Therapists in Dubuque County, IA

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Photo of Laura A Hoffmann, LMHC, LPC, Counselor
Laura A Hoffmann
Counselor, LMHC, LPC
Verified Verified
2 Endorsed
Dubuque, IA 52003
No matter where you are at on your therapy journey, I will provide you with unconditional positive regard and genuine encouragement. I promote an eclectic style and incorporate a person centered, strengths based approach. In addition to an appropriate blend of humor, my clients describe me as warm, empathetic, and very approachable about difficult subjects. I enjoy and pride myself on being a lifelong learner. I additionally have Iowa Board of Behavioral Sciences approval to provide clinical supervision/mentoring for therapists in the beginning stages of their career.
No matter where you are at on your therapy journey, I will provide you with unconditional positive regard and genuine encouragement. I promote an eclectic style and incorporate a person centered, strengths based approach. In addition to an appropriate blend of humor, my clients describe me as warm, empathetic, and very approachable about difficult subjects. I enjoy and pride myself on being a lifelong learner. I additionally have Iowa Board of Behavioral Sciences approval to provide clinical supervision/mentoring for therapists in the beginning stages of their career.
(563) 265-6893 View (563) 265-6893
Photo of Katie Carreno, MA, tLMHC, Counselor
Katie Carreno
Counselor, MA, tLMHC
Verified Verified
Dubuque, IA 52001
Do you ever find yourself becoming paralyzed by "what if" questions? What about constantly thinking of the worst case scenario? I hear you, and I'm here for you. I have experience working with those struggling with anxiety, depression, and lowered self-esteem, primarily ages 12+
Do you ever find yourself becoming paralyzed by "what if" questions? What about constantly thinking of the worst case scenario? I hear you, and I'm here for you. I have experience working with those struggling with anxiety, depression, and lowered self-esteem, primarily ages 12+
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Photo of Valerie Gill, LISW, MSW, Clinical Social Work/Therapist
Valerie Gill
Clinical Social Work/Therapist, LISW, MSW
Verified Verified
Dubuque, IA 52001
With over 25 years of social work experience, my empathetic approach compassionately and openly builds upon client strengths to foster a collaborative working relationship. I am a strong advocate and go the extra mile for my clients. Together, we can create positive change for you to meet your life goals. My clients describe me as “skilled, experienced, direct, and caring”. I comfortably address trauma, sexual abuse, domestic violence, depression, anxiety, life transitions, LGBTQ+, grief, and loss. I work well with individuals, adolescents, families, and couples.
With over 25 years of social work experience, my empathetic approach compassionately and openly builds upon client strengths to foster a collaborative working relationship. I am a strong advocate and go the extra mile for my clients. Together, we can create positive change for you to meet your life goals. My clients describe me as “skilled, experienced, direct, and caring”. I comfortably address trauma, sexual abuse, domestic violence, depression, anxiety, life transitions, LGBTQ+, grief, and loss. I work well with individuals, adolescents, families, and couples.
(563) 235-2853 View (563) 235-2853
Photo of Mindy J Finn, MS, LMHC, Counselor
Mindy J Finn
Counselor, MS, LMHC
Verified Verified
Dubuque, IA 52003
Mindy Finn is a Licensed Mental Health Counselor in the state of Iowa. She has a Master’s Degree in Counseling Psychology from University of Wisconsin-Platteville. Mindy operates from a strengths-based, client-centered approach to empower her clients, promote positive self-image, and improve interpersonal relationships. She is experienced in treating adults, adolescents, children, families, and couples. Mindy specializes in treating trauma, PTSD, depression, anxiety, mood disorders, life adjustment issues, family and relationship issues.
Mindy Finn is a Licensed Mental Health Counselor in the state of Iowa. She has a Master’s Degree in Counseling Psychology from University of Wisconsin-Platteville. Mindy operates from a strengths-based, client-centered approach to empower her clients, promote positive self-image, and improve interpersonal relationships. She is experienced in treating adults, adolescents, children, families, and couples. Mindy specializes in treating trauma, PTSD, depression, anxiety, mood disorders, life adjustment issues, family and relationship issues.
(563) 921-6348 View (563) 921-6348
Photo of Teresa White, LMSW, Clinical Social Work/Therapist
Teresa White
Clinical Social Work/Therapist, LMSW
Verified Verified
Dubuque, IA 52001
Waitlist for new clients
I work with a variety of clients helping with growth, healing, and empowerment. The most important aspect of therapy is the connection between the therapist and the client. We all have struggles throughout our lives. I enjoying helping clients achieve their therapy goals through understanding, empathy, and genuine compassion for what is happening in their lives. I started my career in the helping field in 1999, working with teens as a youth counselor. I spent ten years working with young adults who have experienced foster care and adoption. I really enjoy seeing the growth in those I help.
I work with a variety of clients helping with growth, healing, and empowerment. The most important aspect of therapy is the connection between the therapist and the client. We all have struggles throughout our lives. I enjoying helping clients achieve their therapy goals through understanding, empathy, and genuine compassion for what is happening in their lives. I started my career in the helping field in 1999, working with teens as a youth counselor. I spent ten years working with young adults who have experienced foster care and adoption. I really enjoy seeing the growth in those I help.
(563) 239-3005 View (563) 239-3005
Photo of Ali Schneider, LMSW, Clinical Social Work/Therapist
Ali Schneider
Clinical Social Work/Therapist, LMSW
Verified Verified
1 Endorsed
Dubuque, IA 52003
I am accepting new clients at this time! Moving toward personal healing and growth can be hard! I acknowledge client's vulnerability and meet them with compassion and kindness. I am here to help clients navigate the uncomfortable, difficult, unwanted times in their life. I am a Licensed Master Social Worker with a passion for working with children, adolescents, and adults struggling with anxiety, self doubt, peer or relationship conflict, and depression. We all need help sometimes, and I'll be dedicated to being the help clients seek!
I am accepting new clients at this time! Moving toward personal healing and growth can be hard! I acknowledge client's vulnerability and meet them with compassion and kindness. I am here to help clients navigate the uncomfortable, difficult, unwanted times in their life. I am a Licensed Master Social Worker with a passion for working with children, adolescents, and adults struggling with anxiety, self doubt, peer or relationship conflict, and depression. We all need help sometimes, and I'll be dedicated to being the help clients seek!
(563) 202-8694 View (563) 202-8694
Photo of Elizabeth Heil, MSW, LISW, Clinical Social Work/Therapist
Elizabeth Heil
Clinical Social Work/Therapist, MSW, LISW
Verified Verified
Dubuque, IA 52001  (Online Only)
Are you so busy doing everything you SHOULD do that you don't have a moment for yourself? Do you "have it all" but feel like something is missing? Or are you struggling to find some direction in life? No matter where you are on your journey, I would be honored to accompany you on your path to a life filled with purpose and meaning. Whether you suffer from depression or anxiety, grief or loss, relationship challenges, or you just feel overwhelmed with all the demands of life, I can help you attain a sense of peace and serenity.
Are you so busy doing everything you SHOULD do that you don't have a moment for yourself? Do you "have it all" but feel like something is missing? Or are you struggling to find some direction in life? No matter where you are on your journey, I would be honored to accompany you on your path to a life filled with purpose and meaning. Whether you suffer from depression or anxiety, grief or loss, relationship challenges, or you just feel overwhelmed with all the demands of life, I can help you attain a sense of peace and serenity.
(563) 794-4340 View (563) 794-4340
Photo of Connie Marie Sprimont, LISW, Clinical Social Work/Therapist
Connie Marie Sprimont
Clinical Social Work/Therapist, LISW
Verified Verified
2 Endorsed
Dubuque, IA 52001
Hi, I am Connie Sprimont, an empathetic Licensed Independent Social Worker (LISW) passionate about helping individuals navigate life's challenges and cultivate resilience. With over 29 years of experience, I offer a safe and non-judgmental space where you can explore your journey of personal growth. I hold an MSW degree from the University of Iowa, with a focus on clinical social work practice, equipping me with the knowledge and skills to support you effectively. Throughout my career, I have had the privilege of empowering clients to overcome anxiety, depression, trauma, relationship difficulties, grief/loss, and life transitions.
Hi, I am Connie Sprimont, an empathetic Licensed Independent Social Worker (LISW) passionate about helping individuals navigate life's challenges and cultivate resilience. With over 29 years of experience, I offer a safe and non-judgmental space where you can explore your journey of personal growth. I hold an MSW degree from the University of Iowa, with a focus on clinical social work practice, equipping me with the knowledge and skills to support you effectively. Throughout my career, I have had the privilege of empowering clients to overcome anxiety, depression, trauma, relationship difficulties, grief/loss, and life transitions.
(563) 363-6294 View (563) 363-6294
Photo of Bridget Bartlett, LMSW, LISW, Clinical Social Work/Therapist
Bridget Bartlett
Clinical Social Work/Therapist, LMSW, LISW
Verified Verified
Dubuque, IA 52001
Not accepting new clients
Please note: I only accept private pay for marriage/couples/family therapy. Are you struggling in your significant relationships? Are you seeking therapy for your family? If so, I can help! I offer marriage, couples and family therapy. Therapy with me will include various exercises to improve your communication with your significant other and or family, as well as bring humor, fun and passion back into your partnerships. Family therapy can include various people in your life; i.e. your significant other, children, step children, parents, aunts, uncles, friends, business partner, co workers, etc,
Please note: I only accept private pay for marriage/couples/family therapy. Are you struggling in your significant relationships? Are you seeking therapy for your family? If so, I can help! I offer marriage, couples and family therapy. Therapy with me will include various exercises to improve your communication with your significant other and or family, as well as bring humor, fun and passion back into your partnerships. Family therapy can include various people in your life; i.e. your significant other, children, step children, parents, aunts, uncles, friends, business partner, co workers, etc,
(563) 278-2002 View (563) 278-2002
Photo of Riley Andrews, MA, LMHC, LPC, Counselor
Riley Andrews
Counselor, MA, LMHC, LPC
Verified Verified
Dubuque, IA 52001
Not accepting new clients
As the mama of young kiddos, who is also coping with life’s transitions, I’ve made it my mission to help mamas thrive throughout their pregnancy and postpartum journey, ensuring a healthy and fulfilling lifestyle for years to come. During my first maternity leave, I thought to myself, if I can help mamas manage their mental health and wellbeing (so they don't have to feel like I do right now), I can prevent kiddos from ever needing to come to see me. So, with that epiphany, I became fully trained to work with Perinatal Mental Health through Postpartum Support International & have since added Brainspotting to best treat Mama Trauma.
As the mama of young kiddos, who is also coping with life’s transitions, I’ve made it my mission to help mamas thrive throughout their pregnancy and postpartum journey, ensuring a healthy and fulfilling lifestyle for years to come. During my first maternity leave, I thought to myself, if I can help mamas manage their mental health and wellbeing (so they don't have to feel like I do right now), I can prevent kiddos from ever needing to come to see me. So, with that epiphany, I became fully trained to work with Perinatal Mental Health through Postpartum Support International & have since added Brainspotting to best treat Mama Trauma.
(563) 363-6244 View (563) 363-6244
Photo of Jessica Hanson, LMHC, Counselor
Jessica Hanson
Counselor, LMHC
Verified Verified
Dubuque, IA 52003
My experiences as a therapist make me well suited to address issues surrounding various areas of mental health; such as, clients struggling with anxiety, depression, and other disruptions in mood. My work focuses on life's journey. Traveling with my clients through the ups, downs and detours life often throws at us. I have experience working with areas specific to various mental health symptoms and perinatal mood and anxiety.
My experiences as a therapist make me well suited to address issues surrounding various areas of mental health; such as, clients struggling with anxiety, depression, and other disruptions in mood. My work focuses on life's journey. Traveling with my clients through the ups, downs and detours life often throws at us. I have experience working with areas specific to various mental health symptoms and perinatal mood and anxiety.
(563) 362-3137 View (563) 362-3137
Photo of Abby N Bottorff, MA, LMHC, Counselor
Abby N Bottorff
Counselor, MA, LMHC
Verified Verified
1 Endorsed
Dubuque, IA 52001
My approach to counseling is guided by self-empowerment and embracing the person you are and the ways you’d like to foster a kinder relationship with yourself. Our work together will be tailored to the parts of you that you’d like to better understand and support. This may include deep exploration of sexuality, gender, spirituality, culture, and the many different experiences that create the “parts” of who we are. My space is anti-capitalist and fueled by radical self-acceptance.
My approach to counseling is guided by self-empowerment and embracing the person you are and the ways you’d like to foster a kinder relationship with yourself. Our work together will be tailored to the parts of you that you’d like to better understand and support. This may include deep exploration of sexuality, gender, spirituality, culture, and the many different experiences that create the “parts” of who we are. My space is anti-capitalist and fueled by radical self-acceptance.
(563) 204-8235 View (563) 204-8235
Photo of Alec Eshelman, PhD, Psychologist
Alec Eshelman
Psychologist, PhD
Verified Verified
1 Endorsed
Dubuque, IA 52001
I completed a Ph.D. in counseling psychology from Southern Illinois University, where I developed expertise in evidence-based treatments that are grounded in rigorous science. I know that every person is unique, so I work to apply these scientific principles in a personalized way that helps you achieve your specific goals. Additionally, I provide affirming, inclusive care that ensures you receive the kindness, respect, and compassion you deserve.
I completed a Ph.D. in counseling psychology from Southern Illinois University, where I developed expertise in evidence-based treatments that are grounded in rigorous science. I know that every person is unique, so I work to apply these scientific principles in a personalized way that helps you achieve your specific goals. Additionally, I provide affirming, inclusive care that ensures you receive the kindness, respect, and compassion you deserve.
(563) 926-6262 View (563) 926-6262
Photo of Shana Kutsch, MA, LMHC, Counselor
Shana Kutsch
Counselor, MA, LMHC
Verified Verified
Dubuque, IA 52003
I am a Licensed Mental Health Counselor with over five years of experience providing individual therapy services to adolescents and adults. I have experience working with a wide range of emotional and behavioral issues including depression, anxiety, stress management, interpersonal concerns, low self-esteem, trauma related issues, loss and life adjustments. I work collectively with each client to create a trusting, safe and supportive therapeutic relationship. In doing so, we build the foundation for addressing issues and concerns that are impacting life.
I am a Licensed Mental Health Counselor with over five years of experience providing individual therapy services to adolescents and adults. I have experience working with a wide range of emotional and behavioral issues including depression, anxiety, stress management, interpersonal concerns, low self-esteem, trauma related issues, loss and life adjustments. I work collectively with each client to create a trusting, safe and supportive therapeutic relationship. In doing so, we build the foundation for addressing issues and concerns that are impacting life.
(563) 278-3684 View (563) 278-3684
Photo of Ricki (Richelle) Christene Bouska, PhD, LMHC, NCC, Counselor
Ricki (Richelle) Christene Bouska
Counselor, PhD, LMHC, NCC
Verified Verified
Dubuque, IA 52003  (Online Only)
I am a woman of great faith, a deep love for my family, and an abundance of hope! I truly believe I was called into the counseling ministry. I have a heart for coming alongside others as they endeavor to move forward in life. With a belief in human potential and each person's inherent worth, I offer companionship for the journey! The name Sacred Space Counseling Center, LLC was intentionally chosen. It encapsulates the essence of what therapy is to me, and ...what I hope it becomes for you! Come, take sanctuary in my Sacred Space!
I am a woman of great faith, a deep love for my family, and an abundance of hope! I truly believe I was called into the counseling ministry. I have a heart for coming alongside others as they endeavor to move forward in life. With a belief in human potential and each person's inherent worth, I offer companionship for the journey! The name Sacred Space Counseling Center, LLC was intentionally chosen. It encapsulates the essence of what therapy is to me, and ...what I hope it becomes for you! Come, take sanctuary in my Sacred Space!
(563) 207-3793 View (563) 207-3793
Photo of Richard Corfman, LISW, Clinical Social Work/Therapist
Richard Corfman
Clinical Social Work/Therapist, LISW
Verified Verified
Dubuque, IA 52003
Not accepting new clients
Clients have come to me for various reasons- marital conflict, depression, anxiety, post traumatic stress, bipolar illness, grief, ADHD and other related mental health diagnoses. I have felt honored to help people to move from feeling distressed to better managing their thoughts, feelings and behaviors so they can enjoy greater success and control over their lives.
Clients have come to me for various reasons- marital conflict, depression, anxiety, post traumatic stress, bipolar illness, grief, ADHD and other related mental health diagnoses. I have felt honored to help people to move from feeling distressed to better managing their thoughts, feelings and behaviors so they can enjoy greater success and control over their lives.
(563) 649-4449 View (563) 649-4449
Photo of Gwen Merfeld, MS, tLMHC, Counselor
Gwen Merfeld
Counselor, MS, tLMHC
Verified Verified
Dubuque, IA 52002
Waitlist for new clients
My approach is rooted in providing trauma-informed, culturally competent care. I have experience working with clients from various backgrounds, aged six and older, and provide individualized services according to each client’s needs. I particularly love working with women, LGBTQIA+ individuals, anxiety, depression, trauma, and religious issues.
My approach is rooted in providing trauma-informed, culturally competent care. I have experience working with clients from various backgrounds, aged six and older, and provide individualized services according to each client’s needs. I particularly love working with women, LGBTQIA+ individuals, anxiety, depression, trauma, and religious issues.
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Photo of Amber Teubert - Serenity Therapy, LLC, LPC-WI, LMHC-IA, LCPC-IL, NCC, CCMHC, Counselor
Serenity Therapy, LLC
Counselor, LPC-WI, LMHC-IA, LCPC-IL, NCC, CCMHC
Verified Verified
Dubuque, IA 52001  (Online Only)
Currently offering sessions via telehealth to clients in Iowa, Illinois and Wisconsin! I am a Licensed Counselor in all three states, and have been providing therapy services since 2012. I have dedicated my career to the Human Services field since 2004 and continue to be dedicated to the helping profession.
Currently offering sessions via telehealth to clients in Iowa, Illinois and Wisconsin! I am a Licensed Counselor in all three states, and have been providing therapy services since 2012. I have dedicated my career to the Human Services field since 2004 and continue to be dedicated to the helping profession.
(563) 557-6869 View (563) 557-6869
Photo of Meghan M. Smith, LMSW, Clinical Social Work/Therapist
Meghan M. Smith
Clinical Social Work/Therapist, LMSW
Verified Verified
1 Endorsed
Dubuque, IA 52001
I am a Licensed Master of Social Work (LMSW) working towards my Independent Social Worker (LISW) license, with an undergraduate degree in Social Work and a minor in Psychology. I earned my Master of Social Work from Clarke University and am a certified yoga teacher. I am a compassionate mental health therapist specializing in Anxiety, ADHD, Life Transitions, Mood Disorders, Relationship Issues, School Issues, and Trauma. My client-centered strengths-based approach incorporates Cognitive Behavioral Therapy (CBT), Mindfulness, and Play Therapy, and other modalities to help clients overcome challenges and improve their quality of life.
I am a Licensed Master of Social Work (LMSW) working towards my Independent Social Worker (LISW) license, with an undergraduate degree in Social Work and a minor in Psychology. I earned my Master of Social Work from Clarke University and am a certified yoga teacher. I am a compassionate mental health therapist specializing in Anxiety, ADHD, Life Transitions, Mood Disorders, Relationship Issues, School Issues, and Trauma. My client-centered strengths-based approach incorporates Cognitive Behavioral Therapy (CBT), Mindfulness, and Play Therapy, and other modalities to help clients overcome challenges and improve their quality of life.
(563) 200-7541 View (563) 200-7541
Photo of Mackenzie Baker, LMSW, Clinical Social Work/Therapist
Mackenzie Baker
Clinical Social Work/Therapist, LMSW
Verified Verified
Dubuque, IA 52002
Navigating the challenges of life can be incredibly demanding, and I wholeheartedly recognize the courage and vulnerability it takes to reach out. My aim for you as the client is to establish a secure and validating environment where you feel comfortable being your true self. Ensuring a sense of safety within the therapy setting is crucial for undertaking the challenging journey of healing and personal growth. I am committed to fostering a non-judgmental and encouraging atmosphere for your journey.
Navigating the challenges of life can be incredibly demanding, and I wholeheartedly recognize the courage and vulnerability it takes to reach out. My aim for you as the client is to establish a secure and validating environment where you feel comfortable being your true self. Ensuring a sense of safety within the therapy setting is crucial for undertaking the challenging journey of healing and personal growth. I am committed to fostering a non-judgmental and encouraging atmosphere for your journey.
(563) 677-6149 View (563) 677-6149
1

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How does your Therapist compare?

Number of Therapists in Dubuque County, IA

100+

Average cost per session

$155

Therapists in Dubuque County, IA who prioritize treating:

95% Anxiety
89% Depression
81% Coping Skills
76% Self Esteem
74% Stress
71% Trauma and PTSD
69% Relationship Issues

Average years in practice

9 Years

Top 3 insurances accepted

85% BlueCross and BlueShield
71% UnitedHealthcare UHC | UBH
57% Wellmark BCBS

How Therapists in Dubuque County, IA see their clients

82% In Person and Online
18% Online Only

Gender breakdown

83% Female
15% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Dubuque County?

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.