Understanding Depression: How therapy can help
What is Depression? A Psychodynamic View
Depression is one of the most common reasons people seek counselling, therapy, or psychotherapy. While the term is often used to describe sadness or low mood, clinical depression goes far beyond this. It can involve a deep, persistent emotional pain, numbness, and self-criticism that can make daily life feel unmanageable.
From a psychodynamic therapy perspective, depression is not simply a chemical imbalance or a reaction to external events. It is an emotional state rooted in our ‘inner world’ made up from the relationships, losses, and experiences that shape how we see ourselves. Exploring these patterns in therapy can help us understand why depression takes hold and how we might begin to move through it.
What Does Depression Look Like?
Those struggling with depression often describe feeling empty, flat, or detached from life. They may find it difficult to think clearly, make decisions, or engage in daily activities. A harsh inner critic can dominate, telling them they are worthless or undeserving. Even small tasks like eating, washing, or getting out of bed can feel overwhelming.
Depression can also make it hard to accept care or kindness. In therapy, this might appear as rejecting positive feedback or minimising achievements. Many people describe feeling stuck , caught in waves of hopelessness and unable to move forward.
Understanding Depression: A Psychodynamic Perspective
Sigmund Freud (1917) proposed that depression (or melancholia, as he called it) can follow not only a literal loss but also an internal one, when our self-worth has been damaged. We may turn anger and grief inward, blaming ourselves as a way to manage painful emotions.
Melanie Klein (1940) expanded on this, showing how early relationships shape our emotional world. She saw depression as a state we unconsciously enter when reality and conflicting emotions become too much to bear. Turning our difficult feelings inward protects others but can come at a great personal cost.
How Can Counselling Help with Depression?
In psychodynamic counselling and psychotherapy, the goal is not to “cheer up” the person or challenge their beliefs directly. Instead, therapy provides a safe and reflective space to explore what self-criticism might represent, whose voice it echoes, and what losses it protects against. Together, client and therapist can uncover the emotional roots of depression, helping the person reclaim disowned parts of themselves and develop a stronger, more compassionate sense of self.
Research supports this depth of work: the Tavistock Adult Depression Study (Fonagy et al., 2015) found that long-term psychodynamic therapy significantly reduces symptoms of chronic depression, with many clients continuing to improve even after therapy ends.
If you are struggling with depression and would like to explore how counselling, therapy, or psychotherapy could help, please get in touch to find out more about working together.
