Coaching or Psychotherapy?
The number of choices a person faces when they decide to seek help are overwhelming these days.*
Within the Autistic community, it’s known that many medical and mental health professionals are misinformed when it comes to autism. Help-seekers might anticipate encountering someone who misunderstands them or is out to fix them in a way that is unwittingly harmful. Sometimes things do need a remedy or guidance, but personal change is a process that starts with understanding and respect—no matter your neurotype.
Given that the pathology paradigm still seems to dominate the narrative about autism, who is more likely to understand and actually help—a psychotherapist or a coach?
The answer is not clear-cut.
SOME THINGS EVERY CONSUMER SHOULD KNOW
Governing Bodies and Third Parties
Psychotherapy is a licensed profession in many states, which means that in order to sell one’s services, one has to demonstrate competence in specific ways. I had five years of training, completed a lot of hours of clinical practice and supervision, and passed an exam administered by New York State. Over those years I was continuously evaluated by a body of more senior colleagues and deemed fit to practice. There are standards and ongoing education requirements I must uphold in order to maintain my license. The laws governing my profession are meant to protect the consumer. I cannot work with people outside the state in which I am licensed.
Psychotherapy is reimbursable by insurance due to mental health parity laws, but people’s coverage can be spotty and insurance companies can sometimes work hard to not have to pay on these claims.
NB: Psychotherapists cannot legally make claims about treatment outcome.
Coaching is not a licensed profession, though increasingly people might seek accreditation through bodies like the IFC. Anyone can sell their services as a coach. Many coaches offer their lived experience as an indication of their know-how and demonstrate competency by garnering social proof. They are not supposed to work with people with mental health issues, but there is no entity that regulates them. Coaches can work with anyone, anywhere.
Coaching is not reimbursable by insurance as it is not predicated on illness. The consumer is financially responsible for choosing this investment. In some cases, if a person is on Disability, it might be reimbursable through a state-run program.
NB: Coaches can make claims to whatever they want (not that they all do).
The Definition of Professions and the Nature of Problems
The issues psychotherapists and coaches can address have some overlap.
However, the law defines one profession and not the other and it also restricts how one might market itself and places no restrictions on the other. These circumstances affect the consumer’s experience and influence choice.
Psychotherapy is legally defined, in New York anyway, as the diagnosis and treatment of psychopathology. For someone like me who believes that psychopathology can sometimes be a social construction, it gets a bit complex. Yet, this is the reason why insurance covers it—the patient is ill and merits treatment. While practitioners can be humanistic and strengths-based in their individual approach, like me, the pathology paradigm informs the larger context. It’s also part of the reason for the stigma around mental health care.
Coaching is not legally defined—it can address anything, except psychopathology. In order to help clarify, I’ll say that generally speaking, it is a service people want to help them improve something in their lives. A coach I once consulted succinctly described her offering as a combination of mindset work, action steps and accountability. If a discreet learning objective exists and support is desired while making that shift, then coaching can be great. (Though I might argue that something as complex as mindset is better suited to therapy.) Seeking coaching usually does not have stigma associated with it.
NB: Our systems have not caught up with the impact of trauma on individuals and groups, which adds to the complexity of identifying and responding to problems. In some cases, it is necessary to go outside our health care system for help, which is why coaches can serve an important function.
The Identified Problem Guides the Direction
Identifying one’s problem can be tricky.
Many autistic people, whether diagnosed in childhood or not, frequently get the message that they’re doing something wrong and need to change. The imperative to fix can become internalized such that people might stridently and firmly believe they need to alter themselves in order to survive or be acceptable to others.
In psychotherapy, we might explore the need to fix. Unearth the feelings around it. Connect to your actual experience and integrate it into self understanding so that you can start feeling comfortable being yourself and begin to redefine your needs and goals on your own terms. This is a particular kind of intangible skill-building that results in greater awareness, self definition and capacity to face life’s challenges. Psychotherapy looks inward as a way of creating balance and equilibrium with the demands of living, while shedding any legacy of trauma.
In coaching, fixing is the shared goal. Want a partner but have no idea how to meet people? Keep getting the interview, but never the job? Budgeting time or money seem impossible? Sometimes actual steps and concrete feedback are what’s needed to build competency in an area of life. If the actions are taken, habits are formed, and outcomes achieved, it doesn’t matter so much what’s going on internally if the external, quantifiable goals have been met. And, yes, people tend to feel better when they can meet their goals.
A personal example:
I had no idea how to run a business and needed help. Did I have FEELINGS about becoming a businessperson? Yes, in fact, I did. Many of them were unconscious and unhelpful and related to my trauma history. Not exactly psychopathology, but troublesome enough. I actually did look for a therapist, but those I found were not a fit. (One of them even tried to hire me for her group practice! Not good! Actually, a boundary violation!) In this case, I lacked some basic know-how that unsurprisingly left me feeling anxious and overwhelmed. I chose to develop my skills through coaching, peer groups, and education. And, guess what? I moved through some of those difficult blocks and felt better.
TL;DR
If there is a skill or concrete thing you can identify that you think might lessen your distress, try COACHING as a means to move you in that direction. Ask friends for recommendations, go to a trusted organization, or check out my Resources page.
If you need help understanding yourself, your emotions, your relationships, or there’s just a lot to process before you can get from here to where you want to be, or you’re having trouble identifying your needs, seek THERAPY.
There are a lot of different therapies out there, some of which aren’t known as well as psychotherapy. Those that do not rely as much on rapport and talking might suit some autistic people better. Movement therapy. Drama therapy. Psychedelic- or equine-assisted therapy. Occupational therapy. Trauma therapies, which work from the bottom up (meaning the body is the primary vehicle for communication, not words).
In all these cases, you’d want to go with someone who does not hold outdated and biased views of autism. On that score, you’ll have to do a gut check. And while going to the doctor can be a bit dicey for an autistic person, ruling out any possible medical factors for your distress is important.
NB: Sometimes the autistic person doesn’t need to change, but elements of the environment do. Consultants and agencies are perhaps better suited to creating and implementing a person-centered plan for accommodations and support at home and work. At other times, the person needs to exit the environment.
Hopefully this information has helped you make an informed decision about what is best for you!
*This conversation presumes a person is not in crisis. IF YOU ARE IN CRISIS: Call or text 988 from anywhere in the US for the Suicide and Crisis Lifeline. You can also initiate a chat via their website.
