“Are you analyzing me?”
Psychiatrists become acclimated to this question being launched by anyone to whom we are brave enough to disclose our occupation. Mental health stigma persists, and psychiatrist jokes are part of that legacy. All humor holds some truth, and this joke reflects discomfort around the mystique of psychiatry. How does it actually work? What do psychiatrists actually do to heal people? How do you know when a psychiatrist is assessing the inner workings of your mind or just holding a casual conversation? My response is usually to laugh and then provide reassurance that I am not on the clock and don’t practice my profession in social settings any more than an architect would walk down the street redesigning every building they pass. It is not hard to prove you don’t have a doctor-patient relationship with friends and colleagues. Most people accept my explanation with relief, and we move on. Physicians don’t accidentally provide health care to people outside of a treatment setting.
In my work as a physician leadership coach, the question launched is, “Is there a difference between coaching and therapy?” The answer is a resounding yes. Simply put, coaching is a process of self-exploration focused on personal and professional goals, growth, and performance. Psychiatric treatment is health care offered to those in need of mental health treatment. Coaching is not health care. When someone benefits from psychiatric treatment, I recommend mental health treatment before they begin a coaching journey.
Therapy and coaching do have some similarities; both involve deep, empathic listening with the goal of self-exploration. Both involve talking as a way of connecting, gathering information, and problem-solving as a team. Both involve a focus on the future and success. Both may be sought out by people looking to address challenges. However, therapy is for mental health conditions, and coaching is for personal and professional growth. Coaching should not be used as an entree to therapy and should not be started until someone is in stable health. Therapy and coaching are separate interventions for separate challenges.
Most coaching sessions are structured or semi-structured meetings in which the coach partners with their client to identify a topic of concern and outcome goals. Clients are encouraged to conceptualize the change they want and the steps needed to make those changes. The meeting may be 30 to 45 minutes or longer in some cases. Client topics can range from personal growth — “How do I better manage my time?” “How do I create more balance in my life?” — to professional skills: “How do I more effectively communicate with my team?” “How do I work to resolve conflict in my department?” Some people enter coaching to explore a transition like moving into a leadership role, changing organizations, or planning for retirement. Coaching allows clients to create the time and space to explore areas for growth and opportunity with support from their coach. It provides a way to help you move forward with intention in your life and career.
Partnering with a psychiatrist coach could lead some physicians to question the exact nature of the service being offered. For this reason, each coaching client signs a coaching agreement defining the relationship between coach and client and clarifying that boundary. My psychiatric training helps me guide coaching clients to gain insight, confront patterns in need of change and overcome perceived barriers to success. My experience informs my coaching, and the focus is different than when practicing psychiatry in an office — just as a surgeon’s experience may aid them in being an adept sculptor outside of the operating room. The skills relate, but the practice is different. Coaching enriches the lives of clients as a highly-personalized process leading to insight, broadened perspective, professional development, and life satisfaction. It leads the client to analyze oneself.
Wendy Cohen is a psychiatrist and physician coach.
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