Q. Despite over 25 years in practice, I remain a
bundle of nerves. Certainly, some very real life stresses
contribute to my state of mind - my son's addiction, our
family's being on the brink of bankruptcy since my husband's
business failed, and more - but I was always plagued by
self-doubt and prone to moments of absolute panic. My longtime
psychiatrist is a great listener and has prescribed an
antidepressant that tones down the anxiety, but it's still
there - whether I'm actually in court or in my office feeling
the weight of responsibility for a client's estate. Is there
something more I can do? I can't afford to
A. While you may not be turning into Tony Robbins any time soon,
it is never too late for change. As you have found, medications are
often not a fully effective solution to behavior and mood problems.
Supportive listening and traditional psychoanalytically oriented
psychotherapy (which perhaps reflects your psychiatrist's
training - and he or she is one of relatively few who have not
shifted their practices to primarily pharmacology) can be extremely
helpful, but may also have limited impact on anxiety
While there is no guarantee that any one treatment will help any
particular person, it makes sense for you to consider trying
behavioral therapy (which can be an adjunct to what you already
have in place, and need not be a replacement).
The original behavioral approach, formerly known as "behavior
therapy" or "behavior modification," dealt strictly with observable
behavior and concepts like conditioning and reinforcement. Within
that realm are techniques with names like "desensitization" and
"exposure therapy," involving an attempt to relearn reactions to
anxiety-producing stimuli or situations on a "gut" level.
Relaxation/meditation techniques that involve teaching the body to
reduce muscle tension and other manifestations of stress can also
be regarded as behavior therapy, though they are also often viewed
through a spiritual lens.
The last few decades have also seen the development and
proliferation of cognitive behavior therapy (CBT), which goes
beyond observable behavior into the realm of thoughts, images,
beliefs, etc. Many of these are "automatic" and learned early in
life. They linger in one's mental background, and put a spin on
one's perception, expectations, view of oneself, etc.
In addressing your self-doubt or an irrational lack of confidence,
a CBT therapist would help you identify the relevant self-defeating
cognitions, evaluate their validity and replace them with more
Because thoughts and feelings are inextricably linked, changing
thoughts in the direction of greater accuracy and self-validation
can bring about positive changes in emotional state. The
combination of these two behavioral approaches stands a good chance
of removing at least some of the anxiety that interferes with your
ability to manage your practice and other challenges.
As always, feel free to come for an individual interview at LCL as
a means of sharpening your understanding of the problem and getting
a referral for further help.
Questions quoted are either actual letters/e-mails or paraphrased
and disguised concerns expressed by individuals seeking assistance
from Lawyers Concerned for Lawyers.
Questions for LCL may be mailed to LCL, 31 Milk St., Suite 810,
Boston, MA 02109; [e-mail email] or called in to (617) 482-9600.
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