Coaching or Therapy? A Map for Coaches

The mantra “Coaching is not therapy” is frequently stated in coach training programs. Yet the distinction between the two professions can be difficult to articulate for many coaches—especially those who are new to the field or who have been previously trained as a psychotherapist specializing in short term therapy. In the course of coaching, clients may present with life patterns that exceed the parameters of coaching. When this occurs, the ethics and appropriateness of referral must be explored.

Coaching theory identifies two core differences between coaching and therapy:

Primary Function:

The primary function of therapy is to create a context in which healing may take place. Therapy assumes that symptoms or behavioral patterns need to be fixed, that something in the client needs to be healed.

The primary function of coaching is to create a context in which life and performance enhancement may take place. Coaching assumes that the client is already high functioning and is capable of taking consistent action steps towards their life vision. However, clients with a psychiatric diagnosis can also benefit from coaching if they demonstrate the ability to make ongoing progress toward their coaching goals and they are actively managing any symptoms.

Time Frame:

Therapy tends to work in the past to promote emotional healing or resolve psychological pain, or in the present to reduce symptoms or destructive patterns.

Coaching works in the “critical gap” between the present and the envisioned future. In coaching, history is approached only as the map that brought the client to the present.

Using the core differences of primary function and time frame, a coach can listen for cues or red flags that might suggest a referral to a psychotherapist—either in addition to coaching or in place of coaching—is indicated. We are not suggesting that a coach should attempt to diagnose or focus on symptoms. However, a coach should be equipped to:

Recognize when a referral might be indicated for psychotherapy and/or medical assessment.

Discern when a client is actually asking for counseling but prefers to call it “coaching.”

Understand how the intensity and longevity of blocks, ruts, and fears differ in high functioning coaching clients from blocks, ruts, and fears, in clients who need psychotherapy to move beyond their stuck place.

Request a consult with another coach when red flags appear.

Using a hypothetical coaching client, Molly, we will explore red flags which might indicate a need for a coach to refer a client to a therapist. As you consider Molly's goals and presentation of self, ask yourself these standard coaching questions:

1) What strengths and resources are present?
2) What are her coaching goals?
3) What blocks or ruts are present?
4) What is the intensity and longevity of the blocks?
5) What are the issues for coaching?
6) Is Molly seeking coaching or therapy under the guise of coaching?

Molly is a 40-year-old junior college graduate currently working for a landscaping company, work she found through a temporary employment service. She comes to coaching with the goal of finding a career that “fits.” On her intake form ,Molly reports a history of sychotherapy to deal with family of origin issues. She also notes that she has successfully dealt with these issues yet acknowledges having no contact with members of her birth family since college. This, she writes, is “no big deal.”

After two months, Molly has kept five of seven scheduled appointments. While Molly seems serious about wanting to find meaningful work, and she readily accepts homework requests you make, she has canceled her last two appointments due to fatigue, frustration, and lack of progress to report.

Molly keeps her next appointment and immediately launches a bitter account of an upsetting recent meeting with her pastor. Unclear as to how this episode relates to Molly’s coaching goals, you probe for clarification.

Coach 1: It’s clear that Rev. Jones didn’t respond the way you expected him to.

Molly 1 (M1): He told me I needed to go back to my shrink—that my problems were out of his league. I don’t need a shrink! All I need him to do is listen to me. He just doesn’t want to deal with me. He asked me if I had other people to talk to, and I told him about my new best friend—someone I met on the landscaping crew.

Coach 2: Molly, let’s figure out how to best use our time together. Is this experience with Rev. Jones where you want to focus today or should we look at your goals for the week and how that process is moving along?

Molly 2 (M2): (With an irritated edge to her voice.) I don’t know what’s best to talk about; I can’t seem to focus on any one thing. It’s too overwhelming.

Coach 3: What is overwhelming, Molly?

Molly 3(M3): I’m uneducated, broke, and alone. I can’t afford to pay for my Prozac since I lost my insurance, so I’ve quit cold turkey. My minister is a joke. With my luck, you’ll be telling me that I’m wasting your time, too.

What thoughts and feelings came to you as Molly's coaching session evolved?

Clearly, a number of potential red flags are raised in Molly’s coaching sessions, among them:

Molly’s identified support network—chiefly her minister, about whom she speaks bitterly. As her coach, several questions seem appropriate to consider: What did the pastor see that made him recommend therapy (M1)? And as the pastor is presented as a major source of support for Molly (M1), how does Molly create and maintain friendships and a support network. Her reference to a “new best friend” (M1) adds fuel to that question. Finally, the bitter references to her pastor might prompt the coach to ask whether Molly has a pattern of placing someone on a pedestal and then, when disappointed by them, making them an enemy. Does she have a pattern of black and white thinking that prevents her from maintaining connections to other people?

Molly’s assessment of the status of her therapeutic issues--including her family of origin issues, past and present, which she reports having “dealt with” and characterizes as “no big deal” (Intake). She also reacts strongly to her pastor’s suggestion that she return to therapy (M1). As her coach, you might wonder if Molly is minimizing issues in order to be seen as a suitable candidate for coaching.

Molly’s expressed and observed state of mind—she’s cancelled appointments due to fatigue, frustration, and lack of progress, and she reports feeling “overwhelmed” and unable to focus (M2). Negative self-talk and pessimism appear (M3). She’s quit taking her anti-depressant without consulting her doctor. Does Molly have the ability to practice basic self-care? Could there be a physical cause for the fatigue? Does she have enough indicators of a biochemical depression to require a medical assessment and follow through by Molly?

Molly’s concern that her coach might terminate their relationship—which may be heard by the coach as a plea not to abandon Molly (M3). Does this feel like an emotional “hook” for the coach? If so, what might that mean for the coaching relationship?

If you were coaching Molly, what would you do? Were you able to recognize the indicators of a biochemical depression and the presence of unresolved family of origin issues that appear to impact her current life? Recognizing these red flags does not amount to “diagnosis.” Rather, it reflects responsible assessment of a client’s suitability for coaching--road signs to possible issues. If you discerned that Molly needs a therapy referral, you had on your coach listening ears!

The recognition that a referral to a therapist is in order raises other questions for the coach to consider:

If Molly refuses to see a therapist will you continue with her as her coach?

How do you decide if you can effectively coach her, despite the presence of red flags?

At what point will you seek consultation with another coach—or do you consult with a therapist?

If Molly enters therapy and continues coaching, will you require her to sign a “Release of Information” form so you can talk with her therapist to ensure coaching goals are congruent with therapy goals?

If you know Molly will terminate coaching with you if you encourage the referral, will you proceed and risk losing her as a client?

When a referral to therapy is indicated, a coach needs to present the referral in an affirming and positive manner. Some clients, because of unresolved life themes of abandonment, might feel rejected by you or judged if you refer them to a therapist. They might discontinue coaching.

With many coaching clients, though, if you emphasize that therapy can greatly enhance the coaching process, they will recognize the suggestion as an integrated plan designed to move them toward their goals.

Theory is great in theory. However, it is in the complex, sometimes subtle interactions between client and coach that the ethics of appropriate referral must be explored. We encourage you to seek peer support and supervision as you actively explore the complexity of the line between coaching and psychotherapy.

Red flags are merely helpful indicators if you notice a coaching client staying too stuck for too long a time. Leave the diagnosing to the therapists and stay in the primary function and time frame of coaching. Coaching offers an extraordinary opportunity for clients to transcend the critical gap between where they are and their envisioned future.

As you listen for all the strengths and resources of your coaching clients, focus on them. Work in the critical gap. Keep the coaching fun. When coaching stops being fun, it is time for a consult!

Kathy Benham is a full time Life Enhancement and Business Performance Coach and Consultant. Kathy specializes in coaching underachieving gifted individuals, professionals with ADD, and small business owners and entrepreneurs (many of these overlap!).

Susan Fox is a Career and Life Coach “home-based” at Union Theological Seminary in Richmond, Virginia where she coaches seminarians around vocational issues and teaches practical theology. Susan also has a small private practice providing coaching for individuals and groups on call discernment, clergy and congregational issues, and life transitions. She may be reached at www.lifelinescoaching.com.

Kathy Benham of Benham Consulting, LLC in Richmond, Virginia