Executive coaching vs. therapy: how to know what you need

You’ve consumed the self-help. You’ve tried the frameworks. You’ve participated in the workshops. You’ve made progress. Years have gone by, and something still won’t budge.

Most leaders explore personal and professional development by guessing what feels right. And that’s not a bad approach! Your intuition often knows the answer. But it’s also not unusual to hire a therapist when what you really need is a coach. Or to push through alone, because asking for help feels like a verdict on your competence.

Many of my potential clients are in this conundrum, trying to decide what kind of support they really need, and whether they actually need multiple kinds of support at the same time. I can’t answer those questions for them (or you), but I wanted to put together my thoughts to help all of us identify the right time and place for the right kind of support.

This article explores the primary differences between therapy and executive coaching, and looks at  less conventional practices, including Reiki, which I’ve added to my own coaching work. None of it is right for everyone or for every problem, all the time. All of them can be helpful, offering a little information, insight, or safe silence to release what desperately wants to go, or to help unlock the right next step.

Executive coaching vs. therapy: finding the line

Coaching and therapy overlap, which is why they get confused. But fundamentally, I think of them this way:

Therapy is clinical

It is practiced by licensed professionals, rooted in the academic study of psychology, and aimed at patterns and wounds: past experiences that shape how you react today. Therapists are well schooled in identifying evidence-based protocols to address debilitating conditions like anxiety, depression, and trauma. Like all health care professionals, therapists are held to confidentiality standards that are governed by law, with some exceptions. Bottom line: if you’re experiencing a mental health condition that is hindering your ability to function—at work, in relationships, in relationship to yourself—seek a therapist.

Therapy has strong research behind it. A network meta-analysis of 198 studies and more than 15,000 adults with depression compared seven kinds of psychotherapy. Each outperformed a waitlist control, with moderate to large effects. Researchers who study this field often point out that how therapy is delivered, including the working relationship and flexible rather than rigid use of a method, matters at least as much as the brand name on the approach.

Executive coaching is applied

Excellent coaching stands on core psychological and organizational research findings but puts them to work on a real situation: a new role, a stalled strategy, a difficult boss, how you show up in the room. Many executive coaches have been in the rooms their clients frequent. They’ve made the mistakes and found paths to success. They often offer mentoring, along with straightforward tools and a safe space to try new things. Confidentiality in coaching is a matter of agreement, not law, and when your organization is paying, it’s fair to ask what your boss or board will hear. Ask that question before the first session, not after.

Coaching also has a research base. A 2023 meta-analysis of randomized controlled trials found a moderate positive effect of coaching across 39 samples and 2,528 participants. In my own experience, the impacts can vary, and even when people report significant benefit, that does not always correlate with observable improvements in leadership effectiveness and career impact.

Early in my coaching career, I worried that when my clients didn’t get the promotion they sought, it meant coaching was not effective enough. However, with over a decade of coaching experience, I now realize coaching can’t make someone a better leader if they don’t enjoy leading or feel called to a different kind of work. The best coaching helps a client find their best fit, where they can act from their strengths and grow in ways that feel important to them, even if it’s not important to others around them, even if it’s not in organizational leadership.

How both therapy and coaching help you succeed

Therapy and coaching are not competitors. Plenty of leaders do both at once, and for good reason. Therapy can help you unpack things you can’t see, which often show up as a drag on your career. Coaching can help you navigate the work itself, including the parts nobody talks about. Coaching can also go the next step and help you establish new, more effective work behaviors, habits, and career management approaches.

No matter how smart you are, at certain points in your career—especially as you reach higher levels of authority and scope of responsibility—it’s common to get stuck learning how to navigate the human dimension of management and leadership. This is why I love supporting leaders: those who invest in themselves for coaching use career challenges to become better people—to get out of their own way, learn techniques to sidestep reactivity, and apply creative leadership strategies that motivate teams and create impact.

Much of this kind of challenge has little to do with skill, effort, and experience. Everyone has issues, but many women and underrepresented leaders arrive at the executive level carrying weight that most of their white male peers don’t:

• Working twice as hard for the same credit in the organization and in the broader culture.
• Looking around the room and not seeing your own color or life experience reflected in the people making the decisions, forcing you to conform to inauthentic perspectives or work hard to make your own viewpoints appreciated.
• Being measured against a male-coded leadership default while being asked to act as though the difference doesn’t matter, and then being told you don’t fit anyway.
• Missing the mentoring and sponsorship that many of your peers received on the way up, including the unwritten rules of getting into the executive ranks.
• Suffering from an imposter mindset that grows in exactly this soil. (I prefer “mindset” to “syndrome” because it’s a story you can revise, not a flaw in you. In one randomized study on young employees, coaching sustainably reduced imposter feelings in participants, which supports the idea that it can be revised.)

None of this is a personal defect, and we, collectively, build and maintain the culture that produces it. That matters for choosing support. If a coach or therapist leaves you believing the problem is you, they’re working on the wrong problem. A good coach helps you read the system, work on the parts you can change, and navigate the ones you can’t. A good therapist helps you carry what it has cost you, and why you may be particularly vulnerable to certain aspects of your situation. You can use both forms of support to improve your situation without either one letting the culture off the hook. For some of us the question isn’t, “Is it coaching vs therapy?” but, “Do I need both coaching and therapy!”

And…as I’ve discovered myself, in my years coaching women and men both, many leaders do all of that work, with a coach, a therapist, or both, and still feel stuck.

When thinking harder stops working

High-achieving leaders are trained to analyze, optimize, and push through. Coaches and therapists call on that mental power to help our clients talk about their situations, unpack the dynamics—past, present, and future—reframe challenges, gain new insights, adopt new mindsets, and change behaviors. That works for many problems, especially in the work itself.

But many people doing the work to become their best selves hit some issues that more analysis can’t solve. While the instinct is to analyze harder, these challenges usually show up in soft-skill areas: dealing with bullies and jerks, self-confidence under pressure, curiosity to experiment with new leadership and management styles, interpersonal influence as the underdog, stress management amid too many priorities, motivation, reconnecting your passion for your work, and executive presence. When you get stuck on these kinds of issues, your brain can get in the way because the problems you’re struggling to surmount sit in your heart and even your body. They can run deep, into your subconscious and conscious, producing stories you tell yourself are true, but actually aren’t. It’s also not unusual that, even though you’re perfectly functional day-to-day, some issues can bring you close to some kind of trauma, still hoping to be healed.

That’s where the spectrum of support structures gets interesting. Talk therapy and drug treatment have been the front line of psychological and psychiatric approaches for decades, and they’ve saved lives. Though coaching is a more recent addition to a professional’s options for help, it, too, has helped people overcome poor habits and behavioral challenges based on old wounds. But people also find relief in ways that don’t sit neatly inside either model.

The 2014 book, The Body Keeps the Score, broke open the complexity that psychologists and psychiatrists address when treating trauma, describing a range of approaches that go far beyond talk therapy, analysis, and drugs. My takeaway from Bessel van der Kolk’s influential work is that there is no one-size-fits-all for deep-seated problems you can’t think your way out of. People struggling with both small and large issues find healing in yoga and bodywork. For others, it’s Eye Movement Desensitization and Reprocessing (EMDR), neurofeedback, Internal Family Systems (IFS), drama and dance, or many other kinds of expressive and somatically connected approaches.

Coaching research is also taking the physical body seriously. Embodied approaches are being developed for executive coaching, such as a model of self-confidence that treats the body as part of the picture.

Beyond talk: Coaching with Reiki

I’ve coached for a long time, and early on I developed a tool to help my clients reduce their reactivity, manage their triggers, and reduce anxiety- and emotion-related stress. While many clients have told me these tools were life-changing (including a few therapists!), I’ve known from personal experience that this intellectual and emotionally based exercise wasn’t always about getting to the root of the dysfunction. What this looked like in my practice was that a client who learned InPower Detriggering would become more skilled at managing difficult conversations and relationships (yay!), but the core mental and emotional model giving them thoughts like “I can’t be the smartest person in the room,” or “if I speak up they’ll fire me,” never truly went away (boo!). The debilitating thoughts and feelings just became more manageable. They became quieter.

And many of my clients told me that they had the same experience with therapy. It helped a lot, but the core issue never quite left the building.

I had resigned myself to getting just that far when I discovered something new. A practice rooted in the idea of a body’s energy field. I became a fan when I found I could use it to reduce some of my own physical pain. But more than a somatic experience, I’ve discovered that Reiki can work on a holistic level, moving energy productively in the mental, emotional, physical, and even spiritual aspect of a person’s life. I became a certified Reiki practitioner so I could explore more dimensions of this amazingly simple and powerful approach to healing things I didn’t even know were broken. I’m convinced that this kind of complementary healing technique can help me and people I love, so I’m currently studying for my Reiki Masters.

Fast forward to today. I’ve added a combination of Reiki and traditional coaching to my practice, and I did it for the reason I apply to everything: people feel a real benefit and can think and feel more deeply about things they couldn’t move on before. That’s applied evidence, and I’m good with it. Reiki is a missing piece in my ability to help my clients get unstuck when they’re not even sure what’s sticking.

What is Reiki?

Plainly, Reiki is a gentle, hands-on or hands-near energy practice. It can be experienced in person or via Zoom. In my coaching, I pair it with structured conversation about what’s going on in the leader’s work and life. We talk through the emotional and mental connections to the problem, looking for patterns and reframes to “loosen up” the interconnected web of thoughts and feelings keeping the client in unproductive patterns. Then we look for the physical connection, the place where that issue lives in the body’s tension, pain, or irritation. In my sessions, Reiki begins to align the whole system. Things start to move. The body relaxes. The mind makes connections. The heart releases. It can be magical.

This Reiki Coaching approach isn’t for everyone, and it isn’t for every problem. When we need to sort through the complexities of office politics holding a client back from a promotion, we dive in deep on the coaching angles. But when stress about those politics is impinging on their productivity and health, I offer a Reiki Coaching session. I include it in my spectrum of services because it’s the right tool in the toolbox for certain challenges. The better question is whether it fits what you’re facing right now.

Which support, when? Questions to ask yourself

A decision matrix would be tidier. Real life isn’t. Start with questions:

• Are old patterns you don’t understand hijacking how you show up now, or threatening the life you’ve built? Therapy is built for that.
•  Is the challenge a decision, a role, a strategy, or a leadership style? That’s executive coaching territory, including figuring out the unwritten rules nobody explained to you.
• Have you done the thinking, used the tools, and still feel stuck or tense? It may be worth exploring body-based or energy practices alongside the others. Check out Reiki Coaching.
• Do you want to talk about it with someone outside your organization, with legal confidentiality? Therapy gives you that. Coaching depends on the agreement you make.
• Bottom line: if your ability to function is slipping, start with a licensed clinician. Coaching and Reiki can be strong complements to clinical treatments. Many people use more than one of these at once, and that’s normal, not a sign something is wrong with you.

_____________________________________

Frequently asked questions

Is executive coaching the same as therapy?

No. Therapy is clinical and addresses emotional wounds, trauma, and mental health conditions. Executive coaching focuses on roles, decisions, and leadership. They overlap, and many leaders use both.

Can I do coaching and therapy at the same time?

Yes. Many people do. Therapy tends to address what the work costs you, while coaching addresses the work itself. A good coach will tell you when something belongs with a therapist.

Is what I tell a coach confidential?

By agreement, yes, but not by law. Coaching conversations generally don’t carry the legal protections of therapy, which vary by jurisdiction. If your organization pays for the coaching, ask in advance what is shared with them.

When should I see a therapist instead of a coach?

If anxiety, low mood, exhaustion, or trauma is affecting your sleep, health, or ability to function, start with a licensed clinician. Executive coaching is forward-looking and applied to roles, decisions, and leadership. If you’re struggling with how to advance your career or manage and lead teams, call a coach.

What is Reiki coaching?

A coaching approach that begins with a structured conversation about what feels stuck and is blocking your ability to show up as your best self. In a Reiki Coaching session, I combine structured discussion with a Reiki session, a gentle energy practice designed to help you align on a path forward. The talk stirs up the energy, and the Reiki aligns it.

Is there scientific evidence for Reiki?

In one meta-analysis of 13 studies, Reiki showed a substantial advantage over control conditions, lowering anxiety by nearly a full standard deviation on standard measurement scales. The average person who received Reiki ended up less anxious than about 80% of the control group. Some of the trials compared Reiki with no treatment, which can’t separate Reiki from the effect of simply receiving calm, focused attention.

Choosing support is part of leading well

You’d never run a team with a single tool. Your own support deserves the same adaptability. Instead of going in circles on the question, “Do I need therapy or coaching?” pick a starting point. Before this month ends, name what is weighing on you. Match it to the kind of help that fits. Start small. Then reflect and refine. Adapt. Repeat.