Coaching for Mental Health: Ethical Dilemma or Ethical Development?

Challenges to Coaching

Unfortunately due to the severity of some coachees’ state and my insecurity I may not have been firm enough in holding them accountable to their goals. Possibly wisely, for all the reasons outlined above, but there must be a pivotal point where I can push for their greater self-responsibility. It is noticeable that obligations to their CPN (Community Psychiatric Nurse) are given priority over their commitment to a self-generated goal, obviously then there is an ability to prioritise their efforts, so how do I detect where to make an effective intervention?

I believe that dependency on state benefits has a strangle hold on full recovery. Enough survival strategies have been learned to tolerate unacceptable conditions, so why should anyone jeopardise their existing security for a ‘pipedream’. Extra incapacity benefits can create even more chronic dependency. As clients have to exhibit more symptoms at benefit renewal assessments, it becomes a strong disincentive to become independent. They may appear to be lazy, but there is greater stress and a genuine fear of inability to cope if abandoned by the state.

Other threats according to David Smail are dependency on “institutionalised authority” and “cultural opinion”, he considers it takes “an unusual independence of spirit” to reject this. How to Survive Without Psychotherapy p 241. I find it frustrating supporting coachees who define their life by someone else’s diagnosis, are in awe of specialists and are seduced by the promise of ‘magic pills.’ Mixed messages from carers can increase fear, as was the recent experience of a young client who admitted feelings of suicide to his CPN. Their reaction was the removal of all his pills, (reinforcing his self belief that he was incapable of self care), and the CPN then left him as his hour was up. Form filling and box ticking assessments can be even more potentially dangerous. One question e.g. “Do you hear voices?” repeated enough can result in the suggestible client hearing their normal internal dialogue as ‘voices’ thus reducing their ability to discriminate and take control of their thoughts and consequent actions.

Coaching is about helping people deal with their personal gremlins, (mind patterns that prevent them seeing their big picture and potential). Mental imbalance requires the same help, the only difference is that the gremlins here appear gigantic. Gremlins feed on negative thought patterns, so an active change of attitude is the most effective aid to recovery. Aspiration and commitment are two vital components, both very difficult for depressed people. Paradoxically, suggestibility becomes a tool to lift coachees’ mood by contact with positive people and humour, the repeated suggestion ‘you will feel better’ becomes true. Coaching works if you really want to change. Unfortunately, depressed people don’t want to do anything and can give up for a while. Fortunately, enforced change happens whether we like it or not, and the positive experience and practical benefits of coaching are remembered. The time consuming process of establishing trust and rapport has already taken place, and a new level of commitment can ensue.

Depression is perceived as socially undesirable but acceptable, whereas psychotic behaviour is seen as aberrant. Viewed in the full context of an individual’s life, behaviour diagnosed as psychotic can be an intelligent response to unacceptable conditions. By using relaxation and visioning techniques and the creative language of image and metaphor the coachee builds up a new inspired picture of their self and their future. In so doing the individual finds their own voice and sets their own context within a complex and challenging world. Appendix 8:Psychosis and Creativity

The diverse needs of individuals, especially those recovering from trauma, require multiple support strategies. Although I consider coaching to be an excellent component I believe it is vital to have effective personal and community support programmes and access to intermediate employment initiatives (e.g. social firms, volunteering, LETS and Time Banks).

My ideal therapeutic coaching model would draw on NLP, Imagework, Brief Therapy, Human Givens and local community initiatives – a holistic combination of thought and action! NLP Coach 2001 (p.23).

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