by Carrie Bowers

Therapy. If this word triggers an image of a couch, a clipboard, and a doctor scribbling mysterious notes while seated behind a reclined and rambling patient, then you are not alone. Counseling, therapy, psychology, and mental health are just some of the terms that have been associated with this Freudian version of psychotherapy, known as psychoanalysis, for more than a century. Modern forms of mental health counseling are varied, more person-centered, and address mental and emotional issues from diverse perspectives. What was once a treatment shrouded in mystery, psychotherapy has developed into a process that is predicated on both the quality of the relationship between the client and counselor and the theoretical framework or style of therapy used to best address the client’s needs and circumstances.

The key components of the therapist-patient relationship, not entirely unlike the attorney-client relationship, are trust, honesty, and boundaries. When these elements are in place, the therapeutic relationship creates a safe arena where the client knows that they can discuss concerns most relevant to their well-being with the knowledge that their therapist will hear them, see them, and support them without judgement. In turn, the therapist is better able to identify patterns, help elicit ideas for change, bear witness and help process any trauma, and identify examples of the client’s inner resiliency.

Like many of your colleagues right now, you may be thinking about talking to someone about feelings of stress, anxiety, depression, anger, turbulence, or trauma. You may also be uncertain about what therapy looks like or how it works. Some of the most frequent questions I get while speaking with attorneys who are interested in finding someone to talk to about their concerns relate to how counseling works, what happens in the sessions, and what kind of therapy they should choose. The answer is: it depends! Therapy is a highly individuated process and there are now many types of theoretical orientations counselors can utilize to help their clients gain a greater understanding of themselves.

Let’s take a look at a few of the most common theoretical frameworks for therapy.

Acceptance and Commitment Therapy (ACT)

ACT is a form of talk therapy focused on helping people increase their psychological flexibility, the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves the individual’s values. It is based on modern behavioral psychology that applies mindfulness and acceptance processes, and commitment and behavior change processes. ACT principles are effective in both individual and group therapy settings.

Cognitive Behavioral Therapy (CBT)

CBT is based on the idea that habitual and unhelpful thoughts learned through life experiences can lead to problematic behaviors and maladaptive emotional reactions. This is particularly effective with the perfectionistic tendencies that members of the legal profession often struggle with. Emotional reactions color how a person experiences and labels future events or interactions. Typical manifestations of this process are seen when there is a habit of jumping to conclusions, minimizing successes and focusing on the negative, and holding too tightly to ideas about what oneself or others should or shouldn’t be like. Exercises are taught in therapy sessions and practiced as homework between sessions. It is used in both group and individual therapy settings. CBT focuses on a person’s current life and moving forward with healthier coping strategies.

Dialectical Behavioral Therapy (DBT)

DBT was initially developed to expand the principles of CBT while integrating mindfulness techniques and increasing somatic awareness (how emotions manifest in the body) to better treat underlying trauma and attachment issues. It is also proven to be helpful in addressing distress tolerance, emotional regulation, and interpersonal relationships. For example, during the pandemic many people have been overwhelmed and stressed, resulting in both feelings and outbursts of anxiety and irritability that have affected family, friends, and colleagues. Like CBT, DBT helps identify patterns and assumptions that are unhelpful. But DBT also validates underlying emotions and teaches skills that help put them into context.

Emotionally Focused Therapy (EFT)

EFT is an attachment-focused orientation concerned with how personality and relationships are influenced by early-life interactions and how the expression and regulation of emotions can help build more secure bonds with family, friends, and intimate partners. EFT is widely used in couples, family, and individual therapy.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a type of therapy that enables people to heal from trauma symptoms and emotional distress that are the result of disturbing life experiences. It does not require talking about the events or homework. The client listens to music, sounds on headphones, or holds a device in each hand that gently buzzes in an alternating way. As the eyes move from side to side to track the location of the sound or sensation, neurological changes in the brain take place that lessen the symptoms of trauma by organically “resetting” the client’s response to painful memories. EMDR is most commonly used in individual therapy sessions. Research indicates that EMDR can expedite the body’s natural healing process, shortening the duration of therapy needed.

Narrative Therapy

Narrative therapy is based on the idea that that you develop a story (or stories) about who you are and what you are worth that is carried with you throughout your life. The meaning attached to life experiences, both good and bad, color how you see yourself, your context in society, and the world in general. Examples of what stories we use to explain ourselves can vary from those related to relationships, self-esteem, or abilities. Your personal narrative(s), if held too tightly or maintained too rigidly can negatively influence decision making, relationships, and can prevent other, more positive, versions of one’s life from being accepted. Attorneys, for example, often internalize problems and client issues, either taking on stress that is not their own or feeling responsible for solving problems outside the scope of their representation. A narrative therapist can help guide their client through the process of deconstructing messages from internal and external sources, allowing a person to view themselves from a more neutral perspective.

Psychoanalytical

While not an overly-structured model, the psychoanalytical approach allows clients to free-associate and just talk out loud to someone who is willing to look for patterns and themes in the topics you discuss and the way you discuss them. This form of therapy can be long-term, depending on the issue(s) presented.

Solutions-Focused Brief Therapy (SFBT)

SFBT is a goal-focused type of counseling that focuses on workable, goal-oriented solutions, rather than lengthy explorations of past issues. The timeline for sessions can be as short as eight weeks. The process involves identifying what works for the client in the context of their concerns and finding ways to do more of it while also analyzing what coping mechanisms have not worked well and implementing ways of doing less of those.

It is important to note that this list is not comprehensive. It does, however, provide an overview of many of the most common and/or research-supported interventions for improving mental health. The most important aspect of therapy, however, is not the technique used. Research shows that the most important factor in determining the efficacy of talk therapy is the quality of the relationship between the client and the therapist. Any of the above-mentioned theoretical approaches can provide a framework for understanding ourselves. But ultimately it is the trust and safety felt with your therapist that makes the most difference. While looking for a therapist may seem daunting, COLAP staff can help you sort out what you are going through and make recommendations for vetted professionals who meet your specific needs.

For more information on how to find a therapist who will be a good fit for you, please contact COLAP at our confidential number or email address: (303)-986-3345; info@coloradolap.org.

Carrie Bowers is a Colorado certified addiction specialist. Bowers is currently pursuing a master’s degree in counseling for clinical mental health at the University of Colorado-Denver, where she also earned her bachelor’s degree. She has ten years of experience as a paralegal at firms specializing in criminal defense, civil rights matters, and consumer bankruptcy and six years’ experience supporting Colorado’s legal community by educating new lawyers about COLAP services, providing individual consultations to lawyers and law students, and monitoring voluntary participants for sobriety. Bowers has been with COLAP since 2014 with a current focus on assisting bar applicants with character and fitness concerns.

Sarah Myers, executive director of the Colorado Lawyer Assistance Program, is the coordinating editor of this wellness series. Contact COLAP for free and confidential assistance at 303-986-3345 and info@coloradolap.org.