Building a practice by specializing

By Ari Tuckman, Psy.D., M.B.A.
November 1, 2007 - Last updated: May 31, 2011

There are plenty of clinicians out there, so how do you distinguish yourself? How do you increase the odds that a potential client calls you rather than someone else? Many of us practice in areas that have a fair number of other equally qualified professionals. Although we have all received at least something of a generalist education, most of us tend to evolve toward certain populations or clinical conditions, unless you live in an underserved area that forces everyone to be a generalist.

Sometimes this is unintentional as we connect with various referral sources, some of which send a disproportionate number of clients. For example, one psychologist I know was asked to do a presentation on grief which resulted in additional requests. Without really meaning to, he became the local expert on grief. Other times, a therapist will work to intentionally build a reputation in a specific clinical area, perhaps capitalizing on a twist of good fortune, as above.

I contend that it is to your benefit to find and promote a specialty that goes beyond the default anxiety, depression and relationship issues that everyone works with. (I will talk mostly about therapy in this article, but the same lessons apply to assessment.) This is especially true for new therapists or those who are struggling to fill their caseloads.

Probably one of the main reasons most therapists don’t narrow their focus is out of concern that they will do more harm than good by limiting potential referrals. There is some merit to this, but you can mitigate this effect by stating that you specialize in Asperger’s, for example, but also work with children and teens with ADHD, school issues and substance abuse.

I specialize in ADHD, particularly adults with ADHD who tend to be underserved. If a potential client asks about my background, I will say that I specialize in adults with ADHD but since they have all of the same struggles as everyone else, I am also well versed in other areas of practice. After five years of graduate school and 10 years of practice, I am hardly a one-trick pony. However, when it comes to adult ADHD, I am “the guy” in my neck of the woods. This dramatically increases the odds that those referrals will come my way, rather than to one of the many other generic therapists. In addition, after working hard to build my reputation, I am now at the point where the offers to write or speak are coming to me, rather than having to pursue them. This would not happen if I were a generalist. In addition, many of the clients who find me online do so because they are specifically seeking services for ADHD.

Choosing a Specialty
The first consideration in choosing a specialty concerns your interest and abilities in working with that population. Will you tire of having the majority of your caseload made up of these clients? If you are going to be a specialist, then you have to offer a level of expertise which a generalist does not. If you do not yet possess that greater skill, then seek out additional training, supervision or reading.

The next consideration concerns the market for your services. Are there enough clients within a commutable distance of your office to fill your caseload? Related to this, are there already a number of other clinicians specializing in this area which would make it difficult to break in? If so, can you distinguish yourself in some way?

Since every therapist works with anxiety and depression, if you are going to focus on one of these, you need to find either a specific approach (e.g., CBT or biofeedback for anxiety) or subpopulation (post-partum depression, panic disorder). Generic anxiety and depression are too general to distinguish yourself. Here is a brief list of other possible specialties to consider:

•Bipolar disorder

•Anger management

•Defiant teenagers

•Substance abuse in high functioning adults

•Couples therapy or relationship enhancement for empty nesters

•Neuropsychological assessment

On a personal note, I have found adults with ADHD to be in need of more services than are available in most areas. Children with ADHD are well served, but their parents are not. This is very much a growth area, given the small percentage of adults with ADHD who have been diagnosed and are receiving treatment specific to the disorder. By looking over your caseload, you may find that you already have something of an unspoken specialty. If not, some reflection may provide you with one. Once you settle on a specialty, promote it proudly. Think of the other professionals, both within mental health and otherwise, who have contact with those clients and introduce yourself. Soon you too can become the person that those clients seek out.


Ari Tuckman, Psy.D., M.B.A., is the author of Integrative Treatment for Adult ADHD: A Practical, Easy-to-Use Guide for Clinicians. Information and free handouts are available at his website: He is in private practice in West Chester, Pa. His e-mail is:

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