Introduction
Given the high population prevalence of mental health issues, more and more coaching professionals are being called to support people who want to improve psychological well-being and are encountering a shortage of mental health professionals. This article briefly chronicles the 25-year history of the distinctions, overlap, and collaboration of mental/behavioral health professionals and coaching professionals, enabling an evolving collaboration, a beautiful duet going forward.
Phase 1: Distinctions in scope of practice
Over the past 25 years, clear distinctions between the scope of practice of mental/behavioral health professionals and coaching professionals have formed the basis of their work with different, although overlapping, populations. In the US, mental/behavioral health professionals invest in years of education, including Master's and PhD degrees, followed by rigorous state licensing and insurance credentialing requirements, in order to be skilled and qualified in helping people restore or improve their mental health. They routinely roll up their sleeves to deal with tough challenges that impair daily functioning, including past trauma, depression, anxiety, addictions, grief, and relational disturbances. Behavioral health professionals work with addiction, substance abuse, eating and mood disorders etc. This work is intense. It can be fraught with risk, especially when people are harming themselves or at risk of harming themselves, or their situations are straining their significant relationships. This sacred work, hidden from view, helps people heal and stabilize their mental and emotional health. It is a calling that is not for the faint of heart.
On the other hand, coaching professionals in leadership, business, and health and well-being are trained to work with people who have stable mental health and want to improve themselves, their work, and their lives. Coaching helps people expand their internal and external resources to self-actualize and reach their greatest potential. Coaches are not trained nor qualified to help people better manage and overcome trauma, depression, anxiety, addiction, or loss/grief. They refer out to mental health professionals when they encounter such mental health challenges. Occasionally a client works with both a mental health professional on their mental health issues as well as a coach on their path forward to positive growth in parallel.
Phase 2: Overlaps in interventions
This simple distinction - mental health professionals working with people suffering with mental health challenges, and coaches working with people to realize their full potential, began to get blurry over the past decade or more. Both professions began to get training in interventions that can be applied in both contexts. For example, cognitive behavioral therapy was repurposed as cognitive behavioral coaching; similarly, solution-focused therapy as solution-focused coaching. The immunity to change model was developed for coaches, and is based on a cognitive behavioral framework. Acceptance and commitment practices are used in therapy and coaching, as are motivational interviewing, readiness to change, mindfulness, and self-compassion practices. Internal family systems practices are now taught to coaches who have embraced working with the multiplicity of mind.
Going the other way, positive psychology interventions are now used by mental health professionals. Psychologists are trained in behavioral strategies and interventions now also used by coaches to support lifestyle change as a treatment for chronic psychological disorders. All in all, the new and emerging interventions have enriched the work and increased the flexibility of therapists and coaches. There is indeed a symbiotic relationship here. While coaches and therapists still work with distinct populations – the overlap is becoming more fluid and common.
Phase 3: New Collaboration
Emerging developments are launching a third phase of opportunities – a collaboration phase:
The epidemic of mental health conditions in recent years has led to a serious shortage of mental health professionals.
Coaching interventions are showing promise in improving psychological well-being, including autonomous motivation, efficacy, and forward growth, including those with burnout and recent suicide ideation.
The evidence for lifestyle medicine (exercise, plant-forward nutrition, emotional resilience, healthy sleep, and social connections) to address the harm to the mental health of metabolic issues, has opened the door for coaches in health and well-being to work with this population.
Addressing all of the recent trends, large health insurance companies Cigna and United Healthcare have begun to support “behavioral health” coaches and coaching for employees with mental health conditions.
What then is important to the flourishing of this new collaboration?
First and foremost, the responsibility for clinical evaluation, diagnosis, creating, and implementing treatment plans for mental health conditions rests with mental health/behavioral health professionals. Ideally, a client or patient who is willing, ready, and able to engage in lifestyle medicine is offered the option of a coaching program by mental health professionals or physicians, which would then be supervised by the referring professional.
Having basic training in mental health literacy, coaches are able to collaborate effectively with mental health professionals. That said, coaches focus on the coaching process that moves people toward positive well-being goals, not focused directly on the mental health diagnosis and treatment plan. Supervising mental health professionals would lead regular check-ins to monitor and support progress and other resources that might be needed. Similarly, mental health professionals are beginning to get trained in coaching methodologies and some are offering a hybrid model that involves the resolution of past traumas and the movement towards goals and aspirations going forward.
The opportunity for lifestyle medicine coaching to improve mental health is a new frontier. In a time of great population need, shortage of mental health professionals, and evidence for lifestyle medicine in improving mental health, a new collaboration of mental health and coaching professionals
will help more people than ever to both restore mental health and move onto a path toward well-being.
Margaret Moore, MBA, NBC-HWC Simon Matthews, MHlthSc, NBC-HWC Randy Kamen, EdD, Licensed Psychologist