On the surface, therapy with me will be and feel like a caring, improvised conversation guided by the goal of your well-being.

In addition to its neurochemical manifestations, depression operates metaphorically like a colonizer—it places itself over you, uses your resources to perpetuate itself, and tries to pull a particularly sinister trick: making you believe that its messages of your inferiority are right, its presence is legitimate, and that there is no other option than to live beneath it. True to its name, it “presses down” on people, and many clients describe living with depression in phrases like “feeling trapped,” “being smothered,” or “living under a weight.” Anyone who’s lived with depression also knows how taxing it is—it doesn’t just smother, it also extracts from you. It saps your energy and occupies your cognitive space; it structures your perception and displaces positive images, memories, sensations, and vocabularies, relegating them to a censored and marginal realm. It limits your range of activity, feeling, and mood. In its fullest manifestation, it convinces you of its veracity. Your inferiority becomes felt by you as a truth, which infuses daily life with an agony both blunt and searing. In this severest form, when depression’s insistence upon your worthlessness starts to transform into the feeling of fact, there are three basic paths: escaping depression through rebelling against it; accepting depression and adjusting to its rhythms; or exiting depression through suicide, the only domain of “agency” that depression leaves accessible to the imagination.

How could therapy help in such a sticky, pervasive, and suffocating situation?

Depression transforms the territory of the psyche by placing upon it a design for the flow of feelings, the direction of thought, the experience of sensation, the objects of attention, and the daily patterns of behavior and activity. An important therapeutic process is helping a client see this design in its entirety, and since therapists have the perspectival privilege of being outside of your system, we’re not susceptible to its attempts to convince you that there is no outside. So in the beginning of working with someone experiencing depression, I tend to spend a while simply pointing out the patterns of the design as I see them emerge. Even for a client who already has an intellectual ability to identify and narrate the design, it’s important to hear it perceived and described by someone completely outside of its influence, someone who sees and feels it for what it is and volunteers to walk through it with you. Together, we became cartographers of depression’s presence in your life. This adds a kind of buffer between the client and the symptoms—you could think of it as a second layer of gesso that gives you some distance, or as a crowbar that pries you away. Any metaphor of distancing, peeling off, and of gaining perspective works here, as the end goal of this stage is to figure out where depression ends and you begin. When this distancing successfully occurs, what was once felt as familiar becomes foreign, what was once believed as truth is shown to be ideology, and the self-negating thoughts that came cloaked in your own voice are revealed to have the cadence of the colonizer.

The depression will resist these efforts to see it for what it is. This resistance is very creative, as it’s depression’s mechanism for staying entrenched and alive. But some of its more common forms are 1) preventing the client from trusting or respecting the therapist, so that the therapist’s description of the depression design is not truly heard and reckoned with; 2) avoiding exposure to the therapist, which manifests in things like lateness or leaving early, cancellations, or ending the relationship; 3) creating crises that absorb therapeutic attention; and 4) insisting on the hopelessness of therapy—I see this as a display of depression’s aggression, as it digs its heels in to mock therapy, to score points against the therapist, and to frustrate the exercise of healing. Depression-as-troll, sacrificing you in the process.

Depression’s resistance is a good sign because it’s evidence of depression shifting and responding to an external force, but it also typically comes in a concentrated dose of depression’s energy. It is a form of retaliation. Especially in early stages of healing, its concentrated power can throw a person back into the depressive design, as though being hunted and apprehended. This stage of therapy is often characterized by us pulling you out of the design—or, more gently, showing you other ways of being—only to have it pull you back in, and then we pull you back out, and so on. Over time you accumulate more and more experience of life outside the design, along with more and more ability to imagine it. It may take a while, but over time life outside the design will become more familiar, more comfortable, with the hope of it eventually becoming pleasurable and desirable, more rewarding in itself. Sometimes I like to think of the goal of this stage of treatment as a reawakening to—or in some tragic cases experiencing for the first time—the pleasure, or delight, of life lived outside of depression’s design.

This delight is important because it becomes an answer to the resistant depressive question of “why?” Why try to change, when it’s so slow and hard? Why explore different ways of thinking, when there’s so much evidence to support my depressive perspective? Why maintain optimism when I just got punched yet again by depression? Why do the awkward, vulnerable work of stepping outside of the design just to stumble around in a new, unscripted albeit un-depressed way of being? Why keep showing up to therapy?

There always has to be a motivator, a reason. In the beginning, when someone is seeking or starting treatment for depression, the motivation is often to be “free from” something—free from the fear of suicide, free from the suffering of living a dulled and diminished life. These are beautiful motivators, because embedded in them are flickering signs of a real and healthy you, and we use them so long as they’re relevant and effective. But eventually, once you get enough experience outside the depressive design, these motivators begin to feel a bit obsolete, a bit impotent. If we never replaced them with new ones, we’d leave you stuck at the tug-of-war stage, pulled in and pulled out. Some depression-free days, some depressed days, on and on.

This is a risky stage, because tug-of-war is tiring, and so the “why do this?” question reasserts itself. Having planned for this moment, depression says something like “let’s stop fighting, you look tired…I’m sorry. Come home to me.” It offers you a deal, a kind of Pax Romana: submit to it and enjoy a bit of peace, and maybe even you’ll be allowed some good days now and then.

The desire to be “free from” depression is no longer sufficient at this stage, because depression is actively trying to seduce you back into itself. It cuts deals and offers menacing compromises so that it can stick around. We have to have a more powerful counter-seduction, one that draws you in the other direction. This is delight. It’s not just “freedom from” depression, but is also “freedom to” create and enjoy a life of your own design, a life that has rewards within it. It’s this delight that will keep you going through the awkward early stages of dismantling or reappropriating the remnants of the depressive regime—the way it shaped your behaviors, your feelings, your thinking, your language, your sense of self, your imagination, and your relationships. This will take time, and an awakening to the delight of life outside of this design will keep us going.

Eventually, you’ll be far away enough from the depression design that its attempts at seduction look absurd. At this point, depression’s tricks are obvious and its viciousness repulsive. A period of mourning for time lost to the depressive regime often emerges—a difficult stage but again a good sign, as the sadness has within it a condemnation of the depressive worldview. It shows how far you’ve distanced yourself, because thanks to delight, you’ve developed a new aesthetic system—one that is no longer susceptible to depression’s suffocating “comforts,” and instead intuitively feels them to be repugnant. At this point, a potential for lasting change has emerged. Depression loses its magnetism and becomes a relic of your history. You have a new aesthetic system, forward-looking and rooted in your own worth and the delight of the delicious, which is drawn to new horizons. At such a stage, with depression in remission, therapy takes on a new direction, a new tone, and centers new questions. We go from “how do I escape?” to “now that I have, who am I and what do I want to do?”