As a therapist, 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’ll 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 their story. Whatever happens next is crucial.
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, there were a lot of suffering people who would go to the substance abuse programs and get told that their problem was their mental health. Then they’d go to a mental health practitioner and get told that they had to stop using drugs, they needed to be in a substance abuse program. Few stuck with the merry-go-round long enough to get help, most 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, one of the first in the country.
I vowed that when a client shares his problem with me I would not give it back or re-gift it to someone else. I consider it a sacred trust, not to take lightly. I would never tell her that her problem is too big or too difficult for us to handle together. I’ll encourage them 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 them 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, for instance, refers out all of the drug addicts she encounters, 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.
This is what they’ve told me 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 from them. When we tame our problems, rather than evict them or tie them up with duct tape and lock them in the cellar.
My job is not only to pass on this knowledge, but to embody it. I can’t espouse it if I contradict it by sending people away. They learn to sit with the problem by watching me sit the problem and learning all about it. That is why I don’t specialize in anything, so I can represent a willingness to accept life on life’s terms.
Because I don’t specialize in a single kind of client, I also can’t specialize in any one school of psychotherapy. I could have become a Rogerian, a Beckian, or gotten a longer couch and taken up psychoanalysis. I could have read everything ever written by Bowen, or Freud, or Jung, or Lacan and turned myself into a copy of those great psychotherapists. I’ve learned to do CBT, DBT, ACT, EFT, REBT, MET, and many other combinations of the letters of the alphabet, all ending in T. I’ve taken classes in them all, and then some. But I couldn’t specialize in any one approach because I never specialized in any one kind of person. When you throw your doors open to seeing whoever walks in and commit yourself to dealing with whatever they bring you, then you learn pretty quickly that no one approach works for everyone. You have to be flexible.
This is why I call myself eclectic. The only way that works is every which way. It’s always better to have choices, than to have none. So, I became like a mechanic with a whole chest of tools in my garage. The thing is, I have to know how to use all of them and what works best. That’s why I’m a reflective eclectic: because it’s necessary to think about what I’m doing.
Here’s another reason I don’t specialize: I can’t because I’m not just one thing. I’m not only a counselor, I’m also a lifelong learner, a tennis player, a small businessman, a writer, a philosopher, a gardener, an author, as well as a husband, father, son, patient, parishioner, customer, consumer, citizen, and all the rest. I’ve been a student, caddie, Fuller Brush salesman, dishwasher, football player, cook, hockey player, referee, homesteader, grape trimmer, school bus driver, sawmill worker, cow milker, egg packager, newspaper deliveryman, construction worker, bouncer, child care worker, boss, chairman of the board of a non-profit, and one of those guys at the public market, selling cider. I’ve driven truck, delivered milk, preached sermons, put out fires, put on roofs, and had a very important position at a dairy farm as the vice president in charge of manure. I have more stories than I can remember and have lived more lives than your average housecat. And I’m still hungry.
How can a person like that specialize?