When you are depressed, even imagining therapy can feel tiring. You may wonder what you would talk about, whether you would just cry for an hour, or whether talking can change anything. This article describes how a psychologist with an insight-oriented, integrative approach, like Dr. Lehmann, typically works with depression after the first appointment. For the first visit itself, see What Happens in a First Therapy Session?.
Starting where you are
Depression lowers energy, so early sessions do not ask you to arrive with a plan. The psychologist will want to understand how you are sleeping and eating, what you have stopped doing, how long this has lasted, and what was happening in your life when it began. Questions about safety, including thoughts of death or suicide, are a routine part of this. Answering honestly helps the psychologist understand how you are doing; it is not a test.
The American Psychological Association (APA) notes that at the end of a first session a psychologist may suggest seeing a physician to rule out medical conditions, such as a thyroid disorder, if that has not been done. It also describes the early stage of therapy as clarifying what is troubling you before moving into problem-solving.
Thread one: getting through the week
Depression narrows life. Part of therapy is practical support for the days in between: how to break tasks into smaller pieces, what to do on mornings when getting up feels impossible, how to stay connected with people when you want to withdraw. NIMH's list of things that may help alongside treatment is a good picture of this kind of work:
- Some physical activity, even a short daily walk
- A regular bedtime and wake-up time
- Regular meals
- Doing what you can, and deciding what must get done and what can wait
- Talking with people you trust about how you feel
- Putting off major life decisions until you feel better
In therapy these are not a to-do list handed over in the first session. They are tried, adjusted and talked about, including what gets in the way.
Thread two: understanding what keeps it in place
The second thread looks underneath. Depression is often tied to patterns with a history: a harsh inner critic learned early, a habit of putting everyone else first, grief that never had room, a relationship where you feel unseen, or a loss of identity after a job, a move or children leaving home. The APA describes insight-focused approaches as spending more time talking, sometimes about early experiences, to understand the root causes of current problems.
NIMH lists cognitive behavioral therapy and interpersonal therapy among the evidence-based therapies for depression, and notes that other forms of psychotherapy, such as psychodynamic therapy used for a limited time, may also help some people. Dr. Lehmann describes her own approach as insight-oriented and integrative rather than a single named method; NIMH's overview of psychotherapies notes that many therapists combine elements of several approaches to fit the person. What Is Insight-Oriented Therapy? explains the general idea, and Types of Therapy for Anxiety and Depression, Explained compares the main approaches.
What a session can look like
A session might begin with the week: a weekend spent mostly in bed, a hard phone call with a parent, a moment of feeling almost normal. From there the conversation may move between what to try this week and why certain moments hit so hard. Some sessions feel productive and some feel slow. Both are part of it. The APA points out that you may feel more sad or confused at points as therapy goes deeper, and that this does not mean it is not working.
Between sessions
Much of the change happens in the days between appointments. It can help to keep a few lines in your phone after hard moments: what happened, what you felt, what you told yourself about it. You do not need to do this perfectly. Bringing even one example to the next session gives the work something concrete, and the APA encourages clients to carry what they notice back into the room.
How change tends to show up
NIMH says that once treatment begins, people should gradually start to feel better. Gradually is the key word. Many people first notice small shifts, such as a little more energy, getting through a task that felt impossible, or a little less self-blame, before mood itself lifts. The APA encourages clients to help set goals, agree on a rough timeline and speak up if progress stalls. How to Tell if Therapy Is Working covers the signs.
Therapy alongside medication
NIMH notes that for milder depression psychotherapy is often tried first, and that people with moderate or severe depression are usually prescribed medication as part of the initial plan. Dr. Lehmann does not prescribe. Your physician, a psychiatrist or a psychiatric nurse practitioner handles medication, and with your written permission she can coordinate with them. If you take an antidepressant, keep taking it as prescribed and talk with your prescriber before changing anything.
The practical details
- Individual sessions in person at the Franklin office, or by telehealth when you are in Michigan
- Daytime appointments Monday through Thursday; no evenings or weekends
- Often weekly at first, with pace decided together
- $220 per clinical hour private pay; in network with Blue Cross Blue Shield PPO; limited reduced-fee spots
- A $90 late-cancellation fee with less than 24 hours' notice, except for illness or an emergency
Low energy can make keeping appointments hard. Telehealth on difficult days is one option to ask about. More about Dr. Lehmann's approach is on the depression therapy page.