Depression counselling - and the life challenges that often come with it
Depression rarely arrives on its own. It often shows up alongside something else – a life that has become smaller than it used to be, a sense of disconnection from people and things that used to matter, a persistent low mood that’s easy to attribute to being tired, or busy, or “just going through a phase,” right up until it’s been months and the phase hasn’t passed.
This page covers depression as I work with it in counselling, including two things that are connected to it more often than people realise and that aren’t always named directly: loneliness, and living with HIV.
What is depression, and where does counselling fit?
It’s worth being clear and honest about scope here, because it matters.
Depression exists on a spectrum, and counselling is appropriate for different parts of that spectrum in different ways. For many people, what’s experienced as “depression” is closely tied to circumstances – grief, a major life transition, relationship difficulties, burnout, isolation – and responds well to counselling that addresses both the low mood itself and what’s underneath it. This is a significant part of what I work with.
For clinical depression – where symptoms are more severe, more persistent, and significantly affecting someone’s ability to function (appetite, sleep, concentration, motivation, and in some cases thoughts of self-harm) – counselling has an important role, but usually works best alongside, not instead of, medical care. A GP or psychiatrist can assess whether medication would help, and a diagnosis from a medical professional can also be clarifying in itself – sometimes simply having a name for what’s happening, and understanding that it’s a recognised condition with effective treatments, is part of what helps someone start to feel less alone in it.
Where I fit, for clinical depression, is as part of that picture – not a replacement for it. Counselling alongside medical treatment can help with the things medication alone doesn’t address: the thoughts and stories that have built up around the depression, the relationships and routines that have been affected, and the slow work of rebuilding a life that depression has made smaller. Before opening my practice in 2012, I spent twelve years working alongside a psychiatrist in a specialist practice in Bedfordview – an experience that continues to inform how I think about the line between counselling and clinical care, and when a referral is the right next step. See the About page for more.
If you’re not sure whether what you’re experiencing is “depression enough” to bring to counselling, or whether you should see a GP first, or both – that’s a reasonable thing to be unsure about, and a reasonable thing to ask about before any commitment is made. If you are currently having thoughts of harming yourself, please contact SADAG on 0800 567 567 (free, 24 hours) or Lifeline on 0861 322 322 – these services are equipped for crisis support in a way that scheduled counselling sessions are not, and reaching out to them is not a lesser step.
High-functioning depression
One form of depression that comes up often, and that’s particularly easy to miss – both for the person experiencing it and for the people around them – is high-functioning depression.
This is depression that doesn’t stop someone from getting up, going to work, managing responsibilities, and generally appearing to cope. From the outside, everything looks fine, sometimes impressively so. From the inside, very little feels fine. Things that used to bring some sense of enjoyment or satisfaction now feel flat. Getting through the day takes a kind of effort that isn’t visible to anyone else, and that effort itself is exhausting in a way that’s hard to explain to people who haven’t experienced it.
High-functioning depression is often missed precisely because functioning is the thing everyone – including the person experiencing it – uses as the measure of whether something is wrong. “I’m still doing everything I need to do, so I must be fine” is a conclusion that can hold for a surprisingly long time, even as the gap between how things look and how they feel keeps widening.
If this sounds familiar – if you’re managing, but managing has stopped feeling like enough, or has started to cost more than it used to – that’s worth paying attention to, even in the absence of a more obvious crisis point.
Loneliness and isolation
Loneliness doesn’t always look like being alone. Some of the loneliest people I work with are surrounded by people – colleagues, family, even friends – and still feel fundamentally unseen or disconnected. Other times, loneliness is more straightforward: a life that has, gradually or suddenly, become genuinely short on the kind of connection that sustains people.
Loneliness and depression feed each other. Depression makes connection harder – less energy for it, less belief that it would help, sometimes a kind of withdrawal that feels protective in the moment but deepens the isolation over time. And loneliness, sustained for long enough, can produce something that looks a great deal like depression even where there wasn’t a clinical depression to begin with.
A few situations where loneliness comes up often:
- Life transitions that quietly remove a social structure – a job that provided most of someone’s social contact ending, children leaving home, a relationship ending, retirement, moving to a new town or country. The loss of the structure is often more disruptive to a person’s sense of connection than they expected, because so much of that connection was happening incidentally, through the structure, rather than through deliberate effort.
- Living somewhere that doesn’t quite fit – geographically, culturally, or both. This comes up often with clients who have emigrated, but also with people who have moved within South Africa to a town or city that doesn’t yet feel like home, sometimes years later.
- The loneliness of being the strong one – people who are relied upon by others (as a parent, a manager, the family member everyone goes to) often have very few people they can be the ones leaning on. The role itself can become isolating.
Counselling doesn’t manufacture friendships or community – that’s not something a weekly session can replace. But it can be a space where the loneliness itself is named and taken seriously, rather than minimised (“everyone feels like this sometimes”) or treated as something to simply push through. And it can help with the parts of loneliness that are within someone’s own reach to change – including some of the patterns, beliefs, or fears that make it harder to build or rebuild connection, even when the opportunity is there.
Digital nomads, remote workers, and the specific shape depression and loneliness take when your life doesn't have a fixed address
Depression and loneliness show up with a particular shape for people whose lives are location-independent – digital nomads, remote workers, and anyone whose work or lifestyle means they’re rarely in one place long enough to build the kind of community that takes time.
A life that looks, from the outside, like freedom and adventure can carry a depression that’s especially hard to name – because naming it can feel like admitting the life you chose, the life other people are sometimes openly envious of, isn’t working. There’s often a real gap between what the lifestyle is supposed to feel like and what it actually feels like day to day, and that gap itself becomes something to manage, on top of whatever else is going on.
The loneliness here has a specific texture too: not the absence of people, but the absence of people who know you. Co-working spaces, hostels, meetups – these provide contact, sometimes a lot of it, but contact that resets every few weeks as people move on. The accumulated knowing-someone-over-time that most people rely on for a sense of being truly known by anyone simply doesn’t have room to build.
If this describes your situation, my page for digital nomads and remote workers goes into more detail about the broader picture – including burnout, identity, and the practical side of maintaining a consistent therapeutic relationship while moving between countries and time zones. This page exists alongside it because depression and loneliness, specifically, deserve their own space rather than being one item on a longer list.
Living with HIV - counselling alongside medical care
HIV-related counselling is part of my practice, and it sits comfortably alongside everything else on this page – because the emotional impact of an HIV diagnosis, or of living with HIV over time, often overlaps significantly with depression, loneliness, and grief, even when none of those words have been used yet.
A new diagnosis can bring a wide range of responses – shock, fear, grief for a future that suddenly looks different, and often a sense of isolation that’s made worse by stigma, even where that stigma is more anticipated than actually experienced. For people who have been living with HIV for years, counselling is sometimes less about the diagnosis itself and more about everything that’s accumulated around it: decisions about disclosure, the effect on relationships, and the ongoing emotional weight of managing a chronic condition in a context where misinformation and judgement, however outdated, can still surface unexpectedly.
As with clinical depression, counselling here works alongside medical care, not instead of it – supporting the emotional and relational side of living with HIV, while medical management remains with your doctor or clinic. If this is part of what’s brought you to this page, it’s a legitimate and welcome part of the conversation, whether it’s the main reason you’re reaching out or one part of a bigger picture.
How counselling helps - narrative therapy and CBT, working together
Whether what’s underneath is depression, loneliness, grief, or the emotional side of a diagnosis like HIV, I draw on two main approaches: cognitive behavioural therapy (CBT) and narrative therapy – both well-established for depression and low mood, and often most useful in combination.
CBT is widely used for depression because of how directly it addresses the cycle that often sustains low mood: depression reduces activity and motivation, reduced activity removes the small sources of satisfaction and connection that would normally help mood recover, and the resulting flatness reinforces the depression further. CBT-based work often involves gently identifying and re-engaging with small, manageable activities, alongside examining specific thoughts that depression tends to generate – “there’s no point,” “I won’t enjoy it anyway,” “I’ll only let people down” – and testing whether they hold up.
Narrative therapy works alongside this by addressing the broader story depression tells about a person – not just specific thoughts, but an overall account of who you are and what’s possible. Depression is often experienced as a kind of total verdict: “this is just who I am now,” “this is as good as it gets,” “I’m someone things don’t work out for.” Narrative therapy treats this as a story rather than a fact – examining where it came from, what it leaves out, and what other, less totalising account might also be true.
In practice, these approaches tend to work well in tandem: CBT’s structured, activity-based focus can help create small shifts that make room for the slower work of examining and loosening the larger story depression has been telling. I draw on both, depending on what’s most useful at a given point.
How counselling helps - overview
Whether what’s underneath is grief, isolation, burnout, a major life transition, depression, or the emotional side of an HIV diagnosis, the work tends to involve some combination of:
- Understanding what’s actually going on – not just the symptoms, but the story that’s built up around them: what depression has come to mean about who you are, what’s possible for you, and what the future looks like
- Examining whether that story is the only one available, or whether it’s become more fixed and more total than the evidence actually supports
- Identifying what’s been lost – energy, interest, connection, hope – and treating that loss as something real, worth acknowledging, rather than something to talk yourself out of
- Slowly rebuilding – not all at once, and not through forced positivity, but through small, realistic steps back toward things that used to matter, at a pace that doesn’t set you up to feel like you’ve failed again
This is not quick work, and I won’t pretend it is. But it’s work that, done consistently, tends to move – even when, at the start, it’s hard to imagine that it could.
How sessions work
Sessions are one hour, either in person in Jeffreys Bay or online via Zoom for clients across South Africa and internationally. I work primarily with individuals. For details on session pricing, see the pricing page.
Frequently asked questions
Storme Brand is a Registered Counsellor with the Health Professions Council of South Africa (HPCSA Reg. PRC0023531) – you can verify this at hpcsa.co.za. Counsellors and psychologists are both registered with the HPCSA but have different scopes: psychologists can conduct formal psychological assessment and diagnosis and typically work with more complex clinical presentations, while counsellors work with the emotional and psychological difficulties most people experience – including depression and low mood – within a therapeutic relationship. See the About page for more.
Not necessarily, and for some people, not at all. If your depression is significant enough that a GP or psychiatrist has diagnosed it, or would likely diagnose it, medication may be an important part of treatment – and counselling works well alongside that, rather than instead of it. If you’re unsure where you fall, that’s a reasonable thing to discuss with a GP first, or to raise honestly in an initial conversation.
Most major South African medical aids recognise sessions with an HPCSA-registered counsellor. An invoice with the relevant ICD-10 codes is provided after each session for you to submit to your medical aid directly. For current session fees, see the pricing page.
A combination of cognitive behavioural therapy (CBT) and narrative therapy, chosen based on what’s most useful for you – see the section above for how these work together.
Online counselling won’t replace the kind of in-person connection that loneliness often calls for – and it’s not trying to. What it can do is provide a consistent, reliable relationship with someone who takes what you’re experiencing seriously, and a space to work through what’s making it harder to build the connections you’re missing. For some clients – particularly those in remote areas, living abroad, or with location-independent lifestyles – online counselling is also, practically, the only consistent relationship of this kind that’s available to them at all. See more about online counselling here.
The Digital Nomads page covers that broader territory in depth. This page exists for when depression and loneliness specifically are the most pressing part of what you’re carrying – but the two pages overlap, and either is a reasonable starting point.
Yes. Counselling sessions are confidential, and while they work alongside your medical care, they’re a separate relationship from your doctor or clinic. The focus is on the emotional and relational side of living with HIV – medical management remains with your healthcare provider.