Max Bird-Ridnell
on depression.

Depression can be what happens when feelings get turned inward. Anger, grief, or disappointment that has nowhere to go ends up as heaviness, numbness, or self-criticism. It looks like a lack of feeling, but underneath there’s often a lot. As Freud is often quoted: “Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”

I don’t diagnose from a distance, and I don’t treat it as a defect in you. I look at what feelings have been avoided and what that avoidance costs. If you’re in a dark place right now and thinking of harming yourself, please call 911 before anything else.

The focus on feelings is central because it is the avoidance of the emotional life that has led to psychological difficulties in the first place, whether the issues be anxiety, depression, addiction, a history of self-sabotage, problems with intimacy. The list goes on.

ISTDP invites the client to face previously avoided emotions in order to gain access to the dynamic unconscious where the sources of their difficulties can be identified, processed and resolved.

Part of it is designed specifically for people who have been stuck in long-term therapies that haven’t worked. So it’s a very direct and active form of therapy, where both the therapist and the client are working hard.

They’re often the center of it. Grief that was never fully felt, anger that felt too dangerous to show: they don’t go away, they go inward. That’s when people say they feel flat, tired, or stuck.

In therapy we make room for those feelings, at a pace you can handle. When a feeling is finally felt, the heaviness often changes. I can’t guarantee how, or how fast. But it’s why I pay such close attention to what you’re feeling in the room, rather than just talking about your week.

We meet for up to two hours, though it often runs closer to an hour and a half, and then I scale down the fee. I’ll ask what brought you in and what you want to change, and I’ll pay attention to how you’re feeling as we talk.

You don’t have to perform or be upbeat. Low is fine. By the end of the session you’ll know whether this is for you, and you’ll probably have learned something about yourself. If it isn’t a fit, we part ways, and you owe nothing further.

Yes. I’m a therapist, not a medical doctor, so I won’t tell you to start, stop, or change a medication. That’s a decision for you and the prescriber.

If you want to change your dose, talk to your prescriber first. Medication and therapy can do different jobs, and they can work together. If you tell me what you’re taking, I can keep that in mind, and I’m happy to coordinate with your doctor if you’d like me to.

If you’re in danger of harming yourself, or you can’t get through the day, you need more support than weekly therapy. Call 911 now, or go to an emergency room. That comes first.

Some people need a higher level of care, or longer than six months, and I’ll say so honestly after the first session or two. In that case I’d refer you to the right level of support. I’m not going to take your money for something I don’t think will help. If you’re not sure, the free 20-minute call is a good place to ask.

Often it begins with small changes: you feel a feeling instead of going numb, you’re a bit more honest with yourself, you have a little more energy. Then the heaviness starts to shift as the avoided feelings are worked through.

I can’t guarantee any outcome, and depression doesn’t lift on a schedule. We meet weekly, up to 26 sessions, about six months. Early on, we’ll both have a sense of whether it’s working. If it isn’t, I’ll tell you, and we can talk about a referral or a different plan.