Dr. Ali Al Farhan
Consultant Psychologist and Psychotherapist · Associate Professor of Psychology
You may wake up to find that the things you love feel distant. You go to work, answer messages and do what is expected, yet move through the day without feeling as present as you once did. You might say, "My life looks fine, so why does everything feel so heavy?"
A change can also begin differently: less sleep, increasing energy, racing thoughts and decisions that seem unusually clear and appealing. Before treating this as simple enthusiasm or recovery, it helps to ask what has changed, for how long and with what consequences.
Understanding mood brings us closer to these experiences. A psychodynamic perspective also asks what they mean to the person: how they relate to their sense of self, and to loss, need, anger and recognition.
News, stress, sleep and relationships affect us all. Mood disorders involve changes that go beyond a passing response and may affect energy, interest, thinking and everyday functioning. Here, "mood disorders" is an umbrella term for depressive and bipolar disorders, which differ in diagnosis and treatment. [1, 2]
Depression can involve persistent low mood or loss of pleasure, alongside changes in sleep, appetite, energy and concentration, or feelings of worthlessness. A diagnosis of major depression generally requires a combination of symptoms lasting at least two weeks and causing clinically significant distress or impairment. Duration alone does not establish a diagnosis, and severe distress is a reason to seek help sooner. [1]
Bipolar disorders involve a history of mania or hypomania, depending on the type, and may include depressive episodes. Signs that warrant attention include unusually increased energy or irritability, a reduced need for sleep, rapid speech, racing thoughts and impulsivity. Moving between happiness and sadness within a day is not enough to diagnose bipolar disorder. [2]
Assessment considers symptoms and how the person experiences them. Two people may say, "I am worthless," but one feels this after someone they love pulls away, while the other feels it after a limited setback at work.
Sidney Blatt and Patrick Luyten's model explores two important dimensions of psychological experience: relatedness to others and the development of self-definition, worth and autonomy. Some people's distress centres on loss, loneliness and fears of abandonment; others struggle especially with failure, guilt and self-criticism. Both dimensions can overlap in one person. They offer perspectives for understanding, rather than diagnoses that replace assessment. [3]
The following scenes are fictional illustrations. They are not accounts of clients or evidence of any particular diagnosis.
"Salem" does not receive the promotion he expected. Initially disappointed, he begins to reinterpret years of work through this outcome: "I have achieved nothing. Everyone else is better. Even my earlier successes meant little."
"I did not get what I wanted" becomes "I am not worthy." Over time, he avoids friends, puts off work and struggles to sleep.
One possible psychodynamic formulation would explore how much Salem's self-worth depends on achievement. Can he experience failure without losing respect for himself? Can he receive support, or does he hear it as pity that confirms his inadequacy?
His history might reveal acceptance tied to achievement, but it might not. His current workplace may also be unfair. Understanding includes actual circumstances rather than assuming every difficulty began in childhood.
In this example, one possible treatment aim is to help Salem see the event in proportion: a meaningful loss that deserves grief and reflection without becoming a verdict on his whole life. This illustration draws on the attention to self-criticism in Blatt's model; it is not a promised treatment outcome. [3]
After a long relationship ends, "Reem" says, "I know it was exhausting, but I do not know who I am outside it."
Her pain is about more than the partner's absence. She has also lost the routines that organised her day: whose message to wait for, whom to tell her news, and with whom to imagine the future. When her preoccupation with him eases, she encounters an emptiness she struggles to describe.
Exploration might begin with immediate questions: What did the relationship give you? Which parts of your life became smaller within it? What frightens you when you imagine continuing without it?
Needing others is not inherently pathological, and autonomy does not mean dispensing with relationships. Here, the work might involve tolerating loss, rebuilding other sources of meaning and support, and recognising wishes that had been set aside.
Distinguishing grief from a depressive episode remains part of assessment. The experiences may overlap, and an apparent trigger alone does not determine the diagnosis. [1]
Some psychoanalytic formulations explore how difficult it can be to acknowledge anger towards someone we depend on. Blaming ourselves may then feel easier than risking conflict. Love and anger, gratitude and disappointment, can coexist towards the same person. These are among the themes discussed in psychoanalytic writing on depressive personalities. [4]
Imagine someone who continually cares for a relative. Whenever exhaustion appears, they think, "I am selfish for feeling irritated." It may help to distinguish feeling angry from harming someone, and needing rest from abandoning them.
This is one possible formulation of some experiences. It does not mean that all depression is suppressed anger or anger turned inward. Genetic, biological, psychological and social factors interact in depression; one story cannot account for them all. [1, 4]
Therapy may explore what independence or feeling powerful means to someone with bipolar disorder, but that does not adequately explain or manage a manic episode. Reduced need for sleep, impulsivity and a marked change in activity may require prompt medical assessment, even when the person feels exceptionally well. [2]
Bipolar care usually includes medication and psychological follow-up, alongside attention to sleep, routines and early signs of recurrence. Psychotherapy can help people understand the illness's effect on identity and relationships and cope with the consequences of episodes. Findings on psychodynamic treatment for depression cannot automatically be extended to mania or bipolar disorder. [2, 5]
Assessment begins with changes in mood and their timing, sleep and energy, medical and treatment history, and effects on daily life and safety. Asking about previous periods of increased activity is important, rather than relying only on how the person feels on the day of the appointment. [1, 2]
Psychodynamic work may begin with a specific event, such as an unanswered message or feedback at work: what feeling arose, what the event came to mean, and how the person responded. Similar expectations may appear in therapy, such as fearing that the therapist will tire of their sadness or seeing a need for help as proof of inadequacy.
These are possibilities explored through dialogue. Difficulty trusting may also reflect something happening in the therapeutic relationship itself. Listening to the person's experience and revising the formulation remain part of treatment. [4]
A 2023 umbrella review in World Psychiatry found support for the efficacy of psychodynamic psychotherapy for depressive disorders in adults, while identifying research limitations, including bias and imprecision in some areas. It supports psychodynamic psychotherapy as one treatment option, without establishing that it suits everyone or is superior in every situation. [5]
Goals can be agreed in relation to the person's life: renewed interest, better everyday functioning, an ability to seek support, or less harsh self-judgment after mistakes. These are examples to discuss and monitor, not a universal measure or a promise.
For Salem, progress might mean reviewing his performance without condemning himself. For Reem, sadness may remain while she gradually regains the ability to engage, work and build a meaningful day.
Improvement may begin with a lighter mood and extend to having more ways to understand yourself and respond to what you lose and what you need.
If mood changes persist or affect sleep, work or relationships, seek a professional assessment. If there is a risk of self-harm, loss of contact with reality, or severe impulsivity with little sleep, seek urgent help from the nearest emergency department. This page is educational and cannot diagnose your condition.