People are weary. They’re burned out and stressed—from two years of a global pandemic plus a growing list of stressors like a contentious political climate, race-based and gun violence, extreme weather, rising inflation, a stumbling stock market, and war in Ukraine. Brazen behavior is on the rise and mental health statistics are sobering: According to the Kaiser Family Foundation, about 40 percent of US adults reported symptoms of anxiety or depression during the pandemic, up from roughly 10 percent pre-pandemic.
What’s more, we’re now learning that the COVID-19 virus itself may contribute to mental health problems: Survivors have a 35 percent higher risk of developing an anxiety disorder and 39 percent higher risk for depressive disorder in the year following infection. It’s clear that people need mental health support, and even the federal government is starting to heed the call: efforts to support the growing mental health care needs of Americans are increasingly making bipartisan headway.
But what does “support” mean? To most people, mental health care means therapy. It’s a tried and tested approach to improving mental health outcomes, with decades of research behind it. As a practicing, licensed, clinical therapist, I am obviously in support of therapy. As the leader of the clinical strategy and research team at a company that provides mental health benefits, we quickly and eagerly connect our members who have clinical-level mental health needs to licensed therapists who can help.
That will never change, but therapy simply cannot reach everyone who needs support. There is a dramatic shortage of licensed therapists in the US and beyond, and that problem is not solvable overnight. That shortage means new clients spend time on waiting lists, not getting care. Even those therapists who are accepting new patients are typically not in-network with health insurance companies, whose reimbursement rates are too low to make them viable for therapists to join. All these problems make therapy out of financial reach for most people—so we propose expanding the pool of providers who can support people in need.
The Role of Coaching
Coaching could be one possible alternative. Many people need support with their mental health but their symptoms don’t require clinical-level care. Certified coaches trained in evidence-based mental health approaches can help fill the gap.
Evidence shows that subclinical providers can be effective in treating depression and other mental health challenges. Some of the most respected concepts in clinical therapy—like cognitive behavior therapy and acceptance and commitment therapy—can be applied by paraprofessionals to great effect.
In contrast to the body of evidence supporting clinical therapy for better mental health, coaching is a newer modality with less research behind it—but that’s changing. Recent research—conducted by the company Modern Health, of which I am a VP—led by research scientist Dr. Sara Sagui-Henson, shows promising evidence in support of coaching.
In a peer-reviewed study just accepted for publication at the Journal of Technology in Behavioral Science, 58 percent of people who started care with symptoms of depression experienced clinical recovery after at least one session with a certified coach and saw a 76 percent increase in their well-being overall. These findings build upon our previous published research showing the more sessions people participated in, the more their well-being improved.
In that same study conducted during the pandemic, we looked at the therapeutic alliance, or the working relationship between the provider and the client in a one-on-one care setting. A client and provider’s therapeutic alliance includes qualities like trust and personal affection, whether the relationship is collaborative, and whether the two feel they are working on agreed-upon goals.
Prior research suggests that a strong therapeutic alliance yields better outcomes in therapy. But the field has little insight into whether the therapeutic alliance would be as strong, or as important a predictor of positive outcomes in coaching as it would be in therapy. This research found that in a one-on-one virtual care setting, therapeutic alliance was just as strong between clients and their coaches as it was between clients and their therapists (with an average 4.8 therapeutic alliance rating out of 5 for both coaching and therapy) ). Ninety percent of participants were confident in their coach or therapist’s ability to help them and work on agreed-upon goals, and in both cases, a stronger therapeutic alliance predicted greater improvement in well-being.
This may be good news for the entire field, and suggests that mental health coaching could be a viable alternative to therapy for moderate mental health needs. When trained and vetted, coaches can provide similar-quality care that improves mental health outcomes while simultaneously being more affordable in many cases.
It could also be easier for the field to increase the supply of coaches (versus therapists, whose credentials require years of training). And it may be more feasible for coaches to focus on early intervention by preventing clinical-level symptoms from developing, leaving therapists to treat those with more severe symptoms. Coaching is also appealing when considering individual care preferences; not everyone wants to see a therapist, even if one is available. Coaching can be a less stigmatized form of care.
Of course, coaching is not a panacea, and in this field we have our work cut out for us: We need to address institutional and personal stigma, an ongoing problem that presents a meaningful barrier to care for many people. We need to work to increase diversity within provider networks and to ensure individuals receive culturally centered care. We must improve access to care within communities not typically served and continue to ideate on how to bring effective, sustainably priced mental health care to more people.
In addition to digital tools like meditations and courses and alternative modalities like online group care sessions, plus clinical therapy, psychiatry, and medication management for those who need it, I argue that coaching by vetted, certified providers is a great—and increasingly, research -backed—way to serve people with moderate mental health care needs.