Nicholas Makris (he/him)

I specialize in high-functioning depression — the kind that's been minimized, unnamed, or carried alone for years while still appearing functional on the outside. This isn't about coping skills or symptom management. It's about understanding what's underneath, where it came from, and what has kept it in place. Depth-oriented, psychodynamic, and individualized to you.

I have specialized in gender-affirming and trans-competent care since the beginning of my clinical career. I am one of the first AFFIRM Pro consultants nationally and present on gender-affirming care at national medical conferences. I write gender-affirming assessment letters without gatekeeping — for hormone therapy, surgical clearance, name changes, and legal documents. Your identity is not in question here.

I work with adults navigating problematic sexual behaviors, compulsive sexual patterns, sexual identity questions, and the parts of their sexual lives they've never felt safe bringing into a therapy room. This is a kink-affirming, sex-work-inclusive practice. Your sexuality is the context for the work — not the problem to be solved.

Psychodynamic therapy is the foundation of how I work. It's depth-oriented and relational — focused not just on what's happening, but on the history and patterns underneath it. We look at where things come from, what keeps them in place, and what becomes possible when that starts to shift. This isn't about managing symptoms or building coping skills. It's about actually moving something. The work is honest, individualized, and goes as deep as you're ready to go.

I use an affirmative trauma-focused CBT approach — one that integrates the evidence-based structure of TF-CBT with an explicitly LGBTQ+-affirming framework. For LGBTQ+ adults, trauma is often compounded by minority stress, discrimination, family rejection, and healthcare systems that caused harm rather than help. Affirmative TF-CBT acknowledges that context as part of the clinical picture — not a footnote to it.

ACT helps you build a different relationship with the thoughts and feelings that have been running the show — not by eliminating them, but by loosening their grip. For LGBTQ+ adults who have spent years managing hypervigilance, internalized shame, or the weight of navigating hostile systems, ACT offers a framework for moving forward without waiting until everything feels resolved first. Values-based, present-focused, and integrated with deeper psychodynamic work.