A coach is not a therapist

Last week, Brian became licensed as a mental health counselor in the state of Florida.  It took several years for him to reach this point, including the completion of a master’s degree and several hundred hours of supervised experience as an intern.  And even though he’s now licensed, it doesn’t mean his work is done. To maintain his license, he has to earn continuing education credits every year.  It’s a lot of work to become a therapist, and understandably so, as therapists are working with people in their most vulnerable places.  The potential to help is enormous, but so is the potential to cause harm.

Why am I telling you this? As much as I just want to brag all over my husband for being awesome – and goodness knows I do plenty of that already – I’m sharing this because lately I’ve been seeing some things that I find incredibly troubling.  I’m part of a lot of online communities that are focused around women and fitness, and a couple of times in the past week, I’ve seen women show up and ask questions that indicate they are struggling with serious mental problems, like apparent eating disorders and professed self-hatred.

As saddening as I find those women’s stories, what bothered me more was some of the responses those women would receive from some members of the group, who encouraged them try different diets or to hire a coach to help them get through their issues. To be fair, plenty of other group members were like, “maybe you should consider professional help,” but enough of them suggested a coach or a new diet that I really felt moved to write about this.

This is the thing – I’m not anti-coach.  Not even close.  I have friends who are coaches and who do bang-up jobs at their work.  if you are looking for someone to help motivate you or keep you accountable or help you develop a training/nutrition plan so you can reach specific performance goals, an experienced, credentialed coach can be an invaluable asset.  Even a less formal arrangement, like a mentor/mentee relationship, can be a wonderful thing.

But shit starts getting sticky when you move into the realm of mental health. My friend Josey recently wrote a post on her blog at The Span of My Hips in which she took a critical look at health and wellness coaches who cross over into mental health care:

Anyone can be a coach. There is no legal restriction on who can be a coach. There is no regulatory body that ensures all coaches are certified. And then there’s that question…certified in what? There are lots of health coaching certifications. They seem to span from a weekend to months. But, to paraphrase some graphic novel I haven’t read, who certifies the certifiers (sorry)? What does it actually mean to be a certified health coach? Who are you capable of responsibly and ethically working with?

Here’s another post, this one from Psychology Today, that talks about the potential issues that can arise when life coaches – which is something else I’ve been seeing more and more of, particularly outside of the realm of health and wellness – try to provide mental health care.

(And to use a recent example from my own life: I’ve just completed about 30 hours of classroom and online training to become a guardian ad litem.  Doesn’t mean I’m ready to be a social worker.  Not even a little bit. Not even close.)

It’s one thing to provide some guidance and structure to help a person achieve their goals in life, but it is entirely another thing to go wading into the thicket of a person’s psyche in an attempt to help them make sense of things like addiction, eating disorders, post-traumatic stress disorder and anxiety.  There is a reason why the professionals charged with helping people with these problems are governed by licensing bodies and codes of ethics and professional requirements, and that’s because the potential to cause serious, lasting harm is so great.

So it seems to me that there are two factors at play here.  The first, I imagine, is based in economics and class. There’s a reason why mental health coverage was one of the big selling points of the Affordable Care Act, because health insurance providers haven’t covered it particularly well in the past.  (And despite the passage of the ACA, mental health care coverage is still woefully inadequate.)

And of course, that’s the situation for people who actually have health insurance.  Those without health insurance most likely have to pay out of pocket or seek counseling from community based care programs, which are staffed by people who bear staggering workloads.  Brian has worked in similar programs, and it’s easy to see how people burn out and, if possible, leave for private practice.  The people who work in these kinds of programs are asked to bear the brunt of our broken society, and with extremely limited resources through which to do so.  It’s a goddamned travesty.

BUT, as important as discussions of class and economics are when talking about mental health in the U.S., I also have to say that I’m not really sure that’s the biggest factor at play when it comes to what I’ve seen. Rather, it seems to me that what’s actually happening is that, even in the year 2015, the stigma associated with mental health care persists. Thus you end up with people who will pay a coach to tell them exactly what to do in hopes that they will achieve a temporary sense of relief from their internal turmoil, but will never ever ever consider seeking therapy.  Because seeking therapy means you are broken and you are weak and you are a failure, but seeking a coach just means you are trying to achieve a goal, and who can find fault with that?

And in the world of fitness and athletics, there’s also this idea that if you can eat a certain way, get enough exercise of the right kind, make your body look a certain way, bring a certain number up on the scale (or increasingly, in your weight stack), then all the pieces will fall into place.  All anxiety and depression will fall away, you’ll stop hating yourself, your relationships will be flawless and angels will sing your hosannahs every time you walk outside.

But as Moira wrote at Fit is a Feminist Issue, running – or exercise – is not the same as therapy:

But exercise – even in the great outdoors – is not equivalent to therapy in the psychotherapeutic sense. We generally cannot gain deep self-understanding from distance running in the way that we can from therapy. Therapy helps us get at the roots of our suffering, whereas running helps us cope with its branches. For deeper traumas, we must devote time and effort to therapy just as we must train for a marathon. It will be painful, but the gains in psychological well-being from therapy can be genuinely life-altering.

I’m perhaps biased here, not just because of Brian’s profession, but also because I personally have gained so much from therapy in my own life. Running and lifting weights and eating as healthfully as I can have done a lot to help me keep a lid on the anxiety I used to feel all the time, but what really helped me get to the core of those things?  THERAPY.

Have I had shitty therapists?  You bet.  I’ve had my share of therapists that I’ve met for one session, never to return.  But I’ve also had a couple of outstanding ones, and I also have the incredible good privilege to live with one. They were the ones who got me started on the path that led me to where I am today.

Because the truth is that sometimes we do find ourselves facing problems that are just too damn big to tackle on our own, and there’s no shame in that at all.  Life can be a challenging fucking thing, and sometimes it knocks us right on our asses.  Why wouldn’t we take advantage of every tool at our disposal to get back up on our feet?

So yes, by all means, hire a wellness coach or a life coach if you think you would benefit from it, but if you need help from a licensed professional, then please don’t be ashamed to seek that out as well.

30 responses to “A coach is not a therapist

  1. It irritates me that mental health is still seen as a taboo subject. I think it’s important to be open and have honest discussions, reinforcing that it is ok to seek professional help when you need it. How else can we change people’s attitudes. I can’t stand it when someone’s depression is whispered about in hushed tones, it’s nothing to be ashamed of.

  2. I’ve made this comment on related articles before. Exercise and diet in conjunction with therapy can be used as a treatment component when dealing with mental health. However it is only a treatment method it should be used under Medical (consular) supervision. Which means it might not be a useful treatment in every circumstance.

    • That makes a lot of sense. Like, I imagine that a therapy program for a person with an eating disorder is not going to include exercise as part of the treatment. I’m sure there are a lot of other circumstances that I’m not familiar with because, hey, I’m not a licensed therapist and I don’t know jack about a lot of this stuff. 🙂

  3. Oh my goodness yes. I work as a weight loss coach, and the small amount of training I receive on how to deliver that does not come CLOSE to what some people need. I can tell that they are using food as a tool to deal with problems I’m never going to be able to solve in a half hour group discussion. Hell, I’ve considered therapy for MY OWN issues because I think my weight maintenance would be easier if I dealt with my baggage instead of feeding it with the occasional dessert.

  4. As much as I agree with you, I have a thought (that is completely unqualified and non-evidence-based, so please – feel free to shred it).

    We (humans) often (not always, but enough) suck at treating stuff like major depression. There are far too many people in my circle who have been in therapy – publicly funded, privately funded, friend-recommended – who are still literally crippled by their condition. (Including some social workers who have really good access to all levels and who can try all manner of pharmacological and counselling interventions on the NHS’s dime.) I don’t think they need coaches, obviously, because that’s just daft. But there are enough of them in my orbit for me to think that even though professional-grade, properly qualified therapy is the appropriate thing for them, it’s not really helping, never has, and probably never will – unless you count the fact that they aren’t dead as “helping,” which… okay, but what a rotten standard. I don’t know what the answer for them is (but it’s not coaching!), and it’s terrifying to witness.

    I can think of three scenarios when coaching might be a good standalone or complementary thing: if you’re already in therapy for the real shit and want to work toward a goal in addition, if you can’t afford therapy for the time being and the goal work is a decent short term patch, or… maybe if you’re feeling incurable and just want to get by?

    I don’t know. This opinion is based on witnessed hopelessness rather than expertise.

    • I think that’s a totally valid thought. I guess my issue isn’t so much with the person who is hurting and in need trying to do whatever they can to relieve their suffering, as much as it is with underqualified people who are putting themselves out there as authorities in fields beyond their reach in exchange for money. I mean, if you have an eating disorder and you go to a coach who fails to recognize your eating disorder and is instead all, “Here, just work out two hours a day and eat tilapia and asparagus six times a day,” that coach is going to cause SO MUCH damage in the long run. It might help the person feel good and in control for a short period of time but down the road…omg, disaster.

      For what it’s worth, my heart totally hurts for your loved ones. As much progress as has been made with regards to mental health, we still have so much to learn and so far to go.

  5. People giving advice outside their area of expertise is a serious issue. Stigma for seeking certain kinds of help is a serious issue.

    But I have sympathy for people who misstep regarding these issues, for two reasons.

    1) When you don’t know the cause of a problem, how do you know which type of professional to contact for help?
    2) Most people know very little about mental health.

    So when you talk about women asking questions in places focused on fitness, I think about the fitness-focused people who don’t know depression or eating disorders look like so of course they give fitness-based answers.

    • As a social worker with homeless addicts, I would even argue that even professionals trained in this know “very little about mental health.” (Although that could just be a reflection of my own ignorance – I try to study more macro-level problems.)
      Like an iceberg, mental health runs so deep and is affected by so many things specific to an individual: biology, history, social support, current physical status. When we’re trying to treat it, we suspect what might work, ’cause it’s evidence-based, but it might not. We’re just trying to see what sticks.

      • Excellent point. That said I would still be way more likely to trust a professional – especially one who knows the limitations of the field – than someone with limited education and credentials.

        BTW you are my hero for doing the work you do.

  6. Good observations. What do you think of Triathlete magazine’s Best Bodies in Triathlon contest? Seems like post gold for ya. 🙂

  7. Working out, eating right, and taking care of myself changes (and has changed) many things for the better over the years. THERAPY has changed my LIFE. My perspective. My self-esteem. In ways that simply exercising and living healthfully could not. Very, very big difference. And great posting on the subject.

  8. Excellent, excellent post. I am actually considering a Wellness Coach cert program right now, and am at this point undecided if it’s worth it. Because as you say, who certifies the certifiers? I don’t want to end up with some scam of a “certification ” if it means nothing. That being said, if I do move forward and pursue wellness coaching, I am very well aware that there are certain issues that would be so far out of my scope it’s not even funny. Helping to self motivate to lead a healthier life? Sure. Helping with mental health disorders and clinical issues? Not a chance. Great post.

  9. I think threre is room for each perfession without crossing the line. Each field should take an approach that will help an individual reach a happier, healthier state, if they operate under the right guidelines. This is a very interesting artical. Thanks for sharing.

  10. Interesting post – congrats to your husband! I think coaches are necessary for motivation and diet and nutrition, but I think you are right. If you have an issue that is larger or seemingly not going away after your own personal efforts, you should consult someone who is trained to help you.

  11. I couldn’t agree more. I don’t know what it’s like in the States, but in Australia a lot of personal trainers seem to be really influenced by Michelle Bridges, who is a trainer on our local version of The Biggest Loser and somewhat of a celebrity. TV being how it is, a lot of the footage of Bridges training contestants sees them pouring their heart out to her about their emotional/mental health issues, and her getting right into the amateur psychiatry of it all. So many times I’ve overheard PTs (particularly female ones) doing their best psychologist impression on their clients, instead of sticking to what they’re actually taught to do, which is getting their clients moving with good technique and achieving goals. Often these trainers have no empathy with people who have become overweight for whatever reason, let alone psych training, and do incredible amounts of damage. Makes me so mad.

  12. I love this post. I took a lot of sport psych in university, and my professor (who had a PhD) was very explicit in telling us that unless you’re a registered psychologist, you should never delve into someone’s personal life and give advice on how to change it. You should always be there to listen and perhaps somehow persuade them to make a decision that is entirely theirs.

    Now as a trainer I sometimes tell my clients what to do, but always ask for consent before, and ensure they know they can stop/tell me they dislike the exercises I give them at any time.

    It can be hard when people dump all their psychological life issues on me. Sometimes if I feel my client is in danger I suggest counselling, but I’ve learned to listen and empathize, rather than prescribe to change their outlook.

    Life coaching and counselling should be left to registered professionals, not psychology enthusiasts.

  13. Totally agree! I recently read an article making the argument that we wouldn’t let someone who’s been a passenger in a plane be a pilot, nor someone who’s watched “Zero Dark Thirty” plan covert military strikes. So why do we let completely unqualified people tell us what to do in health/wellness areas? Any schmuck who has lost weight, tried a new diet, or known someone with mental health issues is suddenly qualified to write books, go on TV, and counsel others on who to fix up their lives, regardless of actual expertise or training.
    Congrats to your husband, also, for such a huge accomplishment 🙂

  14. Pingback: “Fitspo” (ED TW) | fit, fat, and feminist·

  15. I totally agree with your concerns. Exercise does not solve deeper personal mental health issues. Life coaches can only help on motivation and exercise. That’s all.

    I also have had the benefit for over a year of mental health counselling when I was university student struggling with some personal issues.

  16. This is an awesome post. I think you’ve brought home a pretty solid point around counselling vs. coaching. Yes there is room in the world for both, but they are different, and they serve different purposes – and truly “fixing” mental health issues is a huge responsibility, that truly requires the hours of training therapists and counselors receive. (I feel this is an issue for many regulated health professionals – for instance dietitians vs. nutritionists)

  17. Reblogged this on the redheaded stepchild and commented:
    Love this commentary on how we handle mental health, particularly when we value physical health. It’s so important to find the experts in every part of your life. Even training to be a counselor, I could never do the hard work coaches do. I’d have no clue how to start. But I’d want people with mental health issues to come to me so I can put my education and experience to work and give them a trained perspective that others may not be able to.

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