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Coaching versus Therapy: Which is Right For Me?

Imagine that you are planning a home repair project, such as a kitchen redesign. You would use various tools in your toolbox to complete the project because they each serve distinct and valuable functions. Similarly, coaching and therapy are distinct and valuable tools for improving emotional and sexual well-being: the context, and desired outcomes, impact which of these two tools is ideal.

Two people in a coaching meeting at a table. One holds a drinking mug while looking at the other who is smiling.

What is coaching?

Coaching is a tool that is often used for clients who want to increase fulfillment or reach defined goals in specific areas of their life. At Healing Exchange, coaches focus on goals specific to sexuality and relationship wellness, such as sexual skills, sexual self-esteem, improving relationships, or sex education. Our coaches are qualified sexuality educators and/or counselors with master-level education and are committed to ongoing training. They've worked in settings such as Planned Parenthood, gynecological and wellness centers, and community organizations for LGBTQIA members. Because coaches can come from various educational backgrounds, the coaching field is less regulated than the therapy field, allowing coaches to provide support from different states or countries. The ability to promote sexual health and support people in living their ideal life by offering services across the globe is the ultimate goal of Healing Exchange.

In a similar way that a hammer wouldn't be an appropriate tool to re-paint your kitchen, coaching isn't suitable as a sole treatment for mental health conditions. Coaching isn't therapy; our coaches do not work with clients around mental health or safety crises, severe mental illness, or suicidal ideation. They do not provide or treat mental health diagnoses and cannot bill insurance for coaching services.

Young person sits in a therapy session with legs crossed and hands in their lap.

What is therapy?

Therapy is a more appropriate tool to support mental health challenges or emotional distress interfering with one's ability to engage in everyday activities such as work, school, or relationships. Therapists must have undergone specific formal training in psychology, counseling, or social work, which allows them to diagnose and treat mental health conditions such as depression, bipolar disorder, and anxiety. Because therapists are treating diagnosed mental health conditions, some therapists can accept health insurance. However, most therapists at Healing Exchange do not accept health insurance but can provide a Superbill for insurance reimbursement to those with eligible insurance plans. Therapists are also regulated by different state requirements, and as a result, therapists must be licensed in individual states. Our therapists are licensed to practice therapy in the state of Missouri and Nevada, meaning they can only provide therapy to clients who reside in those states.

What if my therapist offers coaching and therapy?

The training of a therapist can prepare them to also be coaches, and some coaches are licensed therapists. However, it is not good practice to work with one client in both capacities. Therefore, if you begin with a professional as a therapy client and would benefit from coaching, your therapist will refer you to a coach. Similarly, if you begin with a coach who recognizes that you might benefit from a therapist, they will refer you to someone else, even if they are a licensed therapist.

Consider the following scenarios for an idea of how these two powerful tools might be used.

Working with a therapist and coach: Mia's story

Mia, a white 35-year-old cis-gender woman, wants help for low sexual desire and arousal. Decreased sexual desire or arousal is a broad topic that coaches and therapists at Healing Exchange might see in their practices. To determine the appropriate tool, one of the first considerations would be determining what is causing the lack of desire and arousal. The physical, mental, and emotional factors would be considered to determine what contributes to the issue. Mia went to her OB/GYN and got a pelvic exam and bloodwork done. Her OB/GYN found no abnormal physical findings and recommended that she consult a mental health therapist for support. Mia completed an intake call with a therapist.

After the intake call, her therapist used The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which lists the criteria for all mental health diagnoses, to determine if Mia met any of the criteria for a mental health diagnosis that could be causing this lack of desire and arousal. The therapist determined that Mia met the DSM-5 criteria for a mental health diagnosis of Major Depressive Disorder and Female Sexual Interest and Arousal Disorder.

Mia's therapist met with her weekly for 16 weeks and utilized Cognitive Behavioral Therapy (CBT) for unpacking Mia's negative thoughts about her body, increased isolation, feelings of hopelessness and loneliness. Her therapist also provided sex education around sexual anatomy and sexual pleasure, factors contributing to arousal and desire, and types of sexual responses. After 16 weeks, Mia had begun going on dates again and no longer met the criteria for depression and female sexual interest and arousal disorder. However, as she began having sex again, she felt like her sexual experiences weren't very enjoyable. She also wanted to begin exploring BDSM/kink with her new partner. Being that her therapist is not a coach and that education around BDSM/kink is not a medically necessary treatment according to insurance, her therapist suggested she consider working with a sexuality coach.

Mia began to look into coaching and found it could be helpful for her to move toward a more enjoyable sexual experience. During their consultation, the coach explained that their role was to support Mia in moving from functioning to thriving and in their first session, Mia and her coach defined what a thriving relationship and sex life would look like. Throughout their sessions, her coach offered her sex education about kink and BDSM practices. Their sessions utilized expressive arts and movement that fostered a positive attitude about sex. During one of their sessions, Mia reflected that she struggled to do the expressive art journal prompts her coach gave her. Mia's coach was well-educated on motivational theory and goal setting. She used motivational interviewing skills to help Mia explore her ambivalence to complete the journal prompts. Mia and her coach used sessions as a form of accountability for engaging in these practices outside of the session to promote creating the sex life she desired. After her coaching sessions, Mia felt better educated on BDSM practices and better prepared to engage in them safely. Additionally, expressive arts allowed her to embody the sexual vitality she desired, something she didn't have time to explore deeply in therapy.

How might this scenario have looked different if someone's low sexual desire and arousal wasn't a result of a mental health diagnosis and coaching was appropriate from the start?

Working with a coach: Kirby's story

Kirby identified as a Black transgender, non-binary, 25-year-old. They had noticed decreased sexual desire in their long-term partnership but felt their decreased desire didn't fall into a category of "illness" or a diagnosable condition. They felt that working with a coach who was Black and part of the LGBTQ community would be most supportive. They hoped that having a coach with similar identities would provide an increased sense of safety in discussing issues related to race, something they didn't feel as comfortable doing when seeing a white therapist in the past.

Kirby's coach began their session by discussing how they felt about their current sex life questions about their sexual health. Kirby's coach recognized that many of the issues Kirby was feeling weren't an issue of lack of sexual desire but rather a difference in desire between Kirby and their partner. Kirby's coach provided them with sex education about desire discrepancy and the difference between sexual desire and sexual arousal. They also discussed the impact Kirby's stress, including minority stress, could have on their sexual arousal. This education provided Kirby with new language to describe what was happening in their relationship. This new language empowered them to respond differently when issues of sexual desire arose in their relationship.

Because Kirby's coach held the same racial identity and had made it clear they understood the role oppression could play in sexual well-being, Kirby's found it easier to explore how their race impacted their conversations about sexual desire with their partner. Kirby's coach taught Kirby different communication skills and utilized sessions to practice communication through role-playing different scenarios. Kirby included their partner in a few sessions to foster communication about the pressure Kirby was feeling during sex. Kirby noticed improved communication with their partner, and they noticed less distress regarding their level of sexual desire.

While both coaching and therapy are powerful tools for healing, choosing the correct tool based on the context and goals is essential to support the best outcomes. Had Mia only used therapy as a tool for her sexual well-being, she would not have had the opportunity to engage in sex that felt fulfilling through exploring BDSM/kink. For Kirby, therapy wasn't the right tool because their sexual desire wasn't related to a mental health concern. Coaching supported Kirby in learning information about sexual desire discrepancy and learning tangible communication skills. Additionally, having a coach with similar identities affirmed Kirby's understanding of the role oppression played in their sexual health.

White pillow with black text that reads LIFE IS BEAUTY FULL. Pillow is on a green couch and slightly covered by shade.

Do I need a coach or a therapist?

After reading these examples, do you find yourself relating with Mia or Kirby? Maybe you have noticed that, like Mia, you have reached the point in therapy where you are "functioning" but would like to explore other aspects of your life, relationships, and sexuality. Or perhaps you would benefit from sex education and coaching that could provide you and your partner(s) a shared language to understand sex and sexual desire. Below are some questions to determine if coaching or therapy might be a better fit for your goals:

Am I looking for interventions intended to treat a specific mental health diagnosis such as anxiety, depression, eating disorder, or an orgasmic disorder?

  • Therapy services would be more appropriate. Learn more about our therapists here.

Am I already seeing a mental health therapist and looking for collaborative options that could support further sexuality exploration?

  • Coaching could be a good option. Learn more about our coaching services here.

Am I currently feeling emotionally stable enough to "function" but want to thrive in my sex life or sexuality?

  • Coaching could be a good option. Learn more about our coaching services here.

The names and stories of Mia and Kirby are made up as examples to provide more insight around the differences in coaching and therapy.

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