The shower as a whole project
Not because you do not want to be clean. Because the sequence of steps has somehow acquired weight, and you find yourself doing arithmetic about whether it is worth it before eleven in the morning.
Specialties
Depression Therapy Services in Santa Monica, CA
Depression is not always sadness, and it is very often invisible from the outside. It can look like continuing to do every single thing expected of you while pleasure, appetite, concentration, hope, and emotional range quietly withdraw. Sometimes it is heavy and obvious. Sometimes it shows up as irritability, overwork, and the disquieting sense that your own life is happening slightly out of reach.
What It Is Actually Like
When the pattern is costing more than anyone can see
The version I see most often does not miss work. It negotiates with the morning. Getting up involves an internal argument you would be embarrassed to describe out loud. Decisions that used to be automatic — what to eat, which email to answer first — have become strangely expensive. Rest does not restore anything; you sleep and wake up equally depleted, which makes the whole concept of rest seem like a rumor.
So you keep producing, partly because stopping feels dangerous, and then you use your own continued output as evidence that you are not depressed enough to justify treatment. I want to say plainly that functioning and suffering are not opposites, and the bar for deserving help is not total collapse.
Depression can follow loss, chronic stress, trauma, isolation, a hard transition, or years of arranging yourself around what other people need. Sometimes there is no identifiable cause at all, and the search for one becomes another task you are failing at. We can look at context without demanding a tidy origin story.
For some people the loudest feature is self-criticism: every missed task becomes evidence, every achievement gets reclassified as the bare minimum. For others there is no attack, just blankness. Both narrow life until avoidance starts to feel safer than trying one more thing that might not help.
You Might Recognize This
Not a symptom list. A Tuesday.
The friend you keep not texting back
You want to see them. You have wanted to see them for six weeks. The reply sits unwritten and grows heavier the longer it waits, until answering it would require explaining the delay, so you do not.
The good thing that does not land
Something genuinely happened — the promotion, the news, the trip. You watched yourself react appropriately. The feeling that was supposed to accompany it never arrived, and you have told nobody, because how would that sound.
The evening that vanishes
You got home at seven with plans. It is now eleven-forty and you have been scrolling, not enjoying it, not stopping. Tomorrow is going to start with the interest owed on tonight.
What People Bring Me
What usually gets named on the first call
Nobody arrives with a tidy summary. These are the versions I hear most often, and what the work is pointed at once we start.
Common challenges
- Mornings that take an hour longer than they used to
- Interest that has quietly left things you used to want
- Doing the job well and feeling nothing about it
- Sleep that is either too much or gives nothing back
- A running commentary that would be unacceptable aimed at anyone else
- Grief or a life change that never got its own space
What we aim the work at
- Rebuilding contact with what used to matter, in small increments
- Interrupting the loop where less activity makes less possible
- Naming the loss underneath, when there is one
- Treating your own standard the way you would treat a friend's
- Getting sleep and food back into a shape that supports you
- Deciding what you want your next year to contain
Direction, not a promise. Nobody can guarantee where therapy lands, and I will not pretend otherwise.
The Work
What the first month looks like, and the sixth
01
We start with the actual shape of your depression rather than the general category: timing, sleep, energy, appetite, concentration, withdrawal, irritability, loss, and whatever is currently being asked of you. That map tells us what needs practical support this month and what needs longer exploration.
02
Early work usually includes behavioral change, and I will be honest that this part is unglamorous. It is not a walk and a gratitude list. It is finding one or two real points of movement — a single conversation, one boundary, one routine, one task cut down to a size that is possible on a bad day — and then repeating them long enough that action and mood reconnect. Between sessions I will often ask you to track this, because memory during depression is an unreliable narrator.
03
Then we look at what is underneath the shutdown. Depression can turn anger inward. It can preserve a relationship by making your needs disappear. It can be what follows a life carefully built around achievement rather than around anything you actually want. Understanding what it is doing tends to reduce shame considerably, and shame is usually the thing keeping the whole system in place.
04
By the sixth month, if the work is going well, the conversation has typically changed from how to get through the week to what you want the next few years to contain. That is a different and better problem.
05
If hopelessness or thoughts of death are present, I want to know about them. Naming them does not manufacture a crisis; it lets us assess safety and plan properly. This website is not a crisis service. In an immediate crisis, call or text 988 or call 911.
Modalities
Skills and understanding belong together
I integrate DBT, CBT, and psychodynamic or relational work according to the person and the problem—not because every hour needs every acronym.
CBT for the depressive loop
CBT gives us a clear way to see the cycle linking withdrawal, reduced reward, bleak prediction, and further withdrawal. We test thoughts and behaviors carefully and look for credible alternatives rather than cheerful ones, which nobody in a depression believes anyway.
DBT for the lowest stretches
DBT-informed distress tolerance and emotion regulation help when motivation is scarce and shame is loud. These skills are for caring for the hour in front of you when the week is too large a unit to think about.
Psychodynamic work for meaning and loss
Psychodynamic therapy explores grief, anger, identity, early relationships, and the standards you absorbed before you had any say in them. It asks not only how to reduce a symptom but what the depression has been expressing or preventing.
Specifically, for this
- Behavioral activation, planned in specifics rather than intentions
- CBT for the thoughts that present themselves as neutral observations
- Psychodynamic work on grief, transition, and unlived plans
- DBT skills where the low mood turns sharp or self-directed
- Concrete between-session experiments, reviewed honestly
- Regular check-ins on sleep, movement, and daily structure
Closely Related
Where this work often widens
Grief
Grief is not depression, though they share a postcode and are often confused. Grief comes in waves rather than a flat plane, and between waves people are often surprised to find themselves laughing. There is no correct duration for it, and I do not use stage models as a timetable — grief is not a sequence you pass through and complete.
What complicates grief in the people I see is usually one of three things: a relationship that was difficult, so the loss includes the loss of any chance to resolve it; a life that demanded you keep functioning immediately, so the mourning was deferred and is now arriving late and out of context; or grief that nobody around you recognizes as grief — an estrangement, a miscarriage, a diagnosis, a person who is still alive but no longer themselves. We give it the room it did not get the first time.
Life transitions
Transitions bring people to therapy at a rate that surprises them, because on paper nothing is wrong. A move, a promotion, a wedding, a divorce, a new baby, an exit, a birthday with a zero in it. The trouble is that a transition removes the structures you were using to know who you are, and it does so without asking.
The most difficult transitions in my experience are the ones you chose and are supposed to be happy about, because the grief inside them has nowhere legitimate to go. You wanted the job. You wanted the child. You are also, quietly, mourning the version of your life that has now closed. Both are true, and holding both without deciding one is ingratitude is much of the work.
Plainly
What I am honest with you about
Where progress is slow, what therapy will not fix, and what the work asks of you.
- Depression treatment is repetitive before it is transformative. The behavioral part in particular involves doing modest things you do not feel like doing, on days you do not feel like doing them, for longer than seems reasonable, before mood follows action. Nobody enjoys this stage. It is still the stage that works.
- Motivation generally arrives after the change, not before it. Waiting to feel like it is the most common way this stalls, and I will say so directly rather than waiting for you to work it out over three months.
- Therapy will not remove ordinary sadness, disappointment, or grief, nor should it. It also cannot fix circumstances that are genuinely crushing — a job that is unsustainable, a relationship that is not working, a caregiving load with no relief. Sometimes the honest clinical conclusion is that something in your life needs to change, and that is a harder conversation than adjusting a thought record.
- I do not prescribe. For some people medication makes the rest of the work possible, and if I think an evaluation is worth having, I will say so plainly and help you coordinate with a prescriber.
In My Practice
How this shows up for the people I see
Questions
Common questions about depression therapy
What if I am still working and functioning?
You do not need to be unable to function in order to deserve help. High-functioning depression carries a substantial private cost, and getting support earlier tends to prevent further narrowing of your life.
Do you prescribe medication?
No. As a psychologist I do not prescribe. Where a medication evaluation may be useful I will say so and can discuss coordinating with an appropriate medical prescriber.
Is therapy just about changing negative thoughts?
No. Thoughts matter, but so do relationships, grief, physiology, environment, behavior, identity, and meaning. I use CBT tools inside a broader psychodynamic and relational approach rather than treating you as a faulty thought machine.
What if I have thoughts about not wanting to be here?
Tell me directly so we can assess safety and plan appropriate care together. For immediate danger, call or text 988 or call 911. Website messages and email are not monitored around the clock.
A Place To Begin
The first goal is not manufactured happiness. It is making your life reachable again: a little more energy, choice, contact, and honesty, and then a real understanding of what has been keeping you cut off from yourself.
- · Individual therapy, 50 minutes, $300
- · Telehealth anywhere in California, or in person in Santa Monica
- · Free consultation call before anything is scheduled
- · Private pay with superbills for out-of-network reimbursement