Counselling for Depression: What Actually Happens in Therapy

Many people decide they need help with depression long before they know what that help involves. You might have known for months, or even years, that something needed to change, while the specifics of therapy stayed a mystery: what you'd talk about, whether it would help, or whether a stranger could really understand what you're going through. Not knowing what to expect can make reaching out feel like one more hard thing when you’re already struggling. 

But uncertainty shouldn’t hold you back from getting the help you need. So, let’s make depression counselling feel less mysterious by looking at what happens in your first session, the approaches therapists commonly use, how therapy helps, and what you can expect as you begin to feel better.

If you are thinking about suicide or worried about someone who is, you can call or text 9-8-8: Suicide Crisis Helpline anytime, in English or French. If your safety is at risk right now, call 911.

"Can depression be cured?" A More Useful Question

Clinicians don’t typically talk about depression as being “cured.” A more useful question might be: Can therapy help me reach a point where I no longer feel depressed? For many people, the answer is yes. Therapy can help you get to a place where getting out of bed or calling a friend no longer feels impossible.

Clinicians tend to use terms like remission and relapse prevention because depression isn’t a single problem with a simple on/off switch. It often develops through a mix of difficult circumstances and limited ways to cope with what life is asking of you. Its patterns reinforce each other over time, like skipping the gym because you’re tired, then feeling worse because you skipped it.

Symptoms may resurface during periods of stress, but that doesn’t mean therapy failed or that your progress didn’t count, just that it may be time to return to the skills that helped you before.

Therapy can help you get to a place where getting out of bed or calling a friend no longer feels impossible.

How Therapy Actually Changes Depression

Therapy works on several parts of depression at once, including the patterns in how you think, what you do, how you relate to yourself, and how connected you feel to other people. Here’s a closer look at each area and how it can begin to ease depression. 

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It Breaks the Withdrawal Loop

Depression can run in a cycle that feeds itself: low mood reduces activity, reduced activity removes the small rewards and social contact that used to lift your mood, and that absence deepens the low mood further. Therapy interrupts this by rebuilding activity on purpose, in small, deliberate steps, rather than waiting for motivation to show up first.

It Makes Automatic Thoughts Visible

Depression can make negative thoughts feel like plain fact rather than one interpretation among several. A thought like "I'm a burden to everyone" can start to feel as certain as knowing your own name. Therapy slows those thoughts down long enough to examine them, determining what the evidence for and against that thought really looks like when you lay it out. The thought does not have to be argued away. It just has to be seen clearly enough to lose some of its grip.

The Relationship Itself Does Some of the Work

The connection between client and therapist is one of the most consistent predictors of how therapy goes. For someone who has become isolated by depression, a weekly appointment with a person who actually knows their history, who remembers what happened last Tuesday and asks about it, is itself a powerful tool. It's also the honest reason therapist fit can sometimes matter more than modality for some people. Two therapists using the exact same approach can feel completely different to sit across from.

It Helps Address What Is Contributing to Depression

Therapy also gives you a regular, protected place to name and work through what’s contributing to your depression, whether that's financial stress, a co-occurring concern like anxiety, or a difficult life circumstance you may be uncomfortable sharing with others. Showing up week after week can help you take practical steps, make meaningful changes, and chip away at the factors that would otherwise keep you stuck.

A weekly appointment with a person who actually knows your history, who remembers what happened last Tuesday and asks about it, is itself a powerful tool.

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Before Your First Session

Reaching out to a therapist can take more courage than people realize, especially when depression has already drained so much of your energy. If you’re anxious or hesitating, it doesn’t mean you aren’t ready or don’t really want help. A little preparation can make that first step feel more manageable.

• Check your coverage. Coverage plans may include sessions with registered psychotherapists, psychologists, social workers, or other mental health professionals, but the details vary. Check which provider types are included, and how much you can claim per session or year.

• Consider a referral, but know you don't need one. Ask your family doctor for a referral if you'd like the extra support of their input, though you can book directly with a therapist without one.

• Decide in-person or virtual. Think about which setting would feel most comfortable for you. 

• Jot down a rough timeline. Note when things started feeling different, any physical changes like sleep or appetite, and current medications, so you have that information on hand. 

• Ask about a free consultation call. Many clinics offer a short call before you commit, which can take the pressure off your decision.

Who Is Qualified to Treat Depression in Ontario

Several types of regulated mental health professionals can treat depression in Ontario. Understanding their different training and roles can help you find the kind of support that best fits your needs: 

• Registered psychotherapist (RP): Provides psychotherapy and can assess and treat symptoms of depression, but doesn’t provide a formal medical diagnosis.

• Psychologist: Can assess and diagnose depression and provide psychotherapy, but doesn’t prescribe medication.

• Psychiatrist: A medical doctor who can diagnose depression, prescribe medication and, in some cases, provide psychotherapy.

• Registered social worker: May assess and treat depression through psychotherapy, depending on their training and scope of practice.

What Happens in Therapy for Depression

Depression therapy is shaped around you—your symptoms, experiences, needs, and goals—so no two people’s sessions will look exactly the same. Still, you may encounter some common processes along the way. They won’t necessarily happen in a set order, and you may return to some of them as your needs change. Think of this as a guide to what therapy can involve, not a checklist for what your progress “should” look like. 

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Assessment and Goal Setting

The first few sessions often involve questions about your symptoms, how long they've lasted, and what's changed with sleep, appetite, energy, concentration, work, and relationships. Your therapist may ask about safety and suicidal thoughts, particularly if something in the conversation raises concern, though this isn't asked in every case. Goals are usually named in plain, specific terms, such as "get back to cooking dinner most nights" rather than a vaguer "feel better," though landing on that kind of specificity can take more than a session or two.

Some people leave early appointments feeling unexpectedly hopeful or relieved, almost surprised by how much it helped just to say things out loud. Others feel a bit worse temporarily, because the conversation surfaced things that had been sitting unaddressed for a while. Both reactions are common. This early period is also when you're feeling out whether the client-therapist relationship itself is a good fit. If it’s not, it’s more than okay to say so (we promise!), or to ask about meeting a different therapist, if something feels off.

Getting Moving Again

Many therapists, particularly those working from a cognitive behavioural approach, use behavioural activation as one part of treatment. In practice, this can look like tracking mood alongside daily activity to spot patterns you hadn't noticed, scheduling small and specific actions in advance rather than waiting to feel like doing them, and gradually re-engaging with relationships, routines, and basic health habits one at a time. Some therapy for depression involves work between sessions, but the type and amount varies by client and therapist, and it's never meant to feel like homework you're being graded on.

Early wins are intentionally small and, frankly, a little unglamorous: a ten-minute walk around the block, one text back to a friend you'd been avoiding. Those small actions matter more than they sound like they should, because they're proof the loop can be interrupted. This work isn't confined to a single early stage. It continues alongside everything else, sometimes for the whole course of therapy.

Those small actions matter more than they sound like they should, because they're proof the loop can be interrupted. 

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Working on Thought Patterns

Therapy can also help you identify recurring thought and behaviour patterns, work through rumination, and build more flexibility in how you respond to difficult moments. The specific tools depend on the therapist's approach. Cognitive Behavioural Therapy (CBT) often uses thought records and cognitive restructuring, walking through a specific difficult moment and testing the thought that came with it, while other approaches, such as Acceptance and Commitment Therapy (ACT), use techniques like cognitive defusion, which is learning to notice a thought without treating it as automatically true.

This kind of work can become easier once you feel less depleted, though it doesn't always have to follow behavioural work first; for some people, the two happen side by side. It's also common for anger or anxiety to become more noticeable as depression lifts, almost like static clearing to reveal a different signal underneath. Your therapist can work through that with you, too, helping you understand what the shift means and how it may be part of your progress. 

Consolidation and Ending

Later sessions focus on identifying what has actually helped, recognizing your own personal early warning signs (maybe it's sleeping more, skipping meals, or losing interest in something you'd only recently started enjoying again), and practicing strategies you can return to when needed. Sessions are often spaced further apart as stabilization increases, and ending therapy is usually a planned, collaborative process rather than something that just trails off. Many people return for a few maintenance sessions later, if they feel that’s helpful for them. 

Which Types of Therapy Are Used for Depression?

There’s no single type of therapy that works best for everyone with depression. The right approach depends on what you’re struggling with, what may be contributing to your depression, and the kind of support that feels most helpful to you. Some approaches offer practical tools for changing patterns that are keeping you stuck, while others help you relate to painful thoughts and feelings with more understanding and less self-judgment.

• Cognitive Behavioural Therapy (CBT): Focuses on changing unhelpful thought and behaviour patterns. It’s a helpful modality if you feel overwhelmed or stuck and would value concrete tools to begin moving forward.

• Acceptance and Commitment Therapy (ACT): Helps you relate differently to difficult thoughts and feelings rather than getting caught in a constant struggle to make them disappear. As that struggle begins to ease, you can start taking small, meaningful steps toward the people, experiences, and values that matter to you. 

• Compassion-Focused Therapy (CFT): Works with the shame and self-criticism that often accompany depression—and can sometimes feel even louder than the depression itself. It helps you begin responding to your pain with the same care you might naturally offer someone else.

• Internal Family Systems (IFS): Helps you understand and work with conflicting internal “parts,” such as the part that wants to withdraw and the part that longs for connection. Instead of treating either part as the enemy, IFS explores what each may be trying to protect you from.

• Mindfulness-based therapy: Builds your ability to observe difficult thoughts and feelings without automatically reacting to them or becoming consumed by them. Over time, this can create a little more space between what you’re experiencing and how you respond.

Many therapists draw from more than one of these approaches rather than practicing a single modality in isolation. So, the most useful question to ask a prospective therapist may not simply be which modality they use, but how they’d tailor their approach to you and what you’re going through.

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How Long Does Therapy for Depression Take?

There's no single timeline that applies to everyone, but structured, short-term protocols for depression typically run somewhere between 12 and 20 weekly sessions. Some people need less, some continue longer, particularly with a trauma history or recurring episodes that need more groundwork. 

Many people notice some improvement within the first four to six weeks, even if it's subtle at first, like improved sleep. How long treatment actually takes depends on severity, history, and what else is going on in your life, all of which a clinician assesses during initial sessions. 

What If Therapy Is Not Working?

Even if it feels uncomfortable to bring up, if you feel like your progress is stalling, therapy is a safe space to share that information with your therapist. A good therapist treats that as useful information, not criticism, and a decent conversation about it is actually a sign of a healthy working relationship. A few different things could be going on:

• The fit with this particular therapist isn't right, which happens and isn't a reflection on either person.

• The approach itself isn't the right match for what you're dealing with.

• Additional support is needed, such as a psychiatric assessment or medication.

Switching therapists is normal and not a failure, on your part or theirs. But if you’ve found a therapist you trust and still aren’t seeing progress, it may be worth taking a closer look at what else could be contributing. Treatment-resistant depression is a recognized clinical category, but it’s important to reassess before assuming that label applies to you. Sometimes an overlooked or co-occurring condition, such as ADHD, can offer a completely new way of understanding what’s been happening, and that shift alone can move your progress forward in a meaningful way.

Therapy, Medication, or Both

For mild to moderate depression, psychotherapy is an established, evidence-based first-line option. 

For some people, particularly those with more severe depression, therapy combined with medication may work better than either on its own. Medication can reduce symptoms enough so that someone has more capacity to engage in therapy and try new behavioural strategies, while therapy supports the longer-term change that medication alone doesn't build. 

Only a physician can prescribe medication, and whether or not that’s the right decision for you belongs to you and a qualified professional, based on your specific history.

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Cost and Access to Depression Counselling in Toronto

OHIP does not cover private psychotherapy. It does cover psychiatry with a referral, and psychologist services delivered inside hospitals or publicly funded programs. The Ontario Structured Psychotherapy (OSP) program offers publicly funded, evidence-based CBT at no cost, with a self-referral option, though waitlists exist in most regions.

Many workplace benefits plans and health spending accounts cover a portion of private psychotherapy. Private session fees in the Toronto area vary, and many clinics, including Radcliffe Psychotherapy Clinic, offer reduced-fee options for exactly this reason. Our affordable therapy program pairs clients with supervised student therapists for $95 per session, a practical starting point for anyone without extensive coverage. Contact us to learn more. 

Frequently Asked Questions

Can depression be cured permanently?

Clinicians tend to talk about remission and relapse prevention rather than a permanent cure. Many people have a single episode of depression and never experience another. Others have recurring episodes that may become shorter and more manageable as they build skills over time.

How do I know if I need therapy or if I am just going through a rough patch?

A useful marker is whether low mood, low energy, or loss of interest show up most of the day, most days, for two weeks or more, and whether they're interfering with work, school, or relationships. It's common to second-guess whether what you're feeling "counts," especially if you've been managing it for a while. A proper assessment with a clinician is the best place to start. 

Does OHIP cover therapy for depression in Ontario?

OHIP does not cover private psychotherapy, though it does cover psychiatric care with a referral. The Ontario Structured Psychotherapy program offers a publicly funded CBT option at no cost.

What if I do not know what to say in my first session?

That's a completely normal way to begin. "I don't really know where to start" is one of the most common opening lines a therapist hears, and it works just fine as an opening line. Your therapist leads the first session with questions, so you don't need a prepared narrative walking in. 

Is online therapy as effective as in-person for depression?

Evidence broadly supports comparable outcomes between online and in-person therapy for depression. That said, some people engage more easily face-to-face, and symptom severity can factor into which format works best for you. It's worth discussing your preference and situation directly with a prospective therapist rather than assuming one format is automatically better.

Working with a Therapist In Toronto

If depression has made it hard to imagine things getting better, you don’t have to find your way forward on your own. Our therapists offer depression therapy in-person in Toronto and virtual appointments, with support customized to what you’re experiencing and what matters to you. Start with a free 15-minute call with our Intake Coordinator to get matched with the best therapist for you. 

If you are thinking about suicide or worried about someone who is, you can call or text 9-8-8: Suicide Crisis Helpline anytime, in English or French. If your safety is at risk right now, call 911.