Conditions I work with
Depression is not a personal failing. It is a condition with identifiable patterns — patterns that psychological therapy can address directly. Getting there is rarely straightforward, but it is possible.
Understanding depression
Depression is more than feeling sad or going through a difficult period. It is a persistent condition that affects mood, thinking, physical functioning, and behaviour — often simultaneously, and often in ways that interact with and reinforce each other.
One of the most important things to understand about depression is that the condition itself makes it harder to do the things that would help. Low motivation makes activity feel impossible; withdrawal removes sources of connection and meaning; negative thinking filters out evidence that contradicts it. This is not weakness — it is how depression works. It is also why simply being told to push through, or to think more positively, so rarely achieves anything.
Depression presents differently in different people. Some experience it primarily as sadness; others as emptiness, numbness, or irritability. Some are barely functional; others continue to perform at work while feeling hollowed out. Understanding the specific pattern — what triggered it, what sustains it, what it means to the person experiencing it — matters considerably for how to approach it.
Depression also commonly co-occurs with anxiety. When both are present, a careful assessment is needed to understand the relationship between them and where to begin.
How it presents
Depression affects multiple domains of experience — not only mood. The pattern varies between individuals, and not everyone will recognise themselves in every category below.
Persistent low mood, emptiness, or hopelessness. Inability to feel pleasure in things previously enjoyed. Emotional numbness, or — less commonly recognised — persistent irritability rather than sadness.
Negative views of the self, the future, and the world that feel like facts rather than interpretations. Difficulty concentrating and making decisions. Rumination — repetitive, self-critical thinking that circles without resolving anything.
Fatigue that is disproportionate to activity. Disrupted sleep — often early waking, though sometimes excessive sleeping. Changes in appetite and weight. Physical slowing, or in some cases agitation and restlessness.
Withdrawing from social contact and activities previously valued. Reduced engagement with work or daily responsibilities. Increased use of alcohol or other ways of numbing difficult experience.
What keeps depression going
Depression tends to sustain itself through a set of interconnected cycles, each of which makes the others worse.
The most significant behavioural cycle is straightforward: when we feel low, we do less. Doing less removes sources of pleasure, achievement, and connection — which deepens low mood — which makes doing anything feel even less worthwhile. The cycle is self-reinforcing and, without intervention, tends to tighten over time.
Alongside this, depression shapes thinking in ways that are hard to see from the inside. Negative views of the self and the future feel accurate, not distorted. The mind generates evidence for them and dismisses what contradicts them. This is not irrationality — it is a systematic bias that depression produces, and recognising it as such is itself a meaningful step.
Rumination — the tendency to dwell on difficulties, replay failures, or rehearse worst-case futures — is one of the most reliably identified maintaining factors in depression. It consumes significant mental energy, crowds out other activity, and produces no useful resolution. It also tends to feel like problem-solving, which makes it hard to interrupt.
Social withdrawal and avoidance of demanding situations remove sources of support and competence at precisely the time they are most needed. They are understandable responses to feeling depleted — and they also make recovery considerably harder.
The approach
Sessions begin with a thorough assessment — building a clear, shared understanding of your specific pattern of depression and what is maintaining it. The approach follows from that.
Depression is one of the most studied conditions in the psychological literature, and several therapeutic approaches have a meaningful evidence base. That said, the research also shows that depression is genuinely difficult to treat, that not everyone responds to the same approach, and that for moderate to severe depression, a combination of psychological therapy and medication is often more effective than either alone.
The goal of the approaches described below is to address the maintaining cycles directly — the behavioural withdrawal, the ruminative thinking, the self-critical beliefs — rather than simply trying to shift mood. Progress is often gradual, and setbacks are common. For many people who engage with the work, however, meaningful change is achievable — even when it does not feel that way at the outset.
Re-engaging gradually with activities that provide a sense of pleasure, achievement, or connection — even, and especially, when motivation is absent. The principle is that behaviour influences mood, and that waiting to feel motivated before acting tends to deepen withdrawal. This is often the most useful early focus in working with depression.
Examining the patterns of thinking that maintain depression — including self-criticism, hopelessness, and the cognitive biases that make negative views feel like facts. The work involves developing the capacity to notice these patterns and, over time, to relate to them differently. This requires more than simply generating positive thoughts to replace negative ones.
Developing a different relationship with depressive thoughts and feelings — learning to observe them with some distance rather than being pulled into ruminative cycles. Mindfulness-based approaches are particularly relevant for people with a history of recurrent depression, where the risk of relapse is significant and where learning to recognise early warning signs matters.
For some people, depression connects to beliefs and relational patterns that developed much earlier — around worthiness, self-criticism, or how relationships work. Where this is the case, addressing these patterns tends to produce more durable change than symptom-focused work alone. This requires careful assessment to determine whether and when it is the right focus.
These approaches are rarely used in isolation. A clear picture of what is maintaining your depression will usually suggest drawing on more than one — and the balance will shift as the work progresses.
An initial consultation is an opportunity to make sense of your specific situation and to consider together what an approach might look like.
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