Online counselling for depression & low mood

Depression rarely announces itself. For some people it's deep sadness; for many others it's a slow flattening, losing interest in things you used to love, feeling tired no matter how much you sleep, or going through the motions while feeling strangely numb. However it shows up for you, it's not laziness and it's not a character flaw. It's something we can work through together.

Depression counselling is a form of talk therapy, which simply means the treatment works through structured conversation rather than medication. Talk therapy for depression is recommended in major clinical guidelines as a first-line treatment, used on its own or alongside medication where that is appropriate for you.

How I help with depression

As an integrative therapist I'm trained in a broad range of modalities and choose what fits you. For this work I most often draw on Cognitive Behavioural Therapy (CBT), behavioural activation and mindfulness-based techniques (MBCT). Depression has a way of shrinking your world and convincing you nothing will help. Gently, at a pace that feels manageable, we start to widen that world back out.

What depression can look like

It also has forms tied to particular moments in life. Depression during pregnancy and in the months after birth is common, frequently missed, and often dismissed as tiredness by everyone including the person experiencing it.

You might recognise some of these: waking up already exhausted, dreading ordinary tasks, withdrawing from people, comfort-eating or losing your appetite, feeling irritable or tearful for no clear reason, or a quiet sense that things will never really change. If any of that sounds familiar, counselling can help, you don't need to hit rock bottom to deserve support.

Depression lies. It tells you that reaching out is pointless, which is exactly why reaching out is such a brave and important first step.

Why action comes before motivation

The instruction depression gives you is to wait until you feel like it. That instruction is the illness, and following it is what keeps it in place.

What happens in depression is that activity drops, which removes the sources of reward and contact that ordinarily maintain mood, which lowers mood further, which reduces activity again. It is a spiral with its own momentum, and it does not reverse by waiting.

Behavioural activation works by inverting the order: you do the thing first, at a size small enough to be possible on a bad day, and the feeling follows some way behind. Not immediately, which is why people abandon it early, but reliably. It is one of the most robustly evidenced treatments there is, and one of the least glamorous, and it works particularly well for people who find talking about feelings difficult.

What the first six weeks look like

Early sessions are mostly about getting a clear picture: how long this has been going on, what it has cost you, what your sleep and eating are doing, and whether there is anything in the current situation that would make anyone feel like this.

From there we set up something to change between sessions, usually small and specific rather than ambitious. Getting outside once a day. Answering one message. Eating breakfast. The size is deliberate, because depression makes ordinary targets impossible and then uses the failure as evidence.

Somewhere around week four or five most people notice something, and it is rarely feeling happy. It is usually a slightly shorter recovery after a bad day, or an hour in the afternoon that was not awful. That is the actual shape of improvement in depression, and knowing to expect it stops people concluding that nothing is working.

Depression, burnout, or grief

These overlap enough to be confused and differ enough to matter.

Burnout is tied to sustained demand, usually work, and tends to lift on genuine removal from the source, at least partly. Depression does not lift when the circumstances improve, and it colours everything rather than one domain of life. Grief has waves and is attached to a person or a loss; depression is flatter and more global, and tends to bring worthlessness rather than sadness.

The distinction is worth making because the treatments diverge. Time off helps burnout and does very little for depression. If you are not sure which you are dealing with, that is a reasonable thing to bring to a first session rather than something to work out beforehand.

When it does not lift

Some depression does not respond to a first course of therapy, and I would rather say that here than have you conclude the failure is yours.

Where that happens, the useful next steps are practical. A medical review to rule out the physical contributors that mimic depression, including thyroid function, anaemia and vitamin D. A conversation about medication if that has not been considered, which sits with a GP or psychiatrist rather than with me. A change of method, since mindfulness-based cognitive therapy, linked above, was developed specifically for recurrent depression and works for people whom standard CBT does not reach. And sometimes a change of therapist, which is a legitimate outcome rather than a failure of the work.

Sessions that meet you where you are

All sessions are online or by phone, across time zones, starting with a free 15-minute consultation. On the hard days you can attend from your bed, in comfortable clothes, with the camera off if you'd rather. We go at your pace, in whichever way feels most comfortable for you.