The Lost Art of the Generalist
During my second year in grad school I was confronted with the dreadful task of picking the topic of my thesis. It felt insane to me at the time and looking back - I still think it's an insane thing. I had no clinical experience, I had only just completed psychopathology II, and I hadn't even the faintest notion of what I might do for practicum which was another semester away. What in the world am I supposed to be interested in enough to plunge myself into studying and researching for a year?
People around me seem to have it figured out. A good friend of mine at the time was deeply interested in childhood sexual abuse, another friend of mine was interested in autism, another was interested in vicarious traumatization of therapists. They all seemed to have one thing they wanted to know about, they wanted to throw themselves into. Amazing! I envied their certainty and their concise, decisive passion. The problem with me is that I wanted to know more about all of those things! And what about the things I didn't yet know?! I wanted to know more about the things that linger beneath all other things...
What makes grief? What makes self-hatred? What makes a split? What makes envy? What makes a mind? What makes a defensive process? What makes an ego? What makes a human?
Easy questions... right?
After months of agony, I feel like I basically picked my thesis topic out of a hat. My husband came home from work one day and he was upset about something he saw on Facebook. Upset about something on Facebook, eh? That seems like a thing... well, I guess I'll study it.
This was the first message I received during my training as a therapist that you ought to pick a specialization... you ought to have a decided interest and commit to a certain path. You ought to have something that makes you special.
Some months back, I received an e-mail on a listserv from a therapist who was looking for a referral for someone who "specialized" in working with clients who have narcissistic parents. I just about fell out of my chair...
Anyone who has spent an adequate amount of time in this field, has adequately worked with clients who have parents in the narcissistic range of functioning. It's like saying I need a referral for someone who has experience working with clients who have impairment in social or emotional areas of functioning... It's just a given. Surely not everyone who seeks therapy has narcissistically organized parents, but I imagine that those who have more narcissistically organized parents will find themselves in therapy more often. I feel like I shouldn't even have to explain this...
I sense that this field has become quite picky with specialties, we fetishize "experts," and people who "know." Certainly there are many people who know many things. This is important. I rely on people much more experienced than me to provide me with insight and guidance in my own clinical work. They provide me with a sense of community and containment for my own limits. They support my growth. Likewise, if a colleague of mine has a question about a suicidal teen or parenting issues, they know they can consult me because of my experience in these domains.
Despite even my own areas of extensive experience, I hesitate to adopt words like "specialist" or "expert." To me, it implies we have achieved a stage of competency and guaranteed knowing that has no distinguished level beyond that. I believe in the significance of human limits, I believe in the power of the unknown. We simply cannot know we've learned enough - we simply cannot know what we have not yet learned. Never are we no longer susceptible to blind-spots or weaknesses in certain areas. Never can we stake claim over a certain domain. These domains do not belong to us - they simply gift us with the knowledge they permit us to have in our capacity to know what is knowable.
I think it's human nature to hunger for "more." It is innate to seek and conquer. It's an excellent drive that leads us to great discoveries and growth. It also tempts hubris and blindness. It seems to me that we've become preoccupied with specifics and specialness over humanness. In our disavowal and avoidance of the unknown, it becomes an object of fear. We become preoccupied with expertise and fear misunderstanding. We seek and gratify a guarantee for understanding because the potential for difference is intolerable. We avoid the anxiety and miss opportunities; we miss the most basic and general essence of what it means to be human and to suffer humanly.
Most therapists I've talked to about this have found a way to rationalize this (I've also noticed that therapists are specialists in rationalization). Certainly it is reckless to take on cases that have very specific needs with little to no knowledge or experience of that specific need. It is also vital to provide client with the right amount of what they need and the right format of services. I wonder, however, if we're overly cautious at times. Freud himself declared that the "ability to work and love" defined psychological health. Perhaps not everything needs a specialist, not everything needs an expert. Often, a human expert will suffice when the affliction itself is human in nature.
People around me seem to have it figured out. A good friend of mine at the time was deeply interested in childhood sexual abuse, another friend of mine was interested in autism, another was interested in vicarious traumatization of therapists. They all seemed to have one thing they wanted to know about, they wanted to throw themselves into. Amazing! I envied their certainty and their concise, decisive passion. The problem with me is that I wanted to know more about all of those things! And what about the things I didn't yet know?! I wanted to know more about the things that linger beneath all other things...
What makes grief? What makes self-hatred? What makes a split? What makes envy? What makes a mind? What makes a defensive process? What makes an ego? What makes a human?
Easy questions... right?
After months of agony, I feel like I basically picked my thesis topic out of a hat. My husband came home from work one day and he was upset about something he saw on Facebook. Upset about something on Facebook, eh? That seems like a thing... well, I guess I'll study it.
This was the first message I received during my training as a therapist that you ought to pick a specialization... you ought to have a decided interest and commit to a certain path. You ought to have something that makes you special.
Some months back, I received an e-mail on a listserv from a therapist who was looking for a referral for someone who "specialized" in working with clients who have narcissistic parents. I just about fell out of my chair...
Anyone who has spent an adequate amount of time in this field, has adequately worked with clients who have parents in the narcissistic range of functioning. It's like saying I need a referral for someone who has experience working with clients who have impairment in social or emotional areas of functioning... It's just a given. Surely not everyone who seeks therapy has narcissistically organized parents, but I imagine that those who have more narcissistically organized parents will find themselves in therapy more often. I feel like I shouldn't even have to explain this...
I sense that this field has become quite picky with specialties, we fetishize "experts," and people who "know." Certainly there are many people who know many things. This is important. I rely on people much more experienced than me to provide me with insight and guidance in my own clinical work. They provide me with a sense of community and containment for my own limits. They support my growth. Likewise, if a colleague of mine has a question about a suicidal teen or parenting issues, they know they can consult me because of my experience in these domains.
Despite even my own areas of extensive experience, I hesitate to adopt words like "specialist" or "expert." To me, it implies we have achieved a stage of competency and guaranteed knowing that has no distinguished level beyond that. I believe in the significance of human limits, I believe in the power of the unknown. We simply cannot know we've learned enough - we simply cannot know what we have not yet learned. Never are we no longer susceptible to blind-spots or weaknesses in certain areas. Never can we stake claim over a certain domain. These domains do not belong to us - they simply gift us with the knowledge they permit us to have in our capacity to know what is knowable.
I think it's human nature to hunger for "more." It is innate to seek and conquer. It's an excellent drive that leads us to great discoveries and growth. It also tempts hubris and blindness. It seems to me that we've become preoccupied with specifics and specialness over humanness. In our disavowal and avoidance of the unknown, it becomes an object of fear. We become preoccupied with expertise and fear misunderstanding. We seek and gratify a guarantee for understanding because the potential for difference is intolerable. We avoid the anxiety and miss opportunities; we miss the most basic and general essence of what it means to be human and to suffer humanly.
Most therapists I've talked to about this have found a way to rationalize this (I've also noticed that therapists are specialists in rationalization). Certainly it is reckless to take on cases that have very specific needs with little to no knowledge or experience of that specific need. It is also vital to provide client with the right amount of what they need and the right format of services. I wonder, however, if we're overly cautious at times. Freud himself declared that the "ability to work and love" defined psychological health. Perhaps not everything needs a specialist, not everything needs an expert. Often, a human expert will suffice when the affliction itself is human in nature.
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