I recently read an intriguing article from one of my favourite Psychology Today contributors, Dr David Ley, on the rise of Life Coaching in mental health care. As a psychologist, he balanced the arguments for and against extremely well. However, he raised serious concerns about the role of life coaches in treating mental health issues. For example :
“The majority of coaches are paraprofessionals who do not hold licenses or advanced education in the field of mental health”
If this is true, then it is also true that they are generally not held to the same ethical boundaries that licensed psychologists and counsellors are. However, Life coaching is on the rise and a quick search on Google for “life coaching for mental health” will bring up many pages from coaches whose claim is that they can help clients with serious mental health issues. Many of them say that “any support is good” and many of them are recovering addicts or people who have recovered from serious issues themselves. I can see the appeal of this approach but I clearly believe that given that coaching is presently unregulated and there is no need for a license, potential clients should be asking the coach some serious questions. Among my client base, there are clients who have been referred to me by life coaches who felt out of their depth and others who have good, bad and terrible experience (one who was diagnosed with bipolar via Facebook chat). I do fully recognise that Life Coaching can play a role in recovery. However, I fear that unqualified coaches will be putting people at risk due to lack of training and experience in vital areas.
If we take for granted that the amount of Life Coaching offers will increase (some also from disillusioned therapists), where could be the real potential for disaster in ethical terms?
Ethics and boundaries. The therapeutic relationship between client and therapist is regulated and upheld. This includes sexual contact, collection of payment and what a therapist can do to retrieve payment. Even though some coaching associations have a code of ethics, there is nothing to say it is mandatory. As there are no clear boundaries, coaches are free to do as they see fit especially concerning overdue payments and what they see as appropriate behaviour towards clients. On the ethical side, is it really right to be claiming that as a coach, you can deal with mental health issues without the training needed?
“Leaving a client”. Licensed mental health professionals can bring serious trouble on themselves if they are seen to abandon a client in need, for whatever reason. This goes even for the case that the “chemistry” is not there ( in which case, a referral should be made) or in the case of financial difficulty (where other resources can be found). Coaches are under no such obligation.
Privacy and Confidentiality. As coaching is not part of formal healthcare, there are no obligations under HIPAA (Health Information Portability and Accountability Act). There is nothing, apart from self regulation to stop a coach talking openly about any case he or she is dealing with. It might even be the case that they are not aware of the subtle problems that surround confidentiality issues.
Suicide issues. As a therapist who has worked with suicidal patients before, I cannot claim to find it easy. Often the subtle clues that are given must be listened for by an experienced ear and even then, there is no guarantee that the right message is being picked up. Are coaches with their lack of high-end training the right people to be dealing with this?
Liability. Licensed mental health professionals must carry liability insurance. This is for the protection of clients who can have recourse for malpractice. I know for a fact that some coaches do have this but there is no obligation to do so.
There is no doubt that life coaching and other services of that ilk will become more and more popular as time goes on. As I said in a reply to a comment on one of my recent posts, I truly see a role for such services. However, roles should be clearly defined and for the good of the client, without overlaps or grey areas. I leave the last word to David Ley :
Both the UK and Australia have tried to protect clients and ensure good outcomes, by setting up certification, monitoring and supervision requirements for the paraprofessionals.
Until such requirements come to pass in the world of coaching, if they ever do, it’s up to the coaches themselves and the informed consumers, to monitor for the above pitfalls. If you are a client seeking coaching, I encourage you to carefully interview a prospective coach, about their boundaries, their liability protections, the effectiveness and reliability of their methods, and make sure there are clear written guidelines around finances and confidentiality.