Is It Therapy? Is It Coaching? Does It Matter?

Ram Ramanathan  •  May 15, 2020  •  8 min read

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Is It Therapy? Is It Coaching? Does It Matter?

The following article by Elias Aboujaoude, MD is reproduced here in the interests of the coaching profession (See original publication here)

Elias Aboujaoude, MD, is a psychiatrist and author based at Stanford University. His most recent book is Virtually You: The Dangerous Powers of the E-Personality.

My reflections on the article

I agree with the essence of what the author says here. So does ICF, and so do all other responsible coaching organizations. The problem arises since the coaching profession is not regulated in any manner, other than within the credentialing bodies themselves. Unlike counselling, a close cousin of coaching, leave alone therapy, which is the province of highly trained medical professionals, coaching is free for all. If as the author says life coaching is a billion-dollar industry, most of its practitioners have no demonstrated training or qualification.

At Coacharya, we do strongly believe that everyone can be a coach. We also believe that everyone is a leader. We also believe that everyone has the potential to be what they wish to be. Whether they are what they wish to be and claim to be what they wish to be depends on what learning they undergo and how much experience they have before they practice their profession.

The unregulated growth of life coaching is a great danger. I separate life coaching from executive coaching, usually cited as the counterpoint because no organisation will accept someone as a coach with verifying qualifications, whereas in life coaching space it is most often ‘buyer beware’ with no recourse to a hapless buyer.

The first problem is that coach training is expensive, making coaching expensive and unaffordable to most but the elite. Coaching institutions and credentialing agencies need to address this issue.

The other is that coaching along with consulting is the only profession I know of that requires no formal qualification to practice, unlike legal, accounting, medical, architectural, physiotherapy, and several other such professions. Fortunately, there’s no life consulting, only life coaching, whatever that may mean.

Perhaps the only remedy is government regulation since in an unorganized profession there can be no regulation.

These are my personal views borne out of anguish. We invite your more rational views.

Read full article here

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 a mental illness; 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 a 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.

What are your reflections on this subject? We’d love to know!

Ram Ramanathan

Ram

Ram is the Founder and a Principal at Coacharya. As the resident Master and mentor coach, Ram oversees and conducts all aspects of coaching and training services offered under the Coacharya banner.

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