Depression Psychiatrists in Fall City, WA

Photo of Kristy Mitchell, Psychiatric Nurse Practitioner, DNP, ARNP, PMHNP
Kristy Mitchell
Psychiatric Nurse Practitioner, DNP, ARNP, PMHNP
Serves Area
I especially enjoy working with children, adolescents, and families managing ADHD, ASD, anxiety, depression, insomnia, and emotional regulation.
My goal is to create a welcoming space where you feel heard. Together, we’ll create a treatment plan that’s right for you and helps you feel your best.
I especially enjoy working with children, adolescents, and families managing ADHD, ASD, anxiety, depression, insomnia, and emotional regulation.
My goal is to create a welcoming space where you feel heard. Together, we’ll create a treatment plan that’s right for you and helps you feel your best.
(425) 529-5191 View (425) 529-5191
Photo of Dr. Liza Partlow Lohse - LifeStance Health, Psychiatrist, MD
LifeStance Health
Psychiatrist, MD
Serves Area
Our team of psychiatrists, therapists, psychologists, and advanced practice nurses specializes in treating in a wide range of mental health conditions, including anxiety, depression, ADHD, addiction, trauma, PTSD, and more.
Making your first appointment can be one of the most challenging steps in your mental health journey. At LifeStance, we make it simple by offering both online and in-person therapy and psychiatry services, covered by major insurance plans.
Our team of psychiatrists, therapists, psychologists, and advanced practice nurses specializes in treating in a wide range of mental health conditions, including anxiety, depression, ADHD, addiction, trauma, PTSD, and more.
Making your first appointment can be one of the most challenging steps in your mental health journey. At LifeStance, we make it simple by offering both online and in-person therapy and psychiatry services, covered by major insurance plans.
(425) 341-1791 View (425) 341-1791
Photo of Liza Partlow Lohse, Psychiatrist
Liza Partlow Lohse
Psychiatrist
Serves Area
Liza Partlow Lohse, MD, is a Board-Certified Adult Psychiatrist, licensed in the state of Washington. She has over 15 years of experience in outpatient psychiatry; in private practice, university and hospital settings. Dr. Partlow Lohse's goal is to work in collaboration with clients to achieve their mental health goals via psychiatric evaluation and treatment planning using a wholistic approach. That can include focus on lifestyle factors including sleep, nutrition and exercise as well as utilizing behavioral strategies and medication management.
Liza Partlow Lohse, MD, is a Board-Certified Adult Psychiatrist, licensed in the state of Washington. She has over 15 years of experience in outpatient psychiatry; in private practice, university and hospital settings. Dr. Partlow Lohse's goal is to work in collaboration with clients to achieve their mental health goals via psychiatric evaluation and treatment planning using a wholistic approach. That can include focus on lifestyle factors including sleep, nutrition and exercise as well as utilizing behavioral strategies and medication management.
(425) 517-2191 View (425) 517-2191
Photo of Julie Lesko - Julie Lesko, ARNP, Psychiatric Nurse Practitioner, ARNP, PMHNP
Julie Lesko, ARNP
Psychiatric Nurse Practitioner, ARNP, PMHNP
Serves Area
Now in-network with Aetna, Optum, Premera, Regence and United Healthcare. My treatment focus is for those age 17 and older, seeking assessments and treatment for mood, thought and cognitive processing issues. My patients come from many backgrounds and stages of life, but they have in common a desire to experience life with a sense of well-being and balance, without excess frustration, discouragement and anxiety. They seek ethical clinical care that is empathetic and personalized. I provide this in the treatment setting with evaluations, care planning, therapy and medications. Call for a complimentary 15-minute consultation.
Now in-network with Aetna, Optum, Premera, Regence and United Healthcare. My treatment focus is for those age 17 and older, seeking assessments and treatment for mood, thought and cognitive processing issues. My patients come from many backgrounds and stages of life, but they have in common a desire to experience life with a sense of well-being and balance, without excess frustration, discouragement and anxiety. They seek ethical clinical care that is empathetic and personalized. I provide this in the treatment setting with evaluations, care planning, therapy and medications. Call for a complimentary 15-minute consultation.
(775) 232-4550 View (775) 232-4550
Photo of Saskia Vonmichalofski, Psychiatric Nurse Practitioner, ARNP
Saskia Vonmichalofski
Psychiatric Nurse Practitioner, ARNP
Serves Area
I am a Board Certified Psychiatric Nurse Practitioner in Washington State ( License AP60003268). I received Baccalaureate Degrees in Psychology and Nursing from the University of Washington in 1988, and a Master's Degree in Advanced Practice Psychiatric Nursing from the University of Washington in 2007. I worked in inpatient and outpatient settings as a Psychiatric Nurse and have experience working with children, adolescents and adults in an outpatient setting as a Psychiatric ARNP. In my free time I enjoy hiking, skiing, trail running and reading.
I am a Board Certified Psychiatric Nurse Practitioner in Washington State ( License AP60003268). I received Baccalaureate Degrees in Psychology and Nursing from the University of Washington in 1988, and a Master's Degree in Advanced Practice Psychiatric Nursing from the University of Washington in 2007. I worked in inpatient and outpatient settings as a Psychiatric Nurse and have experience working with children, adolescents and adults in an outpatient setting as a Psychiatric ARNP. In my free time I enjoy hiking, skiing, trail running and reading.
(425) 390-8875 View (425) 390-8875
Photo of Chelsea Ratchford, Psychiatric Nurse, DNP, PMHNP
Chelsea Ratchford
Psychiatric Nurse, DNP, PMHNP
Serves Area
Chelsea Ratchford is a Psychiatric Mental Health Nurse Practitioner in Washington who has been practicing since 2024. Chelsea is here to help you achieve the life you want. She offers nonjudgmental care to patients. Together, you and Chelsea can decide on the treatment plan that best fits your lifestyle. She will provide support to help you manage symptoms, improve coping skills, and work through emotional challenges to foster resilience and promote mental wellbeing, whatever that looks like to you. Chelsea will provide education about your mental health condition, including symptoms, triggers, and potential treatment options.
Chelsea Ratchford is a Psychiatric Mental Health Nurse Practitioner in Washington who has been practicing since 2024. Chelsea is here to help you achieve the life you want. She offers nonjudgmental care to patients. Together, you and Chelsea can decide on the treatment plan that best fits your lifestyle. She will provide support to help you manage symptoms, improve coping skills, and work through emotional challenges to foster resilience and promote mental wellbeing, whatever that looks like to you. Chelsea will provide education about your mental health condition, including symptoms, triggers, and potential treatment options.
(425) 395-8610 View (425) 395-8610

More Psychiatrists Nearby

Photo of Kirsten Garza, Psychiatric Nurse Practitioner, PMHNP
Kirsten Garza
Psychiatric Nurse Practitioner, PMHNP
Online Only
I treat a variety of conditions including, but not limited to, depression, anxiety, ADD/ADHD, and bipolar disorder.
I have a very kind, nonjudgmental, and accepting attitude towards my patients. I like to understand my patient's cultures, beliefs, values, and mindsets so that I can approach care from the place they are and help them feel comfortable. I never want a patient to feel nervous, judged, or scolded, for being open and honest.
I treat a variety of conditions including, but not limited to, depression, anxiety, ADD/ADHD, and bipolar disorder.
I have a very kind, nonjudgmental, and accepting attitude towards my patients. I like to understand my patient's cultures, beliefs, values, and mindsets so that I can approach care from the place they are and help them feel comfortable. I never want a patient to feel nervous, judged, or scolded, for being open and honest.
(425) 472-4202 View (425) 472-4202
Photo of Vivian Kisanga, Psychiatric Nurse Practitioner, PMHNP
Vivian Kisanga
Psychiatric Nurse Practitioner, PMHNP
Serves Area
As an experienced psychiatric nurse practitioner dedicated in providing compassionate and holistic care, I bring a wealth of expertise in treating a spectrum of mental health conditions, ranging from anxiety, ADHD, depression, bipolar disorder, schizophrenia, addiction and others.
My approach to psychiatric care integrates evidence-based practices with a patient-centered philosophy. I recognize the importance of staying abreast of the latest research and advancements in psychiatric treatment modalities, allowing me to offer the most effective interventions through medication management and solution focussed therapy.
As an experienced psychiatric nurse practitioner dedicated in providing compassionate and holistic care, I bring a wealth of expertise in treating a spectrum of mental health conditions, ranging from anxiety, ADHD, depression, bipolar disorder, schizophrenia, addiction and others.
My approach to psychiatric care integrates evidence-based practices with a patient-centered philosophy. I recognize the importance of staying abreast of the latest research and advancements in psychiatric treatment modalities, allowing me to offer the most effective interventions through medication management and solution focussed therapy.
(253) 527-6954 View (253) 527-6954
Photo of Erica Johnson - ECARE Psychiatric Services PLLC, Psychiatric Nurse Practitioner, MSN-Ed, PMHNP
ECARE Psychiatric Services PLLC
Psychiatric Nurse Practitioner, MSN-Ed, PMHNP
Online Only
I specialize in Bipolar Disorder, Anxiety, Depression, Schizophrenia, PTSD, and other mental health disorders.
Accepting New Patients. 100% Online. I am a board certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC). I received my post-graduate certificate in psychiatric mental health from Maryville University, St. Louis Missouri, Masters in Nursing Education from Lourdes University, Sylvania, Ohio, and Associates in Applied Science Nursing from Mercy College of NWO, Toledo, Ohio. My practice provides comprehensive psychiatric diagnostic evaluations, evidence-based medication management, and supportive therapy.
I specialize in Bipolar Disorder, Anxiety, Depression, Schizophrenia, PTSD, and other mental health disorders.
Accepting New Patients. 100% Online. I am a board certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC). I received my post-graduate certificate in psychiatric mental health from Maryville University, St. Louis Missouri, Masters in Nursing Education from Lourdes University, Sylvania, Ohio, and Associates in Applied Science Nursing from Mercy College of NWO, Toledo, Ohio. My practice provides comprehensive psychiatric diagnostic evaluations, evidence-based medication management, and supportive therapy.
(509) 606-4430 View (509) 606-4430
Sammy Gathiru
Psychiatric Nurse Practitioner, DNP, PMHNP -, BC
1 Endorsed
Serves Area
I treat various psychiatric disorders not limited to: Mood, Anxiety, Depression, Bipolar and Trauma-related disorders.
Accepting New Clients! I am a Board-Certified Psychiatric Mental Health Nurse Practitioner who provides a comprehensive approach to mental health treatment by incorporating psychopharmacology, psychotherapy and alternative treatment modalities to best address the concern at hand. I provide a client-centered method of treatment, which includes educating clients about their diagnosis, treatment options and working with the client to develop a unique treatment plan tailored to fit each individual.
I treat various psychiatric disorders not limited to: Mood, Anxiety, Depression, Bipolar and Trauma-related disorders.
Accepting New Clients! I am a Board-Certified Psychiatric Mental Health Nurse Practitioner who provides a comprehensive approach to mental health treatment by incorporating psychopharmacology, psychotherapy and alternative treatment modalities to best address the concern at hand. I provide a client-centered method of treatment, which includes educating clients about their diagnosis, treatment options and working with the client to develop a unique treatment plan tailored to fit each individual.
(253) 785-6249 View (253) 785-6249
Photo of M. Wallace Williams - M. Wallace Williams at Motiva Health, Psychiatric Nurse Practitioner, ARNP, PMHNP
M. Wallace Williams at Motiva Health
Psychiatric Nurse Practitioner, ARNP, PMHNP
Tukwila, WA 98188
My practice specializes in depression, anxiety, mood disorders, adjustment issues, personality disorders, and other common psychiatric conditions.
As a board-certified psychiatric mental health nurse practitioner, I merge evidence-based practice guidelines with a patient-centered approach. Your unique values, needs, and goals are at the forefront of our collaboration. Together, we will develop a tailored treatment plan to promote your well-being and achieve positive clinical outcomes.
My practice specializes in depression, anxiety, mood disorders, adjustment issues, personality disorders, and other common psychiatric conditions.
As a board-certified psychiatric mental health nurse practitioner, I merge evidence-based practice guidelines with a patient-centered approach. Your unique values, needs, and goals are at the forefront of our collaboration. Together, we will develop a tailored treatment plan to promote your well-being and achieve positive clinical outcomes.
(206) 208-0084 View (206) 208-0084
Photo of Shantel Escobar, Psychiatric Nurse Practitioner, PMHNP
Shantel Escobar
Psychiatric Nurse Practitioner, PMHNP
Online Only
com - I offer medication services to help with depression, anxiety, ADHD, and other mood disorders in children, adolescents, and adults.
I provide efficient and convenient telehealth services with a professional approach. As a Board-Certified Psychiatric-Mental Health Nurse Practitioner, I am qualified to prescribe psychiatric medications when necessary.
com - I offer medication services to help with depression, anxiety, ADHD, and other mood disorders in children, adolescents, and adults.
I provide efficient and convenient telehealth services with a professional approach. As a Board-Certified Psychiatric-Mental Health Nurse Practitioner, I am qualified to prescribe psychiatric medications when necessary.
(360) 919-0421 View (360) 919-0421
Photo of Jabari Dobson, Psychiatric Nurse Practitioner, PMHNP
Jabari Dobson
Psychiatric Nurse Practitioner, PMHNP
Online Only
My specialties include ADHD, Anxiety, Depression, Bipolar Disorder, and more.
I communicate therapeutically and realistically. I love to create a relaxed and engaging environment to achieve the greatest vulnerability.
My specialties include ADHD, Anxiety, Depression, Bipolar Disorder, and more.
I communicate therapeutically and realistically. I love to create a relaxed and engaging environment to achieve the greatest vulnerability.
(425) 600-3445 View (425) 600-3445
Photo of Shola Adewunmi, Psychiatric Nurse Practitioner, PMHNP
Shola Adewunmi
Psychiatric Nurse Practitioner, PMHNP
Online Only
My expertise includes anxiety, depression, mood disorders, ADHD, and more, and I'm passionate about providing personalized, evidence-based care tailored to each individual.
If you're seeking compassionate and effective mental health support, I'm here to work with you to achieve your goals and promote holistic well-being. My approach to providing mental healthcare is grounded in a holistic and patient-centered perspective. I believe in integrating a range of therapeutic modalities to meet the unique needs of each individual.
My expertise includes anxiety, depression, mood disorders, ADHD, and more, and I'm passionate about providing personalized, evidence-based care tailored to each individual.
If you're seeking compassionate and effective mental health support, I'm here to work with you to achieve your goals and promote holistic well-being. My approach to providing mental healthcare is grounded in a holistic and patient-centered perspective. I believe in integrating a range of therapeutic modalities to meet the unique needs of each individual.
(425) 600-2706 View (425) 600-2706
Photo of Jacqueline Marcell-Koledin - Jacqueline Marcell-Koledin | TMS, Psychiatric Nurse Practitioner, PMHNP, ARNP
Jacqueline Marcell-Koledin | TMS
Psychiatric Nurse Practitioner, PMHNP, ARNP
2 Endorsed
Seattle, WA 98116
It can be helpful for mood challenges such as: Depression; Anxiety; OCD; Addiction; Bipolar/ Depression; ADHD; PTSD; tinnitus; smoking cessation.
Jacqueline Marcell-Koledin, PMHNP-BC, ARNP graduated from the University of Washington at the top of her class with her work and focus on Brain Stimulation therapies such as TMS.
It can be helpful for mood challenges such as: Depression; Anxiety; OCD; Addiction; Bipolar/ Depression; ADHD; PTSD; tinnitus; smoking cessation.
Jacqueline Marcell-Koledin, PMHNP-BC, ARNP graduated from the University of Washington at the top of her class with her work and focus on Brain Stimulation therapies such as TMS.
(206) 673-2408 View (206) 673-2408
Photo of Clare Coetzer, Psychiatric Nurse Practitioner, DNP, PMHNP, LICSW, PMH-C
Clare Coetzer
Psychiatric Nurse Practitioner, DNP, PMHNP, LICSW, PMH-C
Online Only
Whether you're navigating anxiety, depression, trauma, or just feeling stuck, I am here to help; offering both the clinical tools and emotional support you need to heal, grow and move forward.
Everyone has a story worth telling. I'm here to listen- without judgment, with compassion and with care. As a dually licensed therapist and psychiatric nurse practitioner, I bring a unique blend of medical expertise and therapeutic insight and experience to support you on your journey. Together, we will work toward healing and growth- at your own pace and on your terms.
Whether you're navigating anxiety, depression, trauma, or just feeling stuck, I am here to help; offering both the clinical tools and emotional support you need to heal, grow and move forward.
Everyone has a story worth telling. I'm here to listen- without judgment, with compassion and with care. As a dually licensed therapist and psychiatric nurse practitioner, I bring a unique blend of medical expertise and therapeutic insight and experience to support you on your journey. Together, we will work toward healing and growth- at your own pace and on your terms.
View
Photo of Dr. Udo Chukwuocha, Psychiatric Nurse Practitioner, DNP, FNP-C, PMHNP-B
Dr. Udo Chukwuocha
Psychiatric Nurse Practitioner, DNP, FNP-C, PMHNP-B
Online Only
My current focus is clients with anxiety, depression, mood disorders, insomnia, PTSD and ADHD.
Accepting New Patients! Have you been feeling down, stressed, or worried lately? Do you sometimes wonder if what you're feeling is normal? You're doing your best, but you have a hard time keeping up with your daily tasks. You have intense emotions, trouble focusing, forgetful, or get easily distracted? Do you find it hard to get out of bed in the morning, you lack motivation or have no interest in things you normally enjoy doing, and you can sometimes be tearful for no reason? Or is your sleep pattern consistently disrupted which leaves you feeling exhausted the next day? You ARE NOT alone! I would like to help.
My current focus is clients with anxiety, depression, mood disorders, insomnia, PTSD and ADHD.
Accepting New Patients! Have you been feeling down, stressed, or worried lately? Do you sometimes wonder if what you're feeling is normal? You're doing your best, but you have a hard time keeping up with your daily tasks. You have intense emotions, trouble focusing, forgetful, or get easily distracted? Do you find it hard to get out of bed in the morning, you lack motivation or have no interest in things you normally enjoy doing, and you can sometimes be tearful for no reason? Or is your sleep pattern consistently disrupted which leaves you feeling exhausted the next day? You ARE NOT alone! I would like to help.
(213) 493-0990 View (213) 493-0990
Photo of Mosiah Wilson, Psychiatric Nurse Practitioner, PMHNP
Mosiah Wilson
Psychiatric Nurse Practitioner, PMHNP
Online Only
I typically work with a diverse range of patients, including those facing various mental health challenges such as anxiety, depression, and trauma-related disorders.
My name is Mosiah Wilson, and I am a Psychiatric Mental Health Nurse Practitioner (PMHNP) dedicated to providing holistic care to my patients. I believe that mental health is a deeply personal journey, and I strive to meet each individual where they are in their unique experiences. Understanding that everyone is different, I tailor my approach to treatment with compassion and a commitment to addressing the diverse needs of my patients. I see myself as a healthcare provider and a partner in the healing process, creating a nurturing environment where everyone feels valued and understood.
I typically work with a diverse range of patients, including those facing various mental health challenges such as anxiety, depression, and trauma-related disorders.
My name is Mosiah Wilson, and I am a Psychiatric Mental Health Nurse Practitioner (PMHNP) dedicated to providing holistic care to my patients. I believe that mental health is a deeply personal journey, and I strive to meet each individual where they are in their unique experiences. Understanding that everyone is different, I tailor my approach to treatment with compassion and a commitment to addressing the diverse needs of my patients. I see myself as a healthcare provider and a partner in the healing process, creating a nurturing environment where everyone feels valued and understood.
(206) 207-1154 View (206) 207-1154
Photo of Tirhas Zerahaimanot, Psychiatric Nurse Practitioner, DNP, PMHNP-, BC
Tirhas Zerahaimanot
Psychiatric Nurse Practitioner, DNP, PMHNP-, BC
This includes anxiety, depression, PTSD, ADHD, mood disorders, OCD, stress and insomnia.
Dr. Tirhas Zerahaimanot is a doctoral-prepared, licensed, and board-certified Psychiatric Nurse Practitioner. She earned her clinical Doctorate of Nursing Practice (DNP) degree from the University of Washington, Seattle. She has 14 plus years experience in healthcare and of those 13 years, she specialized in mental health.
This includes anxiety, depression, PTSD, ADHD, mood disorders, OCD, stress and insomnia.
Dr. Tirhas Zerahaimanot is a doctoral-prepared, licensed, and board-certified Psychiatric Nurse Practitioner. She earned her clinical Doctorate of Nursing Practice (DNP) degree from the University of Washington, Seattle. She has 14 plus years experience in healthcare and of those 13 years, she specialized in mental health.
(206) 202-0742 View (206) 202-0742
Photo of Audrey Grimm, Psychiatric Nurse Practitioner, PMHNP
Audrey Grimm
Psychiatric Nurse Practitioner, PMHNP
Online Only
I typically work with adult patients experiencing anxiety disorders, addiction, depression, ADHD, and bipolar disorder.
I am a board-certified nurse practitioner specializing in psychiatric mental health. I believe in creating a collaborative partnership where your concerns are heard and addressed, empowering you to make informed decisions about your health and well-being. My approach to mental healthcare centers on creating a safe, non-judgmental therapeutic alliance where we can explore your concerns collaboratively. I primarily draw from evidence-based frameworks, including Cognitive Behavioral Therapy (CBT), Psychodynamic therapy, Mindfulness, and Motivational Interviewing techniques to support behavioral change when appropriate.
I typically work with adult patients experiencing anxiety disorders, addiction, depression, ADHD, and bipolar disorder.
I am a board-certified nurse practitioner specializing in psychiatric mental health. I believe in creating a collaborative partnership where your concerns are heard and addressed, empowering you to make informed decisions about your health and well-being. My approach to mental healthcare centers on creating a safe, non-judgmental therapeutic alliance where we can explore your concerns collaboratively. I primarily draw from evidence-based frameworks, including Cognitive Behavioral Therapy (CBT), Psychodynamic therapy, Mindfulness, and Motivational Interviewing techniques to support behavioral change when appropriate.
(509) 215-2537 View (509) 215-2537

See more therapy options for Fall City

Depression Psychiatrists

What is the goal of therapy for depression?

Therapy for depression has several major goals. One is to relieve the mental pain of depression, which distorts feeling and thinking so that sufferers cannot see beyond their current state of mind or envision feeling better. Another is to give people the mental tools to recognize and correct the kinds of distorted thinking that turn a problem into a catastrophe and lead to despair. Therapy also teaches people how to process negative emotions in constructive ways, so they have more control over their own emotional reactivity. And it helps people regain the ability to see themselves positively, the motivation to do things, and the capacity for pleasure.

What happens in therapy for depression?

Perhaps most important, no matter the type of therapy, patients form an alliance with the therapist; that connection is therapeutic in itself, plus it becomes an instrument of change. Patients learn to identify and to challenge their own erroneous beliefs and thoughts that amplify the effects of negative experiences. They learn to identify situations in which they are especially vulnerable. And they learn new patterns of thinking and behaving. They may be given “homework” assignments in which they practice their developing skills. In addition, good therapists regularly monitor patients to assess whether and how much the condition is improving.

What therapy types help with depression?

Several types of short-term therapy have been found effective, each targeting one or more areas of dysfunction. Cognitive behavioral therapy (CBT) helps clients challenge their negative thoughts and beliefs, learn new behavioral strategies, and curb reactivity to distressing situations. Behavioral activation (BA) is a form of therapy often used in conjunction with CBT; it focuses on engagement in rewarding activity as a pathway to changing negative feelings and disturbed mood. Another widely used approach is interpersonal therapy (IPT), which targets the social difficulties that both give rise to and get exacerbated by depression. Therapists may combine approaches as needed.

Can therapy for depression be done online?

Studies have found that online therapy can be highly effective for treating depression, although it may be more challenging to build a good therapist-patient alliance on screen than in person—at least at first. However, online therapy can offer considerable advantages. Accessibility and convenience are tops among them. Some people actually find it easier to talk about problems online than in person. While online therapy typically limits visibility of facial expression and body gestures that give important nonverbal cues to a patient’s state of mind, it can give therapists a glimpse into a patient’s world and life, providing information that can be highly useful in guiding therapy.

How effective is therapy for depression?

Many studies show that therapy is highly effective provided that patients complete the prescribed course of therapy, commonly 16 to 20 sessions. Over the long term, it is more effective than medication and the effects are more enduring. As a result, psychotherapy has the power not just to relieve current suffering but to prevent future episodes of the disorder. Therapy reverses the dysfunction in neural circuitry that disposes individuals to a negative view of themselves, the world, and their future and they acquire coping techniques, problem-solving skills, and understanding of their own vulnerabilities that are useful over the course of a lifetime.