EPISODE 058 | Coaching Isn’t Therapy and Consulting Isn’t Coaching

Welcome to the second episode in our Clinician to Coach Series! 

In this six-part series, I'm sharing resources and strategies to help you start and grow your coaching business to consistent $5K and even $10K months without overwhelm or burnout.

In today's episode, you're going to hear me talk about: 

• The key differences between consulting, coaching and therapy
• Why you want to clearly articulate what service you're providing and what your client can expect in terms of the coaching relationship
• The gold standard for positioning your coaching services alongside your work as a therapist
• Common scenarios for therapists navigating the coaching space

If you enjoy today's episode -- and if you're excited about the rest of this series -- I would love to hear from you! You can reach out via DM on Instagram @otsgonerogue or by email (simply hit reply to one of our weekly email newsletters).

You can also connect with me through our Facebook page  @otsgonerogue or by going to our contact form, https://www.otsgonerogue.com/podcast-contact.

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If you don't want to miss any future episodes including the upcoming episodes in the series, make sure you're subscribed to the show on Apple Podcasts, Spotify, Stitcher, or wherever else you listen to podcasts. And thanks so much for listening to this week's episode of the OTs Gone Rogue podcast! 

Transcript

Hey Everyone! 

And welcome back to the Clinician to Coach series! 

This is the six-part series where I’m sharing my best strategies to help you start your coaching business and grow it to consistent $5K and $10K months without overwhelm or burnout. 

We kicked things off with our first episode, where we pulled back the curtain on the dark side of coaching. We touched on why healthcare professionals are burning out, we also talked about the trends and opportunities in the coaching industry. We talked about the concerns around industry regulation or lack thereof. And you learned some of the potential issues with coaching certification programs. Last but not least, you learned that there’s more to the conversation in terms of what we need to consider as health professionals navigating the coaching world. 

So now that we set the stage, let’s take this conversation a little deeper… Today, we’re going to be looking at what coaching is -- and what coaching is NOT. More specifically, we’re going to be unpackaging how coaching is different from therapy and how consulting is different from coaching. 

My intentions with this episode are simple. If you’re going to be offering coaching services, I want you to have confidence and clarity in the role you are playing as a coach. I want you to be able to clearly articulate and describe what it is you are providing through this coaching program or this coaching service. I want you to feel confident in how you navigate the gray area between coaching in the online space as a licensed, regulated health professional. And I want your consumers or your clients to have a very clear understanding of what it is they’re receiving through this coaching relationship. 

In the last seven years, I’ve helped therapists to navigate the online space as entrepreneurs, as coaches, mentors and consultants, as course creators, as bloggers, as podcasters, as membership site owners, the list is endless. 

If you’re a regulated and licensed healthcare professional, you have specific rules and regulations you must abide by in order to maintain your licensure. And yes, it is still possible to do this while operating in the online space. There’s a reason why there’s a growing number of attorneys who are now specializing in health and wellness in the online space — meaning this isn’t a new concept. I know this because I’ve attended training sessions with them, I’ve listened to their podcasts, I’ve read their articles and I’ve consulted with some of them. Meaning I’ve accumulated a lot of knowledge in this area in the last several years.

With all that being said, I’m going to start this episode off with a very clear disclaimer: The content being shared in this episode is for general information purposes only. I am not a lawyer and this information is not intended to provide legal advice of any kind and may not be used for professional or commercial purposes. No one should act, or refrain from acting, based solely upon the content provided in this episode without first seeking appropriate legal or other professional advice.

Meaning I’m not here to give you legal advice. Instead what I want you to do is take the information I’m going to be sharing today and disseminate it in a way that feels comfortable for you, based on the advice you’re receiving for your particular state or province and based on your risk tolerance. Take what you want from this episode, and leave the rest. 

Ok now that we got that out of the way… Let’s jump in.

Let’s start off by talking about what it means if you’re a licensed, regulated health professional… 

This means that your licensure trumps everything. Meaning, if you have a yoga certification and an OT license, your licensure as an OT trumps that yoga certification. If you’re a personal trainer, your regulatory body, the rules that you have to follow as an OT, that trumps what you can do as a personal trainer. If you’re a birth coach, the rules and regulations you need to follow as a therapist trumps your role as a coach. If you’re a licensed regulated therapist, you’re obligated to follow the laws and rules that apply to your profession regardless of whether you’re providing therapy or coaching. Meaning you can’t just decide that today, you’re an OT and working with a client in your state but tomorrow, you’re a coach working with a client in the exact same way but outside of your state. You can’t just change your title on a whim. That, my friends, is a slippery slippery slope.

Already, you can see that there are some murky waters here, but we're going to work together on navigating this. Regardless of whether you're coaching full-time, or as an adjunct to a therapy practice, as a licensed provider, you have to be clear about the services you provide, and to whom you provide them. This clarity will not only help you in your marketing, but it will also ensure your clients understand what services they are receiving, and in what context. 

So how does this translate to coaching, especially given everything we covered last week about it being an unregulated industry… Well, first let’s talk about how to differentiate between coaching, therapy and consulting. Once we’re clear on the different roles, we’ll then dive into marketing and positioning. 

We're going to start with consulting. We're going to go through a number of definitions, a number of descriptions. I want you to find what resonates for you — and for your work and then I want you to be consistent in describing what it is that you do.

With consulting, here's a Wikipedia definition: A consultant is a professional, also known as an expert, or a specialist who provides advice and other purposeful activities in an area of specialization. We all know therapists who have worked as consultants or who have provided consulting services. These consulting services could be specific to occupational therapy or like in my case, it might be consulting outside of occupational therapy. 

Another definition, this is from Alan Weiss a very well known consultant to consultants. Alan's definition of a consultant is someone who improves the client's condition by offering advice and guidance on site and off site for the duration of a project and the achievement of the project's objectives and values. With a project, there is a clear start time and end time. There is a clear duration. There are objectives and values related to that project. 

Another way to describe a consultant is someone who provides expertise and solves business problems or develops a business as a whole. In this scenario, a consultant deals with the overall organization or specific parts of it and not individuals within it. The biggest difference between coaching and consulting is around what the client gets from it. With coaching, there aren't any tangible deliverables. It's very much about the time you get with your coach. With consulting, you're typically dealing with a situation where deliverables are involved. With my consulting clients, for example, I’m providing updates and reports in terms of where we are with timelines and our specific project deliverables. This deliverable may be everything from a strategic plan to a training session, to executing on a set of tactics. 

Now let’s look at coaching. In last week’s episode, you heard about all the different ways people can show up as coaches. Meaning this is a very broad umbrella. Let’s start by going through some different definitions of coaching. This one is from Tim Gallwey, the founder of the Inner Game and someone who is often considered the pioneer of the current coaching movement.

“Tim describes coaching is unlocking a person's potential to maximize their own performance. It is helping them to learn rather than teaching them”. Another definition, this one is from the International Coaching Federation. How they define coaching is “partnering with clients in a thought provoking and creative process that inspires them to maximize their personal and professional potential. Clients often say they've created a new outlook on life, finding inspiration, courage, confidence, and answers to long burning questions within themselves”. According to the International Coaching Federation, for many, coaching is a life changing experience that dramatically improves their outlook on work and life, while improving leadership skills. Coaching helps people tap into their potential, unlocking sources of creativity and productivity. 

Then we have Tony Robbins, his area of expertise is in life coaching. He says the fundamentals of life coaching are what distinguishes it from therapy, where life coaches do not diagnose while therapists determine illnesses and pathologies so they can be clinically treated. Therapists analyze their client's past as a tool for understanding present behaviors whereas life coaches simply identify and describe current problematic behaviors so the client can work to modify them. Now I’m not saying this is the gold standard of differentiating between coaching and therapy. I’m simply pulling different examples from frequently referenced sources and I want you to use your critical thinking in terms of what fits best for you. 

Another perspective on how therapists and coaches differ is from Bill Cole, an internationally recognized authority on peak performance and coaching. He says that coaching is an educational discovery-based process of human potential. Therapy is based on the medical model that says people have psychiatric maladies that need to be repaired. 

Coaching focuses on self exploration, self knowledge, professional development, performance enhancement and better self management; therapy seeks to heal emotional wounds. Coaching takes clients to the highest levels of performance and life satisfaction; Therapy seeks to bring clients from a dysfunctional place to a healthy functioning level. Coaching assumes a coequal partnership between coach and client; Therapy assumes the therapist to be more of the expert and in control.

Then, we have our definition of health coaching. A health coach is ideally a healthcare professional, trained in behavior change theory, motivation strategies and communication techniques, which are used to assist clients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well being. Unfortunately, as we discussed in last week’s episode, there is no rule nor is there a regulation that you must be a healthcare professional. I would say it is highly recommended but unfortunately, it is not a requirement. 

Another definition of health coaching is from Duke Integrative Medicine. They define health coaching as the process of creating a dynamic partnership that moves the client towards satisfying and healthy lifestyles. It’s about helping clients to clarify an optimal health vision, exploring options and steps for realizing that vision, enhancing personal accountability and taking action to achieve and sustain their goals. By focusing on the mind, body, spirit and community, health coaches help clients make changes that support their values and vision of their optimal health.

Ok let’s look at what Jessica Drummond and the Integrative Women's Health Institute has to say, this is where I completed my women’s health coaching certification. They say that coaching is unlocking a person's potential to live a healthy, vibrant and purposeful life as a whole human being by her definition. Coaching is supporting her to transform with a full suite of resources and skills rather than fixing her. Healthy behaviours are intimately connected with day to day life behaviours which are ideally based on the client's current vision.

And then there’s the National Board of Health and Wellness Coaching. According to their website, health and wellness coaches partner with clients seeking self directed, lasting changes aligned with their values, which promote health and wellness and thereby enhance wellbeing. 

In the course of their work, health and wellness coaches display unconditional positive regard for their clients, and a belief in their capacity for change. Honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful, and non judgmental. 

It’s interesting to look at these various coaching definitions through an OT lens, isn’t it? Your brain might be screaming right now “BUT THIS SOUNDS LIKE OT!” — and I’m not arguing with you… But let’s keep going with this conversation, we’ll then talk more about positioning yourself as a therapist vs as a coach.

Ok — so coaches offer the client the ability to see outside of their own limitations. Coaching is the assumption that the client comes into the engagement with resources, skills, ideas and strengths. Coaching is distinct from consulting or health care. Coaching is support over expertise. Coaching is a partnership over expertise. Often, as the consultant or the therapist, you’re coming in as the specialist. You're coming in as the expert. But not in coaching.

As you can see, there is necessary overlap between coaching and skilled health education. You can see this. I can see this. As skilled health professionals, we definitely see the value of having people with a professional level of training who are in a coaching role. There are many health professionals who are licensed and regulated in a specific state or province. They have a clinical practice and they are utilizing their coaching skills within that clinical practice. They are not calling themselves a coach per se. They are still identifying or still branding themselves as a therapist. There's nothing wrong with that, of course. But it’s important to consider the difference between a professional coaching relationship where you’re promoting and marketing yourself as a coach vs using coaching skills as part of your clinical practice. As I've mentioned, there can be overlap, but it's up to you to clearly differentiate how you are navigating that space. And I want you to get clear on that BEFORE you engage in services with a client. 

 This is a good time to talk about the coaching relationship. A professional coaching relationship exists when coaching includes a business agreement or contract that defines the responsibilities of each party. A professional coaching agreement or a professional coaching relationship is not in place if you're simply using your coaching skills as part of your healthcare practice. That is a key differentiating factor here. 

When we’re talking about the coaching relationship or the coaching agreement, it's also important that we talk about our ability to choose our clients. In a more traditional clinical setting, there are different ethical considerations in terms of when a client may or may not be a good fit for our therapy services. If that client has self referred or if the referral has come from another healthcare professional, and for whatever reason, there is a conflict of interest, or we do not see this as a good fit, there's a different process that we must follow in our clinical practice for referring them onto someone else.

In our coaching practice, it is very different and it is VERY important that this is a right fit. 

A coaching relationship is distinct from a healthcare relationship. A coaching relationship requires stated commitment from the client that they’re engaging in this work, because as a coach, your role will be empowering them to make changes to their behaviors. It's not just doing something to them passively. It's not making passive recommendations. You're not showing up as the expert. You are showing up in partnership and the client needs to be at an appropriate stage of readiness for this change to be successful. Meaning, it is important that this client is the right fit for your services. You can set this up so that you’re screening potential clients or you can set this up so that they’re self-selecting based on the way you’re marketing yourself and promoting your services. As you evolve in your coaching practice, you’ll become more and more clear, not only about the characteristics of the people that you have the ability to best serve, but you also become more clear on the problem or the problems that you are solving. 

So who IS an appropriate client for coaching? Some of the things you want to consider — are they actively seeking help? Are they aware that they have a problem? Are they ready for change? Do they have capacity for change? Are they coachable? Are there any mental health challenges? Does this person have a fixed mindset or a growth mindset? As your coaching practice evolves, you’ll get better at identifying who is an appropriate client for coaching and who is not. In the beginning, it’s harder to say no to people. You’re eager to sign clients up and you’re eager to generate revenue! But you will get to a point where the money, the revenue, the signups, it will not be worth it if your clients aren’t the right fit for your coaching services. 

There are also some red flags to consider when identifying appropriate clients or perhaps identifying clients who may not be an appropriate fit. This is by no means an extensive list but red flags for coaching might include excessive anger, reckless, impulsive behavior, irrational, repetitive, compulsive or obsessive actions, complaints of acute lack of sleep and somatic disorders, unresolved prolonged grief, signs of paranoia, signs of chronic anxiety, relentless fatigue, suicide ideation, talk about harming others, depression, eating disorders, substance abuse or addiction, neurotic tendencies, psychosis, such as schizophrenia, personality disorders, and bipolar tendencies, acts of violence, consistently blaming or shaming, consistently lying, dishonesty or sexually inappropriate behavior. As therapists, many of us, all of us, have experience working with people who may be exhibiting some of these red flags. 

And if you’re already working with someone who’s exhibiting any of these red flags, you have to be very clear. Are you their therapist? Or are you their coach? The context in which we are working with our clients if any of these red flags come up is very important. Often, these red flags may not show up on your discovery call or on your intake form. This could happen further down in the coaching relationship, where you’ve been working with them for a while. If you’re their therapist, where you’re also utilizing certain coaching tools throughout your relationship, that’s a different situation than if you have engaged in a specific coaching agreement. This is why it's very important as therapists to get clear on how we are working with someone. 

We don't want to be jumping from one role to the other. That is a slippery slope. Yes, there are people who have worked with a coach and a therapist at the same time. I’ve worked with a coach and a therapist at the same time. It doesn’t have to be one or the other. But you as the practitioner shouldn’t be fulfilling both of those roles. There are no specific legal or ethical restrictions that would prohibit a coach who is also a properly supervised registered or a licensed therapist from entering into a therapeutic relationship with a client once the coaching relationship has ended. Or, if someone is a therapy client and you’ve discharged them, there are no legal or ethical restrictions stopping them from then becoming a coaching client. 

But there's a difference between legal and ethical restrictions and best practice.

As you can see, it can get muddy. It can get complicated. There can be overlap so let's do our best to keep this clear. You have to carefully consider your client, what are their needs and what is most appropriate for them. There are people that may benefit from coaching and therapy at the same time, but not from the same provider. They are a different type of service. We have to separate that and be very clear. I am not here to give you legal advice but I am here to try to make your life easier and to help you build a sustainable coaching practice that doesn't give you a headache, that doesn't keep you awake at night worried about the OT police that you're crossing too many lines, that you are making a mess of the back end of your practice. 

I’m telling you now it is much easier to keep it separate. Staying in your lane is so much easier. What do I mean by that? It’s recommended best practice that if you're seeing a client for therapy, then that's the world they stay in. If they're interested in working with a coach, and if they're a suitable candidate for coaching, you could refer them to a colleague. There's enough work out there for all of us people. If you're providing coaching services to a client, and you sense they would benefit from working with a therapist, discuss your concerns with them, and offer a referral to another provider. It's so much easier if we just keep it separate. If you're coaching a client who has seen another provider for therapy, don't overstep your role as a coach. Don't try to be all things to all clients. Get clear on the role you are playing. Get clear on the hat you are wearing. Get this in writing. Be clear on the services you are providing. This is how you grow a sustainable coaching practice. You separate it from your therapy practice. It's going to make your life so much easier. It is going to make your marketing easier. It is going to make business set up and management so much cleaner. 

Clarity is key. I cannot emphasize that enough. Be clearer about the services you provide and to whom you provide them.This clarity will not only help you in your marketing, but it will also help to ensure your clients understand what services they are receiving, and in what context. This helps them to be more successful. Everyone is on the same page. 

Now what do I mean by getting it in writing? This is where I want to talk about the coaching agreement. In healthcare, there is not a set agreement with each client and each patient. We understand that healing is very nonlinear. It can often be unpredictable, and there is no set process or there is no specific timeline. A coaching agreement, however, is a legally binding agreement. It's best to create yours with the assistance of an attorney who specializes in coaching and who is familiar with healthcare scope of practice law in your province or state. 

Completing a coaching agreement sets the expectation for the client and sets clear boundaries for the coach. This should include an explanation of what coaching is and what services are provided. It should include information about the different parties and their obligations, and it should include an overview of the coach's credentials and qualifications. A coaching agreement will describe the coaching process, including how many appointments or how many sessions there will be, how often you’ll meet and the expectations of the client in terms of her commitment or his commitment to the process. It could include specifics on the refund policy, scheduling, payment options, etc. Have this in writing.

The coaching agreement may also state that the services being provided do not constitute therapy, counseling, or the practice of psychotherapy and that a referral will be offered if the services are needed or requested. This agreement is essential if there are any problems that come up later in the professional relationship. There's also something to be said in terms of the energetic commitment. Energetically, the coaching agreement signifies your commitment to each other as a coach and as a client and it's also representative of the client's commitment to herself or himself. 

Then we have disclaimers. These are great things to have on our website. When we think of disclaimers, so what you're offering, if you have a blog, if you have free resources, if you have a podcast. Getting clear, including a disclaimer that what you're offering isn't medical advice. It's for informational purposes only, and it's not intended to substitute professional medical advice, diagnosis or treatment. You get to decide based on a consultation perhaps with an attorney, where you're including these disclaimers.

Next week, we’re going to talk more about setting up and marketing your coaching business. But for the purpose of today’s episode, I want to mention what I consider to be the gold standard in terms of keeping your therapy and your coaching separate. The gold standard is to have your coaching setup as a separate business, a separate entity and a separate website, I mean, totally separate. In the ideal world, at the very least, you have separate tabs on your website where it’s very clear that they’re two different services. If you are actively practicing as a therapist, you want to avoid any overlap between your therapy business and your coaching business. Separate financial accounts, separate contracts, separate policies, separate marketing materials. Your marketing efforts for your therapy practice should be separate from your coaching business. The more you can separate it, the better. 

I’m also going to acknowledge that you’re going to listen to this episode and then you're going to be going out in the real world and you're going to see therapists who are not following what I'm saying at all. But you know what? That’s on them. Be careful with who you are mimicking and who you are following. Can you reference your OT license when marketing your coaching services or your coaching business? Generally speaking, you shouldn't be using your therapy title to market your coaching practice but you can reference your degrees when sharing more about your background and training. As a licensed regulated healthcare professional, you have an ethical responsibility to ensure your coaching clients know your licensure status. But they need to understand that they’re not signing up for therapy. This can be part of your informed consent process. 

For example, if I’m talking to a potential client named Jessica, I might say something like “Ok Jessica, just so you understand, I am a licensed occupational therapist. However, the work that we are doing together does not fall under my therapy work. You and I are going to be engaged in a coaching process. We are working in a coaching relationship. This is the package I offer. Here's an overview of what exactly coaching is and here’s my coaching agreement that I would like to go through with you.” 

They understand that the work you're doing together is coaching, not therapy. Coming back to my disclaimer, I am not an attorney. This is not meant to give you legal advice. This is highlighting where you may be comfortable in taking action and where you may want to get more information or where you may want to consult with an attorney, or at the very least look into different coaching agreements, different templates that can offer you some level of protection. 

One thing we did not talk about in this is insurance because again, this is going to be very specific to your practice. It's going to be specific to the services you are providing. It is going to be specific to your state and your province. It’s going to be specific to any additional certifications you may have. There are a number of insurance providers that will cover you as a coach, as a therapist or both. It is up to you to source that out. It is up to you to do your research. 

Ok we covered a LOT in this episode. Let’s wrap things up by summarizing four common scenarios. Scenario number one, you are practicing as a therapist and using coaching techniques with your therapy client. Are there any issues with that? No, it’s fine. You’re a therapist, and you recognize that in order for your client to meet their goals, that you may be able to utilize some of your coaching skills, your coaching techniques, that is well within your scope of practice. Carry on. 

Scenario number two: That same therapy client is now moving to a different state. They want to continue working with you online where they’re paying out of pocket. So you decide to call yourself a coach. Same service, same business, same approach, same techniques, same tools, you're just flipping a switch to be able to work in the online space. That's not okay. I’m not going to get into specific rules and regulations, let’s just say it’s sloppy. It's not clearly differentiating the type of work that you're doing, the outcomes that that client should be expecting.

Then we have scenario number three. You’re a therapist with a part-time clinical practice and you’re also working in the online space as a coach. You’re marketing your coaching services as a separate entity. Before signing on a new coaching client, you take them through a discovery call process and you have them fill out an intake form, where you’re screening them for red flags. As part of your onboarding process, you go through your coaching agreement together, including what coaching is and what the expectations are for both you and your client in terms of service delivery. They sign off on the coaching agreement and you continue your work together. 

Last but not least, scenario number four. You have a coaching client and since working with them, they've gone through a messy divorce and they're now describing symptoms of insomnia, depression and anxiety. You have experience in mental health BUT they are your coaching client. You know that it’s important to not offer concurrent therapy sessions. You refer them to a therapist and you then have a discussion with them around the pros and cons of continuing your coaching work together while they’re seeing a therapist. You keep it separate and you keep it clean. Easy peezy, right? 

In conclusion, and I know we covered a lot of information, but these are important conversations to have! Coaching and therapy are different professions and they should be treated as such by those who wish to work in either or both capacities. Be a professional. Coaches must understand that having the education and training of a therapist doesn't authorize one to engage in work of a therapist on a whim. Get clear on the work that you're doing. Those who plan to offer coaching services should possess a clear understanding of how coaching and therapy are different. They should be able to explain those differences to potential coaching clients and maintain proper boundaries with those clients to avoid allegations of practicing therapy unlawfully. Review your provincial and state licensing laws to see what if any regulations exist with regard to coaching. Contact your provincial or state board for clarification if needed. Though I've already given you a warning, sometimes that doesn't go as planned and you end up educating them. Consider consulting with an attorney or at the very least looking into various contracts and templates that were created by an attorney with a background in coaching or an understanding of coaching and healthcare. We’ll talk more about this next week but you also want to research which business entity is best if you’re going to offer coaching. Do your best to keep it separate. 

In summary, in this episode you learned key differences between consulting and coaching. You learned key differences between coaching and therapy. It is not a black and white scenario. Get clear on what works for you on your definition and stay consistent. In this episode, you also learned ways of combining more than one role. As skilled health educators, how we may be bringing some of that into the coaching relationship, or as consultants, how we may be bringing some of our coaching skills into that consulting role or as coaches, how there may be times that we are bringing that consulting piece in. There is advising, there is mentoring, there’s coaching and there’s consulting. There's a myriad of ways that we can be showing up. It's important to slow down, get clear, and establish that agreement with your client or potential client before moving forward. 

Last but not least, in this episode I hope you learned the importance of clearly differentiating what you’re doing and how to keep things separate. I hope you have a better understanding of how you can step up as a coach and how you can practice with confidence, but also in a way that is ethical and in line with your morals and in line with your values.

Ok there you have it my friends, I hope you enjoyed our second conversation on the Clinician to Coach series. In next week’s episode, we’re going to talk more about the steps you want to take in order to seamlessly navigate the startup phase of a coaching business. Episode four will explore the benefits of working 1:1 with your clients and in episode five, we’ll focus on how to actually get those clients. Last but not least, we’re going to wrap this series up with our sixth episode, all about creating your signature coaching program. 

Now I have a favour to ask.I would love to get this series in the ears of as many OTs as possible. If you’re enjoying this content, take a screenshot and share it on social media. 

Or take a moment and personally recommend this series to an OT friend or colleague. Better yet, go to Apple podcasts and leave us a review. And if you don't want to miss any future episodes including the upcoming episodes in the series, make sure you're subscribed to the show on Apple Podcasts, Spotify, Stitcher, or wherever else you listen to podcasts. Thanks so much for listening to this episode of the OTs Gone Rogue podcast and I’ll see you next week.