Depression Therapy in NYC:
A Psychodynamic Approach

Depression is one of the most common reasons people seek therapy, and one of the most misunderstood. We speak of depression as if it were a single, uniform condition—a broken thing to be fixed, a chemical imbalance to be corrected, a symptom to be eliminated. But anyone who has been depressed knows that this picture is incomplete. Depression is not one thing. It takes many forms, serves many purposes, and means something different for each person who experiences it.

At Dr. Kull & Associates, we practice psychodynamic therapy for depression—an approach that takes seriously both the suffering of depression and its meaning. This is not therapy aimed at quick symptom relief (though relief often comes). It is work oriented toward understanding why you are depressed, what the depression might be protecting you from, and how you might live differently.

What Depression Is Not

Before we can talk about what depression is, it helps to clear away some common misconceptions.

Depression is not simply sadness. Sadness is a feeling that comes and goes, usually in response to loss or disappointment. Depression is a more pervasive state—a way of being in the world characterized by flatness, heaviness, a sense that nothing matters or can change. Many depressed people do not feel sad so much as numb, empty, or dead inside.

Depression is not simply a chemical imbalance. The "chemical imbalance" theory—while widely circulated—has never been proven, and the evidence for it is weak. Antidepressants can be helpful for some people, but they do not "fix" depression the way insulin treats diabetes. Depression is a psychological condition with biological correlates, not a purely biological disease.

Depression is not weakness or personal failure. People who are depressed often feel that they should be able to simply "snap out of it" or "think more positively." But depression is not a failure of will. It is a complex psychological state that develops for reasons, and those reasons require understanding.

The Psychodynamic View of Depression

Psychodynamic therapy begins with a simple but radical premise: depression is not a malfunction but a communication. It is the psyche's way of signaling that something is wrong—not with your brain chemistry, but with how you are living, what you are avoiding, what you cannot allow yourself to feel or know.

Freud's early work on depression (which he called melancholia) described it as "anger turned inward." When we cannot express anger or aggression toward someone we depend on, we turn those feelings against ourselves. The critical voice that attacks you relentlessly—that voice is not you. It is an internalized version of someone else, someone whose judgment you could not escape.

Later psychoanalytic thinkers expanded this understanding. Melanie Klein wrote about the depressive position—the painful but necessary recognition that the people we love are not all-good, that we have destructive feelings toward them, and that we must bear the guilt and ambivalence this creates. Some people get stuck in this position, unable to tolerate their own aggression, and depression becomes a form of self-punishment.

Fairbairn and other object relations theorists understood depression as related to early deprivation—the child who was not adequately seen, held, or valued internalizes a sense of worthlessness. The depression becomes a kind of loyalty to the original bad object: if the parent was depressed or unavailable, remaining depressed keeps the parent company, maintains the connection.

Winnicott wrote about the "false self"—the adaptive persona we develop when our true self cannot be safely expressed. Many people spend decades performing a version of themselves that others can accept, and the depression is what happens when the false self finally collapses under the weight of its own inauthenticity.

Different Kinds of Depression

Depression is not a single thing but a family of related states. Understanding which kind of depression you are experiencing matters, because the treatment approach differs.

Reactive depression follows a clear loss or disappointment: the end of a relationship, a job loss, a death, a failure. The depression makes sense as grief or mourning. The work of therapy is to help you metabolize the loss—to feel it fully rather than avoid it, to accept what cannot be changed, and eventually to reinvest in life.

Characterological depression is more chronic and pervasive. You have felt depressed for as long as you can remember, not in response to any particular event but as a baseline state. This kind of depression is often rooted in early relational trauma or deprivation. The work of therapy is not to "fix" discrete symptoms but to help you develop a different relationship with yourself—to internalize a more benign, supportive object.

Masked depression presents as irritability, workaholism, substance use, or somatic complaints rather than obvious sadness. You stay busy, distracted, numb. The depression is there but defended against. The work of therapy is to help you slow down enough to feel what you have been avoiding.

Agitated depression is characterized by restlessness, anxiety, a sense of dread. You cannot sit still; you cannot relax. This form of depression often involves a great deal of self-attack—the internalized critical voice is loud and relentless. The work of therapy is to understand where this voice comes from and what it is trying to accomplish.

Treatment-resistant depression is depression that has not responded to multiple treatments—medications, CBT, other therapies. Often this depression is serving a psychological function that has not been addressed. The work of therapy is to ask: What would it mean to give up the depression? What would you have to face or feel if you were no longer depressed?

Why Understanding Matters More Than Symptom Relief

Most treatments for depression focus on symptom reduction: fewer sad days, less hopelessness, improved sleep and appetite. These are not trivial goals—suffering matters, and relief matters. But symptom relief alone often does not last. The depression returns, or it shifts into a different form, or you feel "better" but still fundamentally stuck.

Psychodynamic therapy is interested in a different question: Why are you depressed? Not in the sense of "what triggered this episode" but in the deeper sense of what the depression is doing, what it means, what purpose it serves.

Some possibilities:

• Depression as a defense against rage. If you cannot feel or express anger—particularly toward people you depend on—that anger has to go somewhere. Often it turns inward, and what looks like depression is actually self-directed aggression.

• Depression as loyalty. Remaining depressed can be a way of remaining connected to a depressed parent, or honoring an early loss, or refusing to outgrow the family system.

• Depression as protection. Some people are terrified of their own vitality, competence, or desire. Depression keeps you small, safe, invisible. It protects you from the risks of being fully alive.

• Depression as punishment. If you carry deep guilt or shame—particularly about things you were not actually responsible for—depression can feel like a deserved suffering, a way of atoning.

• Depression as mourning. Sometimes depression is the psyche's attempt to process losses that were never adequately grieved. The work is not to "get over it" but to feel it fully enough that it can be integrated.

Understanding which of these dynamics (or others) is operating in your particular depression changes everything. You cannot think your way out of depression that is protecting you from your own rage. You cannot medicate away depression that is a form of loyalty. You cannot will yourself into health when being healthy feels like a betrayal.

What Happens in Psychodynamic Therapy for Depression

Psychodynamic therapy for depression is not structured or manualized. There is no workbook, no homework, no series of techniques. Instead, the work unfolds through talking—through saying what comes to mind, following associations, noticing what you avoid or cannot say.

The therapist's job is not to fix you or provide solutions. It is to help you notice patterns, to make explicit what has been implicit, to bring into awareness the conflicts and contradictions that have been operating outside awareness. Over time, this process of exploration and understanding itself becomes therapeutic.

Some of what happens:

You learn to tolerate feelings you have been avoiding. Much of depression is a defense against feeling—particularly anger, grief, or desire. In therapy, you gradually learn that these feelings can be felt without catastrophe, that the therapist can bear them with you, that you will not be destroyed or abandoned for having them.

You discover the origins of your inner critic. That harsh, punishing voice that tells you you're worthless or hopeless—it did not originate with you. It is an internalized version of someone else: a critical parent, a shaming teacher, a culture that told you that you were wrong. Understanding this helps you begin to separate your actual self from this internalized attack.

You examine the costs and benefits of remaining depressed. This sounds harsh, but depression often serves a purpose. It may protect you from anxiety, or from having to take action, or from having to face painful truths. The work is not to judge this but to understand it—to make conscious what has been unconscious so that you have more choice.

You work through the transference. The patterns that show up in your relationship with the therapist—the ways you expect to be judged, dismissed, or abandoned—are the same patterns that operate in your other relationships and in your relationship with yourself. By noticing and working through these patterns in therapy, they begin to shift elsewhere.

You develop a more complex relationship with your suffering. Instead of seeing depression as purely negative, something to be eliminated, you begin to see it as meaningful. It is telling you something. The question becomes: What is it trying to communicate?

How Long Does It Take?

Psychodynamic therapy for depression is not brief. Meaningful change takes time—often months or years rather than weeks. This is not because the therapy is inefficient but because the work being done is structural rather than symptomatic.

If your depression is reactive—a response to a recent loss or disappointment—therapy may be relatively short-term. But if your depression is characterological, deeply rooted in early relational experience, the work will take longer. You are not learning techniques to manage symptoms; you are reorganizing fundamental aspects of how you relate to yourself and others.

Research on psychodynamic therapy for depression has found something important: while symptom relief may take longer than with CBT or medication, the benefits of psychodynamic therapy tend to increase after treatment ends. This is the "sleeper effect"—people continue to improve because they have internalized a more reflective stance toward their own experience. They have not simply learned to cope with depression; they have changed in ways that make depression less necessary.

When Medication Might Help

We are not opposed to medication, but we do not see it as a substitute for therapy. Antidepressants can be useful for people whose depression is so severe that they cannot engage in therapy, or who need short-term relief to stabilize before deeper work can happen. But medication alone rarely resolves depression in any lasting way.

Many of our clients come to us while taking antidepressants, and we work collaboratively with psychiatrists. The question is not "medication or therapy" but how each can support the other. Medication may reduce the most acute suffering; therapy addresses the underlying dynamics that generate depression in the first place.

Who This Approach Is For

Psychodynamic therapy for depression is not for everyone. It requires willingness to explore difficult feelings, to sit with ambiguity, to tolerate not-knowing. It requires commitment to the process, even when progress feels slow or invisible.

This approach is well-suited for:

• People who have tried other treatments without lasting success

• Those with chronic, long-standing depression rather than recent-onset symptoms

• People interested in understanding themselves, not just managing symptoms

• Those for whom depression feels tangled up with identity, relationships, and meaning-of-life questions

• People willing to commit to longer-term, open-ended work

It is less well-suited for people looking for quick symptom relief, a structured program, or concrete advice about how to live.

Depression Therapy in Manhattan

At Dr. Kull & Associates, we offer psychodynamic therapy for depression in New York City. We see clients in person at our Columbus Circle office and online throughout New York State.

Dr. Ryan Kull's training is in psychoanalytic theory and practice, with particular attention to relational and object relations traditions. His clinical and research work has focused on understanding severe psychological distress—particularly depression, despair, and suicidality—not as symptoms to be eliminated but as meaningful experiences that require careful attention.

The work we do is exploratory, open-ended, and oriented toward depth rather than speed. It is not the right fit for everyone, and we do not claim it is superior to other approaches—only that it offers something different, something that may be useful for people who feel fundamentally stuck despite trying other treatments.

If you are curious whether this kind of work might be helpful for you, we offer free consultations. This is not persuasion but information—a chance to talk about what you're experiencing and whether psychodynamic therapy makes sense for you.

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