Just therapy in disguise
Posted Dec 09, 2013
The world is awash with coaches. There are more types of coaches today than problems to treat. Life coaches, leadership coaches, executive coaches, group coaches, “mental” coaches for athletes—the list goes on—all define their work as promoting psychological change but confidently declare that they are not psychotherapists. The line so quoted from Hamlet comes to mind: “The lady doth protest too much.”
I’ve been a psychotherapist and psychoanalyst for 35 years. I don’t think that what I do is rocket science and the more people out there providing support, guidance, and psychological help the better. Further, because of ancient stigmas that still exist about mental illness, people will more likely accept coaching for their problems than therapy.
The problems, however, are the same and so are the cures.
What I object to is the self-serving theories and naïve proclamations coming out of different wings of the coaching profession which attempt to differentiate coaching from psychotherapy. They usually declare these differences by fiat, e.g., “therapists focus on the past and and dysfunction,” while coaches focus on someone’s strengths and potential.” And like a stopped clock, these assertions may sometimes be right, they usually are not and, moreover, the need to spend time emphasizing such distinctions doesn’t originate at all from science or neutral observation.
These arguments and proclamations of difference are, in essence, an ideological creation myth that wittingly or unwittingly uses arbitrary claims about the specialness of their profession in order to justify the right of coaches to hang out a shingle, gain social respect, and get well remunerated in the process.
I think that coaches have the right to respect and remuneration, but I don’t find credible the ways these needs get obfuscated by caricatures and theories that have little to do with the best practices of therapy and coaching. What coaches do is simply not different, special, or unique. Saying it frequently and in different ways doesn’t make it so. However, the story of a new profession expressing its narrow self-interest and need to create boundaries with other professions by exaggerating its special difference has a long and rather sordid history in our country.
To take a recent example: in the mid-1970s I entered an experimental 5–year doctoral level training program (called the Doctor of Mental Health program) that offered an academic and experiential curriculum aimed at bringing together the best practices of social work, psychology, psychiatry and psychoanalysis. The program’s founders envisioned a new type of mental health professional who could do psychotherapy of the psychodynamic variety, pay attention to social and community issues, and prescribe specific medications to those who needed them. The program attracted highly competent students, renowned faculty, and had the backing of the leadership of the University of California at both its Berkeley and San Francisco campuses. We had to—and did—establish our competence in all three mental health disciplines, including competence in the practice of prescribing psychiatric medications.
The DMH program was killed by the California Medical and Psychiatric Associations because the M.D.s didn’t want anyone invading the precious turf of their prescription pads. They did it under the banner of patient safety and a drumbeat pounding out the message that the knowledge required to prescribe even the very limited number of psychotropic drugs in question required four years of medical school, a year of a general medical internship, and three years of a psychiatric residency. They repeated this bogus argument even though the evidence of our proficiency was indisputable. Everyone knew that their narrative of “protecting the public” was economically self-serving nonsense. It didn’t matter because they had the power to say who was or wasn’t in the club.
It should be mentioned that, while most of our graduates went directly into private practice, our public position was that we were less expensive to train and more likely to work in areas underserved by traditional psychiatrists. The real struggle, in other words, was about turf; the public debate was a self-servicing smokescreen.
Struggles over turf and economics have been and are the norm in both the medical and mental health fields. Physicians disparage chiropractors who then form associations and lobbying groups to pursue their threatened pecuniary interests, such as greater insurance reimbursements, but frame the agenda on the grounds that their approach has special healing power. Orthopedic surgeons have done the same in relation to podiatrists, ophthalmologists with optometrists, and, historically, M.D.s with osteopaths. Psychologists have used this approach with social workers who have done the same thing to marriage and family counselors who have done the same thing to…..well, you get the picture.
The pattern is always the same. Existing professions hide their competitive self-interest behind arguments about “unregulated practitioners,” “threats to public safety,” and “protecting the consumer.” In response, the new field or discipline does its own predictable dance: It begins to form associations, hold conferences, set up certification systems that establish legitimacy, and spreads the word in a million different ways that its approach is unique and speaks to needs unmet by the existing players.
First and foremost, the “game” is about money and self-esteem, as well as the need we all seem to have to belong to a community in which there is an “us” versus a “them.” Despite public pronouncements to the contrary, the need for a brand new profession is secondary.
Because cultural biases often dictate that people will accept having a coach and not a shrink, coaches are able to help people in many contexts that would never hire therapists, for example, the executive suite in a large corporation. Because our culture stigmatizes therapy primarily a weakness, a cure for being screwed up, or as a process that invariably involves a Freudian excavation of one’s infantile past, “life coaches” can and have helped many people who would never otherwise seek help.
This is a good thing.
The bad thing is when coaches then tend to turn around and make a necessity into a virtue, accepting these caricatures about therapy as true, glibly using these straw men to bolster their claims of being different and special. Whether intentional or not, this move is either naïve and/or dishonest.
Psychological healing of any sort is necessarily client-specific; that is, the “cure” depends on the idiosyncratic strengths, weakness, fears, and conflicts of a very particular client as well as the particular context in which the helping relationship is situated. This is as true for coaches as it is for therapists. If what matters are outcomes, not theories, then the rulebook has to be pretty thin. Meta-concepts, principles, and theories of technique about what makes people tick and what a therapist or coach is supposed to do to help people change are usually undermined by so many exceptions that they continue to exist only as some type of non-empirical and ideological received wisdom. I’ve argued against just such tendencies in my own field and now see it in emerging paradigms in coaching as well.
Coaching, like therapy, has many voices and applications. Like therapy, it is a theoretical Tower of Babel. What follows are just a few of the declarations from leaders in the coaching community and literature about how coaching is different than psychotherapy. I’m confident that every life, leadership or executive coach out there has heard and believes one or more of these alleged distinctions:
1) Coaching has clear goals, often behavioral ones, while psychotherapy is open-ended and aims primarily at internal change.
2) Coaches tend to focus more on strengths while therapists focus on psychopathology.
3) Coaches are more future-focused while therapists value explorations of the past.
4) Coaches hold that their clients are naturally creative and whole while psychotherapists see them as sick.
5) Coaches support their clients’ wishes to move forward toward their goals and dreams, while therapists are likely to diagnose and try to “fix” their clients.
6) Coaches don’t treat so-called “severely disturbed” clients while therapists do.
7) A client hires a therapist because the client has some kind of dysfunction, while a coach isn’t there to repair anything that happened in the past but instead is focused on what is “right” and hopeful about the client.
8) A therapist holds him or herself out—and is experienced by the client—as an expert, while the coach facilitates the change process in more democratic ways that empower the client.
All of these generalizations are wrong, not only because there are so many exceptions to each of them, but because coaches have merely created a false and caricatured “straw” psychotherapist whom they use to differentiate and establish their own alleged expertise. In the members of my profession, that therapist simply doesn’t exist.
There are bad and incompetent therapists and coaches—lots of them—but they aren’t our concern here. It’s the extensive similarities between good therapists and coaches that are in question. For example, good therapists support and help develop their clients’ strengths. Good therapists continually work to position themselves on the side of their clients’ wishes to master conflicts and move toward normal and desirable developmental goals. Much good psychotherapy may be short term and have very clear goals, both behavioral and emotional. The psychotherapists I know don’t view psychological symptoms—painful or self-sabotaging behaviors and attitudes that stem from fear, guilt, or helplessness, for example—as an “illness” or as something that’s broken and needs to be “fixed.” Instead, they see the issues underlying a client’s self-defeating behavior, paralysis, or suffering as the best the client could do in his or her life up to that point. Good therapists believe that that client came by these problems honestly, and that, while the beliefs and fears underlying them might have been adaptive in the context of the client’s early life, they no longer are and, instead, are distracting the client from making use of his or her skills to move forward. Sound familiar?
The therapeutic aim, then, of a good therapist is to encourage people to gradually have new and healthier experiences of themselves, others, and the world, in and out of the therapeutic relationship, that counteract their prior learning. And good therapists believe that it’s usually powerfully helpful for the client to bring insight and self-awareness to these new corrective experiences. Insight and self-awareness is so central to good psychotherapy because it brings the client’s rational and adult self to bear on making better and freer choices that are less contaminated by the past. This is an approach based on compassion, hope, and a belief in clients’ wishes and needs to change and have a better future.
What I’ve just described overlaps with what a good executive or life coach does much more than it differs. For example, any coach who has the opportunity to learn something about a client’s past history that directly bears on the latter’s current dilemmas and doesn’t explore it is doing a grave disservice to the client, however that exploration might be used. Coaches who don’t believe in the importance of unconscious dynamics in their clients’ lives not only severely limit the effectiveness of the coaching, but show an egregious ignorance of phenomena that have been well established for many decades and that are well known to be essential in causing people trouble and helping them get better. Coaches who disavow the importance to their authority and expertise, thereby eschewing the role allegedly embraced by psychotherapists, are fooling themselves. Clients always endow with authority those professionals offering them understanding and emotional support and to pretend otherwise is more than naïve; it deprives the coach of the mutative power that his or her perceived authority can generate, a power that can be used to facilitate coaching goals.
Psychological life and change aren’t all that complicated. People develop beliefs and feelings about themselves and the world growing up that were once adaptive but that now get in their way. They also have developed strengths that have enabled them to succeed despite their fears and inhibitions but which are hidden from view and repressed by virtue of these maladaptive believes and feelings. While supporting these strengths, both good coaches and good therapists promote change by providing or encouraging real “corrective” experiences inside and outside the relationship that counteract the fears and inhibitions they came by honestly in their lives while growing up; and by offering and encouraging the development of insight and self-reflection which clients can then use to lessen the strength of destructive ghosts from the past, and better use their strengths to create the future they really want.
Some version of this picture of psychic reality does or should inform coaching an executive, consulting with a leadership team, helping someone pursue life goals without fear, and even helping a golfer struggling with the yips when facing a three-foot putt.
In other words, there isn’t a dime’s worth of difference of any importance between what good coaches and good therapists do, unless one or the other needs to declare by fiat that there is. The differences that do exist are real but fundamentally irrelevant. For example, a coach might be called in to work with a rising star in a big company and be asked to use a 360-degree evaluation as a guide to that client’s development goals. A man might be encouraged to seek therapy by a wife worried about the former’s use of pornography or because the stresses on his job prevent him from being the wonderful father he had always been. These are merely the inevitable particularities of context, time, goals, and conflicting loyalties (is the coach accountable to the company or the individual? Is the man in therapy for himself or his wife?) that occur in both coaching and psychotherapy.
Finally, many good life coaches are treating mental illness whether they define their work in this way or not. The view that there is “life” and then there is “mental illness” is simply either a convenient fiction or uninformed naiveté. In fact, many good therapists will not work with more serious (e.g. psychotic or borderline) mental illness at all, but refer such clients to psychiatrists. Instead, good therapists will often coach their clients around developing their strengths and improving their current and future functioning at home and at work.
The difference between good and bad therapists and good and bad coaches can’t be underestimated. Many therapists have lousy training with too-few hours of well-supervised clinical work. And many of the top coaching programs require what seems to me to be woefully inadequate experiential learning.
There are just a few generalizations about how the mind works and just a few roads to helping relieve that mind’s suffering and help people develop more capacity and feelings of success. Whatever labels or rules or axioms a professional group claims as unique in its practice are either wrong or are simply different words for the same thing. We need to look together at what helps people with their suffering and improves their lives without marking our respective territories with fabricated distinctions.