Episode 107: Therapy Vs. Coaching: How to Expand Your Services Ethically [featuring Carly Hill]

Show Notes

Ever wonder what the difference is between therapy and coaching? And if you are a therapist who wants to expand your services with coaching, do you have any clue what to do, where to start, and how to protect yourself legally?

In this episode of the All Things Private Practice Podcast, I talk with Carly Hill, LCSW and business coach for therapists who want to add coaching to their businesses. We discuss an important topic for therapists looking to add coaching to their practice: How to do it ethically and protect yourself, your business, and your clients.

Here are three key takeaways from the episode:

1. Don't just slap coaching onto your private practice: It's crucial to separate your therapy and coaching services into distinct business entities. This not only avoids ethical dilemmas but also ensures that you comply with licensing regulations and accounting practices.
2. Understand the difference between therapy and coaching: While some definitions focus on past vs. future-oriented approaches, the simpler distinction lies in medical necessity. Therapy addresses clinical and mental health issues, while coaching tackles situational and nonclinical problems.
3. Coaching certification is not required, but competence is essential: As a therapist, you already possess a wealth of clinical knowledge and experience. It's up to you to determine if you feel confident delivering coaching services in a specific area. While certification can boost confidence, it's not a prerequisite for calling yourself a coach.

Listen to the full episode to learn more about the ethical considerations of incorporating coaching into your private practice. And remember, protecting your license and serving your clients with integrity should always be top priorities.

More about Carly:

Carly Hill is an LCSW and business strategist for clinicians. She specializes in helping overworked and underpaid female clinicians make more money and more impact by teaching them to build the online coaching business of their dreams.

She helps clinicians break free out of the 1:1 model to leverage their time, get paid for their knowledge, and live a life of true freedom. She helps clinicians to find their coaching niche, develop their high ticket offer, and organically call in their ideal clients easily and effortlessly using her unique modern marketing masterplan.

Carly's Website: carlyhillcoaching.com

Carly's Facebook Group: facebook.com/groups/carlyhillcoaching

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A Thanks to Our Sponsors: The Receptionist for iPad, Alma, & Therapy Notes!

✨ The Receptionist for iPad:

I would also like to thank The Receptionist for iPad for sponsoring this episode.

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What's more, The Receptionist offers an iPad list check-in option where clients can scan a QR code to check in, which negates the need for you to buy an iPad and stand. Go to thereceptionist.com/privatepractice and sign up for a free 14-day trial. When you do, you'll get your first month free. And don't forget to ask about our iPad list check-in option.

✨ Alma

I would also like to thank Alma for sponsoring this episode.

Alma makes it easy and financially rewarding to accept insurance. When you join their insurance program, you can get credentialed within 45 days and access enhanced reimbursement rates with major payers. They also handle all of your paperwork from eligibility checks to claim submissions, and they guarantee payment within two weeks of each appointment. You can also attract clients who are the right fit for your practice with a free profile in Alma's searchable directory. Additionally, Alma offers time-saving tools and administrative support, so you can spend less time on paperwork and more time delivering great care to your clients.

Get your first month free with Alma by visiting helloalma.com/ATPP.

✨ Therapy Notes

I would also like to thank Therapy Notes for sponsoring this episode.

TherapyNotes™ is a complete practice management system with everything you need to manage patient records, schedule appointments, meet with patients remotely, create rich documentation, and bill insurance, right at your fingertips. Their streamlined software is accessible wherever and whenever you need it. Go to therapynotes.com and get 2 free months when you use code ATPP.

Transcript

PATRICK CASALE: Hey, everyone, you're listening to another episode of the All Things Private Practice Podcast. I'm your host, Patrick Casale. I'm joined today by Carly Hill, who's an LCSW and a business coach for therapists who really specializes in helping therapists add coaching into their business. And it's an important topic because, you know, if you're in my Facebook group, All Things Private Practice or you've listened to my podcast, I know that a lot of therapists are, one, either leaving the profession because of a variety of reasons and two, looking to add coaching to expand their services. So, we want to talk about how to do it ethically, how to make sure that you're protecting yourself, your business, your clients, etc. So, Carly, thank you so much for coming on and having this conversation.

CARLY HILL: Yeah, thank you so much for having me. To your point, it's very important, right? We worked hard for our license, so we want to make sure that we're protecting it. Yeah, and I can speak to some of those points, and what that actually looks like, if that would be helpful for your listeners.

So, I would say the first thing, and we were kind of talking about this off air, is do not just slap coaching onto your private practice, right? It can't just be counseling and coaching and it all fall under the same business entity. And this is an easy mistake to make because nobody really teaches us this, right? And we just say we want to expand our services, and that just makes sense. And we see other people doing it too. But from a legal standpoint, we do not want to do this.

PATRICK CASALE: Yes. So, I want to get into the why, why we don't want to do this. But most importantly, I want to address something really quickly, which is something we see all the time where someone will say, I'm going to add coaching to my services, right? For a variety of reasons, I don't want to deal with the instate restrictions of licensure regulation, my clients leaving for the summer, I shouldn't have to refer them somewhere else, we already have a rapport, which I totally understand, makes sense. And ultimately, what we see is like, "Patrick Casale Therapy and Coaching." Or, "Patrick Casale Therapy, Coaching, and Consulting." And all of a sudden, it's all under one umbrella, one business entity. Can you talk a little bit about why that is murky? Why that really can get into some ethical dilemma and have some major ramifications?

CARLY HILL: Yeah, 100%. So, then a major reason is because, obviously, as therapists we're tied to our licensure state, the interjurisdictional model. And as coaches, you can see people nationwide, worldwide. It's an unregulated field. So, there's a beauty in that. But when you're taking in revenue nationwide, worldwide, into your practice, or your one LLC, your one business entity, that's going to be a red flag, that you're only licensed in that state, right?

And then even from an accounting standpoint, it's going to get confusing for you because your expenses are totally different for your private practice and your therapy business than it is for your coaching business. And so your CPA will not lend to you when you're bringing everything and it's all under one umbrella.

PATRICK CASALE: Yep, yep, it gets messy very quickly. And I think one thing that people don't really understand is the ethical ramifications of adding a coaching and consulting business to your existing entity, and just saying, "Well, I have different pages on my website, I have them labeled as coaching and therapy. Like, that should be clear enough." But it's not.

And the reason being is that your licensing board and our ethical code does not want a therapy client to ever potentially even confuse the two services, to opt in for coaching, and then ultimately feel like, "Oh, I thought this was therapy. I thought I was getting therapy from this person. And really, in reality, these are the things I received." That can be a very quick way for you to lose your license that you've worked so damn hard for.

CARLY HILL: Yeah, 100% I can't stress that enough because I think it's confusing for us clinicians to even understand the difference between therapy and coaching sometimes because there's so many nuances, so just imagine how confusing it can be for our clients. And that is always a rule of thumb, that we don't want them to be confused. And we really need to use our clinical discernment and knowledge to know if they're a fit for therapy, or if they're a fit for coaching because although the stigma has gotten better, I feel like sometimes clients want help under the umbrella of coaching when in reality, they need to be treated for medical necessity.

So, maybe if we just back up and just kind of talk about the easiest definition to understand if maybe people are wondering what really is the difference between therapy and coaching? Because there's so many overlaps.

PATRICK CASALE: For sure.

CARLY HILL: And I'm curious how you describe it because there's so many definitions that I don't agree with, right? Like therapy works on the past and coaching works on the future. It's like, well, you can do past, present, and future as both a therapist and a coach. So, I always like to view it as, are you treating them for medical necessity? Therapy. Or are you helping them with a more situational, non-clinical, less severe problem? Then it's coaching.

PATRICK CASALE: Yeah, I think it's good to break it down pretty simplistically like that. And I think you could even make the argument with that definition where it's like, well, solution-focused therapy is pretty like, quick strategic, action step-oriented, and to the point where the therapist is offering guidance and support and coaching more so than therapy. So, you really do have to think about it in terms of, is this something that requires documentation for medical necessity or mental health. Or is this something that we are strategically working on in terms of how we're moving through and operating and ensuring that we are straying away from the emotional side of things. And that doesn't mean you can't work on the emotional side of business ownership. But you really are trying to differentiate between medical necessity and strategic action-step conversation and action-oriented coaching because it can get so murky. And this is why you really have to have separation because if you don't, it's so easy for those lines to cross and for you to get into some pretty murky water.

CARLY HILL: Yeah, agreed. It's almost as if, like, when you're a coach, I mean, I teach my clients how to create a coaching curriculum, right? So, they're almost functioning as a teacher, in a way. It's those psycho-educational components to get clients from problem to solution, if you will. So, that's how you can kind of do it like you're creating your curriculum, you're teaching them things that if you were working with all of those same type of ideal clients, you would repeat often or maybe you already are, yeah.

PATRICK CASALE: Absolutely. A question that comes up and I don't know, you know, your thoughts on this is, if I want to become a coach do I have to become certified? And I know there are certification tracks and programs out there that are pretty reputable for coaching. But you also have the ability to just one day say, "Hey, I'm a private practice coach. Hey, I do this thing now." And that's also okay. So, can you speak on the differences there and your perspective on that?

CARLY HILL: Yeah, it's a great question. It does come up a ton. My firm opinion is you don't need a coaching certification. You can call yourself a coach right now. But from that ethical standpoint, obviously, we need to be in integrity with what we're offering. And if you don't feel competent in the curriculum that you're delivering, obviously, you should not call yourself a coach in that area, right?

So, typically, therapists have enough clinical knowledge, and experience, and certifications. I mean, we have certifications, like every letter of the alphabet, I always joke, right? So, typically, you have enough knowledge to call yourself a coach. Some people want to take coaching certifications because it makes them feel more confident or you're just a certification junkie, and we're lifelong learners. Like, I love taking certification.

But personally, I have a coaching certification and I can't say I learned much more than I already knew. If anything, it was just kind of like a self-reflection and a refresher. If you're going to take a coaching certification, I say take it within your niche. And definitely, an ICF certification.

PATRICK CASALE: Yeah, absolutely. And I think a lot of it feels for some people like just reputability because coaching gets a bad rap because you have like life coaches out there who are doing therapy with people who don't have therapy or clinical skill sets in place and can do a lot of damage. But we're really, you know, talking about when you're niching down for coaching, really getting a good understanding of like a good population that you can help on a pretty major level and on a wide scale. So, you mentioned the word global a couple of times, you can certainly work globally, you can certainly work throughout our entire country if you wanted to. So, there are lots of benefits of creating a coaching curriculum, creating a coaching business, expanding into coaching.

And it really does open up opportunities that working within your licensure jurisdiction does not because licensure is quite limiting. And I am for one, a human in the profession who believes that a lot of it is bullshit. Like, if my client who I have five years of rapport with is going away on vacation for a month and needs support, the ethical guidelines then get really murky then because it's like, now should I find a therapist in California who works with this person for a month? They have to re-establish rapport, they may not take their insurance, all the things. It gets so messy.

But ultimately, if you're thinking about adding coaching to your business, I think the main takeaway here is to separate it and to make a different LLC or a different business entity, different business bank account, different EIN, different website, different marketing, everything should be separate. That really has to be the takeaway here because it's so easy to just say, "Well, so and so has coaching on their website. So, like, I'm going to do it too."

And I think everyone feels like it's okay until it's not okay, until something happens and there's a licensure complaint, and then all of a sudden you're scrambling to provide like evidence and documentation to showcase like, "This was clearly therapy, this was clearly coaching. I wasn't like, muddying the waters at all."

CARLY HILL: Right, yeah. And to your point, it can seem daunting maybe to have separate everything and it seems like a ton of work. But it's worth it. It's not that hard. And it gives you the peace of mind that you're doing it the right way.

PATRICK CASALE: Yeah.

CARLY HILL: Yeah. And also to your point, a lot of that is BS. And we understand why the regulations are there, but they're archaic. Most of them were developed in the 1950s. I don't think the board is up to date with the revolution of the internet. Everything changed when the pandemic hit in the telehealth, right? So, people are expanding. And we got into the helping field to impact more lives, to transform people's lives. And I think coaching is such a beautiful way to reach more people. And it's a win-win because you can make more money, you can outgrow the office if you feel capped on your income, you can get creative, and it can be an extension of you, yeah.

PATRICK CASALE: And the possibilities are quite limitless. And you know, you can get really creative in what you want to do. And like the [PH 00:15:18] ports are archaic. Like, if I'm doing telehealth therapy with someone in North Carolina, who lives eight hours away on the other side of the state what difference does it make if that person is also on their computer in New Mexico talking to me. It doesn't make a difference. But because of these regulations, we are seeing a lot of therapists leave the profession because of the high level of burnout, we're seeing a lot of therapists leave the profession. And it's sad to me. And I think it's avoidable if you can diversify your income and take the pressure off of having to do 60-minute increments of your time over and over and over again. And then you feel like the walls are kind of closing in a bit.

CARLY HILL: Amen. Yeah, leveraging your time working smarter, not harder. You know, again, like we have certifications, every letter of the alphabet. We went to school for how many years, right? We spent so many hours studying? Years. So, I firmly believe therapists should be running the coaching industry because you mentioned it earlier, it can be a little sketchy, sometimes, the coaches that are out there, right?

So, another thing I was just thinking of in terms of protecting your license is making sure you hit it on its head with separate, separate, separate, separate, keep coaching clients, coaching clients, and therapy clients, therapy clients. You can't take a therapy client to a coaching client or a coaching client to a therapy client, right? You got to stay in your lane.

PATRICK CASALE: That's a great point. And that's where boundaries can really get crossed, that's where clients can get really confused. And I think it's really important to try really hard to stick to that model because it is very easy to do.

And another thing I see people do is like, put everybody in an EMR. Like, oh, I'm going to put everyone in SimplePractice. Or if I don't have a medical record system, I'm just going to use Acuity or Calendly for both therapy and coaching clients. I really don't recommend that. Like, for coaching clients use Calendly, like use Acuity, use a scheduling service like that. But for your therapy clients use a HIPAA-compliant medical record software, protect health information, or coaching clients. But that's not a necessity, it's still best practice, but it's not the same thing.

So again, it's just differentiation in terms of how you separate your businesses. And I know how easy it is to just say I want to have everything in one place, one email address, one everything. But again, that's not treating the business as separate entities. You really want to ensure that things are as separate as can be. So, it can feel really black and white and it can feel really easy to just kind of defer to saying coaching clients go here, therapy clients go here, this is my website for coaching, this is my website for therapy, and everything is separate. And that is really the best practice, ensuring that you are protecting your license, you're protecting your clients, and you're protecting all the hard work that you've put in.

CARLY HILL: Yeah, and again, it's not as daunting as it seems. It's not an excuse to not start your coaching business because oh my gosh, you're going to have two of everything, right? We don't have to overcomplicate it, and we can figure it out, and it's okay.

Another piece is the coaching contract. So, when we think of paperwork, right, you're not obviously doing treatment plans, and everything that you would do, progress notes in your therapy sessions. But it's very, very important to have an attorney-approved coaching contract that is still abiding by your ethics. So, we're still mandated reporters, informed consent is so important, we still have to have professional liability insurance. And all of that needs to be indicated on our contract.

PATRICK CASALE: Yep. And your contract, and your terms and conditions, and your rates, and your refund policies, those are things that you should have really clearly defined and laid out in these documents because that's what you're going to defer to if you charge someone and they're, "Okay, I want my money back, this program wasn't worth it. Hey, I want my money back. I don't enjoy working with you." You really have to protect yourself. And you have to lay it out really clearly what your policies and procedures are, just like you would in therapy.

So, it can feel daunting to recreate some of this stuff, but ultimately, it's really not that much work. And it takes up a hell of a lot less energy when you know, like, hey, I have a coaching program and I sold 10 spots, and I work half of the time, and I make four to five times more money than I was making doing therapy one-on-one.

So, there are so many ways to leverage your skills as a mental health professional, that are so applicable in so many different arenas, and allow you to really grow. Like my business has taken me to places I've never thought it would, not just in terms of revenue, but in terms of podcasts, and speaking at conferences, and hosting retreats, and doing coaching programs, and all of these things, having sponsorships in place. Like, that can't happen with my therapy practice.

So, ultimately, I really do think it's important to start thinking about what you can offer, who your niche is, who you want to be supporting, and coaching, and really have that differentiation when it starts to come to like, "Hey, here are all the ideas I have." Curriculum, you could do workbooks, you can do, you know, all sorts of things that you can start generating revenue on pretty quickly.

CARLY HILL: Yeah, you said that so well. Honestly, I couldn't have said it better myself. And I think we encourage our clients to think outside of the box. And we should be taking that same advice, right? And thinking outside of the box, like, we're not just therapists. We can be speakers, we can be authors, we can be course creators, we could be podcast hosts, we could be all the things, and it's just with such pure intention to impact more lives, and again, leverage our freedom, and have flexibility, and have security, and pay back your student loans or save for your retirement, and get out of this place of burnout, and trading dollars for hours, and being tied to maybe some of the old conditioning and boxes that we feel like we've been put in.

PATRICK CASALE: Yep, I think that the era of psychotherapy, and mental health, and just what we can do is changing and the perspective of what we can do and our limitations is changing. So, it's really useful to start having these types of conversations. And I hope all of you who are listening, if you take anything away, the main takeaways, again, separation, really getting clear on your niche, really getting clear on who's a therapy client versus who's a coaching client, and then start just thinking about all of the ways that your coaching program can impact people because coaching can have a ripple effect that you don't necessarily get to have in therapy. You can have an effect on people throughout the world. And it's really incredible once you start to think about it that way. It can be a bit daunting, but it's also really empowering. So, really good stuff today, Carly. I appreciate it. Any takeaways before we kind of check out and sign off?

CARLY HILL: No, I think this was well said. And if anything, it just piques somebody's antenna in having this healthy conversation and letting clinicians know that there's other options out there for you

PATRICK CASALE: I like that. There are definitely other options out there for you. I say this all the time. You know, like when I left grad school and went in community mental health, I thought that was the finish line, then I thought private practice was the finish line. And then now with everything I've got going on, I don't really know where that line is anymore. But I just know that there are so many possibilities out there. And you can't see the forest for the trees sometimes because you just don't know that it exists.

So, really start thinking outside of the box and getting creative. You all have the skill sets in order to do so, whether or not you want to go into coaching or not, there's still lots of ways to have an impact as a mental health professional and entrepreneur.

Carly, any place where people can find you? Any links that you have or things that you want to share with the audience?

CARLY HILL: Yeah, absolutely. So, carlyhillcoaching.com. I'm on Instagram, @carlyhillcoaching. I would say that the most beneficial place for therapists to hang out would be my Facebook group. It's called Therapist to Coach Accelerator, tons, and tons, and tons of free resources in there. So, if they just want to continue learning about more details, how you can protect your license trainings from attorneys, maybe figuring out their niche, they can find that inside the Therapist to Coach Accelerator Facebook group.

PATRICK CASALE: Cool. We will have all of that information in the show notes so that you have easy access to all of Carly's information so that you can check it out for yourselves. Carly, thanks so much for coming on and making the time.

CARLY HILL: Thank you.

PATRICK CASALE: To everyone listening to the All Things Private Practice Podcast, new episodes are out on every single Saturday on all major platforms and YouTube. Like, download, subscribe, and share. Doubt yourself, do it anyway. See you next week.