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Someone struggling with serious anxiety, for example, may believe that voicing their worries aloud would be impossible, says Stephanie Cox, a mental health counselor in Jacksonville Beach, Florida. Because a hallmark of anxiety is avoidance, when faced with the prospect of opening up, "someone who's already anxious may start to think, Actually, I don't want to talk about any of this." While some clients find immense value in a less structured approach-perhaps feeling that it leads to unexpected topics or surprising insights-others may see their therapist's relative lack of input as confusing or distressing, especially if they feel unsure of what to talk about. Therapists are ethically bound to protect clients' confidentiality, except in very rare cases: when the client poses an imminent danger to themselves or others; when the therapist believes that a child, elderly person, or dependent adult is being abused; or when they are legally forced to by court order.