Josh Hillebrand LCSW

Tag: therapy

“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
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
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