Therapists in Cave Spring, VA

Photo of Lisa C Westmoreland - Westmoreland Counseling Services, LLC, MS, MA, LPC, Licensed Professional Counselor
Westmoreland Counseling Services, LLC
Licensed Professional Counselor, MS, MA, LPC
Verified Verified
Cave Spring, VA 24018
Counseling and Clinical Supervision: Would you like to improve your overall life satisfaction? Counseling helps people to improve their overall life satisfaction by supporting them in making changes. These changes can improve mood, sleep, relationships, work productivity, physical health and more according to your individual goals. I work with people 18 years old and up to support them in effectively making positive changes in their lives. My focus is on developing a trust-based relationship with clients to support them in reaching their goals that improve their overall life satisfaction and wellbeing.
Counseling and Clinical Supervision: Would you like to improve your overall life satisfaction? Counseling helps people to improve their overall life satisfaction by supporting them in making changes. These changes can improve mood, sleep, relationships, work productivity, physical health and more according to your individual goals. I work with people 18 years old and up to support them in effectively making positive changes in their lives. My focus is on developing a trust-based relationship with clients to support them in reaching their goals that improve their overall life satisfaction and wellbeing.
(540) 709-7530 View (540) 709-7530
Photo of Andrea Church Harris, LPC, Licensed Professional Counselor
Andrea Church Harris
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018
Andrea Church is a Resident in Counseling working towards licensure as a Licensed Professional Counselor (LPC). She has over three years of clinical experience conducting both individual and group therapy in a variety of settings. She best serves children (ages 10 and up), adolescents, and adults with treatment needs such as anxiety, substance use, grief, depression, and trauma. Andrea is trained in Eye-Movement Desensitization Reprocessing (EMDR) to treat trauma symptoms.
Andrea Church is a Resident in Counseling working towards licensure as a Licensed Professional Counselor (LPC). She has over three years of clinical experience conducting both individual and group therapy in a variety of settings. She best serves children (ages 10 and up), adolescents, and adults with treatment needs such as anxiety, substance use, grief, depression, and trauma. Andrea is trained in Eye-Movement Desensitization Reprocessing (EMDR) to treat trauma symptoms.
(540) 802-5806 View (540) 802-5806
Photo of Jacob L Goldshteyn, LPC, Licensed Professional Counselor
Jacob L Goldshteyn
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018
It is one of my primary goals to create a safe, trusting, and non-judgmental environment that will allow you to explore difficult topics and gain greater knowledge of yourself, others, and your relationships. I'm a licensed professional counselor experienced in dealing with a range of life issues, including depression, anxiety, addictions, trauma, relationship issues, and identity concerns. The steps needed to make meaningful changes in our lives can be difficult. It is my passion to support others in making such meaningful changes. Change is a journey--you don't have to walk alone.
It is one of my primary goals to create a safe, trusting, and non-judgmental environment that will allow you to explore difficult topics and gain greater knowledge of yourself, others, and your relationships. I'm a licensed professional counselor experienced in dealing with a range of life issues, including depression, anxiety, addictions, trauma, relationship issues, and identity concerns. The steps needed to make meaningful changes in our lives can be difficult. It is my passion to support others in making such meaningful changes. Change is a journey--you don't have to walk alone.
(540) 208-5983 View (540) 208-5983
Photo of Lindsey Livesay, LPC, Licensed Professional Counselor
Lindsey Livesay
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018
Lindsey is a Licensed Professional Counselor and a Certified Substance Abuse Counselor, with 23 years of experience helping teens, adults, and couples find an optimal way to navigate life's issues. Lindsey specializes in depression, anxiety, LGBTQIA+ issues, trauma, grief, substance use issues, managing anger or stress, unproductive communication patterns, phase of life issues, and more. Lindsey also utilizes skills from cognitive behavioral therapy (CBT), motivational interviewing, solution-focused therapy, and more, tailoring intentional interventions to the unique needs of her clients.
Lindsey is a Licensed Professional Counselor and a Certified Substance Abuse Counselor, with 23 years of experience helping teens, adults, and couples find an optimal way to navigate life's issues. Lindsey specializes in depression, anxiety, LGBTQIA+ issues, trauma, grief, substance use issues, managing anger or stress, unproductive communication patterns, phase of life issues, and more. Lindsey also utilizes skills from cognitive behavioral therapy (CBT), motivational interviewing, solution-focused therapy, and more, tailoring intentional interventions to the unique needs of her clients.
(540) 329-2104 View (540) 329-2104
Photo of Iruj Humayun, Pre-Licensed Professional
Iruj Humayun
Pre-Licensed Professional
Verified Verified
Cave Spring, VA 24018
Iruj Humayun is a Resident in Counseling with experience providing therapy for co-occurring disorders. She has provided treatment for depression, anxiety, PTSD and comorbid substance abuse, and trauma in survivors of intimate partner violence. Iruj works with both adults and children. In 2021, Iruj gave birth to a baby boy born with congenital heart disease. Eight months later, Iruj lost her baby while still orienting herself to a new state and city. Iruj understands pain, loss, PTSD, and hospital trauma and is keen on helping individuals who have struggled like her. She feels strongly about post-partum healing and women’s issues.
Iruj Humayun is a Resident in Counseling with experience providing therapy for co-occurring disorders. She has provided treatment for depression, anxiety, PTSD and comorbid substance abuse, and trauma in survivors of intimate partner violence. Iruj works with both adults and children. In 2021, Iruj gave birth to a baby boy born with congenital heart disease. Eight months later, Iruj lost her baby while still orienting herself to a new state and city. Iruj understands pain, loss, PTSD, and hospital trauma and is keen on helping individuals who have struggled like her. She feels strongly about post-partum healing and women’s issues.
(540) 802-5249 View (540) 802-5249
Photo of Olivia Oakley, MSW
Olivia Oakley
Supervisee in Clinical Social Work, MSW
Verified Verified
1 Endorsed
Cave Spring, VA 24018
I am a dedicated counselor with a strong commitment to providing personalized and effective therapeutic services to individuals aged 14+. I believe in the strength and resilience of every individual, and my goal is to provide strengths-based and person-centered care to empower my clients on their path to healing and self-discovery. I have experience working with children, adolescents, and adults struggling with depression, anxiety, and trauma. I am deeply committed to creating a safe space for individuals within the LGBTQ+ community, offering unwavering support as they navigate the complexities of identity and mental health.
I am a dedicated counselor with a strong commitment to providing personalized and effective therapeutic services to individuals aged 14+. I believe in the strength and resilience of every individual, and my goal is to provide strengths-based and person-centered care to empower my clients on their path to healing and self-discovery. I have experience working with children, adolescents, and adults struggling with depression, anxiety, and trauma. I am deeply committed to creating a safe space for individuals within the LGBTQ+ community, offering unwavering support as they navigate the complexities of identity and mental health.
(540) 306-4707 View (540) 306-4707
Photo of Karen Hetherington, MA, LMHP-R
Karen Hetherington
Resident in Counseling, MA, LMHP-R
Verified Verified
Cave Spring, VA 24018
Are you ready to take the leap and begin therapy with a strength-based clinician who will support you on your journey? I have been involved in the mental health field for many years and have worked with individuals from various backgrounds. My passion is helping clients 18 and above who have women’s issues; anxiety, depression, self-esteem, body issues, setting boundaries, relationship conflict, childhood trauma, people pleasing, and eating disorders. I use a Person-Centered approach along with evidence-based treatments. I provide a safe, relaxing, non-judgmental, environment where my my clients can express themselves freely.
Are you ready to take the leap and begin therapy with a strength-based clinician who will support you on your journey? I have been involved in the mental health field for many years and have worked with individuals from various backgrounds. My passion is helping clients 18 and above who have women’s issues; anxiety, depression, self-esteem, body issues, setting boundaries, relationship conflict, childhood trauma, people pleasing, and eating disorders. I use a Person-Centered approach along with evidence-based treatments. I provide a safe, relaxing, non-judgmental, environment where my my clients can express themselves freely.
(540) 596-5890 View (540) 596-5890
Photo of Shannon Roosma, LPC, Licensed Professional Counselor
Shannon Roosma
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018
Shannon is a Licensed Professional Counselor in Virginia who has approximately 10 years of experience in providing mental health services in multiple environments. She has had the opportunity to work in private practice, university counseling centers, and crisis services. She has worked with clients with a wide range of concerns including depression, anxiety, trauma, personality disorders, abuse histories, relationship issues, stress, life changes, personal growth, and family of origin issues.
Shannon is a Licensed Professional Counselor in Virginia who has approximately 10 years of experience in providing mental health services in multiple environments. She has had the opportunity to work in private practice, university counseling centers, and crisis services. She has worked with clients with a wide range of concerns including depression, anxiety, trauma, personality disorders, abuse histories, relationship issues, stress, life changes, personal growth, and family of origin issues.
(540) 724-8762 View (540) 724-8762
Photo of Morgan Whittaker, LCSW, Clinical Social Work/Therapist
Morgan Whittaker
Clinical Social Work/Therapist, LCSW
Verified Verified
Cave Spring, VA 24018
Morgan Whittaker is a Licensed Clinical Social Worker (LCSW) whose primary areas of focus with clients have been anxiety, depression, trauma (to include but not limited to domestic violence, childhood trauma, and combat), grief/loss, substance abuse, and coping with severe mental illness or coping with changing health circumstances. Morgan has primarily worked with adults, but she does have experience working with adolescents. Morgan completed her Bachelor of Arts (BA) in Psychology at the College of William & Mary and her Master of Social Work (MSW) at Virginia Commonwealth University.
Morgan Whittaker is a Licensed Clinical Social Worker (LCSW) whose primary areas of focus with clients have been anxiety, depression, trauma (to include but not limited to domestic violence, childhood trauma, and combat), grief/loss, substance abuse, and coping with severe mental illness or coping with changing health circumstances. Morgan has primarily worked with adults, but she does have experience working with adolescents. Morgan completed her Bachelor of Arts (BA) in Psychology at the College of William & Mary and her Master of Social Work (MSW) at Virginia Commonwealth University.
(540) 625-1579 View (540) 625-1579
Photo of Kristene Thorne, LPC, Licensed Professional Counselor
Kristene Thorne
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018  (Online Only)
Kristene Thorne is a Licensed Professional Counselor (LPC). She has over 17 years of experience in providing clinical/therapeutic care. Kristene affirms all genders, sexualities, faiths, and families. As a former public school counselor, Kristene works well with children, teens, families, and teachers in the Virginia school system.
Kristene Thorne is a Licensed Professional Counselor (LPC). She has over 17 years of experience in providing clinical/therapeutic care. Kristene affirms all genders, sexualities, faiths, and families. As a former public school counselor, Kristene works well with children, teens, families, and teachers in the Virginia school system.
(540) 592-4916 View (540) 592-4916
Photo of Kyle Calhoun, LPC, Licensed Professional Counselor
Kyle Calhoun
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018
Kyle is a Licensed Professional Counselor with 7 years of experience. She is an experienced practitioner working with people of all ages but has come to specialize in adolescents through adulthood. Some of the diagnoses that Kyle is experienced in treating include but are not limited to depression, anxiety, mood disorders, personality disorders, family systems and attachment disorders, substance-related disorders, stage of life changes, and grief and loss.
Kyle is a Licensed Professional Counselor with 7 years of experience. She is an experienced practitioner working with people of all ages but has come to specialize in adolescents through adulthood. Some of the diagnoses that Kyle is experienced in treating include but are not limited to depression, anxiety, mood disorders, personality disorders, family systems and attachment disorders, substance-related disorders, stage of life changes, and grief and loss.
(540) 274-0711 View (540) 274-0711
Photo of Holly Humphreys, LPC, Licensed Professional Counselor
Holly Humphreys
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018
Holly Humphreys is a Registered Art Therapist (ATR) and a Licensed Professional Counselor (LPC) who works with individuals of all ages using art therapy as a means to attend to each individual’s specific needs. Holly has over 10 years of experience in providing art therapy to at-risk youth in juvenile detentions centers in Virginia. She also has 9 years of experience with providing behavior therapy to people who stutter. Holly completed her Bachelor of Fine Arts (BFA) at James Madison University and her Master of Science (MS) in Art Therapy at Eastern Virginia Medical School. She was born and raised in Roanoke, Virginia.
Holly Humphreys is a Registered Art Therapist (ATR) and a Licensed Professional Counselor (LPC) who works with individuals of all ages using art therapy as a means to attend to each individual’s specific needs. Holly has over 10 years of experience in providing art therapy to at-risk youth in juvenile detentions centers in Virginia. She also has 9 years of experience with providing behavior therapy to people who stutter. Holly completed her Bachelor of Fine Arts (BFA) at James Madison University and her Master of Science (MS) in Art Therapy at Eastern Virginia Medical School. She was born and raised in Roanoke, Virginia.
(540) 346-3017 View (540) 346-3017
Photo of Maham Nasir, MFT, Pre-Licensed Professional
Maham Nasir
Pre-Licensed Professional, MFT
Verified Verified
Cave Spring, VA 24018  (Online Only)
My work is centered around helping families, couples, and individuals nurture their relationships, break unhealthy behavioral cycles, and work through their struggles. I focus on trauma, family and relationship history, and I help my clients uncover new levels of self awareness. I have experience working with individuals who carry a variety of hardships ranging from depression, to anxiety, anger management, bipolar disorder, low self-esteem, minorities/immigrants struggling with identity confusion, individuals suffering with eating disorders, and more.
My work is centered around helping families, couples, and individuals nurture their relationships, break unhealthy behavioral cycles, and work through their struggles. I focus on trauma, family and relationship history, and I help my clients uncover new levels of self awareness. I have experience working with individuals who carry a variety of hardships ranging from depression, to anxiety, anger management, bipolar disorder, low self-esteem, minorities/immigrants struggling with identity confusion, individuals suffering with eating disorders, and more.
(678) 981-9990 View (678) 981-9990
Photo of Lauren Carroll, RIC, Pre-Licensed Professional
Lauren Carroll
Pre-Licensed Professional, RIC
Verified Verified
Cave Spring, VA 24018
Lauren Carroll is a Licensed Resident in Counseling. She is passionate about working with adults who have experienced the effects of trauma, people who identify as neurodivergent, members of the LGBTQIA+ community, and anyone who has struggled with the idea of "fitting in." Lauren has experience working with issues related to grief, depression, anxiety, self-esteem, life transitions, relationships, ADHD, and trauma.
Lauren Carroll is a Licensed Resident in Counseling. She is passionate about working with adults who have experienced the effects of trauma, people who identify as neurodivergent, members of the LGBTQIA+ community, and anyone who has struggled with the idea of "fitting in." Lauren has experience working with issues related to grief, depression, anxiety, self-esteem, life transitions, relationships, ADHD, and trauma.
(540) 306-4210 View (540) 306-4210
Photo of Drew Taylor, LPC, Licensed Professional Counselor
Drew Taylor
Licensed Professional Counselor, LPC
Verified Verified
1 Endorsed
Cave Spring, VA 24018
If you are feeling lost, stuck, or out of touch with your self, I would welcome the chance to meet you. Maybe you have had counseling before and need to revisit something, or maybe all of this is new and intimidating. Whatever your perspective now, there is always something to be gained through exploration.
If you are feeling lost, stuck, or out of touch with your self, I would welcome the chance to meet you. Maybe you have had counseling before and need to revisit something, or maybe all of this is new and intimidating. Whatever your perspective now, there is always something to be gained through exploration.
(540) 340-5085 View (540) 340-5085
Photo of Sabrina Tiffany Mason, LPC, CSAC, Licensed Professional Counselor
Sabrina Tiffany Mason
Licensed Professional Counselor, LPC, CSAC
Verified Verified
Cave Spring, VA 24018  (Online Only)
Tired of responding 'I'm fine" to others when you're feeling everything BUT fine? Is your brain telling you to 'not bother' your loved ones when internally, you feel that talking to someone would be helpful? Whether you've recently encountered a big life change or the small things are building up, you are worthy and deserving of support.
Tired of responding 'I'm fine" to others when you're feeling everything BUT fine? Is your brain telling you to 'not bother' your loved ones when internally, you feel that talking to someone would be helpful? Whether you've recently encountered a big life change or the small things are building up, you are worthy and deserving of support.
(540) 712-3753 View (540) 712-3753
Photo of Nytasia Dockery, Pre-Licensed Professional
Nytasia Dockery
Pre-Licensed Professional
Verified Verified
Cave Spring, VA 24018  (Online Only)
Nytasia Dockery, Supervisee in Social Work (SISW), is a mental health professional with over 3 years of professional experience helping clients of all ages to overcome concerns or conditions related to couples issues, family matters, anxiety, depression, academic issues, career transitions, and much more.
Nytasia Dockery, Supervisee in Social Work (SISW), is a mental health professional with over 3 years of professional experience helping clients of all ages to overcome concerns or conditions related to couples issues, family matters, anxiety, depression, academic issues, career transitions, and much more.
(540) 358-8535 View (540) 358-8535
Photo of Ponteaah Monica Alexander, LPC, Licensed Professional Counselor
Ponteaah Monica Alexander
Licensed Professional Counselor, LPC
Verified Verified
Cave Spring, VA 24018  (Online Only)
Monica Alexander is a Licensed Professional Counselor with 14 years of experience in the mental health and substance use treatment fields. She has provided treatment in various settings and with a wide range of populations. She seeks to help people live more effective lives in order to thrive, not just survive, in life. She specializes in emotional dysregulation, depression disorders, anxiety disorders, substance use disorders, interpersonal conflict, grief, major life transitions, complex trauma, and mindfulness practices.
Monica Alexander is a Licensed Professional Counselor with 14 years of experience in the mental health and substance use treatment fields. She has provided treatment in various settings and with a wide range of populations. She seeks to help people live more effective lives in order to thrive, not just survive, in life. She specializes in emotional dysregulation, depression disorders, anxiety disorders, substance use disorders, interpersonal conflict, grief, major life transitions, complex trauma, and mindfulness practices.
(540) 518-0424 View (540) 518-0424
Photo of Brandie Fraction, LPC, Licensed Professional Counselor
Brandie Fraction
Licensed Professional Counselor, LPC
Verified Verified
2 Endorsed
Cave Spring, VA 24018
Therapy is a powerful and special relationship that I honor in my work. My therapeutic approach is supportive, collaborative, and integrative. I work to create treatment approaches unique to the needs of my clients and to collaborate on identifying goals. I also focus on promoting wellness with my clients. I incorporate techniques used in Cognitive Behavioral Therapy (CBT), Trauma informed care, solution focused, and mindfulness. I use complimentary techniques to include creativity and humor. My specialties include the treatment of anxiety, depression, relationship concerns, substance use and life transitions.
Therapy is a powerful and special relationship that I honor in my work. My therapeutic approach is supportive, collaborative, and integrative. I work to create treatment approaches unique to the needs of my clients and to collaborate on identifying goals. I also focus on promoting wellness with my clients. I incorporate techniques used in Cognitive Behavioral Therapy (CBT), Trauma informed care, solution focused, and mindfulness. I use complimentary techniques to include creativity and humor. My specialties include the treatment of anxiety, depression, relationship concerns, substance use and life transitions.
(540) 384-5050 View (540) 384-5050
Photo of Megan Leigh Keith, MSW, CSOTP-T, Pre-Licensed Professional
Megan Leigh Keith
Pre-Licensed Professional, MSW, CSOTP-T
Verified Verified
Cave Spring, VA 24018
Growth can be such a complicated and overwhelming experience. It can be hard to navigate through these challenges as you explore your ever changing identity, relationships, and environment. Sometimes your feelings can become so big and consuming that you might act out in ways that can be harmful to yourself or others around you. I want you to know that you don’t have to struggle through these big changes and challenges alone.
Growth can be such a complicated and overwhelming experience. It can be hard to navigate through these challenges as you explore your ever changing identity, relationships, and environment. Sometimes your feelings can become so big and consuming that you might act out in ways that can be harmful to yourself or others around you. I want you to know that you don’t have to struggle through these big changes and challenges alone.
(540) 264-3216 View (540) 264-3216

How does your Therapist compare?

Number of Therapists in Cave Spring, VA

40+

Average cost per session

$125

Therapists in Cave Spring, VA who prioritize treating:

93% Anxiety
89% Depression
80% Self Esteem
77% Trauma and PTSD
68% Relationship Issues
68% Coping Skills
57% Stress

Average years in practice

14 Years

Top 3 insurances accepted

74% Anthem | Elevance
65% Aetna
63% BlueCross and BlueShield

How Therapists in Cave Spring, VA see their clients

75% In Person and Online
25% Online Only

Gender breakdown

78% Female
22% Male
FAQs - About Therapy and Counseling

How can I find a therapist in Cave Spring?

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.