Affective Disorders

Visual representation of affective disorders

Mood disorders are among the most common reasons people seek therapy, yet they’re often misunderstood—reduced to “chemical imbalances” that need only medication to correct. While medication can be profoundly helpful, it doesn’t address the meaning of your depression, the patterns that maintain it, or the relational and intrapsychic dynamics that gave rise to it.

I approach mood disorders from a psychodynamic perspective, attending not just to symptoms but to the whole person: your history, your relationships, your internal world, and what your mood symptoms might be expressing about conflicts and needs that haven’t found other outlets.

Understanding Mood Disorders

Affective disorders—conditions that primarily affect mood and emotional regulation—involve far more than feeling sad or having mood swings. They represent fundamental disruptions in how you experience yourself, others, and the future.

Depression can feel like being trapped under a heavy weight, cut off from pleasure, meaning, and connection. Everything requires enormous effort. The future looks bleak or nonexistent. You may feel worthless, guilty, or like a burden to others. These aren’t just “negative thoughts” to be corrected—they often reflect deep-seated beliefs about yourself and your place in the world.

Bipolar disorder involves cycling between different states of self—sometimes energized, expansive, and confident; other times depleted, hopeless, and withdrawn. These shifts can feel disorienting, making it hard to know who you “really” are or to maintain stable relationships and goals.

From a psychodynamic perspective, mood symptoms often serve functions: depression may represent anger turned inward, unmetabolized grief, or an internal relationship with a harsh, critical object. Understanding these dynamics doesn’t replace other treatments but deepens and consolidates gains.

Common Symptoms

Persistent sadness or emptiness
Loss of interest or pleasure
Changes in sleep and appetite
Fatigue and low energy
Difficulty concentrating
Feelings of worthlessness or guilt
Thoughts of death or suicide
Irritability or agitation
Episodes of elevated mood or energy

Conditions I Treat

I provide psychotherapy for the full spectrum of mood disorders.

Major Depressive Disorder

Characterized by persistent depressed mood, loss of interest, and other symptoms that significantly impair functioning. Depression can occur as a single episode or recur throughout life. While antidepressants help many people, therapy addresses the underlying patterns that contribute to depression and helps prevent relapse.

Persistent Depressive Disorder

Also called dysthymia, this involves chronic, low-grade depression lasting two years or more. Because it’s less acute than major depression, it often goes untreated—people assume this is “just how they are.” But chronic depression is treatable, and you don’t have to live with a constant undercurrent of unhappiness.

Bipolar I Disorder

Involves manic episodes—periods of abnormally elevated mood, energy, and activity that can include grandiosity, decreased need for sleep, racing thoughts, and risky behavior. Manic episodes often alternate with depressive episodes. Medication is typically essential, and psychotherapy helps manage the condition and its impact on identity and relationships.

Bipolar II Disorder

Characterized by hypomanic episodes (less severe than full mania) and depressive episodes. Bipolar II is frequently misdiagnosed as unipolar depression because hypomanic episodes may feel good and go unreported. Accurate diagnosis is crucial because treatment differs significantly from unipolar depression.

Cyclothymia

A milder but chronic form of bipolar disorder involving frequent mood swings between hypomanic and depressive symptoms that don’t meet full criteria for either. Despite being “milder,” cyclothymia can significantly impair quality of life and relationships. It often goes undiagnosed for years.

Treatment-Resistant Depression

When depression hasn’t responded to multiple medication trials, the issue may be misdiagnosis (bipolar spectrum, personality factors, trauma) or the need for psychotherapy that addresses underlying dynamics rather than just symptoms. I specialize in these complex cases where standard treatments have failed.

A Psychodynamic Understanding of Depression

From a psychodynamic perspective, depression is rarely just a brain chemistry problem. It often involves:

Aggression Turned Inward

Freud observed that depression often involves anger toward a loved one that gets redirected toward the self. When we can’t express anger at someone we also love and need, we may turn it inward, attacking ourselves with the criticism and hostility we can’t direct outward.

Loss and Mourning

Depression frequently follows loss—not just death, but any significant loss: relationships, health, identity, opportunities, illusions. When mourning becomes stuck or complicated, depression can take its place. Therapy helps complete the mourning process.

Internal Object Relations

We internalize our early relationships, and these internal “objects” continue to influence how we experience ourselves. Depression may reflect an internal relationship with a critical, abandoning, or disappointed figure whose voice becomes our own self-talk.

Narcissistic Vulnerability

Some depression relates to fragile self-esteem that depends heavily on external validation. When life inevitably delivers disappointments and failures, the crash can be severe. Therapy helps develop more stable, internally-sourced self-worth.

“The shadow of the object fell upon the ego.”

— Sigmund Freud, on how lost relationships become internalized in depression

Treatment Approach

My approach to mood disorders integrates symptom management with deeper exploration of meaning and pattern.

Assessment and Stabilization

We begin with a thorough assessment of your symptoms, history, and current life situation. If you’re in acute distress, we focus first on safety and stabilization. This may include coordination with a psychiatrist if medication is indicated or adjustment is needed.

Understanding Your Depression

We explore what your mood symptoms mean in the context of your life. When did this begin? What was happening? What losses, conflicts, or changes preceded it? What function might the depression serve? This isn’t about blaming yourself but about understanding.

Working with Patterns

We identify the relational and intrapsychic patterns that maintain your depression: how you relate to yourself, what you expect from others, how you handle anger and loss, what you believe you deserve. These patterns often play out in the therapy relationship itself, providing live material to work with.

Building New Capacities

As old patterns become conscious and less automatic, new possibilities emerge. You develop greater capacity to tolerate difficult feelings, to express anger appropriately, to mourn losses, and to maintain self-esteem in the face of life’s inevitable disappointments.

Treating Bipolar Disorder

Bipolar disorder presents unique challenges. The cycling between states can feel disorienting—which version of yourself is “real”? Relationships may have been damaged during episodes. You may grieve the hypomanic productivity and confidence even while recognizing the costs.

Psychotherapy for bipolar disorder focuses on:

Understanding your cycles: Identifying triggers, early warning signs, and patterns that precede episodes
Medication collaboration: Supporting adherence and communication with your psychiatrist
Identity integration: Developing a coherent sense of self that includes but isn’t defined by the illness
Relationship repair: Addressing damage from past episodes and building more stable connections
Meaning-making: Understanding what the illness means to you and how to live well with it
Preventing relapse: Developing strategies and self-awareness to catch episodes early

Important for Bipolar

Medication is usually essential
Therapy complements, doesn’t replace, medication
Sleep regulation is critical
Stress management prevents episodes
Recovery is absolutely possible
Many people thrive with proper treatment

Collaboration with Medication Management

As a psychotherapist, I don’t prescribe medication, but I recognize its value for many people with mood disorders. For depression, antidepressants can provide relief that makes deeper therapeutic work possible. For bipolar disorder, mood stabilizers are typically essential for safety and stability.

I work collaboratively with psychiatrists and other prescribers to ensure coordinated care. This includes:

Helping you communicate effectively with your prescriber about symptoms and side effects
Supporting informed decision-making about medication options
Addressing ambivalence or resistance to medication when it’s clinically indicated
Monitoring for signs that medication adjustment may be needed
Coordinating care so that psychotherapy and medication management work together

If you need a psychiatrist referral, I can connect you with colleagues who share a thoughtful, collaborative approach to medication management.

When to Seek Help

You might benefit from specialized treatment for mood disorders if:

Depression or mood swings significantly impair your work, relationships, or quality of life
You’ve tried medication but still struggle
You want to understand why you get depressed, not just manage symptoms
You’ve been diagnosed with bipolar disorder and need therapy support
You suspect bipolar but haven’t been properly evaluated
Depression keeps coming back despite treatment
You have thoughts of suicide or self-harm
You’re tired of just coping and want real change

Crisis Resources

If you’re having thoughts of suicide, please reach out immediately:

988 Suicide & Crisis Lifeline: Call or text 988
Crisis Text Line: Text HOME to 741741
Emergency: Call 911 or go to your nearest ER

You don’t have to face this alone. Help is available.

Common Questions

Do I need medication, or can therapy alone help my depression?

It depends on the severity and nature of your depression. For mild to moderate depression, therapy alone is often effective. For more severe depression, combining medication with therapy typically works better than either alone. We’ll discuss your specific situation and help you make an informed decision.

How is psychodynamic therapy different from CBT for depression?

CBT focuses on identifying and changing negative thought patterns. Psychodynamic therapy goes deeper, exploring the origins of those patterns, the unconscious dynamics that maintain them, and the relational experiences that shaped your internal world. Both approaches have evidence for depression; psychodynamic therapy may be particularly helpful for chronic or recurring depression and for understanding why depression develops.

How long does treatment for depression take?

This varies considerably. Some people see significant improvement in a few months; others benefit from longer-term work, especially if depression is chronic or recurrent, or if there are underlying personality or relational patterns to address. We’ll regularly review progress and adjust the plan as needed.

I think I might have bipolar disorder but I’ve only been diagnosed with depression. Can you help?

Yes. Bipolar II in particular is frequently misdiagnosed as unipolar depression. If you suspect bipolar features, a thorough evaluation can clarify the diagnosis. Getting this right matters because treatment approaches differ significantly.

Can therapy really help with a “biological” illness like bipolar disorder?

Absolutely. While bipolar disorder has significant biological components and usually requires medication, psychotherapy provides essential benefits that medication cannot: understanding triggers, managing stress, processing the impact of the illness on identity and relationships, supporting medication adherence, and building a meaningful life with the condition.