Is It Therapy? Is It Coaching? Does It Matter?
The increasingly confusing boundaries between two helping professions.
Posted May 05, 2020
Patients with mental health issues increasingly seek out “life coaches” when psychotherapy is recommended. Although coaches do not refer to their work as treatment—“coaching is not therapy” is an oft-cited mantra—the description often given for coaching begs the question of where life coaching ends and therapy begins. Unsurprisingly, patients can confuse the two helping professions, which raises potential risks.
Old references to “coaching” focused on tutoring and athletics. The word entered the business world in the last century, gaining in popularity in the 1990s and 2000s. From a focus on leadership training and employee development, the purview of coaching seemed to expand to encompass all of life’s problems, as suggested by the adoption of the “life coach” moniker, with its suggestion of a professional who, theoretically, can help with anything.
Life coaching has grown into a billion-dollar industry, in part due to the stigma still associated with mental health care, frustration with traditional models, and the large unmet need for help. Additionally, there is the relative ease of becoming a life coach since there are no strict training or licensing requirements, no supervision expectations, and no clear legal framework governing practice. The result is a disruptive new profession that can be seen to overlap with psychotherapy.
Several features are often highlighted when distinguishing coaching from psychotherapy. Coaching, it is often said, is more collaborative—the coach does not always know best; it does not dwell on the past; it is results-oriented and aims to maximize capacity, not process feelings; it is short-term; its focus is narrow; it is informal, including around issues of session time and location, contact between sessions, self-disclosures by the coach, and dual relationships outside coaching; it is intended for individuals who do not have mental illness; and it lacks the stigma mental health treatment.
These distinctions, however, hardly separate life coaching from psychotherapy as it is typically practiced today. Several decades ago already, cognitive-behavioral therapy (CBT) shifted the nexus of power away from the all-knowing therapist in favor of a more level, collaboration-based approach between a patient and a therapist who work together as a team. CBT had other features that are relevant here: It was supposed to be time-limited—15 to 20 sessions—and to target specific symptoms or problems affecting patients in the “here and now,” rather than proceed open-endedly from issue to issue.
Further, despite continuing to defend clear boundaries with patients and to warn against associating with them in other roles besides that of therapist, the therapy field has evolved toward less formality around session time and location and access to the therapist between sessions. This is due, in part, to telepsychiatry interventions that allow for more flexible treatment options than traditional models.
Therefore, when it comes to collaborating with clients in a team spirit or adopting a forward-looking, brief, focused, and relatively informal approach, life coaching cannot be said to be dramatically different from psychotherapy. How about the distinctions made with psychotherapy based on clients’ psychological health and stigma? The argument that life coaches work with healthy individuals whereas therapists treat mentally ill individuals carries a big assumption—that coaches are able to diagnose mental illness and refer elsewhere before initiating coaching. Given that the majority of coaches have not received formal mental health training to be able to diagnose mental illness, it is conceivable that serious psychiatric conditions may be missed.
Online self-diagnosing is already common among many patients for whom “Dr. Google” has replaced the clinician as the go-to diagnostician. Increasingly, patients may also seek “treatment” from coaches that they find in online databases. The effect can be a dangerous bypassing of clinicians when it comes to diagnosis and intervention. Finally, seeing a coach may indeed be less stigmatized, but should we, in the name of avoiding stigma, allow the diversion of patients with mental illness to professionals who may not be equipped to help them? A safer response would be to fight stigma every way we can.
A Google search for “life coach” yields over 32,000,000 entries, compared with about 21,000,000 for “psychotherapist.” The internet has facilitated access to many services, including the help professions. This rapid “democratization” is beneficial but may pose health risks in this particular industry. The rise of life coaching has essentially occurred in a regulatory vacuum. Despite at times veering closely to psychotherapy, there are still no carefully spelled out education, training, licensing or supervision requirements for life coaches; no clearly enforced exclusionary barriers to entering the profession; and no enshrined legal protections to any harmed clients.
To psychotherapists who undergo rigorous training and a demanding maintenance of certification process, this represents a worrisome reconfiguring of their professional world that recalls other New Economy shifts: A new “competing” class of professionals is seemingly tackling the same problems but without the same education requirements, codified rules or overall scrutiny that psychotherapeutic practice is held to. In this un-level playing field, psychotherapists may also fear for patient well-being.
Workplace coaching is an established profession with an evidence base that supports its efficacy. Research into life coaching, on the other hand, remains limited and cannot be compared in breadth to investigations of psychotherapy interventions. For life coaching to truly establish itself, it is crucial that studies investigate the efficacy and safety of its modalities in a non-mentally ill population. (The intriguing possibility that “full blown” mental health disorders might be avoided due to early help provided by life coaches also deserves investigation.)
A new helping profession is a welcome development as the demand for help far exceeds the resources available. However, basic training, quality standards, client protections, and clear regulations around who can help with what cannot be ignored—not when it comes to mental health. A public health debate is therefore needed to help define the dos and don’ts of life coaching and better appreciate its potential and limitations. Such clarity would not only safeguard clients and patients; it would also help guarantee the healthy growth of a promising new service.
Visit the Psychology Today Therapy Directory to find a therapist or life coach.
Aboujaoude, E. (2020). Where Life Coaching Ends and Therapy Begins: Toward a Less Confusing Treatment Landscape. Perspectives on Psychological Science. https://doi.org/10.1177/1745691620904962