In-person in Houston, online across Texas • In-network with Aetna, BCBS, Cigna, UHC/Optum, Tricare, Curative, Oscar • Therapy in English, Spanish, Portuguese, Farsi
Depression & Low Mood
Depression Therapy in Houston, TX
Depression is heterogeneous. The term is used for numbness, emptiness, loss of desire, a heaviness present in the background, and a sense of absence from one's own life. Some of these states remit and recur episodically; others have persisted so long that the person no longer remembers being otherwise. Applying a single treatment plan to all of them is one reason so much treatment does not hold.
We want to establish when the depression began, what maintains it, what it may be concealing, and how it has shaped the person's days and relationships. Depression therapy at Real Talk is provided in person and online across Texas.
Depression is more than a deficit of energy. It is a position the person has come to occupy, sometimes in relation to a loss that was never mourned, sometimes in relation to demands that could not be met, sometimes in relation to a version of themselves they have relinquished. The treatment works to understand that position rather than only to elevate mood. This tends to be slower than symptom management, and in our experience it is what allows change to be sustained.
We treat major depressive episodes, persistent depressive disorder, depression within bipolar disorder, and depression that has not responded to previous treatment. Where medication is part of the treatment, we coordinate with the prescriber.
Presentations We See
A first depressive episode in a person who does not recognize themselves in it. Recurrent depression, in which each episode has left residue and the person has organized their life around preventing the next. Persistent depressive disorder, the chronic low-grade form that patients often describe as their temperament. Depression secondary to loss, diagnosis, childbirth, or relocation. Bipolar depression, where treatment must account for the full cycle and for the risks of mistreating one pole. Depression that presented as burnout and was managed as such. Depression that is unresolved grief. And the patient who is not in crisis, is functioning, and knows that something has gone out of their life and has not returned.
What We Pay Attention To
We pay attention to what the depression is about, which is not always what it appears to be. We attend to what it has rendered impossible to say or to want, to the history of the person's losses, and to what they were taught about what they were permitted to need. And we attend to risk continuously.
Why Doctoral Training Matters for Depression: Doctoral training matters most when depression is chronic or recurrent, when it is comorbid with anxiety, trauma, or serious relational difficulty, when the presentation is atypical or complicated by medical factors or bipolar illness, and when understanding what sustains it requires more than a symptom inventory. It also matters in the outpatient care of patients following hospitalization, which requires a clinician able to hold a treatment through a difficult period rather than refer it out at the first sign of deterioration.
Our clinical director reads every inquiry and recommends a clinician within minutes on weekdays, hours on weekends.
I have been on medication for years and still feel this way. Can therapy help?
Frequently, yes. Medication can reduce the weight of depression without addressing what it is about. That is usually where this work begins.
Do you work with bipolar disorder?
Yes. Several of our clinicians have experience with bipolar depression and with outpatient care following hospitalization. We coordinate with psychiatry.
How does this differ from what my primary care physician offered?
Primary care screens and prescribes, appropriately. Here the depression is listened to over time by a clinician trained to understand what maintains it.
Shon Faye. Depression Is a Haunting.
Vogue, 2024. Read here.
Susanna Schrobsdorff. Depression Is a Pandemic.
Time, 2021. Read here.
John Welwood. Depression as a Loss of Heart.
The Sun, 1988. Read here.