TIFT #91: Psychotherapy Coaching: A Novel Approach to Therapist Support

Most therapists wish they had an expert colleague with whom to discuss problem cases and puzzling situations, but few actually access such a resource. Mostly, we muddle through or talk to peers but wish we had a more definitive source of knowledge and stronger support. This post describes an innovative approach to giving therapists the ongoing help they need.

Current solutions in wide use include the following:

1.  Supervision: In this traditional format, oversight by a more senior therapist is part of most comprehensive training, though, sadly, the psychiatric accreditation body has removed this requirement. Nevertheless, most training programs, do provide individual supervision. The advantage of this approach is that the supervisor is often, though not always, a respected teacher in the program and relatively accessible. A potential problem is that available supervisors may be limited. Often older psychotherapists are knowledgable in one orientation or modality, while students may be learning and practicing other forms of therapy. Another broadly relevant issue is funding. Supervisors may give their time gratis, but otherwise may tax budgets for time and insurance. For post-graduate therapists, supervision may be required for further licensing. In those instances, the cost of the supervision is usually born by the supervisee as part of the cost of licensure. Without professional incentives, the cost of paid supervision can be a deterrent to continuation of this support modality.

2.  Mentoring: This form of support usually goes beyond clinical issues and is typically less frequent. Mentors often donate their time, but may be harder to find, especially one with a good fit to the trainee's style and needs. Personal acquaintance is often the key to finding a comfortable mentor. As a paid form of support, mentoring may put stress on the budget of an early career therapist.

3.  Peer supervision:  Groups of therapists often band together to discuss cases and offer advice to each other. In a clinic setting, this can be a required activity with a more experienced supervisor attending the group, but supervisor time constraints often limit the depth of help. Potential problems include the level of expertise and the amount of time given to individual cases.

4. Ad hoc, "hallway" consultation:A final modality is as-needed contact with a respected peer or colleague to discuss a specific problem or situation. This is perhaps the most used last resort, and may be satisfactory for a specific case. The disadvantage is that offering advice does incur a degree of medical responsibility and colleagues may be reluctant to get deeply enough into the details to the point of having liability for the outcome.

Psychotherapy Coaching, a novel approach:

The model described here is one that combines expert knowledge, peer discussion, and continuing education in the form of coaching rather than supervision. Howtherapyworks.com has developed an online support program with three key elements:

Expert coaching sessions: Group discussion is led twice a month by the program director, addressing questions and issues pre-submitted for each session. Coaching is different from supervision in that it gives participants nondirective exposure to expert thinking about principles and options, leaving the therapist free to choose a course of action. The format emphasizes knowledge of choices and ways to analyze a situation, rather than specific answers for the individual case.

Private discussion and support forum: The program includes membership in a private online discussion forum. Members can post issues and questions at any time and receive input and support from other members. The forum is monitored by the director to ensure safety, to offer help, and to identify topics for discussion in the group coaching.

Included online course and content: Because this support modality is nondenominational, meaning not aligned with any one therapy or orientation, the program includes a 10 hour, self-paced online course to help participants become familiar with and make clinical use of the common infrastructure underlying therapeutic action. In addition, the group receives access to exclusive video content on topics suggested in the forum and coaching sessions.

Advantages of this model are:

• Access to director’s expertise.

• The ability to bond with like-minded peers for mutual support.

• Live online coaching meetings focused on pre-submitted member questions. 

• Continuing education based on a nondenominational approach embracing techniques form diverse therapies and welcoming participants from wide ranging backgrounds.

• A growing library of exclusive video content on relevant topics.

•  Online access making support available regardless of geography.

• Monthly membership cost below other paid options.

Further information about this implementation see below. 

Jeffery Smith MD