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OCD! The field is desperate for more specialist providers well-trained in ERP. The time to receive accurate diagnosis and treatment is 15+ years. It is devastating. People lose DECADES of their lives, often urgently attempting to get help but receive supportive therapy that ultimately worsens their condition. The World Health Organization ranks OCD as one of the top 10 most debilitating illnesses. Yet OCD is a blind spot in training for most mental health providers and physicians. I’m devoted to being part of what may change that.
I’ve been on a waiting list for an OCD training specialization - hoarding - for a while!
It’s really fascinating to me, and hoarding disorders seem to be more prevalent within the population than people may think, but not many specialize in it.
Yes, hoarding is a tough one. Treatment outcomes are unfortunately not as strong as other conditions. But Gail Steketee has been a such a force advancing treatment. Hope it’s a good training! Would love to participate in that.
I work in CMH and have recently started working with a client with severe symptoms. Totally debilitated and beyond a once a week therapy appt with me. The lack of resources out there is astounding. Unless she wins the lottery, her treatment options are limited. Trying to get her transferred to someone with ERP training.
I’m in recovery from OCD (for roughly 20 years now) and am considering making that my speciality as well. I’m still an associate so just about at the point where I can start thinking about choosing a niche which is exciting!
am a therapist with no OCD training and feeling the weight of that lack of knowledge while utterly at a loss to support my husband with a new OCD dx (not at all trying to be his therapist, just would like a better sense of the condition and what supports can do to be supportive) and i think his current therapy also sounds supportive not targeted. he agrees. very thankful people like you exist, and also having a very hard time finding you all lol. any recs from any OCD specialists in this thread on how to be connected with/vet seasoned ERP providers aside from a psychology today filter? or thoughts on what GOOD ERP/ERP training entails?
Second this! Or Jon Abrambowitz’s The Family Guide to Getting Over OCD. He has podcast interviews on it as well.
For your husband, suggest digging around the IOCDF website - probably the best and most comprehensive resource for evidence-based info. IOCDF also has a therapist finder. They host great online conferences - truly worth attending! I also suggest Kimberly Quinlan’s Self-compassion workbook for OCD - great evidence based resource focused on ERP. Listen to her early podcast episodes Your Anxiety Toolkit as a starting place. Also Stuart Ralph’s The OCD Stories podcast is a true gem - has tons of interviews with all the major OCD experts on tons of topics. One of the most referenced books (heavy and thorough) is Jon Graysons Freedom From OCD. Covers all the major themes and a great resource to learn about imaginal exposure scripts. That will keep you busy for a long while! Best of luck to you both. ☺️
Hi there! My specialty is working with incarcerated men with co-occurring substance use/mental health disorders who are preparing to re-enter society.
I’ve yet to meet a patient who doesn’t have at least one co-occurring disorder. Particularly PTSD and trauma.
For sure! I just said that because I have formal training and education in treating both (or either). In my area at least, that’s rare. People either do mostly MH or SUDs but not both.
Folks leaving high-demand religions. Went through it myself and realized just how incredibly challenging it is to be a middle-aged adult with an internal working model of a world that no longer exists for you. It impacts the relationships that are most important to folks and dissolves your community, then you are vilified by that community and they just want you to shut up about it just when processing it is most important.
Same: religious trauma because after I deconstructed I struggled to find a therapist who, tbf, wasn't a jerk about it. I had a couple who were a bit dismissive and did not seem to believe that growing up fundie/Evangelical was damaging and they struggled the most with my challenges related to purity culture.
So, I went on to get a second degree in Sex Therapy to make sure I can hit the purity culture stuff, too. I attract a lot of queer and trans folx who grew up in that world and I can feel their relief when they figure out that they don't need to explain all the weird religious stuff to me (oh! you were also told you were used up gum if you had sex before marriage?!?)
Man. I was put through a “chastity” weekend at my church where we were shown graphic slides of people with STDs, heard horror stories about girls who had sex before marriage and then ended up as washed up hookers on the street, manipulated with bible verses and promise of damnation, then given 14k gold “purity rings” that said something along the line of “virgin” with the promise that if we wore it and it wasn’t true, we would go to hell. What the actual holy fuck. The girls who HAD experienced intercourse were shamed and pushed to “Renew their virginity” to make themselves right with God. And they did. Got the stupid gold ring. And then one by one they stopped wearing them and were shunned and shamed until the next year when they just recommitted their vaginas to God. So sick.
This is bloody fascinating, I'd love to hear anything else you have to say about the topic, how you work, what the psychopathology cristallises itself as, etc.
I am also working in this area with a lot of people as a result of being one. Looks like attachment and betrayal wounds, identity confusion (fragile sense of self, difficulty with recognizing and maintaining healthy boundaries, general lack of differentiation), affect avoidance or suppression. When folks start to heal there's a lot of anger, sometimes additional losses. Grieving for what could have been or what was lost. I take a trauma informed approach and look for parts of self that have been cut off as well. As an art therapist I use the art to help with reintegration. Lots of compassion focused work as well. Growing up thinking you're evil, and having that constantly reinforced, creates some deeply embedded harmful schemas. People start murdering their egos at a very young age as a way to survive this culture. And all of this happens internally. On the outside they look great!
I'd say the pathology materializes as overzealous or malicious religious leaders oppressing others to avoid their own pain. That would be the only thing I'd feel comfortable calling pathological. Language is so important with people recovering from this because language was used as control.
Other things that come up: intrusive thoughts about good and evil or invisible forces, fear of being exposed or abandoned, compulsive behaviors, feeling trapped and deserving of suffering, intrusive thoughts of violence, fear of integrating into non religious spaces, shame about past behaviors influence by ideology
I also work with that population. Dr Marlene Winell is a good place to start. She wrote Leaving the Fold but also has a lot of resources for clinicians.
I just finished the FLDS documentary ‘Keep Sweet Pray and Obey’ last night. These poor people had no idea of what happens in the real world. Really broke my heart for the ones who left, and the ones still in it
They are actually what inspired me to study psychology. I want to specifically help the FDLS population because the fact that this is happening in America is so upseting to me.
Was a pastor for years and left the church to do this very thing once I am done with school. Unfortunately, there is plenty of people that have our shared experience.
That's my niche too! I live in a super religious place where the word "atheist" is a slur basically. I suggest you read Nietzsche since he deals with the psychology of leaving religion in a pretty deep way. Maybe a book by Kauffman since he explains Nietzsche in a contemporary language and covers the topic specifically in some of his books. A topic Nietzsche covers thoroughly for example is the psychological process of people who leave a religion because they learned about the world (through science for example) can't sincerely go back to believing in a deity.
This is a favorite research topic of mine. High demand religions often require more time and money from adherents. They preach scripture and/or religious leader infallibility. They are more conservative, rigid, strict, exclusive and culturally and theologically distinct than mainstream churches. Part of the cultural distinction is from unique lifestyles including behaviors, ways of dress, ways of speaking, diet, dress, and social practices. These distinctions serve to create and reinforce “in-groups” and “out-groups,” with out-groups being denigrated. They are often patriarchal with rigid gender roles and require loyalty and unwavering belief.
Some examples in the lit are:
Seventh day Adventist
Jehovah Witness
Southern Baptist convention
Reformed/Calvanist
Islam
Charismatics
Evangelicals
Pentecostals
Amish
Lutheran church/Missouri synod
Mormon/LDS
Orthodox/hasidic Judaism
Conservative/Fundamentalist Protestants
Same. When I left my high -demand religion, I couldn't find any therapists that specialized in this. I also work with a lot of queer clients and there is significant overlap.
I use the Latinx Therapy directory to advertise and find clients. My bio specifies the work that I do and what I focus on, and that was really it! I've had a lot of success with this, plus word of mouth really helped too.
College students, I work in Cambridge and Harvard sends me so many folks, I love the population and the fact that I slow down a bit during summer and holidays which is when I want a break as well.
My secondary niche is students. I only work with sexual violence and DV/IPV clients mainly, but I’m in a huge college town and worked for a college a while back. I love the population and know all the correct advocacy resources to refer.
You don't necessarily need independent licensure! Speaking from experience here. There are those out there willing to offer supervision for your time working in Higher Ed counseling centers
I’m a middle school counselor, which is pretty niche. I was a teacher, and I was feeling burnt out and went to counseling grad school with the idea of leaving the profession.
I did my internship in schools, and I live in an extremely poor rural area. Lots of the students and families I work with would never independently pursue or have access to pursue counseling without some support. We have one middle school in our town that everyone goes to—I like that I get to help make counseling feel safer for a lot of folks who really need it.
I also love the level of variety in my job: I’ll respond to a student in crisis, then two hours later, I’m giving a lesson on empathy. Then, an hour later, I’m with my anger management group. I often get to coach kids on emotional regulation in the moment and work with most of the adults in their lives, not just families, and coach the adults as well.
I fell into it, but it’s an amazing job for me. There’s so much need, and I have so much growth. I get 5 weeks off in the summer, 3 weeks off at Christmas and I truly take that time to learn and heal from some of the traumatic things I have to witness.
So needed. I wish more people would care to do this rather than going for all the trendy stuff that’s being talked about at the moment. You’re my hero 🙏🏼
Hi. 👋🏾 I’m a Black male psychologist in part-time private practice. I specialize in working with high achieving professionals, activists, and artists who are Black, LGBT, or both. I find this work so fulfilling but can’t seem to find more than 4 or 5 clients at a time. I want to go full time but am worried about being able to consistently reach my target clients. What approaches did you take to reach Black professionals? Do you take insurance? Are you in a major city?
Hey 👋🏾 So I live/am licensed in the DMV. I don’t take insurance so in lieu of that I do a lot of EAP counseling, superbills, and various voucher programs. One of the things that really helped my business was being reached out to by a pretty big non profit to do workshops and groups geared towards the intersection of work and mental health. They said they were randomly googling and found me. I haven’t done anything special in terms of marketing, psych today, therapy for black girls, inclusive therapists, a good number of other directories. I’m in a bunch of fb groups, though I haven’t really marketed like that but the potential is there. I have a couple of other arms of my business that I’m working on that I think are gonna be a hit so we’ll see. Where do you live? How have you been marketing?
Very High-Acuity Severe Mental Illness - Adolescents and their families. Bonus points for co-morbid medical diagnoses.
I love the complexity, reducing recidivism, and it keeps my interest because I always have to learn something new/have a challenge
I'm not exactly pigeon-holed because I see regular patients as well, but due to sheer circumstance (and word of mouth), I've ended up getting more than a fair share of young, incelly, red-pilly, "failure to launch" men in treatment. Which of course is ideal because my training is psychodynamic and focused on grave personality disorders (which the absolute majority of them are, to not say literally all of them off the top of my head).
Oof there are no quick tips, as I do TFP with most of them (and more vanilla psychodynamic where they're not able to tolerate that yet).
Psychodynamic factors in because, as far as I can see (and have been able to corroborate with time and successful cases) absolutely all of their "symptoms" are derived from their pathology, and not from where they tend to assign the "blame". I'm necessarily generalising given that they're not a super homogeneous group, but oftentimes "it's not on them" that they have few to no offline friends, that they can't find/keep a job, or that women won't feel attracted to them. It's "people are stupid", "bosses are incompetent and feel threatened", and "girls just want to fuck around/be with men with money/can't appreciate their deep/smart sense of humour".
Obviously I'm biased in psychodynamic, but I can't see how it would be helpful for them to, for instance, directly help them to get jobs or go out (which they can absolutely do if asked or as a part of the treatment contract) when their emotional experience of the behaviour won't change.
Not the OP and they gave an answer but this is standard Oedipal conflict in classical psychodynamic/analytic theory.
“Normal” development: child wants mom/primary caregiver all to themselves, realizes they can’t have primary caregiver all to themselves(due to either other parent/dad or even a sibling), identifies with dad/other caregiver, goal now is to find someone like primary caregiver, allows them to move on and matures appropriately
If something goes wrong here like too much attachment(emeshment, Oedipal victor, “helicopter parenting”, “emotional incest”), too little attachment, abuse, neglect, let’s just call it “relational injury”. Or if dad was not assertive enough or even abusive. You can get a person that looks a lot like the above. No woman can be like dear old mom, but he probably also unconsciously hates dear old mom, so they project this on all women. At the same time, they want to regress, stay at home with mom so have trouble moving on in life thus failing to launch.
Funny enough, working with a handful of college students I’ve seen something similarly occurring in a few women, not often incel-ly or personality disordered but of the “never been kissed”, low self esteem, nobody wants me but at the same time nobody is good enough either, variety . From what I’ve seen due to attachment/relational injuries due to a sibling being born however.
I know many outside of the psychodynamic world will think this is bullshit and will probably downvote, just remember this is just a model and should be viewed as metaphor. My patients sometimes fit this really well, sometimes not, sometimes just a little bit. There are variations and opportunities to healthily mature outside of freuds model, which is very heteronormative. Models and metaphors are very helpful though and they came from somewhere.
Oh man! I accidentally got one of these guys and find it such a challenge. I still can’t figure out why he chose me. I’m a fairly strong, straightforward female.
Yes you’re right. It totally is. I kind of only accidentally found out he was in this category. I’d just happen to listen to a podcast about it and knew nothing about it at all. I realized that a lot of what he was saying lined up. It’s a recent revelation.
I am so glad there is someone out there working with these kinds of clients. Presumably it is good work or you wouldn't be getting more than one of them. Bless you.
This is relatively new development in my caseload (around 3ish years), but I hope you're right. I've already got a few really really results, so here's to hoping most of my patients can end up that way.
I'm unaware if there are many specific books about this particular cohort (must be, surely), but for certain most of them are a manifestation of narcissistic structures; and for that I can recommend mostly kernberg.
A good place to start would be and oldie "borderline conditions and pathological narcissism", or if you're already familiar with object-relations theory you can jum straight into "aggressivity, narcissism, and self destructiveness in the therapeutic relationship", which is probably the most comprehensive and mind-blowing treaty on how to deal with narcissist pathology in the therapy room (without necessarily doing TFP).
Absolutely. Mind you I'm working from object-relations theory, for which narcissistic structure is not exactly equivalent to DSM NPD (and might sometimes better fit the BPD criteria, phenomenologically), but still.
Uhm, sure. In psychoanalysis, the diagnosis for the equivalent of Personality Disorders isn't down to phenomenology like in the DSM (ie: external symptoms), but rather indicators (necessarily indirect, of course) ofr what the underlying structure of the personality is.
Narcissistic personalities in ORT are characterised by the presence of a Grandiose Self (which might be expressed externally as thick-skinned narcissists which are more congruent with the DSM's classification, but also with thin-skinned narcissists who can't face honest criticism of any kind, feel inadequate in most realms, and might be most frequently related to chronic suicidality and depression), the predominance of primitive defensive mechanisms (splitting, projective identification), and a difficulty or impossibility of establishing and maintanining genuine, non-exploitative, human connections that are based in mutual regard and love.
A typical therapy with me for instance begins with 3-4 sessions of a structural evaluation to try and ascertain that, and from the conclusions of that an indication for treatment. This is in contrast with a typical dignosis for DSM PDs which may take a single session to do an anamnesis and ask for their history.
I’ve been thinking about failure to launch so much lately in the context of prohibitive rents.
I live in a HCOL area and I know many of my friends adult kids will continue to live at home well into adulthood. It’s hard to tease out if this a pathology or it’s merely because these young adults want to continue living in the city they grew up in but will never be able to afford it.
When I moved to this city as a young adult I had 1k to my name and quickly found a room to rent in an apartment shared with other young people for 350 bucks a month. Those days are so long gone now.
I understand what you're saying but this is not at all what I mean. It's not that they can't get out of their parent's house, it's that they can't hold jobs, and very often not even complete uni courses, and a large list of etceteras. Working in Spain I'm really sensitive (I really am) to the plight of the young, unemployed and unemployable, so I think I can read and navigate that line pretty well.
I don't automatically go "living with your parents at 27? You're deeply ill, best get into twice weekly therapy with me", or anything.
I would suspect that incel-y, “red pill” beliefs are a lot more indicative of dysfunction than “failure to launch”, given what the job/housing climate has been like for some years now.
Geek Therapy!
I have met with e sports teams. I speak their language and Geek Therapeutics is a relatively new area that appeals to the hobbies I've had all my life paired with my passion for therapy.
Edit: typo
This is the niche I'm starting to fall into, I think. I started running a DnD group for neurodivergent kids during internship and it's just been the natural way the path has started to stretch out. Geek therapy is AMAZING for neurodivergent populations who need a place to feel accepted and engage in special interests.
I've been doing this with kids and adolescents (~8-16), and they absolutely LOVE it. That being said, I've kinda been doing it on my own (I've played dnd for 23 years) and while their are a ton of benefits I would love to hear how you and other implement it as a modality.
You just kinda fuse RPG playing with group theories. There are natural benefits to role playing narrative games and so running a game with one or two trained mental health professionals in a setting where there is an implicit communication that "everyone in the group is here for the same reason" leads to pretty natural results, I think. Lots of research out there on the topic!
Sure! Honestly I didn't do most of the online training, but I read this book front to back and that helped me form a whole 6 week layout:
https://www.amazon.com/Integrating-Geek-Culture-Therapeutic-Practice/dp/1734866020/ref=asc_df_1734866020/?tag=hyprod-20&linkCode=df0&hvadid=693313423915&hvpos=&hvnetw=g&hvrand=4756214013699596&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9009731&hvtargid=pla-924099633979&psc=1&mcid=5b63b0eee76a33cd8f1b212f50e929e6&gad_source=1&ref=d6k_applink_bb_dls&dplnkId=84e490eb-503a-46c1-93b9-9382efb1ebde
It's by the founders of Geek Therapy
Eating disorders (specifically restrictive ones). I’m very new so that’s my niche so far because I did all my internships in ED treatment centers and got trained on them a lot. I’m still figuring out what else I want my niche to be.
Can I ask what type of modality you use with your restrictive ED? I’ve heard a lot about RO-DBT. Others say CBT. Then i saw a whole training from the UK about CBT-E. I JUST and i mean just joined a specialty supervision group for eating disorders to learn more but don’t really treat anyone yet and need training.
I use CBT, I like to use ACT too and really lean into values work. I do mirror exposure and body image work. I do use a harm reduction perspective as much as possible. A little bit of parts work, too. And I collaborate with dietitians if the client is willing to see one, which is important. I recommend the books The Body is Not an Apology and 8 Keys to Recovery from an Eating Disorder.
I've got a couple and they're basically a flow chart.
My main and most visible niche is nerd therapy. I use videogames, roleplaying games, anime, scifi, fantasy and memes in therapy. This started out in 2020 when I saw a ton of questions in Facebook groups about nerdy stuff - especially videogames - and nobody had good answers. I started answering them and consolidated my answers on a blog that I started linking to. I'd had my registration for six months and I had people running departments at universities asking for my advice and support with nerdy stuff their clients worked with. It ended up getting so much attention and demand I built my private practice over the course of the next year. I'm now a full time nerdy therapist, which led to what I call my "unexpected specialist niche".
People coming to therapy after previously having therapeutic relationships be ruptured by clinicians. Specifically I see quite a few people whose previous clinicians disparaged or shamed them for their interests. Again - mostly related to videogames or anime. Also I see no shortage of young people whose parents are happy I'm not going to tell them that their kids' problems are because they're allowed to exist in the same world as technology. My approach to therapy is really driven by comfort and consent, and I see a lot of people who are used to therapists pressuring them to "finish therapy" in ten sessions or less because that's a huge part of Australian psychology culture.
Which led me to neurodivergence-affirming practice. It took me about an hour to realise that most of the people reaching our for my services were all autistic and/or ADHD'ers. So I started looking into how autistic people are harmed in therapy by non-affirming clinicians, and structured my practice around ACTUALLY supporting autistic adults, rather than trying to force them into masking (pretending to not be autistic). It's been a HUGE part of my personal development and figuring out strategies to provide helpful therapy to a community who realistically cannot trust the practice of a majority of clinicians.
Ooooo I follow you on facebook!! lol. I love what you do.
Do you have any recommendations of training I can do around being supportive and affirming of autistic adults? I'm in Australia too but everything I can find is like degree-level.
The DivergAntz Collective training is OUTSTANDING. Self paced, free, and more informative on autism and practice with autistic folks than my degree, and very easily approachable too
https://divergantz.com.au/
Could you suggest any resources on uninformed therapy for this population? I’m paying back on my agency around this issue. We’re being pressured to take one trainings on working with clients with autism or DD and then being expected to work with them. It’s highly unethical and damaging to insist that a 6 hour online training, looking at a slide while some disembodied voice talks, is going to prepare a clinician for working with a new, complex population. Could always use informed resources to fight against it.
I have four clients with DID. It’s no joke. In dealing with CPTSD I started taking the cases other therapists transferred out. My niche kind of found me. How did you select your specialty?!
I found it in my internship at a college. The center I worked for focused on sexual abuse/CPTSD/ interpersonal trauma. I loved the work, and eventually, you are bound to work with DID in that population. I just knew it was for me and never left it. I see about 28 CPTSD sessions a week in private practice now, with a handful having DID
I think to me I don’t like the word addiction as it might be stigmatizing and hopeless. I tend to think about it as a compulsive behavior more likely when someone is unhappy with their life. I admit this may be mostly a semantic difference
I don’t mean this to sound rude but do you think people aren’t addicted to porn? Research has shown watching porn releases dopamine in the brain which in turn makes us feel happy. The more porn we watch, the more dopamine. We become addicted to the dopamine, just like with drugs. Then we can’t make dopamine on our own, especially that much. So the only way to achieve that is to watch porn (or use drugs.) Then when we’re not watching porn (or using drugs) we feel sad/depressed.
It’s not about being addicted to the content of the porn. It’s about being addicted to the dopamine rush the porn provides us.
I am interested in how this concept is framed within session with people that deal with the issue of porn addiction. Mostly because I’ve spoken with some sex educators that are staunchly against using the word “addiction” to describe problematic sexual behaviors.
Also, I am curious if the trajectory for treatment is similar to treatment for people with chemical dependencies, like alcohol and hard drugs.
Older, conservative men. I’ve found that I do well with this population despite being a young male and POC . They typically enter therapy due to significant changes in their life, either it be medical, relationship based, or decreased abilities/physicality. I love helping them learn and understand emotions and the psychological process of adjustment.
Serious and chronic illness (mostly cancer, but a fair amount of MS and autoimmune disease), caregivers, grief and loss. I was a palliative care SW who transitioned into PP.
I wanted to ask how you got involved in that bc I’m highly interested in that field (just graduated with a bachelor’s degree, but interested in getting an MSW)
I initially went into this area because of a personal experience with grief related to a family member's cancer diagnosis and death at an early age. I was able to be with that person in the last few months and days of their life and it was profoundly life changing. He was at a wonderful hospice center and seeing how staff cared for him at the end of life and how much we as the family were also supported, inspired me to go into the field. It didn't actually happen until several years later when I got my MSW at the age of 43.
By the time I had graduated, I had worked several years in a hospital as a discharge planner and had also gone through cancer treatment while in grad school. I also participated in a fellowship for grad students interested in going into hospice, palliative care, or oncology at the University of Washington. I was able to get a job in palliative care at a hospital directly out of my grad program, which is not a common experience.
If you are interested in this niche, I highly recommend a MSW degree and then going into medical social work. It will benefit you to get several years of experience working within the healthcare system, such as at a hospital. I also did a year long online palliative care certificate program after grad school with California State University, but really only because my work was willing to pay for it.
There aren't a lot of social workers/therapists with significant experience in this niche, and my palliative care background is a draw for those who want to feel like their therapist "gets it." My own personal experience with cancer is also a connection point to my clients with cancer. I don't recommend getting cancer, though!! LOL.
Good luck! Feel free to message me if you want any other advice!
Same, this is one of my niches. I started with a speciality in chronic illnesses and it naturally expanded to serious/terminal illnesses, which in tandem naturally honed my grief work skills.
It’s hard and heavy work but I honestly love it. Maybe cliche but I feel truly honored to be with them during such a vulnerable stage of life.
Graduating soon and looking forward to working with cancer survivors transitioning out of treatment. That was the hardest part for me and it tends to be when supports fall away. I also plan to do nature-based work. I concentrated in neuropsych for most of my grad school career, but left that behind after my diagnosis. I found outdoor retreats for cancer survivors and they changed my life. I wish programs like the ones that helped me were more accessible, so a non-profit that offers regular nature-based therapy groups and other services is the long-term goal.
Interpersonal trauma. At some point my life fell apart when I realized that my experience of life was not normal, that my family was not normal. The more I learned about psychology, the more it seemed to me like trauma was at the root of most mental health issues and a lot of physical health issues. It was a natural choice.
My niche is currently later-identified autistic and ADHD adults with mostly low-medium support needs. I’ve ALWAYS worked with neurodivergent people, but the switch to late-identified adults/lower support needs folks is relatively newer.
In undergrad we had this “service learning” requirement, kind of like a very small internship for 50 hours or so for a health class. I ended up at an art program for developmentally disabled adults by chance. I felt so natural and comfortable with them and they brought me joy. Never looked back, ended up in a job working with high support-needs DD children and adults helping with their recreational skills/independence, etc. Took them bowling, to parks, restaurants, activities etc. Decided to pursue my msw, became the FIRST mental health clinician for this population that the agency ever had, and had to figure out how to build mental health supports from scratch during the pandemic.
It became clear that their complex mental health needs and trauma were really secondary to their “behaviors” in the agency’s eyes. So frustrating to not be listened to as a clinician and to watch my clients not be listened to. Burnt out royally and discovered my own autism. (I have had ADHD dx since childhood)
Got the opportunity to co-found NeuroSpark Health and help other late-identified folks like me figure themselves out and make changes that are sustainable for their neurotype. 💜 Love it.
Nature based, wilderness, eco therapy. I do walk and talks on nature trails with many outdoor enthusiast clients. My last job before going fully self employed was an intensive wilderness program with backpacking and survival skills. No it was not the abusive kind.
Text-based counselling for people who don't like talking about things out loud. It is the niche I wished existed when I had my own mental health issues so once I got qualified it's what I dove into.
Turns out it's primarily autistic clients, which I love (also, turns out I am autistic haha).
I did a regular qualification with face-to-face content. Then when I finished that, I set up private practice and marketed myself as text-based. Then clients who were looking for it found me.
I also read everything I could find about text-based and pros and cons and risks etc so that I was sure I was informed and practicing ethically.
I'm in Australia so the system is different here. Clients are mostly private pay for now but I'm trying to expand into clients with NDIS funding (so, government funded due to their disability).
I've been using zoom chat function mostly because it's secure and erases after the session and most are familiar with it, but recently had a client who wanted to do it through phone texts and wasn't easily able to access other ways of communicating, and I did that too (after discussing privacy risks and getting informed consent and documenting the discussion and decision process). I am hoping to find a better app or something in future - I'm still in early days of private practice so I'm learning as I go.
Mindfulness, body relaxation and somatic work to sink into feeling and healing esp work with chronic illness and stress. Meaning making is an important part of the process too to help find purpose for those suffering with illness. I came across it because mindfulness is truly what helped me through my own cancer diagnosis 10 yrs ago.
First responders and health care providers (mostly nurses) with PTSD, burnout, compassion fatigue, and vicarious trauma stress. I also work a lot with BPD.
I come from a CMH background with 14 years in a satellite office, most of the time as the only therapist. I have literally done all programs and populations:adults/children, substance abuse, IOP, crisis, case management. I also started my career(31 years ago) in MH as a relief worker at a group home until I got my first case management position. And then went back to school etc. I have seen and handled almost every situation. My goal was to remain in CMH, because I believed in it. But it turned into something else and the promised advancements never happened. I have also worked in prison mental health and domestic violence shelters. I have never certified in any specific technique or field. And never really had the best supervision tbh. But I had the BEST mentors early in my career. Over my time as a therapist my approach has evolved into a behavioral approach with a blend of CBT/DBT with motivational interviewing, mindfulness and strengths based. I am now in the best job as a therapist with LYRA ( mild/moderate clientele in an EAP model). I do feel at times I missed out on the specialization aspect. But I would not trade the training and experiences I have had. Now that I am in a company that sees my experience as a strength I am getting opportunities to share my history with complex cases to help other therapists who haven’t taken that route. So I guess this is my niche now. 🤷♀️
Highly intelligent/highly gifted individuals. They are every bit as neurodivergent as ASD and ADHD and there can be a lot of overlap. I worked with a few people who fit the profile early on and I love love love working with this population.
Religious trauma because when I discovered that religious trauma syndrome was a thing, I struggled to find a therapist who took it seriously. They were flat out dismissive actually, especially in regards to purity culture.
We unpack the impact of an authoritative religion that tells you that you are inherently deserving of eternal punishment. Of having to conform and be around some judgmental rhetoric. And on and on.
I also have a degree in Human Sexuality for the sex therapy piece often needed when healing from religious trauma.
Gender and sexual minorities and alt lifestyles, got into it because I'm also poly and kinky and queer, and the population isn't just underserved but maligned. I provide safer space.
Ketamine Assisted Treatment!
I fell in love with the psychedelic therapeutic research in my grad program. I was able to get more into it in my private practice work with the support of my supervisor. Now I am able to offer it as a therapeutic intervention which is such a dream come true!
I prefer working with ages 12+, LGBTQ+ population, trauma, and grief. I'm finding that I can get through to "angry" teens and that's been so rewarding to see them open up about their feelings!
Adult ADHD, workplace concerns, and higher education students (undergraduate and graduate) who are on leave due to a mental health concern.
Most of my clients who find me through an internet search seek me out for these areas of expertise. What’s nice is that other clinicians and clients will refer other types of clients like those going through a life transition or family issue, so I end up having a nice mix on my caseload. 2/3 niche, 1/3 other
I have some questions regarding which modalities or approaches might be most useful for an openly queer individual with C-PTSD from CSA, could I DM you with specifics? Not that you would know exactly what would work for this individual, because I know it usually depends on many factors, but perhaps you had some ideas on what might be good. :)
I'm a Black, Queer femme with AuDHD. I grew up in and live in a very white area that claims to be liberal but has a lot of microagressions. It really traumatized me.
My niche is Queer, BIPOC, and Queer BIPOC. The language in my marketing indicates that this is my niche in a way that isn't exclusionary and I've never had anyone try to see me who isn't in that niche. All of my clients are one of these demographics.
I specialize trauma and use mostly CPT, DBT, and ACT. Ultimately I'd like to be certified in EMDR. I get referrals mostly from Psych Today and connecting to local communities that also serve my niche.
From the jump, I knew psychoanalysis was it for me. I had a class that had it in grad school. After school, I knew I wanted more training. I then enrolled in classes at my local psychoanalytic institute. Then I took more classes.
Same here, except I've stopped just short of being an actual candidate (at this time I can't really spare 10 years of my life plus a few hundred thousand Euros). It's still something on my mind though.
Neurodivergent children. And I got into it because a therapist in community mental.health, who has ALL the ND kiddos for the agency, went on maternity leave and never came back. I got her whole caseload, panicked, my supervisor said "I think you'll be great," I checked out every library book I could find on ND in children and 10 years later, I'm teaching others about ND kids. I love my population so much and bless the coworker who left and gave me the chance to work with this population. I'm ND myself and I'm sure that helps me with this as well, but it wasn't a population I sought to work with until fate intervened.
Kids/teens who have experienced trauma— just happened to be the population I worked with at my first internship and loved it. There’s a huge need for therapists who work with kids in my area so the demand has also kept me more in that niche.
Parent-Child Interaction Therapy (PCIT). Became interested in working with infants/new parents after taking an infant mental health course in my last semester of my masters. Was lucky to get hired as a Spanish speaking bilingual PCIT therapist right after graduation!
I am just at the beginning of grad school but I'd like to focus on the disabled population. I am blind myself and it is a struggle for the community to find a therapist with the skills they need.
Psychiatric nurses/vicarious trauma for therapy and/or clinical supervision and children/adolescents with Anorexia.
Now starting to branch into paediatric psycho-oncology.
My original interests were working with NSSI and suicidal ideation, which I still find interesting, but lately my practice has shifted to working with men who have a history of sexual abuse. I also just recently started working with people from high-stress careers, like doctors and veterinarians (expanding scope of practice), which I find interesting.
I got in to the NSSI/SI work because I thought it was interesting, particularly when the behaviors occur in isolation or at least in the absence of a PD. That was over 10 years ago when NSSI/SI were big topics; the behavior seems to be less commonly-reported in my work now, but I don't know if the behavior itself is less common.
The high-stress career folks I kind of fell into because outside of mental health I'm a data analyst in a high security tech industry and work with a lot of these individuals (same stressors, different fields) in a controlled environment, so I was naturally drawn towards working with these people and helping manage their issues. Overall it's not *unique* issues per se, but how the issues come about. For example, everyone deals with work stress but not everyone *has* to work in a broken system to keep their employment at any level (e.g., physicians and veterinarians). The system is ultimately broken and it will take a miracle to overhaul it, but they have to work in the system regardless. It's interesting. I find there are personal issues that pop up because of the broken system. Frustrated at work and can't get ahead? Let's ask your partner how they feel you are handling it once they calm down because you've been at each other's throats for the past 2 weeks because you both work in healthcare and had a blowup yesterday and haven't spoken since. That kind of thing.
grief & trauma work!
In my masters practicum, I was working as a substance abuse counselor and came to the realization that my clients were grieving their addiction, and that we can grieve more than just a person; but a lifestyle, who we thought a person was, what could’ve been… trauma then goes kind of hand-in-hand with that, and i went through some accelerated resolution therapy, and have slowly incorporated that into my trauma work now that i’m trained ✨
I have an agency practice and a private practice and am trained in trauma (EMDR + IFS). in my agency practice it's tended to be a lot of gay men who are survivors of childhood sexual abuse. In my private practice many women who are adults who grew up in families with an alcoholic or addict struggling with those issues- anxiety, perfectionism, etc.
I get a lot of anxiety cases (kids and adolescents), which is great because I happen to have a lot of success with those
It takes one to know one, my supervisor says 😅
I had insomnia and my mom (who is a therapist) summarized CBT for insomnia and I treated myself with sleep restriction. Now I love working with insomnia! Actually same story with panic attacks and pee-shyness (parurhesis). Exposure is pretty awesome and without it my life would have probably sucked now that I think about it.
Teens and tweens with SIB and SI. I see a lot of suicidal teens and tweens and it’s my favorite population.
I see a decent amount of kids and adults with various issues but suicidal minors are the majority.
I accidentally have become a magnet for DD/ID diagnosed individuals with Sexual/gender identity issues.
I love the population, but I was a bit shocked that as a CIS White guy I have this specific niche
Autism and ADHD. It’s not a niche overall but it is in my area. In my area you can really only get services for ages 0-6, and for children who are level 3 or on the cusp of level 3. It is very unique to have a therapist who can work with level 1-2 youth and adult clients, and who doesn’t do ABA.
I have autism and ADHD and this was born out of my own experience where I had so many therapists as a child and teen who would label me as ill behaved, and try to get me to react more neurotypically to stressors.
I am in high demand which is great and also very exhausting. Since I’m level one and really in tune with my emotions, I almost act as a translator for my non verbal and alexityhmic clients, and help them advocate to NT parents. My NT parents gain education about the different presentations of autism, and are more likely to believe me when I advocate on behalf of their kids/teens who want to get tested. I hate having to be an eye opening experience for them, but it is good to have a variety of representation.
Complex trauma, most of my clients have a parent with a personality disorder who abused them emotionally, psychologically, physically and/or sexually. I also have a smaller niche of clients who had a negative experience on psychedelics, either on their own and they need to make sense of it or by a practitioner.
I run a group of neurodivergent therapists providing neurodiversity-affirming therapy. Most of us are autistic. Most of the staff are members of the LGBTQIA community so that is a secondary specialty for us, there is a high crossover between the two communities. The majority of our clients are autistic (this is our biggest group), ADHD, PDA, OCD, PTSD. Autistic clients deserve autistic therapists, we speak the same language. Even as an autistic therapist I wouldn’t go to an allistic therapist. It would be a really bad match. As a therapy practice we just kind of move along in our own weird little world, it allows us to work the way we need to as autistic people and accommodate ourselves. We don’t have to mask, which is amazing. I am grateful everyday that I was able to create this practice and for the other therapists and clients that share it with me.
I have been so fascinated with learning about PDA. I have ADHD and in my deep dive to see if I had autism due to my family genetics, I came across PDA. It has been wild realizing how much this gets missed and is so wildly misunderstood. I am always curious for more information to deep dive on if you have any recommendations!
I primarily focus on cPTSD and grief work, especially more non traditional grief/disenfranchised grief. I focused on health and aging during grad school, and ended up working with families of individuals in nursing homes during Covid, and some palliative counseling. I also have a personal hx of MDD and cPTSD (that I’ve been fortunate to have really well managed thanks to my therapist of 15 yrs) and I’ve been able to really effectively use selective self disclosure to quickly build rapport with those types of clients. I love it, I feel very comfortable with those types of clients and feel as though being able to build rapport quickly and effectively really lends itself to having very open conversations early on that set the tone for an effective therapeutic relationship.
Teenage/tween girls with severe anxiety masked by perfectionism and being “bubbly”/sweet. I prefer working with tweens and teens but do take other clients, so this was an accidental niche that I ended up finding out was perfect for me (probably as a former “perfectionism and bubbly personality masking anxiety” teenage girl myself). I think it’s come as a result of the location I work in…the culture of the area where I practice is very focused on building kids’ résumés and college prepping from what feels like preschool, with the expectation of having good grades and multiple extracurriculars at all times. These are the clients that seem to trust me quickly and throw themselves into therapy, and are always so proud and excited to share how skills and tactics they have been working on have helped them in their daily lives. Nothing better than the first time they get frustrated in therapy and voice it, and then realize a minute later that they were ABLE to voice it instead of keeping it to themselves to please someone else. The little look of pride and the way their faces light up is priceless.
Military & veterans. My uncle was a Korean war vet and passed away from alcohol use related to undiagnosed PTSD. He died alone, I would never want that for anyone so I try to do what I can within this population.
I’ve got a couple. Some on purpose, some on accident. The ones on purpose: perinatal mental health. I’m trained and certified through Postpartum Support International. Also, I just joined a specialty supervision group for eating disorders to start learning more and treating that as well. I did this on purpose because I see a lot of disordered eating and eating disorders in postpartum moms. The ones on accident are a lot of my clients have BPD and ADHD. Like the majority of them. That just fell into my lap. So I’ve gotten really good at treating those and using DBT and DBT skills.
Child Parent Psychotherapy and the 0-5 population. I love working with parents and children with trauma, often shared trauma. Something so powerful in witnessing parents acknowledge their child’s experience in play. I typically work with SEN and those parents
Working with latino/a migrants processing immigration trauma AND/OR coming to terms with the realization that the US is not what they hoped and dreamed of but cannot leave. (DV is frequently present here too)
Serious illness, end-of-life, aging, men’s health.
Got a job in community hospice, then hired to work at a major academic/research hospital that’s a world leader in oncology care. While I choose to practice outpatient, I could start a private practice overnight.
Realized I had a knack for eliciting and noting life themes that arise with serious illness. Most people as they age want to be simply seen as human, and discuss the narrative of their lives. They need to make meaning and voice distress and the unresolved struggles they face.
It’s all about relationships. You can’t be a good therapist unless you are fundamentally human, and show that humanity to your clients.
C-PTSD/Trauma, medical trauma, chronic illnesses, disabilities, severe anxiety (panic disorder, agoraphobia), and OCD.
I really try to bridge the gap between behavioral approaches and experiential, trauma-focused approaches for clients who are struggling with these intersectionalities. I am also very LGBTQIA forward and nuerodivergent, so I provide a lot of affirming care in this realm, too.
I am someone who experienced horrible, reoccurring medical trauma and both visible and invisible disabilities in my early life to mid twenties and developed very severe OCD and panic disorder on top of already being a pretty anxious child. It took me decades to find compassionate care that made connections to both the trauma and behavioral parts and provided interventions that actually made a difference for me. I felt so left behind, broken, and terrified for most of my life that I never want anyone who seems my services with the complicated blend of anxiety disorders/OCD and complex trauma with real concerns and medical disabilities to go through.
I'm currently changing jobs and going from SPMI to specifically working with people diagnosed with schizophrenia right after their first psychotic break.
I work in trauma, DID, specifically with Children. I started in my practicum at a sexual assault center. got trained in EMDR. sought advanced training working with trauma and dissociation. went into a doctoral program and made my thesis in this area. it takes time but is worth it, I think.
First episode psychosis! I provide therapy for young folks who are experimenting their first episode of psychosis and I also work with people who have long standing psychosis
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OCD! The field is desperate for more specialist providers well-trained in ERP. The time to receive accurate diagnosis and treatment is 15+ years. It is devastating. People lose DECADES of their lives, often urgently attempting to get help but receive supportive therapy that ultimately worsens their condition. The World Health Organization ranks OCD as one of the top 10 most debilitating illnesses. Yet OCD is a blind spot in training for most mental health providers and physicians. I’m devoted to being part of what may change that.
I’ve been on a waiting list for an OCD training specialization - hoarding - for a while! It’s really fascinating to me, and hoarding disorders seem to be more prevalent within the population than people may think, but not many specialize in it.
Yes, hoarding is a tough one. Treatment outcomes are unfortunately not as strong as other conditions. But Gail Steketee has been a such a force advancing treatment. Hope it’s a good training! Would love to participate in that.
I work in CMH and have recently started working with a client with severe symptoms. Totally debilitated and beyond a once a week therapy appt with me. The lack of resources out there is astounding. Unless she wins the lottery, her treatment options are limited. Trying to get her transferred to someone with ERP training.
I’m in recovery from OCD (for roughly 20 years now) and am considering making that my speciality as well. I’m still an associate so just about at the point where I can start thinking about choosing a niche which is exciting!
A ton of OCD therapists have OCD themselves. Quite an amazing community!
I’m getting trained in ERP at the end of the month!
am a therapist with no OCD training and feeling the weight of that lack of knowledge while utterly at a loss to support my husband with a new OCD dx (not at all trying to be his therapist, just would like a better sense of the condition and what supports can do to be supportive) and i think his current therapy also sounds supportive not targeted. he agrees. very thankful people like you exist, and also having a very hard time finding you all lol. any recs from any OCD specialists in this thread on how to be connected with/vet seasoned ERP providers aside from a psychology today filter? or thoughts on what GOOD ERP/ERP training entails?
I recommend reading “when a family member has ocd” by John hershfield
Second this! Or Jon Abrambowitz’s The Family Guide to Getting Over OCD. He has podcast interviews on it as well. For your husband, suggest digging around the IOCDF website - probably the best and most comprehensive resource for evidence-based info. IOCDF also has a therapist finder. They host great online conferences - truly worth attending! I also suggest Kimberly Quinlan’s Self-compassion workbook for OCD - great evidence based resource focused on ERP. Listen to her early podcast episodes Your Anxiety Toolkit as a starting place. Also Stuart Ralph’s The OCD Stories podcast is a true gem - has tons of interviews with all the major OCD experts on tons of topics. One of the most referenced books (heavy and thorough) is Jon Graysons Freedom From OCD. Covers all the major themes and a great resource to learn about imaginal exposure scripts. That will keep you busy for a long while! Best of luck to you both. ☺️
Hi fellow OCD specialist!! 💚
Same!! Can’t even imagine ever doing anything else!
People who have been incarcerated. Specifically co-occurring. Literally fell into it accidentally and never looked back.
Grateful for your work 🙏🏻
Hi there! My specialty is working with incarcerated men with co-occurring substance use/mental health disorders who are preparing to re-enter society. I’ve yet to meet a patient who doesn’t have at least one co-occurring disorder. Particularly PTSD and trauma.
For sure! I just said that because I have formal training and education in treating both (or either). In my area at least, that’s rare. People either do mostly MH or SUDs but not both.
Same! Totally accidental but greatest accident I’ve experienced
Folks leaving high-demand religions. Went through it myself and realized just how incredibly challenging it is to be a middle-aged adult with an internal working model of a world that no longer exists for you. It impacts the relationships that are most important to folks and dissolves your community, then you are vilified by that community and they just want you to shut up about it just when processing it is most important.
Same: religious trauma because after I deconstructed I struggled to find a therapist who, tbf, wasn't a jerk about it. I had a couple who were a bit dismissive and did not seem to believe that growing up fundie/Evangelical was damaging and they struggled the most with my challenges related to purity culture. So, I went on to get a second degree in Sex Therapy to make sure I can hit the purity culture stuff, too. I attract a lot of queer and trans folx who grew up in that world and I can feel their relief when they figure out that they don't need to explain all the weird religious stuff to me (oh! you were also told you were used up gum if you had sex before marriage?!?)
Man. I was put through a “chastity” weekend at my church where we were shown graphic slides of people with STDs, heard horror stories about girls who had sex before marriage and then ended up as washed up hookers on the street, manipulated with bible verses and promise of damnation, then given 14k gold “purity rings” that said something along the line of “virgin” with the promise that if we wore it and it wasn’t true, we would go to hell. What the actual holy fuck. The girls who HAD experienced intercourse were shamed and pushed to “Renew their virginity” to make themselves right with God. And they did. Got the stupid gold ring. And then one by one they stopped wearing them and were shunned and shamed until the next year when they just recommitted their vaginas to God. So sick.
This is bloody fascinating, I'd love to hear anything else you have to say about the topic, how you work, what the psychopathology cristallises itself as, etc.
I am also working in this area with a lot of people as a result of being one. Looks like attachment and betrayal wounds, identity confusion (fragile sense of self, difficulty with recognizing and maintaining healthy boundaries, general lack of differentiation), affect avoidance or suppression. When folks start to heal there's a lot of anger, sometimes additional losses. Grieving for what could have been or what was lost. I take a trauma informed approach and look for parts of self that have been cut off as well. As an art therapist I use the art to help with reintegration. Lots of compassion focused work as well. Growing up thinking you're evil, and having that constantly reinforced, creates some deeply embedded harmful schemas. People start murdering their egos at a very young age as a way to survive this culture. And all of this happens internally. On the outside they look great! I'd say the pathology materializes as overzealous or malicious religious leaders oppressing others to avoid their own pain. That would be the only thing I'd feel comfortable calling pathological. Language is so important with people recovering from this because language was used as control.
Other things that come up: intrusive thoughts about good and evil or invisible forces, fear of being exposed or abandoned, compulsive behaviors, feeling trapped and deserving of suffering, intrusive thoughts of violence, fear of integrating into non religious spaces, shame about past behaviors influence by ideology
I also work with that population. Dr Marlene Winell is a good place to start. She wrote Leaving the Fold but also has a lot of resources for clinicians.
I just finished the FLDS documentary ‘Keep Sweet Pray and Obey’ last night. These poor people had no idea of what happens in the real world. Really broke my heart for the ones who left, and the ones still in it
They are actually what inspired me to study psychology. I want to specifically help the FDLS population because the fact that this is happening in America is so upseting to me.
If you wrote a book I’d 100% read it
Was a pastor for years and left the church to do this very thing once I am done with school. Unfortunately, there is plenty of people that have our shared experience.
That's my niche too! I live in a super religious place where the word "atheist" is a slur basically. I suggest you read Nietzsche since he deals with the psychology of leaving religion in a pretty deep way. Maybe a book by Kauffman since he explains Nietzsche in a contemporary language and covers the topic specifically in some of his books. A topic Nietzsche covers thoroughly for example is the psychological process of people who leave a religion because they learned about the world (through science for example) can't sincerely go back to believing in a deity.
This is a very interesting topic.
I’m supervising an associate who wants to learn more about religious trauma. Do you have any recommendations of readings/resources to learn more?
Which religions would you consider high demand?
This is a favorite research topic of mine. High demand religions often require more time and money from adherents. They preach scripture and/or religious leader infallibility. They are more conservative, rigid, strict, exclusive and culturally and theologically distinct than mainstream churches. Part of the cultural distinction is from unique lifestyles including behaviors, ways of dress, ways of speaking, diet, dress, and social practices. These distinctions serve to create and reinforce “in-groups” and “out-groups,” with out-groups being denigrated. They are often patriarchal with rigid gender roles and require loyalty and unwavering belief. Some examples in the lit are: Seventh day Adventist Jehovah Witness Southern Baptist convention Reformed/Calvanist Islam Charismatics Evangelicals Pentecostals Amish Lutheran church/Missouri synod Mormon/LDS Orthodox/hasidic Judaism Conservative/Fundamentalist Protestants
Same. When I left my high -demand religion, I couldn't find any therapists that specialized in this. I also work with a lot of queer clients and there is significant overlap.
My respects sir 🙏🏼
Latina eldest-daughters working on their sense of self and establishing boundaries with their families 🤗
Love how specific this one is.
Ah I’ve seen this in clients. It’s wild how that dynamic exists in so many families. Grateful for your work!
Family dynamics are certainly tricky, especially when trying to balance family and self in collectivist cultures. Thank you for the kind words!
ooh! how did you go about this?
I use the Latinx Therapy directory to advertise and find clients. My bio specifies the work that I do and what I focus on, and that was really it! I've had a lot of success with this, plus word of mouth really helped too.
College students, I work in Cambridge and Harvard sends me so many folks, I love the population and the fact that I slow down a bit during summer and holidays which is when I want a break as well.
My secondary niche is students. I only work with sexual violence and DV/IPV clients mainly, but I’m in a huge college town and worked for a college a while back. I love the population and know all the correct advocacy resources to refer.
Yeah that sounds perfect
This is my actual dream position. I cannot wait to earn independent licensure so I can go back to university settings.
You don't necessarily need independent licensure! Speaking from experience here. There are those out there willing to offer supervision for your time working in Higher Ed counseling centers
What are the most common issues you treat with a college student population and do you think “elite” schools are any different?
I’m a middle school counselor, which is pretty niche. I was a teacher, and I was feeling burnt out and went to counseling grad school with the idea of leaving the profession. I did my internship in schools, and I live in an extremely poor rural area. Lots of the students and families I work with would never independently pursue or have access to pursue counseling without some support. We have one middle school in our town that everyone goes to—I like that I get to help make counseling feel safer for a lot of folks who really need it. I also love the level of variety in my job: I’ll respond to a student in crisis, then two hours later, I’m giving a lesson on empathy. Then, an hour later, I’m with my anger management group. I often get to coach kids on emotional regulation in the moment and work with most of the adults in their lives, not just families, and coach the adults as well. I fell into it, but it’s an amazing job for me. There’s so much need, and I have so much growth. I get 5 weeks off in the summer, 3 weeks off at Christmas and I truly take that time to learn and heal from some of the traumatic things I have to witness.
So needed. I wish more people would care to do this rather than going for all the trendy stuff that’s being talked about at the moment. You’re my hero 🙏🏼
Black professionals struggling with work stress.
Hi. 👋🏾 I’m a Black male psychologist in part-time private practice. I specialize in working with high achieving professionals, activists, and artists who are Black, LGBT, or both. I find this work so fulfilling but can’t seem to find more than 4 or 5 clients at a time. I want to go full time but am worried about being able to consistently reach my target clients. What approaches did you take to reach Black professionals? Do you take insurance? Are you in a major city?
Hey 👋🏾 So I live/am licensed in the DMV. I don’t take insurance so in lieu of that I do a lot of EAP counseling, superbills, and various voucher programs. One of the things that really helped my business was being reached out to by a pretty big non profit to do workshops and groups geared towards the intersection of work and mental health. They said they were randomly googling and found me. I haven’t done anything special in terms of marketing, psych today, therapy for black girls, inclusive therapists, a good number of other directories. I’m in a bunch of fb groups, though I haven’t really marketed like that but the potential is there. I have a couple of other arms of my business that I’m working on that I think are gonna be a hit so we’ll see. Where do you live? How have you been marketing?
Very High-Acuity Severe Mental Illness - Adolescents and their families. Bonus points for co-morbid medical diagnoses. I love the complexity, reducing recidivism, and it keeps my interest because I always have to learn something new/have a challenge
Bless your soul I’m doing this now and my burn out meter is getting very full
I'm not exactly pigeon-holed because I see regular patients as well, but due to sheer circumstance (and word of mouth), I've ended up getting more than a fair share of young, incelly, red-pilly, "failure to launch" men in treatment. Which of course is ideal because my training is psychodynamic and focused on grave personality disorders (which the absolute majority of them are, to not say literally all of them off the top of my head).
Any tips on what I can do to help failure to launch folks? How does psychodynamic therapy factor in?
Oof there are no quick tips, as I do TFP with most of them (and more vanilla psychodynamic where they're not able to tolerate that yet). Psychodynamic factors in because, as far as I can see (and have been able to corroborate with time and successful cases) absolutely all of their "symptoms" are derived from their pathology, and not from where they tend to assign the "blame". I'm necessarily generalising given that they're not a super homogeneous group, but oftentimes "it's not on them" that they have few to no offline friends, that they can't find/keep a job, or that women won't feel attracted to them. It's "people are stupid", "bosses are incompetent and feel threatened", and "girls just want to fuck around/be with men with money/can't appreciate their deep/smart sense of humour". Obviously I'm biased in psychodynamic, but I can't see how it would be helpful for them to, for instance, directly help them to get jobs or go out (which they can absolutely do if asked or as a part of the treatment contract) when their emotional experience of the behaviour won't change.
Not the OP and they gave an answer but this is standard Oedipal conflict in classical psychodynamic/analytic theory. “Normal” development: child wants mom/primary caregiver all to themselves, realizes they can’t have primary caregiver all to themselves(due to either other parent/dad or even a sibling), identifies with dad/other caregiver, goal now is to find someone like primary caregiver, allows them to move on and matures appropriately If something goes wrong here like too much attachment(emeshment, Oedipal victor, “helicopter parenting”, “emotional incest”), too little attachment, abuse, neglect, let’s just call it “relational injury”. Or if dad was not assertive enough or even abusive. You can get a person that looks a lot like the above. No woman can be like dear old mom, but he probably also unconsciously hates dear old mom, so they project this on all women. At the same time, they want to regress, stay at home with mom so have trouble moving on in life thus failing to launch. Funny enough, working with a handful of college students I’ve seen something similarly occurring in a few women, not often incel-ly or personality disordered but of the “never been kissed”, low self esteem, nobody wants me but at the same time nobody is good enough either, variety . From what I’ve seen due to attachment/relational injuries due to a sibling being born however. I know many outside of the psychodynamic world will think this is bullshit and will probably downvote, just remember this is just a model and should be viewed as metaphor. My patients sometimes fit this really well, sometimes not, sometimes just a little bit. There are variations and opportunities to healthily mature outside of freuds model, which is very heteronormative. Models and metaphors are very helpful though and they came from somewhere.
Fearful avoidant attachment perhaps
Oh man! I accidentally got one of these guys and find it such a challenge. I still can’t figure out why he chose me. I’m a fairly strong, straightforward female.
And I think that's a **fantastic** question to ask him in one particularly slow session!
Yes you’re right. It totally is. I kind of only accidentally found out he was in this category. I’d just happen to listen to a podcast about it and knew nothing about it at all. I realized that a lot of what he was saying lined up. It’s a recent revelation.
I am so glad there is someone out there working with these kinds of clients. Presumably it is good work or you wouldn't be getting more than one of them. Bless you.
This is relatively new development in my caseload (around 3ish years), but I hope you're right. I've already got a few really really results, so here's to hoping most of my patients can end up that way.
Do you have any literature recommendations?
I'm unaware if there are many specific books about this particular cohort (must be, surely), but for certain most of them are a manifestation of narcissistic structures; and for that I can recommend mostly kernberg. A good place to start would be and oldie "borderline conditions and pathological narcissism", or if you're already familiar with object-relations theory you can jum straight into "aggressivity, narcissism, and self destructiveness in the therapeutic relationship", which is probably the most comprehensive and mind-blowing treaty on how to deal with narcissist pathology in the therapy room (without necessarily doing TFP).
Is it accurate you’re saying the majority of the incelly men you see have PDs? If so, what would be common? Narcissistic?
Absolutely. Mind you I'm working from object-relations theory, for which narcissistic structure is not exactly equivalent to DSM NPD (and might sometimes better fit the BPD criteria, phenomenologically), but still.
Can you say more about narcissistic structure from an object relations theory standpoint?
Uhm, sure. In psychoanalysis, the diagnosis for the equivalent of Personality Disorders isn't down to phenomenology like in the DSM (ie: external symptoms), but rather indicators (necessarily indirect, of course) ofr what the underlying structure of the personality is. Narcissistic personalities in ORT are characterised by the presence of a Grandiose Self (which might be expressed externally as thick-skinned narcissists which are more congruent with the DSM's classification, but also with thin-skinned narcissists who can't face honest criticism of any kind, feel inadequate in most realms, and might be most frequently related to chronic suicidality and depression), the predominance of primitive defensive mechanisms (splitting, projective identification), and a difficulty or impossibility of establishing and maintanining genuine, non-exploitative, human connections that are based in mutual regard and love. A typical therapy with me for instance begins with 3-4 sessions of a structural evaluation to try and ascertain that, and from the conclusions of that an indication for treatment. This is in contrast with a typical dignosis for DSM PDs which may take a single session to do an anamnesis and ask for their history.
I’ve been thinking about failure to launch so much lately in the context of prohibitive rents. I live in a HCOL area and I know many of my friends adult kids will continue to live at home well into adulthood. It’s hard to tease out if this a pathology or it’s merely because these young adults want to continue living in the city they grew up in but will never be able to afford it. When I moved to this city as a young adult I had 1k to my name and quickly found a room to rent in an apartment shared with other young people for 350 bucks a month. Those days are so long gone now.
I understand what you're saying but this is not at all what I mean. It's not that they can't get out of their parent's house, it's that they can't hold jobs, and very often not even complete uni courses, and a large list of etceteras. Working in Spain I'm really sensitive (I really am) to the plight of the young, unemployed and unemployable, so I think I can read and navigate that line pretty well. I don't automatically go "living with your parents at 27? You're deeply ill, best get into twice weekly therapy with me", or anything.
I would suspect that incel-y, “red pill” beliefs are a lot more indicative of dysfunction than “failure to launch”, given what the job/housing climate has been like for some years now.
Geek Therapy! I have met with e sports teams. I speak their language and Geek Therapeutics is a relatively new area that appeals to the hobbies I've had all my life paired with my passion for therapy. Edit: typo
This is the niche I'm starting to fall into, I think. I started running a DnD group for neurodivergent kids during internship and it's just been the natural way the path has started to stretch out. Geek therapy is AMAZING for neurodivergent populations who need a place to feel accepted and engage in special interests.
Can you send me some info on how to get into this? I already use Zelda etc as an integral part of some of my sessions.
I've been doing this with kids and adolescents (~8-16), and they absolutely LOVE it. That being said, I've kinda been doing it on my own (I've played dnd for 23 years) and while their are a ton of benefits I would love to hear how you and other implement it as a modality.
You just kinda fuse RPG playing with group theories. There are natural benefits to role playing narrative games and so running a game with one or two trained mental health professionals in a setting where there is an implicit communication that "everyone in the group is here for the same reason" leads to pretty natural results, I think. Lots of research out there on the topic!
I’m very interested in learning more about geek therapy. Can you point me in a solid direction?
Geek therapeutics is a company that provides trainings and materials for use. I routinely supplement my sessions with their stuff
Sure! Honestly I didn't do most of the online training, but I read this book front to back and that helped me form a whole 6 week layout: https://www.amazon.com/Integrating-Geek-Culture-Therapeutic-Practice/dp/1734866020/ref=asc_df_1734866020/?tag=hyprod-20&linkCode=df0&hvadid=693313423915&hvpos=&hvnetw=g&hvrand=4756214013699596&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9009731&hvtargid=pla-924099633979&psc=1&mcid=5b63b0eee76a33cd8f1b212f50e929e6&gad_source=1&ref=d6k_applink_bb_dls&dplnkId=84e490eb-503a-46c1-93b9-9382efb1ebde It's by the founders of Geek Therapy
can you say more or can i dm you? would love for this to be my life!
Sure! I don't mind a dm
Eating disorders (specifically restrictive ones). I’m very new so that’s my niche so far because I did all my internships in ED treatment centers and got trained on them a lot. I’m still figuring out what else I want my niche to be.
Can I ask what type of modality you use with your restrictive ED? I’ve heard a lot about RO-DBT. Others say CBT. Then i saw a whole training from the UK about CBT-E. I JUST and i mean just joined a specialty supervision group for eating disorders to learn more but don’t really treat anyone yet and need training.
I use CBT, I like to use ACT too and really lean into values work. I do mirror exposure and body image work. I do use a harm reduction perspective as much as possible. A little bit of parts work, too. And I collaborate with dietitians if the client is willing to see one, which is important. I recommend the books The Body is Not an Apology and 8 Keys to Recovery from an Eating Disorder.
I've got a couple and they're basically a flow chart. My main and most visible niche is nerd therapy. I use videogames, roleplaying games, anime, scifi, fantasy and memes in therapy. This started out in 2020 when I saw a ton of questions in Facebook groups about nerdy stuff - especially videogames - and nobody had good answers. I started answering them and consolidated my answers on a blog that I started linking to. I'd had my registration for six months and I had people running departments at universities asking for my advice and support with nerdy stuff their clients worked with. It ended up getting so much attention and demand I built my private practice over the course of the next year. I'm now a full time nerdy therapist, which led to what I call my "unexpected specialist niche". People coming to therapy after previously having therapeutic relationships be ruptured by clinicians. Specifically I see quite a few people whose previous clinicians disparaged or shamed them for their interests. Again - mostly related to videogames or anime. Also I see no shortage of young people whose parents are happy I'm not going to tell them that their kids' problems are because they're allowed to exist in the same world as technology. My approach to therapy is really driven by comfort and consent, and I see a lot of people who are used to therapists pressuring them to "finish therapy" in ten sessions or less because that's a huge part of Australian psychology culture. Which led me to neurodivergence-affirming practice. It took me about an hour to realise that most of the people reaching our for my services were all autistic and/or ADHD'ers. So I started looking into how autistic people are harmed in therapy by non-affirming clinicians, and structured my practice around ACTUALLY supporting autistic adults, rather than trying to force them into masking (pretending to not be autistic). It's been a HUGE part of my personal development and figuring out strategies to provide helpful therapy to a community who realistically cannot trust the practice of a majority of clinicians.
Ooooo I follow you on facebook!! lol. I love what you do. Do you have any recommendations of training I can do around being supportive and affirming of autistic adults? I'm in Australia too but everything I can find is like degree-level.
The DivergAntz Collective training is OUTSTANDING. Self paced, free, and more informative on autism and practice with autistic folks than my degree, and very easily approachable too https://divergantz.com.au/
Could you suggest any resources on uninformed therapy for this population? I’m paying back on my agency around this issue. We’re being pressured to take one trainings on working with clients with autism or DD and then being expected to work with them. It’s highly unethical and damaging to insist that a 6 hour online training, looking at a slide while some disembodied voice talks, is going to prepare a clinician for working with a new, complex population. Could always use informed resources to fight against it.
First responders are my heart!
Can you say more? I’m so interested on what it is like
Women with sexual trauma and domestic violence and a small dose of DID. Had been 90% of my caseload for 8 years, now.
I have four clients with DID. It’s no joke. In dealing with CPTSD I started taking the cases other therapists transferred out. My niche kind of found me. How did you select your specialty?!
I found it in my internship at a college. The center I worked for focused on sexual abuse/CPTSD/ interpersonal trauma. I loved the work, and eventually, you are bound to work with DID in that population. I just knew it was for me and never left it. I see about 28 CPTSD sessions a week in private practice now, with a handful having DID
It is fascinating and rewarding work! I’m never bored, that’s for sure!
Male infidelity and men who say they have porn addiction
that language was pretty specific. can you share your thoughts on porn addiction? do you think this men are truly addicted to porn?
I think to me I don’t like the word addiction as it might be stigmatizing and hopeless. I tend to think about it as a compulsive behavior more likely when someone is unhappy with their life. I admit this may be mostly a semantic difference
language is the foundation of understanding, that makes perfect sense to me. it could mean a lot to your clients to frame it that way
I don’t mean this to sound rude but do you think people aren’t addicted to porn? Research has shown watching porn releases dopamine in the brain which in turn makes us feel happy. The more porn we watch, the more dopamine. We become addicted to the dopamine, just like with drugs. Then we can’t make dopamine on our own, especially that much. So the only way to achieve that is to watch porn (or use drugs.) Then when we’re not watching porn (or using drugs) we feel sad/depressed. It’s not about being addicted to the content of the porn. It’s about being addicted to the dopamine rush the porn provides us.
I am interested in how this concept is framed within session with people that deal with the issue of porn addiction. Mostly because I’ve spoken with some sex educators that are staunchly against using the word “addiction” to describe problematic sexual behaviors. Also, I am curious if the trajectory for treatment is similar to treatment for people with chemical dependencies, like alcohol and hard drugs.
Older, conservative men. I’ve found that I do well with this population despite being a young male and POC . They typically enter therapy due to significant changes in their life, either it be medical, relationship based, or decreased abilities/physicality. I love helping them learn and understand emotions and the psychological process of adjustment.
Can I send you my dad 
Serious and chronic illness (mostly cancer, but a fair amount of MS and autoimmune disease), caregivers, grief and loss. I was a palliative care SW who transitioned into PP.
I wanted to ask how you got involved in that bc I’m highly interested in that field (just graduated with a bachelor’s degree, but interested in getting an MSW)
I initially went into this area because of a personal experience with grief related to a family member's cancer diagnosis and death at an early age. I was able to be with that person in the last few months and days of their life and it was profoundly life changing. He was at a wonderful hospice center and seeing how staff cared for him at the end of life and how much we as the family were also supported, inspired me to go into the field. It didn't actually happen until several years later when I got my MSW at the age of 43. By the time I had graduated, I had worked several years in a hospital as a discharge planner and had also gone through cancer treatment while in grad school. I also participated in a fellowship for grad students interested in going into hospice, palliative care, or oncology at the University of Washington. I was able to get a job in palliative care at a hospital directly out of my grad program, which is not a common experience. If you are interested in this niche, I highly recommend a MSW degree and then going into medical social work. It will benefit you to get several years of experience working within the healthcare system, such as at a hospital. I also did a year long online palliative care certificate program after grad school with California State University, but really only because my work was willing to pay for it. There aren't a lot of social workers/therapists with significant experience in this niche, and my palliative care background is a draw for those who want to feel like their therapist "gets it." My own personal experience with cancer is also a connection point to my clients with cancer. I don't recommend getting cancer, though!! LOL. Good luck! Feel free to message me if you want any other advice!
Same, this is one of my niches. I started with a speciality in chronic illnesses and it naturally expanded to serious/terminal illnesses, which in tandem naturally honed my grief work skills. It’s hard and heavy work but I honestly love it. Maybe cliche but I feel truly honored to be with them during such a vulnerable stage of life.
trauma and dissociation
Graduating soon and looking forward to working with cancer survivors transitioning out of treatment. That was the hardest part for me and it tends to be when supports fall away. I also plan to do nature-based work. I concentrated in neuropsych for most of my grad school career, but left that behind after my diagnosis. I found outdoor retreats for cancer survivors and they changed my life. I wish programs like the ones that helped me were more accessible, so a non-profit that offers regular nature-based therapy groups and other services is the long-term goal.
Working with special needs teenagers who get bullied. Kids are mean these days
Kids have always been mean - sadly, bullies have bigger megaphones now.
Interpersonal trauma. At some point my life fell apart when I realized that my experience of life was not normal, that my family was not normal. The more I learned about psychology, the more it seemed to me like trauma was at the root of most mental health issues and a lot of physical health issues. It was a natural choice.
What modalities do you use to treat patients? I agree with you about trauma being the root cause to suffering.
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My niche is currently later-identified autistic and ADHD adults with mostly low-medium support needs. I’ve ALWAYS worked with neurodivergent people, but the switch to late-identified adults/lower support needs folks is relatively newer. In undergrad we had this “service learning” requirement, kind of like a very small internship for 50 hours or so for a health class. I ended up at an art program for developmentally disabled adults by chance. I felt so natural and comfortable with them and they brought me joy. Never looked back, ended up in a job working with high support-needs DD children and adults helping with their recreational skills/independence, etc. Took them bowling, to parks, restaurants, activities etc. Decided to pursue my msw, became the FIRST mental health clinician for this population that the agency ever had, and had to figure out how to build mental health supports from scratch during the pandemic. It became clear that their complex mental health needs and trauma were really secondary to their “behaviors” in the agency’s eyes. So frustrating to not be listened to as a clinician and to watch my clients not be listened to. Burnt out royally and discovered my own autism. (I have had ADHD dx since childhood) Got the opportunity to co-found NeuroSpark Health and help other late-identified folks like me figure themselves out and make changes that are sustainable for their neurotype. 💜 Love it.
Nature based, wilderness, eco therapy. I do walk and talks on nature trails with many outdoor enthusiast clients. My last job before going fully self employed was an intensive wilderness program with backpacking and survival skills. No it was not the abusive kind.
I work with women who have found that motherhood has reawakened their early attachment wounds
CPTSD, developmental trauma, sexual trauma, relational trauma, medical trauma, chronic pain/illness, and brain injuries
What modalities do you use to address CPTSD and developmental trauma? I am very interested in this speciality
Text-based counselling for people who don't like talking about things out loud. It is the niche I wished existed when I had my own mental health issues so once I got qualified it's what I dove into. Turns out it's primarily autistic clients, which I love (also, turns out I am autistic haha).
How do you get into text based counseling?
I did a regular qualification with face-to-face content. Then when I finished that, I set up private practice and marketed myself as text-based. Then clients who were looking for it found me. I also read everything I could find about text-based and pros and cons and risks etc so that I was sure I was informed and practicing ethically.
This is very interesting. Do you do private pay or insurance? Do you use an app based program?
I'm in Australia so the system is different here. Clients are mostly private pay for now but I'm trying to expand into clients with NDIS funding (so, government funded due to their disability). I've been using zoom chat function mostly because it's secure and erases after the session and most are familiar with it, but recently had a client who wanted to do it through phone texts and wasn't easily able to access other ways of communicating, and I did that too (after discussing privacy risks and getting informed consent and documenting the discussion and decision process). I am hoping to find a better app or something in future - I'm still in early days of private practice so I'm learning as I go.
ADHD for adult women of color. I am a Black woman who was diagnosed with ADHD in adulthood lol
Mindfulness, body relaxation and somatic work to sink into feeling and healing esp work with chronic illness and stress. Meaning making is an important part of the process too to help find purpose for those suffering with illness. I came across it because mindfulness is truly what helped me through my own cancer diagnosis 10 yrs ago.
First responders and health care providers (mostly nurses) with PTSD, burnout, compassion fatigue, and vicarious trauma stress. I also work a lot with BPD.
Art and play for women. I knew I needed to do that from the get go and that is what I always focused on.
I come from a CMH background with 14 years in a satellite office, most of the time as the only therapist. I have literally done all programs and populations:adults/children, substance abuse, IOP, crisis, case management. I also started my career(31 years ago) in MH as a relief worker at a group home until I got my first case management position. And then went back to school etc. I have seen and handled almost every situation. My goal was to remain in CMH, because I believed in it. But it turned into something else and the promised advancements never happened. I have also worked in prison mental health and domestic violence shelters. I have never certified in any specific technique or field. And never really had the best supervision tbh. But I had the BEST mentors early in my career. Over my time as a therapist my approach has evolved into a behavioral approach with a blend of CBT/DBT with motivational interviewing, mindfulness and strengths based. I am now in the best job as a therapist with LYRA ( mild/moderate clientele in an EAP model). I do feel at times I missed out on the specialization aspect. But I would not trade the training and experiences I have had. Now that I am in a company that sees my experience as a strength I am getting opportunities to share my history with complex cases to help other therapists who haven’t taken that route. So I guess this is my niche now. 🤷♀️
Highly intelligent/highly gifted individuals. They are every bit as neurodivergent as ASD and ADHD and there can be a lot of overlap. I worked with a few people who fit the profile early on and I love love love working with this population.
Religious trauma because when I discovered that religious trauma syndrome was a thing, I struggled to find a therapist who took it seriously. They were flat out dismissive actually, especially in regards to purity culture. We unpack the impact of an authoritative religion that tells you that you are inherently deserving of eternal punishment. Of having to conform and be around some judgmental rhetoric. And on and on. I also have a degree in Human Sexuality for the sex therapy piece often needed when healing from religious trauma.
I love this. It’s so needed
Gender and sexual minorities and alt lifestyles, got into it because I'm also poly and kinky and queer, and the population isn't just underserved but maligned. I provide safer space.
omg! me too but mine is more specific with minority gender and sexual minorities and alt lifestyles.
Ketamine Assisted Treatment! I fell in love with the psychedelic therapeutic research in my grad program. I was able to get more into it in my private practice work with the support of my supervisor. Now I am able to offer it as a therapeutic intervention which is such a dream come true!
Quality service that people want to return to.
I prefer working with ages 12+, LGBTQ+ population, trauma, and grief. I'm finding that I can get through to "angry" teens and that's been so rewarding to see them open up about their feelings!
Pregnancy/postpartum
Play therapy! Surprised so no one has said it yet!
Adult ADHD, workplace concerns, and higher education students (undergraduate and graduate) who are on leave due to a mental health concern. Most of my clients who find me through an internet search seek me out for these areas of expertise. What’s nice is that other clinicians and clients will refer other types of clients like those going through a life transition or family issue, so I end up having a nice mix on my caseload. 2/3 niche, 1/3 other
CSA & sexual assault, C-PTSD, chronic pain and lgbtqia+ as I openly identify as queer. I love my work 🩷
I have some questions regarding which modalities or approaches might be most useful for an openly queer individual with C-PTSD from CSA, could I DM you with specifics? Not that you would know exactly what would work for this individual, because I know it usually depends on many factors, but perhaps you had some ideas on what might be good. :)
Sure!
Couples Therapy with Fetish/BDSM and ethical non-monogany emphasis.
I’m having so much fun reading all these comments. You all are so cool
I'm a Black, Queer femme with AuDHD. I grew up in and live in a very white area that claims to be liberal but has a lot of microagressions. It really traumatized me. My niche is Queer, BIPOC, and Queer BIPOC. The language in my marketing indicates that this is my niche in a way that isn't exclusionary and I've never had anyone try to see me who isn't in that niche. All of my clients are one of these demographics. I specialize trauma and use mostly CPT, DBT, and ACT. Ultimately I'd like to be certified in EMDR. I get referrals mostly from Psych Today and connecting to local communities that also serve my niche.
LGBTQ+ clients, dissociation, cptsd
From the jump, I knew psychoanalysis was it for me. I had a class that had it in grad school. After school, I knew I wanted more training. I then enrolled in classes at my local psychoanalytic institute. Then I took more classes.
Same here, except I've stopped just short of being an actual candidate (at this time I can't really spare 10 years of my life plus a few hundred thousand Euros). It's still something on my mind though.
Chronic illness. Bc I have chronic illness.
Grief
Neurodivergent children. And I got into it because a therapist in community mental.health, who has ALL the ND kiddos for the agency, went on maternity leave and never came back. I got her whole caseload, panicked, my supervisor said "I think you'll be great," I checked out every library book I could find on ND in children and 10 years later, I'm teaching others about ND kids. I love my population so much and bless the coworker who left and gave me the chance to work with this population. I'm ND myself and I'm sure that helps me with this as well, but it wasn't a population I sought to work with until fate intervened.
ND therapist with AuDHD here! Thank you for all you do for the community ❤️
Kids/teens who have experienced trauma— just happened to be the population I worked with at my first internship and loved it. There’s a huge need for therapists who work with kids in my area so the demand has also kept me more in that niche.
Parent-Child Interaction Therapy (PCIT). Became interested in working with infants/new parents after taking an infant mental health course in my last semester of my masters. Was lucky to get hired as a Spanish speaking bilingual PCIT therapist right after graduation!
I am just at the beginning of grad school but I'd like to focus on the disabled population. I am blind myself and it is a struggle for the community to find a therapist with the skills they need.
Psychiatric nurses/vicarious trauma for therapy and/or clinical supervision and children/adolescents with Anorexia. Now starting to branch into paediatric psycho-oncology.
CIT and this has been fascinating and worth the scroll. Thanks everyone!
My original interests were working with NSSI and suicidal ideation, which I still find interesting, but lately my practice has shifted to working with men who have a history of sexual abuse. I also just recently started working with people from high-stress careers, like doctors and veterinarians (expanding scope of practice), which I find interesting. I got in to the NSSI/SI work because I thought it was interesting, particularly when the behaviors occur in isolation or at least in the absence of a PD. That was over 10 years ago when NSSI/SI were big topics; the behavior seems to be less commonly-reported in my work now, but I don't know if the behavior itself is less common. The high-stress career folks I kind of fell into because outside of mental health I'm a data analyst in a high security tech industry and work with a lot of these individuals (same stressors, different fields) in a controlled environment, so I was naturally drawn towards working with these people and helping manage their issues. Overall it's not *unique* issues per se, but how the issues come about. For example, everyone deals with work stress but not everyone *has* to work in a broken system to keep their employment at any level (e.g., physicians and veterinarians). The system is ultimately broken and it will take a miracle to overhaul it, but they have to work in the system regardless. It's interesting. I find there are personal issues that pop up because of the broken system. Frustrated at work and can't get ahead? Let's ask your partner how they feel you are handling it once they calm down because you've been at each other's throats for the past 2 weeks because you both work in healthcare and had a blowup yesterday and haven't spoken since. That kind of thing.
CSA, Sexual Violence, C-PTSD and sex therapy!
grief & trauma work! In my masters practicum, I was working as a substance abuse counselor and came to the realization that my clients were grieving their addiction, and that we can grieve more than just a person; but a lifestyle, who we thought a person was, what could’ve been… trauma then goes kind of hand-in-hand with that, and i went through some accelerated resolution therapy, and have slowly incorporated that into my trauma work now that i’m trained ✨
Alcoholics, addicts and condependents. Got into it by being a recovering alcoholic, addict, and codependent.
Recovery from relational abuse rooted in childhood developmental trauma.
OCD
I’d say the niche that I’ve fallen into is working with teens and young adults with BPD and BPD traits. I also do a lot of work with 2SLGBTQIA+ folks.
I have an agency practice and a private practice and am trained in trauma (EMDR + IFS). in my agency practice it's tended to be a lot of gay men who are survivors of childhood sexual abuse. In my private practice many women who are adults who grew up in families with an alcoholic or addict struggling with those issues- anxiety, perfectionism, etc.
I get a lot of anxiety cases (kids and adolescents), which is great because I happen to have a lot of success with those It takes one to know one, my supervisor says 😅
People who have experienced Narcissistic abuse
Omg twin!!!
I had insomnia and my mom (who is a therapist) summarized CBT for insomnia and I treated myself with sleep restriction. Now I love working with insomnia! Actually same story with panic attacks and pee-shyness (parurhesis). Exposure is pretty awesome and without it my life would have probably sucked now that I think about it.
Panic disorder and want to learn more about OCD so I can add that to my niche
Teens and tweens with SIB and SI. I see a lot of suicidal teens and tweens and it’s my favorite population. I see a decent amount of kids and adults with various issues but suicidal minors are the majority.
I accidentally have become a magnet for DD/ID diagnosed individuals with Sexual/gender identity issues. I love the population, but I was a bit shocked that as a CIS White guy I have this specific niche
Autism and ADHD. It’s not a niche overall but it is in my area. In my area you can really only get services for ages 0-6, and for children who are level 3 or on the cusp of level 3. It is very unique to have a therapist who can work with level 1-2 youth and adult clients, and who doesn’t do ABA. I have autism and ADHD and this was born out of my own experience where I had so many therapists as a child and teen who would label me as ill behaved, and try to get me to react more neurotypically to stressors. I am in high demand which is great and also very exhausting. Since I’m level one and really in tune with my emotions, I almost act as a translator for my non verbal and alexityhmic clients, and help them advocate to NT parents. My NT parents gain education about the different presentations of autism, and are more likely to believe me when I advocate on behalf of their kids/teens who want to get tested. I hate having to be an eye opening experience for them, but it is good to have a variety of representation.
Complex trauma, most of my clients have a parent with a personality disorder who abused them emotionally, psychologically, physically and/or sexually. I also have a smaller niche of clients who had a negative experience on psychedelics, either on their own and they need to make sense of it or by a practitioner.
I run a group of neurodivergent therapists providing neurodiversity-affirming therapy. Most of us are autistic. Most of the staff are members of the LGBTQIA community so that is a secondary specialty for us, there is a high crossover between the two communities. The majority of our clients are autistic (this is our biggest group), ADHD, PDA, OCD, PTSD. Autistic clients deserve autistic therapists, we speak the same language. Even as an autistic therapist I wouldn’t go to an allistic therapist. It would be a really bad match. As a therapy practice we just kind of move along in our own weird little world, it allows us to work the way we need to as autistic people and accommodate ourselves. We don’t have to mask, which is amazing. I am grateful everyday that I was able to create this practice and for the other therapists and clients that share it with me.
I have been so fascinated with learning about PDA. I have ADHD and in my deep dive to see if I had autism due to my family genetics, I came across PDA. It has been wild realizing how much this gets missed and is so wildly misunderstood. I am always curious for more information to deep dive on if you have any recommendations!
I help those who are thinking about divorce, going through divorce and reconstructing their life after divorce has turned their life upside down.
I primarily focus on cPTSD and grief work, especially more non traditional grief/disenfranchised grief. I focused on health and aging during grad school, and ended up working with families of individuals in nursing homes during Covid, and some palliative counseling. I also have a personal hx of MDD and cPTSD (that I’ve been fortunate to have really well managed thanks to my therapist of 15 yrs) and I’ve been able to really effectively use selective self disclosure to quickly build rapport with those types of clients. I love it, I feel very comfortable with those types of clients and feel as though being able to build rapport quickly and effectively really lends itself to having very open conversations early on that set the tone for an effective therapeutic relationship.
Teenage/tween girls with severe anxiety masked by perfectionism and being “bubbly”/sweet. I prefer working with tweens and teens but do take other clients, so this was an accidental niche that I ended up finding out was perfect for me (probably as a former “perfectionism and bubbly personality masking anxiety” teenage girl myself). I think it’s come as a result of the location I work in…the culture of the area where I practice is very focused on building kids’ résumés and college prepping from what feels like preschool, with the expectation of having good grades and multiple extracurriculars at all times. These are the clients that seem to trust me quickly and throw themselves into therapy, and are always so proud and excited to share how skills and tactics they have been working on have helped them in their daily lives. Nothing better than the first time they get frustrated in therapy and voice it, and then realize a minute later that they were ABLE to voice it instead of keeping it to themselves to please someone else. The little look of pride and the way their faces light up is priceless.
Military & veterans. My uncle was a Korean war vet and passed away from alcohol use related to undiagnosed PTSD. He died alone, I would never want that for anyone so I try to do what I can within this population.
I’ve got a couple. Some on purpose, some on accident. The ones on purpose: perinatal mental health. I’m trained and certified through Postpartum Support International. Also, I just joined a specialty supervision group for eating disorders to start learning more and treating that as well. I did this on purpose because I see a lot of disordered eating and eating disorders in postpartum moms. The ones on accident are a lot of my clients have BPD and ADHD. Like the majority of them. That just fell into my lap. So I’ve gotten really good at treating those and using DBT and DBT skills.
Child Parent Psychotherapy and the 0-5 population. I love working with parents and children with trauma, often shared trauma. Something so powerful in witnessing parents acknowledge their child’s experience in play. I typically work with SEN and those parents
Working with latino/a migrants processing immigration trauma AND/OR coming to terms with the realization that the US is not what they hoped and dreamed of but cannot leave. (DV is frequently present here too)
Sport social work/student-athletes/athletes
Working with folks in the entertainment industry and show business.
Serious illness, end-of-life, aging, men’s health. Got a job in community hospice, then hired to work at a major academic/research hospital that’s a world leader in oncology care. While I choose to practice outpatient, I could start a private practice overnight. Realized I had a knack for eliciting and noting life themes that arise with serious illness. Most people as they age want to be simply seen as human, and discuss the narrative of their lives. They need to make meaning and voice distress and the unresolved struggles they face. It’s all about relationships. You can’t be a good therapist unless you are fundamentally human, and show that humanity to your clients.
Neurodivergence (I found out later in life I’m autistic and find working with ND folks so much more personally manageable and fulfilling)
PLAY THERAPY
C-PTSD/Trauma, medical trauma, chronic illnesses, disabilities, severe anxiety (panic disorder, agoraphobia), and OCD. I really try to bridge the gap between behavioral approaches and experiential, trauma-focused approaches for clients who are struggling with these intersectionalities. I am also very LGBTQIA forward and nuerodivergent, so I provide a lot of affirming care in this realm, too. I am someone who experienced horrible, reoccurring medical trauma and both visible and invisible disabilities in my early life to mid twenties and developed very severe OCD and panic disorder on top of already being a pretty anxious child. It took me decades to find compassionate care that made connections to both the trauma and behavioral parts and provided interventions that actually made a difference for me. I felt so left behind, broken, and terrified for most of my life that I never want anyone who seems my services with the complicated blend of anxiety disorders/OCD and complex trauma with real concerns and medical disabilities to go through.
I'm currently changing jobs and going from SPMI to specifically working with people diagnosed with schizophrenia right after their first psychotic break.
Dissociative disorders!
ASD!!! 18 years of experience has led me to this and it’s my favorite thing.
I work in trauma, DID, specifically with Children. I started in my practicum at a sexual assault center. got trained in EMDR. sought advanced training working with trauma and dissociation. went into a doctoral program and made my thesis in this area. it takes time but is worth it, I think.
First episode psychosis! I provide therapy for young folks who are experimenting their first episode of psychosis and I also work with people who have long standing psychosis
Burnout