Is ‘coaching’ a shortcut to mental health care? Not so fast − here are key differences

Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical Campus

Life coach, wellness coach, business coach, weight loss coach, breakup coach – the list goes on and on. All are different titles for similar jobs, with the same limitation: Anyone can claim to be an expert.

Health “coaching” alone is a US$7.6 billion market in the United States, linked to the wellness and lifestyle medicine industries, as well as social media influencer culture. With ongoing shortages of physicians and mental health workers, many Americans see coaches as a more personalized alternative to traditional physical and mental health care.

Yet the profession is poorly regulated, which can make it a utopia for scammers; untrained people providing advice about health, psychology and nutrition; and, in some cases, cult-like behavior, such as a coach encouraging customers to cut ties with family and friends.

And now that AI health coaching has entered the chat, these problems are likely to grow.

As a licensed clinical social worker who specializes in mental health and public health, I have observed coaching’s growing popularity and how patients’ interest appears to stem from a lack of affordable and accessible mental health care.

Coaches have the potential to fill a gap and work alongside therapists to assist clients. Many people seek coaching to help them make a big decision or hold them accountable for making progress toward a set goal – from launching a business to sticking to their wellness routines. Because the industry is unregulated, however, it’s important for people to understand its limits before using a coach’s services.

Why is coaching so popular?

In broad terms, coaches assist someone in creating a plan for achieving specific goals – for example, making a change in their career, diet or relationships. It can be effective in helping people manage chronic conditions, such as diabetes, between doctors’ visits and to follow their treatment plan.

Amid COVID-19, physical and mental health care became more difficult to access, which may have contributed to coaching’s popularity. People who were already skeptical of the health care system have turned to coaches in hopes of one-on-one, specialized treatment.

Another contributing factor may be the rise of the gig economy, with coaching appealing to people wanting to be self-employed. Social media and the internet also have fueled coaching’s popularity by making it easier to research and receive health advice, regardless of whether that advice is accurate.

Is coaching therapy?

The simple answer is no. While resembling therapy, coaching does not require licensing, credentialing or formal education. Practicing therapists, on the other hand, are required to be in good standing with the law, have years of training, are regulated by governing bodies and professional associations, and abide by licensing bodies’ guidelines to keep the client safe.

There’s a common stereotype that coaching is for “high-functioning” people and is oriented toward the future, while therapy is focused on the past and finding problems with people. As a licensed, practicing therapist, I think this could not be further from the truth. Therapists focus on helping a person process their past, focus on the present and work toward goals in the future.

In my experience, I find that these falsities reinforce the stigma around mental health and keep people from getting appropriate help.

According to one academic study, 25% to 50% of people engaging with a life coach have mental health conditions that require a higher level of support. And even though many coaches are savvy in “therapy speak,” they often lack the training to recognize when the client’s needs are beyond what they should be providing.

Risks and regulation

One of the biggest concerns about coaching is that it lacks a central governing body to regulate and oversee members. The industry has taken some steps toward better oversight, and there is one established, accrediting body – the International Coaching Federation.

It is not a requirement, however, for people identifying as coaches to join this organization. Certifications can be provided by anyone or any program, but training is not standardized.

This lack of regulation means anyone can provide coaching, including therapists who lost their licenses for unethical conduct. It has also led to social media coaches and influencers spreading misinformation and confusion about mental health conditions. This is concerning because nonlicensed providers, including coaches, are legally not allowed to diagnose mental health conditions, such as depression or anxiety, or provide treatment for them.

Another concern is coaching clients’ vulnerability to being scammed financially, mistreated or given dangerous advice, such as abusive child-rearing suggestions. Coaching clients do not have the legal rights that therapy clients have, such as patient confidentiality.

Finally, life coaching relies heavily on positive psychology, which focuses on personal strengths and positive traits for happiness – in short, to look on the bright side and not focus on the negatives. Since its founding, positive psychology has come under scrutiny for debunked scientific claims of the therapy’s success. And while this approach works for some, others find that it is too individualistic, not giving enough weight to how external issues such as systemic racism can play a role in mental health.

What to look for

Ultimately, each person’s needs are individual, and a life coach might be helpful. However, there are some considerations to keep in mind during an initial consult:

• What training does the coach have? What’s their background? I recommend looking into their education and licensing, as well as any titles or certificates that you find unfamiliar.
• Is someone telling you that they can cure you or that they have a product that can fix your problem – a meal plan, diet, coaching course, etc.?
• Do they have research and evidence, not just anecdotes, to back up the claims they are making? If something is being touted as “tested” or “proven,” make sure you ask about the data.
• Is the person touting their service as the “only” way to get better? Are they making unrealistic claims, such as being able to cure someone of their trauma symptoms in one month? A credible life coach is not going to promise to completely change your life or cure you.
• Is there a formal contract with the services provided clearly laid out? Does this contract discuss limitations of services provided? Is there clarity around fees and charges?
• Is the coach willing to be flexible about their approach? Do they become defensive when you ask questions?

Life coaching has the potential to be an evidenced-based, short-term practice, but potential clients need to carefully consider whether it is appropriate for them.