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The Difference Between Therapy and Coaching

As a licensed therapist who recently became a certified coach, I am frequently asked to explain the difference between therapy and coaching. Sometimes I can’t tell if the enquirer is genuinely interested or merely being polite, so I have a few nutshell responses to offer before seeing where the conversation takes us.

“Therapy is about healing; coaching is about growth.”

“Therapy is how the past impacts the present; coaching is how the present impacts the future.”

“People come to therapy because they want something fixed. They come to coaching because they want something changed.”

and then the zinger, which is a blog topic in itself,

“People are willing to pay a lot more for coaching than they are for therapy.”

Of course the reality is much more nuanced than a nutshell response can provide, and the more I try to define it, the more slippery it becomes. But what I’ve mostly found is that where you’re from, what you grew up with and what you trained in has a lot to do with how you see it. 

If you’re from England or Canada where therapy was historically the preserve of the rich, the American and those with debilitating mental illnesses (I dare you to draw a Venn diagram), there’s not so much of a distinction. Coaches and counselors stepped into the vacuum to offer therapeutic-type interventions to the general public, while therapists got wind of motivational interviewing and reframe that had typically been the purview of the coaches. Diagnosing was – and still is – only offered only by psychiatrists (the ones with medical degrees) or psychologists trained in standardized assessments. And with the exception of a few sessions of Cognitive Behavioral Therapy offered at the doctors’ office, everyone else offers some combination of private-pay interventions to get you moving in a better direction, no matter what they call themselves.

In the US, however, it’s a different story. Here, therapy is considered part of the already-convoluted healthcare system, which means that national and state boards step in to protect the public from anyone who might seek to offer services without the right credentials. The result is a tangled bureaucratic web of licensure and state-line turf-wars. Insurance companies then join the fray and argue about who, what and how many sessions they won’t cover, providing a catch-22 for therapists who are bound by state guidelines not to allow third parties to influence their treatment. The result is a mess of unnecessary diagnoses, paperwork and way too much fear-based practice, which is then seized on by lawyers who need therapy records for their divorce cases and personal injury claims. At which point you can bet your bikini that those clients who minimized their symptoms to avoid a big diagnosis are disappointed that they didn’t get the big-ass diagnosis after-all, because they’re suing someone for something bad.

If it sounds exhausting, I can assure you, it is. For several months I’ve had a recurring dream where I’m at a conference and someone invites me to participate in a great opportunity, and I go to grab my bag so I can join them. But I have so many purses and backpacks and plastic bags and – in one dream, even a hat and a cat carrier – that no matter how hard I try, I can’t consolidate them all fast enough. By the time I find a temporary solution – like throwing everything in a shopping cart – everybody’s left without me, and I can’t get the shopping cart down the stairs anyway. 

It doesn’t take a psychoanalyst to interpret what’s going on in my head, and you may be wondering why I still hang on to therapy licensure when it represents so much baggage for me. In truth, I do think about letting it go from time to time, but the reason I haven’t is the same reason that I stay in fancy hotels when I travel. If I’m going to go to a strange, challenging and possibly scary place, I want to know that I’m going to be safe and well taken-care of. And that’s how most of my clients feel too, especially when I’m digging into their past issues of trauma and deep-seated shame.

For all of my griping, the truth is that therapy licensure brings with it some meaningful assurances. Although some coach training programs are pretty rigorous (and CTI, the program that certified me, is one of them), a person doesn’t have to complete – or even start – a training program to call themselves a coach. A therapist licensed in any state however, has been through an accredited graduate school program, post-degree supervision, national and state exams and must complete continuing education hours to ensure they stay up-to-date. While therapists may choose not to treat certain diagnoses in their practice, they’re still very adept at spotting them, which can help a prospective client find the help they need. And, despite the shortcomings of health insurance, it does (occasionally) enable access to therapy for more people than would be able to afford it privately.

Of course state licensure isn’t entirely foolproof – there are some terrible therapists out there just as there are some truly incredible coaches. But as a general rule, it’s a bonus and a privilege to work with someone whose state is willing to vouch for their level of education and standard of care, as Minnesota is for mine.

Therapist or coach?

I’m neither, and I’m both.

Whatever you call me, it’s the relationship between us that brings the healing, the magic and the growth.