P1030564Recently an alternative healer suggested that further training as a personal development coach could make me a far more effective therapist.

This well-intentioned advice puzzled me, especially since the healer did not know my work.  How does what I do differ from coaching?

Traditionally psychotherapy has been associated with mental illness. When people are ill, of course, doctors make a diagnosis and then decide on treatment to fix the problem. Insurance companies, which often cover psychotherapy, feed into this medical mindset. Before your medical insurance will reimburse, all parties must agree that a diagnosis is warranted.

That said, much psychotherapy addresses nonmedical problems. While the therapist might treat you for bipolar disorder or schizophrenia, he or she would also be happy to help you find a new career, manage your difficult teenager, or communicate better with your in-laws. The therapist offers a menu. You pick what you like.

In our time, the scope and methods of therapy have greatly broadened. Carl Rogers broke new ground in the mid-twentieth century with the notion of client-centered therapy. More recently other psychologists have challenged therapy’s traditional focus on misery and have turned their attention to happiness.

My profession, which is social work, has traditionally voiced contempt for therapists who see clients under commercial insurance, because these people are relatively well off. Old-school social workers maintain that the profession should properly follow the example of Jane Addams, focusing on the disadvantaged groups struggling for survival.

A coaching perspective, of course, would not distinguish between paying customers on the basis of earnings or illness. Like therapists in private practice, the coach would gravitate toward clients he or she enjoyed helping.

According to one respected source, a “personal coach does not remove [the stresses of a changing world], but goes two steps further. The coach can help us turn [these problems] into challenges and enable us to overcome them by drawing on resources within ourselves that we never knew we had. With our newfound confidence we can then face new challenges” (Laura Whitworth, Henry Kimsey-House, and Phil Sandahl, Co-Active Coaching: New Skills for Coaching People Toward Success in Work and Life [Mountain View, Calif.: Davies-Black, 1998], p. x).

If this is a definition of coaching, what do I do in my practice?

My job, as I see it, is to help people surmount whatever obstacles are keeping them from reaching their goals. There are many kinds of road blocks: educational and career problems, relationship issues, trauma, financial stress, grief and loss, and occasionally also mental illness. Fixing the problem is not the goal but is a prerequisite to reaching it. So is the pursuit of wellness and health.

I ask my clients in our first session to tell me about their lives, past and present, and to identify their goals and the issue that brought them to my door. I listen to how they talk as well as what they say. I see as well as hear.

The focus in our therapy sessions is on mapping a path that will lead the client from point A (right now) to point B (the goal). I offer guidance, suggestions, and resources. The client pursues them and gives me feedback. The client and not some outside observer evaluates the outcome. Isn’t this coaching?

Even in cases where the client is a child and a legal guardian is in charge, the best results come when the goal is something the client wants. The same is true for people who have schizophrenia and severe bipolar disorder.

Severe mental illnesses generally call for psychiatric services and case management, more available at a nonprofit clinic than from a solo practitioner, but people suffering from these afflictions have personal goals like everyone else.

Let’s turn the question around. If therapy is often coaching, is coaching often therapy? Surely something therapeutic is occurring whenever the coach-client relationship promotes wished-for change. The active ingredient is the same in both lines of work.

Of course, personal development coaches are over a marketing barrel. They are inducing psychological change, but they must call it something else or risk being accused of practicing medicine without a license.

Before I could hang out my shingle as a private practitioner in Connecticut, I had to earn a master’s degree in social work (two years of coursework and internships), log 3,000 direct service hours (work with clients), and receive 100 hours of supervision from a licensed clinical social worker. A personal experience of psychotherapy was recommended but not required. After meeting the requirements for licensure I had to pass an examination and pay the state a fee.

To maintain my license I pay an annual fee, earn continuing education credits each year, buy malpractice insurance, and agree to abide by a professional code of ethics. Insurance companies demand that the therapists under contract with them furnish proof of licensure and insurance.

The procedure for coaches is different. Insurance companies do not reimburse for coaching. Many schools teach and certify coaches. The curricula and the standards vary. There are no state licensure standards for personal development coaches. Certification programs are relatively inexpensive and less rigorous and time-consuming than master’s or doctoral degree programs.

While I am not particularly a fan of the professional credentialing process for social workers, it does set some minimal standards. It also provides for greater accountability than the coaching profession. The biggest difference between the two, though, relates to preparation.

Although coaching and psychotherapy are both concerned to help the client change, therapists receive explicit training in self-awareness. They learn how to self-monitor so that their own issues do not derail the therapy. A key part of this knowledge is an understanding of anxiety and the impulse to control other people.

Internships and supervisory hours are supposed to teach mental health practitioners these things. The social work profession probably focuses more than coaching does on understanding human nature. Rather than label people using medical diagnoses, psychological types, or personality profiles, social workers look to see what helps people thrive, how they respond to different stressors, and how they handle environmental and life stage challenges.

Not all therapists are skillful, obviously, and no one practitioner is right for everyone. Still, a few basic principles guide the work.

  • The client is in charge
  • It’s only help if the client asks for it
  • Normalization, validation, and encouragement are key
  • The best change agent is nonjudgmental empathy and liking
  • Responsible practitioners monitor their own issues to safeguard the work

The practice of therapy is a lot like skateboarding. It requires a good sense of balance, skill at regulating speed, and the sense to know when to stop.

Surely therapy and coaching, at their best, have much in common. To be effective, people practicing either one must understand themselves and know how to keep their personal issues, once triggered, from skewing their perception of the client and the client’s needs.

Practitioners who do not continuously self-monitor, whether they are therapists or coaches, risk injury to the clients who seek their help. In the last analysis, both coaches and therapists are bound by the same first principle as the medical profession: primo non nocere. First do no harm.