Jonathan Keigher, PhD | INTEGRATIVE Relational Psychotherapy for DEPRESSION

Depression Treatment in New York

Sometimes depression feels less like sadness and more like losing access to yourself.

There are times when depression is unmistakable. Getting out of bed feels difficult. Your energy disappears. Things you once enjoyed no longer interest you. Even ordinary responsibilities begin to feel overwhelming.

But depression isn't always so obvious. You may continue going to work, caring for your family, maintaining relationships, and doing everything you're supposed to do.

From the outside, your life may look relatively unchanged.

Inside, something feels different.  

You're going through the motions. You have less patience. Less interest. Less capacity to enjoy things. 

You may feel sad, irritable, empty, or simply disconnected.

Sometimes people describe it as feeling like they're watching themselves live rather than actually participating in their lives.

And often, alongside the depression, another feeling begins to develop.

Frustration with yourself for not being able to feel differently.

Depression can make even ordinary things feel difficult.

One of the more painful aspects of depression is how much effort it can take to do things that once seemed relatively simple.

Returning a phone call. Making plans. Getting through a workday. Taking care of something you've been putting off. Being present with the people you love.

You may know what needs to be done. You may even want to do it. But wanting to do something and being able to find the energy to do it can feel like two entirely different things.

Over time, responsibilities accumulate. Relationships receive less attention. Activities that once provided satisfaction gradually disappear. Your world can become smaller without your necessarily realizing it's happening.

And as these difficulties increase, you may begin drawing conclusions about yourself. Maybe I'm lazy. Maybe I'm not trying hard enough. Maybe I've become someone I don't particularly like.

Depression has a way of making its own symptoms feel like personal failures. That's something we need to understand, because the way you respond to being depressed can sometimes become part of what keeps you there.

When feeling bad becomes another reason to criticize yourself.

Some people experience depression with a particularly harsh internal voice. It's the voice that notices everything you haven't accomplished. That compares you to other people. That reminds you of mistakes you've made, opportunities you've missed, or ways you believe you've fallen short.

Even when you accomplish something, the satisfaction doesn't last very long. There is always something else you should have done.

You may recognize how unforgiving this voice is. You might never speak to someone you care about in the same way. Yet when it comes to yourself, the criticism can feel strangely necessary.

Perhaps being hard on yourself has always been how you've stayed motivated. Maybe you learned that mistakes were costly, that approval needed to be earned, or that your value depended on how well you performed. Sometimes criticizing yourself first even feels safer than risking criticism from someone else.

Whatever its history, self-criticism can become so familiar that you stop recognizing it as something you're doing. It simply feels like the truth.



Therapy gives us an opportunity to become curious about that voice. Where it came from, what it expects of you, and why it has become so difficult to experience yourself with anything other than disappointment.

We're not trying to eliminate responsibility or ambition. We're trying to understand why those things have come to require so much self-punishment.

Depression often has a history. But not always an obvious one.

People sometimes come to therapy wondering why they're depressed when nothing particularly terrible has happened. They have a job. A relationship. A family. A life that, by most reasonable measures, should feel satisfying. And yet it doesn't.



Depression doesn't always announce itself after a recognizable loss or crisis. Sometimes it develops gradually, in the context of experiences that are difficult to identify as painful while you're living through them.

Years spent putting other people's needs ahead of your own. Feeling responsible for keeping everyone else okay. Working hard to meet expectations that never seem to end. Remaining in relationships where you feel increasingly unseen. Learning to minimize disappointment because expressing it never seemed particularly useful. Or simply becoming so accustomed to doing what needs to be done that you've lost touch with what you actually want.

None of this means that depression is always caused by earlier experiences or unresolved emotional conflict. Biology, temperament, medical conditions, sleep, stress, and other factors can also play important roles.

But our emotional lives develop within relationships and experiences. It would be unusual if those things had nothing to tell us about how we feel today.

I want to understand the circumstances in which your depression developed, rather than assume that having similar symptoms means having the same problem as someone else.

Sometimes we end up talking about things you never really had the chance to feel.

Loss is an important part of many people's experience of depression. Sometimes the loss is obvious. Someone dies. A relationship ends. A marriage changes. A career doesn't work out as expected.



Other losses are harder to recognize. The relationship you wished you'd had with a parent. The childhood in which you had to become responsible too early. The support you needed during a difficult period but didn't receive. A part of yourself you gradually put aside to maintain a relationship. The life you imagined you'd be living by now.

People can carry these disappointments for years without necessarily thinking of themselves as grieving. You may have explained them away. Accepted that things were the way they were. Told yourself other people had it worse. Or simply continued moving forward because there wasn't much opportunity to do anything else.

But understanding something intellectually doesn't always mean we've had the chance to experience what it meant to us emotionally. Sometimes what looks like emptiness begins to make more sense when we understand what has been missing.

Depression changes the way we relate to other people.

You may want to be around people and still find yourself avoiding them. A friend reaches out, and you don't respond. Your partner asks what's wrong, and you say you're tired. Someone invites you somewhere, and the idea of making conversation feels exhausting.

You may worry about becoming a burden. Or perhaps you're frustrated that the people around you don't seem to recognize how much you're struggling.

Sometimes you withdraw because you don't have the energy for connection. Other times, withdrawal carries feelings that are more difficult to acknowledge. Disappointment. Anger. Resentment. A sense that you're always available to others but rarely feel understood yourself.

Relationships can become another place where depression quietly takes hold. And because relationships are such an important part of our emotional lives, they're also an important part of treatment.

We may explore how you communicate your needs, what happens when you feel disappointed, whether you allow yourself to depend on others, and what you've come to expect from the people closest to you.

These patterns may also appear in therapy. You might worry about disappointing me, feel pressure to show improvement, or hesitate to tell me when something I've said doesn't feel right.

I'd rather we talk about those moments. They give us an opportunity to understand how you experience relationships while developing new ways of being in them.

Understanding depression is part of treating it.

By the time someone comes to therapy, depression has often begun affecting several areas of life at once. You have less energy, so you do less. Because you're doing less, you feel increasingly disconnected from things that once mattered. Responsibilities become harder to manage. You become frustrated with yourself. That frustration deepens the depression, making it even more difficult to get started. And the cycle continues.

Sometimes longstanding emotional patterns, difficult relationships, or unresolved experiences contribute to that cycle. Other times, the depression itself has changed the way you're thinking, feeling, and functioning. Usually, there is more than one thing happening.

This is why I believe effective depression treatment needs to address both the symptoms and the person experiencing them.

Of course, we want you to feel better. To have more energy. To return to activities and relationships that have become difficult. To manage everyday responsibilities without everything requiring so much effort. Those are essential goals of treatment.

But I also want us to understand what has been happening beneath the symptoms. What you've been carrying, how you've come to relate to yourself, and whether there are patterns in your life that deserve attention.

My approach integrates relational psychodynamic psychotherapy with evidence-based treatment, tailored to your particular needs. We'll explore the emotional and relational experiences that may contribute to your depression while also addressing what may be maintaining it in the present.

That might involve reducing withdrawal and avoidance, gradually rebuilding meaningful activity, examining unhelpful thinking patterns, strengthening emotional regulation, or finding more effective ways to communicate your needs.

Sometimes we'll spend time understanding a relationship that's been troubling you for years. Other times, we'll focus on what might help you get through a particularly difficult week. Both belong in treatment.

And if additional support, such as a psychiatric evaluation or medication consultation, could be helpful, we can discuss that as part of your care.

The work is collaborative. We want to relieve the symptoms that brought you to therapy while developing a fuller understanding of the experiences and patterns that may be contributing to them.

Depression doesn't always look the way people expect.

You don't need to experience all of these, and you don't need to feel sad all the time, for depression to be affecting your life.

Sometimes depression also occurs alongside anxiety, trauma, relationship difficulties, or other concerns.

Treatment begins with understanding your particular experience rather than trying to fit you into a predetermined explanation.

What begins to change?

I think people sometimes imagine recovering from depression as waking up one morning and suddenly feeling like themselves again. Occasionally, change is noticeable. More often, it happens gradually.

Getting out of bed doesn't feel quite so difficult. You return a friend's call. Something you've been avoiding becomes manageable. You enjoy a conversation without having to work so hard at being present. You make a mistake and don't spend the next three days criticizing yourself for it. You begin looking forward to things again.

These may sound like ordinary experiences, but when you've been depressed, they matter.

And as the depression begins to lift, something else can happen. You may start recognizing that there are parts of your life you don't necessarily want to return to. Perhaps you've been carrying too much. Expecting too much of yourself. Remaining in relationships that leave little room for your needs. Or living according to expectations that no longer feel like your own.

There is room in therapy to explore those things, too. Not because every aspect of your life needs to change, but because feeling better sometimes allows you to recognize what hasn't been working.

You Don't Have to Feel Better Before Beginning Therapy.

People sometimes put off seeking help because they don't know how to explain what's wrong. They aren't sure whether what they're experiencing is really depression. They worry that their problems aren't serious enough, or that they should be able to figure things out on their own.



You don't need to arrive with an explanation. We can begin with what your days feel like, what's become difficult, and what you miss about yourself.