Life Coaching and the Stigma of Psychiatry

PSYCHIATRIC VIEWS ON THE NEWS

When I began my career as a psychiatrist back in the 1970s, there were many other mental health care disciplines. These included psychologists, psychiatric social workers, psychiatric nurses, and occupational therapists.

Given how community mental health care in the 1960s focused on underserved people from poor and minority communities, paraprofessional staff often came from the same culture as their patients and were therefore able to appreciate their particular values. Some of them became case managers. Occasionally, others were patients or ex-patients who eventually became peer specialists.

My interest in the benefits and problems of these overlapping disciplines led to a book that I edited, A Clinician's Manual on Mental Health Care: A Multidisciplinary Approach (Addison-Wesley, 1982). Pulling it out recently, I noticed that not only did it include chapters on the major mental health care disciplines, but also on psychodrama, art therapy, dance therapy, and music therapy-these modalities are less prominent today as a result of cost-cutting. The book does not mention life coaching.

Supportive psychotherapy
One of the overlapping skills these disciplines required was supportive psychotherapy. In contrast to insight-oriented, psychodynamic psychotherapy, supportive psychotherapy did not try to examine underlying conflicts that contributed to symptoms. Rather, it emphasized a casual and conversational interaction that focused on everyday life. The therapist could provide realistic praise, advice, guidance, and, at times, confrontation.

Supportive psychotherapy was most commonly provided for persons with severe and chronic mental illness in order to help such patients develop, or re-develop, life skills in relationships, work, and daily living. It was sometimes thought to be “second-rate” psychotherapy, especially compared with psychodynamic psychotherapy.

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Life coaching
Life coaching is a relatively new concept. Informally, coaching has probably been around since humanity began, in the sense that someone with more life experience helped another person develop their skills and capabilities. Of course, sports coaches have been around for a century or more.

General life coaches, though, developed very rapidly in the mid 1990s, after an economic downturn in the US. As businesses provided less training and jobs did not last as long, life coaches emerged to fill the gap. Curiously, mental health care services were available, but perhaps those seeking help felt stigmatized for therapy that seemed to address the normal challenges of life. Coaching focused on positive psychology rather than mental dysfunction.

This rapid growth has produced criticism about poor training and lack of accountability in some coaches, but that has also led to endeavors to provide more professional standards and training, such as the International Coach Federation and the International Coaching Association.

Fees and incomes vary, but they can rival that of psychiatrists. There is often a complimentary consultation followed by sessions of varying length and means of communication (eg, email support, phone calls, texting).

Life coaching incorporates tools from other disciplines, including psychology, sociology, and neuroscience, but it is not considered to be a medical discipline. Because it is outside the realm of health care, there is no insurance coverage and no managed care.

Akin to supportive psychotherapists, coaches use a range of communication skills-listening, restatements, and clarifications, for instance-to help clients shift their perspective and develop life skills. The process is much more one of questioning than providing advice. Homework is common. A positive coaching relationship is crucial.

I have seen the importance of life coaching both in my social and professional networks. For example, despite years of on and off psychotherapy, a young male reached an impasse and could not correct his misperceptions. An older male with ADHD was helped by medication, but he still needs guidance on how to refocus and direct his attention.

A psychiatrist colleague recently retired but he turned to coaching as a second career because it emphasized the relationship he had valued most in his work as a psychiatrist. As an example, he finds that coaching is particularly relevant for dieting and exercise needed to reduce obesity. A late-career psychologist switched more and more to coaching techniques. Those who have had mental health care training can add depth to coaching that others may not be able to obtain.

Coaching in psychiatry
Why has coaching become so popular and psychiatry so criticized? Why is burnout seemingly rare in coaches but well over 40% in psychiatrists?

• Coaching does not seem to be stigmatized

• Time and availability of coaches is generous

• Coaching taps into inner resources.

Coaching should have been a wake-up call to us long ago. But it is not too late. Here is what we can do right away:

• Hire them into our systems
• Use them as consultants

• Develop mutual referral mechanisms and relationships with qualified coaches

• Incorporate coaching skills into our own individual practices

• Coaching can become one of the core skills of peer specialists

• Supportive psychotherapy can be reframed and renamed as coaching

Eventually, a subspecialty of “psychiatrist coaching” could emerge. Who knows, maybe our professional associations should hire coaches to help us make our field less stigmatized.