and straight forward that will help you reflect and increase your awareness so that you can work through problems and issues differently? If so, I am your person. I like to work with people who are eager for change. That are willing to be open minded and try new things that can improve their thought process and over all life. I like to work fast and give clients techniques they can use outside of our time together. Through my many years of experience I have learned that therapy does not have to be long process.
Do you ever feel alone or that no one understands how you feel? Do you need someone who is objective, honest and straight forward that will help you reflect and increase your awareness so that you can work through problems and issues differently? If so, I am your person. I like to work with people who are eager for change. That are willing to be open minded and try new things that can improve their thought process and over all life. I like to work fast and give clients techniques they can use outside of our time together. Through my many years of experience I have learned that therapy does not have to be long process.
![Photo of Emily E Skaggs, PsyD, Psychologist](https://photos.psychologytoday.com/3c4b617e-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
I enjoy working with clients from every background. I believe therapy is a collaborative process with the overall goal being to address your concerns or issues in a manner that works specifically for you. I traditionally work from a Cognitive/Behavioral viewpoint, but also integrate family systems and insight oriented approaches. I believe treatment is a collaborative endeavor and I strive to work with clients in the manner that is most helpful to them.
I enjoy working with clients from every background. I believe therapy is a collaborative process with the overall goal being to address your concerns or issues in a manner that works specifically for you. I traditionally work from a Cognitive/Behavioral viewpoint, but also integrate family systems and insight oriented approaches. I believe treatment is a collaborative endeavor and I strive to work with clients in the manner that is most helpful to them.
![Photo of Kay Hubbard, MSW, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/bb3df428-c2e4-403e-a0c3-9bdaa5a73396/2/320x400.jpeg)
Kay Hubbard
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
1 Endorsed
Winchester, KY 40391
I enjoy working with persons of all ages (early childhood through adult.) My approach to treatment is eclectic and contingent upon the client's personality and therapeutic goals. I am committed to using scientifically based treatment interventions to ensure patients are provided the most dynamic techniques to achieve maximum outcomes in the least amount of time. Particular areas of interest include but are not limited to: parent child relational problems, child behavioral difficulties, issues related to emotional dysregulation, depression, anxiety and trauma related stress.
I enjoy working with persons of all ages (early childhood through adult.) My approach to treatment is eclectic and contingent upon the client's personality and therapeutic goals. I am committed to using scientifically based treatment interventions to ensure patients are provided the most dynamic techniques to achieve maximum outcomes in the least amount of time. Particular areas of interest include but are not limited to: parent child relational problems, child behavioral difficulties, issues related to emotional dysregulation, depression, anxiety and trauma related stress.
![Photo of Angie C DeHart, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/3d27a150-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Angie C DeHart
Clinical Social Work/Therapist, LCSW
Verified Verified
1 Endorsed
Winchester, KY 40391
When you're feeling down, even the most mundane stressors can be too much to bear. Talking with a caring professional in a warm and supportive environment can be an invaluable life experience. With almost 30 years of experience working with individuals and couples, I feel confident that I can help.
When you're feeling down, even the most mundane stressors can be too much to bear. Talking with a caring professional in a warm and supportive environment can be an invaluable life experience. With almost 30 years of experience working with individuals and couples, I feel confident that I can help.
![Photo of Samantha N Upshaw Maxey, MA, LPCC-S](https://photos.psychologytoday.com/45062445-46cd-11ea-a6ad-06142c356176/4/320x400.jpeg)
Samantha N Upshaw Maxey
Licensed Professional Clinical Counselor, MA, LPCC-S
Verified Verified
2 Endorsed
Winchester, KY 40391
Living life to the fullest is sometimes easier said than done. I believe people are innately good and wish to do their very best. Sometimes we get to places where doing our best, or living our best lives, is the most difficult thing we can face. My goal, as a clinical counselor, is to help people see their potential and help them identify ways to reach that potential. I specialize in an array of clients and look forward to finding individualized paths to help lead people to a more fulfilled life.
Living life to the fullest is sometimes easier said than done. I believe people are innately good and wish to do their very best. Sometimes we get to places where doing our best, or living our best lives, is the most difficult thing we can face. My goal, as a clinical counselor, is to help people see their potential and help them identify ways to reach that potential. I specialize in an array of clients and look forward to finding individualized paths to help lead people to a more fulfilled life.
![Photo of Rachael Hudson Lanter, MSW, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/b83aac3d-59db-4854-889c-434d566a940e/1/320x400.jpeg)
Rachael Hudson Lanter
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Winchester, KY 40391 (Online Only)
Not accepting new clients
Hi, I'm Rachael! I am a Licensed Clinical Social Worker in the beautiful state of Kentucky. I work with teens and adults to treat anxiety and depression, learn skills to cope with stress, navigate life transitions, practice better self-care, and more. I have experience working with people with disabilities, young moms, and the LGBTQ+ community.
Hi, I'm Rachael! I am a Licensed Clinical Social Worker in the beautiful state of Kentucky. I work with teens and adults to treat anxiety and depression, learn skills to cope with stress, navigate life transitions, practice better self-care, and more. I have experience working with people with disabilities, young moms, and the LGBTQ+ community.
![Photo of Galen McIntosh, MSW, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/943b5c40-ae6d-4104-851a-911ac8bce2eb/3/320x400.jpeg)
Galen McIntosh
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Winchester, KY 40391 (Online Only)
Galen is a native Kentuckian that has spent the last decade exploring the concepts of meaning; purpose; and the role that our suffering plays in not only constructing our greatest challenges, but also in forming the paths to realizing our greatest selves. Galen has worked with people from all across the Commonwealth within a variety of domains: student, educator, researcher, and therapist have all been caps donned during his work to better the quality of Being with whomever he provides help. He is a writer, philosopher, and a friend of nature who loves meeting new people and broadening his perspectives on life.
Galen is a native Kentuckian that has spent the last decade exploring the concepts of meaning; purpose; and the role that our suffering plays in not only constructing our greatest challenges, but also in forming the paths to realizing our greatest selves. Galen has worked with people from all across the Commonwealth within a variety of domains: student, educator, researcher, and therapist have all been caps donned during his work to better the quality of Being with whomever he provides help. He is a writer, philosopher, and a friend of nature who loves meeting new people and broadening his perspectives on life.
![Photo of William Derenge, MA, MBA, LPCA, NCC](https://photos.psychologytoday.com/831e51c4-d959-4fb0-8de4-6f093980580f/1/320x400.jpeg)
William Derenge
Licensed Professional Counselor Associate, MA, MBA, LPCA, NCC
Verified Verified
1 Endorsed
Winchester, KY 40391
Following a multidimensional approach to counseling and therapy, I focus not only on diagnosis and treatment but on the overall mental health and wellness of the clients I serve. I regard the therapeutic relationship shared with clients as the most important element of therapy and the highest predictor of positive and successful outcomes. My approach is tailored to the specific needs of each client to provide a unique therapeutic experience. Today I serve clients of all ages and backgrounds in person and online from Lexington, KY, as well as telehealth for Florida clients. Accelerated Resolution Therapy (ART) trained clinician.
Following a multidimensional approach to counseling and therapy, I focus not only on diagnosis and treatment but on the overall mental health and wellness of the clients I serve. I regard the therapeutic relationship shared with clients as the most important element of therapy and the highest predictor of positive and successful outcomes. My approach is tailored to the specific needs of each client to provide a unique therapeutic experience. Today I serve clients of all ages and backgrounds in person and online from Lexington, KY, as well as telehealth for Florida clients. Accelerated Resolution Therapy (ART) trained clinician.
![Photo of Amber Riley, LPCC, MA, Counselor](https://photos.psychologytoday.com/30f9420a-9e6d-47fd-b793-37c23f9e303d/2/320x400.jpeg)
This is not the life you pictured, is it? You know things need to change but have no idea where to start. Being a human in this fast-paced society is quite difficult and often times heartbreaking. I strive to place the therapeutic relationship as my primary focus, because until someone feels authentically accepted, change is not going to be possible.
This is not the life you pictured, is it? You know things need to change but have no idea where to start. Being a human in this fast-paced society is quite difficult and often times heartbreaking. I strive to place the therapeutic relationship as my primary focus, because until someone feels authentically accepted, change is not going to be possible.
![Photo of Aimee E Kidd, MA, LPCC-S, NCC](https://photos.psychologytoday.com/74ab6849-e61d-4c9b-8244-e1658bfaf531/2/320x400.jpeg)
Aimee E Kidd
Licensed Professional Clinical Counselor, MA, LPCC-S, NCC
Verified Verified
Winchester, KY 40391
In today’s fast-paced world of high demands and overstimulation, people need a peaceful place to relax and refocus. They need to be heard without judgement or interruption. Children need a caring adult to be present with them in the moment, someone to provide them with undivided attention. Teenagers need understanding. Couples need unbiased perspective. Every person's needs matter.
In today’s fast-paced world of high demands and overstimulation, people need a peaceful place to relax and refocus. They need to be heard without judgement or interruption. Children need a caring adult to be present with them in the moment, someone to provide them with undivided attention. Teenagers need understanding. Couples need unbiased perspective. Every person's needs matter.
![Photo of Stacy Lynn Harris, MSW, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/b14f4266-a5ec-41ca-8501-96c97dcbdaa9/1/320x400.jpeg)
Stacy Lynn Harris
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
1 Endorsed
Winchester, KY 40391
Waitlist for new clients
At Seeds of Change Counseling Center, we understand that reaching out can be overwhelming, our friendly therapists will do their best to put you at ease. If you would like to experience relief from your trauma-related symptoms, anxiety, intrusive thoughts, depression, panic attacks, or just want to feel like your old self again, ask me about Accelerated Resolution Therapy (ART). I am recently certified in providing Trauma-Informed Yoga and enjoy "walk and talk" therapy as well.
At Seeds of Change Counseling Center, we understand that reaching out can be overwhelming, our friendly therapists will do their best to put you at ease. If you would like to experience relief from your trauma-related symptoms, anxiety, intrusive thoughts, depression, panic attacks, or just want to feel like your old self again, ask me about Accelerated Resolution Therapy (ART). I am recently certified in providing Trauma-Informed Yoga and enjoy "walk and talk" therapy as well.
![Photo of Bradlee Y. Burtner, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/52e432fa-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Bradlee Y. Burtner
Clinical Social Work/Therapist, LCSW
Verified Verified
2 Endorsed
Winchester, KY 40391
Are you feeling sad, lacking energy, and feeling like something is wrong all of the time? Has your mood been up and down and you've found it hard to get along with people, particularly those closest to you? Have you started using drugs and alcohol in amounts that concern you and are impacting your day to day life?
Are you feeling sad, lacking energy, and feeling like something is wrong all of the time? Has your mood been up and down and you've found it hard to get along with people, particularly those closest to you? Have you started using drugs and alcohol in amounts that concern you and are impacting your day to day life?
![Photo of Christie Hamilton, LPCC](https://photos.psychologytoday.com/a1fb79cd-1de1-4743-9beb-d6d3a485b7bd/1/320x400.jpeg)
Christie Hamilton
Licensed Professional Clinical Counselor, LPCC
Verified Verified
Winchester, KY 40391
Not accepting new clients
I have a special passion for working with adolescents and young adults, and most of my clinical practice has focused on these age groups. I especially enjoy helping clients through life transitions, who are struggling in social relationships, or are adjusting to new environments like moving away from home or starting college. I have experience working with clients on issues including anxiety, depression, behavioral issues, parent-child relational problems, trauma, and adolescent substance abuse. If you’re thinking about finding a therapist for you or your child, I’d love to see if I’m a good fit.
I have a special passion for working with adolescents and young adults, and most of my clinical practice has focused on these age groups. I especially enjoy helping clients through life transitions, who are struggling in social relationships, or are adjusting to new environments like moving away from home or starting college. I have experience working with clients on issues including anxiety, depression, behavioral issues, parent-child relational problems, trauma, and adolescent substance abuse. If you’re thinking about finding a therapist for you or your child, I’d love to see if I’m a good fit.
![Photo of Christopher Sbert, CSW, TCADC](https://photos.psychologytoday.com/e04e7202-dd83-4fad-a2d6-e24cf4b2b580/2/320x400.png)
I am a Certified Social Worker practicing mental health and substance use therapy in Lexington, Kentucky. I aim to support and encourage individuals in obtaining their goals and improving their overall quality of life. I enjoy working with people from all walks of life and varying backgrounds and am LGBTQ+ affirming. I have experience in a variety of settings including community mental health, addiction treatment and more on an individual and group level.
I am a Certified Social Worker practicing mental health and substance use therapy in Lexington, Kentucky. I aim to support and encourage individuals in obtaining their goals and improving their overall quality of life. I enjoy working with people from all walks of life and varying backgrounds and am LGBTQ+ affirming. I have experience in a variety of settings including community mental health, addiction treatment and more on an individual and group level.
![Photo of Brianna Prewitt, MA, LPCA, RYT](https://photos.psychologytoday.com/d14a33a1-ed0b-4b30-9bfa-5118ee0079a2/4/320x400.jpeg)
Brianna Prewitt
Licensed Professional Counselor Associate, MA, LPCA, RYT
Verified Verified
1 Endorsed
Winchester, KY 40391
Waitlist for new clients
In a world filled with labels and titles, we are all simply human first. Being human means we are all bound to get it wrong sometimes no matter how much we have (or don’t have) figured out. Life is hard, and it’s natural that challenges sometimes cloud the way we see ourselves and the world; however, I believe worthiness is our birthright, and it is my goal as a clinician to help my clients see that their worthiness has no prerequisite and isn’t something to be earned.
In a world filled with labels and titles, we are all simply human first. Being human means we are all bound to get it wrong sometimes no matter how much we have (or don’t have) figured out. Life is hard, and it’s natural that challenges sometimes cloud the way we see ourselves and the world; however, I believe worthiness is our birthright, and it is my goal as a clinician to help my clients see that their worthiness has no prerequisite and isn’t something to be earned.
See more therapy options for 40391
How does your Therapist compare?
Number of Therapists in 40391
20+
Average cost per session
$120
Therapists in 40391 who prioritize treating:
100% | Anxiety |
90% | Depression |
90% | Coping Skills |
86% | Relationship Issues |
86% | Trauma and PTSD |
86% | Self Esteem |
76% | Grief |
Average years in practice
13 Years
Top 3 insurances accepted
78% | BlueCross and BlueShield |
78% | Elevance |
72% | UnitedHealthcare UHC | UBH |
How Therapists in 40391 see their clients
72% | In Person and Online | |
28% | Online Only |
Gender breakdown
77% | Female | |
23% | Male |
FAQs - About Therapy and Counseling
How can I find a therapist in 40391?
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.