 Nick Holt is a licensed clinical social worker and certified CBT therapist in West Los Angeles, CA. Picture a therapist seated behind a couch. A client staring at the ceiling, talking about childhood while someone nods and takes notes. Years of it, with no clear endpoint. That image sticks in our collective imagination when it comes to psychotherapy. But I haven’t experienced that as a therapy client in my life, and I certainly didn’t enter the field to provide this form of therapy.
Cognitive Behavioral Therapy is close to the opposite of that picture. And the gap between what most men imagine and what CBT actually is might be the only thing standing between them and getting some help. It Has a Point CBT is structured. We’re not wandering. While we may discuss your history and childhood may be a topic, the goal is to mutually agree on what’s actually driving the problem — the patterns of thinking and behavior that are running underneath whatever brought you in — and then work on it collaboratively and directly. You’ll usually know what we’re doing and why. That structure isn’t rigid, but it means your time isn’t being spent circling. You’re Not a Patient Being Analyzed CBT is collaborative. You’re not lying back while someone interprets you. You’re working alongside me on a problem, and your intelligence, practice and empowerment is an asset in that work — not something we have to get past. For men who are used to solving things, this tends to land better than open-ended exploration. It respects how you already operate. The Premise Is Simple Here’s the core idea: how you think shapes how you feel and what you do. Most of the time we’re not aware of the thinking — it runs automatically, built up over years, and we experience its output as just “how things are.” CBT slows that down. We look at the automatic thoughts and beliefs that are steering the ship, test whether they’re actually true, and adjust the ones that aren’t serving you. When the thinking shifts, the feeling and the behavior tend to follow. More times than not, situations are more complex than we label in our minds. You Arrive at It Yourself This part matters, and it’s where good CBT separates from the mechanical version. I’m not here to tell you what’s wrong with you. My job is to ask the right questions — the ones that slow you down long enough to notice something you’ve been moving too fast to see. The insight you reach on your own sticks in a way that someone else’s observation never quite does. That’s not a technicality. It’s the difference between being told something and actually knowing it. It Gives You Tools You Keep The goal of CBT isn’t to make you dependent on therapy. It’s to teach you to do this yourself. You walk away with actual tools — ways of catching a distorted thought, interrupting a pattern, responding differently under pressure — that keep working after our work together ends. Which brings me to the last point. It Ends I’m not interested in making you a lifelong client. Most CBT work is time-limited by design. We define what you’re here to work on, we work on it, and when you’ve got what you came for, you go live your life. That’s the whole point. Why the Credential Matters CBT is having a moment — which means a lot of therapists now list it as something they do. Not all CBT is the same. I’m a Diplomate of the Academy of Cognitive and Behavioral Therapies, one of fewer than 750 in the world. That designation means my competence in the model has been reviewed and verified against peer standards. It’s not a line on a website. It’s the difference between someone who took a workshop and someone who has actually built their practice around this. If you’re in West Los Angeles — Sawtelle, Brentwood, Mar Vista, Westwood — and something here made more sense than the couch-and-ceiling version you’d been carrying around, that instinct is worth following. Free consultation. No pressure. Just a conversation to see if this fits. Nick Holt is an LCSW and A-CBT Diplomate in private practice on the Westside of Los Angeles. He has spent over a decade as a social worker serving LA County’s most forgotten and most impaired — the people the system failed repeatedly. He has also been a son watching his mother through a long and difficult end, a father, a surfer, a drummer, and someone who has broken his neck and come back from surgical repair of his shoulder. He works with men, caregivers, and high-functioning individuals who are ready to stop managing alone. Free consultations at nickholtlcsw.com.
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 Nick Holt is a licensed clinical social worker and certified CBT therapist in West Los Angeles, CA. Burnout has a reputation. The image most people carry is of an all-at-once moment — a point in time that sits you on your backside without warning. You're fine, and then you're not.
That version exists. But it's not the whole story. More often, burnout is something that festers. It nags. It creeps along slowly, building pressure underneath the surface, before it finally breaks through — if it breaks through at all. The quieter version never announces itself. It just gradually narrows your world until you realize, usually much later than you should have, that something essential has been gone for a long time. That's the version I want to talk about. Because it's the one that's harder to catch — and in my experience, the one that brings more people into a therapist's office than the dramatic collapse ever does. What quiet burnout actually feels like It doesn't feel like collapse. It feels more like distance. Things that used to matter don't land the same way. You get the promotion or finish the project or handle the crisis, and instead of satisfaction there's just — more. Another thing. Another expectation to meet. You find yourself going through motions you used to do with some investment, now just going through them. You're tired in a way that sleep doesn't fix. Not physically exhausted, necessarily. More like your reserve tank has been empty for so long you've forgotten what it felt like to have one. And here's the part that makes quiet burnout so easy to miss: the people experiencing it are usually the last ones to name it. Because they're still functioning. Because they've built an identity around being capable. Because admitting that something's wrong feels like a failure of the very thing they've always been good at. By the time it becomes visible — to them or to anyone else — it's usually been building for months. Sometimes years. The thought patterns that keep it going This is where CBT becomes useful — not as a productivity hack or a reframing exercise, but as a way to understand what's actually maintaining the burnout underneath the surface. Because quiet burnout isn't just stress. It's usually a set of deeply held beliefs doing the work: “I’ll rest when this is over.” The problem is that 'this' never ends. There's always another phase, another crunch, another person who needs something. The rest keeps getting pushed to a future that doesn't arrive. “Other people have it harder.” True and irrelevant. Comparative suffering doesn't make your experience less real. It just makes it harder to take seriously. “If I slow down, things will fall apart.” This one is worth examining carefully. Sometimes it's true. Often it's a belief that's been tested much less than it feels like it has. “I chose this. I shouldn’t complain.” Choosing something — a career, a family, a responsibility — doesn't mean you're immune to its weight. The two things aren't in conflict. These aren't character flaws. They're thinking patterns that made sense at some point — that might have even served you well — and now they're running on autopilot, keeping you locked into a pace you didn't consciously decide to maintain. One of the things that makes quiet burnout so persistent is that these patterns are self-reinforcing. You push through, things hold together, and the belief that you have to keep pushing gets stronger. The cost is invisible until it isn't. Who this tends to affect In my practice, quiet burnout shows up most often in people who are good at managing. High-functioning professionals. Men who have built an identity around being the person others can rely on. Caregivers who have organized their lives around someone else's needs for so long that their own needs have become genuinely hard to identify. I've also seen it in people who work in demanding systems — healthcare, public service, social work — where the expectation of absorbing stress is baked into the job description. People who got into the work because they cared, and who have been running on that care for long enough that they've stopped being able to tell whether there's anything left. The common thread isn't weakness. It's the opposite. It's people who are exceptionally good at pushing through, at reading what's needed, at performing competence — and who have been doing it for long enough that the performance has become invisible even to themselves. If you recognize yourself in any of that, that recognition is worth paying attention to. What actually helps Rest helps, but rest alone isn't usually enough. If the thought patterns driving the burnout don't change, the rest is just a pause before the same cycle resumes. Most people who've been burning out quietly for a long time already know this — they've taken the vacation, slept the extra hours, done the thing that was supposed to help. And then gone right back. What tends to help more is getting specific about what's actually happening — which beliefs are running the show, where the demands are coming from, what you're actually afraid would happen if you stopped. That's slower work than a vacation, but it's the kind that doesn't require you to keep repeating it. CBT is well-suited to this because it's concrete. It gives you a framework for examining what's going on rather than just managing your way through it. The goal isn't to think positively. It's to think accurately — which sometimes means recognizing that you've been running a harder race than you've been giving yourself credit for. A note on asking for help One of the more reliable signs of quiet burnout is that asking for help feels disproportionately hard. Not because the person doesn't know help exists. Because the identity built around competence makes needing it feel like a contradiction. It isn't. Needing support and being capable are not in conflict. But if that's a belief that's genuinely hard to hold, it's worth looking at — because that belief, more than the workload itself, is often what's keeping people stuck. The other thing worth saying: quiet burnout tends to be caught late precisely because the people experiencing it are so good at functioning. By the time it's visible enough to name, it's usually been building for a long time. Earlier is better. Not because there's an urgency to pathologize normal exhaustion, but because the longer those patterns run unchallenged, the more they become the default setting. If something here resonated, that's usually a signal worth trusting. I work with people navigating exactly this in my Sawtelle office in West Los Angeles. Free consultation available — reach out when you're ready. Nick Holt is an LCSW and A-CBT Diplomate in private practice on the Westside of Los Angeles. He has spent over a decade as a social worker serving LA County’s most forgotten and most impaired — the people the system failed repeatedly. He has also been a son watching his mother through a long and difficult end, a father, a surfer, a drummer, and someone who has broken his neck and come back from surgical repair of his shoulder. He knows what it takes to keep moving. He also knows what it costs to never stop. Carving out space for his own psychotherapy has been critical to his growth — not as a therapist, but as a person. He works with men, caregivers, and high-functioning individuals who are ready to do the same. Free consultations at nickholtlcsw.com.  Nick Holt is a licensed clinical social worker and certified CBT therapist in West Los Angeles, CA. Most men don't spend a lot of time thinking about what they want in a therapist. They spend time talking themselves into going at all. By the time they're actually searching, they're exhausted before they've started — scrolling through Psychology Today headshots, reading the same paragraph over and over in slightly different fonts.
So here's a more useful framing: you're not looking for someone who seems nice. You're looking for someone who can actually help. Those aren't always the same thing. Credentials matter more than you think Therapy in California is a licensed profession, but the licenses aren't equivalent. LCSWs, MFTs, and psychologists all have different training backgrounds. Within those categories, there's enormous variation in how much clinical experience someone actually has. Look for post-graduate training in a specific modality — not just a license. A therapist who has completed formal training in Cognitive Behavioral Therapy, for example, is operating from an evidence base. That matters if you're someone who wants to understand why something works, not just whether it feels good in the room. Diplomate status in CBT — granted by the Academy of Cognitive and Behavioral Therapies — means a therapist has met peer-reviewed standards for clinical competence in the model. There are fewer than 750 A-CBT Diplomates in the world. It's not a vanity credential. Look for directness, not warmth theater A lot of men tolerate therapy rather than benefit from it because they end up with a therapist who mistakes empathy for passivity. Nodding is not treatment. Reflecting your feelings back at you indefinitely is not a plan. What you want is a therapist who asks the right questions. Not leading questions with an answer already baked in — but questions that slow you down long enough to notice something you've been moving too fast to see. The insight you arrive at yourself sticks in a way that someone else's observation never quite does. A good therapist knows this. They're not withholding their opinion to be coy. They're creating the conditions for you to do the actual work. Warmth and directness aren't opposites. The best therapists have both. But if you're someone who operates in high-stakes environments, you'll disengage quickly from a therapist who seems afraid to name what's happening in the room — even if the naming comes in the form of a question rather than a verdict. The male therapist question Some men prefer working with a male therapist. Some don't. Neither preference is wrong. What I'd push back on is the assumption that gender is the primary variable. A male therapist who is conflict-avoidant or overly supportive isn't going to serve you better than a skilled female therapist who challenges you. That said — if you've been performing competence your whole life and the idea of being vulnerable in front of a woman feels like one obstacle too many right now, that's legitimate. Work with what actually gets you in the room. Practical over processing If you're high-functioning — good at your job, reliable to the people around you, privately exhausted — you probably don't need someone to validate how hard things are. You need someone who can help you change what isn't working. CBT-based therapy is structured, collaborative, and focused on building skills you can use outside the session. It's not about reliving your childhood indefinitely. It's about understanding the patterns that are running your behavior and having tools to interrupt them. For men who feel skeptical of therapy as a concept, this model tends to land better than open-ended exploratory work — because it respects your intelligence and your time. Location and logistics If you're in West Los Angeles — Sawtelle, Brentwood, Mar Vista, Westwood — you have options. But "options" in LA therapy often means a 45-minute drive each way, which is a reliable way to cancel on yourself after two sessions. Look for someone within a reasonable distance of where you actually live or work. Telehealth is available and useful, but for the kind of deep work that actually changes things, in-person has advantages. The session you show up to physically is the session you're less likely to phone in. What to do with the free consultation Most therapists offer a free 15-30 minute consultation. Use it to notice how you feel in the conversation — not whether you like the person, but whether you feel like they're paying attention to you specifically, not just running a script. Ask them directly about their approach. If they can't describe it clearly, that's information. You don't owe anyone a second session if the fit isn't right. Nick Holt is an LCSW and A-CBT Diplomate in private practice on the Westside of Los Angeles. He has spent over a decade as a social worker serving LA County's most forgotten and most impaired — the people the system failed repeatedly. He has also been a son watching his mother through a long and difficult end, a father, a surfer, a drummer, and someone who has broken his neck and come back from surgical repair of his shoulder. He knows what it takes to keep moving. He also knows what it costs to never stop. Carving out space for his own psychotherapy has been critical to his growth — not as a therapist, but as a person. He works with men, caregivers, and high-functioning individuals who are ready to do the same. Free consultations at nickholtlcsw.com. There's a particular kind of person I enjoy seeing in my West Los Angeles practice. They're successful by every external measure — career on track, relationships intact, responsibilities handled. They're the person other people lean on.
And they're exhausted. Not in a way anyone around them would notice. They're too good at managing for that. But something isn't working anymore, and they know it — which is usually why they've finally ended up looking for a therapist. The problem with being capable: High-functioning men are often the last people to ask for help. Not because they don't need it, but because they've built an identity around not needing it. Competence becomes a trap. The same qualities that make someone effective in the world — self-reliance, stoicism, the ability to push through — can make it genuinely difficult to acknowledge when something is wrong. I've seen this pattern repeatedly since entering the field in 2009. The men who are hardest to reach are often the ones who need support the most. Not because they're broken, but because they've been performing wellness for so long they've forgotten what it actually feels like. What CBT offers that other approaches don't: Cognitive Behavioral Therapy works particularly well for high-functioning people because it's honest and practical. It doesn't ask you to dwell indefinitely on your past or reframe your way out of real pain. It asks you to examine how your mind is working — specifically, the thought patterns that are keeping you stuck — and to build more effective responses. For men who value directness and measurable progress, that structure is often a relief. It feels less like being analyzed and more like doing actual work. The question worth sitting with: If you're someone who handles everything, who keeps it together, who nobody would ever describe as struggling — when was the last time you asked yourself how you're actually doing? Not performing. Not managing. Actually doing. If you're not sure, that might be worth paying attention to. Nick Holt is a licensed clinical social worker and certified CBT therapist in West Los Angeles, CA. He works with men, caregivers, and high-functioning professionals in the Sawtelle neighborhood. Evening and weekend appointments available. Contact him today.  The Westside of Los Angeles is a beautiful place to live. I am grateful for that. 2019 brings many of the challenges from 2018 with it, but also a number of positive developments.
I am honored to report my private psychotherapy practice in West Los Angeles, CA 90025 is FULL as I've received 10+ referrals since late December. I have started a waiting list but I continue to support individuals in linking to other certified Cognitive Behavioral Therapy practitioners, and other services most appropriate to their situation, in the area. My heart is full with appreciation to those reaching out for support. I fully recognize and connect with the privilege of supporting individuals during immense moments of vulnerability and honesty. I also grasp the tremendous disappointment in contacting someone in hopes of developing a therapeutic alliance and learning of their unavailability. This is why I think it is vital to post this update. I think the recent amount of referrals is reflective of the time of history we are in, the impact of our stressful and complicated lives, and the demonstrated inner strength, curiosity and empowerment of those reaching out. My hope is that it is also a symbol of decreased stigma in seeking out support for what each of us experiences in our respective journeys. I truly believe mental health symptoms are part of our unique humanity, and therefore the significance is not 'if' we are having challenges but 'how' we are attending to ourselves. May you keep pushing in 2019 for consistency, contentment and compassion in your support for yourself, loved ones, colleagues and acquaintances. I wish you success in your maintenance of the self-discipline and commitment required to continue your exercise, diet, relationship and routine goals. May we continue to replenish ourselves and radiate our emotional energy outwards to others. Here last year's New Year post. I still feel similar. If it's possible, maybe a bit more grateful -- https://goo.gl/BgMYPe  Below I've included text from the article, "Why Cognitive Behavioral Therapy Is the Current Gold Standard in Psychotherapy."
This link is a recent research opinion article within the field of cognitive behavioral therapy and, to me, has a lot of diverse considerations and implications. I think the article highlights the importance of considering differences amongst providers -- certification, adherence to fidelity within treatment, resilience and more. But, even more important, I read this research as acknowledging where we are as a field. By accepting CBT's scientific basis, years of research and structured modality, I do not see it as diminishing or "throwing shade" at other modalities. There are a lot of skilled practitioners with diverse modalities within the psychotherapy field and most do important, passionate work. I think this truth will remains irregardless of background -- CBT, analytic, ISTDP, etc. -- or conceptualization of the human condition. Instead, I read this article as a consolidation of numerous scientific efforts within the field of psychology. CBT is not a panacea, but it's a good marker in our evolution in what we know works in therapy. As practitioners, let us continue to join together to improve our services for our clients, and remember that difference is NOT deviant. A few key highlights I found interesting: Cognitive behavioral therapy: "(1) ... is the most researched form of psychotherapy. (2) No other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences between psychotherapies, they typically favor CBT. (3) Moreover, the CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of human mind and behavior (e.g., information processing)." However: "...there is clearly room for further improvement, both in terms of CBT’s efficacy/effectiveness and its underlying theories/mechanisms of change." and... "...although CBT is efficacious/effective, there is still room for improvement, as in many situations there are patients who do not respond to CBT and/or relapse. While many non-CBT psychotherapies have changed little in practice since their creation, CBT is an evolving psychotherapy based on research (i.e., a progressive research program). Therefore, we predict that continuous improvements in psychotherapy will derive from CBT, gradually moving the field toward an integrative scientific psychotherapy." Citation: David D, Cristea I and Hofmann SG (2018) Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Front. Psychiatry 9:4. doi: 10.3389/fpsyt.2018.00004 #cognitivebehavioraltherapy #cbt #psychotherapy #research #goldstandard
I'm excited to share my brand new private practice brochure! I just spent a few solid hours working with the amazing staff at FedEx to finish.
Fun cultural fact: If you Google, "to see if working together would be a good fit" with quotations, 90% of websites listed are from therapists. Apparently, we're the only ones who use that phrase. Learn more about my certified Cognitive Behavioral Therapy West Los Angeles psychotherapy practice. #therapy #therapist #westla #westlosangeles #90025 #cbt 
Raising a small child brings all sorts of challenges. Lately, I've found myself waking up early and preparing lunches. During these pre-dawn hours, I've fallen in love with a number of podcasts and listen to them regularly. As a certified Cognitive Behavioral Therapy, CBT therapist in West Los Angeles, I was highly impressed by Alix Spiegel and Lulu Miller's first episode of Invisibilia, "The Secret History of Thoughts". It was a compelling exploration of our thoughts and an interesting analysis of mental health's view of thoughts. The contrast of psychoanalysis, cognitive behavioral therapy and mindfulness and meditation was useful and relevant not only for people experiencing symptoms like depression or anxiety, but also a good reminder for me as a therapist. Check it out and let me know what you think.  This post was originally featured on WellnessUniverse.com.
I recently became a Diplomate in the Academy of Cognitive Therapy (ACT). The ACT is the only cognitive behavioral therapy (CBT) certifying agency in the world. Joining this elite group of therapists is quite an honor. There are many therapists in the world that can say they are CBT trained but only 750 people in the world can say that they are CBT certified. One of the greatest benefits of being an ACT Diplomate is joining their ListServ. Some of the most prestigious CBT therapists in the world are on this list and share their perspectives on a daily basis. Unfortunately, much of this information does not get outside this small network and the clients they work with. In a recent ACT ListServ email from Reid Wilson, Ph.D., Dr. Wilson shared some helpful videos about anxiety relating to his new book Stopping the Noise in Your Head. I thought the videos were fun and demonstrate important concepts in CBT. About Dr. Wilson: He has spent much of his 30+ year career providing free or inexpensive ways to help people combat anxiety and worry, and encouraging them to seek CBT services when appropriate. In promoting his new book, Stopping the Noise in Your Head, he released a free video series called Noise in Your Head, which follows a young woman, Susan, in her struggles with anxiety. Here are a few of the highlights from each video:
This post was originally featured on HuffingtonPost.com
Being an eager, determined, and active male within my personal and professional roles, I understand the inherent challenges when it comes to living and maintaining a balanced lifestyle. It is also a frequent complaint encountered within my role as a therapist working with men. These conversations often start off like this: "I'm functional. I have a good paying job, I'm dating, having sex, I'm happy. I'm close with my family and have quite a few close friends. I eat well, I exercise, take good care of my body, and I like myself. I maintain an active lifestyle and seek out new opportunities for growth and personal development. There's nothing wrong with me, so why should I consider seeing a therapist?" There are many ways to answer this question. For the purposes of this article, I focus on two responses. 1) Few of us fall into this ideal on a consistent basis. Yes, fundamentally and cognitively, we know exercise, diet and nutrition contribute to better mental states. That nature provides us the opportunity to connect with our spirituality, to rejuvenate, and relax. We know giving back to society, mentorship and volunteering reap deep intrinsic rewards. We understand management of stress is vital, and to do so, we need to carve out time to play, be creative and relax. We've heard the importance of healthy and intimate relationships; of the benefits afforded to processing and exploring recent events and stress. But really, who has time to do this?!? Too often, we have competing interests in our day-to-day lives. With pressures coming from employment, peers, family, household chores and more, our daily tasks often become hasty, triaged decisions based in reaction rather than prevention. This makes sense. The Organization for Economic Cooperation and Development (OECD) is a forum where member countries discuss issues and policies relating to economic growth, prosperity and sustainable development. The OECD reports people in the United States of America (USA) work more hours per year, and have more employees working "very long hours" than the average nation. Collectively, the USA ranks 33rd out of 36 nations when it comes to "time devoted to personal care and leisure," an outcome which contributes to poor physical and mental health. Furthermore, our society reinforces a minimized view of such therapeutic activities and encourages other means of support instead. Roger Walsh states, "(these activities) require considerable and sustained effort, and many (individuals) feel unable or unwilling to tackle them. (Individuals) often have little social support, little understanding of causal lifestyle factors, and a passive expectation that healing comes from an outside authority or a pill." He identifies advertising as a main method of refocusing us onto more economic, and easier, ways of soothing these desires. These mechanisms include "self-medicating" via alcohol, nicotine, unhealthy food and other compulsions, which, at a certain point, become unhealthy and suffer from the psychological concept of habituation, the perceived benefits yielding less and less relief over time. These societal messages are further reinforced by many of our friends, family, employers, co-workers and many others. What can we do? Stress exists in all of our lives. It is not a question of if we will experience stress, but rather how we will deal with it. My colleague Ken Howard, LCSW recently listedsome warning signs when it comes to your lifestyle. Here's what I think: 2) Seeing a therapist can be helpful in moving from reaction-based decision-making to a more proactive approach. In doing so, we create an environment for preventative health care and move toward a more balanced lifestyle. Like seeing a doctor for regular check ups and evaluations, seeing a trained mental health professional on a regular basis can be a great way to maintain consistency in perceiving, evaluating, interpreting and responding to the overwhelming complexity making up our daily lives. In fact, with many mental health symptoms seen in primary care physician settings, there is a push within the field to integrate mental health treatment earlier and more often in physical health treatment as well. Very few of us are allowed the conversational space required to explore the deep cognitive and emotional impact of our daily lives, not only on our minds but also on our bodies. Now what? Given the challenges outlined by Walsh, being proactive over your lifestyle is imperative. In order to move toward a more proactive view of your lifestyle and healthcare, I believe integrating mental health treatment or coaching into one's schedule is vital. Prior to a mental health evaluation, it is important to have specific goals in mind. For example, if you are stuck, one goal could be to gain clarity. Other helpful hints in searching out a therapist include interviewing your therapist to ensure they are competent in approaching your unique situation (some great sample questions here), and to establish mutually agreed upon goals prior to beginning treatment. There are exceptional treatment protocols in the field of mental health including resolving uncertainty via Motivational Interviewing and Cognitive Behavioral Therapy, as discussed in my last post. |
Nick HoltMental Health and Therapy Writer. As featured on Huffington Post, Vox Media and elsewhere. Archives
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