Psychotherapy vs Coaching: Which is Right for Me?
Updated: Mar 17, 2022
I work as a life coach – specifically, an Internal Family Systems (IFS) informed therapeutic wellness coach. I’m also a social work master’s degree student, and I’m currently interning as a clinical psychotherapist. I often get asked the questions, “What’s the difference between coaching and therapy?” and “Which is right for me?”
I’ve done extensive research on this topic because, as a practitioner in both fields, it’s important that I fully understand the differences. To be clear, there are some significant distinctions between coaching and psychotherapy. Yet, coaching and psychotherapy in practice can overlap in ways that make them hard to distinguish. If you’re looking for growth, transformation, healing, or support, this article is intended to help guide you towards the resources you need. We will start by debunking a few myths.
Differences Between Psychotherapy & Coaching: Some Myths
The following are distinctions some have drawn between coaching and psychotherapy, which in my opinion, are mostly false assertions.
MYTH 1: “Coaching focuses on the present and future making healthy clients better, whereas therapy focuses on healing pathology and illness rooted in the past.” – FALSE
It is probably true that coaches are less likely to delve into childhood issues when working with clients. It is also true that psychotherapists, not coaches, work with those who have a serious mental illness (SMI). However, therapists bring a wide variety of skill sets to their profession and work with many types of clients in numerous ways. For example, some therapists anchor into a client’s childhood development to discover ineffective patterns they learned early in life – then work with their client to heal and change those patterns in their lives today. Some theories that guide this perspective are Attachment Theory and Erik Erikson’s Stages of Psychosocial Development, and some evidence-based treatment modalities include Eye Movement Desensitization & Reprocessing (EMDR), Somatic Experiencing (SE), and Internal Family Systems (IFS). Other psychotherapists place their emphasis primarily on a present-day focus, perhaps using cognitive behavioral therapy (CBT) or Dialectic Behavior Therapy (DBT) to alter thinking patterns and behaviors that can produce the changes their client seeks.
In short, people can choose a coach based on stated areas of expertise such as career, relationships, or health and wellness. Similarly, people can also seek out therapists for help in particular areas of their lives, or who are trained in specific therapeutic approaches and techniques.
MYTH 2: “Coaching works with the conscious mind, whereas psychotherapy works with the unconscious mind.” – FALSE
Making the unconscious conscious by pulling back entrenched, protective layers of denial can require significant time, energy, and other resources. On the other hand, opening to a new, more awakened state of consciousness can also occur in an “ah-ha” moment of clarity. Both coaches and psychotherapists help their clients gain insight, which is by definition, making the unconscious conscious. Similarly, both coaches and psychotherapists can work in very practical ways to support fully conscious, goal-oriented, deliberate client transformation.
MYTH 3: “Therapy sessions are generally more open-ended and long-term, whereas coaching sessions are more focused and short-term.” – FALSE
Many know the caricature-like image of a client laying on a Freudian psychoanalyst’s couch, week after month after year, discussing their dreams while the therapist scribbles on a notepad, nodding and repeating “Mhmm . . I see.” And while there are certainly therapists who utilize psychoanalytic approaches in their work today, some therapeutic modalities (including psychoanalysis) will likely be available to clients solely through private pay options. Most therapy practiced now is bound by insurance company payments which require a DSM-5-based mental illness diagnosis and a treatment plan with clear goals, measurable objectives, and a defined timeline for treatment. In short, insurance companies push therapists to be short-term and goal-oriented in their work much like one might expect from coaching. Some psychotherapy modalities, such as Solution-Focused Brief Therapy, look amazingly similar to how coaches might traditionally work with their clients.
Personally, I use a client-centered approach in both my coaching and psychotherapy work. I want to support my clients in working towards their own self-determined goals using whatever tools, techniques, and approaches we decide together will work best. In philosophy and approach, there is very little difference between how I coach and how I do psychotherapy.
6 Significant Differences Between Psychotherapy & Coaching
While the actual differences between coaching and therapy could be summarized in several ways, I’ve come up with six primary areas of distinction.
1. Geography: Psychotherapy is regulated at the state level, and therefore, psychotherapists can only work with clients in the states they are licensed. Usually, a therapist is credentialed and practices psychotherapy in the state they live. Therapists have the option to get credentialed in other states, but they are required to apply for and maintain their credentials in each state they wish to practice. COVID and the growth of psychotherapeutic telehealth have resulted in some of these restrictions being temporarily relaxed. Additionally, calls for national psychotherapy licensing and state-reciprocity in licensing have become stronger in recent years. But as of now, clients can usually only work with a psychotherapist in the state they reside. Conversely, if you want to work with a coach, you are free to reach out to any practitioner anywhere in the world, without geographical constraints.
2. Record Retention & Privacy: Psychotherapists are required to maintain certain types of content in client records for specified periods of time, dependent upon regulations set by each state. Coaching has no standardized or enforceable recordkeeping or record retention practices. Additionally, psychotherapy records must adhere to the Health Insurance Portability and Accountability Act (HIPAA) to keep client records private. For example, clients must sign a release of information form if they want their psychotherapist to share their records with other clinicians, healthcare providers, relatives, employers, etc. Coaching, as an industry, offers no such legal privacy protections with recordkeeping – practices such as these are optional for coaches.
3. Confidentiality and Mandatory Reporting: Related to recordkeeping privacy, psychotherapy client confidentiality is also protected by HIPAA and state laws, whereas coaching client confidentiality is not (or at least not to the same extent). Not only are psychotherapists prohibited from disclosing trusted information shared by the client during sessions to third parties, but they also can’t leave revealing information in voice messages or texts or disclose to any third party that someone is a client of theirs. Some won’t even acknowledge a client they might see in public unless that client initiates contact first. There are limitations to confidentiality in psychotherapy, however. A psychotherapist is a mandatory reporter and must report the abuse of a minor, senior, or disabled person if a client discloses this type of information. Psychotherapists are also bound by law to intervene if a client is in imminent danger to themselves or others, and they must testify in limited professional capacities if they are called into a court of law. Again, none of these legal regulations (protections or obligations) are enforceable in a client-coach relationship.
4. Therapeutic Boundaries & Dual Roles. An important goal in a therapist-client relationship is to create a safe environment that focuses on the client’s needs, health, and well-being. State laws govern some boundaries required to create this type of therapeutic environment. For example, in the State of Florida, “Any psychotherapist who commits sexual misconduct with a client, or former client . . . commits a felony of the third degree” punishable by state law. Other punishable acts by psychotherapists include fraudulent misrepresentation, false advertising, and receiving kickbacks for client referrals. Additionally, psychotherapists avoid working with clients that may present conflicts of interest through dual role relationships. A dual role involves a clinician being in a therapeutic relationship with a client while simultaneously being in another role with that individual (or someone close to that individual). Examples of dual roles include being a therapist with a client while also being a best friend, lover, relative, employer/employee, or while engaging in any non-therapy-based business transactions. No such laws directly regulate the coaching profession in these ways.
5. Education & Licensing/Credentialing. Working as a psychotherapist requires a masters-level (or higher) degree from an accredited institution in a psychotherapy-specific field (social work, psychology, psychiatry, counseling, etc.). Additionally, the individual must meet the requirements for state-level government-sanctioned credentialing for psychotherapy, including having met educational requirements, completed supervised internships, passed licensure exams, and received ongoing continuing education. While several independent coaching organizations exist that are working to professionalize the field and “certify” people as coaches, these processes pale in comparison to the well-established rigor of psychotherapy credentialing requirements.
6. Mental Illness Diagnosis & Insurance Coverage. For better or not, modern-day western psychotherapy is rooted in the medical model (some would say “disease model”) of mental health. From this perspective, “disease” is defined by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) and the International Statistical Classification of Disease and Related Health Problems (ICD 10/11). Much of the psychotherapy profession is driven, in part, by insurance companies who have a considerable influence on how psychotherapy is practiced. Their focus is on managed care to reduce expenses, sometimes through limitations or denial of services. Insurance companies require a DSM-5/ICD mental illness diagnosis and treatment plan with measurable objectives before paying psychotherapists for their work. Therefore, if you work with a psychotherapist, particularly if you are using insurance to pay for the services, you will receive a mental illness diagnosis whether you want one or not. On the other hand, coaching is not bound to the medical model, and health insurance does not pay for coaching services.
Why Do Coaches and Psychotherapists Focus On Distinctions?
From the coaching perspective, asserted distinctions are probably, at least in part, an effort to protect their work from claims that they are practicing therapy without a license. Most coaching agreements, for example, explicitly state that the practitioner is not doing psychotherapy. For psychotherapists, asserted distinctions are probably, at least from a monetary perspective, an effort to protect the psychotherapy fields from an incursion of “non-professionals” who might otherwise seek insurance reimbursement - the primary source of income for many therapists.
Beyond monetary considerations, however, psychotherapists (whether clinical social workers, psychologists, psychiatrists, etc.) take great pride in adhering to ethics in the work they do. The coaching field does have emerging, optional, self-governing certification such as through the International Coach Federation (among others). However, psychotherapy is governed by complex social structures to support industry-wide adherence and enforcement of ethical considerations.
For example, as a burgeoning clinical social worker, my career is guided by and bound to:
the Council on Social Work Education Accreditation standards and core competencies that accredit university programs, such as the master’s degree program I’m currently attending,
the National Association of Social Workers Code of Ethics to which all professional social workers are bound,
the Florida Board of Clinical Social Work, Marriage & Family therapy, and Mental Health Counseling licensing requirements for my psychotherapy internship and professional credentialing, and
the Florida Statutes for Title XXXII, Chapter 491, which govern the professional regulations on clinical, counseling, and psychotherapy services, enforced by the State of Florida.
Again, coaching has no such structures related to educational requirements, industry-wide state-mandated credentialing standards, nor state-based regulations and regulatory enforcement around client confidentiality, recordkeeping standards, boundary-based practices and enforcement, or any other safety and ethical considerations.
How Do I Choose?
It may be this article highlighted some “dealbreaker” considerations for you, for example:
If state-mandated and enforced education, training, licensing, and continuing education are important to you, you will want to work with a psychotherapist.
If you want to work with someone living in a different state than you, that person will likely need to be a coach.
If you want greater legal protections around privacy, confidentiality, and boundaries in the helping relationship, you will probably want to work with a psychotherapist.
If you don’t want to be labeled with a mental illness diagnosis, you will want to work with a coach or perhaps a private pay psychotherapist (not using health insurance).
If you DO want health insurance to pay services with your helping professional, you will need to work with a psychotherapist who accepts your type of insurance.
Beyond these types of distinctions, your choice comes to practitioner preferences. If you want to focus on career development, you’ll probably want to work with a life coach or therapist having solid credentials and experience in this arena. If you want to improve your health and well-being or focus on stress management, you can work with a wellness coach, personal trainer, nutritionist, or mental health therapist, depending on your specific needs and desired breadth of focus. If you believe the challenges you struggle with in your life today are related to historical events from your early years, work with someone who has been trained in drawing out these connections and healing past wounds.
Perhaps most important when seeking help with personal growth, transformation, or healing, is finding someone you trust to work with you –a coach, psychotherapist, mentor, peer, guru, shaman, or other spiritual practitioners. You will need to determine for yourself what makes someone trustworthy, whether that be their life experience and education, credentials and licensing, references, or simply the “vibe.” Finally, know that at any point, if the helping relationship isn’t working for you, it’s OK to leave and find something that works better.
Lou Bardach is currently a life coach and student intern at Cypress Wellness Center, working toward LCSW licensure as a master’s in social work student at the University of Central Florida. He has also studied the Internal Family Systems psychotherapeutic model through the IFS Institute’s Online Circle program. He believes health and well-being are cultivated through self-care -- by learning to become one’s own compassionate caregiver. As a gay man experienced in working with LGBTQ+ adolescents and adults, Lou is particularly interested in helping others heal from the effects of homophobia, transphobia, and other types of social oppression. Contact him/them at Lou@cypresswellnesscenter.com