The Case Against Specialization

So often in our conversations at Zencare, we hear therapists say, “Well, I’ve heard it’s important to have a niche, so I specialize in…” And it’s true: it is important to have something that differentiates your practice from the crowd, that shows prospective clients why they should choose to work with you amongst all their other treatment options.

But sometimes, labeling yourself as a specialist can do more harm than good. Here, we’ll take a look at why that is, and consider some other options that might work better for your practice.

What are the drawbacks of specialization?

Put simply, the practice of therapists calling themselves specialists for the sake of “branding” gives rise to two main challenges:

1. People who are not true experts in a given topic position themselves as experts, which makes it even harder for true specialists to stand out and feeds into a cycle of unnecessary hyper-specialization.
   
2. By portraying yourself as a specialist, you can potentially discourage clients facing challenges outside your stated area of expertise from reaching out, when they might actually be a good fit for your practice.

Let’s take a few examples here. If you’ve trained at eating disorder treatment centers your entire career, are a member of ED professional networks, regularly attend conferences and CEs specific to eating disorders, thrive within a treatment team, and want to maintain a caseload primarily of people struggling with disordered eating or in eating disorder recovery, then by all means—market yourself as an eating disorder specialist! In some cases though, well-intentioned clinicians who are not ED experts (but who may be very skilled clinicians otherwise!) take up that space, making it harder for ED therapists to distinguish themselves and potentially compromising client care.

At the same time, many clinicians who are just starting private practice feel the need to pick a specialty in order to give their practice a voice, and in doing so, they fall into a trap of overspecialization. In these cases, clinicians bill themselves as specializing in a narrow field of practice, when really they’re competent to treat a wide variety of more general concerns.  

To gauge whether this might describe you, compare your current caseload to the list of treated concerns on your website. How many of your clients are actually focusing on treating concerns from that list? And of those, how many first arrived at your practice having identified those concerns already? For instance, if you treat trauma, you might have a few clients who come to their first session saying that they want to address trauma, but it’s likely that you have many more who came in to deal with symptoms (such as feeling overwhelmed or having difficulty making decisions) that they only later discover, through time and insight, to be related to underlying trauma. If you bill yourself as only treating trauma, you might miss the opportunity to work with that whole second group of clients—who may benefit enormously from your services.

When does it make sense to represent yourself as a specialist?

Of course, there are certain situations where it makes sense to represent yourself as a specialist. These cases usually fall into three main categories:

• When accepting a referral from another specialist: If a specialist who can’t take on a particular client (because of a full caseload, for example) refers that client to you, then it makes sense to emphasize your shared expertise. Of course, you never want to misrepresent yourself or your skills, but discussing a case from the perspective of a specialist makes sense when it’s relevant to the particular client.
  
• When speaking with a relevant referral partner: Similarly, if you meet with a representative from a referring body within a specific discipline, such as an eating disorder or addiction recovery center, it’s logical to highlight your expertise within the field rather than your more general practice.
  
• When you have advanced training and want to tailor your practice to match: As in the eating disorder treatment example above, there are certainly clinicians who focus their practice tightly on one very specific population. If that’s you, and if you’re excited to have a caseload of clients primarily within that one niche, then it makes sense to bill yourself as a specialist.

What’s the alternative?

You may be wondering: if I shouldn’t call myself a specialist, what should I do to make my practice stand out? Your differentiating factor might not be a “specialty” as we’ve come to think about them, but there is still is something that makes your services unique: who you are as a provider!

Instead of jumping immediately to buzzwords and branding, take some time to think about why you’re drawn toward a certain specialization. For example, many therapists try to appeal to clients during pregnancy and postpartum, which can be an incredibly exciting and rewarding time to discover new insights. Unfortunately, this can also be a really difficult population to get into the office, making it a competitive specialty. So consider: do you really only want to work with folks in the perinatal period? Or is there some other common thread that would connect your interest to a larger population?

Using this example, maybe what you’re most interested in is hormone-related mood changes. Or it could be the role that work plays in identity, daily routine, and self-esteem. Perhaps it’s relationships, with partners, nuclear families, or extended families. Or maybe it’s the exploration of a client’s childhood experiences, and how that influences their beliefs about parenting and the kind of family they want to build. All of these are totally valid perspectives that reach beyond one narrow population, and they may help you see yourself as a generalist with particular interests rather than a specialist who only wants to work with one kind of client.

Once you’ve spent some time refining your sense of what your interests and passions really are, ask yourself: does it still make sense to bill myself as a specialist, or could a different route be more effective? One big reason it’s important to get clarity on this point is that often, clients seeking expertise around specific challenges go through a different therapist search process than clients seeking more general support.

If you genuinely are a specialist, keep the following points in mind as you go forward:

• Clients looking for specialists are likely to find you by word of mouth, such as a recommendation from a friend or physician. If you’re accepting new clients, feel free to let your networks know!
• Generally, a successful specialist practice will require significant offline effort, from meeting referral agents (like treatment centers and partial programs) to giving talks and attending conferences.
• But that said, your online presence is still important. Clients are likely to get more than one recommendation from a referral partner, and they’ll do an online search to decide which of the suggested clinicians is the right fit. You want your polished, professional presence to be the one they choose!

If it makes more sense to bill yourself as a generalist, be sure to consider the following:

• Clients looking for more general support are more likely to search casually online, rather than seeking a specific referral. Because they don’t need to find specific expertise, they might do more therapist shopping and take the time to look for the right therapeutic alliance.
• Especially since your specialist knowledge may or may not be of help to this group, showcasing your personality through your online presence is key! A video is an especially great way to do this, speaking generally about the themes your clients seek care around, and the kind of relationship you seek to build.
• Once you do hear from a potential client, be sure to respond quickly and warmly, with the understanding that they’re likely reaching out to multiple clinicians. Then, focus on offering a positive consultation and intake experience. And when it clicks, it clicks!

In either case, taking a moment to figure out the best way to bill yourself can save you lots of time and confusion down the road. And even more importantly, it can help you connect more quickly with the clients who you’re most excited to serve and who can benefit the most from your support!