GLOBAL ADVANCES IN HEALTH AND MEDICINE ORIGINAL ARTICLE Coaching versus Psychotherapy in Health and Wellness: Overlap, Dissimilarities and the Potential for Collaboration Formación frente a psicoterapia en la salud y bienestar: coincidencias, diferencias y la posibilidad de colaboración Meg Jordan, PhD, RN, CWP, United States; John B. Livingstone, MD, FRSH (UK), United States Author Affiliations INTRODUCTION Some health coaches are licensed healthcare pro- California Institute of Health coaches and psychotherapists both work fessionals (nurses, psychologists, physicians, physician Integral Studies, San Francisco (Dr Jordan); with the art and science of facilitating change in their assistants) who assist their patients and clients in man- Harvard Medical School, patients and clients. While the evolving field of health aging chronic medical conditions, such as heart dis- Society of Behavioral coaching and the established disciplines of clinical or ease, diabetes, arthritis, and cancer. Other health coach- Medicine; Gaffney and Livingstone Consultants counseling psychology share major areas of overlap, es have diverse backgrounds (health promotion, educa- in Health Care Design there are also significant distinctions between the two tion, fitness training, wellness management). Though and Coaching, fields. This article outlines those similarities and dis- they differ significantly in their content knowledge Provincetown, similarities with the intention of fostering a cooperative bases, they both use coaching methodology to enhance Massachusetts (Dr Livingstone). and mutually enriching stance between the two helping the self-identified health and well-being goals of their professions for the benefit of the respective profession- clients. The field of health coaching has become Correspondence als and the countless clients and patients they serve. increasingly sophisticated as it draws from a growing Meg Jordan, PhD, RN, CWP As more psychotherapists add coaching skills to body of evidence-based coaching psychology, positive [email protected] their practice and more health coaches work with com- psychology, adult learning theory, motivational inter- plex medical patients wrestling with stress-related ill- viewing (MI), and new findings in neuroscience. Citation ness, the two disciplines bump up against each other, Psychotherapists, on the other hand, focus on Global Adv Health Med. DOI: 10.7453/ often times with salvos of accusations that coaches mentally-based conditions listed in the Diagnostic and gahmj.13.036 wrongly encroach upon psychotherapy or that thera- Statistical Manual of Mental Disorders V (DSMV) and are pists call themselves coaches without specific coach trained in assessment, diagnosis, and treatment of men- Key Words training. At the same time, a growing paradox exists tal disorders. Yet psychotherapists often work with Coaching, psychotherapy, that while the two fields can be rife with contention, issues related to chronic and acute somatic illness, health, wellness, they also move along a continuum of results-oriented, postoperative states, recovery from injury and trauma, collaboration psychological skills for facilitating goal attainment and also with more general health self-care and well- Disclosures while improving the mental and physical health of ness-related issues. In so doing, the crossover with The authors completed their clients. health coaching is apparent. The core of their profes- the ICMJE Form for sional relationships is to assist client growth through Disclosure of Potential DEFINING THE ROLES OF HEALTH COACHES AND interpersonal interactions.4 Conflicts of Interest, and no relevant conflicts PSYCHOTHERAPISTS Similar to health coaching, psychotherapy goals were disclosed. Though a handful of health and wellness coaches include behavior change, enhanced decision making, may have been in practice for over 25 years, the profes- and better use of resources. In addition, goals may sional health coach training itself emerged in the last include mitigation of mind-mediated symptoms, 10 to 15 years. As an emergent profession, health and increasing self-esteem, reduction in causal links wellness coaching still lacks nationally accepted edu- between mental dynamics and somatic conditions, the cational standards and training benchmarks, as well as impact of learning disorders, and relationship enhance- with agreed-upon levels of proficiency or core compe- ment with adults and children. tencies.1 However, efforts are underway by the National In psychotherapy, the methods used to work on Consortium for Credentialing Health and Wellness these issues are more vigorous versions of what health Coaches (NCCHWC), formed in 2009, to define the coaching may employ in a more limited and circum- profession, set educational standards, and influence scribed way. Plus, the psychotherapist is trained to practice guidelines.2 Some healthcare professions, such assess and diagnose myriad conditions (eg, serious eat- as nursing and chiropractic, already have moved for- ing dysfunction, affective dysregulation, personality- ward with initiatives or certifications to add coaching driven behavioral patterns, abuse experience, chronic skills to their professional practice. The American pain problems). The field of consideration of affect and Nursing Association recently recognized a new role belief systems goes wider and deeper for psychothera- (the nurse coach).3 py than is prudent for health coaching. Effective psy- 44 Volume 2, Number 4 • July 2013 • www.gahmj.com Original Research COACHING VS PSYCHOTHERAPY IN HEALTH AND WELLNESS chotherapy, of course, addresses mental aspects, but ior, or an eclectic mix of theories. More marginally the overall care of the client/patient—especially by used theories or models include gestalt, reality therapy, psychotherapists who are medically trained-nurses, body-oriented or somatic psychotherapy, object-rela- physicians, some social workers—is holistic and tions, acceptance and commitment therapy, narrative, includes health coaching and health educating. If the recovery model, and mindfulness-based therapy. mental health professional is trained in both health coaching and health educating, per se, so much the bet- DRAWING FROM THE SAME APPROACHES ter. Though both of these approaches are usually part Positive Psychology of the educational process for health psychologists, Both psychotherapists and coaches draw from the they are not usually part of the primary education and field of positive psychology with ample examples of professional training of physicians, clinical psycholo- applied findings.5 For example, consider the research gists, and clinical social workers. findings that suggest that three positive thoughts are Health coaching, as understood by the public, is needed to counter or quell the effect of one negative not viewed as a mental health service (psychiatric, thought.6 Emphasizing well-being, strengths-based clinical psychological, clinical social work, family ther- thinking, and cultivating the approaches to happiness apy). Those workers making referrals of clients to are part of the coach’s toolkit. Coaches look at possi- health coaching, those marketing health coaching to bilities instead of problems and causes. Though both industry, and the clients who use it do not view them- coaches and therapists rely on this foundational body selves as being in a mental health context. Although of work in positive psychology, there may be a greater sometimes clients feel more comfortable starting with ease in which coaches access it. Coaches who are also health coaching, they and their coaches may soon dis- psychologists may find it more difficult to depart from cover that the issues are best addressed by mental the medical model in which they were trained.7 health diagnostic and therapeutic skills. For most peo- ple, however, health coaching may be the appropriate Mindfulness modality to meet their health-related needs. A rich field of exploration for both psychothera- pists and health coaches is the burgeoning evidence Drawing from the Same Research behind mindfulness practices and related mind-body The conventional thinking was that changing relaxation therapies such as guided imagery, medical one’s habits took an ironclad will and nonstop motiva- hypnosis, and conscious breath work. While the psy- tion, or as fitness guru Jack LaLanne would yell at his chotherapist may demonstrate a mindfulness practice television audience, “Pride and discipline—that’s all to reduce stress, depression, anxiety or pain, the health you need!” Fortunately, for people who have tried and coach facilitates the actual learning about mindfulness failed numerous times to quit smoking, lose weight, by the clients themselves. Coaches are committed to exercise, or improve their health, there are more effec- following the client’s agenda, determining if some tive strategies and well researched methodologies that option is actually of interest, and helping the client to underpin an expanding array of tools employed by go about discovering it for himself. This follows the both coaches and therapists. The research behind adage that it is far better to give a hungry man a fishing behavioral change now draws from scientifically pole instead of a fish. observed methods for transformation and sustained action strategies. Motivational Interviewing Both health coaches and psychotherapists tap into One approach used heavily by both therapists and theoretical frameworks and conceptual models includ- health coaches