Coaching vs. Therapy vs. Psychiatrists: What's the Difference?

One of the first things I am asked when I tell people that I am a life coach is: what even is that? It’s a fair question and one that can get a little muddy when comparing to therapy and/or psychiatry - particularly because life coaching isn’t regulated. That lack of regulation opens the door to a variety of coaching style; some legitimate and some not so much. This becomes even more confusing when certain coaches step far outside their scope of practice, creating situations that are not only unethical but potentially harmful. For every coach doing the work with integrity, there seems to be one (or more) offering nothing more than AI-generated fluff peppered with emojis and hard sells. This isn’t to say that there aren’t problematic behaviors found in therapy rooms but there is a lot of structure around mitigating these behaviors.

Before diving deeper into that issue, let’s explore the actual differences between therapy, coaching, and psychiatry - what they can do, what they can’t do, and where they overlap.

Mental Health Therapy Professionals

First, let’s clarify some terminology. Miriam-Webster defines "therapy" as "treatment intended to relieve or heal a disorder," which spans everything from mental health to physical conditions. But here, we’re focused specifically on mental health therapy, often referred to as psychotherapy. Some people mistakenly believe psychotherapy is administered only by psychiatrists, but that isn’t the case.

Mental health therapy typically involves talk therapy, but there are many other approaches like EMDR, Internal Family Systems, Dialectical Behavioral Therapy, and Cognitive Behavioral Therapy. CBT, notably, has made its way into life coaching circles as well.

Key facts:

• Some mental health professionals (psychiatrists) can prescribe medication; most therapists cannot.

• Diagnosis often involves tools like the DSM-5 or structured questionnaires.

• Practitioners usually hold a master’s degree or higher and maintain an active license.

• They adhere to strict ethical codes and state-defined scopes of practice.

• Services can often be billed through insurance.

• Therapists provide insight and facilitation but generally do not offer direct advice.

Psychiatrists, while part of the mental health field, are medical doctors. They focus more on diagnosis and medication management. Not all offer therapy services.

Life Coaches

Life coaching is a much newer practice, gaining traction in the late 1980s and early 1990s. While it doesn't have the long-standing clinical history of therapy, many of its tools draw from established modalities.  Life coaching started with a major focus on NLP (Neuro-Linguistic Programming) but in the US most coaches have moved away from this being the primary modality (though some aspects of NLP can be found in coaching models). 

Key facts:

• Life coaches cannot diagnose or prescribe medications.

• They often use models like CBT, REBT, or NLP (not as often) - adapting their approach to meet the client’s goals.

• Life coaching is not covered by insurance.

• No specific degrees or certifications are required to practice, though organizations like the International Coach Federation offer credentialing that is seen as more legitimate.

• There's no formal governing body or universal code of ethics.

Where They Overlap and Where They Don’t

The simplest way to explain the distinction is that therapy often focuses on the past to present, while coaching looks at the present to future. That said, it’s not a hard divide. Many therapists work with clients who are stable but want to navigate their current challenges. Some coaches work with clients whose past traumas still affect them, though ideally without diving deep into clinical territory.

Therapy might move more slowly and deliberately, particularly when working through trauma. Coaching tends to operate on a more action-oriented, goal-driven timeline. Both approaches can be deeply transformational, but their purposes differ.

Choosing the Right Support

Ultimately, the best fit depends on your needs. Sometimes therapy is essential before coaching can be effective. Sometimes coaching picks up where therapy leaves off. There may even be seasons in life where you benefit from both.

A good coach knows when to refer out. If a client’s history is actively disrupting their ability to move forward, that may be outside a coach’s scope. Likewise, some clients may reach a point in therapy where they’re ready to take action but don’t need to continue unpacking the past.

The decision about what type of support fits best lies with you, the client. Whichever path you take, the goal is the same: a more empowered, balanced, and fulfilled life.

Why The NeuroWise

I touch on this a bit on my website but decided that a little more in-depth exploration of where the name came from and what message I am hoping to convey would be a good idea.  When I made the choice to pursue coaching full time I wasn’t sure what my focus was going to be at first.  I knew I wanted to work with people that were neurodivergent because both myself and my girlfriend experience neurodivergence and have struggled with the symptoms associated with that our whole lives.  I knew I wanted to work with people that had overcome addiction and were at a point in their sobriety where the numbness had worn off but there were still leftover behaviors simply being sober didn’t remove.  I knew I wanted to work with people that wanted to break free from people pleasing, that wanted to gain ground in their identity, wanted to become their own person. 

I realized that all these things had a main commonality – behaviors and patterns that were causing more harm than good. 

With that in mind I started to write out things I had done to move beyond some of my more destructive and unhelpful behaviors.  I’d borrowed from so many different modalities and practices and processes that it became challenging to sift through the mud at first.  I’d gone through a dozen names and none of them seemed to fit. One of the concepts that stuck out at me was the one that seemed to be the linchpin to my consistent growth away from these patterns – the stoics called it your reasoned choice while in DBT it was called something else: your wise mind.

I am sure there are many, many different names for the same thing but the overall concept goes like this:

All of use have emotions and all of use have actions but there ALSO exists in all of us this gap between the two where our best decisions are made.