When to seek professional help for loss and bereavement

You may be wondering when ‘normal’ grief becomes problem that could benefit from professional help.

Losses can be very disorienting and painful, making it difficult to envision how to go on living. Other times people do not feel like they are having an especially strong reaction, but wonder if they should. It is not uncommon for people to think that they are “going crazy” after severe loss, making it hard enough to comprehend the present let alone consider the future. Despite how impossible it may seem in the midst of grieving, given enough time and gentle attention, grieving can eventually lead to deep reflection and growth.

As you may be experiencing, the pain of loss can more fully connect you to a sense of what really matters in life. Rather than taking what matters for granted or shying away from the pain that comes with caring, you can learn to deepen your commitment to the things that matter, when you are ready. Until then, it is enough to simply acknowledge your hurt and longing without holding too tightly to any expectations about what you should or shouldn’t be experiencing or doing.

When to Seek Grief Counseling

Under most circumstances, people are able to navigate their grief with the support of family, friends, and community. In fact, when it comes to treating bereavement-related grief alone, research shows that the majority of people are resilient and do not benefit from the addition of counseling or therapy. However, as a general rule of thumb, it is worth considering counseling or therapy if you find that you develop enduring impairments in functioning (e.g., relationship problems, problems at work, difficulty fulfilling important roles). A grief counselor can help if you are experiencing any of the following:

  • Sleep disturbances.Persistent sleep disturbances (e.g., trouble falling asleep, waking in the night, oversleeping, etc.) can disrupt your energy, mood, and focus, making it difficult to tend to the responsibilities and relationships that matter to you. A counselor can help you develop habits that will promote a full and restful night’s sleep.
  • Lack of social support.While family and friends can be of great comfort during times of loss, you may find yourself in a period of life where there are few people who you can turn to for support. A counselor is a member of your community who can provide additional support, offering genuine compassion and companionship during a difficult time. They may also be able to help connect you with other individuals experiencing grief by recommending bereavement groups.
  • Role transitions/stress.Loss can result in changes to your life that may press you to change or take on new roles. For example, you may find yourself having to take greater responsibility for paying bills, maintaining a household, or parenting children. It can also be difficult to maintain or develop new relationships following a loss. Counseling can be useful in helping you find practical solutions to the problems posed by role transitions, manage stress, and help identify areas of life where you can meaningfully invest.

When to Seek Grief Therapy

Sometimes additional factors can compound the difficulties of grieving, in which case it makes sense to seek out the help of someone trained as a mental health professional. Please consider contacting a licensed therapist who practices evidence-based psychotherapy if you are experiencing any of the following factors in addition to your grief. 

History of addiction

Experiencing strong emotions can be a trigger for people to have abused drugs or alcohol. A therapist can help develop healthier ways of coping with emotions so that you can stay present to your experience and choose a path forward that is more in line with your values.

Anxiety and grief

Losing a loved one can be very anxiety provoking. Life without the deceased can seem foreign, strange, and worrisome. The sense of security we gain from our relationships is often disrupted when those relationships change, increasing our awareness of our own mortality and vulnerability. While this is a very understandable and natural reaction to loss, people often get stuck struggling with anxiety. It can be helpful to work with a therapist to develop new coping skills and gain a broader perspective.

Depression and grief

There is a good deal of overlap between the symptoms of depression and the symptoms of grief, and both can be caused by bereavement and loss. While similar on the surface, depression and grief are actually distinct reactions that can be treated differently. You may be experiencing both grief and depression simultaneously, in which case therapy may be of benefit to you. Depression can be distinguished from bereavement-related grief in that individuals struggling with depression may exhibit the following symptoms:

  • Guilt about things other than actions taken or not taken by the survivors at the time of death.
  • Thoughts of death other than the survivor feeling that he or she would be better off dead, should have died with the deceased person, or wishing to join the deceased.
  • Feelings of worthlessness or self-loathing; feeling undeserving of life.
  • Prolonged and marked functional impairment.
  • Hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.

Traumatic death and grief

Exposure to sudden, unexpected, or violent deaths can be very upsetting, whether or not you had a relationship with the deceased. Deaths resulting from accidents, suicide, crime, combat, or sudden illness can lead to intense feelings of fear, helplessness, or horror, in some cases resulting in the development of Post Traumatic Stress Disorder (PTSD). PTSD is a type of anxiety disorder involving struggling with re-experiencing a traumatic event, trying to avoid reminders of a traumatic event, and being hypervigilant (“keyed up” or “on edge”) about possible threats to safety. You may benefit from therapy if you have been experiencing several of the following symptoms of PTSD for at least one month:

  • Re-experiencing the traumatic event:
    • Intrusive and distressing images, thoughts, or perceptions
    • Recurrent distressing dreams
    • Acting or feeling as if the event were happening again (“flashbacks”)
    • Distress when exposed to reminders of the event
  • Avoidance of reminders of the traumatic event:
    • Efforts to avoid thoughts, feelings, or conversations about the trauma
    • Efforts to avoid activities, places, or people associated with the trauma
    • Inability to recall important aspects of the trauma
    • Diminished interest or participation in significant activites
    • Feeling detached or estranged from others
    • Flattening of feelings (e.g., unable to have loving feelings)
    • Sense of foreshortened future
  • Increased arousal
    • Difficulty falling or staying asleeo
    • Irritability or outbursts of anger
    • Difficulty concentrating
    • Hypervigilance
    • Exaggerated startle response

Complicated/Prolonged Grief

Given sufficient time and care, it is generally the case that bereaved individuals’ functioning returns, even without therapy. However, research suggests that about 10% of bereaved individuals do end up having substantial and enduring impairments in their functioning (e.g., for more than one year), in which case therapy can be useful. Consider seeking the assistance of a licensed therapist if you are experiencing several of the following symptoms on a daily basis (from the DSM-5):

  • Persistent yearning for the deceased.
  • Intense sorrow and emotional pain in response to the death.
  • Preoccupation with the deceased or the circumstances of the death.
  • Difficulty accepting the death; experiencing disbelief or emotional numbness over the loss.
  • Difficulty with positive reminiscing.
  • Bitterness or anger related to the loss.
  • Blaming yourself for the loss.
  • Avoiding reminders of the loss.
  • Desiring to die to be with the deceased.
  • Difficulty trusting others since the death.
  • Feeling alone or detached from others since the death.
  • Feeling that life is empty or meaningless without the deceased.
  • Feeling you can’t function without the deceased, or feeling confused about your identity without the deceased.
  • Difficulty or reluctance to pursue interests since the loss or to plan for the future (e.g., friendships, activities).

People experiencing one or more of the above factors are more likely to benefit from evidence-based psychotherapy, though there are also other distressing situations not listed above for which therapy can be helpful. It may be useful to have an initial consultation with a professional to see if therapy can address your needs.

Most importantly, while therapy is a responsible way to care for yourself during times of pain and suffering, it is also about focusing your energy in directions that promote growth and enrich your quality of life. Therapy is an investment in learning new ways to deepen your relationships, find more fulfillment in your experiences, and get more involved in the things that matter to you.

Please feel free to contact us if you or someone you care for is struggling with grief. We have licensed mental health professionals that can help you find the resources you need to deal with grief, loss, and any complications that might be involved.

What are Grief Counseling & Grief Therapy

Deep wounds can lead to profound states of yearning, disillusionment, and exhaustion. Yet grief, bereavement, and loss are nearly universal human experiences – you are not alone in your suffering.

You can learn to carry your loss by weighing the heaviness of your heart, opening fully to your pain, and turning to your friends, family, and community for support.

Giving Yourself Time & Space

It can be helpful to give yourself the time and space to grieve in your own way. No two losses are the same, and there is no “right” way to grieve. In some cases, part of making space for grieving involves setting aside time to speak with a professional counselor or therapist who can help you gain perspective and adapt to the changes you are facing.

Counselors vs Therapists

The difference between a counselor and a therapist is largely a matter of semantics, and the type of work they do can overlap to a great extent. Generally speaking, people with an LPC license are referred to as “counselors,” while those with a LCSW are referred to as “therapists.” Licensed doctors with a Ph.D. or Psy.D have the legally-protected title “psychotherapist.”

Grief Counseling

The term “grief counseling” refers to a type of service for people who are seeking support with what is sometimes “uncomplicated” grief. This simply means that there are not additional mental health concerns that are complicating matters, and the work focuses directly on the grieving process.

Grief Therapy

The term “grief therapy” refers to more comprehensive treatment for individuals who are experiencing long-term problems functioning following bereavement. Grief therapy is also appropriate for individuals who struggle with grief and at the same time struggle with other difficulties such as depression, anxiety, PTSD, or substance abuse.

How We Can Help You

Our depression treatment program has licensed mental health professionals who are trained to help you cope with grief and help you move through a grieving process. Please feel free to contact us if us if you think we could be of assistance to you.

Common Reactions To Bereavement & Loss

The most important thing to keep in mind is that there is no “normal” way to grieve.  There is nothing that you should be experiencing.

There is no timeline for grieving, and how you grieve will depend on a variety of factors, including your history, personality, support system, and the nature of your loss. It can be helpful to be patient and allow your experience to unfold without placing expectations on yourself.

Common reactions include:


  • Difficulty concentrating
  • Questioning of faith
  • Repeatedly thinking about the loss
  • Thinking you are going “crazy”
  • Seeking meaning


  • Feeling that you are on an emotional “roller-coaster”
  • Guilt
  • Apathy
  • Irritability
  • Sadness
  • Loneliness
  • Yearning
  • Compassion


  • Sleep disturbances (insomnia; oversleeping)
  • Loss of appetite/nausea
  • Fatigue
  • Lowered immunity
  • Aches and pains


  • Withdrawing from others
  • Seeking support from others
  • Increased/decreased activity

Given that bereavement and loss can be very painful, mental health researchers have studied how people grieve to try to find ways to be helpful and supportive. Early research conducted by Elisabeth Kübler-Ross in 1969 introduced the “five stages of grief,” though late research has shown that grief does not really occur in the order that she outlined. Instead, many people experience only some (or even none) of the following reactions to bereavement and loss, and they can occur in any order:

  • Denial: “This can’t be happening.”
  • Anger: “Who’s fault is this? This isn’t fair.”
  • Bargaining: “I promise I’ll ____ if ___.”
  • Depression: “I feel too sad to do anything”
  • Acceptance: “I am at peace with my loss.”

As mentioned, these are not really stages but just common reactions to loss, and it is not necessary to go through each reaction or any particular reaction in order to adapt and heal. In her last book before her death in 2004, Kübler-Ross said of the five stages of grief:

“They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”

We encourage you to be gentle with yourself as you go through your grief and to seek assistance and support as needed in your own journey.

Treatment of Chronic Depression Using RO-DBT

Radically Open Dialectical Behavior Therapy (RO-DBT) is a new treatment specifically designed for people with chronic and treatment resistant depression.

RO-DBT was developed over the past 20 years by a team of researchers and therapists led by Dr. Thomas Lynch. The treatment pulls together experimental, longitudinal, and treatment outcome research to create this novel treatment. Research results suggest that it is effective in treating chronic depression and other hard-to-treat conditions.

How does RO-DBT work?

A counterintuitive idea behind the therapy is that it’s possible to have too much self-control. Self-control refers to our ability to restrain acting on our urges, emotions, and wants in favor of longer term goals. Most of the time, self-control is good, but some people can suffer from excessive self-control. For these people, inhibiting and controlling impulses and emotions has become so habitual and automatic that they have problem relaxing control when needed. This can result in overcontrolled people being overly inhibited, perfectionistic, cautious, and feeling exhausted by social interactions.

What do you learn in RO-DBT?

RO-DBT typically unfolds over 30 weeks using a combination of skills classes and individual psychotherapy. Treatment focuses on learning three core principles:

  1. Openness to feedback from our environment and the people in it, in the service of new learning
  2. Flexibility in responding to challenges in our environment (including other’s behavior).
  3. Effective communication of our emotions, recognizing that emotion expression is central to forming strong relationships.

Individual therapy focuses on helping clients adapt the skills learned in classes to their unique life situation.

What is radical openness?
RO-DBT aims to develop radical openness, which has three components:

  1. Acknowledging experiences that are disconfirming or unexpected (which are often distressing), rather than automatically explaining, defending, accepting, regulating, distracting, or denying what is happening in order to feel better.
  2. Self-inquiry, which involves asking oneself good questions in order to learn. This involves intentionally seeking ones’ personal unknown in order to learn from a constantly changing environment.
  3. Responding flexibly by doing what is effective in the moment, in a manner that considers the needs of others.

How is the skills class structured?

The class uses a traditional classroom format. Everyone who attends sits around a table. The facilitators begin each class with a brief exercise, followed review of homework, new skills are introduced, and homework is assigned. Classes are engaging, fairly fast paced, and often quite fun. We aim to create a welcoming, warm, and interesting environment for learning.

If you want to learn more about RO-DBT or see if we are an option for the treatment for chronic depression, give us a call at: 503-281-4852 x1

or send us a message using the confidential form below.

Are you dealing with both anxiety AND depression? We can help.

Can the Depression Treatment Program Help Me with My Anxiety?

Yes. The Depression Treatment Program is a part of Portland Psychotherapy, where we are able to address a variety of mental health concerns, including anxiety. If you have stand-alone anxiety, we can see you on an individual basis and connect you with appropriate classes and groups. It also turns out that some of the same treatments that help with depression can also help with anxiety, and vice versa. So if you are experiencing a mix of anxiety and depression, our services are an appropriate match for your needs.

Is It Anxiety or Depression? Odds Are Its Both.

If you are experiencing low levels of positive mood, high levels of negative mood, and high levels of worry, you may be wondering whether you are anxious or depressed. While it’s tempting to try to get at an “either/or” description of what’s going on, the truth is that anxiety and depression usually travel together. We tend to worry more when depression has taken over our lives, and all of that worry can be pretty depressing. In one study of care utilization in medical settings, researchers found that more than 50% of people who visited their physician during an episode of anxiety or depression were actually struggling from both disorders at the time of their visit. Additional research has shown that for people who struggle with either anxiety or depression, eventually the rate of struggling with both can exceed 75% over the course of a lifetime. Even though anxiety and depression often feed into each other, the good news is that treatments that address one can lead to improvements in the other. Psychotherapy can help you break out of the anxiety-depression feedback loop and get back to living well.

What Kinds of Psychotherapy Actually Work to Alleviate Anxiety and Depression?

Not all psychotherapies are created equally, meaning you’ll be best off if you participate in therapies that science has shown to be useful to many people. We are dedicated to offering evidence-based cognitive behavioral therapies that have been shown to helpful in treating anxiety and depression, including Acceptance and Commitment Therapy and Behavioral Activation.

How Does Psychotherapy Help?

Anxiety and depression can feel overwhelming, and it’s not uncommon for people to feel as though they might “drown” in these moods. This makes it tempting to “get out of the pool” by staying away from the things that make you anxious, and at least that way you might feel a little bit calmer and safer. The down side to getting out of the pool is that you don’t get to have fun splashing around with your friends, which ultimately makes you feel even worse. Antianxiety and antidepressant medications are a bit like wearing “water wings” that can help you get back out there without drowning, but they really aren’t a full substitute for learning how to swim. Psychotherapy is just that – learning how to swim in the water of your moods – so that you don’t drown and are able to do the things you want to do with your life.

Psychotherapy can help you:

  • Clarify who matters to you and what are the most important things in your life
  • Develop greater compassion for yourself and others
  • Build more intimate and fun relationships
  • Become more fully present and engaged
  • Get involved in activities that matter to you
  • Deepen your satisfaction with life
  • And yes, overcome anxiety and depression!

The Depression Treatment Program at Portland Psychotherapy helps you address anxiety and achieve these benefits by decreasing your experiential avoidance and increasing your psychological flexibility.

To learn more about treatment or to schedule an initial consultation, please call 503-281-4852 x1 or fill out the contact form below. We’re happy to be of help.

Bereavement, Grief, Loss & Mourning

Losing something or someone you love can be very painful and disorienting. Sadness, anger, numbness, and despair are common reactions and grieving can take time, patience, and careful attention. It may no longer be possible to live the life you have known, but it is possible to learn to honor your loss while living with greater meaning and purpose. Depending on your situation you may find support from friends, family, a spiritual counselor, or a therapist.

What is bereavement?

Bereavement is a state of loss resulting from the death a beloved person or animal.

What is grief?

Grief is the most common emotional reaction to bereavement or another form of loss. Research shows that the process of grieving varies a lot between people and there is no “right” or “wrong” way to grieve. Healthy coping involves learning to fully experience your loss and grief, honoring your relationship with the deceased, and making adjustments to continue investing in a meaningful life.

What is loss?

Loss occurs when something or someone or something you value is taken away. There are many ways to experience loss, including through bereavement, divorce, moving to a new city, the ending of a friendship, losing health, or losing a job. The more significant the loss, the greater the grief.

What is mourning?

Mourning is the process of adapting to life following a loss. Mourning is the expression of grief through behavior, including private or personal expressions, public religious or cultural practices, and the customs for expressing grief that are shared by your friends, family, and community. It can be a time to fully acknowledge the depth of your loss, and to learn to meet your pain and the pain of others with dignity, honesty, respect, and compassion.

When does grief become depression?

One of the most common triggers for depression is experiencing a loss. People who experience chronic depression often have had losses early in their life that continue to affect them to this day. More episodic depression is often triggered by experiences of loss, such as a change in your health status (the loss of your previous good health), a divorce (including the loss of hopes and dreams for the relationship), the death of a loved one, or losing a job, among many other possible losses. It’s normal to experience periods of sadness and other intense emotions after losses. However, if the sadness becomes very chronic, lasting for weeks with very little relief, then it’s possible that you have gotten stuck and may have progressed into depression. If you seem to be stuck in the sadness of your loss for many months afterwards and unable to move one or feeling disconnected from the world, uninterested in things you used to be, and disengaged from your relationships, you may have progressed into depression and may want to consider getting therapy.

Additional information about grief and loss:

ACT Treatment of Depression

Acceptance and Commitment Therapy (ACT – said as the word “act”) is a new form of Cognitive Behavioral Therapy (CBT) that has gathered a lot of evidence for it’s effectiveness for the treatment of depression over the last couple decades. It examines how the interaction among a person’s thoughts, feelings, and behavior impact well-being, then helps change the interaction to produce greater life satisfaction. ACT uses mindfulness practices to help people increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, ACT heavily emphasizes the role of values to help people create meaningful lives. ACT helps people circumvent unhelpful thinking in those areas of life where it is less helpful – where the mind may have developed limiting rules – and it helps people strengthen aspects of thinking where it tends to be most helpful, such as in committing to valued living.

ACT is particularly helpful for handling feelings of depression because it offers people a way to develop a new relationship with pain and suffering. A basic assumption of ACT is that pain is a normal and unavoidable part of human experience, and that it makes total sense that people have strong emotions in the presence of painful experiences. However, people’s understandable desire to control or avoid their own thoughts and feelings can actually lead to much long-term and unnecessary suffering. For example, a person may develop short-term means for coping with their emotions – such as social withdrawal, substance use, or overeating – that actually end up causing even more suffering in the long term. Worse yet, time spent struggling with thoughts and feelings is time away from the things that matter most in life. Put simply, ACT is about letting go of the struggle with difficult thoughts and feelings in order to pursue a richer, fuller, and more purposeful life.

Acceptance and Commitment Therapy is an evidence-based psychotherapy. Its practitioners and researchers are dedicated to the scientific development of the therapy and empirical evaluation of its effects. ACT has been evaluated in over 300 randomized clinical trials and has been shown to be helpful in addressing a wide variety of mental health concerns. Furthermore, ACT has been shown to be as effective as Cognitive Therapy – the current gold-standard psychotherapy – in improving moderate to severe levels of depression.

Many of the therapists at Portland Psychotherapy specialize in the practice of Acceptance and Commitment Therapy. Our therapists help clients develop self-compassion and mindfulness skills that give them new flexibility in how they respond to painful thoughts and emotions. With a more open relationship to experience, clients can reach beyond suffering and depression to a larger sense of purpose in their lives. Moving forward, our therapists assist clients in clarifying their values and help them to take action in meaningful ways. Our expertise in ACT can help you learn to let go of the struggle with pain, be more mindful, get clarity on what really matters to you, and commit to living a full, vibrant, and more satisfying life.

If you’d like to learn more about ACT for depression on your own, this book provides a good overview:

Why choose us?

Depression involves changes in thinking, mood, and behavior that reflect some hurt, emptiness, or dissatisfaction with life. These changes can be problematic because they can lead to further pain and suffering, unless special care and attention is dedicated to promoting your healing and growth.

The Depression Treatment Program (DTP) is a collection of specialized services offered at Portland Psychotherapy. The program was developed to address the treatment needs of individuals with this common but serious disorder, with an emphasis on delivering the best available treatments and the highest standards of care.


  • Expert care. Our DTP therapists are specialized in the treatment of depression, meaning their expertise is matched to your treatment needs. If you are already seeing a healthcare provider outside of Portland Psychotherapy for other issues, he or she may recommend that you participate in one of our program’s groups or see one of our therapists on an individual basis to help you receive special attention and support in this area.
  • Personalized care. Your suffering will be met with compassion and understanding. Our therapists are skilled listeners and guides who are dedicated to helping you find a way forward that works best for you. If it is determined that group therapy is a good match for your needs, we will help you connect with your fellow group members to form a community of mutual appreciation and support. We will work closely with you to form goals, take actions, and monitor your progress as you make peace with your suffering and become more engaged with healthy living.
  • Modern treatments. Our depression treatments are based on the best available modern research. Portland Psychotherapy is itself a dedicated research facility, meaning our clinicians are highly informed and up to date with providing the most effective and proven care.
  • Treatment for complicated cases. In addition to offering depression-focused individual and group psychotherapy through the DTP, Portland Psychotherapy has competent therapists available who can help you address other issues that can come along with depression, such as anxiety, substance abuse, body image concerns, trauma, and other issues.
  • Care coordination. We will communicate and work with your other health care providers to help insure that your treatments are working together to produce the best possible care.


If you or a loved one is struggling with depression or mood problems, we’re here to help.

Give us a call at: 503-281-4852

or send us a message using the confidential form below.

What happens when I come in?

Initial Consultation. The first step on the road to recovery is to talk with one of our therapists who can help develop a treatment plan that fits your situation. During your first meeting, you will have the opportunity to express your concerns, talk about how depression has affected your life, and ask any questions you may have. Your therapist will want to learn more about your symptoms, your history, and about what is important to you in life.

Your therapist will also ask you to complete some questionnaires to help measure your depression and life satisfaction. These measures will help you and your therapist better understand your experience, and will serve as a baseline when tracking your progress.

In addition to addressing your depression, issues such as substance abuse, trauma, suicidal ideation, and medical conditions may need to be considered when planning your treatment. By learning more about your personal situation during your initial consultation, your therapist will help determine whether individual therapy and/or group therapy will be the best match for your treatment needs.

Depending on your situation, you may have other medical or mental health care providers involved in your treatment. Your therapist will want to know about the types of care you are receiving in order to coordinate your care. It can be helpful to bring a list of your other health care providers’ contact information to give to your therapist, along with information about any medications you may be taking.

Finally, while there are practical matters to attend to, you and your therapist will want to have a good working relationship that is personal, genuine, and fulfilling. The initial consultation is an opportunity for you and your therapist to begin forming a meaningful and curative relationship.

Individual Therapy. Following your initial consultation, you and your therapist may conclude that you are a good match for individual therapy. Individual therapy can work as a stand-alone treatment for depression, or can be supplemented with group therapy. Individual therapy can help address issues that may not be fully addressed in the ACT for Depression Group (see below), such as substance abuse, trauma, suicidality, or chronic illness. Individual therapy is tailored to your specific treatment needs, but generally involves developing new skills to deal with difficult thoughts and emotions while moving forward with life. Individual therapy involves meeting once per week for 45-50 minute sessions over roughly 3 or more months; the time frame is adjusted depending on whether you are continuing to make progress.

Group Therapy or Skills Class. During the initial consultation, it may also be determined that you are a good match for a therapy group or skills class that relates to your problems. While you may be facing other issues such as anxiety or substance abuse, the group is an opportunity to focus your attention on finding new ways to overcome depression. Depending on the level of care appropriate to you, you may attend the group alone or attend both the group and individual therapy. Group therapy is effective in treating depression, with the added benefits of the support and perspective that can be gained from interacting with your fellow group members. We usually offer a variety of other groups and classes. You are welcome to consider attending any services you find helpful.

Medication Evaluation. Your provider will speak with you about whether you would like to consider antidepressant medication if you are not taking one or whether you are happy with your current medications if you are already taking some. They will then help you either get in to see our psychiatrist on staff or help you find an appropriate referral (this often depends on your health insurance).

Get an initial consultation

If you’d like an initial consultation to learn about your treatment options, or just want more information, we’re here to help.

To reach us, give us a call at: 503-281-4852

or send us a message using the confidential form below.

What is depression?

All people feel sad at times, and it is a normal part of life to occasionally feel “down” for a few days, particularly when losses are experienced or bad things have happened. Some people find themselves stuck in feelings of helplessness, hopelessness, and worthlessness, sometimes for weeks and even years at a time. This dark and empty state is often labeled clinical depression. In this state, motivation to do the things that once seemed worthwhile and meaningful drains away and not much feels worth doing. This pain is real and can feel devastating, but you are not alone in this suffering. In fact, nearly 10% of adult Americans could be diagnosed with some form of depression in any given year. Depression can take various forms, and each individual’s struggles are unique. Some of the various forms of depression include:

Major Depression. The DSM-IV is a book that provides the most accepted guidelines for distinguishing between various forms of depression. The DSM-IV describes Major Depression as a period of at least two weeks in which a person feels sad or empty, or does not have interest or take pleasure in things that used to be enjoyable. Other symptoms include significant changes in weight and appetite, over or under sleeping, being restless or slowed down, fatigue or loss of energy, excessive feelings of worthlessness or guilt, difficulties with concentration and decision-making, and recurrent thoughts of death or suicide. These symptoms last most of the day, nearly every day, and can be distinguished from the symptoms associated with medical conditions (e.g., thyroid problems) or bereavement.

Bereavement. While sometimes extremely painful, the grief felt in response to the loss of a loved one, technically speaking, is not a form of depression. A person who is experiencing grief usually does not require therapy, but eventually comes to terms with the loss with the guidance of their cultural support system. However, some grieving individuals may choose to seek additional support from a therapist to help relieve associated symptoms (e.g., insomnia). It is possible for a person to experience both bereavement and depression, in which case additional support is likely to be helpful.

Dysthymic Disorder. A person with dysthymia has many of the symptoms of Major Depression, though the symptoms tend to be less severe. The key feature of dysthymia is it’s chronicity – the DSM-IV says the symptoms must have lasted at least two years.

Bipolar Disorder. People with Bipolar Disorder experience the symptoms of Major Depression, but also experience periods of persistently elevated, expansive, or irritable mood. Despite sometimes being depressed, they may also sometimes feel “on top of the world” and become very active in pursuing pleasurable activities that are later regretted (e.g., buying sprees, sexual indiscretions). Other symptoms of feeling “keyed up” may include a decreased need for sleep, being more talkative or feeling pressure to keep talking, racing thoughts, and distractibility. These “manic” symptoms last several days at a time and can sometimes lead to hospitalization.

Seasonal Affective Disorder. When depression is tied to the winter months but resolves over the summer, it is possible that the person is experiencing Seasonal Affective Disorder (SAD). This form of depression is specifically linked to the winter months and is not better accounted for by changes in lifestyle (e.g., seasonal work).


Sometimes depression can seem like a major struggle in a never ending battle. At other times, depression means not feeling like doing anything at all. The apathy drains out all motivation, and it’s hard to see the point of going on living. A person who is depressed is likely to give up, stop striving for anything, and can’t picture how the world could ever mean anything again. What remains is a desire for the pain and suffering to go away, to finally have some relief.

Because depression is so painful, we can become consumed with trying to get rid of it. We try to look on the bright side, find a silver lining, drink alcohol, use drugs, take prescription medications, exercise, sleep in, ruminate, read books, go to therapy, seek spiritual guidance, give up, and try all over again, desperately trying to make the pain go away. Unfortunately, our attempts to escape the suffering that comes with depression can actually backfire, leading to more of the very thing we were trying to escape. The problem is that focus on escaping the suffering can cause us to lose contact with the activities and people that connect us with a sense of purpose and meaning in life.