Niche/Practice actually feisable? Too narrow or too wide?

[thebalmofhurtminds]

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In addition to some of the great advice here, I would also really recommend staying open and refraining from nailing down exact practice ideas before you've even begun graduate school. As I'm sure many of us can attest, the goals you have prior to graduate school, during graduate school, and during postgrad training can change wildly. There's nothing wrong with thinking about the future and especially the pragmatic/economic aspects of it, but don't get too hung up before you've even started training.

A research coordinate position sounds like a great idea to move toward your goals right now.

 

[cara susanna]

If you're interested in learning more about ABA and both sides of the controversy surrounding it, we've had some good discussions here in the past. Just do a search for "ABA"

Also, I am not an autism person or an ABA person but I am a trauma person, and I would caution around perpetuating the narrative that ABA is "traumatic." I am not going to argue that it isn't distressing for some, but distress doesn't equate to trauma. It takes a lot to rise to the level of what we would consider a traumatic event in this field. The one study that people often point to as evidence that ABA is traumatic was very, very poorly done and honestly absolute garbage.

From your posts it sounds like you've been involved with or read a lot of the advocacy work being done in ADHD and autism. Which is great, and that work is important, but it WILL clash with some of the evidence-based and best clinical practices that you would learn as a professional. It's like when I read people talk about complex PTSD being a thing and exposure being tantamount to torture on social media. Or trigger warnings.

 

[borne_before]

Treatment of neurodevelopmental conditions "gets so hung up on academics" because children spend 75% of their first 18 years in school - which can be hell. Most child clinical psychologists (and I'm okay with this blanket statement), are really ignorant about learning, teaching, school processes, and what not.

That being said, OP, I like how you're thinking about this stuff. And I think there could totally be a market for high functioning adolescent and emerging adults to complement the lack of transition supports out there. The 14 to 30 yo demographic really struggles with these children. I don't think your logic is ill advised.

FWIW, grad school is about being exposed to things. When I started, I wanted to become a researcher/professor. My first therapy class changed that quick. I couldn't imagine not providing therapy! I also did not want to touch ASD with a ten foot pole. Now guess what, I'm an ASD specialist.

 

[PsychNLife]

I just want to thank everyone for their responses. As I've been reading them and thinking, I think I have some ideas going forward. I've been thinking a lot about my interests, and it seems like MAYBE it could be helpful to add BPD to my ideal client focus, because there is also a HUGE overlap with ADHD and BPD in terms of symptomology, as well as a lot of room to meet the need of that clientele. Obviously they are different conditions, but BPD has a lot of similar difficulties in regards to emotional regulation, social relationship issues, and self image that I also really am drawn to with ADHD. So maybe by adding that in as part of my focus, it can help broaden things up for me!

Also, I hear what a lot of people are saying, and I know for SURE i will have clients that are all other types of dx as well, and I should always be prepared and welcome that, and I'm totally okay with that. Absolutely no reason I would be unwilling to work with an OCD, PTSD, MDD or any other client as part of a portion of my practice or within a hospital program.

HOWEVER, while I've been looking at schools, I've been primarily focused on ADHD and ASD. Therefore, I am really hesitant to like..... start my entire damn school search over to see who else might also work with BPD (as well as my ADHD/ASD schools I've found). I've already excluded a lot of schools based on not having any ADHD or ASD work there................do I now start over? I thought I was basically done with my school list.

There also now is the issue of the doctorate. Part of what was really drawing me into getting a doctorate is the fact that Psyd's/PHD's can work with assessment tools, fancier diagnostic tools, and work with complex and comorbid cases more easily, which i thought was REALLY important for my populations. And now, I can't tell if these are as worth it with these populations anymore. I mean, i suppose I will still need to do some assessment work occasionally, even if not batteries of tests, and even if only sometimes. And, it would still be good to understand assessment well. I mean, there are a lot of other reasons that I personally am drawn to a doctorate (somewhat higher salary, personal accomplishment, my parents promise to fund anything that is needed)... but the reason I thought I NEEDED the doctorate was because of the diagnostic assessment and evaluation tools, and being better with complex comorbid cases. Well I guess there is one other thing I would NEED a doctorate for, which is being able to run a hospital program or develop a program, which is much harder for MA clinicians I suppose (which I am interested in doing possibly at some point, not fully sure yet).

Feels like a chaotic mess.... and I thought I was DONE with deciding I wanted a doctorate and my school list.

 

[cara susanna]

I just want to thank everyone for their responses. As I've been reading them and thinking, I think I have some ideas going forward. I've been thinking a lot about my interests, and it seems like MAYBE it could be helpful to add BPD to my ideal client focus, because there is also a HUGE overlap with ADHD and BPD in terms of symptomology, as well as a lot of room to meet the need of that clientele. Obviously they are different conditions, but BPD has a lot of similar difficulties in regards to emotional regulation, social relationship issues, and self image that I also really am drawn to with ADHD. So maybe by adding that in as part of my focus, it can help broaden things up for me!

Also, I hear what a lot of people are saying, and I know for SURE i will have clients that are all other types of dx as well, and I should always be prepared and welcome that, and I'm totally okay with that. Absolutely no reason I would be unwilling to work with an OCD, PTSD, MDD or any other client as part of a portion of my practice or within a hospital program.

HOWEVER, while I've been looking at schools, I've been primarily focused on ADHD and ASD. Therefore, I am really hesitant to like..... start my entire damn school search over to see who else might also work with BPD (as well as my ADHD/ASD schools I've found). I've already excluded a lot of schools based on not having any ADHD or ASD work there................do I now start over? I thought I was basically done with my school list.

There also now is the issue of the doctorate. Part of what was really drawing me into getting a doctorate is the fact that Psyd's/PHD's can work with assessment tools, fancier diagnostic tools, and work with complex and comorbid cases more easily, which i thought was REALLY important for my populations. And now, I can't tell if these are as worth it with these populations anymore. I mean, i suppose I will still need to do some assessment work occasionally, even if not batteries of tests, and even if only sometimes. And, it would still be good to understand assessment well. I mean, there are a lot of other reasons that I personally am drawn to a doctorate (somewhat higher salary, personal accomplishment, my parents promise to fund anything that is needed)... but the reason I thought I NEEDED the doctorate was because of the diagnostic assessment and evaluation tools, and being better with complex comorbid cases. Well I guess there is one other thing I would NEED a doctorate for, which is being able to run a hospital program or develop a program, which is much harder for MA clinicians I suppose (which I am interested in doing possibly at some point, not fully sure yet).

Feels like a chaotic mess.... and I thought I was DONE with deciding I wanted a doctorate and my school list.

Speaking as someone who specializes in BPD, assessment knowledge is extremely helpful IMO. There is a ton of misdiagnosis in that population.

Also, if you go that route, you'd probably want to look at programs that offer training or opportunities to train in dialectical behavior therapy. You can get that post-grad, but it's harder to break into it IMO.

 

[PsychNLife]

Speaking as someone who specializes in BPD, assessment knowledge is extremely helpful IMO. There is a ton of misdiagnosis in that population.

Also, if you go that route, you'd probably want to look at programs that offer training or opportunities to train in dialectical behavior therapy. You can get that post-grad, but it's harder to break into it IMO.

any BPD interest would still be in addition to my other interests i mentioned as well though, so my main question is 1) if that means I need to restart my school search (god that would take forever, restructure the SOP's that I've already been in the process of writing, and 2) if it still makes sense to go for a doctorate. From what you say, it seems like it would still be beneficial for me to do a doctorate. But maybe with a postdoc that allows for DBT training?

 

[PsyDr]

Making definitive statements about advanced subject matter to people with more training than you = not gonna help you in an admissions interview.

"BPD and ADHD have symptom overlap"= you telling someone something as fact.
"I think BPD and ADHD symptoms share some overlap."= telling someone your opinion.

 

[PsychNLife]

Making definitive statements about advanced subject matter to people with more training than you = not gonna help you in an admissions interview.

"BPD and ADHD have symptom overlap"= you telling someone something as fact.
"I think BPD and ADHD symptoms share some overlap."= telling someone your opinion.

I'm sorry, you are right, I don't know enough to state that as a fact. Would it be accurate to say that there at least could be some overlap in those areas though?

 

[summerbabe]

1) if that means I need to restart my school search

I would hope not. What I focused on for dissertation and thesis has nothing to do with my primary clinical interests/skills (SMI, trauma). Some of your PIs who research ASD or ADHD may combine their research programs with clinical work serving those populations, which could be a great fit for you. And programs with faculty interested in this work means likely more opportunity for supervised clinical work in these areas.

But the majority of your clinical training during the doctorate is to build up your general competency to practice as an independent psychologist (e.g., evidence-based treatment of depression and anxiety, suicide risk evaluation, administering and interpreting an IQ test, etc).

Practicum sites available in that locale and have a working relationship to your program can be really important in allowing for experiences with more specialized work. For example, if somebody wanted significant experience working with LGBTQ populations, choosing a school in a very rural/remote part of the US, even if they have faculty doing that kind of research, could mean less clinical opportunities. And just because there are faculty listed with certain research interests does not necessarily mean that you'll get those clinical experiences.

Internship (and especially postdoc) can provide generalist or more specific experiences. Having some specialized experiences already during grad school and LORs speaking to interest/skill in these areas can help with matching to internships with more specialization opportunities, which can be important for non-generalists.

2) if it still makes sense to go for a doctorate

You're taking in a lot of info and trying to make a lot of decisions, which is stressful. Applying requires time and money so if you've already put in a lot of time and you're able to comfortably fund the application costs, you can apply and keep figuring out your interests and career directions.

If you receive interviews, that's a great way to learn more about different programs and further assess fit. Interviews are as much a time for programs to interview you but also for you to interview programs, including asking specifically about how/whether they can support your career goals. And you can always decide later that you're better off with a Master's degree or just need more time to decide and decline any interviews or offers you may receive. Or if you aren't successful in receiving interviews, then to re-evaluate what it would take to be more competitive if you apply again.

 

[PsyDr]

I'm sorry, you are right, I don't know enough to state that as a fact. Would it be accurate to say that there at least could be some overlap in those areas though?

I would think the exclusion criteria for BPD would prevent the idea of symptom overlap, as would the difference in onset.

But that’s not really my point. You’re trying to get into grad school. I’m pointing out something that might block that goal. Do whatever you want with that.

 

[Sanman]

I just want to thank everyone for their responses. As I've been reading them and thinking, I think I have some ideas going forward. I've been thinking a lot about my interests, and it seems like MAYBE it could be helpful to add BPD to my ideal client focus, because there is also a HUGE overlap with ADHD and BPD in terms of symptomology, as well as a lot of room to meet the need of that clientele. Obviously they are different conditions, but BPD has a lot of similar difficulties in regards to emotional regulation, social relationship issues, and self image that I also really am drawn to with ADHD. So maybe by adding that in as part of my focus, it can help broaden things up for me!

Also, I hear what a lot of people are saying, and I know for SURE i will have clients that are all other types of dx as well, and I should always be prepared and welcome that, and I'm totally okay with that. Absolutely no reason I would be unwilling to work with an OCD, PTSD, MDD or any other client as part of a portion of my practice or within a hospital program.

HOWEVER, while I've been looking at schools, I've been primarily focused on ADHD and ASD. Therefore, I am really hesitant to like..... start my entire damn school search over to see who else might also work with BPD (as well as my ADHD/ASD schools I've found). I've already excluded a lot of schools based on not having any ADHD or ASD work there................do I now start over? I thought I was basically done with my school list.

There also now is the issue of the doctorate. Part of what was really drawing me into getting a doctorate is the fact that Psyd's/PHD's can work with assessment tools, fancier diagnostic tools, and work with complex and comorbid cases more easily, which i thought was REALLY important for my populations. And now, I can't tell if these are as worth it with these populations anymore. I mean, i suppose I will still need to do some assessment work occasionally, even if not batteries of tests, and even if only sometimes. And, it would still be good to understand assessment well. I mean, there are a lot of other reasons that I personally am drawn to a doctorate (somewhat higher salary, personal accomplishment, my parents promise to fund anything that is needed)... but the reason I thought I NEEDED the doctorate was because of the diagnostic assessment and evaluation tools, and being better with complex comorbid cases. Well I guess there is one other thing I would NEED a doctorate for, which is being able to run a hospital program or develop a program, which is much harder for MA clinicians I suppose (which I am interested in doing possibly at some point, not fully sure yet).

Feels like a chaotic mess.... and I thought I was DONE with deciding I wanted a doctorate and my school list.

You're putting the cart before the horse. Calm down and stop overanalyzing stuff. If you're interested in ASD and ADHD, talk about your interests and first get into grad school. No one expects you to have a foolproof plan for your future or private practice before you even get into school. Plenty of us that have graduated and have jobs have not done that. One of the things that is good about psychology is the the licensing allows one options for practice. My area of study was health and neuropsychology. I now work in geriatrics. My work pivoted over time. You will figure it out as you go along. First, master the required hoop jumping, then you can figure out the real world.

 

[singasongofjoy]

Perhaps, but the OP wants only high-functioning ASD individuals and does not want to deal with academic issues. What would drive all of these relatively functional autistic individuals without academic issues to the OP's door? More specifically, what would drive the parents there and make them spend significant money on top of what they may already need to spend related to academics? If you do the assessments for the ASD person for academic needs, perhaps you can keep a small population for therapeutic treatment. It really depends on the day job, non-competes, SES of the area, etc.

I work with plenty of adolescents and adults who do great academically, or at least perfectly fine. It's the soft skills and once they finish high school that they flock to the clinic because, as one of my clients who was valedictorian and went off to college on a full scholarship noted, "I failed college because I did not know that I did not know how to make a sandwich." In families with bright kids on the spectrum, the teachers and parents often focus so much on academics- in part because that is an area of success and strength - no one ever assesses whether they actually have the adaptive living skills (and have been able to generalize those skills), the planning and executive functioning, and the soft skills to function in adulthood. My brilliant client lacked the planning, sequencing, problem solving to keep herself fed in school which is ultimately representative of a bigger problem than failing classes. It's a lot easier for kids with intellectual disability to access services to learn ADLs, navigate the community, and get and keep a job than it is for our folks without ID who often qualify for very few services in adulthood, but can't keep and maintain a job, home, or long-term relationship. So in short - what would drive these people to your door- the fact that they finished / are finishing high school and suddenly all of the external structure in your day to day life disappears.

 

[singasongofjoy]

Speaking as someone who specializes in BPD, assessment knowledge is extremely helpful IMO. There is a ton of misdiagnosis in that population.

Also, if you go that route, you'd probably want to look at programs that offer training or opportunities to train in dialectical behavior therapy. You can get that post-grad, but it's harder to break into it IMO.

maybe this question is answered in an earlier post above but... BPD- borderline, or bipolar? Which do you do more of?

 

[cara susanna]

maybe this question is answered in an earlier post above but... BPD- borderline, or bipolar? Which do you do more of?

I think you're asking if I specialize in borderline personality disorder or bipolar? If so, borderline personality disorder. Although a lot of them historically have been misdiagnosed as having bipolar 2.

My specialties are trauma and BPD, so basically what people would consider more "complex" trauma cases (although you all know how I feel about the idea of complex PTSD, lol).

 

[erg923]

I think you're asking if I specialize in borderline personality disorder or bipolar? If so, borderline personality disorder. Although a lot of them historically have been misdiagnosed as having bipolar 2.

How do you find SCID vs SADS for this investigation/diagnosis? Do you do this (I kinda hope)? Which is better for you? How is the CAPS with this question/population?

How do you like the MMPI-RF vs PAI for supplementing....if you do this/these as well?

Do you find things like the Mood Disorder Questionnaire (MDQ) helpful.... or more a waste of time?

 

[Therapist4Chnge]

How do you find SCID vs SADS for this investigation/diagnosis? Do you do this (I kinda hope)? Which is better for you? How is the CAPS with this question/population?

How do you like the MMPI-RF vs PAI for supplementing....if you do this/these as well?

Do you find things like the Mood Disorder Questionnaire (MDQ) helpful.... or more a waste of time?

MDQ....I'm not familiar w. this assessment. I use the 2RF a lot for forensic-related work, but haven't used the PAI since training.

 

[WisNeuro]

Yeah, I rarely see the PAI anymore.

 

[cara susanna]

How do you find SCID vs SADS for this investigation/diagnosis? Do you do this (I kinda hope)? Which is better for you? How is the CAPS with this question/population?

How do you like the MMPI-RF vs PAI for supplementing....if you do this/these as well?

Do you find things like the Mood Disorder Questionnaire (MDQ) helpful.... or more a waste of time?

I prefer the SCID. I like the CAPS to rule out or confirm PTSD. For objective testing, I love the PAI. It has one of the best scales for measuring BPD, with numerous studies that have examined predictive validity. I used it to measure BPD for my thesis back in grad school.

I'm actually not familiar with the MDQ so I can't answer that. For a self-report measure of BPD, I like the McLean.

 

[PsyDr]

I think the PAI vs MMPI debate is really discussing the merits of putting the variability in the number of questions OR putting the variability in the number of possible responses. And some silly historical things.

Should be interesting to see what the MMPI-3 brings.

 

[WisNeuro]

I think the PAI vs MMPI debate is really discussing the merits of putting the variability in the number of questions OR putting the variability in the number of possible responses. And some silly historical things.

Should be interesting to see what the MMPI-3 brings.

I was supposed to go to a workshop for 3 at the UM but it was canceled due to the pandemic. I don't recall if they later offered a virtual workshop or not yet, also interested to see what substantive changes were made.

 

[ExecutiveDysfunction]

I was supposed to go to a workshop for 3 at the UM but it was canceled due to the pandemic. I don't recall if they later offered a virtual workshop or not yet, also interested to see what substantive changes were made.

Haven’t watched this, but Pearson put out what looks to be a summary of changes

 

[Unipsychler]

How do you find SCID vs SADS for this investigation/diagnosis? Do you do this (I kinda hope)? Which is better for you? How is the CAPS with this question/population?

How do you like the MMPI-RF vs PAI for supplementing....if you do this/these as well?

Do you find things like the Mood Disorder Questionnaire (MDQ) helpful.... or more a waste of time?

The MCMI is a really useful assessment tool for personality disorders. At my personality testing externships, we used that instead of MMPI or PAI.

 

[AcronymAllergy]

The MCMI is a really useful assessment tool for personality disorders. At my personality testing externships, we used that instead of MMPI or PAI.

MCMI and/or MBMD are often used in transplant evaluations. Downside is that the MCMI's validity scales leave a lot to be desired.

 

[erg923]

The MCMI is a really useful assessment tool for personality disorders.

I have very much heard the opposite.

 

[summerbabe]

I have very much heard the opposite.

I've used the MCMI a bunch at a previous training setting where it was part of the standard battery and it can have AWFUL sensitivity and specificity (in addition to the questionable validity).

For over-endorsers and people who present themselves in a negative fashion (but likely without PD) and people with genuine PD, it's not uncommon to see that individual spike half of the total personality scales so at that point, all I can really take away is the possibility of Axis 2 stuff that needs a lot more further assessment. But it's likely I already knew that going into the assessment.

I don't currently have access to the MCMI but even if I did, I would very rarely use it, if ever.

 

[LadyHalcyon]

I've used the MCMI a bunch at a previous training setting where it was part of the standard battery and it can have AWFUL sensitivity and specificity (in addition to the questionable validity).

For over-endorsers and people who present themselves in a negative fashion (but likely without PD) and people with genuine PD, it's not uncommon to see that individual spike half of the total personality scales so at that point, all I can really take away is the possibility of Axis 2 stuff that needs a lot more further assessment. But it's likely I already knew that going into the assessment.

I don't currently have access to the MCMI but even if I did, I would very rarely use it, if ever.

Interesting. I love the mcmi iii, not as fond of the iv. It's true it definitely overpathologizes if taken at face value but it provides very useful information in terms of personality traits. I typically do not like incorporating tables into my reports; however, I especially think it is problematic to include tables when using the MCMI for the reasons mentioned.

 

[cara susanna]

The MCMI-III is a fun instrument but, as mentioned, it overpathologizes and the personality scales map more onto Millon's theory than the DSM-5 criteria. So, for instance, someone spiking antisocial on the MCMI-III doesn't necessarily correspond with DSM-5 criteria for ASPD because Millon conceptualizes it differently.

 

[Unipsychler]

Interesting. They LOVE the MCMI at a few different PD-focused clinics within NYC's Mt Sinai system.

 

[LadyHalcyon]

Interesting. They LOVE the MCMI at a few different PD-focused clinics within NYC's Mt Sinai system.

NYC has a lot of dynamic folks

 

[erg923]

Interesting. They LOVE the MCMI at a few different PD-focused clinics within NYC's Mt Sinai system.

If you love it, you love Ted and his work. A lot of people don’t. And I have never been a fan.

It strikes me as much easier and cheaper to, ya know, just apply DSM criteria after an in-depth interview.

 

[WisNeuro]

The MCMI is kind of terrible, really. Almost impossible to invalidate IME.

 

[cara susanna]

I just find it useless diagnostically. Although, honestly, I generally find the MMPI-2 useless for personality diagnostics as well. Like erg mentioned, a good interview with a structured scale is all you really need. I throw in the PAI as a validity check and because some of the scales are useful (like I said above, the BPD scale is excellent) but that's about it.

 

[borne_before]

As an aside, I have a colleague who does a lot of autism work. She gets referrals from well meaning counselors who have said to a client "Oh, have you ever thought you have autism?" She does her eval and includes a (MCMI/MMPI), and most of these referrals end up being PD. That's what I mean by you're not gonna get a ton of "good" referrals.