Therapists in Vancouver, WA

View neighborhoods in Vancouver
Photo of Rachel Ryan, Licensed Professional Counselor in Vancouver, WA
Rachel Ryan
Licensed Professional Counselor, LPC
Verified Verified
Vancouver, WA 98683
Imperfections are not inadequacies; they are reminders that we're all in this together. - Brene Brown. I am here to help create a non-judgemental space for you to explore the many beautiful facets of your life. I use a Strengths-Based approach in therapy which allows for clients to recognize they are already whole, but have gotten some cracks along the way that may need to be mended. I will do my best to help you explore where your strengths already are and help you learn to be deeply connected with who you are. I help people on their path, wherever it may be.
Imperfections are not inadequacies; they are reminders that we're all in this together. - Brene Brown. I am here to help create a non-judgemental space for you to explore the many beautiful facets of your life. I use a Strengths-Based approach in therapy which allows for clients to recognize they are already whole, but have gotten some cracks along the way that may need to be mended. I will do my best to help you explore where your strengths already are and help you learn to be deeply connected with who you are. I help people on their path, wherever it may be.
(360) 564-8019 View (360) 564-8019
Photo of Kelly Fenimore, Mental Health Counselor in Vancouver, WA
Kelly Fenimore
Mental Health Counselor, MA, LMHC, LPC
Verified Verified
3 Endorsed
Vancouver, WA 98662
I believe we are all born with good intentions and infinite possibilities, but sometimes, life knocks us off our path. Our past experiences may have shaped who we are today, as well as what our relationships look like with ourselves and others, but despite whatever tragic events that occured during our life, we are driven towards resiliency. Except this is where we can get stuck: what we used to do, what we've always done, isn't working anymore; we need to find another way. When we allow ourselves to feel connected to others and focus on our strengths, rather than weaknesses, we are able to heal.
I believe we are all born with good intentions and infinite possibilities, but sometimes, life knocks us off our path. Our past experiences may have shaped who we are today, as well as what our relationships look like with ourselves and others, but despite whatever tragic events that occured during our life, we are driven towards resiliency. Except this is where we can get stuck: what we used to do, what we've always done, isn't working anymore; we need to find another way. When we allow ourselves to feel connected to others and focus on our strengths, rather than weaknesses, we are able to heal.
(360) 347-9212 View (360) 347-9212
Photo of Anna Claybaugh, Clinical Social Work/Therapist in Vancouver, WA
Anna Claybaugh
Clinical Social Work/Therapist
Verified Verified
Vancouver, WA 98685  (Online Only)
You are ready to stop patterns that involve giving your power away. You are looking for more fulfillment in life and are ready to reclaim your authentic self. You are tired of feeling like everything else comes before your dreams, goals, empowerment and mental health. You who want to learn how to build more loving awareness and compassion towards yourself in order to support your best life. You are interested in learning more about what makes you who you are, how to shift out of unhealthy beliefs and figure out what’s holding you back from securing happiness and abundance for yourself. Resonate? Then, let's work together.
You are ready to stop patterns that involve giving your power away. You are looking for more fulfillment in life and are ready to reclaim your authentic self. You are tired of feeling like everything else comes before your dreams, goals, empowerment and mental health. You who want to learn how to build more loving awareness and compassion towards yourself in order to support your best life. You are interested in learning more about what makes you who you are, how to shift out of unhealthy beliefs and figure out what’s holding you back from securing happiness and abundance for yourself. Resonate? Then, let's work together.
(360) 654-7698 View (360) 654-7698
Photo of Louise Fritz Counseling, Counselor in Vancouver, WA
Louise Fritz Counseling
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98683
Not accepting new clients
In over 25 years of working with individuals and couples, I have developed a very successful growth process. It begins by my understanding the problems that brought you into therapy, and then, together, developing treatment goals that take into account those problems, your strengths and fears, and that considers the progress you have already made. Then we engage as appropriate, always staying focused on you and your goals. I enjoy and am trained in both short-term specific problem therapy and also in-depth psychodynamic therapy. I look forward to meeting with you.
In over 25 years of working with individuals and couples, I have developed a very successful growth process. It begins by my understanding the problems that brought you into therapy, and then, together, developing treatment goals that take into account those problems, your strengths and fears, and that considers the progress you have already made. Then we engage as appropriate, always staying focused on you and your goals. I enjoy and am trained in both short-term specific problem therapy and also in-depth psychodynamic therapy. I look forward to meeting with you.
(360) 558-3610 View (360) 558-3610
Photo of Marieke Renner, Counselor in Vancouver, WA
Marieke Renner
Counselor, LMHC
Verified Verified
1 Endorsed
Vancouver, WA 98683
Accepting New Clients! Are you wondering how past experiences are affecting you today? Do you want to break the cycle and do things differently with your children than what you experienced growing up? Or maybe you are just curious about counseling and not sure what to expect? I am experienced working with clients with all types of trauma/(C-) PTSD, emotional neglect, anxiety, depression, bipolar disorders, OCD, grief, and anger issues, and I can support you navigate these types of challenges and potentially help you find healing and a sense of belonging in your life. I see individual adults of all ages.
Accepting New Clients! Are you wondering how past experiences are affecting you today? Do you want to break the cycle and do things differently with your children than what you experienced growing up? Or maybe you are just curious about counseling and not sure what to expect? I am experienced working with clients with all types of trauma/(C-) PTSD, emotional neglect, anxiety, depression, bipolar disorders, OCD, grief, and anger issues, and I can support you navigate these types of challenges and potentially help you find healing and a sense of belonging in your life. I see individual adults of all ages.
(360) 227-6984 View (360) 227-6984
Photo of Davina Karpstein, Counselor in Vancouver, WA
Davina Karpstein
Counselor, MA, LMHCA
Verified Verified
2 Endorsed
Vancouver, WA 98683
If you are seeking guidance, it takes courage and strength. Whether you are struggling to adjust to a life transition, finding it hard to make changes last, or just ready to face your past, you do not have to find your way alone. Your thoughts, feelings and behaviors may feel overwhelming and impossible to understand or connect but I can work with you to create a space for change and help you find relief from the suffering.
If you are seeking guidance, it takes courage and strength. Whether you are struggling to adjust to a life transition, finding it hard to make changes last, or just ready to face your past, you do not have to find your way alone. Your thoughts, feelings and behaviors may feel overwhelming and impossible to understand or connect but I can work with you to create a space for change and help you find relief from the suffering.
(360) 732-8993 View (360) 732-8993
Photo of Roberto Damarius Brindusesc, LPC Intern in Vancouver, WA
Roberto Damarius Brindusesc
LPC Intern
Verified Verified
1 Endorsed
Vancouver, WA 98683
Hello, I am Roberto Brindusesc. My fascination with psychology has been a defining aspect of my academic and personal journey. During the early stages of my undergraduate education, I was confronted with the challenges of depression and anxiety. At that pivotal juncture, I became acutely aware of my own limitations in comprehending and addressing them. It was this that ignited my passionate pursuit of knowledge and practical tools within the realm of psychology.
Hello, I am Roberto Brindusesc. My fascination with psychology has been a defining aspect of my academic and personal journey. During the early stages of my undergraduate education, I was confronted with the challenges of depression and anxiety. At that pivotal juncture, I became acutely aware of my own limitations in comprehending and addressing them. It was this that ignited my passionate pursuit of knowledge and practical tools within the realm of psychology.
(360) 968-7482 View (360) 968-7482
Photo of David Grushkin, Counselor in Vancouver, WA
David Grushkin
Counselor, MS, LMHC, LPC
Verified Verified
Vancouver, WA 98662  (Online Only)
Therapy isn't mysterious. It's a conversation that helps you create clarity about your feelings, what you really need or want, and how to get there. My photo shows me years ago enjoying a hike in Yellowstone. I also enjoy my clients. It is refreshing to provide a comfortable place for you to express your true feelings, to problem-solve and clarify your thinking. It is OK to seek help. Emotional overload happens to everyone. Your problem doesn't define your value. Imagine newborn babies. They are all equal and valuable. Self-limiting beliefs are "learned" later. It is an essential understanding that your true self is perfect.
Therapy isn't mysterious. It's a conversation that helps you create clarity about your feelings, what you really need or want, and how to get there. My photo shows me years ago enjoying a hike in Yellowstone. I also enjoy my clients. It is refreshing to provide a comfortable place for you to express your true feelings, to problem-solve and clarify your thinking. It is OK to seek help. Emotional overload happens to everyone. Your problem doesn't define your value. Imagine newborn babies. They are all equal and valuable. Self-limiting beliefs are "learned" later. It is an essential understanding that your true self is perfect.
(360) 389-3962 View (360) 389-3962
Photo of Rachel Hay, Clinical Social Work/Therapist in Vancouver, WA
Rachel Hay
Clinical Social Work/Therapist, LSWAIC, MSW, MAS
Verified Verified
Vancouver, WA 98662
I offer a unique blend of talk therapy and sound healing based interventions. Whether you're dealing with anxiety, trauma, chronic pain, or simply seeking greater self-awareness I am here to accompany you on your healing journey. With over 15 years as a Social Worker, working with children and families in the community my approach to therapy is grounded in compassion, authenticity, and collaboration, creating a safe and supportive space for clients to explore their thoughts, emotions, and experiences without judgment.
I offer a unique blend of talk therapy and sound healing based interventions. Whether you're dealing with anxiety, trauma, chronic pain, or simply seeking greater self-awareness I am here to accompany you on your healing journey. With over 15 years as a Social Worker, working with children and families in the community my approach to therapy is grounded in compassion, authenticity, and collaboration, creating a safe and supportive space for clients to explore their thoughts, emotions, and experiences without judgment.
(360) 322-1575 View (360) 322-1575
Photo of M'Lyss Maree Fruhling, Counselor in Vancouver, WA
M'Lyss Maree Fruhling
Counselor, MA, LMHC
Verified Verified
1 Endorsed
Vancouver, WA 98660
Are you ready to let go go old habits and ways of thought that shackle you? Would you like to move through your stuck places, your anxiety and your depression? Many people believe they are stuck in anxiety and depression when what they are really dealing with is a spiritual crisis. Once we bring in a level of work that acknowledges the very real struggles that they are dealing with, people begin to heal in new ways.
Are you ready to let go go old habits and ways of thought that shackle you? Would you like to move through your stuck places, your anxiety and your depression? Many people believe they are stuck in anxiety and depression when what they are really dealing with is a spiritual crisis. Once we bring in a level of work that acknowledges the very real struggles that they are dealing with, people begin to heal in new ways.
(360) 869-0785 View (360) 869-0785
Photo of Lisa Talvitie, Counselor in Vancouver, WA
Lisa Talvitie
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98684
Whether you are preparing for a new chapter in life, going through a crisis, or grieving a loss, life is easier when we get the support we need. I provide counseling in a safe, judgment-free environment where we can work together to sort out your current situation, learn tools, and set goals.
Whether you are preparing for a new chapter in life, going through a crisis, or grieving a loss, life is easier when we get the support we need. I provide counseling in a safe, judgment-free environment where we can work together to sort out your current situation, learn tools, and set goals.
(360) 339-8705 View (360) 339-8705
Photo of Tracy L Clason in Vancouver, WA
Tracy L Clason
ARNP, PMHNP, PLLC, BC
Verified Verified
1 Endorsed
Vancouver, WA 98662
My treatment approach to mental healthcare is focusing on the use of Cognitive Behavioral Therapy (CBT), Dialectical Behavioral therapy (DBT), DBT skills training, pet therapy and functional medicine as a specialty. The services I offer include; medication managment and psychogenomic testing for adult clients 18-65 years old. I have over 18 years of experience treating the following conditions; depression, anxiety, mood disorder, bipolar disorder, PTSD, ADHD and a variety of other conditions. I offer services that span grief/loss, life adjustment, work and parenting for example.
My treatment approach to mental healthcare is focusing on the use of Cognitive Behavioral Therapy (CBT), Dialectical Behavioral therapy (DBT), DBT skills training, pet therapy and functional medicine as a specialty. The services I offer include; medication managment and psychogenomic testing for adult clients 18-65 years old. I have over 18 years of experience treating the following conditions; depression, anxiety, mood disorder, bipolar disorder, PTSD, ADHD and a variety of other conditions. I offer services that span grief/loss, life adjustment, work and parenting for example.
(360) 464-9458 x9024 View (360) 464-9458 x9024
Photo of Tyler Jansen, Psychologist in Vancouver, WA
Tyler Jansen
Psychologist, PsyD
Verified Verified
1 Endorsed
Vancouver, WA 98660
I primarily work with people who are working to overcome porn addictions, are struggling with self-worth, or are generally overwhelmed with stress and difficult emotions. I also enjoy working with people who want to integrate their faith into their therapeutic work. I strive to provide a non-judgmental, down-to-earth environment in which to address the issues that may feel embarrassing or shameful to broach, and earnestly want to help you reach your goals, and cheer for and encourage you every step of the way, while teaching tips and tricks that might make the process smother and easier for you. I'd love to meet you!
I primarily work with people who are working to overcome porn addictions, are struggling with self-worth, or are generally overwhelmed with stress and difficult emotions. I also enjoy working with people who want to integrate their faith into their therapeutic work. I strive to provide a non-judgmental, down-to-earth environment in which to address the issues that may feel embarrassing or shameful to broach, and earnestly want to help you reach your goals, and cheer for and encourage you every step of the way, while teaching tips and tricks that might make the process smother and easier for you. I'd love to meet you!
(360) 228-2687 View (360) 228-2687
Photo of Real Life Counseling, Clinical Social Work/Therapist in Vancouver, WA
Real Life Counseling
Clinical Social Work/Therapist
Verified Verified
1 Endorsed
Vancouver, WA 98683
We at Real Life Counseling are a group practice. We believe that everyone deserves counseling tailored to fit their needs. We enjoy the opportunity to teach and advise the people who come to our practice. The goal is to empower people to use their strength and wisdom to overcome their challenges and find solutions.
We at Real Life Counseling are a group practice. We believe that everyone deserves counseling tailored to fit their needs. We enjoy the opportunity to teach and advise the people who come to our practice. The goal is to empower people to use their strength and wisdom to overcome their challenges and find solutions.
(360) 524-3994 View (360) 524-3994
Photo of Melissa Cantwell, Counselor in Vancouver, WA
Melissa Cantwell
Counselor, MA Ed, LHMCA
Verified Verified
1 Endorsed
Vancouver, WA 98663
Waitlist for new clients
I’m a Licensed Clinical Mental Health Counselor Associate at A Better Way Counseling. This is a second career for me. I have spent the last 18 years in the world of public education with a master's degree in Special Education. The majority of my career has been spent supporting families and their children through the education system with the resources they need to succeed. I have worked with children ages 3-21 with a wide variety of disabilities such as autism, ADHD, visual impairments, dyslexia, communication disorders, anxiety, depression, and more.
I’m a Licensed Clinical Mental Health Counselor Associate at A Better Way Counseling. This is a second career for me. I have spent the last 18 years in the world of public education with a master's degree in Special Education. The majority of my career has been spent supporting families and their children through the education system with the resources they need to succeed. I have worked with children ages 3-21 with a wide variety of disabilities such as autism, ADHD, visual impairments, dyslexia, communication disorders, anxiety, depression, and more.
(360) 843-2108 View (360) 843-2108
Photo of Sara Giza, Clinical Social Work/Therapist in Vancouver, WA
Sara Giza
Clinical Social Work/Therapist, MSW, LSWAIC
Verified Verified
Vancouver, WA 98662  (Online Only)
After receiving my master’s degree in Social Work from the University of Louisville and obtaining a certification on executive leadership strategy for violence and abuse prevention from the University of Pennsylvania, I moved to Vancouver in June 2021. I spent ten years working in various nonprofits and community organizations’ before going to graduate school. My professional background involves working with both teens and adults on their mental health challenges. My areas of expertise include working heavily with trauma, sexual assault, domestic violence, grief, chronic illness and LGBTQ+ issues.
After receiving my master’s degree in Social Work from the University of Louisville and obtaining a certification on executive leadership strategy for violence and abuse prevention from the University of Pennsylvania, I moved to Vancouver in June 2021. I spent ten years working in various nonprofits and community organizations’ before going to graduate school. My professional background involves working with both teens and adults on their mental health challenges. My areas of expertise include working heavily with trauma, sexual assault, domestic violence, grief, chronic illness and LGBTQ+ issues.
(360) 209-7507 View (360) 209-7507
Photo of Rebecca Lomeland, Counselor in Vancouver, WA
Rebecca Lomeland
Counselor, LMHC
Verified Verified
2 Endorsed
Vancouver, WA 98662
Do you find yourself struggling to break unhealthy cycles, no matter what you do? You may be fed up with your own inability to cope and connect well with others, feeling full of shame and regret. You might not even remember a time when things didn’t feel this way. But one thing is for sure: you’re ready for some relief. You’re ready to find some clarity. You’re ready to start feeling confident and secure in your own skin. Most of all, you’re ready to find the empowerment you need to turn over a new leaf.
Do you find yourself struggling to break unhealthy cycles, no matter what you do? You may be fed up with your own inability to cope and connect well with others, feeling full of shame and regret. You might not even remember a time when things didn’t feel this way. But one thing is for sure: you’re ready for some relief. You’re ready to find some clarity. You’re ready to start feeling confident and secure in your own skin. Most of all, you’re ready to find the empowerment you need to turn over a new leaf.
(360) 383-5614 View (360) 383-5614
Photo of Tina Remacle, Counselor in Vancouver, WA
Tina Remacle
Counselor, LMHC
Verified Verified
Vancouver, WA 98684
Sometimes, our trauma responses cause us to not make the changes we wish to see in our lives. Sometimes, it feels like no matter what we do, we're getting further away from our goals. I want to help you process your past so that you can have the future you desire. As a counselor, I help you to understand the patterns that have been present in your life, and how they're currently affecting you. I help you to find the courage, awareness, and strength within yourself to make different choices to get the life you desire.
Sometimes, our trauma responses cause us to not make the changes we wish to see in our lives. Sometimes, it feels like no matter what we do, we're getting further away from our goals. I want to help you process your past so that you can have the future you desire. As a counselor, I help you to understand the patterns that have been present in your life, and how they're currently affecting you. I help you to find the courage, awareness, and strength within yourself to make different choices to get the life you desire.
(360) 614-2675 View (360) 614-2675
Photo of Jamie A Bunnell, Marriage & Family Therapist Associate in Vancouver, WA
Jamie A Bunnell
Marriage & Family Therapist Associate, LMFTA
Verified Verified
Vancouver, WA 98684  (Online Only)
Imagine having hope and happiness within your life instead of depression, anxiety, or at a loss in knowing where your life is taking you to. Learn to highlight the best assets, the strengths you already possess. Focusing on your Emotions and Solutions to bring you to the inner peace and balance within yourself while releasing trauma and past hurt. You are the only one that can direct your path and create everything you want within your healing journey. We often can stand in our own way so it is vital to knock these barriers down to find our true selves!
Imagine having hope and happiness within your life instead of depression, anxiety, or at a loss in knowing where your life is taking you to. Learn to highlight the best assets, the strengths you already possess. Focusing on your Emotions and Solutions to bring you to the inner peace and balance within yourself while releasing trauma and past hurt. You are the only one that can direct your path and create everything you want within your healing journey. We often can stand in our own way so it is vital to knock these barriers down to find our true selves!
(360) 968-7534 View (360) 968-7534
Photo of Jocelyn Tello, Psychologist in Vancouver, WA
Jocelyn Tello
Psychologist, PsyD
Verified Verified
Vancouver, WA 98660  (Online Only)
People describe me as calm, empathic, and balanced. I believe in the potential of those I see. I know people can and do manage and sometimes overcome debilitating mental health conditions. I rely on client collaboration and feedback to stretch a person beyond the distortions that render one paralyzed. Be ready to stretch and discover that you can. I have a little over 20 years in the social service and mental health field. I have worked within schools, hospitals, prisons, and community mental health agencies in California, Oregon, and Washington.
People describe me as calm, empathic, and balanced. I believe in the potential of those I see. I know people can and do manage and sometimes overcome debilitating mental health conditions. I rely on client collaboration and feedback to stretch a person beyond the distortions that render one paralyzed. Be ready to stretch and discover that you can. I have a little over 20 years in the social service and mental health field. I have worked within schools, hospitals, prisons, and community mental health agencies in California, Oregon, and Washington.
(360) 228-3488 View (360) 228-3488

How does your Therapist compare?

Number of Therapists in Vancouver, WA

800+

Average cost per session

$150

Therapists in Vancouver, WA who prioritize treating:

93% Anxiety
87% Depression
76% Trauma and PTSD
71% Relationship Issues
69% Self Esteem
67% Stress
66% Grief

Average years in practice

10 Years

Top 3 insurances accepted

72% Aetna
54% Cigna and Evernorth
51% UnitedHealthcare UHC | UBH

How Therapists in Vancouver, WA see their clients

65% In Person and Online
35% Online Only

Gender breakdown

78% Female
20% Male
2% Non-Binary
FAQs - About Therapy and Counseling

How can I find a therapist in Vancouver?

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.