Navigating the Insurance Maze

The Therapist’s Complete Guide to Working with Insurance – And Whether You Should

with Barbara Griswold, LMFT

Barbara Griswold, LMFT

Navigating the Insurance Maze

The Therapist’s Complete Guide to Working with Insurance – And Whether You Should

with Barbara Griswold, LMFT

Coaching vs. Therapy: What's the Difference? (And Why It Matters)

I often receive calls from therapists who are thinking about providing coaching instead of therapy. They may be tired of dealing with insurance plans. They may want to avoid the burden of writing progress notes for each client meeting. They may feel they can earn more money with coaching. Or they may want to work with clients in another state where they are not licensed. They may have the sense that coaching is much less regulated, which can sound freeing.

For all these reasons, it is tempting to say, “I’ll just rename what I’m doing with my clients ‘coaching’ and then I’ll be able to get around all these burdensome rules and regulations.” But this can be a dangerous path. Research should be done before you hang out your shingle as a coach.

Here are some things to consider before you consider moving into coaching, and some frequently asked questions:

Who can be a coach? There are no state or federal laws that I know of that govern coaching – basically, anyone can call themselves a coach. There are some coaching associations such as the International Coaching Federation (ICF) and the International Association of Coaches (IAC) who have set up some ethical guidelines, but there are no regulations.

How is a coach different from a therapist? “According to the ICF, a coach is responsible for discovering, clarifying, and aligning with what the client wants to achieve; encouraging client self-discovery; eliciting client-generated solutions and strategies; and holding the clients responsible and accountable for meeting goals and creating outcomes,” writes Sara Jaspar, a staff attorney for the California Association of Marriage and Family Therapists. “For these reasons, coaching often relates to career development, achievement, and advancement.” Since many of these tasks occur in therapy, you can see it may be hard to identify the difference between coaches and therapists.

Let’s see if this helps: When you are providing coaching, you cannot practice psychotherapy in that session. Depending on how your state law defines psychotherapy, you may not be able to apply psychotherapeutic and family systems theories and methods to individuals, couples or groups to assess, diagnose, or treat relational issues, emotional disorders, behavioral problems, mental illnesses, or alcohol and substance use.

According to Jaspar, “coaches may not delve into the past, provide a cure to a mental illness, or relieve mental and/ or emotional suffering. Coaches may not seek to resolve the deeper underlying issues that cause serious mental and/or emotional problems.” If you are doing these things in your coaching sessions, you have crossed the line into providing therapy.

What if I’m a licensed therapist? Can I also have a separate coaching practice? Be careful here. These two professions are distinct but can be easily confused by the public, especially if you are a licensed therapist. “It is recommended the [two] practices be advertised separately to avoid confusing and/or misleading clients regarding the scope of work performed as a coach and/or psychotherapist. When practicing both professions, the best practice would be to have different business names, separate letterhead, business cards, promotional materials, and websites,” says Jaspar.

Can a therapy client later become a coaching client? While there are no laws against this, it may be unwise. Therapists should carefully consider the best interests of the clients, and avoid moving from one relationship to another for their own financial gain. The therapist should explain the differences between coaching and therapy, and how the client’s rights are different.

“Psychotherapists who are thinking about transitioning from a therapeutic relationship to a coaching relationship may want to put themselves in the shoes of their therapy clients and consider how difficult, if not impossible, it may be for a therapy-turned-coaching client to alter his or her understanding of the relationship and to maintain the boundaries of the new relationship,” says Jaspar. “If it is clear that a client is unable to maintain proper boundaries, it is the coach or psychotherapist’s responsibility to consider whether it is in the best interests of the client to terminate that relationship.”

Can I provide both coaching and psychotherapy to the same client? As we said earlier, you may not use therapy techniques to a coaching client. However, you can use coaching techniques as part of your therapy to help therapy clients reach their treatment goals.

My therapy client has moved to another state, where I’m not licensed. Can I continue to see him if I change it to a coaching relationship? For many reasons, this could be unethical and unwise. “If it is the therapist’s professional belief that based on client’s presenting issues and/or diagnosis the client should continue seeing a therapist, it would be unethical for a therapist to terminate the therapeutic relationship and begin coaching the client just so that he or she could continue seeing the client,” says Jaspar. That is, if that client needs therapy, and you can’t give it due to interstate legal issues, it is time to make a referral to someone licensed in that other state. You can’t just keep doing therapy with a client and rebrand it as coaching in an attempt to bypass state licensing laws.

Will my current malpractice insurance cover my work as a coach? No. “Given that psychotherapy and coaching are distinct professions, a separate malpractice policy for coaching is required,” says Jaspar. However, you may purchase liability insurance for coaches (CPH & Associates is one organization that offers these policies).

Can I use the same intake paperwork for coaching clients as for therapy clients? No – they should be quite different. When serving on a state professional association ethics committee, I witnessed a case where a coaching client filed a complaint against a licensed therapist, alleging the coaching intake forms asked deeply personal questions, which felt inappropriate for a coaching relationship. Jaspar recommends that the coaching agreement include an explanation of what coaching is and what services are being provided, information about the parties’ obligations, and an overview of the coach’s credentials and qualifications. It may also cover methods of communication, the length and frequency of the coaching sessions, fees and any extra expenses, accepted methods of payment and time of payment. The agreement should also state that the services being provided do not constitute behavioral health treatment, counseling, or the practice of psychotherapy, and that a referral will be offered if these services are needed or requested. Finally, it is a good idea as part of the agreement to inform the client as to the limits of the relationship (for example, informing the client that there is no coach-client confidentiality or privilege).

Do coaching clients have a right to privacy/confidentiality? The quick answer to this question is usually not. I am not aware of any state laws that ensure that information a coaching client shares during a coaching relationship will remain private. “Therefore, prior to establishing a coaching relationship with a client, coaches should make clear that although they will do their utmost to respect a coaching client’s right to privacy, that right to privacy is not the same right to confidentiality that is enjoyed by psychotherapy clients,” says Jaspar.

So, what’s your biggest piece of advice when it comes to coaching? Before you decide to venture into the world of coaching, or decide whether to engage in coaching with a therapy client, I STRONGLY advise you to consult with a mental health attorney who can give you advice on how to ethically advertise your coaching practice, and give you feedback on the agreements and policies you intend to implement with coaching clients. An attorney can also inform you of any state laws that might apply, and give you tips to keep you out of hot water. Read as much as you can on the difference between coaching and therapy, so you can explain it clearly to clients, and so you can avoid getting pulled into providing therapy in your coaching sessions (which can be tempting).

References:

Sara Jasper, JD, Staff Attorney; Coaching vs. Therapy. July 10, 2015, updated February 2022 by Mike Griffin, JD, LCSW (CAMFT Staff Attorney). https://www.camft.org/Resources/Legal-Articles/Chronological-Article-List/coaching-vs-therapy; Assessed Dec 1, 2022

The website for the International Coach Federation is www.coachfederation.org. The website for the International Association of Coaching is www.certifiedcoach.org. The ICF offers individual credentialing as an Associated Certified Coach, a Professional Certified Coach, or a Master Certified Coach and identifies the following coaching specialties: Executive and Corporate Coaching, Small Business Coaching, Personal/Life Coaching, and Career/Transition Coaching. The IAC offers certification as either a Certified Masteries Coach or a Master Masteries Coach

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Barbara Griswold, LMFT

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Barbara Griswold, LMFT, is a private practice coach and the author of Navigating the Insurance Maze: The Therapist's Complete Guide to Working With Insurance – And Whether You Should, 10th edition. Check out Barbara's online catalog of helpful online courses, practice forms, and other therapist resources related to insurance, documentation, and running your therapy business here.