A degree program in psychology or social work or mental health counseling is often broad-based and diverse, with courses in a little bit about everything. Yes, some programs are specific to such areas as substance abuse or behavioral psychology. In others, all courses are informed by a specific theory. However, most clinicians still come from schools that teach a broad curriculum. If this background is the case for you, specialization is something you might consider as an add-on once you have been in practice for a number of years. Be aware that there are both advantages and disadvantages to doing so.
Advantages of Specialization
Lets you treat those you most want to treat: Specialization lets you limit your practice to the area that interests you the most. Whatever your interest – whether couples or teens or people with anxiety disorders or eating disorders – most of your schedule will be filled with people who match that area.
Focuses your on-going education: It is impossible to keep up with everything that is being discovered about all the ways people are in distress. By choosing a specialty you can focus on one (or more) area, choosing in-service training, reading and supervision/consultation accordingly.
Markets you as unique: If there are a large number of private practices in your community, specialization helps you stand out. Marketing is easier because it is targeted and specific.
Identifies you to prospective clients: Clients are often looking for a specific service, either for a diagnosis or a population. Examples of diagnoses include treatment of a phobia, obsessive-compulsive disorder or depression. Examples of population-specific treatment include couples work or adolescents or children with autism. Marketing your specialization makes it easier for clients to find you.
Invites referrals from other professionals: Referral sources appreciate knowing that the person they refer will get the specific help they need. Defining a specialization gives other professionals (physicians, clergy, school counselors, etc.) some confidence that you will be a positive match for their referral.
Makes you attractive to insurance panels: Insurance companies are interested in providing a wide range of specializations within their panels. Like any referrer, they want satisfied customers. By identifying yourself as an “expert” in a niche, you are more attractive to those panels and will receive more referrals for that particular area of expertise.
Disadvantages of Specialization
Trends come and go: New understandings about clinical issues and the popularity of treatment modalities come and go. In the early 1980s, for example, the incidence of incest and sexual abuse was rediscovered. Trauma work became an important “new” area for specialization. Clinicians flocked to workshops. Colleges started offering courses. Being a specialist in trauma made a clinician stand out from the clinical crowd. These days, it is understood that to be effective every clinician must be familiar with the effects of sexual (and physical and emotional) abuse and needs to know how to treat trauma.
Over the last 50 years, there have been spikes in demand for therapists specializing in satanic cults, multiple personality disorder, bi-polar disorder and eating disorders, women’s issues, men’s issues and sexual dysfunction. Current trends include more sophisticated treatment for people with autism and transgender issues.
Approaches to treatment wax and wane in popularity as well. In the 70s, Rogerian therapy was popular; in the 80’s strategic and systemic family work; in the 1990s, Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR) came of age. Now Cognitive Behavior Therapy (CBT) is seen by many insurers as the treatment of choice for mood disorders and anxiety disorders. Seasoned therapists often use or integrate elements of some or all of those techniques.
The field of mental health continues to evolve and it’s important to evolve with it. Over time, a trend often becomes integrated into a common idea of good practice (or, in some instances, is discredited). Beware of getting so identified with one specialty that your work will become considered obsolete by referral sources. Consider whether there will be enough demand for your particular specialization in the future to keep your practice full.
You limit your knowledge: If you focus your own in-service education on only one area, be it substance abuse or trauma or kids with disabilities (as only a few examples), you are narrowing your ability to treat other issues as they arise. As you know only too well, people are complicated. Often the initial complaint is only the proverbial “tip of the iceberg.” To serve our patients well, it’s important to keep a generalist’s skills as well as an expert’s perspective.
You may become bored and therefore complacent. People are more alike than different. After seeing six people a day with anxiety disorder, a specialist in that, or any other diagnosis, can become bored or disinterested or can start to “coast.” This situation can lead to less than attentive treatment of the individual patient. It can also result in your dissatisfaction with your career. Both patient and therapist are no longer getting what they need.
You may limit your market: Once referral sources and prospective clients see you as a specialist in a specific area, you may not attract enough individuals to fill your practice. If, for example, you are known for your work with substance abuse or addiction, prospective clients and referral sources may not understand that you are capable of treating people with other diagnoses as well.
The Answer is Balance
What is most needed today may not be as important as a clinical skill tomorrow. It’s therefore essential to maintain a balance between developing a niche and maintaining your general skills. By all means, follow your interests and trends in developing a specialty or two. But remember that your reputation as a fine therapist with many skills for many different problems is what will sustain the vitality of your private practice.