Therapists in Ballston Spa, NY

Photo of Heather Abreu, LCMHC, Counselor
Heather Abreu
Counselor, LCMHC
Verified Verified
Ballston Spa, NY 12020  (Online Only)
I am Heather Abreu. I am a Licensed Mental Health Counselor with 20 years of experience from NYC working statewide via Telehealth. I work with both adults and adolescents specializing in anxiety, addiction treatment, family dynamics, and major life transitions. I work with individuals presenting with a wide range of concerns. I have extensive experience working with individuals with addiction and with their loved ones, with individuals who have experienced trauma, and with families in conflict. I work with individuals struggling with life transitions such as personal identity, divorce, and career change.
I am Heather Abreu. I am a Licensed Mental Health Counselor with 20 years of experience from NYC working statewide via Telehealth. I work with both adults and adolescents specializing in anxiety, addiction treatment, family dynamics, and major life transitions. I work with individuals presenting with a wide range of concerns. I have extensive experience working with individuals with addiction and with their loved ones, with individuals who have experienced trauma, and with families in conflict. I work with individuals struggling with life transitions such as personal identity, divorce, and career change.
(347) 632-9840 View (347) 632-9840
Photo of Erin Gorman, MA, LMHC, Counselor
Erin Gorman
Counselor, MA, LMHC
Verified Verified
1 Endorsed
Ballston Spa, NY 12020
Waitlist for new clients
The decision to begin therapy can be challenging and can follow attempts to manage difficult life circumstances independently. I believe that healing begins when there is a safe, non judgmental space to grow a therapeutic relationship. I spent the early part of my career working extensively with adolescents and families which allowed me the opportunity to help them work through their trauma as they struggled with grief and loss, anxiety, self-injury, depression and PTSD. Additionally, I spent almost 7 years in an outpatient clinic as an Administrator, also providing clinical counseling to children, adults and families.
The decision to begin therapy can be challenging and can follow attempts to manage difficult life circumstances independently. I believe that healing begins when there is a safe, non judgmental space to grow a therapeutic relationship. I spent the early part of my career working extensively with adolescents and families which allowed me the opportunity to help them work through their trauma as they struggled with grief and loss, anxiety, self-injury, depression and PTSD. Additionally, I spent almost 7 years in an outpatient clinic as an Administrator, also providing clinical counseling to children, adults and families.
(518) 351-6667 View (518) 351-6667
Photo of Michelle Burdick, LCSW, Clinical Social Work/Therapist
Michelle Burdick
Clinical Social Work/Therapist, LCSW
Verified Verified
3 Endorsed
Ballston Spa, NY 12020  (Online Only)
Everyone needs help and it's OK to not be OK. I specialize in adults (18+) transitioning into adulthood, new life roles, careers, relationships, family issues, parenting, or other challenges that life throws at us. I provide a caring and safe place to talk through your concerns, challenges and barriers. I have extensive experience treating anxiety, depression, trauma, self esteem issues, relationships, LGBQT, and mood disorders. I always emphasis the importance of self-care and will help you develop personal methods. You don't have to suffer alone. Email me if you would like to meet and discuss your counseling needs and goals :)
Everyone needs help and it's OK to not be OK. I specialize in adults (18+) transitioning into adulthood, new life roles, careers, relationships, family issues, parenting, or other challenges that life throws at us. I provide a caring and safe place to talk through your concerns, challenges and barriers. I have extensive experience treating anxiety, depression, trauma, self esteem issues, relationships, LGBQT, and mood disorders. I always emphasis the importance of self-care and will help you develop personal methods. You don't have to suffer alone. Email me if you would like to meet and discuss your counseling needs and goals :)
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Photo of Liz Davis, LMSW
Liz Davis
Licensed Master Social Worker, LMSW
Verified Verified
1 Endorsed
Ballston Spa, NY 12020
Confused by what all the acronyms are behind the therapists names? Aren't they all just therapists? Realizing that in every therapy profile they describe their self as "eclectic".... How about trying to understand where you fall on a sliding scale but wondering how your insurance could play effect? What is therapy?.... Life throws a lot at us and it always seems to occur all at once, leaving us with unanswered questions and lack of support. I'm here to help make sense of it all and get us to where we mentally deserve to be at this time in our life.
Confused by what all the acronyms are behind the therapists names? Aren't they all just therapists? Realizing that in every therapy profile they describe their self as "eclectic".... How about trying to understand where you fall on a sliding scale but wondering how your insurance could play effect? What is therapy?.... Life throws a lot at us and it always seems to occur all at once, leaving us with unanswered questions and lack of support. I'm here to help make sense of it all and get us to where we mentally deserve to be at this time in our life.
(607) 414-2609 View (607) 414-2609
Photo of Rosalinda Affinito, MSW, LCSW, Clinical Social Work/Therapist
Rosalinda Affinito
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Ballston Spa, NY 12020
Hello ! So glad you are taking that first step towards a positive change and considering therapy. A good connection with whomever you decide to work with is crucial for the best outcome. I have always been passionate and committed to supporting my clients who are struggling with current and past challenges. Together, we explore the patterns and mindsets that are holding you back from living a healthier and more peaceful life. I offer a caring and nonjudgemental approach to talk through concerns in a safe space.
Hello ! So glad you are taking that first step towards a positive change and considering therapy. A good connection with whomever you decide to work with is crucial for the best outcome. I have always been passionate and committed to supporting my clients who are struggling with current and past challenges. Together, we explore the patterns and mindsets that are holding you back from living a healthier and more peaceful life. I offer a caring and nonjudgemental approach to talk through concerns in a safe space.
(518) 601-3677 View (518) 601-3677
Photo of Kelly M Tobin, PhD, Psychologist
Kelly M Tobin
Psychologist, PhD
Verified Verified
1 Endorsed
Ballston Spa, NY 12020
Receiving a proper diagnosis through testing can help a person receive the support they need to live more fully. Treatment may focus on therapy, medication, or specialized programs to assist students with learning disabilities. Psychological assessments do not tell a person that something is wrong with them. Rather, they bring struggles to light and highlight strengths so that the person can get help and use their strengths to their advantage. Understanding your strengths allows you to hone in on them. This might mean finding outside-of-the-box ways to go about things so that they work best for you.
Receiving a proper diagnosis through testing can help a person receive the support they need to live more fully. Treatment may focus on therapy, medication, or specialized programs to assist students with learning disabilities. Psychological assessments do not tell a person that something is wrong with them. Rather, they bring struggles to light and highlight strengths so that the person can get help and use their strengths to their advantage. Understanding your strengths allows you to hone in on them. This might mean finding outside-of-the-box ways to go about things so that they work best for you.
(518) 707-1647 View (518) 707-1647
Photo of Jennifer Trudeau-Brown, LMHC, ATR, Counselor
Jennifer Trudeau-Brown
Counselor, LMHC, ATR
Verified Verified
Ballston Spa, NY 12020
I am a Licensed Mental Health Counselor (LMHC) and Registered Art Therapist (ATR) who loves to help others connect with their authentic self. I have worked with clients of all ages with various concerns related to anxiety, depression, ADHD, OCD, eating disorders, substance abuse, trauma and PTSD in both a psychiatric hospital setting and private practice. I believe that with positive support, a change in mindset, and creativity true transformation can happen. Just like the Lotus we too have the ability to rise from the mud, bloom out of the darkness, and radiate into the world. - Author Unknown.
I am a Licensed Mental Health Counselor (LMHC) and Registered Art Therapist (ATR) who loves to help others connect with their authentic self. I have worked with clients of all ages with various concerns related to anxiety, depression, ADHD, OCD, eating disorders, substance abuse, trauma and PTSD in both a psychiatric hospital setting and private practice. I believe that with positive support, a change in mindset, and creativity true transformation can happen. Just like the Lotus we too have the ability to rise from the mud, bloom out of the darkness, and radiate into the world. - Author Unknown.
(518) 412-7656 View (518) 412-7656
Photo of Kate Miechkowski, LMSW, Clinical Social Work/Therapist
Kate Miechkowski
Clinical Social Work/Therapist, LMSW
Verified Verified
Ballston Spa, NY 12020
Clients would describe me as friendly, to-the-point, and practical. I'm genuinely curious about how you got where you are and, more importantly, where you want to go. Whether it's problems in your marriage, questioning your career, grieving a death, or wrestling with addiction, I want to hear about it. I've been around the block and found that building trust and a strong relationship matter more than specific clinical models and coping skills. While I enjoy working with a wide variety of people, I've found that I work very well with men.
Clients would describe me as friendly, to-the-point, and practical. I'm genuinely curious about how you got where you are and, more importantly, where you want to go. Whether it's problems in your marriage, questioning your career, grieving a death, or wrestling with addiction, I want to hear about it. I've been around the block and found that building trust and a strong relationship matter more than specific clinical models and coping skills. While I enjoy working with a wide variety of people, I've found that I work very well with men.
(518) 415-6980 View (518) 415-6980
Photo of Patricia A Huber, LCSW-R, Clinical Social Work/Therapist
Patricia A Huber
Clinical Social Work/Therapist, LCSW-R
Verified Verified
Ballston Spa, NY 12020  (Online Only)
Waitlist for new clients
Since earning my degree from the State University of New York at Albany in 1999, I have consistently applied a dynamic blend of expertise to my roles in psychotherapy, program implementation, and clinical supervision. My approach is driven by a passion for integrating cutting-edge technology and a strength-based perspective to transform the therapeutic process. Utilizing CBT techniques, I help clients cultivate healthier, more constructive thought patterns. Central to my practice is a commitment to a strong, collaborative partnership with each client, dedicated to guiding them along their unique journey of recovery and growth.
Since earning my degree from the State University of New York at Albany in 1999, I have consistently applied a dynamic blend of expertise to my roles in psychotherapy, program implementation, and clinical supervision. My approach is driven by a passion for integrating cutting-edge technology and a strength-based perspective to transform the therapeutic process. Utilizing CBT techniques, I help clients cultivate healthier, more constructive thought patterns. Central to my practice is a commitment to a strong, collaborative partnership with each client, dedicated to guiding them along their unique journey of recovery and growth.
(518) 245-3257 View (518) 245-3257
Photo of Molly Brockway, LMSW, Clinical Social Work/Therapist
Molly Brockway
Clinical Social Work/Therapist, LMSW
Verified Verified
Ballston Spa, NY 12020
Hi there! I am a NYS Licensed Master of Social Work practicing psychotherapy at Clearwater Counseling Associates. I utilize a variety of theoretical approaches based on the wants and needs of my client. I strive to understand who you are, who you want to be and develop an individualized treatment plan to help you reduce stress, symptoms and meet your fullest potential.
Hi there! I am a NYS Licensed Master of Social Work practicing psychotherapy at Clearwater Counseling Associates. I utilize a variety of theoretical approaches based on the wants and needs of my client. I strive to understand who you are, who you want to be and develop an individualized treatment plan to help you reduce stress, symptoms and meet your fullest potential.
(518) 896-8485 View (518) 896-8485
Photo of Denise L Snyder, LCSW-R, Clinical Social Work/Therapist
Denise L Snyder
Clinical Social Work/Therapist, LCSW-R
Verified Verified
Ballston Spa, NY 12020  (Online Only)
I work with clients with a wide range of issues including depression, anxiety, and relationship concerns. I provide a safe space to express thoughts and concerns without judgment. My clients want to get their lives back on track so that they can feel confident and happy again.
I work with clients with a wide range of issues including depression, anxiety, and relationship concerns. I provide a safe space to express thoughts and concerns without judgment. My clients want to get their lives back on track so that they can feel confident and happy again.
(518) 425-9830 View (518) 425-9830
Photo of Tressa Frese, MSEd, LMHC, Counselor
Tressa Frese
Counselor, MSEd, LMHC
Verified Verified
Ballston Spa, NY 12020  (Online Only)
Hello! I'm a NYS Licensed Mental Health Counselor practicing psychotherapy at Clearwater Counseling Associates. It is my mission to provide individuals with empathy, care, and compassion to assist in overcoming life's obstacles . I use a variety of theoretical approaches based on the needs of my client. I have experience working with a variety of diagnoses (anxiety, depression, post-traumatic stress disorder, personality disorders, schizophrenia, etc.) and populations (adolescents and adults). I also have experience assisting clients with addictions primarily substance abuse in developing relapse prevention plans in order to maintain abstinence.
Hello! I'm a NYS Licensed Mental Health Counselor practicing psychotherapy at Clearwater Counseling Associates. It is my mission to provide individuals with empathy, care, and compassion to assist in overcoming life's obstacles . I use a variety of theoretical approaches based on the needs of my client. I have experience working with a variety of diagnoses (anxiety, depression, post-traumatic stress disorder, personality disorders, schizophrenia, etc.) and populations (adolescents and adults). I also have experience assisting clients with addictions primarily substance abuse in developing relapse prevention plans in order to maintain abstinence.
(518) 333-9839 x102 View (518) 333-9839 x102
Photo of Whitney Closson, MS, BA
Whitney Closson
MS, BA
Verified Verified
Ballston Spa, NY 12020  (Online Only)
I am currently offering Mental Health Coaching. I collaborate with clients who face anxiety, stress, trauma, or are struggling with life transitions. They seek coping strategies, stress management skills, and validation in a supportive space. Their goals include reducing anxiety, building resilience, and finding fulfillment. They desire control over emotions, healthier relationships, and greater joy. Seeking help is a brave step towards reclaiming mental well-being and growth. Let's ride the waves of anxiety, together.
I am currently offering Mental Health Coaching. I collaborate with clients who face anxiety, stress, trauma, or are struggling with life transitions. They seek coping strategies, stress management skills, and validation in a supportive space. Their goals include reducing anxiety, building resilience, and finding fulfillment. They desire control over emotions, healthier relationships, and greater joy. Seeking help is a brave step towards reclaiming mental well-being and growth. Let's ride the waves of anxiety, together.
(518) 254-8608 View (518) 254-8608
Photo of Valerie Anne Mitchell Fadil - Valerie Mitchell Fadil, LCSW-R, LCSW-R, Clinical Social Work/Therapist
Valerie Mitchell Fadil, LCSW-R
Clinical Social Work/Therapist, LCSW-R
Verified Verified
Ballston Spa, NY 12020
I have over 30 years of experience working for the Jewish Board in NYC as a clinician, supervisor, director and senior director with clients ranging in age from 7-85. Additionally i have had a private practice in New Jersey since 2003. I employ an eclectic mix, utilizing Cognitive Behavioral, psychodynamic, supportive and family systems approaches, depending on the age and circumstances of the client.
I have over 30 years of experience working for the Jewish Board in NYC as a clinician, supervisor, director and senior director with clients ranging in age from 7-85. Additionally i have had a private practice in New Jersey since 2003. I employ an eclectic mix, utilizing Cognitive Behavioral, psychodynamic, supportive and family systems approaches, depending on the age and circumstances of the client.
(518) 855-3757 View (518) 855-3757
Photo of Powell Cucchiella - Positively Elite- Sport & Performance , LMHC
Positively Elite- Sport & Performance
Mental Health Counselor, LMHC
Verified Verified
1 Endorsed
Ballston Spa, NY 12020
Hello! I am a Licensed Therapist with a specialty in working with high school and college athletes interested in maintaining peak performance. We work together to understand, manage and train their mental performance so that they can more consistently and confidently achieve at their peak potential in athletics, school and relationships. As a former division 1 athlete, I understand quite well the challenges we face in consistent/confident performance. Now, as a therapist and mental coach, I would like to help your athlete gain control back over their ability to perform. Give me a call or email to discuss the possibilities! - Powell
Hello! I am a Licensed Therapist with a specialty in working with high school and college athletes interested in maintaining peak performance. We work together to understand, manage and train their mental performance so that they can more consistently and confidently achieve at their peak potential in athletics, school and relationships. As a former division 1 athlete, I understand quite well the challenges we face in consistent/confident performance. Now, as a therapist and mental coach, I would like to help your athlete gain control back over their ability to perform. Give me a call or email to discuss the possibilities! - Powell
(518) 975-3422 View (518) 975-3422
Photo of Kelly Albright, LCSW, Clinical Social Work/Therapist
Kelly Albright
Clinical Social Work/Therapist, LCSW
Verified Verified
Ballston Spa, NY 12020  (Online Only)
Hello and welcome! I am glad you are here and considering working with me. I am passionate about working with college students and young adults, particularly those with ADHD, Anxiety, and OCD. I also enjoy working with my clients through life transitions and relationship challenges.
Hello and welcome! I am glad you are here and considering working with me. I am passionate about working with college students and young adults, particularly those with ADHD, Anxiety, and OCD. I also enjoy working with my clients through life transitions and relationship challenges.
(518) 855-3445 View (518) 855-3445
Photo of Heather L. Lofink, LMHC, Counselor
Heather L. Lofink
Counselor, LMHC
Verified Verified
Ballston Spa, NY 12020
Not accepting new clients
Do you feel depressed, overwhelmed, anxious, or unsure of which direction to take your relationships, your job, or your life? Are these feelings holding you back from living the life you truly want? I love joining with my clients to explore these barriers and working to overcome them to create peace, health and happiness. Through skill building and meaningful conversation, you can move forward. In my practice, counseling can include humor; both laughter and tears are important parts of healing and growing. While I certainly respect that serious matters are discussed in therapy, we can usually find ways to enjoy our progress.
Do you feel depressed, overwhelmed, anxious, or unsure of which direction to take your relationships, your job, or your life? Are these feelings holding you back from living the life you truly want? I love joining with my clients to explore these barriers and working to overcome them to create peace, health and happiness. Through skill building and meaningful conversation, you can move forward. In my practice, counseling can include humor; both laughter and tears are important parts of healing and growing. While I certainly respect that serious matters are discussed in therapy, we can usually find ways to enjoy our progress.
(518) 363-6469 View (518) 363-6469
Photo of Tearle Ashby, LCSW-R, Clinical Social Work/Therapist
Tearle Ashby
Clinical Social Work/Therapist, LCSW-R
Verified Verified
Ballston Spa, NY 12020  (Online Only)
I strongly feel that the therapist/patient relationship is one of shared effort and accountability. Successful therapy is a mutual commitment to develop and attain goals that assist patients in achieving, returning to or creating a quality of life that is fulfilling and enjoyable.
I strongly feel that the therapist/patient relationship is one of shared effort and accountability. Successful therapy is a mutual commitment to develop and attain goals that assist patients in achieving, returning to or creating a quality of life that is fulfilling and enjoyable.
(518) 662-1975 View (518) 662-1975
Photo of Alaina Bullock, LMHC, Counselor
Alaina Bullock
Counselor, LMHC
Verified Verified
4 Endorsed
Ballston Spa, NY 12020
Not accepting new clients
In therapy with me, clients can expect a compassionate, supportive, non-judgmental approach. One of my priorities in the therapy room is to create a safe environment for individuals to make discoveries, gain clarity, and start the healing process. My specialty is in maternal mental health, including anxiety, depression and mood related issues during the perinatal period, infertility, loss, family planning and trauma related to pregnancy and/or delivery.
In therapy with me, clients can expect a compassionate, supportive, non-judgmental approach. One of my priorities in the therapy room is to create a safe environment for individuals to make discoveries, gain clarity, and start the healing process. My specialty is in maternal mental health, including anxiety, depression and mood related issues during the perinatal period, infertility, loss, family planning and trauma related to pregnancy and/or delivery.
(518) 241-3373 View (518) 241-3373
Photo of Alisa Sawyer, LMHC, Counselor
Alisa Sawyer
Counselor, LMHC
Verified Verified
Ballston Spa, NY 12020  (Online Only)
Are you finding this time in your life is bringing more overwhelm, anxiety, sadness anger or pain than it is joy? Does life feel very different than you imagined it would right now? Especially when our experience feels very different than what we had expected, it can bring up confusion, self doubt, & worst of all that deep down voice-criticizing, putting us down and have us wondering is it just me? Big life changes things like, starting college, getting married, pregnancy or new motherhood & more, have a way of bringing up some of these deeper held struggles and fears to surface.
Are you finding this time in your life is bringing more overwhelm, anxiety, sadness anger or pain than it is joy? Does life feel very different than you imagined it would right now? Especially when our experience feels very different than what we had expected, it can bring up confusion, self doubt, & worst of all that deep down voice-criticizing, putting us down and have us wondering is it just me? Big life changes things like, starting college, getting married, pregnancy or new motherhood & more, have a way of bringing up some of these deeper held struggles and fears to surface.
(518) 767-7541 View (518) 767-7541
1

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How does your Therapist compare?

Number of Therapists in Ballston Spa, NY

50+

Average cost per session

$150

Therapists in Ballston Spa, NY who prioritize treating:

86% Anxiety
78% Depression
72% Self Esteem
70% Relationship Issues
66% Trauma and PTSD
66% Coping Skills
62% Grief

Average years in practice

19 Years

Top 3 insurances accepted

63% Aetna
53% Anthem Blue Cross Blue Shield
53% CDPHP

How Therapists in Ballston Spa, NY see their clients

62% In Person and Online
38% Online Only

Gender breakdown

85% Female
13% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Ballston Spa?

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.