Why I Don’t Specialize In Anything

I could’ve had a specialty. I did some post grad work in family therapy and some more in substance abuse. I sought for ways to address the desire my clients had to quit using tobacco back in the days when few others were doing so. I ran therapy groups for sex offenders. For almost twenty years I had a caseload full of victims of trauma, depression, bipolar disorder, and anxiety disorder. I sought clients with borderline personality disorder, when most thought they were untreatable. I could have specialized in any one of these conditions and turned away clients without them, but I’ve always resisted specializing in anything.

This is why.

When a person has a psychological problem it takes a long time before they will get help for it. Sometimes it takes several fretful days, sometimes much, much longer. The average, I’m told, is seven years. They don’t get help at first because they think they should be able to handle things on their own or they’re ashamed to admit there’s a problem. At last, they seek help, not because they want to, but because they have to. The problem just overwhelms them. Friends and family can’t handle the problem either. So, they find a counselor and tell him what the problem is. Whatever happens next is crucial. It can determine success or failure, survival or defeat.

The person with the problem might get lucky and bring his problem to just the right person with the right specialty, but it seldom works out that way. Often people can’t pinpoint what their problem is, or they’re mistaken, or there are multiple, overlapping problems. Sometimes the counselor has not advertised their specialty well enough, or there aren’t enough counselors. Most of the time, when counselors specialize, it’s hard to get the right match.

When I began in this field, about twenty-five years ago, there was a large population of suffering people who would go to the substance abuse programs and get told that their problem was mental health. The same people would go to mental health and get told that they had to stop using drugs, they should go to a substance abuse program. Few stuck with the merry-go-round long enough to get help, they just went back to their problem. It was easier that way. The luckier ones got two therapists, one for substance use, one for mental health, as if they really needed two, as if the two issues could not be addressed together and the treatment goals combined.

This, I thought, was insane. The two conditions overlap almost two thirds of the time. That’s a lot of people getting the run around. There’s just no reason for it. There had to be a better way. I developed a program that integrated mental health and substance abuse treatment.

When you share your problem with me I won’t give it back or re-gift it to someone else. I consider it a sacred trust that I do not take lightly. I will never tell you that your problem is too big or too difficult for us to handle together. I’ll probably encourage you to enlist additional supports and I might consult with experts myself, particularly if it’s a problem that is new to me, but I won’t just send you away.

Incidentally, this attitude towards problems is the reason why I’ve done so many things in the course of my career, the reason why few things are new to me. The counselor who refers out all the drug addicts that comes, for instance, never learns a thing about drug addiction and is forced into an ever more narrow specialty. Almost everything I know I’ve learned from clients; they’ve taught me what works, what doesn’t and what it’s like when it doesn’t.

No matter what the problem, this is what works: When we sit with our problems, rather than deny them, run from them, or overreact. When we listen to what our problems are trying to tell us, not so they can be the boss, but so we can learn. When we tame them, rather than evict them or tied them up with duct tape and lock them in the cellar.

I cannot teach you this approach if I just send you to someone else. If I do that, I’ve actually just taught you the opposite: that your problem is too much for me to handle also. That is why I don’t specialize in anything, so I can represent a willingness to accept life on life’s terms.

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