Change causes crisis and crisis causes change; nevertheless, too many people are capitalizing on the current state of —well everything, and providing mental health treatment without a license. This article is of particular interest to anyone who has been injured by seeing a “life coach” or someone providing coaching or counseling services without a license.

Let’s start at the beginning. In order to do anything you have to be motivated. Likewise, to be motivated to spend money on something (especially these days) people have to have a pretty pressing reason. This often means they have a “problem” that is causing them emotional distress. Due to long wait times for first appointments and/or stigma associated with counseling, some people seek out coaches. Unfortunately, they do not realize that coaches are not licensed nor regulated. Most states have licensing boards that regulate counseling. There is a reason for this. The activities in which counselors engage have the ability to substantially help people, but can also substantially hurt people. If you have a problem with a life coach, there is no recourse unless you can show that he or she was knowingly providing services/treatment for a mental disorder such as depression, anxiety, or an eating disorder.

Coaches are not supposed to diagnose or treat mental disorders, but many of them do. Although there are certifications people can get in anywhere from 48 hours to six months, it is not necessary to be certified to hang out your shingle as a coach. Counselors, on the other hand, have to have a master’s degree in counseling or psychology, including 750 hours of practicum and internship experiences, followed by 3000 hours of post-masters supervised experience before they can even apply for licensure.

Currently there is very little interest on the part of law enforcement to pursue coaches who are treating whomever they want for whatever disorder as long as they do not use the words “counseling,” “diagnosis” or “treatment,” (even if that is exactly what they are doing). Unfortunately, inappropriate treatment can result in people becoming worse, or becoming jaded about the whole counseling experience.

Let’s take a look at some dangerous case examples:
Example 1:
Seven years ago “Susan” was raped. Over the next few years, despite being on a regimen of antidepressants and therapy, her PTSD led her into a deep depression. She began to rely on food and alcohol to stop the involuntary flashbacks, quell the anxiety and help her sleep. She was arrested for DUI and flunked out of graduate school. One day, the company she worked for hired a life coach and had him work with each employee. The life coach heard Susan’s story and, instead of identifying that she had a serious mental health problem and a family history of suicide, he minimized the trauma and told her, “You already had your power taken once. Why are you still letting them take your power away? What would happen if you just let it go?”
This made “Susan” feel like the flashbacks and depression were somehow her fault and she should be able to stop them. She knew that if she could, she would have by now. She rapidly spiraled into crisis and came to the conclusion that “they” would always have power over her and she would never be able to escape. She was admitted to the crisis stabilization unit after trying to commit suicide.

Example 2:
Heather seemed to be a pretty “together” sort of person. She had been in and out of counseling for depression and an eating disorder for years, but it never seemed to work. She decided to try a life coach. After all, she was already good at dieting and exercise, a life coach could help her reach her goals even better. She met with her coach a couple of times and felt like they could work together. One day, a few weeks into their relationship, Heather was feeling “fat” and depressed so her coach decided to do an exercise. She took Heather to the mall and pointed out random women and asked her if they were more or less lovable and valuable based on their weight. What Heather’s coach did not realize is that people with eating disorders equate being overweight with laziness, stupidity, ugliness and depression. Further, control is a driving factor in eating disorders and Heather did view the thinnest women to be more lovable and worthy…thus it intensified her drive to lose more weight to be like them.

“Heather” realized after the exercise that her coach just didn’t get it. She could not see how awful it is to live as a fat person. Heather dropped out of coaching and increased her purging to more than 15 times per day. This continued for three years until she was admitted to the hospital at 87 pounds.

Example 3:
Joan came from an average family, but it was always suspected that her father had an alcohol problem and her mother was a bit depressed. Joan had experienced bouts of depression in the past, but currently only had mild depressive symptoms. She sought the assistance of a life coach for her overeating. The life coach had Joan keep a food diary and they worked out a menu and eating schedule. Each week Joan tried desperately to stick to the plan. She enlisted the help of a weightloss buddy and even went as far as putting a padlock on the snack cabinet. Nothing worked. She was becoming progressively frustrated and depressed. Her coach finally confronted her and said, “Each week we work together to develop your action plan, but you never follow through. It seems to me that you really don’t want to change.”
Whether this was intended to be reverse psychology or the coach actually was that insensitive, I do not know. Nevertheless, Joan dropped out of coaching and, feeling like a failure, drank herself into a stupor. Six months later she was admitted for substance abuse treatment where she also began to address how she used food to cope with her anxiety and depression and rebuild her shattered self esteem.

My goal is not to deprive people of an honest living, but to emphasize the need for coaches to have training in screening for psychological and behavioral problems and ethical guidelines for working with these persons. According to the National Institute of Mental Health, nearly 10% of people will experience clinical levels of depression in their lives and 5-8% will have a diagnosable anxiety disorder. That means it is possible that as many as one in five people will experience a mental health issue at some point in their lives. Many of these people are currently seeing a therapist, in which case treatment between the coach and therapist needs to be coordinated to avoid contraindications. Still some people have not had success with therapists, and continue to present with a diagnosable disorder. They need to be referred to a therapist in lieu of or in addition to coaching, because they are still at high risk for being psychologically injured by a well-intentioned coach who does not understand the biopsychosocial foundations of depression, anxiety, addiction and the like. If traditional talk therapy has not worked, coaches might refer the client to a therapist that specializes in brief motivational therapy.

Example 4:
Rachel had just gotten out of a bad marriage and was feeling depressed. She decided she needed to see a life coach to help her get back on track. She researched coaches in her area and found “Tom.” When she first met him she was impressed with how successful he appeared to be at such a young age. He was charming and seemed to be able to achieve anything he set out to do. Rachel wanted to be like that too. She began sessions with him. Rachel was making progress. After a few months, she finally got up the nerve to ask Tom out. He accepted. They began a sexual relationship. When Tom ended the relationship, Rachel was devastated. She felt like he had built her up to ask him out and then used her.

It has been shown that by creating “a safe space and supportive relationship for personal growth, discovery and transformation,” a power dynamic evolves between client and counselor. Therapists are ethically and legally prohibited from having sex with clients or forming “dual relationships.” Clients who engage in sexual relationships with their therapist often report symptoms similar to Rape Trauma Stress and impaired future relationships. Nevertheless, the first core function of coaching is to create” a safe space and supportive relationship for personal growth, discovery and transformation,” yet there are no enforceable ethical or legal guidelines for coaches regarding sex with their clients.

Example 5:
John was recently separated from his wife and was trying to lose some weight and get back into shape. He enlisted the help of “James” who was a life coach and personal trainer. During their sessions, James created a safe space and supportive relationship for personal growth, discovery and transformation. John confided in James about how, as his marriage fell apart, he became progressively lonely and ended up having an affair. John reported that he was terrified that his wife would find out and the stress of waiting for the divorce hearing was making it hard for him to stick to his action plan.

Unfortunately for John, his wife found out he was seeing a coach. Since coaches are not protected by confidentiality or privilege, James was subpoenaed to testify against John. John felt very manipulated and betrayed and declared he learned his lesson about trying to get help.

Scope of Problem:
Unfortunately, because coaches are unlicensed and unregulated there is currently no way to know how many inappropriate clients are being injured by coaches. Counselors have procedures in place where malpractice in tracked and investigated by their state board. Coaches have no state regulation. Suicides of mental health counselors and psychologists are often “staffed” and investigated within the mental health agency and by the agency’s accrediting body (JCAHO, CARF etc.). Coaches have no such mechanism to improve and prevent the repeat of costly mistakes.

What needs to happen?
1. Coaches need to be trained in screening for mental health disorders and required to refer clients for further assessment if they exhibit symptoms of an emotional, mental or behavioral problem.
2. Coaches need to have a code of ethics that addresses:
a. Working with people with mental, emotional or behavioral issues
b. Forming dual relationships with clients
c. Clearly articulating their ability to maintain confidentiality
3. Coaches need to be held accountable when they work with and injure clients because they disregarded signs that a client had an emotional, mental or behavioral issue.