Josh Hillebrand LCSW

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“Do I Really Need Therapy?”
Why People Doubt Therapy

I’ve worked with a lot of clients who struggle with doubt about whether or not they really need therapy. For some of them, the act of seeking therapeutic support itself elicits guilt and self-criticism. In fact, this is something I experienced when I first sought therapy at my college counseling center when I was an undergraduate student. I felt like there was something phony or manipulative or overly dramatic about the idea of going into a therapist’s office for an hour each week and “talking about my problems” when I was aware that so many other people seemed to have it worse. I thought I should just be able to “toughen up,” “pull myself up by my bootstraps,” and carry on. I struggled with this so much that I would schedule sessions only to later cancel them – I lost track of how many times I did that! In retrospect (and after working on this issue with my therapist), I came to realize that this pattern was an ego defense. Telling myself that I didn’t really need therapy was a way of telling myself that I really wasn’t hurting (even though I very much was at the time). It was a denial of the pain I was feeling. Thankfully, I have a patient and caring therapist who helped me work through that in order to progress to talking about the stuff that was contributing to my suffering.

Reasons To Seek Therapy

If you’re like I was, and you’ve been wrestling with the idea of therapy, here’s a non-exhaustive list of valid reasons to seek therapy:
- Because you want to
- Because you’re experiencing some kind of pain in your life (this could be emotional, psychological, physical, spiritual, relational, work or academic, familial, intergenerational, systemic, sexual pain)
- Because you’d like a trained therapist’s perspective on what you’re going through
- Because you need to tell your story (or a specific part of it)
- Because you want to feel closer to other people
- Because you want to feel closer to yourself
- Because you’re experiencing symptoms like panic attacks, rumination, insomnia, self-harm, difficulties with substance use, or others
- Because you had a difficult childhood or upbringing
- Because you had what seemed like a perfect childhood with perfect parents but you’re still feeling “off”
- Because it seems like your inner critic is winning most of the arguments in your head
- Because you want to accomplish something or have healthier habits
- Because it feels like you’re out of control
- Because it feels like you’re overly controlled (such as constant planning, work and productivity, being early to every appointment, thinking and thoughts and intellectualization are the only ways you know to connect to the world)
- And so many more!
Find A Therapist You Connect With

Notice that the first reason on the list is simply because you want to. That is as valid a reason to seek therapy as any other. Therapy can be a powerful healing experience. Of course, it is important that you find someone who gets you and who you connect with and who you feel safe with. And that can take some trial and error. I didn’t connect with my first therapist but I’m so glad I gave it another shot because I found a therapist who is one of the most compassionate and wise people I have ever known. So, if you’ve been chewing on whether or not to seek therapy, I hope this provides you with the encouragement you need to start the process today!
December 11, 2025
Working with Anger
I’ve been working on anger with a lot of clients recently. Some people need support in acting on their anger. For these folks, they tend to be conflict-avoidant, will push down their anger, put a smile on their face to keep the peace. Others need help taking a step back from their anger – right now, they’re entire body-mind is getting hijacked by anger and they are lashing out at themselves and others in ways that later elicit a lot of shame and guilt.

Anger is a powerful emotion. It’s definitely something I have needed to learn to work with time and time again. Even still, I can still go into judgment mode with myself for getting too “irrationally” angry because the pedestrian in front of me is walking so slowly (and I have places to be!!!) or if I get mad about losing a game of online chess and my brain produces all sorts of expletive-poetry.

For me, it’s also an emotion that has been influenced by multiple social constructs (emotions are never just biological phenomena happening in a vacuum). In terms of gender, men are often sanctioned to be more attuned to and expressive of their anger than other emotions. It’s more expected to see a man yelling in public than crying in public. In terms of religion, anger has Old Testament connotations for me. I was raised in a conservative, fundamentalist Christian household so reading about the wrath and jealousy of angry and just God was a frequent occurrence. In terms of race, my whiteness could give me a sense of entitlement that could manifest as righteous indignation.

However, it’s important that, like all emotions, there is something inherently valid about anger. At its core, this emotion is about protection: it can motivate us to stand up for ourselves and our loved ones, to take important action when there is injustice. It’s a part of the human experience. Still, it can be a trickier emotion to navigate because of its power. Here are some tips for working with anger in effective ways.

If you’re someone who tends to avoid anger to an unhelpful degree, reflect on the following questions:
- What are you afraid might happen if you allow yourself to express your anger? That you’ll lose control, that you will lose relationships, or you won’t be able to tolerate the fiery emotion itself?
- Think of where and when and from whom you might have learned that it is not okay to express anger. Did you grow up in a family that tended to sweep things under the carpet? Or maybe you a parent who had such explosive anger that it was terrifying and you learned the message that you can never allow yourself to get to that point?
- See if you can begin expressing your anger to yourself – not necessarily spiraling into a heated form of rumination but rather acknowledging any anger that might be present. Like, “Yup, I’m feeling angry that I lost that chess game and now my cheeks are feeling hotter.” If you work on your ability to mindfully acknowledge and validate anger with yourself, you’ll be laying a foundation to be able to express anger effectively to others when needed.
If you’re someone who tends to be overcome and overwhelmed by anger, such that you’re feeling out of control, here are a few ideas:
- First, it might be helpful to learn a few quick and effective self-regulation skills in case your anger is throwing you into fight-flight-freeze mode during which your prefrontal cortext is offline. I would recommend the TIPP skill in particular for a rapid deescalation method that works by activating the parasympathetic nervous system.
- Next, identify what your common triggers for anger, even for low levels of annoyance and irritability. Information is power, so the more you know about what can set your anger off, the better you’ll be able to recognize it and intervene earlier. If you wait too long to practice regulation skills, the anger will likely take over and be in the driver’s seat. So, it’s important to act when the anger is at a low-moderate leve before it gets high.
- Imagine how you would like to be able to handle situations more effectively. You can tap into a personal sense of values for this – think about how you would like others to think about you and your relationship with anger. Perhaps there is a part of you that would like to be known as someone who can keep their cool, be flexible, gentle, or kind. Then, imagine yourself acting in those ways in the presence of the triggers. This is call imaginal rehearsal and can increase the chance of you acting in these more effective ways when you encounter these triggers in actuality.
- Mindfulness practices can be very helpful, as they can help build our ability to sit with discomfort and delaying automatic reactions that get the better of us.
Feel free to reach out if you’d be interested in doing personal work related to your anger!
November 22, 2025
4 A’s of Acceptance for Difficult Emotions
So much of the world says that if you’re feeling anxious, guilty, shame, angry, sad, or any other painful emotion, then something is wrong with you. Instead, you’re expected to be one hundred percent happy all of the time just like all the smiling faces you see on social media. But this is completely bogus and please throw it out the window. Every emotion – even the painful ones – is there for a reason and trying to give us important information. And going even further, the struggle to not experience these emotions often makes them even more intense and can drive our suffering up. So, the next time you’re feeling an emotion you’d rather avoid, try using the 4 A’s of Acceptance instead:
- Acknowledge the feeling: name it, label it, notice how this particular emotions makes your body feel, say “hello and how are you doing?” to it
- Allow: give that emotion permission to be there, such as “Okay, anxiety and that corresponding racing heart I will let you be here right now”
- Accommodate: pretend that painful, distressing emotion is a house guest and try to greet and host the emotion with a sense of hospitality. In practice, you can do this by imagining that you’re opening up space around the emotion as it is showing up in your body. So, if a sense of guilt is giving you a pit in your stomach, close your eyes and bring that pit to mind and then open up around the pit.
- Appreciate: this can be one of the most difficult and also powerful steps of accepting difficult emotions. Try to connect with even a sliver of gratitude for what the painful emotion is trying to do for you. If it’s anxiety or fear, their likely trying to protect you from or prepare you for something. If guilt or shame, they may be trying to get you to connect with your personal values and to repair meaningful relationships. If it’s anger, it’s also likely trying to protect you, your loved ones, or something else important. If it’s sadness, it could be your body’s way of acknowledging and grieving the loss of something that mattered to you a lot.
Acceptance can be a radically powerful way of being in the world and you can start practicing it today with your own private feelings. Imagine if we lived in a world where everyone was actively practicing acceptance of painful emotions on a daily basis: I sincerely believe there would be far less war, hate, injustice, poverty, climate change.
November 19, 2025
Cognitive Defusion
Let’s say you’re stuck on a difficult thought like “I’m a terrible person,” “Nobody likes me,” or “I’m going to sound like an idiot during my presentation tomorrow.” Traditional Cognitive Behavioral Therapy (CBT) might have you look at the evidence for and against these thoughts, and then identify a more adaptive thought. This can be a helpful approach for some people. But, if that doesn’t work for you, try out one of my favorite concepts and skills from Acceptance and Commitment Therapy (ACT): cognitive defusion.

Cognitive defusion says we don’t need to spend time challenging thoughts. After all, sometimes this can just get us caught up in a back-and-forth with our own mind and result in more and more spiraling and rumination. The idea behind cognitive defusion is that we can use mindfulness to remind ourselves that our thoughts are basically just strings of words in our heads. Further, the skill can help us take a step back from the thoughts, noticing them with curiosity, and this can give us the space we need from these troublesome words. Once we have that space, we can choose something more productive to do with our time, which might look like enjoying another episode of The Pitt or Alien: Earth.

Here are some ways to practice cognitive defusion (some of these are more on the silly side but can be effective but use your own intuition for which ones to try out):
- Repeat the thought out loud as fast as you possibly can for 60 seconds
- Say the thought as slowly as possible (pretend to be the sloth character from Zootopia)
- Sing the thought to the tune of your favorite song or the Happy Birthday song
- If the thought is “I’m a bad person,” try saying “I’m having the thought that I’m a bad person” and notice if that shifts anything for you. Next, try saying “I’m noticing that I’m having the thought that I’m a bad person” and see if that shifts anything further. You could also try writing the thought out and follow the same pattern.
Remember the goal is not necessarily to banish the thought from your consciousness forever. Rather, it’s to help you take a step back when you’re hooked on a thought so you can have more psychological flexibility in a sticky moment. If you have more of this type of flexibility, you could spend more of your time doing the things you actually care about rather than letting that thought distract you for the rest of the day.
November 16, 2025
Do You Have An Addictive Personality?
I’ve worked with a lot of people who were certain and very worried that they have an addictive personality. When people use this label, they’re referring to something like “it’s easy for me to get hooked on something and I have a hard time getting of it.” The so-called addiction can take on a life of its own despite one’s better judgement (or doing something over and over without a mindful, intentional quality of mind). However, in my experience, it’s not just a personality issue. There’s usually something else going on beneath the surface. Here are some of the questions I help people consider when they’re worried about having an addictive personality:
- Substance Use Disorders: Perhaps someone is struggling with a substance use disorder. This can definitely be a difficult and uncomfortable question to sit with. Reflect on what your relationship is like with substances such as alcohol or marijuana or other drugs. Do you continue to use substances even if they’ve done more harm than good, such as getting you into health (both physical and mental), legal, or relationship issues? Maybe your body gets more of a hit or rush or buzz or high from substances compared to others or maybe it takes more of the substance to get a hit or rush or buzz or high than compared to others. Both of those could suggest genetic traits that would increase your vulnerability to a substance use disorder. If you need to use larger quantities or use more frequently, these could also be signs of a substance use disorder.
- Neurodivergence: Impulsivity and sensation seeking are qualities often associated with an addictive personality. But, they’re also common for people who are not neurotypical. In The Neurodivergent Mind by Jenara Nerenberg, she describes that people with neurodivergence often need to find the right level of stimulation. Everyone has a sweet spot for stimulation. Both understimulation and overstimulation can be distressing and result in reduced mental health and in short term efforts to cope that might not work out so well in the long run. If you think you might have an addictive personality, perhaps its a sign that you have a neurodivergent mind and you’re doing your best to find activities or other sources that provide you with the right kind of stimulation you need to feel regulated. I’ve especially seen this in people with under-cared-for ADHD, they get hooked on certain activities and substances. Part of my work with these folks is to help them keep what is working, identify what’s not, and help them find the right kinds of stimulation that can fit into their daily lives.
- Emotional Coping: are you using substances to cope with stress or painful emotions like guilt or anxiety? If you weren’t raised in an environment where the adults around you modeled how to regularly practice emotion regulation (such as a family that either never even talked about emotions or one that thought emotions are more of a weakness best left avoided), then perhaps your “addictive personality” type is really an attempt to find external ways and methods of coping with internal emotional and mood states.
- Disconnection from Values, Meaning, and Sense of Purpose: Someone who is disconnected from their values, meaning in their lives, or a sense of purpose might attempt to cope by engaging in behaviors that could make them think they have an addictive personality. Think of thrill seekers who like jumping out of airplanes for fun or perhaps people who experience many and frequent short-term intimate relationships or people who are “addicted” to their work lives (AKA workaholics) might be struggling with an existential sense of emptiness. On the surface, this might look like an addictive personality but could be a sign that these deeper questions would benefit from exploration.
Again, these are some of the factors that could contribute to someone experiencing an addictive personality. If any of this resonates with your own experience, feel free to comment and share!
November 16, 2025
The ACE Skill or Dropping Anchor
One of my favorite skills from Acceptance and Commitment Therapy is the ACE skill which is also known as dropping anchor.

Imagine you’re on a boat that is trying to get into the harbor. And suddenly there is a huge storm that appears out of nowhere. There are huge waves rocking the boat, horizontal rain, high winds. What should the boat do? If it tries to continue moving towards the harbor, it’s likely going to crash against the rocks, capsize, or get swept out to the sea. So, the boat needs to drop its anchor and wait for the storm to pass.

Same thing for us when we’re hit by an emotional storm. If we’re suddenly overwhelmed by anxiety or rage or guilt or shame, and we try to take action when the emotions are raging, we’re at great risk of making the situation worse. So, these are perfect times for dropping our own anchor to ride out the storm and to get grounded. We can do that with the ACE skill:
- Acknowledge our thoughts and feelings
  - “I’m noticing there’s a lot of anxiety/anger/guilt/shame/hurt present”
  - “I’m having the thought I want to punch that guy in the face”
  - “I’m having the thought that I’ll never be able to recover from this”
- Connect with our body
  - Do any type of movement like clenching and unclenching fists, stretching, or yoga poses
  - Notice with curiosity any body sensations and watch them and how they fluctuate and change moment-to-moment
  - Try sitting in a chair and pressing your feet into the ground
- Engage with the present moment
  - Pay attention to what is actually present for you on a very literal level
  - Look around the room that you’re in and describe objects that you see (shape, color, design)
  - Remind yourself of what time and day it is
  - Ask yourself, what’s going to be helpful for me to focus on and then focus on whatever you identify
Now please note that in the same way that a ship dropping its anchor will not have any affect on the stormy weather, the ACE skill might not get rid of the emotional storm you’re experiencing But that’s not the goal of this skill anyway. It’s to help you stay grounded or anchored until the storm passes, and then you can more effectively respond to the situation later.

You can practice this skill throughout the day, even for a few seconds, and even if no emotional storm is present. I sometimes practice the ACE skill when brushing my teeth!
November 15, 2025
How to Cope with a Crisis: The TIPP Skill
When you experience a crisis – something sudden, unexpected, and immediately threatening, your body will do its job and automatically protect you by sending you into fight, flight, or freeze mode. This can be good and useful if you’re in a situation that demands immediate physical action like jumping out of the way of a car or running out of a burning building. You won’t even have to think, your body will do the work for you.

However, let’s say you are no longer being immediately threatened and/or you’re having a difficult time calming down even after the crisis has passed. Or, maybe it’s simply no longer helpful to be in crisis mode. You’re going to need a skill to help bring the prefrontal cortex – the most recent part of the brain that evolved and which is responsible for executive functioning, planning, consideration of long-term consequences and benefits – online.

To help jumpstart the prefrontal cortex, so to speak (actually, these skills will help down-regulate the body by activating the parasympathetic nervous system). I’d recommend one of my favorite skills from Dialectical Behavior Therapy (DBT), the TIPP skill. But please note you should consult with a medical doctor before using any of these skills if you have a heart condition, are pregnant, or have another health condition that you’re concerned about:
- Tip your body temperature by putting an ice pack on your forehead, hold your breath, and bend forward so your head is between your knees for 30 seconds. Repeat for several rounds until you begin to notice your body down-regulating. For a more intense version, you could submerge your face (just up to your ears) in a pot of ice water and hold for 30 seconds.
- Intense exercise: if you have space, do some sprints, or try some burpees, or even just jump up and down for several minutes. Anything to get your heart rate up like you are doing some serious exercise.
- Progressive Muscle Relaxation: squeeze both feet and curl your toes in as tightly as you can without causing pain and hold for a few seconds and then release and notice the difference. Repeat at least two more times. Then do the same thing with your calves, your upper leg muscles, your core, squeezing shoulders up to your ears, clench your hands into tight fists, squeezing your face so you’re making a tight facial expression. It’s important to pause and notice the relaxed feeling after every “squeeze” round.
- Paced Breathing: try Box Breathing where you inhale for four counts, hold for four counts, exhale for four counts, hold for four counts, and repeat. Or, try inhaling for about six counts and exhaling for eight counts (you can change the numbers as needed but just make sure the exhale is longer than the inhale). My own opinion is that it’s more helpful to aim for long, quiet inhales and exhales through the nostrils only while keeping the mouth closed.
Once the body is in a calmer state (even if not totally relaxed), you will be able to think more clearly in order to consider your next steps.
November 15, 2025
CBT for Depression
Cognitive Behavioral Therapy (CBT) is one of the most well-researched psychotherapy treatments for depression. CBT is based on the idea that our thoughts and beliefs have more of an impact on our mood than the situations we find ourselves in. Consider the following example: someone is thinking about cleaning their apartment. In one scenario, they have thoughts about how nice it will be to have the apartment clean, imagine inviting friends over to hang out, remind themselves they don’t have to clean the whole place at once. In another version, especially if someone is depressed, they might have thoughts like “I’m too tired,” “let’s wait another day,” “no one will want to visit me anyway.” The person in the first scenario is much more likely to clean the apartment which is aligned with their goals. Not so much when the brain is depressed and having all these Automatic Negative Thoughts (ANTS).

CBT has a whole program for helping people begin to notice their automatic thoughts and how these thoughts affect their behaviors and feelings. As a side note, this is why I often use mindfulness interventions with clients, because we all need to build the muscle of being able to notice our thoughts and thinking, and then deciding what to do with them instead of just automatically getting swept away by them. The idea is that when the brain is depressed, it’s not thinking all that clearly. It gets pulled into what we call cognitive distortions or thinking mistakes. Like black-and-white thinking, personalization, mind-reading, and a whole lot more. This is one reason why it can be so hard to live with depression – in a very insidious way, your thoughts are working against you.

Further, the underlying theories of CBT suggest that our ANTS can often be traced back to maladaptive core beliefs which usually fall under one of the following categories:
- I’m unloveable
- I’m unworthy
- I’m incompetent
These harmful messages likely got stuck in our brains because of painful negative events or relationships that we experienced at some point in life. CBT will help people begin to identify what their maladaptive core beliefs are, help them identify what they would like to believe about themselves, and begin taking actions in accordance with the adaptive beliefs.

If you’re suffering from depression, please seek out professional help from a licensed therapist to get the help and support you deserve!
November 14, 2025
Exposure and Response Prevention (ERP) for OCD
One of my specialties is treating Obsessive Compulsive Disorder (OCD) with a type of therapy called Exposure and Response Prevention (ERP). This is one of the most researched treatments for OCD. To understand how it works, you also have to know a bit about how OCD works.

OCD is characterized by obsessions and compulsions. Obsessions are unwanted intrusive thoughts and compulsions are any action or behavior that attempts to provide relief from the obsessions. But, as people begin using compulsions, they often have to do more and more to cope with the same obsessions. I’ve worked with many people who started treatment when it felt like they were spending most of their waking hours engaged in compulsions. This left them feeling burnt out, stressed, depleted and like they didn’t have any time or energy for all the good stuff in life.

The unwanted intrusive worries that characterize obsessions can usually be categorized into different themes. Here are some examples of different OCD themes:
- Contamination OCD: you might have intense worries about germs and use compulsions like excessive hand-washing, doing the laundry several times a day, going through a bottle of hand sanitizer in a few days or less
- Harm OCD: worries about impulsively hurting someone else or hurting oneself, blurting something inappropriate out loud, etc. Compulsions might include avoiding sharp objects, biting the tongue, staying away from subway platform edges and keeping your hands in your pocket.
- Pedophilia OCD: intrusive thoughts that you might be a pedophile even though you really aren’t. You might have compulsions that tell you to avoid going anywhere near kids or tricks to get the thoughts to go away (which usually only works temporarily)
- Religious/Morality OCD: worries about being immoral, doing something profane or sacriligious, having “bad thoughts” about religious figures. Compulsions might include avoiding religious practices and activities, or over-engaging in religious practices such as praying for forgiveness or mercy because of the “bad thoughts” multiple hours a day.
- There are many more themes too!
ERP works by helping clients approach and expose themselves to the distressing stimuli (i.e., we’re going to stand on the edge of the subway platform, we’re going to touch the inside of the public trash can). It also helps clients learn skills to decrease compulsions (this is the Response Prevention aspect of ERP). This can be one of the most challenging types of therapies for anyone to do and requires a skilled therapist trained in ERP to support clients as they seek change. While these exposures can be intense in the short term, they provide longer term freedom and flexibility from a life controlled by rigid OCD rules and compulsions.
November 13, 2025