Therapy or coaching? For a growing number of trained clinicians, the answer is both.
getty
The coaching industry is booming. According to the International Coaching Federation’s 2025 Global Coaching Study, there are now nearly 123,000 coach practitioners worldwide—a fifty-four percent increase since 2019—generating $5.34 billion in annual revenue. And a growing number of them have something in common: they’re clinically trained therapists.
Across the country, therapists are quietly—and sometimes not so quietly—rebranding as coaches. They’re leaving insurance networks, ditching the DSM (the manual used to diagnose mental health conditions), and building businesses that let them charge what they want, work with whoever they want, and help people without the constraints or stigma of the medical model.
Not everyone in the therapy world is thrilled about it: critics call it a dangerous erosion of professional standards. But as someone who’s spent two decades in the mental health field, I can’t help but ask: when we police therapists for stepping outside the traditional model, are we protecting clients, or are we protecting an identity?
The Exodus
The reasons therapists are leaving traditional practice aren’t mysterious. More than half report experiencing burnout, according to a SimplePractice survey, and nearly a third of those who burned out have considered leaving the profession entirely. Insurance reimbursement rates remain stubbornly low—the average insurance reimbursement for individual therapy is thirty-six percent less than private pay rates, according to Heard’s 2025 Financial State of Private Practice Report, with therapists averaging $111 per session from insurance versus $159 from private-pay clients. And Medicare’s 2025 Physician Fee Schedule actually cut the conversion factor by about 2.83 percent, while medical services increased.
Most therapists I know, myself included, didn’t go into this field thinking about personal branding or revenue models. We went into it because we wanted to help people, and we assumed the system would figure out the rest. It didn’t. The model we were trained for—see clients one-on-one, bill insurance, repeat—has left a lot of us underpaid, overextended, and wondering why we need a caseload of twenty-five just to make a living with a master’s degree. For many of us, coaching is a way to keep doing the work without the system that was making it unsustainable.
Carly Hill lived that reality. A licensed clinical social worker and author of Therapreneur, Hill spent the early years of her career in community mental health—driving across the county and doing sessions in schools, homes, and parking lots for about thirty dollars an hour.
“Years into my career, I still wasn’t making $50,000 annually,” Hill told me. “And I started to realize that no matter how hard I worked, the model itself had limitations.” Hill eventually built a coaching business and now helps hundreds of other clinicians make the same transition through her program The Coach Intensive™. She’s part of a growing wave of what she calls “therapreneurs”: clinicians who are taking their training out of the therapy room and into a different kind of container entirely.
Carly Hill, LCSW, has helped hundreds of therapists make the leap to coaching.
Jamie Kalidova
But the financial frustration, Hill says, is just the surface.
“Most of the clinicians I work with are experiencing a combination of burnout, lack of autonomy, and a desire for scalability,” she told me. “There’s also a realization that happens for many of them: they’ve been coaching all along. They notice that some of their favorite work with clients—helping with confidence, relationships, decision-making, identity—is often non-clinical in nature.”
The Line Nobody Can Draw
If you Google “the difference between therapy and coaching,” you’ll find a tidy distinction that sounds reassuring: therapy addresses the past; coaching addresses the future. Therapy treats mental illness; coaching facilitates personal growth.
The problem is that almost nobody who’s actually done both thinks that distinction holds up.
“It’s a helpful soundbite, but it’s also one of the biggest sources of confusion,” Hill said. “Both can involve exploring the past, understanding patterns, regulating emotions, and creating change. So the idea that therapy is ‘past-focused’ and coaching is ‘future-focused’ doesn’t really hold up in practice.”
And then there’s the modality question, which makes things even messier. Many of the tools clinicians are trained in—Internal Family Systems, somatic work, cognitive behavioral therapy— aren’t legally restricted to licensed practitioners. None of them requires a therapy license. Breathwork facilitators do nervous system work all day long , most of them with zero clinical credentials. The idea that a trained clinician would be in trouble for using these same tools outside of a licensed therapy context, when unlicensed people use them freely, is hard to make sense of.
Hill draws the line at medical necessity: “Therapy is treating medical necessity. Coaching is not. Are you diagnosing? Are you treating a DSM condition? If the answer is no, you’re coaching—regardless of what tools you’re using.”
It’s a useful framework. But plenty of clients exist in a gray zone—not diagnosable, but not exactly “just looking for personal growth” either. And the regulatory landscape hasn’t caught up to that complexity.
The Risk Worth Worrying About
The criticism of therapists becoming coaches has always struck me as misdirected. I get the impulse to protect the profession, but we’re guarding it from the wrong people. The coaching industry itself is essentially unregulated. Anyone can call themselves a coach tomorrow—no degree, no supervised hours, no licensing board, no ethical code with teeth. The ICF offers voluntary credentialing, but there’s no legal requirement to hold it. The barrier to entry is, functionally, a website and a Calendly link.
Which means a licensed clinical social worker with a decade of clinical experience, training in ethics and boundaries, and the ability to recognize a client in crisis gets lumped into the same category as someone who completed a weekend online certification.
To be clear—there are excellent coaches without clinical backgrounds doing rigorous, ethical work. The problem isn’t the absence of a therapy license. It’s the absence of any standard at all. Hill put it bluntly: “There are what I call ‘champs and chumps’ in every industry. There are coaches who probably shouldn’t be coaching. And if we’re being honest, there are also therapists who probably shouldn’t be practicing.”
She also points out that clinicians bring something to coaching that can’t be replicated with a certification: “They’ve spent years studying human behavior. They’ve been trained in ethics, boundaries, and risk assessment. They know how to hold space for complexity. They understand when something is outside their scope and requires referral.”
Meanwhile, consumers have no way to tell the difference between someone with real expertise and someone who hung a shingle last week with no training behind it.
What Therapists Should Know
For clinicians considering the move, Hill emphasizes that—whether or not the distinction makes clinical sense—the current regulatory landscape still requires you to navigate it carefully. “Even when operating in a coaching capacity, a licensed clinician is still held to their ethical standards,” she said. She recommends clear informed consent, separate business entities, and a referral network. Not because the line between therapy and coaching is always clinically meaningful, but because licensing boards and liability law haven’t caught up to the reality of how clinician-coaches actually work.
Her take is that clinicians entering coaching already understand the ethical stakes—and should carry that with them.
What Consumers Should Know
If you’re hiring a coach, the most important thing isn’t the title; it’s the fit. Hill recommends asking what a coach is trained in, what their scope of practice looks like, how they handle situations outside their scope, and whether they have a referral network if something clinical surfaces.
Therapy is appropriate when there’s a diagnosable condition, significant distress, or impairment. Coaching is appropriate when someone is generally functioning but wants support with goals, decisions, or growth. In practice, there’s enormous overlap—behavioral change, emotional regulation, relationship patterns—which is exactly why the distinction is so hard to draw. A clinician-turned-coach can often bridge both worlds, but they should be transparent about which hat they’re wearing.
Bridging The Divide
At the end of the day, therapists and coaches are trying to do the same thing: help people navigate being human. The therapist-to-coach pipeline is easy to frame as a story about money, or burnout, or professional abandonment. But Hill sees it differently.
“This shift reflects a larger change in how people seek support,” she said. “We’re seeing a growing demand for preventative care, personal growth, and flexible support outside of traditional systems. Coaching is meeting a need that therapy was never designed to fully meet on its own.”
And plenty of consumers prefer it that way. Coaching lets people seek support without a diagnosis or the feeling that something is wrong with them.
The mental health industry spent decades underpaying, overworking, and undervaluing its clinicians—then acted shocked when they found another way. What Hill envisions is a continuum of care—therapy and coaching not as competing camps but as complementary services. But that would require the therapy world to stop treating coaching as a betrayal, and the coaching world to stop pretending credentials don’t matter. The clinicians building the bridge anyway might be the ones who finally force the conversation.
Megan Bruneau, M.A. Psych is a therapist, executive coach, and the founder of Off The Field Executive & Personal Coaching. She hosts The Failure Factor podcast featuring conversations with entrepreneurs about the setbacks that led to their success.