Can Coaches Work With Clients Suffering With Depression?
There was a question posed on Quora the other day by somebody suffering from mild depression.
She wanted to know whether she would be best served by visiting a psychotherapist or hiring a Life Coach.
The answers were highly predictable and in many cases highly wrong as people were lining up to ridicule the thought of hiring a coach.
There is way too much political correctness and ignorance when it comes the topic of depression and coaching.
I think it’s largely a product of coaches (quite sensibly) not wanting to be step over the mental health line and end up on the wrong end of a law suit.
And also people who have no clue what coaches do and the efficacy of coaching loving to offer an opinion.
Let’s look at what you shouldn’t do with a client:
- You should never diagnose depression or any other mental illness, unless that is, you’re also qualified to do so
- You should never take on a client who has unmanaged depression
- And you should not under any circumstances suggest a client stop or even wean off any medication
However, there is absolutely nothing wrong with working with people who are suffering from mild to moderate depression under the right circumstances.
I have done it scores of times and had some great results.
I once had a woman come to me who had been in therapy for over twenty years.
I asked her when she decided it wasn’t working, when her therapist invited her round to his new house she’d paid for?
Fortunately she saw the funny side of things and we made more traction in two months than she had in 20 years.
Is it because I’m a genius?
Absolutely not. It was because she responded more positively to a completely different modality.
Therapy can be very useful for a great many people, but it’s not always the answer, and we shouldn’t be afraid to say that out loud.
Even though I said you cannot diagnose depression, you can be on the look out for warning signs that it may be present.
If you sense something isn’t quite right because a prospect may say something like they feel helpless or that life holds little interest anymore, then don’t dick around, ask the following question outright:
Do you think it’s possible you could be suffering from depression?
If they say ‘yes’, then you follow up by asking:
Are you currently under medical supervision?
If they say ‘no’ that definitely is a reason to bail, at least temporarily.
Politely and firmly suggest they get checked out by their PCP to make sure that coaching is right for them and add that if their doctor is comfortable with the arrangement then you’d be delighted to work with them.
On the other hand, if they say they are working with a therapist or that their condition is being well managed with drugs and/or therapy, then you may be good to go after you have done one more thing.
If the client is working with a therapist you should always insist they ask her if it’s ok to hire you to coach them prior to starting the coaching process.
There are two reasons for doing this.
Firstly, it’s a matter of professional courtesy.
But secondly, and more importantly, if the client isn’t responding to help or the situation is worse than they are suggesting the therapist then has the ability to request their patient just focus on working with them for the time being.
And you must do this in writing. Send a follow up email to the prospective client so you can document that you did your due diligence.
In twelve years of coaching I cannot remember a client come back to me and say they were told not to hire me by their therapist.
In fact I have had a great many referrals from therapists who think coaching would be advantageous. Only last month a client hired me in Australia after her therapist had found my website and recommended me.
However, I suspect some clients didn’t bother asking which is why I put it in writing.
Until we know to the contrary we have to trust our clients. If we don’t, then we shouldn’t be working with them.
What If The Consult Goes Smoothly?
I have had consults that went really well and I had no inkling the client had any mental health issues when I agreed to work with them.
That is why on my intake form I ask two questions.
- Are you currently under the care of a medical doctor or mental health practitioner for specific non-routine issues? If yes, please give more details.*
- Are you taking any prescribed medication and if so, please list and explain what condition they have been prescribed for?
The answer to these two questions tells me a lot. I have had clients say they weren’t under medical care, but then listed a drug or drugs that I know are used in treating mental health issues.
I will ALWAYS challenge this and require clarification.
I must stress, I am not diagnosing or assuming anything I’m just trying to get a clearer look at the big picture.
Almost a quarter of drugs that are prescribed are ‘off-label’ which means they exhibit beneficial side effects for some people above and beyond those that they were clinically tested for.
For example, the SSRI Prozac (fluoxetine) can be successful for use in managing the pain of fibromyalgia.
The anti-psychotic Seroquel can be given in very low doses for the treatment of insomnia.
And the SNRI Cymbalta (duloxetine) had been proven effective in dealing with migraines with some people.
If in doubt ask and keep asking until you are sure.
*Note: As per the consult, if they say yes on the intake to being under medical supervision then you must insist they get the all clear from their therapist or doctor.
When I Didn’t Spot Clients Suffering With Depression
There have been three occasions where I didn’t pick up anything awry on the consult or during the first session when there were issues.
Two of those occasions came like a bolt from the blue and both involved the client bursting into uncontrollable crying leaving me wondering what the hell had just gone wrong?
And by the way, crying in and of itself is not an issue. I’ve had at least a score or more clients in tears (no jokes please) and there can be any number of reasons, many of which can be good.
If you want to understand how to deal with a crying client, check out this post.
A long awaited breakthrough can induce tears as can a revelation that they are in the wrong job, so don’t assume (there’s that word again) it’s necessarily a case for concern.
With these two ladies it definitely was a bad thing though and I had to gently end the coaching relationship there and then.
This may sound harsh, but it’s for their benefit.
It’s too easy to think we should push on through and help them as best we can. No! We help them the best by urging them to seek medical support.
You maybe wondering what happened with the third client. Well he’d forgotten to inform me he that he’d stopped taking his bi-polar medication.
I found out the hard way when he called me and went ballistic down the phone at me for charging him for a session he failed to attend.
We parted company immediately after he spent five minutes hurling abusive language down the phone at me.
I’d love to get your thoughts on this topic in the comments below. Do you agree with me or disagree and what are your reasons?