Lessons From the Couch, About the Couch: So you can coach me too, right Doc?

This is the third entry in my series on psychotherapy entitled Lessons From the Couch, About the Couch. This series seeks to educate the potential consumer of counseling/psychotherapy about important aspects of therapy, and how to go about smartly engaging in the process in order to maximize benefit.

I have a confession: I watch Iyanla’s Fix My Life series. And I have to admit, it became a bit addictive and I found myself  hardly able to WAIT until the next week’s episode! And then I started to think about why.  And it dawned on me — it has all the makings of good entertainment; melodrama, a hook, something the viewer can identify with, and a twist to keep you from channel surfing and never coming back. But those attributes of the show, yes The Show —  the drama, the hook, and the entertaining — that was exactly the problem with it. People’s pain, and issues, and desire to be whole should not in any way be held out for public consumption (in my opinion). It shouldn’t be for entertainment purposes. It shouldn’t be for the voyeurs to gawk at. How people experience pain is personal. The work they do to alleviate it adaptively is personal. That brings me to my question: What exactly is the difference between psychotherapy and coaching?

While Ms. Iyanla does not market herself as a psychotherapist, what she does comes across as therapy.  And it starts out very similarly to how a real, therapeutic relationship with a psychologist or counselor begins.  For example, initially Ms. Iyanla tries to establish a rapport before easing into the sensitive issue(s). In many respects, it would appear to the therapy unsavvy layperson that there is very little distinction between coaching and counseling. But then it starts, and I am reminded that no, this aint therapy.  The change in tone. The loud voice. The perhaps overly assertive (code word for what some might call aggressive) confrontation. The touching and hugging and rubbing of backs. The up in yo’ face. The very things that I love about the show because it’s just great entertainment and keeps pulling me back, — is the very problem that I have with it. No, this aint therapy!

See, it would be unethical for psychologists to get in your face, yell, or raise our voices in anger or frustration. I get it though. That’s what sports coaches do. And maybe that’s just Ms. Iyanla’s tactic. It is not customary to have so much (if any) physical contact with the patient at all. We are trained and cautioned to have very strict boundaries. Emotionally, physically, and ethically.  For the five or six or seven years of clinical training we do, we are indoctrinated to knowing about boundaries and understanding lest that WE ourselves are a tool in therapy. And everything we do, say, feel, react — EVERYTHING is interpreted by the client. Can impact the relationship.  That is a key difference between coaching and psychotherapy.

Mental health professionals understand that it is the relationship that fuels the change.  And we know how fragile the therapeutic relationship is. Perceived insults or slights can indelibly impact it. And when that occurs, there is no sustainable change that can occur.

So boundaries, the ethics and strict professional standards, and the regulation of our professional practice by law are key differences between mental health professions and coaching. Anyone can become a coach. And while there might be a couple hundred hours of training needed, there is no process of vetting. No process of intense supervision, feedback or opportunity for correction.

The focus on the past (because we understand that to move forward, you oftentimes first have to go backwards), the type of client (we work with pathology, mental disease, and people who at times are very entrenched in their illnesses), and the many years of academic study, rigorous clinical training, supervision, and practice to hone our craft are important differences that separate us from coaching. Last, but certainly not least, counseling and psychotherapy are based upon the sciences of psychology, human behavior, neurobiology, and physiology among others. We have over a hundred and twenty years of research and scientific study to back us. And we use the research to form the basis of our interventions.

What we (psychologists) do is treatment. While we fuel change, motivate, and seek to shape human behavior just like coaches do, we treat. Period. We treat the wound. We dig deep and look for the wound because nine times out of ten, there is a wound. It isn’t always in the form of abuse, or assault. Sometimes it is much less salient, but just as profoundly impacting on a life. We know that there is always a wound. And that wound, and that lack of healing is what keeps people in a perpetual state of stuck.

So naw, I can’t coach you. I cannot put on my metaphorical happy face and cheer you along to the job, salary, business or life you dream of.  While mental health professionals aspire to move people forward, that’s simply not all we do. I can figuratively hold  your hand, take you on a long journey, guide you to the deep places, find the hurt, partner with you to heal the hurt, and allow you to own your story. I can empower you to be the best you by empowering you to do the hard work. And being perhaps the only constant you have ever had in your life while you do it. Once you’ve done that, the job, the salary, the life…will follow.

Don’t get it twisted; there are some uber talented, TALENTED coaches of all sorts. And there is a place for coaches. And yes, I still do love so many things about Ms. Iyanla! But the place for the coach is not with the couch, or with those who would be best served on the proverbial couch. And the techniques should not in any way mirror psychotherapeutic techniques.  Because simply, coaches do not do therapy. They encourage, they motivate, they empower, they move people towards their life goals and towards positive change. But that is not therapy. And that is not treatment. And the very best coaches understand that. And they don’t blur the very definite lines. And with that, they are ok.

There is room for both of us. There are more than enough people in need of some type of assistance. We’ll take the people in need treatment. And we’ll leave the coaching to the coaches.

Be well,

The Good Dr. Nik


Dr. Nicole M. Alford is a DMV-area Clinical Psychologist in private practice. She is a prolific blogger, teacher, mentor, compassionate activist and media commentator. To learn more about Dr. Nik’s services, please visit http://www.TheGoodDrNik.com, and please follow her @theGoodDrNik on all social media platforms.

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