By Dr. Gaby Cora

Much has been written about the similarities and differences between being a coach and a therapist.

While the medical model has been invaded by third party payers, time restrictions, and stigma, the coaching model is viewed as a process of improvement and has boomed as an alternative. Today’s coach is yesterday’s shrink.

Truth be told, great therapists will assist their patient’s path toward well-being and will help them achieve each goal that they set for themselves. Great coaches will help clients achieve their goals.

While analytical therapy styles have prevailed in a one-way communication model (the patient talks while the therapist listens), the coaching style follows after the cognitive-behavioral therapy model: the patient – or client – is highly involved in identifying automatic thoughts and repetitive patterns and works proactively on improving them. This therapeutic style is highly interactive, where the trained therapist is a good listener, a great strategist, and an excellent communicator.

While many therapists became coaches because they burnt out because of finances or challenging cases, others integrated a coaching practice to reach a wider audience.

As someone who practices both, I’d like to mention some clear guidelines in practice:

As a therapist:

· Therapists abide by the highest standards of ethics and confidentiality (HIPAA).

· Psychiatrists are “brokers” of information as they provide for guidance regarding the course of action, particularly as this relates to discussion of medical issues and medication therapy.

· Therapists should only provide for therapeutic sessions and receive compensation for their services. They should not engage in business or personal relationships with their patients. This is a major differentiation with coaching: coaching is highly unregulated, and may present instances in which boundaries are blurry.

· Related to the previous point, therapists should never engage in any romantic relationship with any patient (as per the American Psychiatric Association’s Code of Ethics, which is the highest medical standard).

· Therapists can only practice within the state where they are licensed to practice and can only provide for services that they have been trained to provide. For example, a psychiatrist facilitating hypnosis can touch their patients’ forehead during the procedure. As medical doctors, psychiatrists are licensed practitioners who can “touch” the patient for a therapeutic purpose. Unlike psychiatrists, other therapists (including social workers and psychologists) are not qualified to do this.

· Expenses for therapy sessions are healthcare expenses. Although some insurance companies may cover for these services, others may have carved-out mental health services or will only support these if provided for by therapists charging the lowest fees. This is one reason why many psychiatrists have left the practice of psychotherapy and have focused on building a practice of pharmacotherapy only. Other psychiatrists continue to integrate both psychotherapy and pharmacotherapy.

As a coach:

· “Formal” training as a coach may include no training at all, one-weekend training, or a year-long-two-hour-week training.

· Coaching is not regulated. Coaches who are interested in reading about ethics will do this on their own; others who may participate in formal training may have a better discussion.

· Coaching expenses may be tax-deductible as educational or training expenses.

· Coaching does not have the stigma attached. On the contrary, most people love to say they have a coach.

· Coaches “only” guide you through the process of doing what you have decided to do. They do not provide for solutions but enhance your problem-solving ability.

· Although confidentiality issues are agreed upon, many coaches go into business with their clients. This may also mean coaches may become “friends” and may end up in more personal relations.

· Coaches can coach globally. There is no licensing process and there are few rules and regulations.

Coaches have been savvy marketers and promoters of their services, most say: “therapists intervene in a model of deficiency whereas we intervene in a model of improvement.” The truth is anybody who is seeking for therapeutic or coaching assistance is experiencing some challenge, trouble, or desire to continue to improve. Good therapists and good coaches will be able to help their patient and client in the best possible way.