Is it necessary to have a niche practice in order to make a comfortable living?

This question comes up frequently in our consultations with colleagues. Many clinicians have developed thriving practices without focusing on any given specialty or population segment.

You can make a good living as a generalist under the following conditions:

  • You're good at what you do, and you have a strong reputation in your community.
  • There are not enough mental health clinicians in your area to serve the demand. Your schedule is always full.
  • You have a steady stream of referrals, either from insurance or from other professionals.

If you're just starting out, it is more challenging now than it was 10 years ago to develop a generalist practice. With the availability of telehealth, your competitors are statewide and beyond, not just in your local community. Furthermore, many prospective clients are turning to online therapy platforms, which have lower fees.

Advantages of having a niche practice

A niche practice can provide greater career satisfaction. By specializing, you can focus on the types of people or issues that you most enjoy working with - which helps prevent burnout. That's good for you, and good for the clients you serve.

As your reputation grows, you will probably find that more and more referrals come to you via word-of-mouth, thus reducing the need for marketing and advertising your services.

Specialists often get paid more, due to their focused training and expertise. If you are out of network with insurance, some companies may pay your full fee for a given client, with a single-case agreement.

If you choose to stay in-network with insurance, you may be able to negotiate a higher reimbursement fee in your contract, particularly if there is a demand for your specific expertise.

With a niche-focused practice, you will inevitably be turning away prospective clients who are not within the niche. This gives you an opportunity to refer them to other clinicians - which helps build goodwill with your colleagues.

Getting started in a niche/specialty

The words niche and specialty are sometimes used interchangeably, but in terms of marketing they have different meanings:

Niche - The types or demographics of the people you work with. Examples: military families, executive women, divorcing couples, children with school problems, etc.

Specialty - The types of problems you treat or the methods you use. Examples: anxiety, ADHD, schizophrenia; cognitive behavioral therapy, biofeedback, etc.

Like most mental health professionals, you probably like to help various types of people with various types of problems. How do you decide which to focus on?

In choosing a niche or specialty, consider your interests and your skills. Ask yourself the following:

  • Of the clients I most enjoy working with, what do they have in common? Are they of a certain age group or other demographic? Do they struggle with a specific type of problems such as divorce, conflicts in family business, physical illness?  Do they have common backgrounds or interests?
  • What types of problems am I most effective in treating?
  • What types of clinical issues do I get most excited about?
  • Which aspects of my clinical work tend to energize me, rather than drain me?
  • What's the most frequent positive feedback have I received about my methods or approach?

Also explore the demand (or not) for services that you are thinking of offering. For example, if you enjoy working in person with college students, you'll have a better chance of success in your practice if you live in or near a college town.

How do you know if a given specialty service is in demand?

  • Call around to other mental health professionals who provide the types of services that you might specialize in, and find out how long people have to wait for their first appointment. A long waiting list suggests high demand.


  • Take notice of complaints you hear from clients and others about difficulties in finding help for their problems. Can you develop a specialty in any of those issues?


  • Follow local and regional news stories about community problems related to mental health issues. You may learn about layoffs, domestic violence, problems with access to to treatment, etc. Or you may learn that a local mental health specialist has closed their practice or died. If there is a need for services and you can fill that need, it's a win-win for you and for the community.


  • Notice opportunities to supplement what other specialists are doing. For example, child custody evaluators often recommend counseling or therapy for family members. Ethically, they cannot provide these services themselves after conducting an evaluation, so they're going to need experts to refer people to.


  • While networking with current and potential referral sources, find out which services they most often seek for their patients and clients, and their biggest frustrations in finding such services.


  • Keep notes on what people in your community need and want in terms of mental health services. A pattern will eventually emerge that can help you decide on a niche or specialty that will flourish.

Developing your niche/specialty

Once you've determined your focus, explore opportunities to get additional training and/or certification. Subscribe to newsletters and journals that publish content in your area of interest. These steps will help ensure that you hone your knowledge and competence in this area.

The next step is to set up a focused business plan outlining your goals, action steps and time lines. This will help keep you on track and accountable, which will significantly increase the likelihood of success.