A Research Paper By Tessa D’Arcangelew Ampersand, Transformational Coach for Mid-Career Movement Builders, UNITED STATES
Overcoming the Stigma of Mental Illness in Mental Health
“A broken person is not coachable.” This statement, said by an instructor during a coaching workshop, was the harsh summation of the overall fear swirling among students new to coaching trying to understand the difference between coaching and therapy. The instructor said this to differentiate between a person open to coaching and a person who ought to be referred to therapy; but, there is an important distinction between differentiation and othering. Moreso, people are complex and multiple realities can be true at once. People who need therapy are not broken, they just need different support—in the form of therapy or psychology—to move forward, and oftentimes, therapy and coaching can operate as a partnership to support a client in their forward movement. I am not a therapist, but as a student of coaching, I seek in this paper to uncover the ways that students and instructors cause unintentional harm in how they talk about therapy, and to offer alternative ways for coaching students to think about and understand therapy as it relates to their coaching practice.
Stigma About Mental Illness Dissuades People From Seeking Care
In the United States, and in consumer culture more broadly, the term broken implies something to be discarded. When we affix terms like “broken” or speak about mental health conditions from a place of fear, we are othering, someone, to the point of no return—to the trash heaps of society. This is dangerous. According to the National Alliance on Mental Illness, 21% of U.S. adults experienced a mental health condition in 2020, but less than half sought out treatment. The impacts of not receiving care and treatment for mental health conditions are significant. There is a 40% higher rate of developing the cardiovascular disease for people with depression and high school students are twice as likely to drop out. This has a cascading effect beyond the individual, with 8.4 million Americans spending an average of 32 hours/week providing unpaid care for loved ones, and 70% of youth in juvenile criminal facilities facing mental health conditions. Tragically, suicide is the second leading cause of death for young people aged 10 to 34.
People face many barriers and obstacles when seeking care. For many, the costs of mental health care are simply too high. Over a quarter of respondents in a 2021 healthcare survey reported being concerned with the affordability of healthcare in case of sickness.Often, someone can’t get care simply because there aren’t enough providers, or their insurance company won’t pay for it—even if they have already been diagnosed and simply need a prescription refilled. Among rural Americans, 25+ million live in a designated Mental Health Professional Shortage area where there are not enough providers to meet the need. Even in the state of California, with the world’s fifth largest economy, the CSU Center to Close the Opportunity Gap and American Civil Liberties Union California Action (ACLU) reported in a 2022 report that, “Decades of underinvestment have contributed to California schools having only one social worker for every 6,000+ students and having the third highest ratio of students-to-school counselors in the nation.”
Perhaps the most complicated of all barriers to mental health care comes in the form of stigma. “[Authors] Link and Phelan (2001) defined stigma with four components distinguishing it from other social phenomena: (a) It is fundamentally a label of an out-group; (b) the labeled differences are negative; (c) the differences separate “us” from “them”; and (d) label and separation lead to status loss and discrimination.”Stigma can operate on an individual basis where people self-stigmatize, on a network or community basis in which friends, family, colleagues, or their coach can enforce negative othering and discrimination, and on a structural basis, such as the failures of the insurance industry to provide adequate treatment coverage or schools to provide enough providers.
Most People Are Impacted by Mental Health Issues
Despite these dire statistics, mental health issues touch nearly everyone in the United States. With 1 in 5 Americans experiencing a mental health condition, it is a high probability that nearly everyone is directly impacted or directly connected to someone with a mental health condition. The global COVID-19 pandemic also dramatically increased mental health issues. Many people had adverse reactions to the loss of social networks, fear of a deadly virus, family separation, loss of income, isolation, an increase in access to guns and subsequent violence, political turmoil, or the psychological symptoms resulting from suffering long-COVID. Depression and anxiety, already the leading mental health conditions in America, have increased and educational leaders are calling out an epidemic of youth suicide. The social and economic upheaval have been so significant, that it is hard not to imagine how people could develop anxiety disorders, adjustment disorders, panic attacks, depression, or turn to unhealthy coping mechanisms such as alcohol use disorder or disordered eating. All of these—whether they are acute or long-term—are listed in the DSM-5, which is used by mental health professionals to diagnose a mental health condition eligible for treatment.
It is likely that as coaches we will work with clients who would benefit from therapy. The International Coach Federation Code of Ethics calls coaches to, “Remain alert to indications that there might be a shift in the value received from the coaching relationship. If so, make a change in the relationship or encourage the Client(s)/Sponsor(s) to seek another coach, seek another professional or use a different resource.” This would apply to people who may need professional mental health care, and it is critical that as coaches we get right the conversation about therapy. It is understandable that many coaching students come into this new practice with a concern about how therapy and coaching might overlap, and a fear that if they do not adequately recognize when therapy is needed, they could cause harm to the client. After all, the session, “What is Coaching” is offered by ICA as the first session in the Foundations series. This duty of care is important, and coaches should continue to pay close attention to the boundaries and limitations of the coaching practice. Additionally, as coaches, we also have a duty of care to invest in our own learning, uncovering bias, and the ability to thoughtfully raise and talk about therapy without contributing to stigmatization.
Facilitating the Coaches’ Growth to Facilitate Client Growth
As coaches, one of our primary goals and markers of success is the facilitating of client growth. The coaching mindset requires that facilitating client growth first starts with facilitating our own growth. Coaches wanting to thoughtfully raise questions about therapy can take three steps:
Assess Your Own Mindset
Do you consider people who want or need therapy to be broken? Even if you do not use that language outwardly, it is possible for your inward mindset to come out in how you address clients. It is important that emerging coaches and coaching students understand all the different tools available to support clients, including therapy. Take the time to assess your own mindset and bias when it comes to mental health conditions. Notice the type of person you imagine when you think about someone with a mental health condition. Notice the feelings that come up. If feelings that come up are fearful or judgmental, coaches have a responsibility to address the ways in which we may be othering clients. NAMI has an In Our Own Voice program in which people living with mental health conditions share their powerful stories. With over 600 local affiliates across the United States, these programs can be easily accessed. Or a quick google search will turn up similar opportunities in other communities or online. You could even try therapy for yourself to understand more about how therapy works and who it serves.
De-stigmatize Your Coaching Agreement
Choosing to de-stigmatize the coaching agreement, website, and other ways that you represent yourself can immediately build a safe space for someone to explore with you as a coach whether or not coaching is the right tool for them, or if they need therapy. Imagine a person who has been struggling to move forward or feeling overwhelmed seeking out a coach, and finding a website that talks positively about the value of therapy while explaining how it is different from coaching, or a coaching agreement that uses affirmative language to explain the scenarios in which you would suggest a different professional, such as “I am not trained to treat mental health conditions, which impact 1 in 5 Americans. If you are unsure whether you need therapy or coaching, we will discuss your needs and goals and I can partner with you as you make that decision.” Now imagine that same person encountering language such as, “I am not a therapist and will refer you out if I notice mental illness.” How we talk matters. In the first scenario, the website or coaching agreement acknowledges the prevalence of mental illness and offers partnership, the second is rejecting in tone. De-stigmatizing is not only about not stigmatizing, but also about mindfully and intentionally choosing to show affirmation, love, and non-judgment in how you explain your limitations.
Focus on the Problem, Not the Person
As coaches, we have been trained that we will come up against moments where we can no longer help a client, where they are truly stuck. This could very well be where a therapist comes in. While we coach the person, suggestions about therapy and mental health conditions must focus on the problem. Start with curiosity. Ask the client how they are feeling about your coaching around a problem, ask “How can I best show up for you with this?” Be specific in naming the words the client has used that make you think they may be dealing with a mental health challenge. Are they focused on past trauma, using words like depressed or anxious? Name what they have shared and ask what they think may be at the root of that. Build trust and believe your client when they articulate how you are helping to them; and, know that fighting self-stigma to accept that therapy may be needed could take time for some clients. And of course, stay true to coaching ethics and be clear when you feel unequipped to support a client and need to end the relationship.
People who need therapy are not broken. In fact, you probably know many people who are in therapy or could benefit from therapy. Facing many barriers, people who seek out therapy ought to be seen as heroic, and the choice celebrated. By taking a mindful and self-aware approach to the question of therapy and mental health conditions, coaches can support clients as they decide to seek out their own care. Therapy and coaching can also work in tandem for clients, with the former helping them to uncover the past and understand a mental health condition and treatment options, while a coach helps them to look forward. Ultimately, many coaches entered the field out of a desire to support others in their growth and well-being, this noble desire ought to extend to those with mental health conditions, by demonstrating non-judgment and acceptance.
Amir Whitaker, C. L.-P. (2022). State of Student Mental Wellness California. California Association of School Counselors, CSU Center to Close the Opportunity Gap, and ACLU California Action.
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. PubMed, 37 - 70.
International Coach Federation. (2020, November 12). Retrieved from International Coach Federation
NAMI. (2022, June). Mental Health by the Numbers. Retrieved from National Alliance on Mental Illness
Nicholas C. Coombs, W. E. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. National Library of Medicine, Published Online.