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The Coaching Edge

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ND2012-1Helping Clients Take Their Best Shot

By Lynn Grodzki

A new style of working has emerged that integrates the in-depth understanding of traditional therapy with the experience of being instructed, pushed, and challenged identified with coaching. But can a clinician effectively encompass both styles with the same client?

I walk into my waiting room on Monday morning and see a heavyset, middle-aged man slumped in a chair. His body droops, elbows on his knees, head down. I can't see his face--just his round, hunched-over body and a bald spot at the top of brown, thinning hair. He doesn't move as I approach.

"Rick?" I say, and he looks up, nods slowly, and stands. His eyes are watery, and I wonder whether he's been crying.

I know a little bit about him already. His doctor, a colleague of mine who's just seen him for an emergency appointment for chest pains--which have turned out to be anxiety-related--referred Rick to me late Friday afternoon. The doctor left a message on my office phone when she made the referral: "Rick's a good man, but very stressed and worried. He has a lot of family complications that he'll tell you about. If he keeps going the way he is, he'll probably lose his job as well as his health."

When Rick sits down, I ask my standard question: How can I be of help? Rick doesn't answer immediately. He wipes a limp hand across his eyes, and I wait in silence.

"I was called into my supervisor's office last Friday. I'm on probation," he announces in a quavering voice. "It's serious. I could get fired: my supervisor put a memo in my file. I can't afford to lose my job. I thought I was having a heart attack that evening, but the doctor said it was just anxiety. That's why I'm here."

I ask Rick to tell me more about what happened on Friday. Coming back from lunch late, he'd gotten a frantic phone call from his wife, who struggles to manage complications from her diabetes. Also, Rick's mother, who suffers from dementia and lives in his home, had hit his wife, in a fit of confusion and agitation. In the midst of this conversation, Rick's secretary, Anne, had walked into his office to ask about a report that was a week overdue. Distracted and overwrought, Rick snapped, yelling at Anne to get out of his office and adding a string of invectives about her intrusiveness. Out of sympathy for his family situation, Anne had been covering for Rick's tardiness and work errors for months, but now, he was yelling at her. Shocked and offended, she went to his supervisor to complain.

Rick fumbles in his pockets looking for a tissue, although a box is on the table right in front of him. "I can't believe I yelled at Anne. She didn't deserve that. I said terrible things to her. My supervisor was right to call me on the carpet. What a mess."

Once he's gotten his story out, I do what I usually do to try to establish initial rapport. I say, "You were in the middle of a complicated situation, rushing because you were late, your wife on the phone crying, and then Anne came in and you were mortified that she'd overheard the scene with your wife. I see how upset you are."

Rick nods his head to signal yes, I understand him. We settle into a familiar therapeutic rhythm: he talks; I listen, nod, and make a comment. Then Rick nods--clearly reassured--and talks more. His narrative shifts away from the office to the stressors in his life: his mother, his wife, his fatigue. He continues to open up as I let the story unfold. Our conversation develops a relaxed back-and-forth rhythm.

But after 15 minutes of this comfortable flow, I start feeling antsy and begin to attend to an inner voice that I've come to hear in my sessions more and more. Instead of a calm observer of the situation, it's a sharp, bossy presence in my head. "This man is drowning," the voice barks at me, "and you're letting him describe the temperature of the water and his feelings about wetness." I mentally shake my head as if to clear it of the interruption--to get back to the more pleasant cadence of listening and nodding--but the intrusion continues. "He needs to make some changes to keep his job. Get him to focus and start to create a plan."

"OK," I think, "the coach has entered the building." This coach's voice is a relatively new presence in my therapeutic work, and it often takes me by surprise. Increasingly, I notice it when I'm with a client like Rick, who needs to fix a critical problem.

I sit up straighter in my chair and politely, but firmly, interrupt Rick. "I'd like to shift gears now and get back to your initial problem, the one that brought you into my office today. Are you serious about finding a way to fix the mess you made on Friday so that you can keep your job?"

Rick's eyes widen and he looks surprised. I know I'm not transitioning as gracefully as I might, but the coach's voice is urging me to take action now. I wait for his response, which will let me know whether this was a wise move. He begins to object, but then pauses, sighs, and looks right at me.

"Lynn, you're right. I got off track. I've been in therapy before and I know there's a lot in my life that isn't working for me. But my number-one concern is that I keep my job. Everything and everyone in my family depends on me keeping my job."

"OK," I say. "If that's your priority, then you need to make some immediate changes. Today, in the time we have left, we can create a plan to help you calm down and become more productive at work."

Rick nods his head vigorously. "That would be good. I need to hold my temper and get my reports in every day. I haven't been productive in a long time."

Rick is following my lead and letting me focus the session. For the next 30 minutes, we brainstorm a series of action steps: make appropriate apologies to Anne and his boss, shift his workflow to ensure that his weekly reports are complete before he leaves on Friday, and manage his time more efficiently. We role-play talking to Anne and his boss, while he makes notes on a pad of paper, which I always keep on the table in front of clients, so he can remember the key steps. One fun idea involves setting up his computer screensaver to help him remember to stay calm during the inevitable interruptions of the work day, by reminding him of his favorite relaxation activity--going fishing.

At the end of the session, Rick says, "I'm amazed that I can take so many practical steps to improve things right away. This sure is a different kind of therapy than I'm used to."

I plan to see him for weekly sessions, and regularly check on his progress at work. Once that situation is stabilized, I imagine we can shift back to a more traditional, noncrisis mode of therapy. Rick won't need a strategic coaching approach for all of his problems. But as he leaves, I wonder, as I often do when I bring in a coaching approach, what another therapist would call this session. Is it psychotherapy or coaching or some mixture of both? This is the predicament I face--being both a therapist and a coach.

Welcome to CoachU

My education as a social worker was primarily psychodynamic, but like many therapists, I've explored a variety of methods: Gestalt therapy; self-psychology; emotive, cognitive, and behavioral approaches; couples therapy; and others. But in 1996, after a decade in practice, I signed up for yet one more multiyear training program--that changed my career. It started at lunch with a therapist friend, when I mentioned that I had a client who was spending a lot of time talking about his frustration at work. "I'm sure I could outline the steps to help him get a promotion," I told my friend. She frowned.

"What?" I asked. I knew her expressions pretty well.

"Giving him the steps toward a promotion isn't what I'd call psychotherapy."

"What would you call it?"

"I'm not sure, maybe some type of business coaching."

Having spent some years running a business before I'd begun therapy training, I was intrigued by the idea of diversifying my work with business coaching, something I'd never heard of at the time. I found a coaching school, CoachU, and signed up for a two-year program of classes. All the classes were taught by phone via the new technology of bridge lines. Since updates about classes and other information were handled online, I was required to get a computer and connect via e-mail. Just by signing up, I started becoming more tech-savvy than I ever would have become otherwise.

Most students at CoachU took the basic courses first, outlining the coaching process and philosophy, with action-verb names like "listening," "challenging," "advising," "messaging," and "strategizing," and then selected a specialty area of practice--business or executive coaching, sales coaching, organizational coaching, or life coaching. Since I was pretty sure that, as a therapist, I knew all about listening, challenging, and advising, I reversed the order and took my business specialty courses, which sounded more interesting and practical, first. At the end of my second year, in order to graduate, I grudgingly signed up for the general classes, sure that they'd teach me nothing new.

It was true that some of the general coaching classes were a superficial hodgepodge of methods borrowed from organizational development, mentoring, counseling, and personal growth. But as I took more of these courses and signed up for additional master classes with Thomas Leonard, the founder of CoachU and one of the initiators of the coaching profession, I began to realize that I hadn't fully understood what coaching was all about. What caught my interest was how it differed from, yet complemented, therapy. Coaches seemed to be far more adept than I was at quickly and easily motivating clients to make changes. It occurred to me that learning coaching skills could not only prepare me for a coaching career, but also make me a better therapist. So I began to pay closer attention in my classes, to deconstruct what made coaching something perhaps related to, but also distinctly different from, therapy.

The difference started with the way the coaches in my classes talked. In my therapy training--primarily psychoanalytic and psychodynamic in my social-work program--therapists used what I came to regard as a peculiar "therapy-speak." Not only did they use a specific jargon and cadence when they talked to clients, they seemed to measure their words, speaking carefully and calmly, hiding emotional reactions behind composed faces, asking questions, rather than expressing their own opinions. They made use of long, sometimes excruciatingly long, silences. Therapists said things like, "Alice, how does that make you feel?" "Tell me more." "Who in your life does that remind you of?" They used pointed interpretations, such as, "I hear that you were unhappy when your friend spoke dismissively. Your decision to stay silent with her resembles your father's punishing silences. This might signal a negative transference."

Our coaching teachers didn't speak that kind of language. They encouraged us to avoid pussyfooting, to talk like "normal" people having normal conversations. We were taught to speak up quickly and candidly, show honest reactions, and not be afraid to use humor and anecdotes to lighten the tone and instruct the client. Like therapists, we were supposed to ask clients lots of questions, but they were less of the "why" variety and more about "what" and "how" and "when." The focus was far more on what a client thought than on what a client felt.

Above all, the emphasis was on the doing. "What do you want to do about all of this? How can you make that happen? What's your first step? Can you do it faster, with a little more fun? What's the biggest, boldest way you could meet this goal? How can I support you?"

My therapy training taught me to let clients lead and concentrate on creating an atmosphere in which they could feel safe enough to bring up whatever was on their minds. But as a coach, my job was to lead, often by example. Coaching was designed for functional adults, not vulnerable clients. It was intended to change behavior, so we learned to use our words to encourage, motivate, set goals, and challenge clients. Coaches thought nothing of making clients' goals larger or asking clients to achieve them faster. They actively brainstormed with clients, made suggestions, and offered advice. Coaches made big requests for bold actions right up front, instead of slowly helping clients develop insight so they could decide how to handle a life predicament.

In coaching class, for example, I heard, "Gene, you complain about the continual lack of respect you get from your brother. I request, as your coach, that you respond to his criticism in a way that makes you a better, not a worse, man. I want you to figure this out and implement it within the next week. How about it?" Or "Susan, I know you're having trouble paying your bills this week. But let's expand that conversation. Let's create a plan for prosperity today. What do you need to do to have enough money in your life, now and always? Once we outline a plan, I'll coach you to see this through."

As a psychodynamic therapist, I was taught that my primary role was to be a blank slate personified. From the start of the session, I followed, allowing clients to communicate whatever they wanted, interrupting only with an occasional question or comment. But a coaching session had a specific internal structure, beginning with the coaching agreement--a clear, strategic plan for the outcome of the session, which the coach and client constructed at the beginning of each and every session.

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7 comments

  • Comment Link Monday, 14 January 2013 03:47 posted by Dorothy

    This blog was... how do I say it? Relevant!! Finally I have found something which helped me.
    Thanks!

  • Comment Link Tuesday, 01 January 2013 22:35 posted by Katherine Ferris

    Thank you Lynn, for this great article. I believe your article is well worth reading, not just by psychotherapists, but by all therapists involved in working with clients in a therapeutic setting.

    As a clinical hypnotherapist and childbirth educator, I can relate to your model of integrating coaching into clinical practice. A good hypnotherapy session will usually involve suggestions that lead to solutions, in other words some form of conscious or subconscious coaching is generally involved.

    I have enjoyed reading your newsletters and am looking forward to reading your book.

    Katherine Ferris
    Clinical Hypnotherapist
    http://www.sydneywellbeing.com

  • Comment Link Wednesday, 26 December 2012 20:55 posted by Mary Castor

    I truly appreciated reading this timely article. I have recently embarked on a new career as a psychotherapist after having worked as a social worker in the capacity of a case manager for the past 35 years. In working with clients now using psychotherapeutic skills, the tenets of coaching techniques resonate well with me as these skills offer tangible measures of hopefulness for clients early on in treatment. Empathy, acceptance and genuine positive regard are the hallmarks to a successful therapist-client relationship but I have found people want action steps like a road map in getting from point A to point B. A good therapist I believe promotes due diligence by incorporating coaching skills during treatment. I would advocate for more research in this area. Thanks again for sharing your insights.

  • Comment Link Wednesday, 12 December 2012 13:43 posted by Jonathan Sibley

    Thank you, Lynn, for a thought-provoking article.

    As a therapist and coach, I am wary of a potentially overly binary question along the lines of "is X therapy or coaching?", preferring something closer to "Is this within the agreement I have with my client, within my scope of expertise, and is it potentially helpful to my client?"

    A therapist, coach, and consultant might disagree about how a specific intervention should be labeled (there is disagreement, for example, within coaching about whether something that sounds like consulting has a place within a coaching conversation), but if it helps the client, is based on the helper's expertise, falls within appropriate codes of ethics, and within an understanding of the work that will be done together, I am happy to work within overlapping domains.

    Also, I'd like to suggest that although therapy, particularly when it doesn't look like coaching, tends to be focused on healing, some of the other distinctions you make between therapy and coaching are not universally accurate. For example, many therapists make an effort not to position themselves as experts who are "above" their clients but see themselves as co-explorers on a shared journey.

    The bottom line is that it sounds like you are doing great work that is helping your clients and that some form of coaching-informed therapy and therapy-informed coaching is a good fit for you and your clients. You are also asking important questions about the relationship between coaching and therapy and how we can best help our clients.

  • Comment Link Tuesday, 20 November 2012 11:30 posted by Lisa R. Mitchell

    As always, Lynn's contribution to our field is timely and thought provoking. I admire her work deeply because she has always shown such a dual sensitivity to issues. In this article, she discusses the role of self disclosure (AKA "personal anecdotes" in the coaching world)and mentoring in a therapeutic relationship. And, in her honest, open-hearted fashion, she models this for us with her account of feeling "antsy" with a client and continuing to struggle and experiment with the integration of coaching and therapy.

    I have appreciated times when coaches have referred clients to me for therapeutic issues that existed outside of the coach's expertise. I have also referred clients to coaches when I felt a more specific and direct approach on subjects such as business and parenting would be better helped by a coach.

    It is interesting to start to think of an integration. I will now be looking for times when my "inner coach" is wanting to come out. And, I will begin to ask questions about that voice rather than squelch it in the name of "being a good therapist".

    Lynn, you ALWAYS hear and see between the lines.
    Thank you for the article and for highlighting this IN BETWEEN for our profession.

  • Comment Link Monday, 19 November 2012 14:37 posted by Ken Howard LCSW

    This is a great article, and I am a long-time fan of Lynn Grodzki. I work as she describes, as a therapist who applies coaching skills. I don't think therapy and coaching are -- or should be -- so "apart" as some people describe. Maybe coaching looks very different from psychodynamic and psychoanalytic therapy, but it doesn't look that different from Cognitive-Behavioral Therapy or Positive Psychology, or any behavioral/goal-oriented model. Also, while I love Lynn dearly, she fails to mention a serious commercial and political problem in the field: which is that there are people who cannot, or more likely will not, make the sacrifices necessary to get a college undergraduate degree, a graduate degree, and undergo supervised practice and licensing exams to become professional psychotherapists, but they want to make $100-200 per hour talking, so they become "coaches" instead, with no formal education, no formal oversight, no consumer protection agencies, no objective codes of ethics, and no continuing education requirements. Therapists undergo all of these. For a "coach" with no other training to earn what a therapist does with all of theirs is like paying a candystriper the same salary as a nurse practitioner. I believe in therapists using coaching techniques, but I don't believe in coaches competing for the same client dollar with therapists who actually know what they are doing in a very formal context of deep, prolonged, and supervised training.

  • Comment Link Sunday, 18 November 2012 17:36 posted by Larry Drell, MD

    Great article. Despite years of academic psychiatric and psychotherapy training, I have always thought of myself simply as a coach in the counseling room.

    Thank you for your beautiful story of your development. It is always good to not feel alone.

    I have often wondered how to merge the directness of a coach with the tools and knowledge of therapist. I think we can and must do this to really be good therapists.

    However there are bad teachers and bad coaches and one has to be very skillful at when to use which tools. Being honest with oneself and just more real with another human being always seems to be a useful part of the therapy.

    This may be a stretch but i think when i simply taught a senior partner in a law firm to throw a baseball in the alley behind my office (telling him to get his body into it and showing him he could loosen up and do it) I helped his self esteem and relationship with his wife more than challenging his belief system. Discussing and remembering how his mother criticized him excessively never got him to the next level of confidence.

    And directly telling a patient that they were actually talking to me with an annoying arrogant condescending tone and that was going to lose them points in the world they wanted to win in, was probably more effective than interpreting their behavior. Of course i think i had already established a positive relationship so he could hear me.

    But it is a never ending challenge of how to be most effective. I love your honesty about taking leaps listening to your inner voice.

    So thank you for focusing on incorporating coaching tools into the psychotherapy and suggesting how it can be used with ourselves and our patients.

    Looking forward to your book

    Larry Drell,MD
    http://counselingandtherapydc.com for info on coaching,therapy,and the treatment of anxiety and depression.