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.
Between Psychotherapy and Coaching
Views both parties as naturally creative, resourceful and
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
Works with clients with entrenched problems.
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.
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
Analyze and treat origins and historical roots of negative
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
Accountability less commonly expected.
Contact between sessions for accountability and
Contact between sessions for crisis and difficulties only.
Uses coaching skills.
Uses therapy techniques
vs. Therapy: What Are the Differences and When Do You Refer? The Coaches
Training Institute, 2012.
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
Coaching, Goals, and Problem-solving
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.
Beyond Coaching- Accountability
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.
Coaching- Depth and Complexity
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.
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
by use of Information Technology
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
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.
All existing confidentiality protections are equally applicable.
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.
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.
There are potential risks, consequences, and benefits of telehealth.
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.
for additional information on confidentiality issues when using online
of Client Healthcare Information
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
with California-located Clients (office or online)
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.
(only) Available to Out-of-State Clients
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.
additional information regarding differences between therapy and coaching:
vs. Psychotherapy, the Great Debate, Patrick Williams, Choice Magazine,
Vol. 2 Issue 1.
vs. Therapy: What Are the Differences and When Do You Refer? The Coaches
Training Institute, 2012.