“Finding a psychotherapy niche”, was previously published in my Johns Hopkins blog on building a successful psychotherapy practice

My graduate students often ask, “how do I choose an area of expertise, when I have virtually no experience in the field?” They raise an important question. For most people it’s not a good idea to claim an area of expertise too early. At this begining juncture, as you go through your training, your internship or your first job(s), it can be useful to pay attention to what you enjoy and what you are curious about.What have you gone out of your way to read more about? What sustains your interest? What do you find yourself talking about outside of class? When you have your choice about what to do for a research paper, what do you choose? What courses have you selected for your electives? What theoretical orientation(s) seem(s) most compatible with your personality style? Do you like CBT? Psychodynamics? Family Systems? Rogerian approaches? Pay attention to populations that intrigue you. Do you enjoy Children? Adolescents? Adults? Rape Victims? Alcoholics? Writers? Artists? Divorcees? Does the notion of working in a psychiatric ER appeal to you? Do you enjoy learning about short-term therapy or would you rather work doing long-term treatment?

What areas, topics and activities have you disliked during your training and beyond? What paths would you prefer not to pursue? You don’t need to have all of the answers, yet. It’s just time to start thinking about these issues.

And, what about your interests outside of work? Did you enjoy volunteering at your son’s nursery school or was the 3rd grade Little League Team more your speed? What do you do in your free time? Do you volunteer in your Church’s program for the homeless? Are you a docent at the art gallery? What sorts of activities fill you up. Volunteer activities reveal much about you. Where do your passions lie?

In graduate school, a colleague of mine identified eating disorders as her passion. In each course we were required to write a paper about a particular disorder. In every class, she wrote her paper about eating disorders. For example, in Cognitive Behavior Therapy she wrote a paper on CBT with eating disordered patients. In the Psychobiological basis of behavior she wrote a paper on the psychobiology of eating disorders. In psychodynamics…. in assessment…. and so on. She wrote her masters and dissertation on eating disorders. She did placements in obesity and eating disorders. Today, she is an international renown figure in, not surprisingly, eating disorders. Clearly, if one already has a set of well developed interests, one can use the academic experience to develop these interests and expertise more comprehensively.

But, what if you feel you don’t have a well developed set of interests? Or, what if you have already graduated? Or, what if you’ve been practicing for years but are just now taking the plunge into private practice? How do you go about identifying your interests?

When I was a graduate student, some internship applications required that we trace the trajectory of our interests linking them up to our own psychodynamics. A colleague came to me in distress, she told me: “I haven’t pursued any particular interests. I’ve just met the requirements for the program”.

“This is not a problem I assured her.” I asked her what courses she had taken? What electives? What placements had she completed? And what papers did she write in every course? What was the topic of her masters and her dissertation? Also, what patients had she worked with most intensively? Sure enough, a clear, undeniable theme emerged: she was seriously interested in grief and bereavement. Once I articulated that theme, I asked her how she thought this interest had evolved. She told me that as a teenager the death of her father devastated her entire family.

Each of us struggle with certain issues and each of us has certain sources of gratifications in our lives. If we reflect on the paths we have taken and our reactions to them, these themes will clearly emerge and they may very well form the foundation for a very gratifying professional life.

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