Therapy, Counseling, or Coaching?
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The Differences between Coaching, Mental Health Counseling, and Therapy.

By David Joel Miller, MS, Licensed Therapist & Counselor.

There are some significant differences between coaching, counseling, and therapy.

Therapists, along with clinical psychologists and social workers, all need to be licensed and can diagnose mental illnesses. As a result, they can bill insurance when someone has a diagnosable mental or emotional illness. Mental health counselors, or clinical counselors, as they are called in California, fall into this category. There are other types of counselors who may or may not be licensed but who do not diagnose or treat mental illness.

Coaches can have virtually any training or function. There’s a world of difference between coaching an athletic team, coaching a business executive to be more productive, or coaching someone through the process of discovering life’s meaning and purpose. While there are programs for training and credentialing some types of coaches, anyone who wants to describe themselves as a life or self-improvement coach can do so.

In the interest of full disclosure, I am licensed in California as a Marriage and Family Therapist and as a Professional Clinical Counselor. I’ve also completed a training to become a certified life coach.

Most mental illnesses are defined by their symptoms.

The process of diagnosing most mental illnesses involves counting up the number of mental, emotional, or behavioral symptoms the client experiences. There are a few exceptions, but generally, there is no requirement to discover the cause of the illness. Depression, for example, can be endogenous within the person and have no specific cause, or it can be reactive depression in which some particular life circumstance or problem has affected the client excessively.

For a group of symptoms to be defined as a mental illness, it must impair occupational functioning, social functioning, cause subjective distress, or impair another important area of functioning. Deciding if something is an impairment may be the judgment of the treating professional, or it may be because the client defines it as an impairment.

Problems of living aren’t always mental illnesses.

Towards the back of the Diagnostic and Statistical Manual Of Mental Disorders (DSM-5–TR) or a list of problems that may be affecting someone’s mental health but which are not specifically considered a mental illness. These can include such things as low income, failed school examinations, other housing problem, phase of life problem, problem related to living alone, parent-child relational problems, partner relational problems, and so on. Some people struggle with these problems without developing the symptoms of a serious mental illness, while other people may become severely depressed, anxious, or develop some other mental illness.

Some problems are treated by both therapists and coaches.

Many of these problems of living may be covered by a company’s employee assistance program. People with these issues are referred to licensed practitioners. Marriage and family therapists frequently work with couples or families. There are also frequent “couples relationship boot camps” or marriage encounter seminars conducted by coaches or even volunteers.

Therapists and coaches both use interventions.

Therapists, in their training, develop a theoretical orientation which tells them what they think caused the problem and, therefore, how they should go about correcting it. The corrective part involves using interventions.

A therapist might work on self-esteem issues to help the client with severe major depressive disorder. The coach might work on those very same self-esteem issues to help someone become more assertive at work or better able to conduct work-related trainings or seminars.

Two people might both have low-paid jobs and wish they had better career prospects. One might become seriously depressed and unable to get out of bed to go to work because of their working conditions. As a result, they have developed major depressive disorder.

The other might seek help from a coach to develop a career search strategy to take them to a better-paying job. There is a specialty among mental health counselors called “career counseling,” but many life coaches also spend time focused on developing a plan to help the client to land their ideal job.

The difference is not the intervention but the problem being addressed.

Treatment of mental illness doesn’t mean you will have a happy, productive life.

Mental health professionals often treat a client until the symptoms of depression or anxiety a reduced to the point that they no longer interfere with the client’s jobs, friendships, or keep the client from doing other things they would like to do. Once those symptoms are reduced and the client no longer meets the criteria for the illness, the treating therapist or mental health counselor can no longer bill medical insurance for treatment. There can be some benefits to continuing to work with the client even after symptoms disappear in order to build sufficient skills to prevent a relapse into depression or anxiety. Keeping a client out of the psychiatric hospital can be a legitimate goal of treatment even if the client no longer has enough symptoms to meet the full criterion for a particular mental illness.

Does David Joel Miller see clients for counseling and coaching?

Yes, I do. I can see private pay clients if they live in California, where I am licensed. If you’re interested in information about that, please email me or use the contact me form.

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