Credit Jon Han
What does it take to feel understood?
This is arguably the single question helping to reshape the modern psychotherapeutic landscape.
Call it boutique therapy: a swirl of contemporary tastes and consumer expectations that has yielded a collection of psychotherapeutic options specially designed for almost any circumstance in which humans could find themselves.
Forget the old distinctions between therapists who specialize in mood disorders versus those who do marriage counseling. The new niche market is exponentially more refined.
In need of a therapist to help get your start-up going? Check. To help you tackle the particularities of life as a Hasidic Jew? As a Muslim? Check, check. To help you end a relationship? To grieve the loss of a pet? To better understand the tapestry of female sexuality? To struggle through the issues of young adulthood? Check.
Perhaps nowhere is this phenomenon more evident than in the realm of psychotherapies designed for people who identify as L.G.B.T. Therapists, both gay and straight, have increasingly started practices geared specifically toward lesbian, gay, bisexual and, most recently, transgendered patients. (Not to mention those patients who prefer not to identify with any one category.)
For Matthew Silverstein, a psychologist in West Hollywood, Calif., this development springs from dire necessity. âThereâs a tortured history of practices that have been called psychotherapy,â Dr. Silverstein said, referring to notorious techniques like âconversion therapyâ that purport to change patients from gay to straight and that continue to be practiced to this day. âThereâs still a vulnerability that many L.G.B.T. patients feel when coming into a psychological treatment,â he said.
For Dr. Silverstein and others, the advent of specialization has created âsafe refugesâ for patients who for so long were without recourse to anything of the kind. âUntil the 1970s, we simply didnât have the tools,â he said. âThere wasnât an understanding of gay identity, or of gayness as a cultural or developmental process.â
For the psychologist Douglas Sadownick, a colleague at Antioch University in Culver City, Calif., there is an added layer of emphasis. âWe work on the assumption that gay people have their own psychology, they have their own blueprints,â he said.
It is with this conviction that Dr. Sadownick runs one of the countryâs first and only clinical psychology masterâs programs dedicated to L.G.B.T. studies, which he helped found at Antioch in 2006. Here, the training to become an âL.G.B.T. affirmingâ therapist includes a distinctive curriculum: Platoâs Symposium and the poems of Sappho and Walt Whitman are all assigned reading.
For Dr. Sadownick, the essential qualities of an L.G.B.T. affirming therapist come down to two fundamental capabilities: to be able to identify oneâs own âinternalized homophobia,â often operating outside of conscious awareness, and âto treasure being gay, as good for society, good for evolution,â he said. âTo be aware that this idea of being L.G.B.T. may have a lot more potential than weâve given it.â
Undoubtedly, the Internet has contributed to the shifting therapeutic landscape. Where before, word of mouth was crucial to the search for a therapist, prospective patients are now likely to take to the web, and faced with thousands of anonymous possibilities, look for some way in which to determine who may be the best fit, whose boxes check their own boxes.
Itâs not unlike how one may proceed through OkCupid, seeking potential mates who share a taste for George Orwell, Judaism and taco trucks, in the hope that these commonalities actually mean something.
And many therapists, in turn, feel the pressure to fold themselves into recognizable categories. For Rachel Sussman, a psychologist in New York who self-describes as a ârelationship specialistâ (from first date to breakup), it seemed necessary to carefully brand herself to build a practice.
âI have a marketing background,â she said. âI became a therapist as a second career. And I knew I had to hit the ground running. Once upon a time, you would just hang a shingle and wait for people to come to you. I donât think that happens anymore.â
And then there are those therapists who become accidental specialists, stumbling into a niche, as Lawrence Josephs did, after appearing in a documentary that made its way to YouTube. âThanks to Google I am getting more patients looking for someone they think of as an infidelity expert,â he wrote last year in The New York Times.
Like so much to do with psychotherapy itself, the new specialization is largely an urban phenomenon. Take Jocelyn Charnas, known as âthe wedding doctorâ in certain New York circles, who came to her specialty through personal experience.
A practicing psychologist, she had recently gotten married and was aware that there was all too little conversation revolving around the psychological challenges of the experience. âWhen you get engaged, itâs the ring, the venue, the flowers, which is all wonderful and interesting, but nobody seemed to be talking about the universal experience that this is also difficult,â she said.
For Dr. Charnas, weddings are not just weddings, but rather pressure-cooker moments that contain layer upon layer of psychologically fraught material. âTypically, itâs really not whether youâre having roses or lilies that is keeping you up at night,â she said. âWhile that may be the manifest content of it, the underlying content could be a number of things, like fears of disappointing your mother, or disappointing yourself. There are so many latent emotions.â
Thus, for Dr. Charnas, within weddings lies the very fullness of human experience. This is what makes every case different, every stressed-out bride-to-be distinct from the last.
In Los Altos, Calif., the psychologist Howard Scott Warshaw has developed his own brand as âThe Silicon Valley Therapist,â specializing in everything that he says makes Silicon Valley unique: the particular personality type that is suited for computer programming but less adept at parsing human ambiguity, the environment that seems to expect nothing less than extraordinary achievement.
âSome of these engineers, they love the software world, because it provides a metaphor of looking at life that really makes sense and facilitates their entire worldview,â Mr. Warshaw said. âSo if youâre going to deal with someone like that and you canât speak that language, thereâs going to be a real communication problem.â
And because Mr. Warshaw was a computer engineer before he became a therapist, he believes he has the necessary knowledge to communicate with his clientele. âIâve done the job theyâve done,â he said. âIâve been in the pressures theyâve been in. I really understand what it is to go through a software development cycle. So I can hear them in a way that some therapists without this background simply canât.â
But many clinicians would contend that shared experience is irrelevant to the treatment of their patients. âThis whole idea that when you walk in the door, thereâs a template for: âWe are the same, and out of that sameness we can build an immediate rapport,â to me that seems like a very problematic notion,â said Michael Garfinkle, a psychoanalyst in New York. âMy basic orientation, especially at the beginning, is a great curiosity and openness to what Iâm hearing. Thereâs a recognition that it takes a long time to learn the way that someone speaks.â
Dr. Garfinkle is often asked by prospective patients, âDo you have a specialty?â
This is how he likes to respond: âMy youngest patient is 9, my oldest patient is 82. My patient whoâs most well is mildly anxious, my most severely ill patient, so to speak, is someone who has been in and out of hospitals with schizophrenia for most of his life.â
Similarly, Justin Shubert, a psychologist in Los Angeles and the director of Silver Lake Psychotherapy, is quick to note that seeing a therapist whose label matches your label is not without its hazards.
âIt can be limiting because you may end up with someone with a narrower perspective,â Dr. Shubert said. âJust because someone understands what itâs like to work with a Hasidic Jew, doesnât mean that they understand what itâs like to have two sisters, or to be depressed.â
One may also wonder: Where is the line between Mr. Warshawâs kind of highly targeted Silicon Valley therapy and the less explicitly psychological work of a life coach? For Mr. Warshaw, the distinction is clear. âIn coaching Iâm working to maximize your performance in a specific activity right now,â he wrote in an email. âIn therapy Iâm working to maximize your potential and who you are, then you can take that to any endeavor you care to.â
But in all this talk of software development cycles and maximized potential, itâs easy to lose sight of something much more fundamental, a persistent truth that surfaces again and again when therapists talk about what actually helps their patients.
As Dr. Shubert observed, âRegardless of the technique that the therapist uses, itâs the relationship itself that heals.â
His perception is hardly newfangled. Freud himself had something to say on this subject. In a letter to Carl Jung, written in 1906, he put it thus: âPsychoanalysis is, in essence, a cure through love.â