Psychiatrists, Psychologists, Psychotherapists, and Coaches

Misha Saidov

Answers to the “who is who and who does what” question

– Is she a psychiatrist?

– No, she is a psychologist and a psychotherapist.

– Same thing.

– Actually, it’s not.

– How come? They all work with people.

– Sure, but their educational background, training, and responsibilities differ to an extent.

– So, who is who, and who does what?

Psychologists, psychiatrists, and psychotherapists

People often cannot tell the difference between the three professions. It is not surprising as these are all “helping” professions, not to mention that they even sound similar. Adding coaches to the list, one can only become more confused.

This article will briefly describe the four professions. It will try to answer the “who is who and who does what” question by discussing shared features and differences between the four professions. It is good to know what these professions are about, so you know what you can and cannot expect from experts specialized in each of them.

Of course, we start with the ultimate thing psychologists, psychiatrists, psychotherapists, and coaches have in common. They all aim to help those who are in need of help. The remainder of the article will tell you why drawing clear boundaries between the four professions is not easy. But, it will also speak about the unique features of each profession.

Psychiatrists

Psychiatry is a medical specialty that focuses on diagnostics, treatment, and prevention of mental, emotional, and behavioral disorders. A psychiatrist is a medical doctor and, as such, is the only one of the four experts who can prescribe medications. Some mental disorders, such as schizophrenia, require medications. Other mental health disorders and conditions do not necessarily require medications (e.g., some cases of anxiety), but taking them might make recovery easier and more efficient. For these reasons, psychiatrists often collaborate with psychotherapists.

Not to forget, some psychiatrists are also psychotherapists. They can also be coaches, but this happens less frequently. To find out more about psychiatrists (i.e., their educational background and practice), you can visit the website of the Canadian Psychiatric Association.

Psychologists

According to the Canadian Psychological Association, psychologists are specialized in studying how people think, feel, and behave. They use the scientific approach to gain valuable insights and then use these insights to help people understand and change their behavior.

Describing the typical duties of a psychologist is difficult as the very field of psychology is broad. Here is a brief example to illustrate this breadth: Psychologists can specialize in clinical, educational, and occupational psychology.

Let’s assume that the one opts to specialize in clinical psychology. In that case, one can further specialize in mental health and psychopathology, forensic psychology, health psychology, and counseling and psychotherapy. You get the point – there are so many options!

Also, some psychologists work primarily as researchers, while others work primarily as practitioners. Researchers can work within academia, but they can also work for different organizations. Options for practitioners are numerous as well. They can provide their services in various settings, including clinics, correctional facilities, schools, and organizations. Finally, some combine the two, working as research practitioners.

If asked what is unique in psychologists, compared to experts coming from the other three professions, it would be:

1. The most comprehensive training in psychological assessment

Psychologists are trained to construct, evaluate, and use psychological instruments (i.e., psychological tests). So, if you should go through any form of evaluation (e.g., personality assessment), it’s most likely that a person making an assessment will be a psychologist.

2. Well-developed research skills

Out of the four professions, psychologists undergo the most comprehensive research training. Even if they work as practitioners, they understand the importance of evidence-based assessment and treatment methods.

Coaches and psychotherapists

The previous paragraphs covered the unique features of psychiatry and psychology. So, what is left now is to explain who coaches and psychotherapists are. What is their scope of work? What are their unique features?

Shared features

Both coaching and psychotherapy focus on facilitating change in clients’ lives. Change can assume establishing healthier boundaries with others, fostering well-being, stress management, decision-making, career development, working through inner conflicts, or any form of personal growth.

In order to facilitate change, coaches and psychotherapists use their competencies (i.e., knowledge and skills) ethically. Interestingly, coaches and psychotherapists often rely on the same theories and use similar skills. Anyway, competencies are important. But, what is often even more important is a coaching or psychotherapeutic alliance.

Alliance refers to a high-quality, trusting relationship between the two parties (i.e., a coach or therapist and a client). Both coaches and psychotherapists are trained to help people live more satisfying lives. Lives that their clients consider “worth living.”

Distinctive features. Or not?

At this point, one might ask: “What are the differences between the two?” If both coaches and psychotherapists use knowledge, skills, and alliance, and if both can work with their clients on different matters – what are the differences?

Why do we call one a coach and another a psychotherapist?

Coaching is future-oriented while psychotherapy is present or past-oriented. You can often hear – coaches aim to help you achieve your future goals, while psychotherapists aim to help you understand and deal with present or past issues. Although there is some truth in coaching being more goal and action-directed, there is no clear cut between the two professions in this respect. Specifically, to help you achieve your future goals, coaches will often discuss your past and present with you. By doing so, they will help you connect who you were and who you are with who you want to become. Also, psychotherapists might start from your past or present, but your work with them will inevitably reflect on your future.

Some psychotherapeutic approaches, such as Cognitive Behavioral Therapy (CBT), Solution Focused Therapy (SFT), and Acceptance and Commitment Therapy (ACT), focus on clients’ values and future goals and are clearly future-oriented. Overall, the main point here is that there is no clear cut between the two professions based on past/present/future orientation.

Coaching is about destabilization, while psychotherapy is about stabilization

Psychotherapists often work with people shaken by symptoms or distress. They work on establishing stability. On the other hand, coaches work with those who are “too stable” and need to move away from stability to grow further. Their clients need to be “destabilized” so they can make changes and unlock more of their potential. So yes, there is some truth in the idea of stabilization/destabilization, but what the two processes share is that the ultimate goal of both is helping clients to move, to go further, and live better.

In psychotherapy, one does not want stability for the sake of stability. One wants stability to direct one’s life in the desired direction. So, it’s a struggle to change and a desire to accept the challenge, transform, and progress that exists in both cases.

Psychotherapists treat mental disorders, whereas coaches do not

The psychotherapy training usually includes modules concerning different forms of psychopathology. As part of their training, therapists learn about mental disorders. They also learn how to identify and manage the symptoms. Thus, their training is suited to working with individuals showing symptoms of mental disorders and experiencing compromised daily functioning due to those symptoms.

On the other hand, not many coaches have substantial knowledge of mental health and psychopathology. Thus, their training is more suited to working with individuals with no significant symptoms of mental disorders (i.e., those whose daily functioning is not compromised by symptoms).

Coaches are optimally equipped for working with individuals who are “mentally healthy” but want to unlock more of their potential. Coaches can help their clients fulfill their potential by helping them to assess their values, set goals, and identify steps toward those goals. It can include identifying clients’ resources and working on overcoming internal or external obstacles encountered along the way towards self-actualization.

How a life coach helps clients reach their full potential you can read in this article.

Payment-related differences

This point is related to the previous one. Specifically, if one meets the diagnostic criteria for a mental disorder and needs psychotherapy to get better, one’s insurance company might cover the treatment fees.

On the other hand, coaching cannot be “medically necessary,” as the prerequisite for coaching is that one does not experience severe symptoms that impede one’s functioning. So, you pay for your coaching sessions. Note that psychotherapy is not always covered by insurance companies, meaning that people often pay for it as well.

Accreditation and services

Psychotherapy regulated more strictly regulated than coaching. In the U.S., most states require a state license so one can legally practice psychotherapy. Being licensed in one state allows one to practice in that particular state but not necessarily in other states across the U.S.

On the other hand, a coaching license is not mandatory in the U.S., meaning that coaches can work throughout the U.S.

In Canada, only a few provinces have formally regulated the profession of psychotherapy so far. For more information about professional regulation in Canada, visit this link.

It is worth noting that, even when having a license is not mandatory, professional designations are good to have as they show that one is qualified and adheres to an ethical code and standards of practice. Professional designations also demonstrate that one is subject to a disciplinary procedure in the case of wrongdoing. Finally, they show that one updates one’s skills regularly.

Hopefully, this article removed a bit of the confusion around the four helping professions or, at least, did not create more confusion.

Hopefully, you now have a clue about who is who and who does what.

As you have read, every attempt to make a distinction between the four professions in only a few words reflects oversimplification. We wanted to illustrate the overlap between the professions (i.e., the scope of work) and explain that the same person can hold more than one of these positions. Most frequently, it is psychiatrists or psychologists who are also psychotherapists.

Who can help me with my problem or current life situation?

Now that we described the four professions, you might have an idea who would be the best fit for your needs. If you are still uncertain, here’s a brief summary concerning who and when can help you best in a particular situation.

If you feel mentally healthy but feel stuck, as if you know that you can achieve more but need help “to unstuck yourself,” going to a coach might be a good idea. A coach might help you with your motivation and goal setting and can also hold your hand while you make the first big (and brave) steps.

If you struggle with mental health and experience symptoms that interfere with your daily functioning, we recommend contacting a psychotherapist.

If you suffer from a mental disorder and believe you might benefit from taking medications (e.g., you are going through a depressive episode), going to a psychiatrist might be a good option.

If your state does not require medications, a good psychiatrist will tell you so and advise you on other ways to help yourself (e.g., a psychiatrist might recommend finding a good psychotherapist).

Finally, as described earlier in this article, psychologists can be contacted for many reasons as they can specialize in very different things. Whom you’ll contact depends on your needs. For instance, you might need an IQ assessment or personality assessment. But it can be an entirely different thing that you need. For instance, you want someone who can assess the efficiency of the coaching program you’re creating, or you need someone to take care of your employees’ well-being.

We remind you that one person can hold more than one of these positions and that these are only the simple guidelines to help you make an initial decision about whom to contact and when.

Most experts working in these professions chose their calling as they wanted to help people the best they could. So, even if you’ve contacted the “wrong” professional, the professional will refer you to the right place.

How to choose a good psychotherapist or a good coach?

You’ve probably heard that the best marketing strategy is word of mouth. If you are searching for a good psychotherapist or a coach, it’s always good to ask around. Satisfied clients will often speak highly of their coaches and psychotherapists, while unsatisfied ones will remain quiet (at best). So, by asking around, you will eventually get some good recommendations.

You’ve spoken to people around you, and they recommended some therapists or coaches. What next? Once you contact the professional, we encourage you to ask about the professional’s license, background, area of expertise, experience with issues similar to what you will bring into sessions, treatments they use, and (of course) their fees.

If you have a diagnosed mental disorder and seek psychotherapy, you may also ask whether a particular psychotherapist accepts your insurance. Based on all the information, you can determine whether the professional seems competent enough and whether you can afford the services.

Now, imagine you find someone who seems competent and is affordable. Overall, the one seems to be really good. However, the truth is that finding someone good does not necessarily mean that the one is good for you. The reason? For psychotherapy or coaching to be fruitful, there should be a solid alliance between the two parties. In other words, it’s essential to find the right match. The criteria for assessing whether someone is the right match for you is your personal comfort with the person.

So, regardless of whether you seek psychotherapy or coaching, we encourage you to seek information from people around you (step 1 – recommendation), professionals themselves (step 2 – competence), and yourself (step 3 – personal comfort). One’s recommendations and competencies do not mean much if you feel uncomfortable with the one. If your inner voice is telling you: “no, it’s not the one,” seek further.

Misha’s coaches

In the very end, let us say a few words about how Misha finds coaches for himself. When searching for a coach, Misha relies on three rules:

1. Coaches have to be products of their products. What does this mean? It means that coaches should already be in a place Misha is trying to reach. They need to live following their own values, of course, but they also need to have specific knowledge in the area Misha is trying to improve at the very moment.
2. The “wow effect” should be visible from the first session. According to Misha’s experience, if there is no click between him and his coach during the first session, it is unlikely that the click will ever happen. And “the click” is vital.
3. There should be simplicity but also sophistication. Coaches should speak clearly and directly, so you can easily understand and interact with them. But at the same time, you should be aware that you are working with very sophisticated individuals. Misha believes that high-quality coaches inspire awe and respect in their clients, and these two are must-have ingredients for coaching to be successful.

Sources:

Crowe, T. (2016). Coaching and psychotherapy. In T. Bachkirova, G. Spence, & D. Drake (Eds.), The SAGE handbook of coaching (pp. 85-101). Sage.