My depression is much like yours, at it's worst. I, too, keep getting kicked down. I, too, wonder why, what's the point, nothing ever changes. But like you, I have had periods of normal, content, even happy... for awhile.

For me it comes down to having to face up to decades of unresolved grief... have just reached that point in therapy where I have had to admit I've been fooling myself that I had it sorted out. There is a heap of deep sadness that I never have expressed in any healthy way. So that work has just begun and I don't want to do it, I'm afraid of it, but the alternative seems to be more of what you describe.

However I don't feel it is selfish for me to be alive -- as strongly as the disease wants me to believe such things (and it still hurts in that dull throbbing way), I know it is the disease and not ME. I can act as if I'm worth living, go through the motions, until the crap lifts a bit.

Your T seems to be pushing you with a tough love approach, and I get the feeling you know you should follow through with it, do the PHP, however you can. Your T very likely believes in you more than you do yourself, or would not have presented you with this ultimatum.