Last semester, a student asked me “Why are you a Coaching Psychologist, and not a therapist, when you clearly know so much about psychotherapy?” (I paid him for the flattery later.) I gave a rather glib answer at the time, and since then I’ve been wanting to find time to marshall my thoughts and be honest and upfront about my reasons for preferring to be part of a young upstart of a discipline, rather than adopting a label with a century-long pedigree. Today’s the day.
I think Freud did the world a great service. He did more than most to illuminate how we have rather little conscious awareness of the causes of our own behaviours. Freud called this the unconscious mind, which isn’t a term I love, but his work served to orient society to the fact that we aren’t all rational word-and-number-crunching machines who simply do what’s best for ourselves and society. As it happens, Freud seems to have been most proud of a different aspect of his work, namely the ‘discovery’ of mental structures like the id and ego. Personally, I think these ideas are pretty near useless in practical terms, though they may be interesting to talk about.
Later in the twentieth century, Carl Rogers started the second huge school of therapy, and his central tenet was that it is the nature of the relationship between the therapist and the client which helps the client overcome problems. I think the evidence for a non-specific effect in psychotherapy is unarguable, but psychologists typically earn more money than counsellors or therapists, so I’d like to imagine that we can offer something different to justify the price tag.
What I mean to say is that I have a huge deal of respect for psychotherapy. I wish more people would see psychotherapists instead of seeing their family doctor and being prescribed anti-depressants, anxiolytics, and goodness knows what else. Psychotherapy works.
Issue 1: The applicability of the medical model to the behavioural domain
The Oxford English Dictionary defines therapy as, “The medical treatment of disease; curative medical or psychiatric treatment.” This probably fits with the idea most British (dare I say most European) folk have about therapy. The United Kingdom Council for Psychotherapy gives a slightly broader definition: “talking therapy … helps people with emotional, social or mental health problems.” Definitions like these, to a greater or lesser extent, suggest that any ‘therapist’ is working to cure a disorder or disease. In fact, there is a huge debate in the worlds of psychology and therapy about the extent to which it makes sense to apply ‘the medical model’ of illness to the psychological domain. The evidence that there’s something chemically wrong with the brain that causes depression really isn’t very impressive. Some therapists will say they are helping fix a disorder, some dislike even the word ‘disorder’. Some psychologists will assess a client and then give a diagnosis like ‘major depressive disorder’, whilst others think this entirely inappropriate and bad science.
The very word ‘therapy’ however, comes from Greek and means ‘healing’. There’s no getting away from the fact that therapy was and is generally intended to help people who are struggling. When you see that someone has lost their job because they can’t get out of bed in the morning without hitting the bottle, it does feel to the observer like something must be ‘wrong’. Whether or not calling this a disease or a disorder is helpful from a scientific point of view is a debate for another day. In simple lay language, we have sympathy and we imagine that this person must have substantial pain. Some psychologists have always dedicated their time and energy to understanding those events and circumstances that mean people feel they are struggling with life. As a result, I believe, we live in a more humane society, with better ways of helping and supporting people who are seriously struggling to function in society. And let’s be honest, “seriously struggling to function” describes pretty much all of us at one time or another. I’ve done my fair share of this type of work, and I’ve had my fair share of these types of experiences.
What if John Doe was functioning well, with a successful job, but he wanted to be amongst the elite? What if he wanted to start a business that would fund a very comfortable lifestyle for himself and his family? What if Jane Doe, a very able student, felt really driven to be a great pianist, playing in concert halls? Would we want to say there is something ‘wrong’ or would we more often applaud their drive, their motivation, and their dedication? What if Peter wanted to lose weight, but found that he kept giving up on diets and exercise plans because his life was too busy with other commitments? What if John, Jane, or Peter felt that they currently didn’t have the psychological skills and wanted support from an expert in how to motivate themselves, how to learn faster, or how to improve their relationships with peers and customers? Would the natural response be to say “go and see a therapist”? Unless you are a therapist or psychologist you probably answered, “of course not.” (In fact, a really good therapist would often be able to suggest some quite useful things in these areas, though it might not be what they specialise in.)
Psychology is a very very broad discipline. Some psychologists can tell you about the most intimate behaviour of rats, whilst others analyse the patterns of behaviour shown by millions of people when they act together on Facebook. There have always been certain psychologists who have dedicated their lives to studying those people who seem to be getting on exceptionally well in life — the creative, the genius, the talented, the successful. Recently, much of this work has gained new momentum and has been given two labels. The basic science is often called Positive Psychology and the applied work of showing clients how to use these principles in their lives is usually called Coaching Psychology.
Issue 2: Going from ‘good’ to ‘great’ isn’t the same as going from ‘struggling’ to ‘good’
Remember Jane, who wanted to be a pianist? She’s done as many piano grades as it’s possible to do and she’s currently working with a piano teacher whose students have graced the stage at Carnegie Hall. Her cousin, Zach, age twenty five, wants to start learning the piano. Will Zach need the same teacher? My guess is that if Zach paid to see the same teacher, she’d probably refuse to see him because teaching beginner piano isn’t her speciality. In fact, the chances are that a really great teacher who often works with beginners will get faster progress out of Zach, because that teacher will know much more about the problems that trip up beginner pianists. It isn’t that the ‘beginners’ teacher is a lesser teacher, it’s that we each get good at helping people if we’ve worked with lots of people like them before.
Now, let’s not take this too far. It’s not a perfect analogy. The parallel is only approximate, though the relationship between coaching psychology and therapy is something like the above example. Therapists and coaching psychologists might sometimes use the same principles and even practices, but there are often considerable differences. If a therapist is working with someone in the depths of depression who can hardly get themselves out of bed in the morning, the therapist and the client might both describe this as an issue of motivation. Similarly, a coaching psychology client who is currently ‘only’ putting in 60-hour weeks might want to know how to increase his motivation. Simply lumping these challenges together and calling them ‘motivation’ is a bit like putting Zach and Jane in the same box and calling it ‘playing piano’. A decent coaching psychologist could probably help somewhat, in principle, with the client who’s depressed, and the therapist could probably make some decent suggestions for the guy who wants to have productivity superpowers, but that doesn’t mean it’s the best possible match. The great innovation of the Industrial Revolution was specialisation. It applies in psychology too.