Friday, March 1, 2013

Why a Coach and not a Therapist?

This has been a transitional time for me, and I thought I'd talk about it with you, my readers:
It has taken about five years to transpire.  It started when a series of small injuries gave me the message it was time to stop gardening as a career, and find another vocation.  I thought I'd given up counseling as a career, but after exploring a few other avenues, I found myself opening that door again.  I even began to feel I was "called back to that place."  It felt good.

However, the counseling job I left, was not the job I returned to.  In the interim, managed care had hit the agency scene.  Now, instead of just the client's stated problem indicating the treatment, insurance coverage, county mandates, levels of care (LOC) and a host of other initials (that I couldn't even be sure what they stood for) dictated treatment planning.  Not only that but length of treatment and goals was also mandated by the agency providing funding.

I was fully unprepared.  When I'd left being a service deliverer, I was in private practice as a family therapist.  Although I would provide a diagnosis when required to for one of the few people I filed insurance for, I was a "systems thinker," meaning that I thought more in terms of how one person fit in the whole of their networks, not how they were diagnosed by some numerical code.  Oh sure, I'd been taught those codes in grad school, and I knew how to use the DSM IV, but I avoided it wherever possible, and most people I knew used it only sparingly, preferring to diagnose people as "Adjustment disorder not otherwise specified" which was the most "non-diagnosis" diagnosis you could hang on a person, and was unlikely to affect a person further down the road.

Now I found myself diagnosing people in order to guarantee length of stay, coverage of treatment, admission to a program, etc, and while the diagnoses fit, this was almost directly opposite to twenty years prior in my life.  I kept adjusting myself to fit the times, adjusting, adjusting....

Then there was the paperwork, and that ultimately was my downfall.  For every thing one writes there is a release, and  privacy warnings, and justifications and history, and so on.  Twenty years later, I found I could just not keep up.  It was sad but true.  Paperwork had gone from five to ten pages to over thirty per client, and often the client did not stay, but the paperwork had to be completed.  I was attending more to paperwork than to client needs.  I was ultimately let go from my last position because my productivity was not up to par -- not my productivity in seeing clients, mind you, but my productivity in completing paperwork.  At one point one of my supervisors was giving me a pep talk saying, 'Come on Linda, get with it, we need your clinical skills!!'  But alas, it was not to be, I could not keep up with that amount of paperwork, even to do the work I so dearly loved.

I have been grieving deeply for that work.  I cannot do work with PTSD, deep depression, or borderline personality disorder in a coaching venue.  It requires psychiatric support and groups and one on one contact that this modality will not afford me and that I would not feel ethically right in performing it.  But there are oh so many benefits in moving to coaching for my beleaguered soul!

I had skills that I could rarely offer in the current climate of the public agency setting:  creative, artistic teachiing and coaching skills that were outside the realm of the cognitive behavioral brief therapy measurable existence.  More and more treatment planning was calling me to measurable goals.  Coaching calls me to the same things, but the difference?  The CLIENT sets the goals, not managed care.  If my client wishes to explore spiritual or esoteric or creative goals that are not so behaviorally measurable, SO BE IT!!

If I challenge my client to dream or visualize or create, and the goals do not fall within the 12 designated sessions funded by managed care, THE CLIENT makes that choice.  After all, isn't the goal of most therapy of whatever form that the person entering the therapy become responsible and be able to make active and healthy choices for their life?  I had begun to wonder how we help people to do so when we just begin to engage and the funding is cut, or we form a relationship and the insurance policy changes to one not covered.  Bye-BYE!!  Sorry you're not covered any more...

Do I sound a little bitter?  Yes, I am.  Public agency work enabled me to see people who might not have otherwise sought out counseling or been seen.  But often the services ended suddenly or too soon, and the client rarely felt in control of their circumstances.  Even private insurance clients felt the same way and were left high and dry before even getting basic needs met.  

So coaching offers us a new way.  We don't deal with pathology, we deal with HEALTHY CHOICES.  We contract ahead of time for clear financial guidelines and clear goals tow ork to achieve mutually agreed upon objectives. These are, of course, open for discussion as the relationship moves along.  No one but you dictates what goes on in your session. The client is responsible for getting their needs met, and each person, the coach and coachee, has responsibilities that can be spelled out in each session. I hope that, given the opportunity, you will try it out.

What a novel idea -- mutual accountability.  That my friends is why a coach and not a therapist!

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