Lawyer who’s a ‘bundle of nerves’ may benefit from behavioral therapy

Issue July 2011

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 retire.

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 disorders.

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 accurate thoughts.

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; or called in to (617) 482-9600. LCL's licensed clinicians will respond in confidence.