"I want to do the rest of this session outside while we walk. Would you be willing to walk with me?" Nancy was surprised, but she followed me outside. My office adjoins a public school with a beautiful outdoor track next to some woods. At the school, I set a medium pace and we walked alongside each other. We talked or we walked in silence, but we kept moving. I was modeling action: rather than telling her to move, I'd move with her, as a partner. After 30 minutes, I stopped and we sat on the steps near the track.
Nancy was winded. "That was different," she said. "Is that how you usually do therapy?"
"You're the first," I said. "You did well on the walk. Good going!" She continued to catch her breath. "Here's the thing. I can't be your personal trainer or your dietician. I can only be your therapist. I work with words. But I can walk and talk at the same time, and so can you. I know you're going through a very rough time."
Nancy nodded and took my empathy as a signal to start complaining. She said, in a small voice, "You have no idea how hard this is for me--no one gets it."
I held up my hand in a stop position. Here came the coaching edge. "Nancy, let me finish. I know some of what you're facing. I know that you have some decisions to make about how to live your life. To do that, you need more than my pity, or your own."
Nancy gave me a sharp look and started to tear up, which embarrassed her. I stayed silent until she composed herself. Finally, she took a deep breath. "I thought therapists were supposed to be nice," she started in that small voice. I still stayed silent, watching her. I wondered if this experiment--treating her as a cancer survivor the way I'd learned to treat myself--would help her reach inside and find some of her own inner strength.
"What do you think you can do for me?" she asked.
"I don't know what I can do for you, but I can tell you what I can do with you. I want you to have a place and a time, each week, with someone who knows what it means to have to fight for better health. I'll hang in there with you, week after week, while you find your own answers about your next steps. And I'll take some of those next steps with you, literally." I smiled now and glanced back at the track.
Nancy and I worked together for close to a year. We walked a lot of miles around the track. We laughed a lot; once she lost her little-girl voice, it turned out she had a wicked sense of humor. During our walks, she created a series of short- and longer-term plans. She changed her diet, found a trainer, and got into a routine at the gym. She reveled in getting stronger and told me about her reps on the equipment and her ability to do squats. She took an art class and discovered that it was a positive outlet for her grief and anger. She saw a lawyer and made a will with provisions for her husband and children if she died early. When she told me about that, she walked fast, with tears streaming down her face. I came to admire her tremendously and even though, as her therapist, I wanted to be more nurturing or empathic at times, I understood that she needed me relate to her from a position of mutual strength, speaking to the part of her I believed could step up to the challenge. I was her role model and, as she continued to monitor her cancer and think about further treatment, she became a model of grace under fire for me.
The integration of coaching techniques into my therapy practice is still a work in progress. I'm not always entirely clear about where therapy stops and coaching begins. But I suspect that most therapists these days, maybe barring those analytically trained, practice at least some default "coaching," even if they don't call it that. By and large, therapists today do more than listen, nod, observe, ask a few softball questions, and provide a neutral "holding environment": they encourage, challenge, and even offer their opinions and advice on occasion. Still, they're not really coaches--because the therapeutic zeitgeist has different origins and purposes. Notwithstanding jokes that private psychotherapy is primarily a salve for the worried well, most people consult a therapist because they're seriously hurting. Clients suffer from crippling depression, anxiety, phobias, out-of-control anger, post-traumatic symptoms, addictions--the whole catalogue of emotional miseries. They're not ready to begin checking off "clean sweep" bliss lists, nor would it be helpful, much less humane, to have an Andrew barking at them to "Pick up your pace, right now!" And while all good therapists try to see the potential health and strength beneath their clients' symptoms, promoting an "unconditionally constructive" message to someone in deep despair would convey not compassion, but callous obliviousness.
Still, there comes a point in therapy when even wounded clients can raise their heads, look around, and begin to see a world much more expansive, containing more possibilities than they could have imagined while crouching defensively in pain. It somehow seems perverse to dismiss them from therapy just when they're ready to forge ahead in their lives, beyond the land of "just OK" to something more like--brace for it--genuine happiness.
The therapy model is about nurture, the treatment of psychic injuries, healing, rehabilitation--a process that delivers people from what Freud famously called "neurotic misery to common unhappiness," but that's also where, frankly, a lot of people get stuck. Many of our clients want to go beyond a life lived in neutral, but don't have the motivational skills, practical knowledge, active support, or challenging encouragement they need to identify and pursue long- buried, unacknowledged, or only vaguely intuited dreams and possibilities. Bringing a coaching approach into psychotherapy offers our clients options for a happier, larger, more successful life. Coaching skills aren't a great leap from the skills many therapists already use to make change. Clients might have the best of both worlds if we learned to shift our intention, apply a coaching structure, use new language, focus on action, and work in partnership.
Therapy has already blossomed (or exploded--pick your own term) into what seems like a million different models, theories, and practices. Increasingly, however, people may want something that extends beyond therapy, into that liminal space between treatment and personal development, between healing and growing. Therapy may well take a turn into something like the kind of pure coaching partnership that I had with Andrew and Pam, but adapted for therapy. The vision of what this might look like is evident in the relationship that Nancy had with me: more egalitarian and motivational; still therapeutic, but more directive.
I'm working to find the right balance with my clients, to stay within my role as their therapist, but access a coaching skill set as needed, so that we can both be on that same bicycle. Can this vision work? Can a clinician effectively encompass both therapeutic and coaching styles with the same client? As I deconstruct what I've learned about coaching skills and try to find uses for them within my clinical practice, I'm aware of potential pitfalls. I caution myself and others not to mix roles (don't have dual relationships or try to be both therapist and coach with the same client), but I do encourage integration (do be a therapist with coaching skills and a coaching approach). So far, with me and my "double-whammy" clients, with whom I'm using both coaching and therapy approaches, it seems to be working, but I'm still exploring this new terrain. I'll let you know what more I discover.
Lynn Grodzki, L.C.S.W., is a Master Certified Coach as well as a psychotherapist in private practice. She's the author of several books about practice-building, most recently Crisis-Proof Your Practice: How to Survive and Thrive in an Uncertain Economy. She's on the faculty of CoachU, and her next book is on how to integrate coaching skills and psychotherapy. Contact: firstname.lastname@example.org. Tell us what you think about this article by e-mail at email@example.com, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine.