Depression Therapy
Psychological therapy for depression, low mood, loss of motivation and feeling stuck
Psychological therapy for depression, low mood, loss of motivation and feeling stuck
Depression is not always experienced as feeling intensely sad.
Sometimes it can feel more like losing interest in things that used to matter, struggling to find motivation, becoming increasingly withdrawn or simply feeling as though you are going through the motions of everyday life.
You might still be working, looking after other people and meeting your responsibilities while internally feeling exhausted, disconnected or increasingly critical of yourself.
I am Dr Aaron Shaw, Chartered Clinical Psychologist, and I offer evidence-informed psychological therapy for adults experiencing depression, persistent low mood and related difficulties.
Therapy can help us understand what may have contributed to how you are feeling, identify the patterns that are keeping you stuck and begin finding realistic ways forward.
When low mood starts affecting everyday life
Everyone experiences periods of sadness, disappointment or low mood.
Depression tends to involve something more persistent.
Things that previously felt enjoyable or meaningful may begin to require much more effort. Motivation can disappear. Everyday tasks can feel surprisingly difficult.
You might notice that you:
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feel low, flat or emotionally numb
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have lost interest in things you previously enjoyed
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struggle to motivate yourself
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feel tired or lacking in energy
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withdraw from friends, family or activities
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find it difficult to concentrate or make decisions
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spend increasing amounts of time thinking about things that have gone wrong
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feel guilty or believe you are letting other people down
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become increasingly critical of yourself
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feel hopeless about things changing
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struggle with sleep or find yourself sleeping much more than usual
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put things off because everything feels difficult
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feel disconnected from the person you used to be
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continue functioning outwardly while internally feeling very different
Depression can affect work, relationships, confidence, motivation and the way you see yourself.
And because depression itself makes things feel more difficult, seeking help can sometimes feel like another task that requires energy you simply do not have.
What is depression?
Depression is more than simply having a bad day or feeling temporarily unhappy.
It can affect our emotions, thoughts, behaviour, motivation and physical wellbeing.
When people become depressed, they may notice changes in how they think about themselves, other people and the future.
Thoughts such as:
What's the point?
I should be coping better than this.
Everyone else seems to manage.
I've let people down.
Nothing is going to change.
can begin to feel increasingly convincing.
At the same time, motivation and energy may reduce.
Activities that once provided enjoyment, connection, achievement or structure can gradually disappear from daily life.
Over time, this can create a cycle in which feeling low leads us to do less, and doing less leaves us with fewer opportunities to experience the things that might help improve our mood.
Depression can look different for different people
There is no single experience of depression.
For some people it develops relatively suddenly following a difficult period or significant life event.
For others it develops gradually and can be difficult to trace back to one particular cause.
Persistent low mood
You may feel sad, flat or emotionally heavy for much of the time.
Sometimes people describe feeling as though there is a cloud hanging over them, even when they cannot identify anything immediately wrong.
Loss of interest or enjoyment
Things you previously looked forward to may stop feeling rewarding.
You might still go through the motions of hobbies, relationships or social activities without experiencing the same enjoyment from them.
Loss of motivation
One of the most frustrating aspects of depression can be knowing what you would like to do but feeling unable to make yourself do it.
This can easily be mistaken for laziness or lack of willpower.
In reality, reduced motivation can become an important part of the depression cycle.
Self-criticism and guilt
Depression can change the way we evaluate ourselves.
Mistakes may feel more significant, achievements may be dismissed and you may find yourself focusing increasingly on perceived failures or shortcomings.
For some people, the internal voice becomes extremely critical:
You should be doing more.
Other people cope better than you.
You're letting everyone down.
This self-criticism can deepen low mood and make it even harder to take constructive steps forward.
Withdrawal and isolation
When energy is low, withdrawing can feel understandable.
You may cancel plans, stop replying to messages or spend increasing amounts of time alone.
This can provide some immediate relief from the effort involved in interacting with people.
However, over time it may also reduce opportunities for connection and support.
Feeling emotionally numb
Depression does not always involve feeling intensely upset.
Some people describe feeling very little at all.
You might feel detached, disconnected or unable to experience the positive emotions you think you should be feeling.
Why can depression become difficult to break?
Depression often creates self-reinforcing patterns.
Imagine that you wake up feeling exhausted and low.
You decide not to go for the walk you had planned because you do not feel motivated.
You then spend more time at home, perhaps thinking about everything you should be doing.
That leads to more guilt and self-criticism.
You feel worse.
The following day, getting started feels even harder.
None of those decisions are irrational.
They make sense when we understand how you are feeling.
But gradually depression can reduce the very things that normally help provide:
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connection
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enjoyment
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achievement
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routine
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physical activity
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purpose
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confidence
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a sense of progress
At the same time, patterns such as rumination, avoidance and self-criticism can consume increasing amounts of mental energy.
Psychological therapy can help us understand these cycles and identify places where change may be possible.
Rumination: when thinking stops being helpful
People experiencing depression often spend a great deal of time thinking.
You might repeatedly analyse:
Why do I feel like this?
What's wrong with me?
Why can't I just get myself together?
What should I have done differently?
Reflecting on our experiences can be useful.
Rumination is slightly different.
Rather than helping us reach a conclusion or take action, the mind repeatedly circles the same questions without finding an answer.
It can feel as though thinking harder should eventually solve the problem.
Instead, you may finish feeling more stuck than when you started.
Therapy can help you begin noticing when reflection has turned into rumination and develop different ways of responding.
Depression and burnout can sometimes look similar
Depression and burnout can share several features.
Both can involve exhaustion, reduced motivation, difficulty concentrating, withdrawal and feeling less able to cope with everyday demands.
There are also important differences, and sometimes the two overlap.
Burnout is often closely connected with prolonged demands or pressures, particularly around work or caring responsibilities, whereas depression can affect many different areas of life.
You do not need to work out which label fits before seeking help.
Part of psychological assessment involves understanding the broader pattern and what may be contributing to how you feel.
Read: Burnout vs Depression – How Can You Tell the Difference?
How can psychological therapy help with depression?
Therapy is not simply about trying to "think positively".
When you are depressed, being told to focus on the positives can feel both unrealistic and unhelpful.
Psychological therapy instead involves developing a detailed understanding of what has happened and what may currently be keeping you stuck.
We might explore:
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what was happening when your mood began to change
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losses, changes or pressures you have experienced
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changes in your daily routine and activity
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patterns of withdrawal or avoidance
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how you respond to yourself when you are struggling
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expectations or standards you place upon yourself
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difficult thoughts about yourself or your future
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rumination and overthinking
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relationships and sources of support
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sleep, work and other factors affecting your wellbeing
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earlier experiences that may be relevant to current patterns
From there, we can begin identifying practical areas for change.
Sometimes this involves gradually rebuilding activity, connection and routine.
At other times, therapy may focus more strongly on self-criticism, difficult beliefs, unresolved experiences, relationships or patterns that have developed over many years.
The approach depends on the individual.
What happens in depression therapy?
First, we understand what has been happening
The first stage of therapy involves getting a detailed picture of what you have been experiencing.
We can explore when things began to change, what was happening around that time and how low mood is currently affecting different areas of your life.
You do not need to arrive with a clear explanation for why you feel the way you do.
Working this out together is part of therapy.
We develop a shared understanding
Clinical psychologists often refer to this as a psychological formulation.
A formulation brings together your current difficulties, circumstances, experiences, thoughts, emotions and behaviours to understand how the problem may have developed and what is maintaining it now.
Rather than only asking:
"Do you have depression?"
we are also interested in:
"What has contributed to you feeling this way, and what is keeping you stuck?"
We identify where change may be possible
When motivation is low, trying to change everything at once can quickly become overwhelming.
Therapy therefore often involves identifying manageable areas where change is possible.
Small changes in activity, routine, relationships, thinking or behaviour can begin providing experiences that challenge the sense that nothing will make a difference.
We work on the deeper patterns where needed
Sometimes depression is closely linked to longer-standing beliefs.
You may have spent years believing that you need to achieve, please other people or avoid making mistakes in order to feel worthwhile.
You may have become accustomed to responding to yourself with criticism rather than compassion.
Where these patterns are relevant, therapy gives us an opportunity to understand and work with them rather than simply addressing the immediate symptoms.
We work towards maintaining progress
As things begin to improve, we can identify what has made the biggest difference and think about how you can continue using what you have learned beyond therapy.
We can also consider signs that your mood may be beginning to deteriorate again and develop a plan for responding earlier.
My approach to depression therapy
There is no single psychological approach that is right for everyone experiencing depression.
My work is therefore integrative and formulation-led.
Rather than assuming that everyone with depression needs exactly the same therapy programme, we first try to understand your particular circumstances.
Depending on your needs, therapy may draw upon approaches including:
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Cognitive Behavioural Therapy (CBT)
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behavioural activation
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compassion-focused approaches
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mindfulness and acceptance-based approaches
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work focused on self-criticism and perfectionism
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emotional regulation strategies
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psychological approaches that help make sense of earlier experiences and relationship patterns
We will discuss the reasoning behind the approaches we use so that therapy remains collaborative and makes sense to you.
Why work with a Clinical Psychologist?
Clinical Psychologists undertake extensive doctoral-level training in psychological assessment, formulation and psychological therapy.
Their training covers a range of psychological models rather than one single approach.
This can be particularly useful when depression does not fit neatly into one explanation.
For example, someone may be experiencing low mood alongside anxiety,
perfectionism, work stress, difficult relationships or the impact of earlier experiences.
My role is therefore not simply to apply a standard treatment to a diagnosis.
It is to understand the wider psychological picture and work with you to develop an approach that reflects your individual circumstances.
You do not need a diagnosis to ask for help
Some people hesitate to seek therapy because they are unsure whether what they are experiencing "counts" as depression.
You do not need to diagnose yourself before getting in touch.
You might simply recognise that:
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you have not felt like yourself for some time
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things you used to enjoy no longer feel enjoyable
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motivation has disappeared
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you are becoming increasingly withdrawn
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you are much harder on yourself than you used to be
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everyday tasks require far more effort
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you feel stuck and do not know how to change things
An initial consultation gives us an opportunity to think about what you have been experiencing and whether psychological therapy may be appropriate.
Depression therapy face-to-face and online
I offer individual psychological therapy for adults experiencing depression, low mood and related difficulties.
Face-to-face appointments are available on weekday evenings in Bristol and on Saturdays in Cheltenham. Online appointments are also available across the UK.
If you are specifically looking for face-to-face psychological therapy in your area, you can also visit my local therapy pages for further information.
Using private health insurance
I am recognised by a number of private medical insurers, including AXA Health, WPA and Vitality.
If you are hoping to use private medical insurance to fund psychological therapy, your insurer may require you to obtain authorisation before treatment begins.
I have created a separate guide explaining how private health insurance appointments work and the information you may need before booking.
Related depression resources
Burnout vs Depression: How Can You Tell the Difference?
Burnout and depression can both involve exhaustion, withdrawal and reduced motivation.
This guide explores some of the similarities and differences.
Frequently Asked Questions
What is the difference between feeling low and depression?
Periods of low mood are a normal part of life.
Depression tends to be more persistent and can affect several areas of functioning, including motivation, enjoyment, energy, concentration, relationships and the way you think about yourself or the future.
You do not need to decide whether your difficulties meet a particular diagnosis before seeking support.
Do I need a diagnosis before starting therapy?
No.
Psychological therapy can begin by exploring the difficulties you have been experiencing.
Part of the initial assessment involves developing a clearer understanding of what is happening and considering what type of support may be appropriate.
What if I have no motivation to make changes?
This is extremely common in depression.
We do not need to wait until you suddenly feel highly motivated before beginning.
Therapy can help us identify realistic, manageable steps and understand the patterns that may currently be making action particularly difficult.
How many therapy sessions will I need?
There is no fixed number that is appropriate for everyone.
Some people are experiencing a relatively recent episode of depression linked to particular circumstances.
For others, low mood is connected with patterns that have developed over many years.
We can discuss this during assessment and review progress together throughout therapy.
Can I have therapy if I take antidepressant medication?
Yes. Psychological therapy and antidepressant medication are sometimes used alongside one another.
Decisions about medication should be discussed with the healthcare professional responsible for prescribing it.
Psychological therapy can focus on understanding and changing the patterns contributing to your difficulties whether or not medication forms part of your wider treatment.
Can depression therapy take place online?
Yes.
Online psychological therapy can be appropriate for many people experiencing depression and allows me to work with adults throughout the UK.
Whether online or face-to-face therapy is most suitable can be considered during your initial consultation.
Can I use private health insurance?
I am currently recognised by AXA Health, WPA and Vitality.
Insurance policies differ, so you should confirm your individual level of cover and obtain any necessary authorisation from your insurer before beginning treatment.
A note about urgent support
My private practice provides planned psychological therapy and is not an emergency or crisis service.
If you need urgent help with your mental health, please seek urgent support through NHS services.
If you or someone else is in immediate danger, contact the emergency services or attend your nearest Emergency Department.
Thinking about getting support for depression?
When you are feeling low, contacting someone for support can itself feel difficult.
You do not need to know exactly what is wrong or what type of therapy you need before getting in touch.
A free 15-minute consultation gives us an opportunity to briefly discuss what you have been experiencing, answer any initial questions and consider whether arranging a full psychological assessment would be a helpful next step.
Book a Free 15-Minute Consultation
If you are looking for depression therapy, you can view support options in your area or get in touch to arrange an initial consultation.