3 Questions to Consider When Deciding on a Clinical Specialty

By Kristie Overstreet, Ph.D., LPCC, LMHC, LPC, CST

A few days ago, I was coaching a registered intern who was overwhelmed due to working full time to gather hours for licensure and prepping for her exam. She couldn’t concentrate on her tasks at hand and reached out to me because she wanted help with creating her future private practice. She had worked herself into a tailspin and was drowning in options. She was pressuring herself to pick a clinical specialty.

I explained to her that she didn’t have to decide on an area of clinical focus right now. I helped her understand that picking the right niche area of clinical practice is a process that takes time. I asked her to permit herself to think about a few questions that will help her through her journey. Here are three of those questions that were helpful in narrowing down a focus.


Start by making a list of your natural skills. For example, do you enjoy managing projects, creating organizational flow, have a knack for helping someone who has been traumatized, enjoy working with kids, or feel comfortable talking about sexuality? These are just a few of the many skills that you may possess that can help you determine the direction of your niche clients. If you can’t figure out your natural skills, ask a peer, friend, or supervisor for their suggestions.


Think about what clinical areas make you excited. Maybe it’s working with the LGBTQI community or working with veterans. Take time to think about specific types of clients you would enjoy learning more about. If you’re passionate about helping people find recovery from drugs and alcohol, addiction counseling may be a great niche area for you. Write out all of the areas of clinical focus that you find interesting. Then use this list as a guide to help you narrow down your options.


Just as it’s important what skills you have, you also need to know what areas to avoid. Do you find it difficult working with teens? Do you feel uncomfortable working with couples? Explore where you may feel countertransference in your clinical interactions. This can be a red flag that encourages you to do more work in supervision in this area. This is an easy way to cross a few options off your list. Also, be sure to discuss these with your supervisors and get their feedback.

It’s normal to be unsure about what area to specialize in. Don’t expect that you will pick one area and remain there for your entire career. For example, if you decided to specialize in trauma work for PTSD clients, it will be unlikely that this is the only area you will work in. As your job experience and opportunities change, so will your options. Your specialty will evolve and grow over time, so practice patience along the way.