Niche specialization: Is finding your niche important?
Is it necessary for independent practitioners to have an area of specialty practice? A quick review of popular sites such as the Psychology Today Therapist Directory gives the impression that most psychologists have one or more niche areas of practice.
The range of specialty areas of focus is seemingly limitless and includes diagnoses such as OCD, ADHD, PTSD; symptoms such as self-harm, insomnia or sexual dysfunction or therapy; modalities such as individual, couples or family therapy; specific patient populations defined by race, ethnicity, age, or sexual orientation; and therapeutic approaches such as CBT, DBT, psychoanalytic therapy, or even equine therapy!
Therapists have the challenging task of demonstrating their competence in the basics (approachable, good listener, good training), underscoring their skills in the common reasons that people seek therapy (anxiety, depression, life transitions, loss) and identifying the niche areas of practice or patient populations of interest.
Premature identification of a subspeciality might be more harmful than helpful when developing an independent practice. The early career psychologist focuses on developing skills that generalize widely, for example, treating anxiety and depression across a variety of patient populations. As a health psychologist working in a cancer center, students often approached me seeking practicum training. Trainees at the practicum level need to develop generalizable experience. Clinical health psychology is an example of a specialization that should be acquired after foundational skills have been developed.
It is tempting to focus on a subspecialty. Practitioners are drawn to the field because they have a passion for treating a particular target population. In addition, there is usually so much demand in any given niche area, that a practitioner can become inundated with referrals of a specific population.
For example, although an early career professional may want to develop a niche practice in treating a particular patient population such as self-harming adolescents, an exclusive focus on any given population may eventually feel limiting.
As psychologists, we may have preconceived ideas about our specialization area that do not align with our client’s motives for seeking therapy. For example, a client with an anger problem was referred to me for therapy following his heart attack. He did not see himself as having any problem with anger nor did he see himself as in need of psychological treatment. This client accepted the referral with the thought that his life was already good but might be optimized.
If I had specialized in “anger management,” I doubt the client would have accepted the referral. From his perspective, he was looking for something more akin to philosophical or existential
counseling, a focus with which I felt comfortable. A different psychologist might have observed that he met criteria for narcissistic personality disorder and referred him accordingly. In truth, he was a cardiac patient, a person with anger problems, a man grappling with his own mortality, and a fragile individual with a personality disorder. None of those labels defined him as a human being.
I have found it is more important to understand the limits of my own scope of practice than to emphasize my niche. If I had not felt comfortable with the client described above, whose personality disorder was at the extreme end of the continuum, it would have been important to recognize this early and refer him elsewhere diplomatically.
This is not always easy and if the client has a good rapport, they may not wish to accept a referral. It can be humbling for the psychologist to help their client understand the therapist’s limitations in scope of practice and reason for referral.
Development of a niche practice is a function of the psychologist’s area of interest, training opportunities, referral sources, and serendipity. While the niche may help the practitioner to define their practice, it is good to maintain a balanced, heterogenous caseload.
Charles Darwin coined the terms “lumper” and “splitter.” Lumpers use broad categories and emphasize similarity while splitters emphasize differences. As therapists, we must be both lumpers and splitters. Practitioners are most content when they strike a balance by identifying niche areas of interest but do not narrow the target population prematurely.