The Physician Philosopher Podcast

TPP 51: Coaching versus Therapy for Doctors

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Larry Keller

How is coaching different than therapy? This is one of the most common questions that I get asked about physician coaching.  And it is definitely one of the most important questions to answer for doctors who are looking for help as they feel trapped in medicine. 

Why? Because “Trapped Physicians” often feel burned out.  They know they need to make a change, but they aren’t sure how to do it.  Trapped Physicians often feel unappreciated, undervalued, overworked, and unheard.  Many have thought about going part-time, changing jobs, or leaving medicine altogether. 

When the rubber meets the road, they really just want help.  That is when many of physicians who feel trapped start looking into the tools that are out there.  And two tools they are likely to find are coaching and therapy.

So, what’s the difference between coaching and therapy?  That’s what we are going to discuss in this post.

My Experience With Therapy

I want to be clear right upfront.  I am not a therapist, social worker, or counselor.  And I think that therapy is the right thing for many, many doctors who are struggling.  I highly encourage anyone who feels that they need therapy to seek it out.   

However, in this post I want to talk about my experience in therapy as a patient when I was struggling with burnout and depression.  And that of what I’ve heard from the more than a hundred doctors that have been clients inside of ACE – multiple who simultaneously get therapy and coaching. 

So, if coaching and therapy both exist.  And some even use both at the same time.  This implies that there is a difference between the two. That’s what this article is all about – the difference between coaching and therapy. 

Therapy First 

Let’s start with therapy.   

What seems to be fairly well-understood is that therapy places an emphasis on trying to figure out how you got to where you are right now. In other words, a lot of time is spent determining how your past experiences have led to your current problems. 

And this is important work.   

Determining how you got to where you are right now may prevent you from making the same decisions in the future. It can also provide insight in terms of how your brain ticks.

Moving Forward From Your Past

However, there is still work to be done once you understand your past.  Understanding our past is only a part of the battle.  And, in this way, coaching and therapy are often complimentary (more on this later).     

In my experience – and that of many of the clients in the Alpha Coaching Experience – knowing how you got to where you are is helpful, but moving forward from that place is often the real work to be done. 

And for good reason.

Being the Victim of Your Past 

Far too many people place themselves in the position of being a victim of their past or their circumstances.  This poses a problem because one thing that is certainly true about the past is that it cannot be changed. 

So, if you are the victim of your past, and it is currently causing you to feel a certain way.  Then there is a strong possibility you will always be the victim of this unchanging past. 

This can be true about difficult relationships in your past.  Or trauma you have experienced. It can be true about your boss or your job.  The same can be said of the broken medical system that burns you out. 

While therapy can be really helpful to allow you to understand why you feel the way that you feel due to your past circumstances, it also has the potential to prevent you from ever moving forward from your past. 

Enter Coaching for Physicians 

This is where coaching comes in.  Coaching does not care about your past. And when you get coaching, you’ll notice something strange.   

Why? Because the past has taken up enough of your time.  It is time to move forward. 

In coaching, we take a deep dive into your thoughts and how they are showing up in your life.  How they make you feel, the actions that they produce, and the ultimate result you are experiencing. 

And then we help you move forward by changing the narrative that you have told yourself in your past.  And this makes sense, right?  If your past got you here, then we shouldn’t keep repeating our past.  We should move forward from it.

An Example from the Alpha Coaching Experience 

Let’s consider an example.  Inside ACE, we have doctors who are upside-down in student loan debt.  They are working more than they want. Constantly on call.  And they feel like they are depriving their families at home.   

This sort of experience leads people to think that they have to choose between being a good spouse, a good parent, and a good physician. Talk about a quick recipe for physician burnout.   

This leads to thoughts like “I’m a bad mom” or “I’m not a good husband.” Or when people suffer from imposter syndrome, this will show up as “I’m not even a good doctor.” 

What many doctors do in this situation is to fix things by changing their situation.  They change jobs.  They try locums.  Or any variety of other things.

What they learn is that changing situations doesn’t make the problem any better.  So, their past teaches them that there is nothing they can do.  They are the victim of an impossible situation.   

Everything seems to be happening TO them, and very little FOR them.  You can see how a lot of doctors would feel trapped in this narrative. 

Control What You Can Control

Through coaching, we stop looking to our past for answers. Instead, we look internally at the thoughts we are having, which are leading to our feelings. 

And there is example after example that shows how helpful this realization it is. 

As EpEpictetus famously said, “The chief task in life is simply this: to identify and separate matters so that I can say clearly to myself which are externals not under my control, and which have to do with the choices I actually control. Where then do I look for good and evil? Not to uncontrollable externals, but within myself to the choices that are my own…” 

Or we can turn to the serenity prayer taught in Alcoholics Anonymous, “God grant me the serenity to accept the things I cannot change; Courage to change the things I can; And wisdom to know the difference.” 

While therapy may look backward into the past to try to understand our present, coaching involves determining what is currently under your control.  The thoughts that you are having and the work that can be done to change thoughts that aren’t proving helpful in your life. 

The Difference Between Coaching and Therapy

So, if therapy helps us determine our past.  Then, coaching helps us to understand the current thoughts we have about our past, and whether we want to keep those thoughts around.

If they aren’t serving us, then we work to change those thoughts.  In this way, we stop focusing on things we cannot control (like the past) and focus on the things we can control – our internal dialogue, thoughts, and narrative.

In this way, you can stop being the victim who understands their past, and start being the champion of your future.

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  1. d

    As a psychologist and a coach, I don’t agree with all of the distinctions in this post. Both therapy and coaching focus on the past and present. To say that coaching does not “care” about the past, and then offer comments that are clearly learned from one’s past, such as “I’m a bad mom,” may confuse readers.

    Also stating that therapy “has the potential to prevent you from ever moving forward from your past” is both incorrect and potentially dangerous for readers who need services and are discouraged from seeking them out due to this post.

    • Jimmy Turner, MD

      Discouraging people from therapy is certainly not my goal. As I say in the podcast episode related to this post, I think they are complimentary… but it as also been my experience (and the experience of many that reach out) that therapy has a tendency to focus on the past and to provide tools to help deal with the past, but does not have a huge focus on how to move forward from the past (i.e. to not continue to focus on it).


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