While some people use the terms interchangeably, there are distinct differences between therapy and health coaching. That being said, both modalities are designed to help people improve their mental health and achieve personal growth, so unsurprisingly, there’s some confusion when comparing the two. 

Deciding which approach is the right fit as a career requires thoughtful consideration of their needs and your scope of practice. Remember: one isn’t better than the other. Each approach serves different purposes, and whether someone can benefit from one, or even both, depends on their personal situation.

In this article, we’ll help you gain clarity around what therapy and health coaching are and how to recognize when a client needs one over the other. 

At HG Institute, scope clarity is one of the most important skills we build into our coaching certification program. Knowing when to treat, when to refer, and how to stay in your lane makes you a practitioner that clients can trust.

Note: This content touches on mental health and wellbeing. If you’re feeling overwhelmed or need support, you don’t have to navigate it alone. In the U.S., you can call or text 988 to reach the Suicide & Crisis Lifeline, or text HOME to 741741 to connect with a trained crisis counselor. If you’re outside the U.S., you can find local crisis and support services at findahelpline.com.

Therapy vs. coaching: The core differences

In short, therapy is considered a medical treatment, whereas coaching is a process rooted in partnership and personal development. 

In terms of credentials, therapists practicing in the U.S. require post-secondary schooling (Master’s or PhD), followed by supervised clinical hours that vary by license type and state. Health coaches, on the other hand, typically require completing high school-level education (or sometimes an Associate's or Bachelor’s) before taking part in health coaching certification programs approved by governing bodies like the National Board for Health & Wellness Coaching (NBHWC). Regardless of title, to be effective and maximize outcomes for clients, both practitioners often pursue ongoing education beyond getting certified or licensed. 

The goals of mental health therapy 

• Diagnoses and treats complex psychological disorders such as ADHD, anxiety, depression, OCD, and BPD

• Works within established clinical frameworks (DSM-5-TR) to assess, diagnose, and develop treatment plans

• Focuses on helping clients process and heal past traumas and grief

• Helps clients uncover the driving forces behind their behavioral and relational patterns

The goals of health coaching

• Focus on setting and achieving personal goals (action-oriented approach)

• Guide clients through common non-clinical health issues

• Helps clients develop self-determination, realize their strengths, and channel them to make lasting changes 

• Helps clients with productivity, motivation, building healthy habits, stress, and communication skills

Therapy vs coaching: Where do they overlap?

Both health coaches and therapists work with their clients and patients to facilitate lasting change. In order to do this, they often draw from the same sources of knowledge and use theoretical frameworks and conceptual models, such as:

• Self-determination theory

• Adult development theory

• Learning theory

• Transtheoretical model

• Social cognitive theory

• Nonviolent communication techniques

Scope of care: The line every practitioner needs to understand

Scope of care is the legal and ethical boundaries and limits of a practice, as defined by the professional codes of ethics and the relevant state licensing board (for therapists). Furthermore, for therapists, it determines what assessments, diagnoses, and interventions they’re allowed, or not allowed, to provide.

Understanding this is necessary to provide safe and effective care as a practitioner, whether a coach or therapist. Maintain a list of trusted health practitioners in case you discover a client needs more specialized or varied support. That way, you can refer them to another professional who is better equipped to provide the help they need.

What licensed therapists can do that coaches cannot

One of the main differences between therapists and health coaches is that therapists are legally permitted to diagnose mental health illnesses, depending on their training and certifications. 

They can also evaluate their clients’ emotional states and focus heavily on exploring the underlying factors that drive a client’s patterns of behavior. For example, if a client tends toward perfectionism and overworking themselves, a therapist can help them unpack the reasons behind it.

What health coaches can do that therapists often don't

Despite common misconceptions, coaches aren’t supposed to give advice or answers. Health coaches aim to create an environment and provide guidance that allows clients to recognize their potential and make their own decisions. 

Why clarity here protects both you and your clients

When a coach or therapist tries to provide support that’s outside of their scope and knowledge, it can potentially cause harm to the client’s mental health and even physical well-being. That’s why it’s so important to build clarity around what your practice offers and what your client needs.

How to talk to your clients about the difference between therapy and health coaching

It’s important to communicate your scope of care right from the very start, including in promoting your services and in conversations when determining if you’re the right fit for a potential client. 

If your client comes to you and says they think they need therapy, you should be prepared to explain, with clarity and kindness, why you think it’s a good idea or not.

Signs a client needs therapy, not coaching

If your client is in a constant state of high emotional distress and has trouble functioning in their daily life, it could mean that they need a therapist. A therapist would be better suited to help a client if they are dealing with the following mental health issues:

• High degrees of anxiety

• Depression

• Eating disorders

• Post-traumatic stress disorder 

• Obsessive thinking

• Addiction

• Substance abuse

• Suicidal ideation

How to refer clients to therapists

Being a good coach means being able to help clients reach their goals, which includes having the self-awareness to know when therapy is the better option.

When referring a client to another professional, approach them with kindness and empathy. Make it clear that you want the best results for them, and that you’d like to discuss whether a therapist would be better suited to help them work through their challenges.

Avoid lecturing or telling them what they should do. Instead, explain your position, ask them what they think about it, and give them a choice so they can feel a sense of agency over their mental health journey.

Here are some tips for referring a client with empathy and care:

• Be curious and non-judgmental

• Communicate in a positive, supportive, and calm manner that you’re concerned about your client’s welfare

• Be an active listener and validate what they say

• Explain why you think it would be beneficial; be specific by directly addressing the issue(s)

• Use open-ended questions to gain insight into your client’s mindset

• Ask them how they feel about seeing a therapist

• Leave space for silence so your client’s feelings and thoughts can settle

• Take a step back if your client doesn’t seem receptive to the idea of therapy; let them know that they can reopen the subject at any time if they wish

• If they accept therapy or are open to it, ensure them that you’ll be there to support them as they transition to working with a therapist 

When coaching and therapy can complement each other

Some individuals can also benefit from working with both a health coach and a therapist.

Coaching is often the first step in a person’s journey toward improving their mental health. For example, a manager who works with a coach to enhance their decision-making skills may also discover that they’re dealing with underlying imposter syndrome that requires exploring past trauma and toxicity in familial relationships.

But what might it look like the other way around? 

Let’s take a client who, with the help of a therapist, has been able to deconstruct their past trauma and how it’s shaped who they’ve become. After a few months of working with their therapist, they now feel ready to follow through on an actionable plan with clearly-defined goals. This is where working with a health coach could be beneficial in helping them develop healthier daily habits.

What this means for practitioners building a practice

Clarity, clarity, clarity. This is an important building block of your practice as a health coach. It means: 

• Knowing the scope of your practice and your abilities

• Exactly how you can help clients, and how you cannot

• When another practitioner would be a better fit for your client

• Being a clear and empathetic communicator 

Having clarity in all aspects of your practice enables you to protect yourself and your clients, legally and ethically.

How HG Institute builds scope clarity into every program

Scope clarity is a core value at HG Institute, making sure we bake it into all of our training. We offer an NBHWC-approved mental health coach certification program that dives into the role of a health and wellness coach, ethics and professional standards, and boundaries, as well as the opportunity to put what you’ve learned into practice. 

As you continue your journey, we’re here to make sure you’ve got the knowledge and tools to help clients on theirs.