Coaching vs. Psychotherapy

Psychotherapy and coaching may seem like they are worlds apart — as close to the uninformed as medicine and cheerleading. They are not only similar but are in many ways identical. As a retired therapist and an active creativity coach, I have some ideas about how this has come to be. On the one hand, psychotherapy, at least to me, never quite became the science it had hoped or promised to be. No theory of psychotherapy has ever been proven sufficiently rigorous or singular to win the title of “the best” or “the most effective.” And therapeutic techniques that flow directly from DSM diagnoses have similarly fallen short.


In contrast, coaching has evolved into a helping discipline unencumbered by the burden of calling itself scientifically minded or medically based. It asserts instead that helping requires an orientation away from the pathological to the normal, as well as the psychological, social, and contextual.

As a coach, I have never placed much emphasis on pathology and diagnosis. I always consider instead my client’s nature, which includes elements of despair, hope, fearfulness, addictive tendencies, and both personality strengths and shortfalls. I’ve been very careful in this role to avoid robotically co-creating goals and assigning homework — core “clinical” tools. I always saw the same all-too-human person sitting across from me as when practicing psychotherapy.

Over the years, I’ve come to appreciate how the two seemingly disparate professions have converged in their core orientations and approaches. They are both helping professions that rely on certain and specific strategies that are surprisingly simple to articulate: both helpers listen; both use themselves and what they know and feel; both empathize and, maybe sometimes in rather different ways, support their clients and cheerlead for them. And both are keenly aware that a human being with a formed personality and two feet planted in real-world circumstances is sitting across from them.

Psychotherapy may balk at this characterization and conclude that coaching is “merely” helping and not doing anything like science or medicine. But it can’t really justify any fancier claims. The arguments against the legitimacy of the DSM, its “mental disorder” paradigm, and its checklist mentality should persuade any open-minded therapist that “diagnosing” is for insurance and prestige purposes only. To announce to someone who is in despair that she has “the mental disorder of clinical depression” is a linguistic gambit, not a medical diagnosis. Therapists know this.

In my experience as a therapist and current work as a coach, I know that in both roles, I am carefully and compassionately listening to another human being and responding according to their understanding of human nature. If a client announces that he hates his job, a right-minded therapist is hopefully not going to impose some pseudo-medical interpretation of despair. She is going to believe that her client means exactly what he says. She may investigate to make sure that he is indeed saying what he means and not fibbing or fooling himself, but centrally and crucially both coach and therapist are going to formulate the same internal question: “What does meeting in the middle look like?”

The Limits of Coaching

Consider a client of mine whom we’ll call Jane. Jane is a middle-aged writer who has had some successes but who craves better sales and more recognition. She isn’t particularly interested in achieving another “middle list” success — it’s the prestige of a bestseller that she craves. What’s standing in the way of her pursuit of greater achievement? As it turns out, the answer is, ‘many of the sorts of things that both creativity coaches and therapists would expect to see.’

Jane isn’t sure that she has a bestseller in her. She feels resistant to talking the matter over with her literary agent and is resistant to writing. As a result, her mood has plummeted. Taking care of her husband, who is ill and who requires many medical appointments, further drains her, reduces her available writing time, and lowers her mood. Dealing with a lack of enthusiasm from recent readers has put her in an extra-deep slump. She feels generally anxious and has difficulty concentrating on her writing or on much of anything. Her sleep isn’t good, her eating habits disappoint her, and when she does manage to get to her desk, she finds herself procrastinating and distracting herself, sometimes for hours.

Both therapist and coach understand that this is what real life looks like. The therapist might find herself wending her way to a depression diagnosis, an anxiety diagnosis, an attention-deficit diagnosis, or some other pathological label. But in session, both would likely proceed in quite similar ways. They would listen; they would ask questions; they would ask follow-up questions. They would help Jane prioritize which of these issues she wanted to focus on. They might reflect on Jane’s language, maybe wondering aloud if, when Jane says, “I’m probably over the hill,” or “I don’t think I can come up with an idea for a bestseller,” such thoughts are really serving her. They might, with Jane, co-create a new sleeping regimen or help her acquire a useful anxiety management tool or two. They might “use themselves” by role-playing a Jane-literary agent interaction, with the therapist or coach playing the agent. They might point out a pattern, say, the way that reader criticism seems to overly affect her, or wonder aloud about Jane getting some support in her role as caretaker of her husband.

In this scenario, has the coach overstepped? I don’t believe so. And if a therapist had operated this way, would she have been operating exactly according to her mandate, if that mandate was to “diagnose and treat mental disorders?” Maybe not. But she would have operated completely in line with her implicit mandate to help a person in distress. Neither would be practicing medicine or following a version of the scientific method. Both would be attempting to be supportive, humane, helpful, and wise. Each might come to session with a different set of tactics and techniques, but both would be doing essentially the same sort of work and hoping for the same sort of positive results.

At the same time, both would expect Jane, and clients with similar narratives to be defensive and resistant. Neither would be surprised if the client were to take two steps backward for every half-step forward. Both would nod in understanding if the client found it hard to change, hard to keep to a program, hard to come to a session, hard to put everything on the table. Both coaches and therapists know these sorts of things.

I think that this is very good news for both professions. Therapists can own that they are not doing medicine, are not at the beck-and-call of pharmaceutical companies, psychiatry, the DSM, the ICD, or any other tentacle of the medical/mental disorder apparatus. At the same time, they can own that they are a useful class of helpers who are good at listening, understanding, and responding. They can feel more human (and more humane) and less white-coat-ish. Freed of these burdens, coaches, for their part, can step even more fully into helping — they can become better helpers by deepening their understanding of human nature and by bringing that increased wisdom to their sessions. Aren’t those excellent outcomes for both?

Do coaches need to know more than they currently know to meet this ideal of helping? Yes, absolutely. But most therapists do as well. Both groups of helpers need to rely less on their standard tactics — goal-setting and goal-monitoring for coaches and a single theoretical orientation like cognitive-behavioral therapy for therapists. Both are well-positioned to provide more wisdom and wide-ranging understanding than most in either group can currently muster. Each group can point to the shortcomings of the other group, but in this movement toward the middle, where coaches become more psychologically minded and therapists become less attached to the medical model and pseudo-scientific notions, perhaps the outline of a new wave of superior helping will emerge. I hope it will arrive soon.

Questions for Thought and Discussion

How do you resonate with this debate between coaching and psychotherapy?

In what ways do you see the two disciplines converge? Diverge?

How would psychotherapy and coaching look different with a client like Jane?





 


File under: Musings and Reflections