Most private practice clinicians are trained to be generalists who can see a wide range of diagnoses and populations. But if you are in a community that is rich with professionals, there are many good reasons to develop skills and experience in a specialization or two, both to follow you own interests and to stand out from the crowd. (See Part II for advantages and disadvantages of specialization).
There are many ways that clinicians define their specialties. Sometimes it’s by diagnosis (PTSD, eating disorders, substance abuse). Sometimes it’s by population (children and or adolescents, veterans, immigrants, individuals with autism or intellectual disability). Sometimes it’s by theory (Psychoanalysis, Adlerian, Internal Family Systems, Dialectical Behavior Therapy). And sometimes it’s by who should be in the room (individual, couple, family or organization teams). Often it is some combination.
But how do we choose from the plethora of possibilities? The important word here is “choose.” Every clinician can take charge of defining and refining a practice to focus his/her studies, their participation in in-service training and their choice of supervisors. To maintain marketability in a community that has a large therapist presence, it may be necessary to become known as the “go to” for a particular issue, population or style.
Equally important, choosing a specialty area we care about deeply and for which there is a local need can keep us fresh and interested in our work.
5 Ways Clinicians Choose a Specialty:
By training: Some prospective therapists know what they want to do from the start. They choose academic programs that prepare them specifically to work with substance abuse, trauma, child therapy, etc. Some choose a program with a specific theoretical orientation. In my case, I went to the Alfred Adler Institute in Chicago (now called Adler University) because Adler’s theory spoke to me in a deeply meaningful way.
By personal experience: Sometimes the passion for a particular area comes from our own histories or from observing others we care about who are in pain. For example, a friend of mine developed skills in supporting people with cancer after observing her mother’s needs when she was battling cancer. Still another friend, who went through a rocky and drug-addicted period during adolescence, has embraced helping other young people who are addicted and conflicted get on their emotional feet.
By community need: While working as a high school guidance counselor, a colleague became aware that there were insufficient mental health services specifically designed to serve the needs of recent immigrants. She made it her personal mission to develop cultural competence with that particular immigrant group so she could help them recover from trauma and adjust to their new circumstances. Another colleague recognized that there were almost no mental health services in her town for people who were on the high functioning end of the autism spectrum. He did the research and reading, attended workshops, and found a supervisor to develop the necessary expertise.
By being thrown into the “deep water”: Sometimes an employer needs a clinician to do work for which she or he was not specifically prepared. Yes, it is a requirement of licensure not to do work we don’t have the training to do. But sometimes the boundary of what we do and don’t know isn’t crystal clear. Take, for example, a young clinician who works with traumatized children. Her training was fabulous in terms of treating trauma and even parental substance abuse but didn’t include preparing her for the unique problems of kids who were removed from their homes because of the parents’ opioid addiction. As the opioid epidemic has spread in her area, there are more kids who are suffering the consequences of what is sometimes very sudden addiction of parents and disintegration of their families. Treating those kids has meant that she and other clinicians in the clinic where they work have had to get up to speed on the specific issues related to opiod addiction.
A specialization may choose you: Sometimes a specialization is like a cat. You may not choose it but it may choose you. It is up to you, then, to decide whether to “adopt” it. In my case, I developed a specialization working with corrections officers. Why? Because I worked successfully with one young man who was stressed by his stressful job. He told a friend who also came to see me and he told his friend who told his friend. Within months, I had four young prison guards coming to see me to learn how to cope with their stressful job. It was up to me to do the research and get the supervision I needed to serve them well.
Specialization lets us follow our interests and narrow our field to something manageable. By pursuing a specific population or training or community need, we can hone our own craft and better serve our patients. It also provides a “marketing edge,” a way to distinguish ourselves from the other mental health providers in our community and to target our marketing to insurance panels, other professionals and the public. By choosing purposefully, each of us can develop a practice that is intellectually and personally satisfying as well.