In both the behavioral health field and the recovery community, I’m often asked to differentiate between clinical (counseling) and non-clinical (coaching) practice. It’s a great question – let’s take a look.
The primary services offered in the former are, of course, clinical. Expectations here are for measurable clinical outcomes from taking meds as prescribed to following a discharge plan; everything we might collate under the rubric of (so-called) “patient compliance.” Fair enough.
In the clinical model, professionals seek to provide medical or psychological healing for patients. Patients are involved in discussions of recommended services in the hope that this expert opinion will be adopted and result in the desired healing.
Counselors are primarily concerned with finding and, if possible, resolving the “why” behind settled patterns and responses: “what happened to you?” This search may take several sessions, even years to establish, interrogate and resolve. In therapeutic relationships, clients make a commitment to this process irrespective of the length of engagement.
To reach this healing, counselors will work deeply with the client’s past, revealing unresolved issues or trauma, ingrained defensive patterns and unhelpful operation principles.
By contrast, non-clinical conversations proceed from acknowledging the presence of two experts: client and coach. The client is the expert on his own life; the coach is the expert on hers. Thus the basis of mutual respect, and the coach’s role of facilitating the client to reveal preexisting strengths, resources and preferences Through this process, clients build imagination, test options, celebrate resilience and deepen their discernment: “what if?”
Thus, these non-clinical conversations are purposeful and serve the client’s immediate goal for resolving current or emerging logistical issues and opportunities. Clients work with coaches for as long as they assess this process as useful. Some items may be squared away within a single session.
Coaches, therefore, work with a focus on the present and the future, not the past.
In summary:
- Counselors are focused on understanding the path to the client’s presenting problem(s), revealing unhelpful operating beliefs and behavior patterns, and their origin. The counselor’s goal, and the purpose of her questions, is to help the client break these cycles and achieve improved behavior and outcomes.
- Coaches are focused on what can be done to logistically ameliorate or resolve the present issue and, in so doing, to enable improved self-efficacy moving forward.
Coaches and counselors are engaged in different, if complementary, conversations, occasionally with the same client. The ethical imperative of maintaining role boundary integrity is obvious.
For further discussion, please see the International Coaching Federation, What Makes Good Coaching Work: Clarity and Trust.
