by Kent Bassett

What Is The Difference Between Therapy and Coaching?

THERAPY Emotion-focused psychotherapy is an effective treatment for chronic pain and other chronic neuroplastic symptoms. It usually involves a once-a-week session with a licensed therapist. For unlearning chronic symptoms, the best trainings to look for in a therapist are Pain/Neural Reprocessing Therapy, Emotional Awareness and Expression Therapy, and Experiential Dynamic Therapy (also known as ISTDP and AEDP). These therapy approaches take many years for a therapist to learn and master.

These directories can be utilized to find therapists from one of those three trainings: PPDA Directory, PRT directory, IEDTA directory, and Sirpa Directory (Europe-based).

The bad news: very few therapists have this kind of training background. Another roadblock is that the therapist must be licensed in the state where the patient resides in order to practice legally. That leaves many people in Pain Reprocessing Therapy “deserts.” And the fees are a factor: the going rate for this kind of therapy is between $200-450 per 50 minute session, twice as much as the average coaching fee.

The main advantages of therapy for pain recovery are that therapists tend to have deeper training and can work with a broader spectrum of clients, including those who cannot benefit from coaching.

COACHING Neural Reprocessing Coaching is also an effective treatment for chronic symptoms. The training to look for is Pain/Neural Reprocessing Coaching. While some coaches are certified by the International Federation of Coaches (ICF), there is no regulation around who can call themselves a coach (unlike with therapists). ICF certification takes about one year of training and mentoring to obtain, versus 5-8 years of training for the average therapist. Many pain recovery coaches have attended coach trainings that are unaffiliated with the ICF, and practice without certification.

The going rate for this kind of coaching is between $100-200 per 50 minute session.

Coaches can work with people in any state or country without bureaucratic restrictions. Many therapists and physicians work with people in other states by simplifying what they do and calling it “coaching.” Their fees, though, usually match their credentials, meaning therapists charge more for coaching than coaches do, and physicians charge more than therapists—even though everyone’s calling their service “coaching.”

The main advantages of coaching for pain recovery are accessibility and affordability. Additionally, most mind-body health coaches have had chronic symptoms themselves, and bring an embodied wisdom from that struggle.

Advantages of Therapy

Therapy is often a good fit for anyone with a history of childhood abuse, neglect, and trauma, who hasn’t been to therapy before, or feels their past wounds may need more attention. Therapy, as opposed to coaching, is usually necessary if someone cannot engage in a coaching relationship without spikes of anxiety or brain fog that disrupt the process. Therapists trained in experiential dynamic therapies (EDT) are especially well-equipped to help patients who struggle with basic functioning and with dramatic spikes of pain/anxiety.

Therapy is also recommended for anyone who has a number of other psychological challenges in addition to chronic symptoms. For example, someone who has back pain, but also struggles to set boundaries with verbally abusive family members. A high-quality therapist can help with both of those issues.

Therapists are much more likely to work in what’s called the “transference,” which refers to how patterns from a client’s early relationships with parents and siblings show up in sessions and distort the therapeutic relationship. Often the most healing moments are when invisible habits become seen by re-enacting them with a skilled therapist.

As a general rule, if you can find a great therapist who is informed about the principles of pain/neural reprocessing therapy and mind-body healing, then on paper, they have more training and more skills than the average coach.

I always encourage clients who ask if they should also consider to therapy to explore it.

Advantages of Coaching

While both therapists and coaches tend to allow clients to drive the process based on their own goals, coaches are especially trained to make space for clients to discover their own motivations and needs, and to guide those clients towards reaching them.

Coaches in the field of pain/neural recovery coaching are more likely to emphasize the aspects of healing having to do with shifting beliefs, thoughts, and behaviors. They are more likely to emphasize pain neuroscience education. And while some will work with emotions carefully, they tend to be less likely to inquire about early childhood experiences, childhood abuse, traumas, and relationships with caregivers and siblings.

Coaches who have been through therapy themselves are more likely to feel comfortable working with emotions, so this is a good question for any prospective coach, “do you work with emotions, and if so, how? What training and background do you have with emotions?” Emotional processing is often, but not always, a critical part of chronic symptom recovery.

The Cost Factor

Therapists’ fees tend to be $200-400 per 50 min session ($300-400+ for a psychiatrist with med services), whereas coaching fees tend to be half as much—between $100-200. Some therapists will work at a reduced fee of $100-150 for people with lower incomes.

It’s About Finding The Right Person

Even with their additional training, some therapists are less effective than coaches because it is just so individual, both for the healer and the client. Some coaches have spent 5, 10, or 20 years struggling with chronic debilitating symptoms, and they have an embodied wisdom from their own healing process that emerges from that experience—a relationship with a person like this can be healing. Of course many therapists also have personal experience with mind-body symptoms, or a long history of guiding people towards healing that brings a different kind of wisdom.

In other words, each coach or therapist brings their individual sensibility to the healing relationship no matter what their training is, and I would suggest that finding the right individual who you feel comfortable opening up is of utmost importance, and training background is one of several factors to consider.

It’s Not Necessary to Commit Right Away

It’s often a good idea to meet once with 2-4 coaches/therapists to figure out who feels like the best fit. The process does not need to be rushed and you shouldn’t feel compelled to commit too quickly.

You Don’t Always Have to Choose

Many people choose to work with a coach for several months to learn the basics of pain neuroscience, predicitive coding, somatic tracking, and to return to activities they’ve avoided. Then later, they may take up working with a therapist to go deeper into their history of suffering and to change relationship patterns.

Both coaching and therapy are very effective ways of unlearning chronic symptoms.