When people say that you should specialize, what exactly does that mean? Does that mean treating a specific population, getting special training, or what?
(I realized after reading my response that most of my examples involve assessment and not therapy, so if you are talking about strictly therapy, I'd probably defer to someone else more in the know, as I know very little about the "common" range of Dx's a typical clinician will purport to work). However, I do know quite a bit about the business side of things, so I tried to include some very basic information about market place competition.
It means that you should have an area of focus and not just be, "I'll see anyone for anything." For example, if a clinician enjoys working with children they may work with elementary school aged children who have a range of issues: learning disabilities, behavioral problems, etc...though it'd be less realistic for them to see a child in the morning, a geriatric patient in the late morning, and then a forensic patient in the afternoon. That can happen, particularly in a small town (the mental health version of a family physician who does cradle to grave), though it is much harder to market yourself as, "I do everything!"
As for
how to specialize, it probably starts while you are still in training, at least it is easier to start then. For instance, if you enjoy working with young children, you'd most likely want to gain experience during your practica, internship, and/or post-doc years. Some people jump into "new" and unrelated areas outside of the area in which they trained, but it is much harder to do well and do ethically. Some people make that jump, but they tend to do it under the mentorship of someone else, at least in the beginning.
I'm not saying you
HAVE to know what population you want to work with for your career and you
HAVE to gain training throughout or you can't do it, but it really helps. Many times clinicians gain experience in one area and it sort of spills into another area. For instance, a person may handle a lot of ADHD assessment for a school district, though along the way they find an opportunity to do IQ assessment for gifted students. These two areas have a lot of crossover, moreso than someone going from ADHD assessment to doing in-depth trauma work. I'm not saying a person can't do both in-depth trauma work and ADHD assessment, but they are quite divergent areas.
Carving out a niche will allow you to tailor your services to a targeted market and get know as the "go to" person who treats a specific Dx or age range. It is much easier to find referrals when you can be someone's "personality assessment" person, as most people do not treat all types of cases.
I know a clinician who only likes to do therapy, and she will refer out all of her assessment cases to someone else who primarily does assessment work. I also know clinicians who specialize in eating disorders, and while they will see an ocassional non-ED case/referral, most of their business is ED-related because they are well known in the ED community. Could they compete as a generalist in the market...maybe, but it is much easier to compete in the "eating disorder treatment" market.
As for speciality training...let me preface this by saying I have a bias towards boarding and I have pretty conservative views around "scope of practice" issues. I believe there are a number of areas where a person should not practice unless they have
significant formal training and
significant mentorship (neuropsychology and forensic assessment as it relates to capacity/competency referrals, etc), though many people "dabble". Most people who "dabble" frustrate me to no end because they don't seek out proper training and mentorship, so their "work" is often not equivilant to someone who specializes in that area. This can cause a host of ethical, legal, and professional problems.
I had a professor put the fear of God into me about doing assessment work that had any chance of making its way into court. He is board certified and a leader in the field, and he said that there are plenty of people who "dabble", but it can get ugly if they ever get dragged into court and they have to defend their work. I'm not saying this to scare anyone, but the legal and ethical considerations of working outside of your scope of practice are often minimized in favor of better money. While trying to find your path, be aware that you can't be all things to all people, and if someone asks you to do work outside of your scope, it is your license that is on the line.
Short version: Find your niche so you can be the "go to" person for a specific patient population, or you'll just be another fish amongst the thousands competing for the same food/resources.