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.
I learned to use the first minutes of the coaching session more purposefully. After saying hello, I'd ask clients about their progress since the last session. Then, we'd discuss what ideas they had for the focus of the next hour, determine a plan for the session, and jump right in. "OK, Ruth," I might say, "I understand that you want to talk about whether to move to a new city. That's an important topic, but it's a big one to cover. Given our time today, what aspect of this topic makes most sense to discuss first?" Developing collaborative, clear goals for a session constituted the coaching agreement. If any one aspect of coaching could be called the most necessary, this would be it. Because each coaching session needed to deliver measurable results, I found that taking the time to set a good coaching agreement--being careful not to rush through this--greatly enhanced the likelihood of a successful hour. When I took the time to arrive at a solid, workable agreement, my coaching sessions usually went well, with the client very satisfied; however, when I forgot this step or the agreement was too vague, things tended to meander, and often the client left feeling unresolved about what we'd achieved.
As I grew more comfortable with coaching, I began to wonder about structuring my therapy sessions in a similar way, and tried to weave this and other coaching methods into my therapeutic work. A major feature separating the two approaches was the attitude that set the tone for sessions. Traditionally, psychotherapy has focused on pain and suffering--the dark side of the spectrum of life's emotions. But in coach training, optimism and a positive attitude rule supreme. At CoachU, we focused on expansive, even visionary, topics, which included peak performance, accomplishment, pleasure, and happiness. In fact, the coaching approach was so uncompromisingly hopeful that, initially, true to my psychodynamic training, I could barely keep from rolling my eyes at all this happiness-and-bliss talk.
I learned at CoachU, in no uncertain terms, that if I wanted to be a coach, I had to quash my cynicism and get on the happiness bandwagon. "You can't be a very good life coach without having a very good life," a senior coach said. Then, in a class called Buff--as in, getting to perfection--she asked everyone to complete the "Clean Sweep" checklist, a 100-item list of conditions in four categories of the perfect life--physical environment, relationships, money, and well-being--to which we should aspire. A few, which provide the tenor of the exercise, include:
- I have 6 months' living expenses in an easily accessible account.
- I do not suffer.
- I laugh out loud every day.
- There's no one whom I would dread or feel uncomfortable "bumping into" (in the street, at an airport, at a party.)
- I don't gossip or talk negatively about others.
- I surround myself with beautiful things.
- As I worked down the list, one statement stopped me cold:
- I live in the geographical location of my choice.
Now here was an item I didn't think I'd ever check off. In high school, when other students talked about their plans for college and beyond, I had only one goal: to get out of Silver Spring, Maryland. To me, at age 17, Silver Spring, a low-key, middle-class suburb of Washington, D.C., was the epitome of all things boring, and I wanted only to be gone. Determined to experience the '60s counterculture, I went to the University of Wisconsin in Madison, a genuine hotbed of revolutionary politics and protest--and best of all, it was so not Silver Spring. I got so caught up in the antiwar movement and my new freedoms that I didn't have time to go to classes. Dropping out after a year, I embarked on a nomadic, hippie lifestyle. Along with my husband at the time, I lived in a school bus that we drove around the country, making enough money to live on by organizing rock concerts.
But my adventure in a countercultural lifestyle ended as so many like it did in that era: after six years, my marriage fell apart and I came home, back to Silver Spring, to regroup, with a 4-year-old child in tow. I was exhausted, run-down, and seriously depressed. I thought I was just visiting long enough to get my energy back, but my parents sat me down and urged me to stay put, go back to college, find a job, grow up, and take care of my son. I saw their point and agreed. The one place I wanted to escape had now become home again.
Twenty years later, I was still in Silver Spring. With the help of my own therapy for more than a decade, I was no longer depressed, was married again--happily this time--enjoyed a circle of family and friends, lived in a comfortable house of my own, and had a private practice as a therapist. But I just couldn't make myself say that I "lived in the location of my choice." During the next coaching class, when I reported my inability to check off this item, the teacher asked if I appreciated the cost, to myself, of not loving where I lived. I had no answer for that. But, ever the diligent student, I wanted to get a passing score on the survey, so I decided to see what it would take to learn to love Silver Spring.
I started with my immediate neighborhood. I took long walks and found a hidden delight. Down a dead-end street, just minutes from my house, was a steep hillside that led to a secluded branch of the Anacostia River. The little path by the river was green, quiet, and private. Large, old oak trees blocked any sign of houses when I stood on a rock by the river. Waterfowl, deer, and fox called this area home. I felt as if I were in the country, instead of the suburbs. During another walk, I explored streets lined with flowering cherry and magnolia trees--a gift from the original city planners. I planted a small kitchen garden and dreamed about making my own salad. I met neighbors who stopped by to chat as I knelt outside digging in the dirt.
Reconsidering what the concept of home meant to me, I began to appreciate the gifts of being back where I grew up and getting the chance to "do over" old, sometimes painful childhood memories. Looking back on my 24-year-old self who agreed to stay in Silver Spring for the sake of her child, I could regard my personal history with more compassion. In just a few weeks, I began to shift from resigned acceptance to real affection for my immediate surroundings--a process that continued long after the coaching class was over.
With a lot of help from good therapists through the years, I'd looked at my family-of-origin and the issues that led to my desire to escape Silver Spring, much of it based on feelings of anxiety and depression, and had found ways to shift old beliefs that I was unlovable and unworthy. But the pursuit of unalloyed happiness had never been on the agenda of my own psychotherapy, and wasn't part of what I offered my clients. Before learning to be a coach, I functioned well. I showed no egregious symptoms of emotional distress, accepted myself, and had acquired a degree of self-awareness and self-acceptance. But coaching taught me to seek delight in life, rather than just feeling a sense of quotidian OK-ness. It offered strategies for a larger sense of fulfillment and happiness, and normalized them as realistic goals--a completely novel way for me to view and live my life. With more to choose from, including happiness and possibility, in the jargon of CoachU, I was finally "at choice."
I printed off the Clean Sweep checklist and began to offer it to my therapy clients as a resource for life improvement. One client, who suffered from depression, was in a difficult marriage, worked a low-level job, and was barely surviving financially, came in with it the next week and handed it back, angrily. "I have a score of 6 out of 100 on this list," she said snarling, "It's a stupid exercise." Other clients in later stages of therapy, not so depressed and more ready to think about their future potential, welcomed the list, and picked items to add as topics for therapeutic discussion. Some clients, who might have been on the verge of terminating because their early therapy goals felt complete, now asked to stay and work on more future-oriented goals and visions, spurred on by ideas from the checklist.
As I proceeded in my coach training, what began to stand out as the critical element--the difference between coaching and therapy and the one I was most unsure of carrying over to a therapy setting--was the idea of partnership. Coaches are, above all, partners with their clients, not quasi-medical experts or psychological wisdom dispensers. The difference in the coaching partnership relationship is often explained by imagining you're learning to ride a bicycle for the first time and being helped by a therapist, a consultant, and a coach. A therapist would be standing off to the side, closely observing your attempt to stay upright. She'd be empathic, compassionate when you fell, and might make insightful interpretations about why you're so unbalanced. She'd help you understand the origins of your lack of stability and again watch as you got back on the bike, this time, armed with all of your new (theoretical) insights.A consultant might be the ex-Olympian bike-riding expert accompanying you, riding speedy circles around you while you wobble along, struggling to keep the bike and yourself upright. He'd note your current lack of ability at riding, tell you exactly how and where you're doing it wrong, give you a detailed, step-by-step plan for doing it right, submit a report with all of the findings and suggestions, including specs for the state-of-the-art bike you'd need to buy, and then ride off, leaving you to do what he'd told you to do. A coach would climb on the seat right behind you and ask, "Where do you want to go today?"
A Coach at Your Back
Having a coach right behind you, an ally guiding you and the bike as you both peddle along together, is an example of the partnership position. Rather than observing from a neutral distance (therapist), explaining how to do it and what equipment to use (consultant), a coach shows you how to ride the bike, stays right along with you, helps you practice your riding skills, and keeps you motivated to continue riding until you know how to do it like a pro. You're in the steering position, but she has your back. She has no agenda other than wanting you to get where you wish to go.
After I graduated from CoachU in 1998, I started working as a business coach, helping therapists develop the business side of their practices, at a time when managed care was beginning to take a heavy toll on therapists' incomes. With my practice-building program gaining interest, I fleshed out the manual with the idea of writing a book. On a whim, I sent a query to an editor, asking her if she was interested in a book about my program, although I didn't yet have a manuscript, just a few loose chapters. I got a speedy response from the editor saying to send it on.
At that point, I developed a crippling case of writer's block. I just couldn't move forward. I'd never hired a coach for myself, but if not now, when? I sought out Pam Richarde, a former therapist, now working exclusively as a life coach and director of training at CoachU, who'd helped other people get published. During our first call, one of Pam's questions was, "What's important about writing this book?"
"Well, it would be good for my career. It would help me build a business-coaching practice. I think it would help me teach more classes. I'd be an author and could present workshops." On and on I went with ideas that were basically about furthering my career.
"Anything else?" she asked.
"No, that's all I can think of."
"And you're really stuck. You haven't written a word in over a month."
Pam took a moment to think about this. "Lynn, I'm listening to your reasons for writing and, sweetie (I learned later that Pam called all her coaching clients affectionate names), I just don't think that you have a big enough vision to get you over the writer's block. I request that you find a bigger, better reason, other than your personal career agenda, for this book to exist."
"Like what?" I asked.
"Honey, that's what I'm asking you! I can't find the answer, but I do believe it's inside you. If I was thinking about this for myself, I might be thinking about my values. Think about this over the week and let's talk more on our next call."
For Pam, the best way to shift perception when someone was stuck was to get them to think bigger. She invited me to develop a vision for the book, so I looked at a bigger reason for writing one--beyond my capital-C Career. I took long walks that week and thought about what a book with this topic might accomplish for others. It occurred to me that if I could help therapists be more successful, it might keep the therapy profession alive in the world, maybe help it grow! I thought about all the therapists I knew who toiled in private practice--good, generous, caring people--who deserved to earn a good living. I began to get the spirit and motivation I needed. I finally started writing in earnest.
Pam was a cheerleader while I was writing, but she also brought in her expertise with publishing. When I'd completed four chapters, she outlined the next step--how to write a book proposal--and when I'd done that, she opened her Rolodex and gave me the name of a copywriter to perfect it and a book-marketing expert to advise me about how to get the world interested in it. I sent out the proposal to six publishers and got back three offers. As a coach, Pam modeled a partnership position: she stood behind me and it felt, to me, as though my goals became her goals. Her interest in my success felt real and helped me move forward faster and more easily than if I'd been on my own.
But when I tried to describe my relationship with Pam to other therapists, I got stuck. Pam was kind of an advisor, but she worked with me, as one therapist would describe, "close-in," like a longtime buddy. She had immediate, real reactions. She cared a lot about my goal. Certainly, no therapist had ever called me "sweetie" and "honey." But she wasn't really a friend or even a colleague. And while I paid her--as I would a therapist--she was transparent and self-disclosed tidbits about her own life and her work to help me stay motivated. She'd "break the frame" to e-mail me between our sessions to find out how I was doing and if I was making progress on a specific action. She made suggestions freely and openly and I got immediate and long-lasting results from her partnership stance within our coaching. My book got published and became a resource for tens of thousands of therapists, fulfilling the vision Pam pushed me to define.
The Coaching Edge
In 2005, I was diagnosed with breast cancer and underwent a bilateral mastectomy with no reconstruction. My body, as I knew it, changed forever. My doctor told me to start exercising, but after so many years of sitting--as a therapist, coach, and author--I just couldn't get myself moving. So I hired a young sports coach as a personal trainer. In the same way that psychoanalysis represents an extreme model of psychotherapy, a sports coach is an extreme experience of coaching. My trainer, Andrew, was young, but a serious coach who ran soccer, basketball, and martial art camps for children. When I explained the physical limitations from my surgery, especially my problem with upper-body range of motion, he looked me over and said, "I think I'll train you to play basketball, the way I train the kids I coach. It'll help you get strong and fit, and stretch your arm and chest muscles." I laughed at this, as though he were joking; I'd never even held a basketball or played any sport. But Andrew didn't even smile. He was serious, and I was about to learn what it meant to be coached to the extreme.
Working with Andrew was a full mind-and-body reeducation. I signed up for three hours of training (or torture, as I called it) each week. I was out of shape, and the first year of training was miserably difficult. Over the course of that year, Andrew cajoled, pushed, encouraged, and challenged me again and again, helping me rebuild my physical capacity to a point far beyond what I could have imagined possible. I learned to do lunges and push-ups, jog, lift weights, and, of course, play basic basketball. That frightened me because it was a contact sport, but also thrilled me as I--an antijock, if ever there was one--learned to shoot baskets and make layups.
When I was too tired to jog, Andrew literally got behind me and pushed. He wasn't physically exceptional (shorter than I, no defined muscles), but his passion for sport and training made him an impressive athlete on and off the basketball court. He was patient and demanding, a constant cheerleader and a rigorous tactician, noting and measuring any amount of progress. I had to learn perfect form for every layup or dribble. I became stronger, more coordinated, and more confident. My improved physical health and fitness was a kind of revelation, opening up an aspect of myself I'd never known existed. In the moments when I could catch my breath, I observed that Andrew often relied on a technique called, in coaching jargon, a "coaching edge."
Using the bicycle metaphor, when you're positioned to sit right behind a client and see when the client is about to crash, you can't just stay mum and casually observe the crash. Using a coaching edge means delivering a "Put on the brake!" message when the client is about to self-destruct. A coaching edge gets attention and, hopefully, a buy-in from a client for action or peak performance. When Andrew wanted me to run faster during my sprints, he didn't ask in a therapeutic, friendly voice--"Could you move a little more quickly, please, Lynn?" He barked. "Pick up your pace, right now! Give me 100 percent. Let's see you really run!"
This coaching edge is one of the hardest skills to teach aspiring coaches or therapists who want to coach, too, because it's confrontational. For me, it took a client whose experiences paralleled many of my own to help me put together the elements of how best to work as both therapist and coach. Not only was Nancy, who was 32, young to have breast cancer, but like many who become ill at that early age, it was an extremely aggressive form. She'd completed her surgery and chemo, but was being watched carefully by her medical team. Her oncologist had strongly encouraged her to lose weight and exercise, to become as physically healthy as possible. But depressed and angry about her illness, Nancy was stuck in a rut of watching endless hours of TV and being preoccupied with her rotten luck. She was already in couples therapy with her husband, but had decided she wanted some individual sessions with a therapist who understood cancer.
In our first therapy session, Nancy said she couldn't get herself to stay on her diet and exercise program, and knew why. "Part of me just wants to give up," she admitted in a little girl's whining voice. She knew she was grieving. Bitter about getting the disease so young, she also worried about her two young children. What would become of them? She took out her worry and anger on everyone and everything--her treatment team, her husband, her friends. She repeated several times that it was so unfair, that no one really understood how awful this was for her. I listened silently for about 15 minutes, nodding my head, saying little other than a few validating comments. Then I switched gears.
"Do you have a jacket?" I asked.
"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: email@example.com; website: privatepracticesuccess.com.
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