The Role of Coaching in Mental Health

Jacob J.
Jacob J.
Research Manager

There’s a Problem

Mental health problems are increasing in severity and frequency; unfortunately, access and availability are not increasing to meet the demand. [1-3] Data from the U.S. National Institutes of Health (NIH) Health Risk Survey shows that 18–25-year-old individuals have the most need for mental health support and services but are the least likely to receive mental health support and services. The rates of individuals seeking mental health support has significantly increased over the past few years and dramatically increased further due to the COVID-19 pandemic. [4]

How can we address it?

The growing need to identify solutions to the heightened mental health crisis has led the World Health Organization (WHO) and United Nations to promote the expansion of mental health services beyond the traditional psycho-medical and psycho-pharmacological methods to include peer support services. The WHO’s Comprehensive Mental Health Action Plan 2020-2030 helps provide frameworks for improving mental health care to be more individual centered, rights-based, and recovery focused. [5-6] Additionally, the action plan identified peer support services as a valuable expansion of mental health services because they can provide benefits to quality of life, increase mental and physical health outcomes, lead to positive behavior changes, and offer cost effective options. The predominant methods of mental health care have focused on diagnosis, medication, and symptom reduction with less concentration on many other wide-ranging determinants of mental health. The WHO also recognized that many worldwide mental health systems operate with significant resource restrictions, outdated legal and regulatory systems, and an overreliance on clinical treatments. These challenges create a scenario where established mental health care services are unlikely to meet the expanding need for improved access. [7]

Governments have recognized the value of peer support programs. There is currently a bill in the US Senate to expand federal resources to improve frameworks for incorporating peer support programs into primary care. This bill has been supported by the National Association of State Mental Health Program Directors (NASMHPD), Mental Health America (MHA), the Depression and Bipolar Support Alliance (DBSA), the National Association of Peer Supporters (N.A.P.S) and the Association for Behavioral Health and Wellness (ABHW). [8] The US Surgeon General’s 2021 Report also identified the need for programs that can be added on to existing mental health services to help youth and young adults. [9] The NIH’s Substance Abuse and Mental Health Services Administration has also encouraged the development of peer support systems. [10] The American Psychological Association has also endorsed the development of peer support programs. [11]

Mental health problems present in a wide range of severity and for many reasons. Not all mental health difficulties are clinical in nature. Many individuals experience mental health challenges that do not rise to the severity of a clinical disorder, but still struggle in a manner that needs external support. [12] Peer support services can help in these circumstances. An individual’s goals for seeking support may not require diagnosis or symptom reduction, but a focus on goal attainment. [13-17]

It’s important to recognize that something can provide therapeutic benefits without being a clinical intervention. Healthy dietary changes and exercise can lead to clinical improvements in heart health; however, it is important to note that diet and exercise are not clinical treatments or prescriptions. Similarly, working in a less toxic environment can lead to substantial improvements in depression and anxiety, but getting a new job is not a clinical intervention. [18,19]

Coaching as a solution

Healthy Gamer’s coaching program was not created in isolation. It is the result of multiple calls to action from institutions like the World Health Organization, further spurred by the US Office of the Surgeon General and the growing body of evidence that peer support programs are valid and effective. [20,21] We are committed to scientifically studying the effectiveness of our coaching programs through research studies approved by an Institutional Review Board (IRB), which includes an independent, third party ethical review.

Coaching is a peer support service that focuses on principles of recovery, positive psychology, mindfulness, and motivational interviewing to help individuals achieve goals, enact positive behavioral changes, generate solutions, and utilize their own resources. Coaching focuses on attaining achievements through a client’s own actions, rather than decreasing symptoms or treating a disorder. Coaching is a complement to clinical practice and can help an individual focus on making changes to factors and determinants of mental health that do not require clinical intervention. [22,23]

Healthy Gamer Coaching utilizes skills from recovery and life coaching to work in tandem with an individual to help achieve goals. Coaches are peers that get to know an individual as equals, facilitate goal setting, provide an external perspective that can help with self-reflection and self-awareness, and promote self-efficacy. Recovery programs focus on moving forward, not treatment. [22] Coaches are not licensed or trained to diagnose or treat medical conditions.

What tools do coaches use?

Positive psychology is an important tool in a coach’s toolkit to help cultivate happiness. Coaching uses these tools to help a client identify goals, identify solutions, take actions, and learn from the process of implementing changes. [24-28]

Coaches incorporate aspects of mindfulness and promote a greater mind-body connection. Mindfulness is a practice that allows the client to observe their behaviors and catch negative thought loops. As a result, they start to understand themselves, manage their emotions and increase agency to act, which fosters lasting change in their lives. While not a clinical intervention, mindfulness has been shown to help people deal with feelings of stress, anxiety, depression, and even clinical mood disorders. [29-34]

Motivational interviewing is an evidence-based technique designed to create behavioral change in the client. Coaches empower clients to discover their reasons for creating change in their life. They accomplish this through active listening and then help the client cultivate self-reliance. [35,36]

All these methods have a proven track record for providing therapeutic benefits to individuals suffering from clinical illness, and have also been used in non-clinical settings to create substantial, positive change. These benefits include but are not limited to decreases in feelings of depression, anxiety, addictive behaviors, loneliness and isolation, and improvements in social functioning, community engagement, and physical health. [24-41]

Coach Competencies

Coaches follow the International Coaching Foundation’s standards for competence. [42]

  • Setting a foundation
  • Coach and client alliance
  • Communication
  • Facilitating learning and growth

Healthy Gamer has and continues to develop systems for quality assurance to ensure that clients receive professional, competent, effective, and evidence-based peer support. Healthy Gamer coaches have access to a range of mental health consultants (Psy.D, PhD, LICSW, MD, etc.) to ensure all coaching conversations remain in the scope of coaching..

Therapy is a clinical practice.

Clinicians are taught and trained on the processes of diagnosing and treating illnesses. [43] The practice of therapy is restricted to licensed clinicians who have been trained in diagnosing and treating clinical conditions. Coaches are neither trained nor licensed to provide clinical services, such as diagnosis or treatment.

Clinical practice, including psychotherapy, includes a few key steps:

  • Entering a formal therapist and client or doctor and patient relationship
    • This is acknowledged through appropriate documentation, policies, and procedures of a clinical practice.
    • This relationship is regulated and protected by law, with respect to aspects like patient privacy.
  • A formal process of diagnosis
    • Accounting for current and past medical history
    • Assessing for symptoms of mental illness defined by the DSM-5 and ICD-11
    • Performing a differential diagnosis
    • Laboratory testing and imaging when appropriate
  • Providing clinical or medical care
    • Therapists or doctors will formulate a treatment plan aimed at diminishing or preventing symptoms of an illness or disorder
    • Establishing a longitudinal relationship which may include:
      • Long- or short-term psychotherapy modalities intended to treat illness
      • Medication and follow up care
      • Coordinating with other forms of medical care
  • Clinical care is private and protected by formal regulations and laws

These steps are important because clinical care is about the treatment of an illness. Medical care is a tightly regulated process, with clear guidelines such as standards of care, to ensure that patients have the best chance for their clinical problems to be resolved. 

Therapy can still be very helpful and help someone improve into a state of greater positive health, even after the resolution of a clinical illness. In a sense, therapists can do the work of a coach, but a coach can never do the clinical work of a therapist. Public health organizations have agreed clinical psycho-medical and psycho-pharmaceutical solutions are not enough to meet demands and address all the aspects of health a person may need help with. [5,6]

Coaching is value additive to traditional therapy and medicine. It does not replace or interfere with therapy or medical practice in any manner and has substantial evidence supporting benefits to traditional mental and physical health. [24-41]

 

Coaching

Therapy

Definition

The International Coaching Federation (ICF) defines coaching as “partnering with clients in a thought- provoking and creative process that inspires them to maximize their personal and professional potential.”

The American Psychiatric Association defines psychotherapy as “ a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.”

Relationship

Peer Support

Formal provider and patient relationship

Credentials

Certification and credentialing is highly encouraged.

Licensing is required by law.

Primary Purpose

Facilitate goal setting, self-reflection, self-awareness, and promote self-efficacy. [22]

Take actions and learn from the process of implementing changes. [24-28]

Diagnosing and treating illnesses. [43]


Eliminate or control troubling symptoms [48]


Can also be used to attain non-clinical benefits similar to coaching.

Typical Topics

Well-being, goal-attainment, emotional understanding, goal setting, life purpose, motivation, procrastination [42]

Difficulties in coping with daily life
Impact of trauma, medical illlness or loss
mental disorders such as depression or anxiety [48]

Techniques

ICF competencies: Setting a foundation, coach and client alliance, communication (active listening, powerful questioning, etc.), and facilitating learning and growth (creating awareness, planning and goal setting, etc.) [42]

Motivational interviewing [35]

Positive psychology [24-28]

Mindfulness [29-34]

Formal systems of diagnosis, including diagnostic schemes such as ICD-11, DSM-5, as well as laboratory testing, neuropsychological testing, and imaging. [43]

Evidence based clinical psychotherapies (Psychoanalysis, Cognitive behavioral branch of therapies, psychodynamic branch of therapies, as well as others)

Active listening

Can also include motivational interviewing, depending on the diagnosis.

Coaching and Therapy together

Coaching and therapy utilize some shared techniques, such as being trained in listening and asking powerful questions. This does not mean they serve a similar purpose. Therapy has additional focuses on diagnosis of pathology, treatment, and symptom reduction. Coaching is not about fixing problems; it’s about moving in a direction that helps an individual achieve goals, develop self-efficacy, and learn skills to become self-aware and self-reliant. [45,46]

Coaching and therapy can work together. Many clients work with both a coach and a therapist. There are many factors that contribute to an individual’s mental health. Achieving goals, finding meaning and purpose, making behavior changes, developing awareness, and learning to be more authentic are some of the many factors that can improve a person’s mental health. Coaching helps clients put attention on these elements to help achieve a more holistic and multifactorial approach to moving forward in life. Focusing on these elements with a coach can help an individual and their therapist put more focus on healing. [47]


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Reviewed by Alok Kanojia, M.D. M.P.H.
February 2022