Where Therapy and Coaching Overlap, and Where They Do Not

Oct 26, 2020

coaching , work

Psychotherapist Leanne Hoffman soon realised that her therapeutic skills could be effectively used in her work as a coach
Here she explains how they complement one another, and the kinds of difficulties coaching is more suitable for
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I started out my career in HR, training and development. After a number of years, I knew that I wanted to focus more on one-to-one work and to really get hold of some of the things that got in the way of people performing. And of course, to do the same for myself. So, I retrained as a psychodynamic psychotherapist whilst continuing to work part-time.

Sometimes I felt a bit of a tension; what worked best, did people or I benefit more from therapy or coaching? The answer can obviously never be that simple and of course both have their place; some people have a preference, and others like myself have received (and practice) as both. The famous quote by Socrates “The unexamined life is not worth living” is something that both coaching and therapy address.

Five years ago, I set up HealthyMinds@Work with two friends who were also psychotherapists. We were becoming increasingly aware that some of the insights and tools that we covered in therapy would be of real use in organisations. We saw that in therapy, a lot of the time was spent thinking about struggles with work, managers and group dynamics. We felt that there could be effective ways of preventing some of these issues landing in therapy when things had been allowed to become chronic; we wanted to take therapeutic ideas out to a wider audience.

This led us to blend a psychodynamic approach into coaching and supervision and we now work in this way with safeguarders, head teachers, teachers, and leaders in a variety of not for profit and commercial settings.

How coaching differs from therapy

Coaching in comparison to therapy is a structured conversation where the coach helps the coachee set goals, explore what is currently happening, think about options or barriers or better ways of doing things, and action plan what needs to be done. It relies on the coachee taking responsibility for this form of problem solving. The results can be profound.

One client I have been working with for five years has grown their profit five times and tripled their employees. In the coaching sessions we worked together on the following areas to support the expansion of the company and ensure she did not get burnt out: leading a team, restructuring and increasing personnel, setting challenging goals for the business, creating a culture to increase profit, moral, retention and ownership.

Why therapists can make good coaches

I think therapists can make exceedingly good coaches! We have transferable skills around listening, showing empathy, asking really good questions, helping people reflect and make sense of their worlds, challenging thinking and decisions, and providing new perspectives. In addition to this many, if not all, issues at work have an emotional component, and therapists are used to helping people build awareness of their emotional responses, make sense of them and manage them better.

In organisations there is a greater demand for leaders to have emotional intelligence, and the training that therapists receive puts them in a unique place to do this as coaches. In addition, working with a psychodynamic approach further helps people explore group dynamics, what they bring to relationships, how their former ways of relating impact relationships and group working. They examine even more about themselves and how they work with others.

Case study (fictionalised)

Nita is overworked, stressed by the pressures of too much work. She is often told by her fellow colleagues that she needs to get a better work life balance though Nita loves spending time at work and this is her focus.

In the initial session with Nita I get her to use the Wheel of Life tool to work out what segments of her life are important, how happy she is with each of these, what are her priorities, what makes her happy and productive and needs to be in place to perform well. We also go through a number of questions to get Nita to reflect on her career to date, what she wants in terms of her career and what she wants to achieve through the coaching.

In coaching it is important to start with SMART goals that can be measured, something that I do in a much looser way in therapy!

In the second session we work through the Wheel of Life, creating an action plan of what Nita wants to do to set boundaries, fill her tank of resilience and design her work life balance. Nita wants to be as productive and effective in her job, not get burnt out but is keen for work to be the priority.

In the third session we tackle Nita’s stress at work. I take Nita through the GROW model (see below) plus introduce a cognitive behavioural therapeutic tool, the ACB model. The questions below are the coaching questions I would ask the coachee:

Set goals

What are your goals for this session or for managing your stress better? e.g. I want to sleep better, not overeat as result of stress, learn what makes me stressed and how to reduce my stress.

Explore current reality

What is currently happening at the moment?
What have you tried?
What are the challenges?
What is working?

At this point I then take Nita through the ACB therapeutic tool (see below) that helps to understand and reframe the inner dialogue that causes the triggering of stress chemicals. Included in this is some psychoeducation around the amygdala (alarm bell system), and the neo cortex (rational brain), what causes us to feel stressed, our inner critical dialogue, and errors in thinking (e.g. catastrophising) that cause us to feel stressed.

We discuss how Nita’s relationship with her manager often causes stress as she feels she is not living up to her manager’s demanding expectations. We discuss what her manager may be a “stand in” for and Nita can reflect that this is often what happens with other managers and may be related to her relationship with her mother. At this point I do not dig deeper and let Nita come to some conclusions about what meaning she takes from this. I ask Nita ways that she could set clearer expectations upfront to avoid this pattern of feeling that she disappoints.

ACB therapeutic tool

Activating event: What is the activating event that triggered you to feel stressed?

Consequences: What are the consequences of the activating event i.e. what physical, emotional and behavioural responses do you have when emotionally triggered or stressed?

Beliefs: What are the assumptions and beliefs that you are telling yourself that cause you to release the stress chemicals?

Rescript: How can you rescript your beliefs (your inner critical voice) to provide more realistic data and avoid telling yourself things that will cause you to go into fight/flight or freeze mode?

Generate Options

After exploring what is currently going on for Nita and providing some psychoeducational input on stress, Nita then thinks about all the options that will help her better manage her stress.

The way forward

Nita now thinks about what she is going to do and by when. I ask if there are any barriers that will get in the way. We check how motivated she is to complete her actions to ensure she is committed to doing them.

As you can see, coaching is much more active, focused on problem solving and relies on the person’s functioning part. If they are suffering from depression or other more moderate to serious mental health issues coaching may not help.

Atul Gwande, a well-known surgeon, public speaker, policy maker and journalist has presented a TED talk on the benefits of a coach. He quotes Itzhak Perlman, a world-class violinist who he interviews, who says, “Why me I always had a coach” and Atul shares how his coach, helped him review and improve his surgery skills even after years of practising. “It’s not how good you are now; it’s how good you’re going to be that really matters” says Gawande and he believes that this is what a coach enables.

In our world where time is poor, change seems constant and people’s jobs demand more expertise, coaching provides a useful way to develop, reflect and become more conscious, in the workplace. It may not go as deep as therapy into the whys, but it provides a structure for people to change behaviours and be more productive. When coaches are also therapists there is an added opportunity to work a bit deeper where appropriate, introduce therapeutic ideas and theories plus better understand and manage their emotional responses. This will truly deepen organisations emotional capacity.

Leanne Hoffman is a verified welldoing.org therapist and a coach in London and online