What is the Difference Between Coaching and Psychotherapy?

Uncategorized Oct 08, 2019

If you've been researching coaching and psychotherapy, you have surely run into the questions about the differences between the two. It runs the gamut; Is Coaching the same as therapy? Can Coaches provide mental health care? Can Psychotherapists provide coaching? Is Coaching really therapy in disguise? How do I know the differences between the two and which do I need?  

There is a lot of misinformation circulating. One of the most troubling I often observe is Coaches and Psychotherapists inaccurately interpreting the practice of and the laws governing the two practices. I assure you they are very different and are regulated as such. I am going to do my best to describe the differences and offer my opinion with legal citations on them both.

And, as always, if you have questions about healthcare law you should consult with a healthcare lawyer who specializes in interpreting and advising on the area of law in question. 

Coaching versus Psychotherapy 

Coaching focuses on developing skills to improve the achievement of goals.

Psychotherapy also focuses on developing skills to improve performance but goes a layer deeper to explore and target emotional, cognitive, and behavioral symptoms using a psychotherapeutic approach. 

Coaches focus on the surface level, present behaviors that are impacting a person’s performance. They cannot (legally or ethically) provide therapy or analysis of a person’s emotional health unless they are also a licensed psychotherapist and providing the service under their psychotherapy practice.  

Psychotherapists are trained and sensitive to the nuances of emotional, cognitive, and behavioral symptoms that impact a person’s wellness.  

Psychotherapy is regulated for this reason. There are risks involved in treating such sensitive and complex areas of one’s life that require a deep understanding of the dynamics involved that impact one’s emotional and behavioral health.   

It is important for consumers and practitioners to both understand the differences between coaching and psychotherapy and when to refer to a psychotherapist for the appropriate level of care.  

Coaching focuses on developing skills, performance, productivity, and improving personal and professional development. Coaching is done with a relatively emotionally and cognitively well-adjusted individual to improve their performance. Coaching is directive and may work on behavioral challenges. 

Therapy works to treat and / or resolve underlying cognitive, emotional, and behavioral issues that are impairing functioning. There are myriad of psychotherapeutic orientations that therapists use to help people.

Psychoanalysis aims to help the patient understand unconscious forces that are playing out. To help people become more aware of themselves and their patterns of (unconscious) behavior. Psychoanalysis works to integrate the unconscious and conscious; making the unknowns known. A therapist treats underlying issues to address the reasons why distress is occurring. They help to process traumas and other difficult emotions and analyze and understand limiting or destructive patterns.  

In coaching, when someone is repeatedly stuck in the same enactments over and over and unable to make progress, we discuss and refer to therapy to help resolve the underlying factors that are causing the person to stay stuck. It could be sabotage and self-protection, or a mental health issue that needs a higher level of care. There may be unconscious drivers playing out that are preventing the person from moving forward to make better serving decisions and actions. 

Therapy deals with the why’s and how’s. Coaching deals with the hows. 

In my coaching practice where I work with workplaces and people who are dealing with career and performance needs, sometimes mental health issues come up. I recognize patterns and connections between how old emotional wounds, traumas, and maladaptive patterns come up. When I see that it is interfering with their daily functioning because of untreated or unresolved issues, I refer them to a psychotherapist who specializes in the area they need. I do not attempt to “coach it” or provide therapy because it needs a different level of care, understanding, and treatment that I do not offer in my coaching practice. In my psychotherapy practice, If I see performance issues coming up, I will coach them, because I also have expertise in coaching skills through my education and experience.  

It remains unchartered territory legally. The industry has not caught up yet as coaching remains unregulated. Psychotherapy boards have been pursuing action against coaches providing unlicensed healthcare - for good reason. Coaches are generally ill-equipped to provide mental health care as their training and experience do not provide them with the deeper knowledge and skills to do so which can result in doing more harm than good when they engage in the practice of providing unlicensed mental health care. 

Psychotherapists undergo years of rigorous study and supervised experience that covers critical areas of assessment and diagnosis, pattern recognition, designing and executing intervention appropriate for the level of care to treat the issues that arise, and transference and countertransference enactments. 

I work as a coach in my HR firm and with the U.S. Securities and Exchange Commission and I offer coaching and education and I am not providing therapy in either. In my private psychotherapy practice, I provide both coaching and psychotherapy.  

Read more from Zencare about the differences between Coaching and Therapy

How to Decide if You Need Coaching or Psychotherapy  

Psychotherapy. If there is an event in the past or present that is creating impairment and impacting functioning, psychotherapy is indicated. Examples are a traumatic event in life or work, depression, and anxiety, or other mental health issues that have disrupted a person’s life and work.  

Coaching. If there is a technical skills gap involved that is affecting performance and productivity in work and life, then coaching is indicated.   

Sometimes, people need both.    

In short, Psychotherapists can provide both therapy and coaching. Coaches can provide coaching only, not therapy. 

Psychotherapists generally draw on one or more theories of psychotherapy.

A theory of psychotherapy acts as a roadmap for psychotherapists: It guides them through the process of understanding clients and their problems and developing solutions.

Approaches to psychotherapy fall into five broad categories:

Psychodynamic Therapy and Psychoanalysis For people needing an understanding and awareness of unconscious drives that are impacting their present behaviors. Often, when someone tells me that they know all of the behavioral techniques and tools, but they still aren’t working for them; i.e. they are still having reactions or engaging in behaviors that are not working for them, I may suggest working with an analyst. 

This approach focuses on changing problematic behaviors, feelings, and thoughts by discovering their unconscious meanings and motivations. Psychoanalytically oriented therapies are characterized by a close working partnership between therapist and patient. Patients learn about themselves by exploring their interactions in the therapeutic relationship. While psychoanalysis is closely identified with Sigmund Freud, it has been extended and modified since his early formulations (APA.org).

Psychodynamic therapy involves the interpretation of mental and emotional processes rather than focusing on behavior (Gad, 2017). Psychodynamic therapists attempt to help clients find patterns in their emotions, thoughts, and beliefs in order to gain insight into their current selves. These patterns are often found to begin in the client’s childhood since psychodynamic theory holds that early life experiences are extremely influential in the psychological development and functioning of an adult (Gad, 2017). 

Psychodynamic therapy aims to help the client identify important pieces of the puzzle that makes them who they are and rearrange them in ways that allow the client to form a more functional and positive sense of self.

Behavioral Based Therapies

This approach focuses on learning's role in developing both normal and abnormal behaviors. Behavioral-based therapies are often used in situations for people needing tools and techniques for behavioral change.  

Behavioral-based therapies such as the widely recognized cognitive-behavioral therapy (CBT), aims to reduce or eliminate symptoms instead of exploring the client’s deep-seated needs, urges, and desires (McLeod, 2014). 

Cognitive Therapy 

Cognitive therapy emphasizes what people think rather than what they do. Cognitive therapists believe that it's dysfunctional thinking that leads to dysfunctional emotions or behaviors. By changing their thoughts, people can change how they feel and what they do. (APA.org).

Humanistic Therapy

This approach emphasizes people's capacity to make rational choices and develop to their maximum potential. Concern and respect for others are also important themes. 

Three types of humanistic therapy are especially influential. 

Client-centered therapy rejects the idea of therapists as authorities on their clients' inner experiences. Instead, therapists help clients change by emphasizing their concern, care, and interest.

Gestalt therapy emphasizes what it calls "organismic holism," the importance of being aware of the here and now and accepting responsibility for yourself.

Existential therapy focuses on free will, self-determination and the search for meaning

Integrative or Holistic Therapy 

Many therapists don't tie themselves to only one approach. Instead, they blend elements from different approaches and tailor their treatment according to each client's needs.

SOURCE: Adapted from the Encyclopedia of Psychology via APA.org 

 

Privilege and Confidentiality

The psychotherapist-patient relationship is privileged, which means the conversations had between psychotherapists and patients are protected and not subject to disclosure except under circumstances discussed below.  

Coaching is not privileged or protected under the law. There are codes of ethics directed by some of the coaching associations that dictate confidentiality, but there are no protections under the law. 

Florida Statute 90.503 Psychotherapist-Patient Privilege

There is no privilege under this section:

(a) For communications relevant to an issue in proceedings to compel hospitalization of a patient for mental illness, if the psychotherapist in the course of diagnosis or treatment has reasonable cause to believe the patient is in need of hospitalization.
(b) For communications made in the course of a court-ordered examination of the mental or emotional condition of the patient.
(c) For communications relevant to an issue of the mental or emotional condition of the patient in any proceeding in which the patient relies upon the condition as an element of his or her claim or defense or, after the patient’s death, in any proceeding in which any party relies upon the condition as an element of the party’s claim or defense.

Exceptions: When a Therapist May, or Must Break Confidentiality

Source: Nolo.com By , Attorney

"Almost all legal rules have exceptions—the therapist-patient privilege isn't any different in that regard. Here's an overview of some of its exceptions.

Waiver

A patient can undo the therapist-patient privilege simply by waiving it. A patient might waive confidentiality, for example, by agreeing to the disclosure of mental health records in a lawsuit for emotional distress.

Crime-Fraud Exception

An exception to the therapist-patient relationship in some states involves the patient seeking or obtaining the therapist’s services in order to commit a crime or form of fraud. So, for instance, deceitful statements by a patient to a psychiatrist intended to persuade the latter to prescribe inappropriate controlled substances likely wouldn’t be privileged. That isn’t to say, however, that all statements by that patient over the span of therapy would be admissible in court—probably only those related to the crime. (Stidham v. Clark, 74 S.W.3d 719 (Ky. 2002).)

Dangerous Patient Exception

Most states have an exception to the therapist-patient privilege for dangerous patients, often referred to as the Tarasoff duty. (Tarasoff v. Regents of Univ. of Cal.,17 Cal.3d 425 (1976).) Depending on the jurisdiction, the exception either allows or requires therapists to report statements by patients that indicate dangerousness. The law might, for instance, say that therapists must disclose statements when the patient presents a risk of serious harm to others and disclosure is necessary to prevent that harm.

The therapist’s required course of action can depend on the circumstances and can involve notifying the potential victim, the police, or both. (United States v. Chase, 340 F.3d 978 (9th Cir. 2003).) For instance, if a patient tells her psychiatrist that she plans on shooting her ex-boyfriend, the psychiatrist may have to notify the police and warn the former beau. If the patient is sufficiently mentally ill, the therapist may be required to initiate involuntary commitment proceedings.

In some instances, once the duty to warn has arisen and the therapist has divulged the patient’s statements, those statements may be used at trial. State law can, however, allow the therapist to warn but prevent him or her from testifying at any eventual trial. Indeed, several courts have held that the duty to warn is distinct from the admissibility of the patient’s statements in court—that a therapist must still warn of a dangerous patient but may not testify about the statements causing the warning. (United States v. Ghane, 673 F.3d 771, 786 (8th Cir. 2012).)

Child Abuse Exception

Many states have statutes requiring healthcare providers, including mental health professionals, to report any suspected abuse of children, elders, and dependent adults. So, in most cases, therapists who hear admissions of such abuse from patients not only can report their patients’ statements—they must.

If, for example, a man confesses to his therapist that he recently beat his stepdaughter, the psychotherapist-patient privilege as to that confession may well fold. The therapist may have to report the admission to the authorities, and the patient’s incriminating statements may be admissible in court. (Hayes v. State, 667 N.E.2d 222 (Ind. Ct. App. 1996).)"

 

Final Thoughts and My Opinion 

I am not a fan of the hyper-pathologizing of human behavior and the responses to painful and often traumatic life events. Our industry, in my opinion, is sometimes corrupt in this regard. I will spare you my political soapbox on the how's and why's of this. Thankfully, many of my colleagues and I share this perspective and we don't find it particularly empowering or helpful to impose such stigmatizing labels or sanctimonious will upon people. 

This, in itself, may offer a compelling reason for working with a coach versus a therapist. But know this, humanistic therapists do largely exist and they are uniquely qualified to work with deeper mental health needs versus what a coach can provide. Additionally, many psychotherapists are also skilled in coaching using integrative methods that draw from analytical, cognitive, behavioral, and humanistic therapies.

I suggest, first, spending some time clarifying your needs, desired outcomes, and specific challenges that you want to address. Then, do your research to find the professionals who specialize in the area you are seeking assistance with, be it a therapist, coach, or both. And, finally, get a sense of who they are and how they work using the five categories of psychotherapy to guide your inquiry and vetting if they are the right fit for you. 

 

 



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