A few questions you might be asking yourself are:
- Do I see myself counseling or health coaching?
- Which professional identity fits me and my career path?
- What is my vision of working with clients or patients?
These are important questions without easy answers. You may see yourself clearly in a helping role with a client or patient, and yet the specific details of that role and how best to pursue it are unclear. Likewise, navigating the array of personal and professional opinions can feel daunting. How’s a person to decide? When it comes to health coaching vs. counseling, what’s the difference?
Are you considering a career as a health coach? Find out what differentiates this career from counseling in this article from health coach and mental health professional Kelli Saginak. #changeagent #kresserinstitute
Whereas professional definitions of counseling and health coaching exist and the differences are relatively clear, the similarities and areas of overlap between the two professions can be confusing. Therefore, when exploring the differences between health coaching and counseling, a closer examination of the professional identity, including ethical codes and scope of practice of counseling and health coaching, can clear up any confusion lurking, and inform your decision and next steps. The good news is that both professions play important roles in a collaborative network of care with the ultimate goal of helping people live healthier lives.
My Experience with Health Coaching and Counseling
As an ADAPT Certified Functional Health Coach and former university professor of counselor education, I have education, training, and professional experience in both mental health counseling and health coaching. Having studied both professions extensively, including the ethical codes and standards of practice, the professional boundaries are clear, and I honor my ethical responsibility to “stay in my lane.”
For instance, in my work with clients as a health coach, I have observed how mental health issues or “red flags” can interfere with a client’s vision, goals, and coaching outcomes. Progress literally stalls or even stops. I can hear in my mind and feel in my body the need for a deeper conversation. As scary as candid conversations with clients can feel when red flags appear, coaching a client through the obstacles of seeking mental health counseling and then witnessing their progress after they begin treatment is essential and priceless.
Coaching clients to seek mental health counseling flows out of the respect I have for my professional identity and scope of practice as a health coach that I learned while in the ADAPT Health Coach Training Program. Likewise, my sincere desire to make my clients’ health and wellness a priority strengthen my appreciation for a collaborative model of care. In other words, I am as passionate about honoring my professional scope of practice and embracing a collaborative model as I am about helping my clients and being the most effective health coach possible.
Health Coaching vs. Counseling: The Differences
What Is Counseling?
With historical origins dating back to the early 20th century, counseling services emerged in response to an identified need for vocational guidance and mental health counseling for individuals who were experiencing developmental transitions and psychological issues. Out of this need grew a variety of counseling specialties that are beyond the scope of this article (e.g., career, vocational, and school counseling) and yet add to the rich diversity of mental health services available. For simplicity’s sake, this article will focus on the differences between mental health counseling specifically and health coaching.
According to the American Counseling Association (ACA):
“Counseling can include, but is not limited to, psychotherapy, diagnosis, evaluation; administration and interpretation of assessments, tests, and appraisals; referral; and the establishment of counseling plans for the treatment of individuals, couples, groups and families with emotional, mental, addiction and physical disorders.”
The American Mental Health Counselors Association (AMHCA), a division of ACA, scope of practice states that mental health counseling “encompasses a broad range of clinical practice, including dealing with normal problems of living and promoting optimal mental health in addition to the prevention, intervention and treatment of mental and emotional disorders.”
Mental health counseling may involve “psychotherapy” or “therapy,” as these terms are often used interchangeably with “counseling” depending on the provider’s professional identity, which includes scope of practice and ethical codes, philosophy of mental health or theoretical orientation, and specialization. Yet, generally, counseling is more short-term, holistic- and wellness-based, developmental in nature, and involved with present-day circumstances and transitions (e.g., divorce, career). Therapy or psychotherapy typically follows more of a medical model of care, and is long-term involving past issues, deeper psychological wounds (e.g., sexual abuse, post-traumatic stress disorder or PTSD), and/or psychopathology (e.g., schizophrenia spectrum, depressive and personality disorders).
Contemporary mental health counseling generally approaches client issues from either a wellness model or a medical model, or a combination of both models depending on clinical assessment (1), which involves a diagnosis based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Whereas a diagnosis is not always involved in mental health counseling, one is often needed to inform treatment options, which may include risks and medications, and for insurance and billing purposes.
Who Can Offer Counseling?
A variety of licensed providers can offer mental health counseling:
- Social workers
- Psychiatric nurses
- Nurse practitioners
Health coaches may also be licensed to provide mental health counseling. What generally delineates practitioners who provide mental health counseling is professional identity, which encompasses standards of practice (ethical codes and scope of practice), education and training (curriculum and clinical standards), and licensing requirements, including continuing education, and the professional organizations in which they belong and that govern their professional identity.
Education and training to deliver mental health counseling is completed at the graduate level through institutions of higher education where degrees and endorsement for licensure are earned and granted. Departments that offer degree programs in mental health counseling are usually accredited by the specific governing body of the profession (e.g., American Psychological Association, Council for Accreditation of Counseling and Related Educational Programs, Council on Social Work Education). It is within the various governing bodies where standards and scope of practice, and ethical codes reside and are articulated.
Program length, which includes an internship, practicum, or residency, depends on the specific degree requirements. Additionally, licensing often involves passing a national exam and accumulating post-degree direct client contact hours or completing a residency. Post-degree requirements vary, and yet generally involve continuing education and training (i.e., continuing education units, or CEUs) and sometimes supervision.
To stay within their scope of practice, mental health counselors complete additional education and training necessary in order to work with specific client populations (e.g., addiction, child and adolescent, gerontological, and rehabilitation). Within client populations, counselors may specialize in treating a specific diagnosis (e.g., anxiety, depression, eating disorders, personality disorders, attention-deficit/hyperactivity disorder, substance use disorder). Advanced and specialized training and certification in specific treatment options and approaches also exist (e.g., biofeedback, eye movement desensitization and reprocessing or EMDR, brainspotting, and mindfulness-based stress reduction).
Foundationally, mental health counseling is informed by an array of theoretical perspectives depending on the counselor’s education and training, preferred theoretical orientation and philosophy of mental health, and presenting client issues. For mental health counselors, theories serve as a “road map” or “guide” through the process of assessing clients’ psychological problems and determining possible treatment solutions. (1) Common theoretical approaches to mental health counseling generally include, but are not limited to:
- Psychodynamic or psychoanalytic
- Integrative or holistic, which includes eclectic models
Contemporary theories, models, and approaches supporting mental health counseling today include:
- Positive psychology
- Dialectical behavioral therapy
- Body-oriented or somatic psychotherapy
- Acceptance and commitment therapy
- Narrative therapy
- Recovery model
- Mindfulness-based therapy
- Solution-focused therapy
- Brief therapy
- Motivational interviewing
- Transtheoretical model
In short, the practice of mental health counseling involves a number of preparation paths leading to licensure, with each path leading to a variety of specializations within specific professional identities and standards of practice. Whether grounded within a wellness model, a medical model, or a combination of both, mental health counseling generally involves clinical assessments, diagnosis, and treatment plans that inform, structure, and evaluate the counseling process. Nonetheless, mental health counseling aims to help individuals grow interpersonally while reducing psychological and emotional distress, improving functioning, and increasing mental health, emotional resilience, and overall well-being.
What Is Health Coaching?
As a newer field that is evolving and expanding rapidly, health coaching is defined as “a client- or patient-centered process that assumes a working relationship/partnership develops between patient and [coach] to advance healthy lifestyle behavior change using tools such as nonjudgmental dialogue, goal setting, and accountability.” (2)
Likewise, the National Board for Health & Wellness Coaching (NBHWC) states:
“Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work health and wellness coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental.”
Furthermore, the NBHWC scope of practice emphasizes:
“Health and wellness coaches work with individuals and groups in a client-centered process to facilitate and empower the client to develop and achieve self-determined goals related to health and wellness. Coaches support clients in mobilizing internal strengths and external resources, and in developing self-management strategies for making sustainable, healthy lifestyle, behavior changes.”
Margaret Moore, Erika Jackson, and Bob Tschannen-Moran, authors of the Coaching Psychology Manual, view health coaching as a “growth-promoting” partnership that facilitates clients’ capacity to “achieve a higher level of well-being and performance in life and work, particularly when change is hard.” Health coaching relies on a “powerful methodology” that focuses on assisting clients with achieving their self-identified health and well-being goals through the pillars of “mindful presence, authentic communication, self-awareness, and safe and sacred space.” (3)
Supported by the belief that “every client has the potential to be creative and resourceful in order to fully self-actualize” (3) and is their own personal expert, health coaching is a client-centered process of autonomous self-discovery, visioning, clarifying, aligning, facilitating, empowering, generating, implementing, and holding clients responsible and accountable for achieving their health and wellness goals. As Moore, Jackson, and Tschannen-Moran emphasize, “client-originated visions, plans, and behaviors are the ones that stick.” (3)
Moreover, health coaching uses a non-expert, inquiring approach to empower clients to evolve into who they most want to be by taking small, yet measurable behavioral steps that will enable them to achieve their goals, wellness vision, and a “higher level of health and well-being.” (4) In short, “the goal of health coaching is to encourage personal responsibility, reflective thinking, self-discovery, and self-efficacy.” (3)
Whereas health coaching does not involve clinical assessments, diagnosing, treatment plans, or “psychological therapeutic interventions,” health coaches “may provide expert guidance in areas in which they hold active, nationally recognized credentials, and may offer resources from nationally recognized authorities such as those referenced in NBHWC’s healthy lifestyle curriculum.” (5) For instance, providing guidance is an important ethical responsibility for health coaches working in clinical practices to ensure that patients understand clearly the care plan prescribed by their practitioner, including how to take any prescribed medications correctly. (6)
Health coaching methodology generally rests on a foundation of bodies of knowledge and theory such as:
- Coaching psychology
- Behavioral and positive psychology
- Appreciative inquiry
- Nonviolent communication
- Motivational interviewing
- Emotional intelligence
- Design thinking
- Flow theory
- Cognitive-behavioral theory
- Strengths-based coaching
- Neuroscience and the workings of the brain
- Self-determination theory, which is considered the “key theory in health coaching” (3)
To encourage personal responsibility, reflective thinking, self-discovery, and self-efficacy, health coaching uses relevant assessments with the intent of increasing clients’ insight, identifying strengths and resources, and supporting their vision and goals. Although structured with intent and purpose, clients are fully responsible for setting the agenda of health coaching sessions within:
- A competency-driven health coaching framework (i.e., the ADAPT model of health coaching)
- SMART goals
- A results- and outcome-orientation
- Action steps
- Client accountability and self-monitoring
Health coaching is best suited for individuals who are functioning well in their daily lives and not experiencing serious psychological or emotional distress or crisis. Although challenged by the health or wellness issues they are experiencing, clients appropriate for health coaching are fully capable of participating in the coaching process, taking responsibility, being accountable, and making consistent progress toward their desired outcomes, even when change is hard.
Likewise, some might argue that effective health coaching provokes client discomfort to further motivate change. Whereas some health coaches are licensed mental health providers and can offer mental health counseling when serving in a health coaching role, honoring health coach scope of practice is essential and ethical. That being said, health coaches can work with clients who are receiving mental health counseling simultaneously through a collaborative model of care.
The Training You Need to Become a Health Coach
As a new and growing profession, health coaching is not fully regulated; therefore, education and training standards continue to evolve and operationalize. The health coaching profession lacks nationally accepted educational standards and training benchmarks, or core proficiency levels or competencies. (7) However, established in 2009, the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) has led the charge to clarify health and wellness coaching and articulate competency-based education and training standards, including ethical codes and scope of practice.
In 2016, the NCCHWC (then the ICHWC and now the NBHWC) created the Code of Ethics and Health & Wellness Coach Scope of Practice and with the National Board of Medical Examiners (NBME) agreed formally to develop and initiate “a national board certification for health and wellness coaches in 2017.” (8) As a “nonprofit affiliate of the National Board of Medical Examiners (NBME), the NBHWC announced in 2019 the American Medical Association’s (AMA) approval of new Category III Current Procedural Terminology (CPT®) Codes for health and well-being coaching effective January 1, 2020.” (9) This is a tremendous step forward in the legitimizing of health coaching and its integral role in transforming healthcare.
In addition to the NBHWC, the International Coaching Federation (ICF) also leads the coaching industry in its efforts to strengthen coach preparation, program accreditation standards, and standards of coaching practice, including core competencies. As the largest accrediting and certifying body of coaches, ICF certified coaches span a variety of specialties such as life, career, health and fitness, business, and leadership, to name a few.
Whereas the NBHWC and ICF are actively pursuing and articulating high standards of practice, including health coaching competencies and research, the length of training continues to vary between a few months and a few years as is common in graduate-level health coaching training programs. Because health coaching remains unregulated, it is important to pursue education and training through programs that are accredited and maintain rigorous and robust accreditation standards.
For example, similar to mental health counseling, health coaching can involve a number of specialty areas. Health coaching can focus broadly on general health and overall wellness or focus more specifically on issues such as:
Offering support and health education within specialty areas often involves additional training and certification, and experience personally and professionally. It is common for health coaches to have personal experience with either healing and recovering from their own health issues or supporting loved ones on their wellness journey.
In short, health coaching is a powerful, client-centered partnership. At its core, health coaching inspires and empowers people to remove the internal and self-imposed obstacles to making long-lasting, sustainable, and rewarding changes in their lives—some of which may even be life-changing and life-saving.
Overlapping Similarities between Health Coaching and Counseling
Increasingly, health coaching and mental health counseling are needed to serve those who struggle to make the necessary changes in their health and wellness. Both professions follow similar research agendas to support the most effective methods and strategies for provoking lifestyle and motivating behavior change. In terms of professional practice, which includes a variety of methodologies and strategies, both professions follow standards of practice and professional codes of conduct and regulation, including ethical responsibilities and scope of practice.
Health coaching and mental health counseling reside within similar theoretical frameworks and conceptual models (e.g., motivational interviewing, positive psychology, transtheoretical model, mindfulness, and positive psychology). (10) In fact, motivational interviewing has its roots in mental health counseling and was developed by psychologists William R. Miller and Stephen Rollnick to assist people with substance use disorders. (11) Furthermore, the Transtheoretical Model, often referred to as the Stages of Change, was developed by psychology professors, James Prochaska and Carlo DiClemente through their analysis and integration of psychotherapy theories during studies of participants’ experiences in a smoking cessation program.
Similarly, both health coaching and mental health counseling include short- and long-term goals that focus on behavior change, enhanced decision-making, and problem-solving. Additionally, both professions seek to empower clients to:
- Better use internal and external resources
- Increase self-esteem and self-efficacy
- Improve relationships
- Strengthen the mind-body connection
At the most fundamental level, health coaches and mental health counselors assist people with living healthier, well lives. Both care about client health and wellness and view the relationship with clients as perhaps the most essential catalyst to change. Whereas “how” health coaching and mental health counseling provoke change may be different, as reflected in the Chinese proverb:
“There are many paths to the top of the mountain, but the view is always the same.”
Notable Differences between Health Coaching and Counseling
Whereas education and training, professional identity, scope of practice, and ethical codes are perhaps the more distinct differences between health coaching and mental health counseling, other differences important to consider and realize include:
|Clients expect help on taking action and achieving health-related goals||Clients expect to explore psychological issues and learn how to process them|
|Clients often function well in their daily lives in spite of their health issues||Clients show higher levels of distress and may struggle to function in their daily lives|
|Coaches use evocative inquiry and powerful questions to help clients lean into change||Counselors focus on symptom reduction through comfort, healing, and recovery|
|Coaches help with goal setting, facilitating the process of change, and exploring new perspectives and possibilities||Counselors may share information, teach skills, and make recommendations that align with a treatment plan|
Why the Client’s Expectations Matter
First, individual perceptions of health coaching and mental health counseling often differ. Commonly held assumptions are that health coaching focuses on health and wellness (i.e., “I need help losing weight.”), whereas mental health counseling addresses mental illness or pathology (i.e., “I don’t feel like myself.”). In other words, clients do not see the issues they bring to health coaching, such as changing lifestyle habits, as severe enough for mental health counseling. Likewise, clients who have completed mental health counseling may be attracted to health coaching because of its focus on taking action, achieving goals, and moving forward versus in-depth processing and rehashing the past. In this light, clients may prefer health coaching. (10)
Whereas health coaching may be a more comfortable, and even appropriate, path for clients to take for help with addressing a health-related issue, such as stress or an autoimmune issue, clients and their coaches may sometimes uncover deeper psychological issues interfering with the clients’ ability to make progress and implement change. Clients may think and want to believe that they have resolved or healed old wounds or psychological pain only to experience it again during health coaching. Whereas it’s normal for health coaches and clients to acknowledge the past contextually, diving deeper into and exploring the psychological issues hindering clients’ progress is outside the scope of practice of health coaching and is best addressed through mental health counseling. (10)
Client Presentation for Counseling vs. Health Coaching
Secondly, clients more appropriate for mental health counseling often present with higher levels of distress that are noticeably interfering with their daily functioning, including personal care and hygiene. They are often trying to manage difficult psychological issues or pathology that is consuming their energy and hindering their quality of life. The significance of their distress is often reflected in their appearance, behavior, cognitive processes, mood and affect, and insight and judgment. (10)
Health coaching clients, overall, function well in their daily lives, even with the health and wellness issues they are managing, and remain grounded and stable throughout the stages of change of the coaching process. Although often ambivalent and uncomfortable at times, especially when they discover that they are their biggest obstacle to change, the discomfort that arises in their process of change does not cause distress that hinders their quality of life, progress, or the coaching relationship. (10) Presentation differences outside of normal ranges are considered “red flags” in health coaching that require attention and action.
The Coaching Process Focuses on Empowerment
Third, and central to both mental counseling and health coaching, is helping clients change, improve the quality of their lives, and achieve optimal health and wellness, although the process and methodologies are generally different. A notable characteristic of health coaching is the process of evocative inquiry using provocative, powerful questions. (10) With clear intention, purpose, and within a relationship of trust and safety, health coaching evokes clients to lean into the discomfort of change, and stretch toward new possibilities, opportunities, and their vision of wellness. Of course, similar client experiences, and even insights, may emerge in mental health counseling. Yet, beyond establishing ongoing trust and safety, mental counseling is most concerned with symptom reduction through comfort, healing, and recovering.
What Health Coaching Methodologies Look Like
Lastly, health coaching generally follows the structure of a competency-based process outlined by the governing accreditation body (e.g., NBHWC, ICF) within the artful, yet intentional use of practical coaching skills, like:
- Establishing or refining a client’s short-term SMART goals or action steps for what will be accomplished between sessions
- Exploring broader perspectives and inspiring interest in new possibilities
- Facilitating the process of self-discovery, learning, and insight
In contrast, mental health counseling tends to follow a client’s lead with the structure of a clinically prescribed treatment plan that may involve:
- Teaching skills
- Implementing theoretical techniques
- Making recommendations
- Sharing information
Herein lies perhaps one of the most glaring differences between health coaching and mental health counseling: the sharing of information, which would take a health coach out of their role.
What to Do if Your Client Is Not Making Progress
Realizing the similarities and differences between health coaching and mental health counseling can support client health, well-being, and outcomes while honoring scope of practice, ethical codes, and red flags can inform and support appropriate referrals and collaborations. In other words, connecting clients with the most effective services and resources ultimately supports the best client outcomes.
One key consideration for health coaches to honor is when clients are not making progress. It is crucial that health coaches—and all practitioners and providers for that matter—monitor and take appropriate action when clients are not making progress. Because health coaching emphasizes active, action-based goal attainment, consistent progress is essential. Consistent progress does not have to be monumental and can be measured by small steps and mini habits; however, consistency is key. Effective, ethical health coaching does not involve kicking the can around in hopes that change will miraculously happen. Although change can take time, consistent forward movement toward achieving goals is a key assessment indicator for health coaches to monitor.
To ensure that clients receive the most appropriate services and make progress, health coaches need to be intuitive and skilled at identifying client red flags that indicate the need for a deeper conversation with the client. Health coaches must learn to trust their senses and intuition with clients, and take action when progress ceases and red flags emerge, then skillfully coach the client through possible obstacles and resistance to a mental health counseling referral.
A client who is maintaining their daily functioning and not making progress in health coaching might benefit from coaching and counseling simultaneously. The health coach and client could continue working toward the client’s goals while the counselor addresses the psychological issues hindering progress through mental health counseling. This type of collaborative approach can be effective as long as the client begins making progress in coaching. The health coach and client may also decide to pause coaching while the client addresses the psychological issues first before returning to coaching.
Call for a Collaborative Model of Healthcare
With a more lucid understanding of the differences between health coaching and counseling comes a clearer vision of how health coaches and counselors can collaborate and work together to support, and even advance, client health and wellness. With the ever-increasing chronic health issues, including mental health, weighing on individuals today, the need for a collaborative model of client care is greater than ever.
Advocating for a collaborative model of care is the vision that Chris Kresser and the rest of us at Kresser Institute continue to promote and advance through education and training. The scope of the chronic illness epidemic is growing, and conventional medicine isn’t equipped with an effective way to address it.
There simply are not enough practitioners to address the lifestyle and behavioral changes that people need to make today. More important is that most medical providers and practitioners are not trained in behavior change, although they could benefit from training in the “coaching paradigm.” (6) However, certified health coaches are trained experts in behavior change. They work collaboratively with a variety of professionals and specialists, including counselors and mental health providers, to help their clients achieve change.
For example, a client with type 2 diabetes who is working with a health coach to change their lifestyle habits may also need mental health counseling to treat a diagnosis of PTSD. Or a client diagnosed with depression who is receiving mental health counseling might also benefit from working with a health coach to create healthier lifestyle habits to support their treatment. Both of these examples portray how health coaches and mental health counselors can collaborate to help clients achieve improved benefits and outcomes.
Should You Pursue Health Coaching or Counseling?
Circling back to your initial questions and confusion, where are you now? Do you see yourself counseling or health coaching? Which professional identity fits you and your desired career path? Which role aligns with your vision of working with clients or patients best? You might not have immediate answers to these questions, and yet, I hope this article has cleared the path a little more.
Understanding and honoring the differences and similarities between health coaching and mental health counseling increases the opportunities for a collaborative model to evolve, from which clients ultimately benefit. Likewise, we feel more confident to invite referral options into our conversations with clients and coach them on the benefits.
A collaborative approach involving mental health counseling and health coaching can help clients in unique and complementary ways that ultimately enable them to live healthier, well lives, and knowing the differences is key.
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