“Sarah, you market yourself as offering all three! What’s the deal? Aren’t these all basically the same thing?”
So glad you’re curious about this! I’m happy to break down the differences in these services and the professional behind the services. This will be an informative article for ANYONE seeking transformational change in themselves, their circumstances, their career or job, or their relationships, and looking to hire a therapist, coach, or consultant to help them.
Counseling/Therapy/Psychotherapy—all interchangeable terms
Let’s actually start with Counseling, or therapy, or psychotherapy, or mental health treatment. One of the most significant differences between counseling/therapy and coaching or consulting is this: Counselors and Therapists are required to have specialized education and training, as well as, licensure in their respective states. What specific education, training, and licensure?
EDUCATION
First, a Bachelor’s degree in science, human science, or life science field (LMFT usually doesn’t specify what kind of Bachelor’s degree is needed). Next, depending on profession, this could be obtaining a Master’s degree as the finite degree for legal practice, or this could be a PhD degree as the finite degree for legal practice. What does this mean? Well, for Licensed Professional Counselors (LPC), Licensed Clinical Social Workers (LCSW, LCSW-C, LISW) and Licensed Marriage and Family Therapists (LMFT), obtaining a Master’s degree is the highest degree needed to then participate in the next steps towards clinical licensure and then permitted to provide treatment to individuals independently. For Clinical Psychologists (who can provide two distinct services: therapy, as well as, facilitate and interpret psychological testing) are required to obtain a PhD (Doctorate of Philosophy in Psychology) and licensure to clinically practice. Licensure is not necessarily needed for providing education or doing research. Did I mention that for ANY of these professions, your finite degree HAS to come from an accredited university or school, with specific curriculum guidelines of the course material that is required to move on to obtaining clinical licensure, and internship and/or practicum hours (often, unpaid and part of graduate coursework and training) to demonstrate applied knowledge before granting a person a degree. Okay, that’s JUST the education part.
SUPERVISED WORK EXPERIENCE
After higher education, comes real live world work experience. And lots of it. Paid. After you get hired somewhere. Clinical Social Work Licensure candidates (in Virginia), for example, are required to complete 3000 hours of direct clinical work while under the supervision of another Licensed Clinical Social Worker who has also passed necessary requirements (governed by each state separately) to be able to provide adequate supervision to a licensure candidate. Are you seeing the trend yet? Regs, regs, regs (a.k.a regulations to boot)! Now 3000 is the number of hours of WORK you need to do (by the way, 3000 done ‘straight through’ is no less than 2 years of fulltime, employed, paid work), and 100 hours of face-to-face supervision (which is usually an out-of-pocket cost to the licensure candidate; after undergrad school, grad school, now we have to pay for supervision to get licensed, this can run anywhere from $50/hour to $200/hour or more depending on where you live).
EXAM & CONTINUING EDUCATION
Now, after we have all the degrees, completed the unpaid internship, completed the 2 years of work, completed the hours for supervision and paid for those, we get to apply to take the exam. There is a fee to apply to take the exam and a fee to take the exam. If you want to take a practice exam, that has a fee, too. Once the exam is passed (and examination is different in every state for Social Workers, zero universality in the curriculum at graduate schools, work/supervision requirements, and examination) the state you live in has now granted you (The newly Licensed Clinical Social Worker) legal permission to provide mental health treatment privately to citizens in the community, without direct oversight from anyone else, except the Board. Hooray! Now you are a therapist. After this, there are continuing education requirements to keep your license active and in good standing (and fees paid every year for renewal), allowing you to keep practicing. For Virginia, this is 30 hours of education every 2 years, 6 hours are required in ethics. However, every state is different (this is why Master’s Level Clinicians cannot practice across state lines without having a license in every state where they want to see patients). For my Maryland License, it’s 40 hours of education every 2 years, 3 required in ethics, 20 hours must be live face-to-face training/education and only 20 can be self-study, and they have a special little caveat of only allowing CEUs (continuing education units) from a specified list of approved CEU providers. Wooooof. That’s a lot of stuff. What it should tell you is: your therapist was committed, dedicated, and accomplished A LOT of things and paid A LOT of money to sit on the other side of the room to help you get well and effectively manage the symptoms of your mental health disorder.
Let’s recap with a chart:
Counseling/Therapy Requirements
Education | Bachelor's Degree | Master's Degree | Sometimes PhD degree | Accredited School | Specialized Clinical Curriculum |
Experience | 2 grad school internships | 3000 hours paid clinical work | Monitored by Licensed Clinical (100 hours) | Experience providing specific clinical services | |
Examination | Apply to site for exam w/ experience noted | Licensed Supervisor must sign off & submit hours | Schedule & Sit for exam | Get passing score | |
Oversight | After exam, apply for licensure | Pay for application + pay for License | Regulated by State Boards | Ethical standards for practice | HIPAA & Confidential/Privacy laws |
Remaining Licensed | Obtain CEUs required | Take trainings in specified areas i.e. ethics | Special requirements for accredited CEU providers | Special requirements for how the learning took place | Renewing & paying annually to remain in good standing |
Bottom line take away: To become a Counselor, or therapist, you must demonstrate applied knowledge to a higher degree independently through rigorous and specific clinical course work, through internship or practicum hours while in school, through paid work experience that is supervised by someone more senior in the field, through passing the state board examination, pay all the effing fees, and then through continually learning and applying newly found knowledge in this ever-changing healthcare field (like all healthcare fields) every single year.
WHAT ELSE ABOUT THERAPY IS DIFFERENT?
That up there was all the before-someone-sits-down-on-my-couch stuff that is required and well governed by several institutions to ensure you (the newly licensed therapist) is not causing harm to the public by not really knowing what you’re doing. We are WELL-TRAINED, folks. WELL-EDUCATED in our field. We are often FURTHER-SPECIALIZED with certifications and niche treatment modalities. We have been RIGOROUSLY TESTED and someone has SUPERVISED tons of our direct work with people to, in fact, ensure we know WTF we’re doing out there with people’s mental health. And all of us clinicians take it very seriously. We are HEALTHCARE PROVIDERS.
This last piece is significant in outlining the differences between these three professions and professional services. The absolute #1 difference between Mental Health Therapists and coaches/consultants is the ability to diagnose and treat mild up to severe mental health disorders as defined in the DSM-5 TR and ICD-10. We are trained in providing treatment to clients/patients with diagnosable and interfering symptoms of a health condition. Do we provide treatment like medication or surgery? No. But what we do is treatment, none the less. And the treatment we, licensed mental health professionals, provide the public is vital. Because we are healthcare providers, we are allowed to credential with and, therefore, submit claims to commercial and government health insurance companies, independently (Thank you to Joe Lynch and many other folks at Virginia Society of Clinical Social Work for making this a real thing here in VA for clinical social workers—this organization and its founding members lobbied and then succeeded in getting laws passed that allow LCSWs to work independently from psychiatrists, psychologists, and/or other physicians, and I am eternally grateful for their pioneering and trailblazing this for our profession).
BENEFITS FOR CLIENTS
The most significant difference for clients? Well, counseling can, and with high probability for almost every client does, go deeper into a person’s life/self. The focus with counseling, or therapy, is on healing (there’s that healthcare thing again) from either a past or current situation that is causing significant distress and dysfunction and (with good ol’ insurance regs) is considered problematic enough for the person/patient/client to warrant medically necessary intervention/treatment. And to help the patient move forward after healing.
Another example from healthcare: high blood pressure is the dysfunction a person experiences when they visit a doctor -healthcare provider- and ask for treatment recommendations to manage the symptoms and potential long-term effects of the illness if left untreated. What the doctor then does is provide (really doctors prescribe more so than provide, that’s for another day…) an intervention/treatment that is deemed medically necessary to lower, limit, or cease the dysfunction altogether, likely a blood pressure medication that lowers one’s blood pressure to a typical baseline. Problem/issue is the health condition (high blood pressure and the dangers if it goes untreated) and the solution is to be assessed and examined (sometimes with tests- like getting labs, using monitoring devices to ensure it actually IS high blood pressure and not something else; we -therapists- use tests to assess too, they’re called scales and some examples include the DAST-10, the GAD-7, the PHQ-9, and the ACES) by a healthcare provider and that provider then suggests treatment options for the patient, a.k.a take the medicine.This is exactly what therapists do with mental health dysfunction, except our methods of intervention and treatment take much longer (often) than medications, surgery/and surgery recovery, and many other medical treatments and interventions. In addition, our follow-up in between appointments is much sooner due to sensitive and debilitating symptoms clients continue to experience after treatment begins, because treatment is not as cut-and-dried as taking a medicine and then seeing a direct correlation with lower blood pressure. With mental health disorders, there are also dangers to the patient if they go untreated—especially trauma. (See: What Happened To You and Trauma: the Invisible Epidemic, riveting accounts and examples of how untreated trauma wreaks havoc on a person’s physical, physiological, and mental/psychological health). All of this is for anyone who believes therapists are not “real” healthcare providers. That is such an insulting statement. I wonder how an orthopedist would feel if the general public and others in the same professional industry claimed they weren’t “real” healthcare providers because they mostly assess and then kick patients to physical therapy (the beautiful analogous profession to mental health therapy, by the way, big love for PTs!) for the “treatment” part (unless patient needs surgery)? Yeah, I didn’t think so. And in my experience, therapists are the ONLY healthcare profession that keeps appointments running on time! We deserve some love and recognition. Especially after the work we all put in during the pandemic when everyone was losing their minds and ALL kinds of issues increased (domestic violence, child abuse, substance use and addiction, relationship problems, divorce, activations of past trauma, and on and on). Yes. We are REAL healthcare providers and the work we do with clients is significant, and we deserve credibility for our hard work to reach the point of providing treatment to clients independently.
Okay, off the soap box. That’s counseling or therapy in a nutshell. We need specific education, post-education training, and demonstration of knowledge to diagnose and treat mental health disorders.
Coaching
Right off the bat, let’s highlight the clear distinction between coaching and counseling/therapy. Coaching is not therapy, counseling, advice-giving, mental health care or treatment for substance abuse. Coaching is also not a replacement for counseling/therapy, psychiatric interventions, treatment for mental illness, recovery from abuse, professional medical advice, financial assistance or advice, legal counsel, or other professional services. So, if it’s not any of this, what is coaching exactly?
Coaching is a professional service designed to help motivate you to arrive at your own insights, ideas, and conclusions. Most coaching clients gain clarity on their barriers to reaching a goal and then how to move through those barriers to accomplish what they want. Coaching uses a solution-focused approach to help clients move forward in the areas they want to grow. Coaches do not diagnose problems or health conditions, rather, they partner with clients to determine the most pressing questions clients want to explore and then coaches create an experience for the client to arrive at their own answers based on client autonomy and empowerment to choose for themselves.The International Coaching Federation (ICF) defines it like this: “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” Wikipedia defines it like this: “Form of development in which an experienced person, called a coach, supports a learner or client in achieving a specific personal or professional goal by providing training and guidance.” And both of these are great definitions of what coaching is and how it can help someone.
BENEFITS FOR CLIENTS
How is coaching helpful to someone in different ways than counseling is helpful to someone? Coaching can benefit clients by creating space for them to move forward in the area of their choice. Certified coaches are skilled at co-creating pathways toward improved capacity for wellbeing, productivity, and goal attainment, either in professional or personal life. Coaching can help people improve in business, parenting, relationships, health, finances, and many other areas. Counseling, on the other hand, is beneficial to clients by creating a trusted and safe space for healing (the healthcare thing, psychological dysfunction and deep emotional wounds). Licensed counselors are skilled at sitting with difficult and intense emotions and emotional expression. They are well versed in the process of finding relief from various forms of emotional disruption. Another key distinction is that counseling has a longer history. It follows the medical model and therefore, is a profession and service based on scientifically and empirically tested methods of intervention and treatment, and these findings have been validated and replicated over and over again. The International Coaching Federation is exceptionally mindful of creating a delineation between coaching and counseling. The organization strictly outlines credentialing to avoid a coach performing counseling instead of coaching. No coach should ever provide unlicensed counseling, and good training will allow the coach to know the difference. While coaching can be therapeutic, it is not therapy. Every person should be made aware of this. And in my trauma-informed training and practice, I find transparency to be an important piece of trauma-informed care, trauma-informed business practices, and trauma-responsive communication. The more you know, the better you can make a healthy choice for yourself in choosing a provider to assist you.
COACHING GUIDELINES
Some other key factors and differences in coaching. 1) Agreements for working together-Coaching agreements are stricter in some ways than for counseling/psychotherapy agreements. This mainly occurs due to counseling regulations falling in line with the medical model, and the agreement between therapist and client is implied through this model, health insurance contract regulations, and the ethical obligations of the therapist as is monitored by the state licensing Board. (As I mentioned earlier, a lot of regs, and a lot of oversight so that we, therapists, do not cause harm to clients—the age-old healthcare ethical standard of ‘do no harm’). 2) Confidentiality and Privacy- Therapists inherently hold confidentiality and other parts that also appear in a coaching agreement as a part of their practice. Coaches have to include their personal values and business expectations in their coaching agreement to protect themselves and their clients. Another essential distinction between counseling and coaching is the expectation of privacy. Although, ethically, coaches are expected to maintain confidentiality for their clients, under the law, conversations could be compelled by a governing body—meaning court systems, attorneys etc. have full right to request records for coaching clients or ask the coach to provide information, and there is no law protecting the coaching client from having this confidential information exposed or used in a court proceeding. The law, however, does protect a therapy client; and legal entities and governing bodies cannot compel a counselor’s conversations with a patient—meaning the only way confidential information can be obtained from the records of a therapy/counseling client is through court-ordered subpoena (and even this can be quashed—which means a subpoena can be suppressed/avoided to protect client’s privacy if deemed necessary and appropriate). Coaching clients have no protection in the eyes of the law in terms of privacy and confidentiality, although it’s good and expected practice of coaches to maintain a client’s privacy, it’s important to note it cannot be guaranteed. 3) Self-Disclosure-There can be, and often there is, a higher level of self-disclosure in coaching; and a higher level of self-disclosure is permissible in coaching guidelines, not so much with therapy. Dual relationships in counseling, such as meeting with a client for coffee or in a non-private space, are inappropriate and not permissible via Board regs (Hart, Blattner, & Leipsic, 2001), but coaching relationships can often overlap, where coaches can provide services to friends, neighbors, whomever, without restriction. The protection of boundaries for a therapist is essential and is expected under licensing regulations. These boundaries are in place to protect both client and counselor in a therapeutic setting, as we’ve already discussed, due to the intense and sensitive nature of psychotherapy treatment.
It’s important to note here: There is a higher burnout rate among therapists than coaches due to emotional exhaustion and heightened levels of stress. Therapists are containers for clients/patients most difficult symptoms, thoughts, feelings, and reactions as they move towards healing. Because providing psychotherapy involves intense emotions, a therapist’s resilience is regularly tested. More acute and/or higher risk client populations affects the level of stress, as well as, agency structure, patient caseload, and amount of support a clinician is getting from supervisors. There are life-threatening scenarios sometimes involved in counseling, which can also clearly compound the level of stress.COLLABORATION OVER AUTHORITY
Since coaching is not focused on psychological and emotional healing, there is less wear and tear on the coach. Also, coaching is designed to really put the client in the driver seat, with the client determining the goal they want to achieve and the client demonstrating a high level of motivation to work towards the change they want to see. Therapists are required to assess, monitor, and address symptoms of mental health diagnoses and disorders, which leaves therapists (and all other healthcare providers) at least slightly in the ‘one-up’ position from clients—meaning therapists carry a slight authority over clients. *Side note* I do my very best to collaborate with therapy clients and reduce the gap of authority, allowing and promoting autonomy with clients (by the way, this is also in the Social Work ethical code), while being mindful to ‘do my job’ which requires some directing and intervening for a client’s well-being and health. Coaching is getting out of your own way to achieve something in the future; Counseling is getting the past out of the way from impacting the present so healing and return to normal functioning can be achieved.
*Disclaimer* There are no governing bodies or regulations for coaching services: anyone, anywhere, for anything can provide coaching services. Coaches can obtain certifications (through organizations like ICF and Beautiful You Coaching), and this gives them more credibility than coaches without any certifications for coaching, however the certification requirements vary by which organization is offering coaching certifications, which further highlights the “wild-west” nature of the coaching industry. It’s important for folks to be aware that just because a coach sounds really awesome and says they will provide you with needed solutions, do your due diligence in vetting your preferred coach for yourself. Many coaching scams happen out there. And many coaches are not legit. Coaches without certifications that are, or were formally, licensed mental health clinicians, carry more credibility due to the training they received and the oversight from licensing boards, which demonstrates some degree of understanding of working with people. However, just because a coach was a licensed clinician does not necessarily make them a good coach.
Consulting
Let’s start with a definition provided by another consultant, featured in a Forbes article about the differences between coaching and consulting. “A consultant is a Subject Matter Expert who can provide technical and professional advice.” A consultant has significant understanding, knowledge and experience in the subject area a client is seeking to grow in or learn more about. It’s kind of like being taught by a college professor—consultants give information and guidance directly for clients to follow to achieve certain results or outcomes, or to learn and apply something specific. Consulting actively assists the client resolve a particular business challenge. When you hire a consultant, you get access to their tools and strategies that support you in executing the action steps to achieve the goal you have set (Ex. Starting a new business). A coach will guide and coax answers from the client, while a consultant tells the client exactly what they need to do. When you work with a coach, you gain clarity, answers, and strategies for uncovering your own truth, on your own (with support, accountability, and motivation from the coach). Rose Guagliardo says it like this: “Coaching is helping you arrive at your own revelations and conclusions. Consulting is telling you exactly what to do based on an expert’s advice and experience.”
I think we’re really starting to see the distinction here between these professions and professional services. Counselors/Therapists—specialize in diagnosing and treating mental health disorders. Coaches work more as an equal with clients, to help clients find answers for themselves, offering a sounding board and asking the right questions to get clients thinking of their own solutions. And Consultants are experts, usually in matters of business or some specific subject, and will impart their experience and wisdom onto a client explicitly.Exploring possibilities, uncovering new interests or skills, leveraging current strengths and assets is the name of the game for coaching. Consulting would then take those possibilities the client has and turn them into options and a clear roadmap for execution.
OVERLAP BETWEEN ALL THREE
Now, here is a bit of overlap between counseling and consulting: both focus on the problem or issue and both offer up best practices for addressing the problem or issue. In both scenarios, the client has autonomy to choose to follow or not follow to specific advice from the therapist or consultant. However, it’s likely outcomes will not be as good for the client if they don’t follow to some degree the expert advice being given by either the well-trained mental health professional or the well-trained subject matter expert. Additional overlap found in both coaching and counseling includes the focus on the client—how are they functioning, how do they want to function, what aren’t they achieving right now that they want to achieve (relief from MH symptoms OR acquiring more happiness by tapping into dormant creativity)? And to some degree both counseling/therapy and coaching focus on helping clients tap into their own ability to solve problems and challenges that emerge in life or personal functioning. It’s just that the problems of focus are different: one is a treatable health disorder and one is a personal/professional/relational issue in which the client chooses to make a change. Another similarity between coaching and counseling, while consulting is the one different on this: counseling and coaching are more long term, as it’s about the client uncovering things for themselves, or uncovering things with the help of a therapist to get to real healing. Consulting, on the other hand, is more short-term work related to a specific issue or need.
Yes, I know that was a lot to digest—good thing this article will be here for you to reference again and again. I learned a lot in researching and really teasing out the nuanced differences in these services. The unregulated nature of both consulting and coaching leaves cost for these services to vary widely. That’s why it’s important to do your own vetting when choosing any human to help you with anything, and choose someone you can trust who doesn’t guarantee you results, because that can’t ever be guaranteed. Fees and cost for psychotherapy services also can vary, but less so, as there are industry and location standards for setting rates (and insurance companies set their own rates and grossly underpay contracted master’s level providers, so understand that whatever your therapist “charges” it’s likely they are not actually receiving that amount, at least not from insurance).
BONUS CONTENT
A little side note, while we’re on the topic of fees. What I see out there is coaches charging sometimes quite large amounts per hour or for a service they offer, and people are willing to pay for it (not hating, just stating). However, often that person would not ever pay $300/hour for psychotherapy, deeming it less valuable than a coaching service. This confuses the heck out of me! Especially after writing this article. Allow me to remind you about the requirements from initial education to supervised work to continuing education a clinical social worker, therapist, licensed professional counselor, psychotherapist, licensed marriage and family therapist, and licensed clinical psychologist undergo to be granted competency and legal permission to practice healthcare. From where I sit, licensed clinicians should be making more than unregulated and uncertified coaches, but as I always say, I don’t make the rules. I highlight this as food for thought. If you’ve ever felt like you can’t quite find the “right fit” with the therapists available in your insurance network, consider paying out of pocket for the provider of your choice, and let me tell you why you should consider this: 1) you are still getting that highly regulated and monitored healthcare service 2) which is still bound by privacy and confidentiality and other legal guidelines for ethical practice which protects you, the client, with laws already in place 3) you will get high quality service from a well-trained professional who has already been somewhat vetted 4) you get increased privacy protection in not using your insurance (oh yeah, forgot to mention above, your information does not remain private if you opt to use insurance, company can ask for full records for a client at any time for any reasons and per our contract, providers are required to give whatever information the insurance company asks for), 5) and finally through requirements for disclosure and remaining up to date with current practices and trends as required by CEU credits, you’re likely getting a therapist with specialized training and/or certifications that are current and scientifically tested and proven to be helpful for others with your same symptoms or issues. They are worth every penny! We actually care and actually want to help, and want to be fairly compensated for all of our hard work in getting to this point AND for the incredible emotional toll it puts on a person to hear, help, and absorb intense symptoms and emotions day after day for decades. If you want to hire a coach, great! But don’t substitute a coach for a therapist because you didn’t want to pay the therapist out of your own pocket without help of insurance benefits.
Conclusion
Did you learn something new? I know I did! There is a place in this world for each of these services and service providers. There are areas where one provider could offer all 3 services, and many do. Understanding the differences and knowing what you’re going to get if you hire a therapist, coach, or consultant is important. Trust isn’t inherent either, and requires building over time, even with professional/client relationships. However, for what it’s worth to anyone, below is a list of coaches I endorse would feel comfortable referring anyone to the folks for their coaching services.
Also, be sure to click embedded links for more information. Lots of rich stuff out there and there is always room for you and for me to learn even more. Thanks for reading! Drop a like or a comment if this was helpful, informative, or resonated with you in some way. All the best!
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Great Article summarizing the differences.