Ronald Mah, M.A., Ph.D.  Licensed Marriage & Family Therapist MFC32136

                                   Psychotherapy for Children, Teens, Adults, Couples, & Families, Consulting, & Training

          433 Estudillo Ave., #305, San Leandro, CA 94577-4915 - Office: (510) 614-5641 - Fax: (510) 889-6553 - e-mail: - website:

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Choosing between a Coaching or Therapy Relationship

(and Telehealth Issues)


Coaching and therapy 

are related but have significant experiential differences for clients as well as legal and ethical ramifications.  Both relationships share many common perspectives and activities.  Both relationships involve what may be called coaching, counseling, and consulting (hereafter, referred to as coaching).  However, therapy goes beyond coaching. The boundaries and hence, the legal and ethical scope and limitations between coaching and therapy are important to understand in choosing and establishing a professional relationship for a client. 


Differences Between Psychotherapy and Coaching



Views both parties as naturally creative, resourceful and whole.

More apt to view clients from a medical model.

Does not diagnose or treat.

Diagnoses and treats.

Trained to work with functioning clients.

Trained to work with major mental illness.

Works with clients that are able to form an alliance and have common goals.

Works with clients with entrenched problems.

Co-Active® model.

Therapist the "expert."

Coach and clients on a peer basis.

Hierarchical difference between therapist and clients.

Alliance designed by coach and client together.

Treatment plan largely designed by therapist.

Focus on evolving and manifesting potential.

Focus on healing and understanding.

Emphasis on present and future.

Emphasis on past and present.

Action and being oriented.

Insight oriented.

Solution oriented.

Problem oriented.

Explore actions and behaviors that manifest high self-esteem.

Explore genesis of behaviors that create low self-esteem.

Regard and coach negative self-beliefs as Saboteurs (temporary obstacles).

Analyze and treat origins and historical roots of negative self-beliefs.

Coach and client ask: "What’s next/what now?"

Therapist and client ask: "Why and from where?"

Works mainly with external issues.

Works mainly with internal issues.

Discourages transference as inappropriate.

Encourages transference as a therapy tool.

Accountability and "homework" between sessions held as important.

Accountability less commonly expected.

Contact between sessions for accountability and "wins" expected.

Contact between sessions for crisis and difficulties only.

Uses coaching skills.

Uses therapy techniques

Coaching vs. Therapy: What Are the Differences and When Do You Refer? The Coaches Training Institute, 2012.


Responsibility in Crises

In acting in either role of a coach or of a therapist, when the client presents a crisis in the form of a danger to oneself or to others or otherwise presents, immediate actions must be taken.  Such actions are established by legal and professional precedents- protocols that include mandated reporting of child abuse, elder abuse, domestic violence, suicidality, instituting a request for involuntary hospitalization and so on. Both coaches and therapists are responsible to take action to protect and stabilize when there are dangers to clients or to others.


Coach, Coaching, Goals, and Problem-solving

When working as a coach, the professional works with clients to reach specific life goals that enhance growth.  This normally would mean that there are not significant emotional difficulties. The coach may for example help a client plan to change his or her lifestyle, improve work or career functioning, develop new relationships, and so forth.  If someone is having stress created by lifestyle choices, coaching can be helpful.  Goals in coaching are measurable, and the behavior or action to achieve goals are identifiable. A series of small goals may be used to move toward a significant life change. These goals may include a series of actions that the client and coach work identify and problem-solve. Coaching assists an individual in reaching his or her goals through finding effective actions for problem-solving.  In establishing a coaching relationship rather than a therapy relationship, the process stays within these definitions and boundaries. 


Therapy Beyond Coaching- Accountability

In a therapy relationship, the process often includes all of the perspectives and activities of coaching, but goes beyond them.  As a licensed psychotherapist- in my case as a Licensed Marriage & Family Therapist by the State of California, there is a legally defined scope of practice.  Coaches may or may not be certified by educational entities or professional associations.  Coaches may be held accountable if certified or a member of a professional association by such groups.  Sanctions, disciplinary actions, or expulsion from such certifying entities or associations would be ways coaches could be held accountable.  In addition to any actions by a professional association he or she is a member of, licensed psychotherapists are also accountable to the government licensing/regulatory agency. 


Therapy Beyond Coaching- Depth and Complexity

In addition to coaching/counseling/consulting, as the therapist often engages with clients to a greater depth.  The therapist works with individuals, couples, or families who have greater complexity of thinking, emotional difficulties, or ingrained behavioral problems due to past or recent wounds, attachment problems, trauma, or to a chemical imbalance.   If ones anxiety is caused by emotions and thoughts that originate from ones perceptions and interpretations, therapy can help the client learn where those come from.  Behavioral goals in therapy are often more difficult to identify and resolve since they involve deep internal emotional distress, and habitual relationship and self-destructive thoughts and behaviors. The client's personal self-assessment and disclosure of emotional or psychological well-being define growth and change, rather than outside criteria or achievements.  While therapy helps clients strive for achieve life and problem-solving goals, therapy also explores the roots of problematic behavior and choices- in particular by dealing with challenges, emotional and relationship distress, and various obstacles.  The therapist works with the client to anticipate problems and develop ways to deal with them in the future.




There are important qualifications or limitations to working with clients from a distance through online (internet) technology- telehealth.  These have to do with the quality of telehealth work versus in-person treatment.   Important considerations include risks to working with clients, online security of confidential client information, and whether therapy can be legal and appropriate or if the work, process, and relationship must be confined to coaching. 

Services by use of Information Technology

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telehealth (formerly called telemedicine) by the State of California.  Under the California Telemedicine Act of 1996, telehealth is broadly defined as the use of information technology to deliver medical services and information from one location to another.  If a client and the professional (coach or therapist) chooses to use information technology for some or all treatment, the client needs to understand that


(1) The client retains the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benetiss to which he or she would otherwise be entitled.

(2) All existing confidentiality protections are equally applicable.

(3) The client's access to all medical information transmitted during a telehealth consultation is guaranteed, and copies of this information are available for a reasonable fee.

(4) Dissemination of any of the client's identifiable images or information from the telehealth interaction to researchers or other entities shall not occur without the client's consent.

(5) There are potential risks, consequences, and benefits of telehealth.


Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to coaching or therapy, better continuity of care, and reduction of lost work time and travel costs.  Effective coaching or therapy is often facilitated when the coach or therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client.  Coaches or therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences.  When using information technology in coaching or therapy services, potential risks include, but are not limited to the coach or therapist’s inability to make visual and olfactory observations of clinically, therapeutically, or other potentially relevant issues such as: the client's physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression.  Potential consequences thus include the coach or therapist not being aware of what he or she would consider important information that the client may not recognize as significant to present verbally to the coach or therapist.  


Link for additional information on confidentiality issues when using online technology.




Confidentiality of Client Healthcare Information 

Client healthcare information must be kept confidential including for storage, record keeping, and transmission.  Confidentiality requirements for healthcare providers extend to activities using information technology, and are also specifically delineated in some cases.  Coaches and therapists must maintain client confidentiality if they are a Covered Entity under the Health Insurance Portability and Accountability Act (HIPAA), as defined by the Confidentiality of Medical Information Act, and under California Telemedicine Act.  Unencrypted e-mail and social media that is used by most people, due to transmission over the open internet is not secure from various individuals or corporate and other entities.  Unethical persons may hack confidential information, while information technology businesses and other agencies parse online communication to gather data for internal uses, marketing, sale to other parties, and other uses. To secure against potential invasions of client-therapist communication, Ronald Mah uses patented technology from PrivateTree to set up personal encrypted online confidential rooms for communication between himself as the coach or therapist and the client.  Clients who work with Ronald Mah using telehealth processes are required to use this technology which meets or exceeds the confidentiality requirements of the various laws and ethical standards.



California-licensed with California-located Clients (office or online)

Ronald Mah can only practice psychotherapy as a Licensed Marriage & Family Therapist in California- his state of licensure.  Clients who see him at his office are recommended to work with him as a Licensed Marriage & Family Therapist since it would give them the most legal protections, potential third-party-payer (insurance) coverage, and a greater spectrum of strategies and processes for growth and change.  Utilizing online (internet) communication for psychotherapy work with clients is permissible for Ronald Mah only with individuals who are in California.  Clients in California are also recommended to work with him as a Licensed Marriage & Family Therapist as it is permissible and has the most protections.  Telehealth work with individuals outside California in another state is considered practicing in without a license in that state.  Psychotherapy with Ronald Mah involving someone in another state is not an option.


Coaching (only) Available to Out-of-State Clients

Any work with Ronald Mah that involves clients in another state will be in a coaching relationship and forgo the depth work of therapy.  If appropriate, a psychotherapy client who moves out-of-state from California who wishes to establish a coaching relationship with Ronald Mah may do so upon signing a coaching general information and consent form.  This is a different form for a different or more limited relationship than for therapy.  


For additional information regarding differences between therapy and coaching:

Coaching vs. Psychotherapy, the Great Debate, Patrick Williams, Choice Magazine, Vol. 2 Issue 1.

Coaching vs. Therapy: What Are the Differences and When Do You Refer? The Coaches Training Institute, 2012.



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Copyright © 2007 Ronald Mah, M.A., Ph.D.
Last modified: July 06, 2014