Coaching vs. Therapy – Referring Coaching Clients with Mental Illness
Updated: Aug 24
[Note: This post was updated February 2021 for freshness & clarity.]
A recent article in the Wall Street Journal, titled “Executive Coach or Therapist? It’s Getting Harder to Tell the Difference” (Bindley, 2019) again renews the debate about the blurred line between where coaching ends and where therapy begins.
But why are personal issues coming up when coaches are hired by companies to do executive coaching (performance improvement or development)?
Here’s a good reason — According to a Harvard Business Review (HBR) survey of 140 leading coaches, even though organizations don’t hire coaches to deal with personal problems or issues in the lives of their executives, 76 percent of the time when an executive coach is engaged, personal issues are also addressed (Coutu & Kauffman, 2009).
That is a staggering percentage!
I’ve written before about coaching and mental illness, but wanted to do a second post with new coaching guidelines from the International Coaching Federation. I also wanted to include some statistics about the prevalence of mental illness among U.S. adults in the workplace.
International Coaching Federation – Referral Guidelines The International Coaching Federation (ICF) is quite clear in its guidelines to coaches about when and how to refer a coaching client to therapy (Hullinger & DiGirolamo, 2018). There’s a white paper as well as a one page reference sheet explaining why, when, how to refer, and even signs for referral.
The ICF guidelines for referral talked about the importance of coaches staying within their scope of work and within their level/area of expertise. “A mental health professional is equipped to diagnose and help the individual develop coping skills to manage deep emotions related to difficult situations” (Hullinger & DiGirolamo, 2018, p. 4-5).
Distinction between Coaching and Therapy “Coaching focuses on visioning, success, the present, and moving into the future. Therapy emphasizes psychopathology, emotions, and the past in order to understand the present. The purpose of coaching is frequently about performance improvement, learning, or development in some area of life while therapy often dives into deep-seated emotional issues to work on personal healing or trauma recovery. Coaching tends to work with well-functioning individuals whereas therapy work tends to be for individuals with some level of dysfunction or disorder” (Hullinger & DiGirolamo, 2018, p. 6).
When Clients Need Counseling and Not Coaching In a Harvard Business Review (HBR) survey of 140 leading coaches, Coutu and Kauffman (2009) found that although companies don’t hire coaches to address personal issues in executives’ lives, “more often than not, personal matters creep in.” They discovered that 76 percent of the time when an executive coach is engaged, personal issues are also addressed.
Similarly, in the same HBR article, Anthony Grant (a coaching psychologist and professor at the University of Sydney) shared that studies conducted by the University of Sydney have found that between 25% and 50% of those seeking coaching have clinically significant levels of anxiety, stress, or depression.
Dr. Grant wrote: “I’m not suggesting that most executives who engage coaches have mental health disorders. But some might, and coaching those who have unrecognized mental health problems can be counterproductive and even dangerous. The vast majority of executives are unlikely to ask for treatment or therapy and may even be unaware that they have problems requiring it. That’s worrisome because contrary to popular belief, it’s not always easy to recognize depression or anxiety without proper training. . . .Given that some executives will have mental health problems, firms should require that coaches have some training in mental health issues – for example, an understanding of when to refer clients to professional therapists for help.”
Harder, Wagner, and Rash (2014), wrote that workplace depression is under-diagnosed. One reason might be because of the fear or stigma associated with mental illnesses. The workplace prevalence of depression is estimated at 9-11%, yet only approximately 2% of employees receive diagnosis and treatment. Despite this data being more than 20 years old, it speaks to the worrisome problem of a mental illness not being diagnosed and treated.
Mental Illness Prevalence and Treatment According to a United States National Survey on Drug Use and Health, in 2018, approximately 47.6 million adults aged 18 or older had any mental illness (AMI)* in the past year. This number represents 19.1 percent of U.S. adults. *[AMI is defined as having any mental, behavioral, or emotional disorder in the past year that met DSM-IV criteria (excluding developmental disorders and SUDs [substance use disorders (alcohol or illicit drugs)].
Among the 47.6 million adults in 2018 with AMI, fewer than half (20.6 million, or 43.3 percent) received mental health services in the past year!
Depression Prevalence and Treatment Of the 17.7 million adults aged 18 or older in 2018 who had a past year major depressive episode (MDE), 64.8 percent (or 11.5 million adults) received treatment for depression, but 35.2 percent (or 6.2 million adults) did not receive treatment for depression.
Depression in the Workplace One study estimates that 6.4% of working U.S. adults have depression in a given year (Kessler et al., 2006).
Recognize & Remember Your Limitations It is absolutely imperative that coaches acknowledge their limitations and lack of training and expertise in dealing with mental health issues.
Recognize When Clients Need Counseling “[C]oaches [must] recognize and know how to manage a client who shows up with a mental health issue that goes outside the scope of coaching. . . .Some clients who seek coaching may exhibit severe mental health problems that need to be addressed in therapy, sometimes referred to as counseling. Coaches need to be aware of their limits and recognize when a client needs more than what coaching can provide” (Hullinger & DiGirolamo, 2018, p. 4).
Recognize When to Refer to Mental Health Professionals “Common issues that warrant a referral to therapy include anxiety, depression, eating disorders, post-traumatic stress (PTSD), substance abuse, suicidal ideation, and thought disorders” (Hullinger & DiGirolamo, 2018, p. 11).
Written By: Steve Nguyen, Ph.D. Organizational & Leadership Development Leader
Bindley, K. (2019, September 20). Executive Coach or Therapist? It’s Getting Harder to Tell the Difference. Wall Street Journal. https://www.wsj.com/articles/executive-coach-or-therapist-its-getting-harder-to-tell-the-difference-11568971811
Coutu, D., & Kauffman, C. (2009, January). What Can Coaches Do for You? Harvard Business Review. https://hbr.org/2009/01/what-can-coaches-do-for-you
Harder, H. G., Wagner, S. L., & Rash, J. A. (2014). Mental Illness in the Workplace. Gower.
Hullinger, A. M. and DiGirolamo, J. A. (2018). Referring a client to therapy: A set of guidelines. International Coaching Federation. https://coachingfederation.org/app/uploads/2021/02/Therapy-White-Paper.pdf
Kessler, R. C., Akiskal, H. S., Ames, M., Birnbaum, H., Greenberg, P., Hirschfeld, R. M., … Wang, P. S. (2006). Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. The American journal of psychiatry, 163(9), 1561–1568.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2019, August). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf