Depression Therapy
Depression doesn't always look like sadness. For a lot of the people I work with it looks like flatness: the things that used to matter have gone quiet, the day is something to get through, and the energy it takes to act normal is more than anyone around you realizes.
I treat depression with Acceptance and Commitment Therapy (ACT) as the foundation, drawing on Cognitive Behavioral Therapy (CBT) for the thinking patterns and the collapsed daily routine that keep it going. The goal isn't just a lower score on a symptom measure. It's getting your life back to a size worth living in.
What this can look like
- Waking up already tired, with the day ahead feeling like a list of things to survive
- Work, friends, food, sex, the things that used to land, have all gone flat
- Running the workday on autopilot and having nothing left for anyone by 6pm
- Sleeping too much, or lying awake at 4am taking inventory of everything you've failed at
- A running commentary that you're lazy, behind, or quietly letting everyone down
- Pulling back from people, then feeling worse for being alone with it
- Looking fine on paper: still shipping, still showing up, and privately hollow
How I treat it
Acceptance & Commitment Therapy (ACT)
Depression shrinks your world. It starts with skipping the thing you don't have energy for, which is reasonable, and ends with a life narrow enough that there's genuinely not much left to feel good about. Then the mind reads that narrowness as proof of what it was already saying about you.
ACT works on both ends of that. You learn to hold the heavy thoughts (that you're a burden, that it's pointless, that you've wasted years) without either arguing with them or handing them the steering wheel. Alongside that we get specific about what actually matters to you, and start rebuilding toward it in pieces small enough to do on a bad week. ACT has been evaluated in over 500 randomized controlled trials, with depression among the best-supported targets.
The values work tends to be what makes the difference. Waiting to feel motivated before you act is the trap, because with depression the motivation shows up after the movement, not before it.
Cognitive Behavioral Therapy (CBT)
CBT is the most studied psychotherapy for depression, and two pieces of it do a lot of work here. The first is getting your week structured again, deliberately scheduling activity rather than waiting for the energy to arrive, because withdrawal is the engine that keeps depression running.
The second is catching the thinking patterns that feel like observation rather than opinion: all-or-nothing reads on your performance, mind-reading what your colleagues think of you, discounting anything that went well. We test those against evidence instead of taking your mood's word for it. In practice most of my depression work blends ACT and CBT rather than running either one by the book.
What working together looks like
We start with a thorough intake covering how long this has been going on, whether it's a first episode or a pattern you know well, sleep, substance use, and what's already been tried. If this has been with you since childhood rather than arriving after something specific, that changes the plan, and it's worth saying out loud early.
From there we set goals you can actually measure and track them, so you'll know whether the work is doing something instead of guessing. Depression is good at erasing progress from memory, which is exactly why we write it down.
Everything happens over secure telehealth. For depression that's often a real advantage, because the days you least want to leave the house are usually the days worth not missing.
If you're in crisis right now
If you're having thoughts of ending your life, call or text 988 (the Suicide and Crisis Lifeline) or go to your nearest emergency room. If you're in immediate danger, call 911.
My practice is outpatient telehealth, which isn't the right level of care during an active crisis. Thoughts of suicide are common in depression and are something we can work with in ongoing therapy, so please don't screen yourself out of reaching out. But if you need someone right now, use the numbers above rather than waiting for an intro call.
From the blog
Common questions
I'm still functioning. Is it really depression?
It can be. A lot of the people I see are performing well by every external measure and running on empty underneath it. Holding a job together doesn't rule depression out, it just means the cost is being paid somewhere less visible. Whether it meets criteria for a diagnosis is something we sort out at intake, and it matters less than whether it's worth treating.
I've tried therapy for this before and it didn't help.
Worth telling me on the intro call, in detail. What was tried, for how long, and where it stalled genuinely changes what I'd do differently. Sometimes the approach was a poor fit, sometimes the fit with the therapist was, and sometimes it was going somewhere and ended too early. None of those mean therapy can't work for you.
Do you prescribe medication?
No. As a psychologist I provide therapy, not prescriptions. Plenty of people do best with both, and I'm glad to coordinate with your psychiatrist or primary care doctor so the two are actually working together rather than in parallel.
What if I'm having thoughts of suicide?
Say so. Thoughts of death or of not wanting to be here are a common part of depression, and telling me isn't going to get you hospitalized by default. We'd talk openly about what the thoughts are like and build a safety plan as part of treatment. If you're in immediate danger, call or text 988 or go to your nearest emergency room rather than waiting for an appointment.
How long does treatment take?
It depends on whether this is a first episode or a long-running pattern, and on how much happens between sessions. Most people notice something shifting within the first couple of months. We set concrete goals early and measure against them, so you're not relying on your memory of how bad things were.
I don't have the energy to do therapy homework.
Then the homework was set wrong. With depression the first steps are supposed to be almost insultingly small, because the point is building momentum, not proving discipline. If something I assign is too big, that's useful information for me, not a failure on your part.
Flat isn't a permanent setting
If you've been waiting to feel a bit better before doing something about it, that's the depression talking. I offer a free, confidential 15-minute intro call. Telehealth across 40+ states, in English or Spanish.
Written by Dr. Olivier van Hauwermeiren, PsyD. Licensed Clinical Psychologist, NY & WI, PSYPACT