What’s your specialty?

A couple of years ago I went to a workshop, “Building Your Dream Psychotherapy Practice” at the New York City chapter of NASW (the National Association of Social Workers). At the time I was the director of a group therapy center here in New York and always eager to learn about new ways of promoting the practice.

After a lengthy introduction, the workshop facilitator (we’ll call her Blue, both because she was wearing an over-sized, bright blue cable-knit sweater and for a reason that will shortly become clear) introduced us to the (seemingly revolutionary, to her) concept of an elevator speech. “It’s a 60-second speech that you’re prepared to give to anyone, at anytime about who you are, the problems you help with, and how you help.”

She went first: “My Name is Blue. I’m a therapist in Brooklyn, New York. You know how some people, when the seasons change, they get the winter blues? Well, I use science-based techniques to help people feel better when the days get shorter and colder.”

“In other words,” she explained to us, in more technical terms, “I’m a cognitive-behavioral therapist who treats seasonal affective disorder.”

Others were asked to take turns. There were anxiety specialists, and postpartum-depression specialists, and career-changer specialists. There were those who work with adult men with AD/HD and those who led groups for older moms.

Several times, our host, Blue, interrupted people to suggest they were being too technical: “Don’t say, ‘bi-polar disorder.’ Say ‘intense mood swings,’” for example.

I couldn’t resist taking a turn. “My name is Matt Lundquist. I’m the director of a group psychotherapy practice in Manhattan. I’m part of a movement of thousands of therapists and patients who are moving away from diagnosis and pathology towards creating approaches to helping people that focus on strengths, creativity, and possibility. I specialize in helping people who feel marginalized, categorized–”

She interrupted me, obviously irritated. “What problem do you treat?”

“That’s just it!” I exclaimed, enjoying myself perhaps a bit too much for politeness’ sake. The room was captivated. “I work with people who are tired of being related to as the sum of their problems; people who are in pain and don’t want to be diagnosed, treated, assessed. I work with people, not problems.”

Blue could tell I was beyond help.

As she rushed to move on (a therapist who’s also a doula specializing in the emotional challenges that come up before and after birth; an expert on adult-sibling relationships), I sat, awkwardly, as more than a dozen aspiring therapist in the room crept towards me and gingerly handed me their business cards and resumes. I’d caused a scene.

These few years later, I’m a lot more comfortable causing that scene. Not just for the sake of it. I’ve learned that the response of many of the young therapists in that room is reflected in much greater numbers among “consumers” (i.e. regular folks like you who are just trying to get some help in living their lives).

My specialty?

There’s a lot of pressure on professionals of all stripes, not just therapists, to “specialize.” Just as in medicine, it’s good to be the “social-anxiety guy,” or the “adult-children-of-alcoholics gal.” This gets reflected by group therapists in the form of groups organized around a particular issue or class of patients (grief and loss groups, or twenty-something groups).

Since going into private practice I’ve connected with a few online networking groups. I like the collegial atmosphere, hearing updates on talks that colleagues are giving or changes happening in their practices. Primarily, however, they tend to function as rather awkward referral networks, inevitably organized around specialties. Most of the therapists who post to the group for recommendations don’t know one another personally (otherwise they’d reach out to one another directly) and as a result, the standard of a good fit becomes the institution of the specialty:

“I’m looking for a dialectical-behavioral therapist on the Upper West Side specializing in work with incest victims.”

“I have a referral for a 22 year-old female looking for an eating disorder support group for college students.”

Inevitably the message is followed by several quick replies, “So-and-so specializes in that.” Or, “I’m forming a group for this issue.” It works about like you’d expect.

I think it misses the mark in several ways. It assumes that the diagnosis (and often here–not always–, we’re talking about a self-diagnosis that the patient makes as part of the very process of looking for a certain kind of specialist) encapsulates the nature of the work to be done. One assumes that an eating-disorder expert will treat an eating disorder, that a seasonal-affective-disorder expert treats that issue, and so on. But what if someone has both struggles? Or struggles with bits and pieces of every diagnosis? Or there’s no diagnosis that captures his or her pain and, more importantly, who he or she is? What if it’s the case that who we are, including the very ways that we struggle and experience pain and difficulties in living can’t be summed up by our age, gender, diagnosis, and which Manhattan neighborhood is on our subway line?

None of this is to deny the very real pain that so many people find themselves in, with struggles like postpartum depression, the pain of incest, or the winter blues. My critique is not meant to imply that these challenges don’t exist, or that those who suffer from them are not experiencing very real pain. Nor is it meant to suggest that those who specialize in treating those challenges don’t do effective work. What I am suggesting is that the very construction of specialization is reflective of a narrow, outdated way of thinking about psychotherapy, pain, growth, and what it means to help people who are suffering emotionally.

Your therapist’s dreams

Let’s not forget the title of the seminar, “Building Your Dream Private Practice.” See, the thing about dreams is that they start out in our heads–ideals to take with us into the world like swatches of fabric, off with us to find a match. The trouble is, therapy ought not be about the therapist’s dreams, but yours. Maybe the help you need doesn’t fit with her dream. Maybe your life and your struggles aren’t much of a dream at all.

Get off the elevator

The very premise of an elevator speech–to use Blue’s words, “It’s a 60-second speech that you’re prepared to give to anyone, at anytime…” –assumes  that how I help as a therapist a) can and should be summed up in a 60-second conversation and b) doesn’t need to be particular to the person I’m talking to. “Anyone, at anytime” implies a “one-sized-fits-all” approach–the very notion that seeking a “specialist” presumes to prevent.

The fact is, the sort of work involved in helping you with your pain doesn’t fit into a sound bite. In fact, anyone who tells you he or she knows how to help you before you’ve had the chance to build some of that help, together, is probably trying to sell you kitchen supplies. If that happens, I’d recommend taking the stairs.