What’s the Difference Between Therapy, Counseling, and Coaching?

The mental health world uses a lot of professional titles that sound similar, and can be confusing even to mental health professionals. With this post, I’ll address some of the basic definitions that often confuse those unfamiliar with these key differences, specifically:

  • What’s the difference between a psychologist and a psychiatrist?
  • What’s the difference between a therapist and a counselor?
  • What’s the difference between therapy and coaching?

What’s the difference between a psychologist and a psychiatrist?

It’s easy to understand the confusion between these two professions. Both have doctoral degrees and work in mental health care, and the services of both professions are covered by most health insurance. But there are significant differences between a psychologist and a psychiatrist.

Psychiatrists

A psychiatrist is a medical doctor with specific training in mental health. Psychiatrists are focused on the medical treatment of mental disorders, which occurs primarily through the use of medication. Patient visits with psychiatrists are typically fast (often just 15 minutes), and focused on ensuring that patients are taking the right medications in the right dosages to achieve their desired effects. While some psychiatrists do psychotherapy, the overwhelming majority do not, choosing to refer patients to outside therapists when it appears that talk therapy would be helpful.

Psychologists

A psychologist also has a doctorate degree, and so also goes by “Dr.” But psychologists are trained specifically in psychotherapy and mental health assessment, and typically do not prescribe medication. (There are a handful of states where psychologists with additional medication training can earn limited prescribing privileges.) Psychologists often do talk therapy in 45 to 50-minute weekly visits, focused on coping skills, recovering from trauma, and any other specific symptoms or concerns you may bring in. Psychologists also do mental health assessments for court systems.

What’s the difference between a therapist and a counselor?

Before we get too far into the technicalities, let’s just say this up front: Today, there isn’t much difference between a therapist and a counselor. The terms are often used interchangeably to refer to a mental health professional trained in healing conversations, one who can assess, diagnose, and treat the full range of mental and emotional disorders

If you want to get technical, though, the terms have somewhat different origins and ever-so-slightly different umbrellas. 

Therapists

A therapist, as it is used in the mental health world, typically means a psychotherapist, one who has been trained in using psychotherapeutic techniques to treat mental illness. Therapists use a wide range of theories and perspectives in that treatment. Many US states consider psychologists, clinical social workers, marriage and family therapists, and mental health counselors to be “psychotherapists” under state law, with some states adding other license types to that list. Psychotherapy is that specific field of work that emerges from psychology, the study of the mind.

Counselors

A counselor is someone who has specifically studied counseling, which has somewhat different origins. Counseling (again, as it is used in the mental health world) grew out of the child guidance movement, and from research focused on human development. As a separately licensed profession, mental health counseling is relatively young, with most state licensure laws taking effect just within the past 30 years. Mental health counselors may have training in areas like career counseling that more traditional therapists may not be trained in.

All that said, there is much more overlap than difference. And where differences exist, they are tendencies, not guarantees. 

Mental health counselors are generally licensed at the master’s degree level, though some also have doctorates. Some psychologists have degrees specifically in Counseling Psychology and may refer to themselves as counselors. 

What’s the difference between therapy and coaching?

Many therapists are branching out into coaching services, and many coaches advertise services that sound a lot like therapy. What’s the difference between therapy and coaching?

Fundamental tasks

The most basic difference is in what these professions do. Therapists assess, diagnose, and treat mental illness. As such, therapists often focus their work on identifying and reducing symptoms. 

Coaches motivate and encourage people to achieve specific goals. Because it does not involve identifying and reducing symptoms, coaches often describe their work as being more positive in nature. 

Of course, there is overlap -; many therapists focus attention on client strengths and resources, and many coaches aim to reduce and resolve the problems that stand in the way of clients achieving their goals. 

Regulation

States heavily regulate therapy. Therapists typically must be licensed or working under supervision, and licensure requires a graduate degree along with significant additional experience. Consumers who believe that their therapist behaved unprofessionally can file a complaint with the therapist’s state licensing board, which has the power to investigate and discipline licensees. 

Coaching, on the other hand, is largely unregulated. Anyone can call themselves a “coach” and open a coaching business, regardless of training or experience. While coaching is a legitimate field with a growing research base and a code of ethics, adherence to that code of ethics is entirely voluntary.

Marketing

Some therapists find that marketing their services as “coaching” allows them to reach clients they would not otherwise reach. Some consumers are reluctant to attend therapy, but are willing to meet with a coach. In addition, because of the legal challenges involved with doing therapy across state lines (licensure laws are different from one state to the next, with many states effectively not allowing telehealth to be provided by therapists licensed in another state), some therapists seek to expand their geographic reach by offering services under a coaching framework instead.

Because coaching is less regulated, some therapists who are disciplined by their state licensing boards choose to go into coaching instead. A 2016 study of therapists who had their licenses disciplined or revoked found that all of those in the study whose licenses had been revoked for misconduct had simply switched over to coaching. 

Ultimately, both professions have value, and the work can look fairly similar between therapy and coaching. But once the assessment, diagnosis, and treatment of mental illness is involved, that work becomes therapy.

Looking for more great posts?

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