Sarah Cottrell: Hi, and welcome to The Former Lawyer Podcast. I'm your host, Sarah Cottrell. I practiced law for 10 years and now I help unhappy lawyers ditch their soul-sucking jobs. On this show, I share advice and strategies for aspiring former lawyers, and interviews with former lawyers who have left the law behind to find careers and lives that they love.

Today, I have Annie Little back on the podcast. She and I both get asked quite frequently by our lawyer clients for thoughts and advice around finding a therapist, how to find a therapist, what to look for when you are thinking about getting a therapist as a lawyer.

She and I talk about this topic all the time so we're bringing you one of the topics that she and I previously talked about that we think is really important for lawyers to be aware of and thinking about when they're looking for a therapist.

That is the difference between Dialectical Behavior Therapy (DBT), and Cognitive Behavioral Therapy (CBT). As we say in the episode, neither of us are mental health professionals or experts. We are just sharing from our experiences and observations. But hopefully, this conversation will be very helpful for you if you are someone who is thinking about therapy, in therapy, interested in therapy, or all of the above. Without further ado, let's get to my conversation with Annie.

Hey, it's Sarah. I'm popping in here to remind you that I have created a free guide, First Steps to Leaving the Law for anyone out there who is just like, “Ugh! This job is the worst. I need out. Where do I start?” Which is exactly where I was when I realized that I didn't want to be a lawyer. You can go to formerlawyer.com/guide, sign up, and get the guide in your inbox today. When you grab that guide, you get on my email list, which is the way I keep everyone the most up-to-date about everything that's happening with Former Lawyer. It's also the best way to get in contact with me because I read and respond to every email. If you are ready to figure out what's next for you, go to formerlawyer.com/guide, download the free guide, First Steps to Leaving the Law, and get started today.

Hey, Annie, welcome back to The Former Lawyer Podcast.

Annie Little: Oh, thank you. I'm so happy to be back.

Sarah Cottrell: I am excited for this conversation, which should just be a continuation of Sarah and Annie's Voxer conversations as we have talked about before. Why don't we start with you introducing yourself just for anyone who has not listened to one of the episodes that you've been on before, and then we'll go from there?

Annie Little: Yes, I'm Annie Little, a former lawyer, of course, and founder of JD Nation, which is my career coaching and new ADHD coaching business. Yeah, so I just help lawyers find jobs that they actually like and then succeed in them.

Sarah Cottrell: Love it. For anyone who's listening who's like, "Oh, ADHD, interesting," you should go back and listen to the episode where Annie and I talked about her adult diagnosis of ADHD and all sorts of things related to that.

Many people who are listening to the podcast have since been diagnosed with ADHD after listening. If you're a lawyer, and that sounds interesting, you're definitely not alone. Check out that episode.

Annie is here today because we want to talk about something that we talk about a lot in the podcast, and also, Annie and I have talked about in the podcast before, which is related to therapy, which, as you know, if you listen to the podcast, I pretty much on every episode say if you're a lawyer, you need to be in therapy.

If you're a lawyer who's thinking about leaving the law, please be in therapy, just trust me, it will be helpful. But of course, both Annie and I, we both work with lawyers who are wanting to transition into other jobs, whether they're in the law or outside of it.

Because both of us talk a lot about therapy, we often get questions about “What should I be looking for in a therapist? Does it matter what modality my therapist practices?” all of these things.

I've talked on the podcast before about the things to look for, or some of just my opinions about that. Before we get started with this conversation, of course, Annie and I want to be clear, neither of us is a mental health professional. We are sharing from our own experiences and our own opinions. But there are some things about the modalities that people use in therapy that we thought would be helpful to discuss.

Annie, maybe you want to give a little bit of background of how this conversation came about via our Voxer conversation.

Annie Little: Yes, definitely. Also just because they know you and I, we're not mental health professionals, but a lot of what I'm going to be sharing comes from my therapist who's certified in all these modalities and she was beyond thrilled to hear that we were going to do a podcast on this because I referred her to my ADHD episodes.

She was like, “Oh, my gosh, I'm so excited.” She was like, “No way, this is amazing.” Anyway, we were going over some therapy stuff and I was going through something and she was saying, as she often does, “Oh, and listen to that. That's another DBT skill. That's so great.” I'm like, “Uh, yeah,” so DBT, which stands for Dialectical Behavioral Therapy, which just even that, I'm like, “What even does dialectical mean?”

But she's always saying that to me, then I'll go afterwards and Google what is dialectical behavioral therapy? I'm like, “Uh.” It doesn't stick, especially because the main stuff that comes up if you're googling it right now, you might be saying, “Oh, it's people with schizophrenia and borderline personality.”

So you’re like, “Obviously, that's probably not what it's being used for for me.” But then you dive deeper and I know Sarah, you and I talked about this a little bit too, you Google it and you dig down and you're like, “I kind of get it,” and then nothing sticks.

I've been with the therapist for two and a half, three years. I'm like, “Okay, so you say DBT skills,” she'll be like, “That's this DBT skill.” I'm like, “I have no idea what you're talking about.” She's like, “Oh, no, you know, you know,” and I'm like, “No, I really don't.”

So in this particular context, we were talking about a situation where somebody was acting in the way a narcissist would act, very manipulative, gaslighty, all those things. I was like, “Is DBT basically like being good at dealing with narcissists?” I said it jokingly and she goes, “Well, yeah, actually, it kind of is.” I was like, “What?” She's like, “Yeah. One of the ways that it's used that isn't broadly broadcast is for people who were raised in invalidating environments.”

I was like light bulb. I mean, first of all, I'm like, “I must talk to Sarah about this.” Then all these other thoughts about wow, I mean, I come from a family with narcissistic parents, you've done at least one episode, I'm thinking of where you talked about the legal profession being like a narcissistic system, and just that whole sense of “Oh, being invalidated,” especially because what I then said to my therapist was, “Oh, that seems to make a lot of sense to me because I have such a strong aversion to CBT,” which is Cognitive Behavioral Therapy, which more people have heard about it.

She said, “Oh, for sure because with CBT, it can feel like you're being gaslighted if it's not being used appropriately.” I'm like, “Yes. That's how I feel about it.” Then she has never used CBT with me. She's like, “We haven't needed that for you because it is designed for cognitive distortions primarily. Things that are objectively not true.”

Whereas things that are open to interpretation, i.e. your experience, those are better suited to other modalities like DBT or something else. I was like, “Oh, my gosh, must talk to Sarah.” Then you probably got two max link Voxers from me.

Sarah Cottrell: 15 minutes.

Annie Little: 15 minutes times two, and being like, “Hey, does this make sense to you?” And knowing that I also remembered that we had talked before that you had a successful experience with CBT.

You and I had talked about how CBT can feel invalidating, but then you had also said, “I've done CBT and it worked well,” so I wanted to explore that with you if you were willing to because I thought, “This is going to open up a lot of doors for us in terms of helping our coaching clients to find the right kind of therapist.”

Sarah Cottrell: Yeah, I think it's so important for so many reasons. First of all, I have a very similar experience as you have with DBT. I know we talked about this where I felt I kept looking it up because I was like, “Wait, what is it again?” Then I'd read something and I'd be like, “Okay.” Then I'd completely forget and the next time I heard the term, I'd be like, “Wait, what is it again?”

I think something that is helpful, I think for people to understand is that CBT is very widely taught and very widely practiced. There is nothing inherently wrong with CBT—and I will talk more about my personal experience with CBT as we're having this conversation here—but the thing that is challenging, I think, especially for lawyers, especially if you are existing in a system that is narcissistic or you're working for a narcissist, is that if you're not working with a practitioner who's skillful and is able to recognize as your therapist did, Annie, when it is appropriate to say, “Oh, this is a cognitive distortion situation or this is a distress tolerance situation that is CBT-able,” you can end up in a situation where everything is being treated as a cognitive distortion, whether or not it actually is.

The reality is that, as I know people who have listened to the episode where I had a conversation with Kelsey about narcissistic systems, the reality is that many people who become lawyers either were raised in or currently work in a system that is narcissistic, that is very, what did you say, emotionally invalidating or invalidating environment?

Annie Little: Just being raised in an invalidating environment, yeah.

Sarah Cottrell: Right. The challenge, of course, is that if that is your background, it's not that you don't experience cognitive distortions, but it is unlikely that applying a blunt instrument of like, “Let's just treat all of the challenges that you have,” as though they're the result of cognitive distortions is going to be highly problematic because, in fact, it's not appropriate for you, your experience, and your situation.

It might be helpful at this point for me to talk a little bit about my personal experience with CBT for people to understand how CBT can work versus how I think you sometimes see it talked about or applied.

A big part of it is CBT is one of many modalities that a therapist can use. However, the intent of CBT, as I understand it and as I've experienced it in terms of it being practiced, is that it is more geared towards dealing with specific situations or experiences where you are basically going to go to a therapist and work on that specific issue for a limited period of time.

While a therapist who you work with on a longer-term basis may use CBT as one of their modalities, CBT is not intended to just be something that is endlessly applied to all things indiscriminately.

For example, I know I've talked on the podcast before about how I have clinical anxiety and panic disorder. When I first started having panic attacks, or after I had my first panic attack where I went to the ER because I literally thought I was dying and I was not, it was panic, my psychiatrist at the time referred me to a therapist who used various modalities, but one of them was CBT.

I was specifically referred for CBT related to panic attacks because one of the things, and I'm sure many people who are listening know this because as I have learned in this work, so many lawyers have had the experience of having one, if not multiple panic attacks, if not, actually have a clinical panic diagnosis.

But one of the things with panic is that you can get into a cycle of essentially anticipating that you'll have a panic attack and that anticipation dials up your nervous system to the point that it actually increases the likelihood that you'll have a panic attack.

One of the ways that CBT can be used was how I experienced it, which was basically working through the distress tolerance for panic and cognitive distortions around the panic to decrease the occurrence of the panic, essentially being able to train your nervous system to know, “Hey, I might panic and that would suck, but also I will survive and I don't have to be constantly bracing against the possibility of panic.”

I can't remember exactly, but I think I met with the therapist for, I want to say it was 12 sessions and it was specifically around having panic, anticipating panic, and ways to decrease nervous system dysregulation around the anticipation of having a panic attack.

I'm pretty sure we even used a workbook that was like week one, week two, whatever. The thing about any of these methods or therapy in general is you hear me talking about it, and if you're someone who has experienced a panic, for example, it can sound like, “How can that really be helpful?” Or “I already know all of those things.”

But one of the things that is true, and this is what we're talking about, CBT or DBT, or many of the other things, many of the other modalities, is that you can know it cognitively, but sometimes going through the process is helpful.

For me, that CBT process of understanding the panic, creating distress tolerance to the symptoms that I would have when I had a panic attack or when a panic attack was threatening, those things were very helpful.

Ultimately, I met with that therapist for 12 weeks-ish, and then essentially graduated. It wasn't because, “Oh, I'm never going to have a panic attack again,” but it was because the CBT was specifically geared towards acquiring certain skills and dealing with the panic in a particular cognitive way.

The reason I think that this is important for people to know is one, I know I've said on the podcast before that CBT can be very inappropriate for lawyers, however, it can also be very helpful. I think the distinction is whether or not your practitioner is able to apply modalities as appropriate as opposed to just blanket application of the ideas as opposed to applying them as they are actually designed and meant to be used.

Annie Little: Yeah. When you were talking about the workbook thing and saying that might seem like, “How would that help?” But one thing that when people talk about CBT, when they're coaches or whatever, and you see it, and they're talking about change your thoughts, change your feelings, for me, I'm like, “How can I change my thoughts about something that's true?”

That's a big difference. With the workbook situation, I also have panic disorder, but the thing is when you're in a state of panic or anticipation of panic, that's a state of emotional dysregulation.

When you're in the state of, I'm saying this generally, you obviously know this, Sarah, but when you're in a state of emotional dysregulation, it's harder for you to access that cognitive intellect to be like, “That's why this is going on.” So having a workbook and being able to have gone through that process or to be able to look at that process as you're going through it, that's really helpful because with emotional dysregulation, you can go from zero to 100 with no thoughts. No thoughts, just panic vibes.

Sarah Cottrell: Panic vibes.

Annie Little: Panic vibes. No thoughts, just panic vibes.

Sarah Cottrell: I'm laughing because it's so accurate.

Annie Little: Right. Maybe another way to think about it is we need those steps because when we're in a state of regulation, it's like, “Oh yeah, obviously, this workbook seems stupid,” obviously, I get that, but as soon as you're in a state of dysregulation around panic, you're like, “Ah, ah, ah,” and then you just start panicking.

So 12 weeks of working with somebody sounds about right to learn like, “Okay, this is what I do in this situation and I'm able to implement it.” Then you're done.

Sarah Cottrell: Yeah. Here's another example of a skill that I learned or that I did during that time that helped me in terms of increasing distress tolerance for panic. This is going to sound so basic, but you know those little coffee straws that are really tiny? For me, when I panic, and this is very common for a lot of people with panic, when I have a panic attack, I feel like I can't get a full breath even though I actually am getting a full breath.

One of the things that I did as part of the exercises in that period of 12 weeks CBT was basically breathing through a coffee straw for a certain period of time. I can't remember, like 30 seconds or whatever, and either focusing on a specific image or thinking about something specific.

Basically, the idea is you are training yourself to know that “I feel like I can't get a full breath, but I’m okay. My nervous system does not need to further spiral as a result of this.” That's an example of something that's very tactile. That was a specific skill that I learned as part of that CBT experience.

Basically, what I think is so important for people to know is that CBT can be extremely helpful. However, when it's collapsed to just you have cognitive distortions and all your issues are coming from cognitive distortions, that's incredibly problematic because one, many of the things that you think or perceive are not cognitive distortions.

If you're being told they are, then you're basically being told you need to believe something that is not accurate, which is going to be very difficult to do and not be effective, but also is particularly problematic if you're dealing with a system where there's any sort of narcissists because one of the hallmarks of being in a relationship with a narcissist is essentially them gaslighting you and telling you, "Oh, you feel like this, or I'm making you feel this way by creating this environment, but actually it's your fault for feeling that way." Then CBT and the way that it's applied, if it's applied indiscriminately, can feed into that.

Annie Little: Oh, yeah, it's extremely triggering. That is what made so much sense to me in learning more about this. Whenever somebody says something about “Oh, well challenge your thoughts about this,” I'm like, “I feel so triggered and anxious right now,” and it's because when it's not a cognitive distortion that's being funneled through the CBT framework, it feels like being taken advantage of by a narcissist all over again.

Because in that episode that you and Kelsey did about narcissistic systems, it's like you would think that because we have so much exposure to these narcissistic relationships, we would be inured to them, immune, but we're actually even more sensitized to them, we're more sensitive.

When you guys were talking about that, I was like, “Yes, so much that.” Whenever I see people just broadly talking about CBT stuff where it's like, “Oh, that's just not true. That's just something that you're telling yourself or it seems that way,” I'm like, “No, no. Go away.” If you're feeling very triggered by that modality, I mean that can be something if you also know that you spent a lot of time in a narcissistic system, relationship, whatever.

Sarah Cottrell: Yeah, and I think this is something that you can definitely be looking for as you're looking for a therapist. People will ask me, “Do I need to find a therapist who's a former lawyer?” I say, “No because literally none of my therapists have been former lawyers.”

Annie Little: No. And they all have a bunch of lawyers as clients. All of mine have been like, “Oh, yeah, I have tons of lawyers.”

Sarah Cottrell: 100%. But you do not need to have a former lawyer who's a therapist. However, it is very helpful to know what modality a potential therapist applies. In particular, you really want to understand to what extent are they going to be practicing this cognitive distortion, so we need to change it.

Because if they do not have experience with narcissism or narcissistic systems, and if they are over-applying CBT or using it in a way that it is not intended to be used, which is that more directed and time-limited application that I talked about, then them not being a lawyer combined with that can be very problematic because you are more likely to end up in a situation where you're being told your perception of your workplace or your perception of your boss is wrong, or the way it makes you feel is wrong, when in fact, it may not be that you have a cognitive distortion.

In fact, in many cases, you do not. It's that the person or the situation is exactly as problematic as you think it is. The tools that you need are something different than trying to change how you perceive the situation.

Annie Little: Yeah, hey, so we can cut this if it seems out of whatever, but ADHD, I made this random connection just now, as we're talking about this, you and I are very literate in anxiety, panic, and all that, and a lot of your listeners are as well, but I was thinking for anyone who hasn’t had panic attacks in the way that we have or doesn't quite understand that, because I feel like the idea of cognitive distortion, or an interpretation of something, that can get muddied, like, “Well, you can have an opinion about something, but you can also have a cognitive distortion.”

One place where I've seen CBT be really effective, like when I'm talking to my husband who doesn't have any of these things that I'm trying to explain, trying to basically rehash our conversations with him and he's like, “What?” So I love watching Hoarders and they always have a therapist on site to help people navigate.

This is one way to think about it, a cognitive distortion is looking at an old newspaper with mouse poop on it, and that person being like, "Keep it. I'm not throwing that away," that is a cognitive distortion that there is value in that and that it's okay and it's not contaminated.

The therapist will say, "We're going to do some CBT with them to help them address this cognitive distortion." But what's important to understand is that those cognitive distortions stem from trauma. They start with the CBT to be like, "Look, this is contaminated. This can make you really, really sick. Your pets are really sick because of the state of your environment."

Then they know that there's an event that really made their hoarding spiral. They stop using CBT once they start addressing the trauma. The CBT is like you've developed these cognitive distortions as a survival mechanism or a coping mechanism.

It's objective to everybody except the hoarder in that moment that this old newspaper covered in mouse droppings is not a thing of value and should absolutely be trashed.

You can see it works pretty quick. I mean, they start with CBT, then they have to address the trauma and relationships with their family and whatever else. But then they have a breakthrough where they're like, “It's just an object. It's just trash.”

There's that distress tolerance where they feel like, “If I throw this thing away, I'm throwing away a piece of myself or a piece of somebody or whatever.” Then they have the breakthrough and they're like, “No, this is just a piece of garbage. It's going to feel scary to put it in the dumpster, but I'm going to survive.” Then it snowballs from there.

I don't know if that'll help people, but I feel like sometimes panic in talking about other people, they don't really get it. But I'm like, “You get a piece of garbage covered in mouse poop that if somebody thinks that's valuable, that's a cognitive distortion.”

Sarah Cottrell: Yeah. Here's an example that I just thought of in terms of a work context. This is going to be entirely based on my experience, let's say that when you get an email and you see the little envelope pop up in the lower right hand of your computer, some part of you is just like, “Oh, my goodness, it's the end of the world. This email is just a threat.” It feels like an immediate threat.

There are pieces of that response, at least in my case, that were a cognitive distortion of this sense of this email is life-threatening, it was not actually true that the email was life-threatening.

However, the sensitivity to that, the sensitivity that had developed, was not about the email and actually thinking the email was life-threatening. It was about feeling a pressure to constantly be on top of things and never drop any balls and basically be perfect because news flash, perfectionism is a very, very commonly a symptom of having had some sort of, let's say, emotional trauma and you develop perfectionism in order to try to avoid whatever emotional harm would have occurred if you did not/if you do not behave perfectly.

That's an example where someone might, in terms of applying CBT, you might talk about or work through the reality of “Okay, when this little envelope pops up on my screen, that is not literally a threat to my life.”

However, if you don't also deal with the underlying state that results in that being your response, and if you don't also layer in the reality that in many legal workplaces, yes, it is not literally life-threatening, even though your nervous system is like, "Oh, my goodness, it's a lion," the reality is that there is a lot of emotional distress being perpetrated by actors in these systems and it is reasonable as a human to not want to, for example, be belittled or talked down to.

So part of what is bringing up that response is the reality that you know what the email could be, although it isn't necessarily an email from someone who you are in a working relationship with, who could ultimately, and has in the past, responded, reacted, or treated you in these ways that are harmful.

Again, in that whole scenario, there is some aspect of cognitive distortion, but that's not the only thing that's at play. This is why I think it's so important for people when they're thinking about therapy and what modalities they are interested in having their therapist be acquainted with, it is so important to know, for example, how would a therapist approach that particular situation?

Because, yes, you can deal with the cognitive distortion of “This email is not a literal threat to my life,” but the problem is if it remains there, it turns into “It's your fault because you're overreacting to this email.” There's so much more going on there that requires support. Even in terms of the realities of the situation than just “I'm overreacting to this email so this is all my fault.”

Annie Little: Yes. That little envelope thing is the newspaper covered in mouse poop. That's it. A little email, the little envelope popping up. Then once you get past that, that's where your therapist needs to be able to recognize “We're going to use these other modalities because we know what the underlying emotional trauma is,” and they're going to dive into something else.

Also, the distress tolerance that CBT addresses, that's also a component of DBT. In some ways, there are some, as with everything, so much nuance. Part of CBT is also part of DBT. Didn't you say that DBT came out of CBT or vice versa or something? Again, all the things we Google, can't remember. But there is some overlap in these things as well.

To your point, the most important thing when picking a therapist is not so much “Do you do CBT? Do you do DBT? Do you do IFS?” It's like, “Here are the types of things I'm struggling with. What would your approach look like?” Then having that therapist explain how they would approach it and seeing how you feel about it.

Sarah Cottrell: Yeah. I think a huge part of it is that CBT relies on cognition and rationale. So being rational and the ways that you're thinking might be distorted or the ways that you may be getting overly tangled in your thinking, whatever.

If the thing that you're struggling with is something that is not purely cognitive, then the limitation of CBT is in the name, it's the limitation is that if what is happening is not purely something that you can apply logic and reason to, to walk back, then there's going to need to be something else brought in, whether it's DBT or one of many other things, as you said, like Internal Family Systems Therapy, somatics, all of these things.

Annie Little: EMDR.

Sarah Cottrell: Right. Whereas DBT is, I don't want to say that it's not based on cognition because it still does, like you said, have a lot of skills, there are many DBT skills where there's some overlap, but it ultimately is not to look at cognitive distortions. Ultimately, DBT skills are based on your feelings are what they are, and let's deal with them as is, or even your thoughts are what they are, and let's deal with them as is.

Annie Little: The radical acceptance skills. That's the DBT thing.

Sarah Cottrell: Yeah. The other thing that I just thought about that I think is important to note is that when you and I are talking about DBT, we're really actually, and I know we've said the term several times, but we're really talking about DBT skills, because DBT, dialectical behavioral therapy itself, is actually this whole process of being in group therapy and individual and other things and at least six months and all of this stuff.

A lot of times when people talk about using DBT and therapists talk about using DBT and their practice or as we're talking about DBT, what we're really talking about is not the full-blown DBT, but rather some of the DBT skills that are part of that type of therapy modality that can be brought into therapy even with other modalities.

Annie Little: That’s such a good point.

Sarah Cottrell: Yeah. Because the thing is there is a difference between the individual skills and the actual approach and what it is designed to treat or how it can be used and its limitations.

Annie Little: Yeah. It's interesting too, because as you talk about that, it's reminding my therapist when I was asking her about this stuff, she said she used to hate DBT. She was like, “What is it?” Because even she, as a practitioner, would read the DBT textbooks or whatever and she'd get done and be like, “What did I just read?”

There was all this stuff because the primary purpose is it's for these group therapies and for schizophrenia and these really serious other conditions. To bring it all back to the workbook, she said that she got this adolescent workbook for DBT skills for some reason and she went through it and she was like, “Oh, oh, DBT skills,” and then she went and got certified in DBT.

She was like, “Oh, this is actually really valuable.” So I'm so glad you brought that up, Sarah, because it's about the DBT skills that can be taught. It's not to say that you would necessarily need to go through the whole DBT process, but just building those DBT skills in the same way that you would build CBT skills is super helpful.

Sarah Cottrell: Yeah, and I think the reality is that to a pretty great extent, I think some of the negative things perceptions, maybe I should say most of the negative perceptions of CBT I think are largely, and even the things that I don't like when I see someone talking about CBT is that it's just being applied indiscriminately as though all problems, emotional or otherwise, are absolutely the result of some sort of cognitive distortion, that you're not dealing with any sort of reality.

Annie Little: Like you're living in the matrix. If every thought you have is a cognitive distortion and everything that is problematic for you, you can apply the model of CBT to, then you're living in the matrix. How can every single thought you have potentially be a cognitive distortion?

Sarah Cottrell: And I think fundamentally, the indiscriminate application of that type of let's say, distortion of CBT is that it particularly is problematic when applied to either people within systems that are in some way unjust or individuals who are at some sort of disadvantage because there is a very strong tendency when you're indiscriminately applying CBT principles to essentially attribute any problem someone might be having to their own individual inputs and ways of thinking. When CBT is applied indiscriminately, it does not allow for the reality that there are many things that contribute to someone's experience.

Annie Little: Institutionalized racism, for example.

Sarah Cottrell: Yes, yes.

Annie Little: I saw a post years ago where somebody was talking about it and they're like, "That's just a thought that you have. Racism is a thought, it's a construct, it's not real." I was like, “Oh, boy, delete your account. Delete your account.”

Sarah Cottrell: Yeah, yeah. In the legal profession, which is still highly patriarchal, highly misogynistic, and highly many other things, to indiscriminately apply CBT to the challenges that people operating that system are facing, would ignore the ways in which those realities significantly influence the experience of everyone in that system.

This is all a very long way of saying that both CBT and DBT can be helpful. DBT skills in particular can be extremely helpful because of the reality that many of us who became lawyers did grow up in emotionally invalidating environments or in invalidating environments. Why do I keep saying emotionally invalidating? Hmm, interesting.

Annie Little: Interesting.

Sarah Cottrell: But the thing that I think is so important for people to know is that you really want to be looking for someone who understands the nuances. These are some of the things that you can be thinking about and asking about when you are thinking about working with a therapist, what modalities do they use, how have they used CBT in the past, or even to talk about how they might approach a particular instance of behavior or something because they do not need to be a lawyer at all.

However, they also need to not be telling you that everything that you perceive is probably wrong and ultimately you are the problem because let's be real, as lawyers, that's basically what you're being told or have been told for a very long time.

Annie Little: Yes, and I love how you said asking them how they would address certain behavior. For my fellow ADHDers out there, because a lot of people that have recently been diagnosed, something that they'll ask me in addition to medication options is, “Is there a therapy that can be helpful?”

Again, people with ADHD are far from a monolith. But if it's something that you're looking into, and especially if you're newer, it doesn't really matter. If you have ADHD, the CBT can be extremely invalidating as well. Although your practitioner doesn't need to be an expert in ADHD, for example, my therapist is not so there's some two-way education going on where I'm explaining, but the thing is she's not wielding CBT like this hammer and every issue I have is a nail.

She comes from a place of curiosity and like, “Trust in me that what I am experiencing is real.” She's not there to further invalidate my experience. People with ADHD, especially those of us who were not diagnosed for many, many years, even if you never have had experience with a narcissistic system, the experience of feeling invalidated is your entire existence as someone with ADHD.

Again, while there are some instances where CBT can be helpful for certain things with ADHD, I wouldn't know because I have undiagnosed ADHD for so long and came from a narcissistic family situation and then went straight into a narcissistic system like lawyering.

I have it from all different ways, but let's say you had a wonderful upbringing and you've had wonderful work experiences, you just want to find something new and you happen to have ADHD, it's still very worthwhile to make sure that anyone that you're going to work with is going to believe that your ADHD is real. Because yes, there are many, many practitioners out there who still don't think that ADHD is a legit thing, especially "adult ADHD," so it's just another thing to layer in if you've got that additional fun brain that so many of us lawyers have with ADHD.

Sarah Cottrell: Yeah, I think that's really important. In preparation for this conversation, speaking of DBT workbooks, I bought an ebook that was on a Kindle Daily Deal a couple of weeks ago, a DBT workbook for teens with anxiety and I actually bookmarked something.

I'm just going to read this. It’s basically describing so many lawyers. Anyway, so this is what it says. It says, “Do you tend to get stuck in thinking traps, all-or-nothing thinking, catastrophizing, disqualifying positives and focusing only on the negatives, assuming you know what someone is thinking and feeling, believing that you or someone else or a situation should be a certain way, generalizing from specific situations, or blaming yourself for things over which you have no control?”

Annie Little: Check, check, check, check.

Sarah Cottrell: Then it goes on to say, “Dialectics is a helpful way to think and act more flexibly and get unstuck.” I was like, “This is literally describing so, so, so, so, so many of us who have become lawyers.” Literally check, like you said, check, check, check, check, all of those things.

All that to say DBT skills can be helpful if you are someone who is like that, which as you're a lawyer and you're listening to this podcast means there's a reasonable possibility that that is the case.

One of the reasons we wanted to have this conversation is that we just get asked a lot, each of us, for advice about how to find a therapist, what to look for in a therapist. While we have both had lots of therapy, we are not experts in any way, but I think that this particular issue is something that is really important and can be a really helpful way to think about what you might be looking for in a therapist and how to identify someone who is going to be a good fit.

Annie, do you have anything else that you think people should know or that we should talk about in terms of DBT versus CBT and how lawyers should think about finding a therapist or anything else?

Annie Little: Yeah, as you were saying all that, I think it's worthwhile to ask when you're interviewing therapists or whatever, what their thoughts are on DBT because thinking about my practitioner, if I had met her 10 years ago, we wouldn't have been a good fit. Not because she was using CBT, but because she wasn't using DBT skills because she wasn't into it.

Now that she's into it, we're a really good fit. So it's like not a personal failing on the part of your therapist, I just think it's something that would be something that you would want for them to have in their toolkit that they could draw on in their work with you. And same, they should have CBT in their toolkit as well in case you need that too. Maybe just add that to your list of must-haves or nice-to-have things when you're looking for a therapist.

Sarah Cottrell: Yeah. As you were talking, I just had the thought that another helpful question to ask a potential therapist is “How do you go about determining whether your client is or your patient is dealing with a cognitive distortion versus there being some other underlying issue?” Because that can also be a really helpful way to get a sense of their approach and how they might address those issues.

Annie Little: Their first line of defense is, we want the first line of defense to not be CBT when we're talking to lawyers.

Sarah Cottrell: Yes, in general, you're probably in a situation where you do not want to be made to believe that your reality is not what it is in your workplace in particular, which again, to be clear, we all have cognitive distortions and I've talked to some about, I could ramble on for quite a long time about various things that came up, or that I dealt with in CBT.

One of the things I will say, one of the skills that still occasionally I bust out if things are just really going haywire is I started practicing what was called worry time during my first stint with CBT.

Worry time is basically if you find yourself constantly thinking about and ruminating on issues throughout the day, whatever they are, basically, your brain is just constantly looking for something to be like, “Maybe this is horribly wrong. That would explain why I'm feeling all of this physical anxiety.”

Literally, in a notes app on my phone, if I had a thought of whatever, I'd be like, “Write it down,” and I would tell myself, “I am going to worry about this. But I'll do it later.”

Annie Little: Compartmentalization.

Sarah Cottrell: Then at 8:30 or whatever at night, or later, I would basically sit down with my note like, “This is now my worry time.” That was helpful for me in two ways. One, because just telling myself, “Just don't think about anything that might go wrong,” was not going to do it for me.

Annie Little: No, no.

Sarah Cottrell: But also, it was this recognition of “Yes, you can worry about these things,” but also I would get to worry time and often some things that had felt so urgent during the day, I'd written them down and been like, “Oh, my gosh, okay, I'm going to put it aside,” I would get to worry time and be like, “Actually, I don't really feel like I need to spend time worrying about this.”

Annie Little: Oh, that's awesome.

Sarah Cottrell: That, again, is one of those things that I think when you talk about it, some people are like, “That sounds weird.” But that is a CBT skill that even now, I don't have to use it very often. But if I find myself getting into a situation where my brain is just constantly trying to latch onto whatever thing to ruminate on because it's like, “I need to worry because worrying is productive,” I will start doing worry time and have a worry time note on my phone.

Generally for me, at least at this point, pretty quickly, it'll break that essentially habit, the habit of needlessly ruminating.

Annie Little: That's amazing.

Sarah Cottrell: What we're saying is CBT can be helpful. DBT can be helpful. As lawyers, DBT can often be particularly helpful, but also a huge part of it is how your particular practitioner applies it, and avoiding someone who's just indiscriminately applying any modality is really the key unless you are specifically looking for someone who is practicing that specific modality to address a very particular issue.

Annie Little: Like hoarding. I'm sure you've got lots of hoarders listening.

Sarah Cottrell: As I look at our basement situation, which is truly questionable, anyway.

Annie Little: As long as there's no [cat pellets] in there, you're good, you're good.

Sarah Cottrell: All the real thoughts here at Former Lawyer HQ. All right, well, Annie, I really appreciate you coming on and talking with me about this. I know that you and I both get a lot of questions about therapists and therapy and what to look for. Hopefully, this will be helpful food for thought for people as they're thinking about getting a therapist because if you haven't gotten a therapist yet, 10 out of 10 recommend.

Annie Little: Hey, you should get a therapist because it's Tuesday.

Sarah Cottrell: Yeah, exactly. Perfect.

Annie Little: You don't need any other reason.

Sarah Cottrell: All right. Amazing. Annie, if people want to connect with you, where can they find you online?

Annie Little: You can find me at thejdnation.com or on LinkedIn. It's Annie Little on there. I'm kind of on a hiatus. But I've got tons of content that's already on there and I do pop in from time to time still.

Sarah Cottrell: Amazing. All right, well, thank you very much for joining me, and thanks to everyone for listening.

Thanks so much for listening. I absolutely love getting to share this podcast with you. If you haven't yet, I invite you to download my free guide: First Steps to Leaving the Law at formerlawyer.com/first. Until next time, have a great week.