Therapist or coach: Understanding the difference and how to pick one

"I'm really struggling," said pretty much everyone who endured the past two years. From the pandemic to economic, humanitarian and climate crises, we've all been through the wringer. It's no surprise then that as a therapist (Yael) and coach (Brad), we often hear from neighbors, friends and colleagues, not to mention fellow passengers in ride-shares, about their challenges and frustrations.

Talking about our struggles offers a pathway toward healing. But a backyard chat or gab through gridlock won't offer the kind of help many individuals need. While the two of us often find ourselves encouraging others to seek formal help, we also understand that connecting to the right helper can be complicated, because the wellness industry offers so many confusing options.

Our backgrounds encapsulate two main branches of it: therapy and coaching. Below, we offer tips for how to determine whether a therapist or coach is the right kind of helper, and guidance on finding one who is qualified to meet your needs.

- Do you need a coach or a therapist? Let's begin with a fact first articulated by ancient Confucian, Taoist and Buddhist philosophers in the 5th century BCE and confirmed through modern social science research: No one gets a pass from suffering in life. If you are alive, you are certain to face psychological struggles, including pain, anger, sadness, fear and overwhelm. It is simply part of the deal.

But not all struggles are created equal, nor should they be treated as such. For instance, being sad about job loss is qualitatively different from experiencing major depression after being laid off; worrying about your kids' safety should not be confused with an obsessive-compulsive disorder that manifests in being afraid to drive them; butterflies in your stomach and trouble sleeping before returning to in-person work are not the same as a generalized anxiety disorder that consistently get in the way of your going to work.

A key distinction separating what we'll call emotional discomfort from mental illness is whether you are functioning below what you'd consider ordinary levels. Mental illness is reflected not only by periodic unhappiness, doubt, or angst, but also by whether those experiences contribute to thinking and behavioral patterns that interfere significantly and chronically with your daily functioning. Helpers who treat mental illness fall squarely into the therapist camp.

As Denver-based therapist, clinical psychologist, and author of the ACT Daily Journal, Debbie Sorensen said, "Therapists are trained to address emotional and mental health concerns and are licensed to ensure they follow the ethical guidelines of their field." This includes therapists who have degrees in social work, psychology or psychiatry, and who have undergone extensive training and continuing education in the diagnosis and treatment of mental illness.

Sorensen added that therapy goals often "focus on addressing a problem you're having and can be useful for exploring your history, relationships, or ongoing behavioral patterns." Because therapists treat diagnosable mental health disorders, services may be covered by insurance. Out of pocket rates for therapy (and coaching) vary widely.

Unlike psychotherapy, coaching aims to help people who are already functioning at ordinary or even higher levels work through emotional discomfort and make additional gains. A coach can help you perform better physically, emotionally, professionally, socially or athletically, depending on their specialty.

Confusion about which approach suits you best is understandable, because despite their differences, therapy and coaching have a lot in common. Both focus on working through emotional discomfort and setting life-enhancing goals.

Los Angeles based intimacy coach and author of "Radical Intimacy," Zoë Kors told us that she even considers "therapy to be a prerequisite for coaching" because, an individual "who has developed a high level of emotional skill with a good therapist makes a powerful coaching client poised to create a life they love to live."

And Richard Winters, an executive coach and emergency physician at Mayo Clinic, explained that coaches often employ therapeutic strategies with clients and therapists regularly draw from coaching strategies.

But remember: Although both professions can help you get to a better place than where you began, therapists are trained to treat mental illness or other significant emotional and relational concerns while coaches seek to help you elevate performance in a specific area.

After you have decided on the appropriate practitioner - therapist or coach - you can turn your attention to the approaches they draw from. - Finding the right therapist Perhaps the best strategy for finding effective therapy is to look for a therapist who has experience in both treating your problem and an evidence-based model. If you are struggling with a serious mental health issue, such as depression or anxiety, start by looking for a mental health professional who offers a treatment that has been rigorously studied. These include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT) and emotionally focused therapy (EFT). If a prospective provider has an approach you've not heard of, be direct in asking them to share the scientific support for what they do.

Jenny Taitz, a Los Angeles-based clinical psychologist and author of "How to Be Single and Happy," suggested framing your inquiry in this way: "What is the basis for the suggestions and techniques you are providing - are they rooted in research?"

For those who worry about putting a prospective therapist on the spot, Taitz advised keeping in mind that you are investing your time, money and vulnerability in the help-seeking process, so it's important to verify a proven track record for the treatment into which you are entering.

Consider, too, whether a therapist has qualities that would help you form a warm, trusting relationship, because a solid alliance improves treatment effectiveness. A clinician who can offer information or direct you to resources that confirm the validity of their approach and who you like is one who is probably worth giving a shot. - Finding the right coach If you want to achieve a specific goal outside of mental health - such as getting a promotion or becoming more organized - you can focus your search on coaches.

Although the International Coach Federation does certify coaches with a certain level of training, many high-quality coaches do not have a license. So instead of looking for a license, place your energy into looking for the evidence supporting the services that a coach offers.

As in psychotherapy, coaching approaches that draw from ACT, CBT, DBT and behavioral science ought to be central to a good coach's practice. In addition, a trustworthy coach ought to have a substantial body of work laying out their approach, particularly if they are not also a licensed therapist. Think of their body of work as their credential - not just the quantity, but also the quality and evidence it contains.

Look for books, articles or podcasts that a coach has written or from which they draw. For example, one of us (Brad) has written a book on his approach to sustainable excellence and emotional health and asks prospective clients to read it before commencing a coaching relationship. Other well-regarded coaches may lecture at colleges and universities or have large online repositories of writing supporting their work.

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Of course, just because someone has published a book does not necessarily make them a good coach (or therapist, for that matter). This partly explains why the coaching industry is notorious for charismatic, business savvy professionals with questionable skills.

As Mayo Clinic executive coach Winters warned, you can risk the "wild west of website landing pages created by a marketer" if you simply do an Internet search for a coach. Indeed, some well-known figures have built entire empires based on marketing without much, if any, rigorous evidence behind their approaches. For example, though it may sound enticing, research has shown that overemphasizing "positive thinking" can actually exacerbate general unhappiness and mental illness.

When it comes to finding a high-quality coach, begin with recommendations from trusted individuals including colleagues, friends or credible experts. Word-of-mouth and referrals from people you know and trust can help prune out ineffective people and approaches. Verify that the coach has specialization in the particular areas on which you want to work. Look for testimonials and success stories that speak to their effectiveness. Kors also recommended "asking for a complimentary 'discovery session' in which you can get a feel for how a coach works."

Clarity on the nature of the problem with which you want help, who can help, what kind of science supports the help you are seeking and testimony from trusted others will place you in a position to make improvements in your well-being. It might even aide you in guiding friends and colleagues toward the kind of support that could more reliably make a difference for them, too.

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Yael Schonbrun is a practicing clinical psychologist, assistant professor at Brown University and author of the forthcoming book "Work, Parent, Thrive." Brad Stulberg is an executive coach and author of the new book "The Practice of Groundedness."