Coaching vs. Therapy & How to Choose

When I started out as a Coach, I asked myself what the difference between coaching and therapy was. If you’re looking for a question that is widely asked and poorly answered, look no further. These are a few of the statements I read on the difference between the two practices:¹

• Depth: Therapy is more in-depth than coaching. Therapy focuses on depth, going into traumas and deeply held patterns, while coaching focuses on breadth.

• Chronology: Therapy is about processing the past, while coaching is about moving towards an inspirational future.

• Accountability: Therapy is an open-ended supportive space, while coaching is a structured and accountable space.

• Action-orientation: Therapy is an exploratory space, while coaching is a structured, action-oriented space.

• Skill-level: Therapists are more skilled because of the higher educational barrier (Master’s-level at least), while coaching is a field with loose boundaries.

• Developmental Stages: Therapy brings people from dysfunction to baseline and coaching takes people from baseline to great.

• Domain-specificity: Therapy is about life, and coaching is about business.

The problem is that all of these are wrong.

Here’s the truth

Note: all data references the USA.

Coaching and therapy are both forms of “inner work” - the practice of inquiring into, growing, and developing ourselves. Both can be effective settings to work through mental health issues, which broadly encompass the conditions that affect our mood, thinking, and behavior.

Mental health issues exist on an acuity spectrum², which helps delineate the severity of a condition. People on the low acuity end are generally able to tolerate reality well and move about their lives as intended. In contrast, people on the high acuity end generally have severe mental health issues that require support (e.g., psychosis). Therapists are trained to work across the entire acuity spectrum.

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The problem is that the demand for mental health services is much, much higher than the supply of therapists available. This is especially true for high acuity patients, who need the most specialized help and are the most poorly served population.³ This trend is compounded by the increased rate of incidence of mental health issues over time.⁴

Enter coaching

In general, coaching has a lower barrier to entry than therapy (we’ll touch on the downside of this later). A lower barrier to entry means a higher supply of practitioners. Well-trained coaches are able to support low to medium-acuity mental health issues, which allows public health systems to more efficiently allocate therapists and other clinicians to people with high-acuity issues.

So are you guaranteed better care with a therapist over a coach? Not really…

The difference between coaching and therapy, according to the textbook

The barrier to becoming a therapist is high. With a Master’s level education and licensure, therapists can:

• Diagnose and write treatment plans (and prescribe medication, in the case of psychiatrists).

• Bill health insurance (although some companies are doing this with coaching too).

• Coordinate care. This is the BIG one. Therapists can help patients navigate the healthcare system to find other providers (e.g., PCPs, psychiatrists) and then coordinate care with those providers. Only ~1-2% of the clinical population seeing therapists actually needs this.⁵

These three things are the main distinction between what therapists can do and what coaches can’t do (and shouldn’t).

The difference between coaching and therapy, in practice

There isn’t one. Not a clear one, at least.

If you only take away one point from this writing, let it be this: The difference between coaching and therapy is smaller and less significant than the difference between really good practitioners and really bad practitioners, whether they call themselves “coach” or “therapist”.

Digging in deeper, each of the differences I outlined above can easily be refuted.

• Depth: Coaches (especially those who are trauma-informed) can also move to the same level of depth as therapists.

• Accountability & Action-Orientation: Certain forms of therapy are very challenging & action-oriented.⁶

• Skill-level: The variance of quality within each field of coaching and therapy is at least as large as the variance between fields.

• Developmental Stages: This is a totally arbitrary distinction. Coaching can work with the past and therapy can focus on the future. There’s nothing written into the philosophy of either that says otherwise.

• Domain-Specificity: Also arbitrary. Neither practice is explicitly limited to a specific domain.

Notice how working with a therapist doesn’t guarantee quality of care or good bedside manner. I saw this during my time in leadership at Talkspace, a prominent healthcare company focused on expanding access to mental healthcare. We implemented measures to track the quality of care that our therapists provided, and the range of quality was HUGE.

The best therapists were like magicians. They took their craft seriously, committing themselves to the lifelong study of the art of therapy. They also co-created the therapy experience with their clients, and their clients raved about them. In contrast, the worst therapists treated the job as a “job”. They didn’t seek to create a growth-oriented space, instead showing up with a “check the box” mentality, running the clock out on their session timers. As a result, they constantly churned clients from their caseloads.

This spread in quality is driven by many factors, including the dynamic of residents self-reporting issues to supervisors (more on that another time). There’s no “magic formula” or “secret sauce” for good care that only Master’s programs or therapy licensing bodies have.

The quality control issue is even bigger with coaching. The problem is that anyone can call themselves a coach, so you don’t really know what you’re getting. That’s why high-quality coaches go through rigorous training, much like therapists. I deeply care about serving my clients, so I took the Heroic Coach certification, a data-backed training in flourishing and leadership coaching. I also constantly evolve my philosophy and test it in the laboratory of my own life before sharing it with clients. I talk more about that here.

Choosing a practitioner to work with

Here are a few guidelines to think through:

• What you want is a really good practitioner - it doesn’t matter if they call themselves a therapist, coach, shaman, healer, or guide. Expand your search across the gamut of inner work practitioners to find a person who pushes you in the right ways and who you’re excited to meet with.

• Focus on the relationship. Do you mesh with the practitioner? Can they clearly explain their methodology, training, and approach? Do you feel philosophical alignment? A good proxy for relationship alignment is to try a session or two. For example, I gift a session to all prospective clients so they can experience what coaching is like with me.

• Don't over-focus on credentials. Remember, therapeutic licensure does not guarantee quality of care. Same with coaching certifications. Note: I said over-focus. Not focus. Credentials are a valuable proxy for the legitimacy of training. I probably wouldn't work with someone that had 0 training.

My friend and fellow coach (Corey) offers a helpful framework:

If you’re struggling with mental health issues and need help dealing with them to function in day-to-day life—go to therapy.

If you already function pretty well and want to optimize your performance, clarify your values, become more intentional with how you live, or pursue meaningful, purpose-driven work that fulfills you—hire a high-quality coach.

I’d amend this slightly and add a third option. It’s also completely viable to work with a therapist AND a coach (I do this). I’ve found two people I resonate with and who push me in the right ways - one just happens to be a coach, and the other a therapist. I use the therapy space to work through any issues I have with my mental health and the coaching space to work on my purpose, habits, and business.

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1. Prominent coaching institutions make these distinctions, like Co-active

2. Charlie Health

3. National Council for Mental Well-Being

4. NAMI

5. From discussions with Talkspace’s clinical team.

6. For example, Phil Stutz’ therapeutic philosophy, detailed here: Heroic