Professional coaching can contribute to personal growth and development by providing encouragement and support using a handful of simple techniques designed for deepening exploration in a co-created working relationship. Focuses can be wide ranging and include development and clarification of goals, refining communication, boundary setting, and conflict management skills. A coaching stance typically seeks improved performance, for example increased efficiencies at work or navigating executive function more effectively. It can help in defining career goals including career change. It also seeks to find and develop excellence among employees and refine or develop leadership skills. It is an approach geared towards self-improvement and relies on directed supportive inquiry, sometimes borrowing techniques from evidence-based therapeutic approaches, for example cognitive behavioral therapy (CBT), rational emotive behavioral therapy (REBT), and dialectical behavioral therapy (DBT). While this seems productive on the surface (who does not potentially benefit from a reframe of distorted thinking?), there are some well-defined elements of a therapeutic stance that are not incorporated into coaching training, and this can matter.
While coaching is prohibited from working with formal medical diagnoses, it is also limited by a stance geared towards improvement without understanding implicit drivers of behavior and decision making. This is a skill set specifically developed in psychotherapy training and underpins success achieved with techniques commonly employed in CBT. Research has shown it is the relationship within which reframe is delivered that leads to durable change. This is partly why using psychotherapeutic frameworks without the requisite training in therapy can sometimes fall flat or even worse invalidate an individual’s perspective and experiences. Furthermore, psychotherapists are trained to recognize when and how a misapplied intervention has potential to be harmful and how to engage appropriate repair when this does occur. This means acknowledging the client’s feelings and clinician contribution instead of letting someone stew in anger, disappointment, or self-doubt. This is important because many people seeking the services of both coaching and psychotherapy struggle with self-confidence, self-doubt, and a lack of self-efficacy. These exchanges, if not addressed, risk contributing to rather than ameliorating the very problem for which help is sought. Some psychotherapy training also focuses on effectively navigating impacts of the clinician’s own internal emotional responses using this information to better understand the client. Attunement to one’s own emotional responses is critical to preventing harm. Some exchanges with a client can elicit residua of the past, and these must be recognized and addressed to help those entrusting their care to the process. When a client decides to engage in self-destructive behavior despite work with the clinician, it may be tempting to interpret this as an affront to one’s knowledge and training. This risks a divisive or punitive reaction rather than a stance that serves to support and better understand. Emphasizing the ethics of guidance rather than directives helps to create a platform for curiosity about one’s feelings rather than a thoughtless reaction. Self-awareness is an ongoing task in a relationship dedicated to fostering someone’s own self-efficacy.
It is a given that people presenting for psychotherapy come with vulnerability, often seeking help as a last resort, sometimes feeling like a failure or feeling apprehensive and profoundly discouraged. Coaching clients can also reach out in desperation, seeking answers to a problem they have not been able to resolve on their own. While there is robust conversation around the strength it takes to recognize and reach out for help, common stigma still widely perceives this as a so-called sign of weakness rather than an intelligent assessment and plan of action. Psychotherapists are acutely aware of the range of feelings that accompany reaching out, whether for therapy or for coaching.
Because of the nature of the work, trained and licensed psychotherapists are bound by a code of ethics, rules, regulations, and laws, all of which are integrated into core curricula and emphasized throughout education, training, and supervision. This preparation reflects an understanding of the particular vulnerability that people bring to therapy seeking assistance for problems they have long struggled with, usually having frustrated all other options. Therapists are acutely aware that it can be difficult to bring intimate problems to a stranger. Furthermore, a unifying stance of psychotherapy regardless of theoretical framework is beneficence towards the client. This is one of six foundational principles protecting and guiding the working relationship of therapy. In other words, it is a mandate to prioritize client well-being, and this informs decision making with each considered intervention. This also contributes to a stance of humility in the work while at the same time offering a unique expertise. Supervision, mentoring, and often the psychotherapist’s own therapy support this stance, working to recognize interactions which risk negatively impacting the client. For example, when a client expresses anger or distrust directed at the therapy process or the therapist, great care must be taken to contain one’s own feelings and use them as guidance to consider the client’s experience and the best intervention. It is the therapist’s job to harness internal experience to benefit the client. Sometimes this is simple, but when a client accidentally (or deliberately) pokes at a clinician’s sensitivity it can be more challenging. It is still, however, an ethical obligation and where education, training, supervision, and consultation function as safeguards. Containing feelings arising in the therapy room requires an exquisitely fine-tuned barometer for one’s own feelings: Where are they coming from, what meaning do they hold, are they client-valanced or one’s own past experiences showing up to potentially interfere (countertransference)? Maintaining a therapist stance of curiosity for the range of feelings arising between two (or more) people requires discipline. It also underpins the need for consistent care of one’s own emotional sphere in service of client understanding and growth. A concrete example might be a client who has been afraid to show anger comes in and expresses irritation that the clinician is a few minutes late. In this kind of working relationship, noticing and validating those feelings is important. Even more important, however, is paying particular attention after that exchange when relational expectations and assumptions come into play. Management of this is sometimes referred to as a corrective emotional experience and serves to gradually extinguish learned expectations.
To be of service, a primary task is to understand the perspective of the client, and this is where a lot of the quiet, internal work of the therapist happens. Therapist silence is not passive; it is an active process of identifying relational assumptions, considering themes, what something might mean in particular to an individual, identifying stories imposed upon the client at an early age or during times of stress or trauma (you were such a difficult child it was your fault we got divorced; if you were smarter you would be more successful; you have to be perfect to be loved; if you are angry I will abandon you). Silence is an act of recognizing and containing feelings and deciding how and when to best intervene. Quiet also creates space for tolerating uncertainty, which can be generative. Instead of waiting for a solution delivered from the outside, there is room for the recipient of silence to consider what might be important, sit with feelings, and consider how these may inform choices and possible decisions. This also creates opportunity to tolerate ambiguity or uncertainty and for someone to make their own connections between assumptions and earlier experiences in relationship (I never realized, I do that because I was always the one keeping peace when my parents fought). A therapist might guide an exploration to that end or make suggestions and hold silence while the client feels, reflects, and considers. This is a unique environment, a protected time and space with a professional trained to help you understand, connect with, and trust your own intuition. All of this strives for behavioral change reflecting a deeply felt sense that the individual is in fact the best determinant of future goals.
All of this is to say, learned skills can make an enormous difference in someone’s life, and coaching can be very effective in this realm. Defining goals, developing efficiency strategies, sharing encouragement and support, tips, and tools are all part of this defined working relationship. A caveat is that techniques of CBT can easily be misfired by a coach who has not done the internal work of understanding your unique sensibilities and situation. So, if in working with a coach you find yourself feeling invalidated, more unsure, insecure, or frustrated, know that this is not your personal shortcoming, and it probably is not deliberate; it is truly a reflection of the limitations of the technique.
Maire Daugharty is an anesthesiologist who expanded her expertise by earning a master’s degree in clinical mental health counseling, merging her long-standing interest in mental health with her medical background. As a licensed professional counselor, licensed addiction counselor, and licensed marriage and family therapist, she brings a well-rounded perspective to her private practice, where she works with adult individuals and couples on a wide range of concerns. In addition to her counseling practice, she continues to work part-time as an anesthesiologist and has a deep understanding of the unique challenges faced by clinicians in today’s medical landscape. To learn more about her practice, visit Physician Vitality Services.
