Mental Health Services
Here are our current ongoing mental health offerings:
-One-on-one mental health counseling (not all insurances accepted at this time, call or text the office)
-Mental health letters of support for gender-affirming surgery or electrolysis for adults
-Peer Support Trans Group (not facilitated) on the First Monday and Third Monday of the month at 6:00pm (free)
-Mental Health Medication if within the scope of our family nurse practitioners
We offer mental health medication that is within the scope of practice of our primary care nurse practitioners. We do not treat bipolar disorder, schizophrenia, schizoaffective disorder, psychosis, mania, substance use disorder, alcohol use disorder, and other conditions which cannot be safely managed in primary care.
Additionally, you may require treatment by a specialized psychiatric nurse practitioner or psychiatrist if your other health conditions make it less safe to prescribe medications for you. We would refer you to a psychiatric prescriber in those cases.
If your mental health symptoms are severe, we may recommend a higher level of care than what can be safely provided outpatient, such as an intensive outpatient program, partial hospitalization program, or residential treatment.
We treat the following conditions:
ADHD
Autism
Depression
Generalized anxiety disorder
Insomnia
Panic disorder
PTSD
Social anxiety disorder
ADHD
ADHD is a lifelong condition where there are mood, concentration, and attention differences. There are three main types of ADHD, with differing degrees of symptoms based on the type and the person. You can read more about ADHD on our neurodiversity care page.
We do offer stimulant mental health medication for ADHD but require supporting documentation prior to starting medication such as notes from a past therapist, psychological evaluation, or notes from a past psychiatrist or primary care provider. Common stimulant medications include Methylphenidate (Ritalin), Amphetamine-dextroamphetamine (Adderall), Lisdexamfetamine (Vyvanse), and others.
Many people are not aware that there are both stimulant and non-stimulant mental health medications for ADHD available. Non-stimulant psychiatric medication options include Bupropion (Wellbutrin), Guanfacine (Intuniv), and Atomoxetine (Strattera). Your provider will work with you to find the best treatment option for you while working to minimize side effects.
We also offer a late diagnosed neurodivergence group facilitated by a licensed mental health clinician.
Anxiety
Generalized Anxiety Disorder (GAD) is a condition in which a person experiences significant anxiety, worry, and difficulty relaxing around a variety of situations such as personal relationships, social situations, the workplace, and other environments. GAD is often best treated with a combination of anxiety medication and therapy or counseling. Lifestyle changes such as minimizing caffeine and alcohol, increasing physical activity, sleep hygiene, and relaxation exercises such as deep breathing, guided imagery, or meditation can be very helpful. While GAD can be a lifelong condition, quality of life is usually significantly improved with a combination of anxiety medication, therapy, and lifestyle changes.
Social anxiety is a condition in which a person experiences anxiety, worry, and fear of judgment or negative evaluation in social situations specifically. In extreme situations, it can progress to agoraphobia, a condition which makes it hard for an individual to leave the house. Depending on how severe the social anxiety is, some people take daily anxiety medication, others take only as needed anxiety medication, and other people can manage with only counseling and lifestyle changes.
Panic disorder is a condition in which a person has panic attacks. Panic attacks look different in each person and may include sweating, chest pain, racing heart, shortness of breath, dizziness, tunnel vision, nausea, upset stomach, palpitations, and other symptoms. Some people with panic disorder take both daily anxiety medicine and as-needed anxiety medicine. Some people need only counseling. Most people do best with a combination of medication and counseling.
Many people also assume incorrectly that the only anxiety medications available are habit-forming medications like Alprazolam (Xanax) or selective serotonin reuptake inhibitors (SSRIs) like Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro), etc. SSRIs are taken daily, and may come with side effects such as weight gain, decreased sex drive, and decreased range of emotions. There are many other anxiety medications available, which we are happy to explore with you! Buspar, gabapentin, and pregabalin (Lyrica) are good examples of anxiety medicines that are taken daily for anxiety. Other anxiety medicines include Clonidine, Hydroxyzine, Guanfacine, Propranolol, and others. These medications may be taken daily or as needed.
Depression
Depression is a condition in which a person may experience feelings of worthlessness, hopelessness, sadness, grief, and guilt over a period of time that lasts longer than normal sadness. Other symptoms of depression include problems sleeping, appetite issues, attention and concentration problems, loss of pleasure in hobbies or other important daily activities, problems taking care of yourself or others, work difficulties, relationship problems, and thoughts of self-harm. Depression may come and go, be related to a specific situation, or be lifelong. Usually a combination of medicine, therapy, and lifestyle changes work better together than any one of these treatments works alone.
Similarly, there are many other options for depression. The most common class of psychiatric medications is selective serotonin reuptake inhibitors (SSRIs). These include escitalopram (Lexapro), sertraline (Zoloft), citalopram (Celexa), fluoxetine (Prozac), and others. These medications are generally well tolerated, but for some people can cause side effects such as decreased sex drive, weight gain, and some feelings of loss of emotional range.
There are other classes of psychiatric medications that can also help that are not SSRIs. These include selective serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Duloxetine (Cymbalta), Desvenlafaxine (Pristiq). Other options include tricyclic antidepressants such as amitriptyline and nortriptyline. There are also atypical antidepressants such as mirtazapine, trazodone, bupropion (Wellbutrin), and others which can be helpful if other medications have not worked or had negative side effects. Bupropion (Wellbutrin) is a good choice for people who wish to avoid decreased sex drive and weight gain.
Autism
Autism is a condition where there are differences in processing sensory information and in social interactions. You can read more about autism on our neurodiversity affirming services page.
Though the only FDA approved medication for autism are antipsychotics, we have clinical experience with medications that may help reduce anxiety and improve quality of life.
We offer medication treatments to help improve some of the symptoms associated with autism such as irritability, anxiety, inattentiveness, executive dysfunction, insomnia, and sensory overstimulation. Beta blockers such as propranolol can help with sensory overstimulation, irritability, and meltdowns. Low dose naltrexone can help with sensory overstimulation and irritability. Guanfacine and clonidine can also help with anxiety and irritability, as well as inattentive symptoms.
We also offer a late diagnosed neurodivergence group facilitated by a licensed mental health clinician.
PTSD
Post-Traumatic Stress Disorder (PTSD) is a condition in which a person develops mental health symptoms in response to traumatic events. Many people think only military veterans can experience PTSD, but a variety of life experiences can create PTSD including single events and exposure to trauma over time. Single events that may cause PTSD include car accidents, sexual assault, witnessing violent events, and other events. Chronic exposure to trauma in the form of abusive relationships, childhood adversity, war, racism, and poverty may also result in PTSD.
Symptoms of PTSD include nightmares, flashbacks, dissociation, irritability, rage, insomnia, sense of foreshortened future, memory problems, and addiction. There are treatments which may improve symptoms of PTSD including medication and counseling.
Medications for PTSD include SSRIs, anxiety medicine, and medications which may specifically help nightmares such as prazosin, clonidine, or guanfacine.
Counseling is also helpful for people with PTSD. There are now forms of therapy which do not require talking about the traumatic event directly, such as Eye Movement Desensitization and Reprocessing (EMDR) therapy, somatic therapy, and internal family systems therapy.
Insomnia
Insomnia is a condition characterized by sleep problems. Some people with insomnia have difficulty falling asleep, while others have difficulty staying asleep, and yet others have challenges with both falling asleep and staying asleep.
Insomnia may be caused by traumatic events, stress, medical issues, medications, depression, anxiety, and other conditions. Some people only have short periods of insomnia during stressful periods, and other people have lifelong challenges with insomnia.
Insomnia can be treated with medication, lifestyle changes, supplements, and counseling. Lifestyle changes include reducing caffeine and alcohol, reducing stress, increasing physical activity, reducing light exposure at night, avoiding eating too close to bed, and other changes. Thirty minutes of moderate to vigorous physical activity per day can be as effective as some prescription medications without side effects.
Supplements for anxiety may include melatonin, valerian root, skullcap, kava kava, chamomile, and others. Many supplements interact with other medications and conditions, and we recommend discussing any supplements with your provider before starting them.
Medications for insomnia include trazodone, clonidine, hydroxyzine, mirtazapine, and others. We do not recommend taking benzodiazepines such as alprazolam (xanax), clonazepam (klonopin), or others due to the risks of rapid tolerance and dependence. It is important to note that medications for insomnia may help you fall asleep, but may disrupt sleep quality or increase the risk of sleep disorders such as sleep apnea.
Thoughts on Mental Health Treatments
It is important to acknowledge that everyone has a unique experience with mental health medications, and no single medication is going to work or be appropriate for everyone. We are happy to help personalize and individualize your treatment and work with you to choose the best medications for you!
Mental Health Navigation
We are happy to help you find mental health services in the community including intensive outpatient programs, eating disorder treatment, substance use treatment, or residential treatment options. We also have local referrals for transcranial magnetic stimulation (TMS) and ketamine treatment for individuals with treatment-resistant depression.
Questions for Prospective Therapists
If your provider says they are neurodiversity-affirming and informed, consider asking them some of the questions below to ensure they are able to understand your needs:
What experience do you have working with people experiencing neurodivergent burnout?
What are some recommendations you have for treating burnout?
What experience do you have helping people recover from skill regression after an ADHD diagnosis that does not push people towards burnout?
How do you help patients who tend to intellectualize their feelings and problems and struggle with changing longstanding patterns of behaviors that are not aligned with their goals or values?
What experience do you have with executive dysfunction that does not use shame, guilt, or obligation and what strategies do you use?
What experiences do you having helping neurodivergent people build a life that is more accessible navigating strategies in the home, workplace, and relationships? Ex do you help with FMLA/ADA accommodations, discussing balance of chore responsibilities versus outsourcing, etc?
What experience do you have with demand avoidance and what strategies do you use to help neurodivergent people achieve their goals who struggle with demand avoidance?
What experience do you have with helping neurodivergent people manage relationships with food which may include sensory sensitivities, history of restriction, etc
What experience do you have helping people navigate a lifetime of shame from a missed diagnosis and trauma related to chronic social rejection? What strategies do you use to help with these?
How do you help people who may have trouble identifying sensations in their body or feelings (poor interoception/ alexithymia)?
How do your policies account for difficulties remembering appointments?
How do you approach helping neurodivergent individuals create accommodations in areas where they may face systemic barriers (e.g., workplace, healthcare)?
How do you create individualized coping strategies for managing stress or overwhelming situations without overwhelming the client further?
What is your therapeutic style, and how do you adapt it to the needs of neurodivergent individuals, considering different cognitive and emotional processing styles?
How do you support neurodivergent clients in advocating for their needs, both in therapy and in other areas of life (e.g., at work or in school)?
How do you adapt traditional therapeutic techniques (e.g., CBT, DBT) to be more effective for neurodivergent clients?
How do you ensure that your approach is culturally competent and sensitive to the diverse experiences and identities of neurodivergent individuals?
How do you help neurodivergent individuals who may struggle with emotional awareness or expression, particularly when they find it difficult to articulate their emotions?
How do you balance fostering independence in neurodivergent individuals while ensuring they receive adequate support for challenges they may face?
How do you approach supporting neurodivergent individuals during times of crisis or extreme emotional distress, while avoiding exacerbating symptoms of burnout or dysregulation?
How do you involve a neurodivergent person’s family or support system in the therapeutic process, especially in cases where social dynamics and understanding are key to treatment?
How do you incorporate non-medication-based interventions (e.g., mindfulness, behavioral strategies) into treatment for neurodivergent individuals, especially for those who prefer to avoid or complement medication?
How do you help neurodivergent individuals with long-term planning, such as navigating life transitions (e.g., starting a career, moving out, etc.) while taking their specific needs into account?
How do you help neurodivergent individuals who tend to mask or rely on maladaptive coping mechanisms to manage their symptoms in healthy and sustainable ways?
What is your understanding of the importance of special interests and stimming to neurodivergent people and how pursuing these interests is important to the nervous system?
What is your understanding of the relationship between neurodivergence and gender identity?
What is your experience working with chronic illness?
What is your experience working with neurodivergent people who have previously had misdiagnoses or comorbidities of OCD, BPD, and/or bipolar disorder?
What are your thoughts on ABA therapy?
Mental Health Resources
Counseling
Phone: (509) 720-7397
Email: admin@mahinatherapy.com
360-949-9140
652 Officer’s Row, Vancouver, WA 98661
info@wildheartsociety.org
1219 SE Lafayette St
Portland, OR 97202
3620 SE Powell Blvd
Portland, OR 97202
admin@fullspectrumpdx.com
503-765-5733
11 NE MLK Blvd., #203, Portland, OR 97232
hello@rebelheartpdx.com
Spectrum Counseling & Mental Wellness
1220 SW Morrison St Suite 1201, Portland, OR 97205
971-373-4497
Administrative assist #: 971-301-2297
info@spectrumcounselingpdx.com
Willamette Wellness Center: Home
Portland, OR and surrounding areas
Phone: 503.404.3637
Fax: 503.974.0907
Email info@WillametteWellnessCenter.com
(360) 952-3070
Contact email: info@starmeadowcounseling.com
1584 NE 8th Street, Suite 200
Gresham, OR 97030
Email: info@newpatterncounseling.com
Phone: 971-421-8696
Fax: 503-328-8094
Portland: 4800 S Macadam Ave Suite 230
Portland, OR, 97239
Beaverton: 8555 SW Apple Way #320
Portland, OR 97225
Phone: 971-266-2862
1711 Main St.
Vancouver, WA 98660
360.200.4481
frontdesk@mmh.hush.com
108 SE 124th Ave. Suite 6
Vancouver, WA 98684
nowrongbody@gmail.com
(360) 910-1662
Vancouver Counseling Solutions
Adminbb@csfamilytherapy.com
601 E. McLoughlin Blvd.Vancouver, WA 98663
Phone: (360) 281-6824
Fax: (360) 314-2908
Email: abetterwaycounseling@live.com
5411 NE 107th Ave Suite 101
Vancouver WA 98662
Office: 360-828-7871
info@heritagenwconsulting.org
Integrative Trauma Treatment Center
(971) 266-6910
360-838-3356
Wanderlust Therapeutic Services
Vanc (360) 356-1114
Fax: (603) 589-4981
(360) 953-3199
Neurodiversity-affirming Psych Prescribers