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Guide3 min read

Coaching or therapy? When to refer a coaching client

How to tell ordinary strong emotion from a sign that a client needs other support, and how to raise a referral without ending the coaching.

The short answer

Raise a referral when you see a pattern that is persistent, broad and stops the client functioning day to day, or when the client talks about harming themselves or asks you to diagnose or treat them. Tears or strong feeling in a session are not, on their own, a reason to refer. A referral does not always end the coaching: you and the client agree whether it continues beside the other support.

Every coach meets this question, whatever their training or credential. A client cries about a review, or describes months of poor sleep, or mentions a therapist. The skill is to know which of these change your role, and what to say when one does.

What is the difference between coaching and therapy?

Coaching works with a client who can function and wants to move forward on a goal they choose. Therapy treats a mental-health condition, and it is done by a qualified professional. The boundary is about what the work is for, not about which feelings come up. Coaching conversations touch fear, grief and anger all the time.

Coaching and therapy can run at the same time. When a client already has a therapist, you coach the goal they brought to you, and you leave the clinical work to the therapist.

Try a question

In the first session, Chen tells her coach that she has a diagnosed anxiety disorder and sees a psychologist. She wants coaching to prepare for a job change, and she wants the two pieces of work kept separate. What best describes the coach's role?

AThe coach should ask Chen's consent to talk with her psychologist so the work aligns
BThe coach should coach the job change and offer tools for the anxiety it brings up
CThe coach should refer Chen to a mental health professional before coaching starts
DThe coach should coach the job change and leave the anxiety to the psychologist
Show the answer

The answer is D.

Coaching and therapy can run at the same time if the boundary stays clear. Chen already has a psychologist for the anxiety, so the coach does not refer her again or add tools for it. She wants the two pieces of work kept separate, so the coach does not contact the psychologist. The coach works on the job-change goal.

Based on: ICF Core Competencies 2019, Competency 1 Demonstrates Ethical Practice (1.6, 1.7).

An original question in the style of the ACC Exam, written for Robin. Not affiliated with the ICF.

Which signs call for a referral conversation?

Look for a pattern, not a moment. These signs suggest the client may need support that coaching cannot give:

  • Low mood, anxiety or poor sleep that lasts for weeks and gets in the way of work or home life.
  • Talk of harming themselves or someone else.
  • A request that you say whether they have a disorder, or that you treat it.
  • The same distress coming back in every session, so the coaching goal cannot move.

A client who is nervous before a presentation, flat after a setback or tearful about a hard decision is having an ordinary human reaction. Staying steady with that feeling is part of coaching.

Try a question

Which client situation most clearly suggests that the coach should raise the option of support from a mental-health professional?

AThe client becomes tearful, and then apologises, when talking about a poor performance review.
BThe client feels nervous and sleeps badly the night before a big presentation.
CThe client reports weeks of low mood, poor sleep and trouble coping at home and work.
DThe client is frustrated, and a bit flat, that a career goal is moving slower than hoped.
Show the answer

The answer is C.

Emotion in a session is not a reason to refer. The signal is a pattern that is persistent, broad and affects the client's ability to function. When that pattern appears, the coach keeps the distinction between coaching and therapy and raises referral.

Based on: ICF Core Competencies 2019, Competency 1 Demonstrates Ethical Practice (1.6, 1.7); ACC Candidate Guide, exam domain Definition and Boundaries of Coaching (signs of mental health conditions).

An original question in the style of the ACC Exam, written for Robin. Not affiliated with the ICF.

Try a question

Which client behaviour is NOT, on its own, a sign to consider a mental health referral?

ABecoming tearful while describing a hard decision
BLow mood lasting months that stops them working
CAsking the coach to say whether they have a disorder
DSaying they have thought about harming themselves
Show the answer

The answer is A.

Tears or strong emotion in a session are part of ordinary coaching, and the competencies expect a coach to stay steady with them. The signs that call for a referral conversation are different: talk of self-harm, symptoms that persist and stop the client functioning day to day, or a request for diagnosis or treatment. Emotion alone does not make a client a therapy case.

Based on: ICF Core Competencies 2019, Competency 5 Maintains Presence (5.4), Competency 4 Cultivates Trust and Safety (4.5) and Competency 1 Demonstrates Ethical Practice (1.7). ACC Candidate Guide, Definition and Boundaries of Coaching content outline (signs of mental health conditions; referrals).

An original question in the style of the ACC Exam, written for Robin. Not affiliated with the ICF.

How do you raise a referral?

  1. Name what you have noticed, in plain words and without a label. For example: "You've mentioned for a few weeks now that you can't sleep and can't face work."
  2. Say why it matters: it may need support that coaching does not give.
  3. Suggest the kind of professional who could help, such as a GP or a therapist, and share how to find one if you can.
  4. Agree with the client what happens to the coaching: does it continue alongside, pause, or stop?
  5. Note what you agreed, and check in at the next session.

The client decides whether to act on the referral. Your job is to be honest about what you see and clear about what coaching can do.

Try a question

Over several sessions Tomás has described symptoms that sound like ongoing depression. He is not in immediate danger and says he wants to keep going with coaching. What is the most appropriate action?

AName the concern, suggest a qualified professional, and agree whether coaching continues.
BCheck that Tomás feels safe today, and carry on coaching in the way he wants.
CAgree with Tomás to make his low mood the coaching focus for now.
DName the concern, suggest a qualified professional, and pause the coaching until he is seen.
Show the answer

The answer is A.

Referral does not always mean ending or pausing coaching. The coach shares the concern honestly, encourages professional support, and agrees with the client whether and how coaching continues alongside it. Tomás is not in immediate danger and wants to continue, so the coach does not pause the work for him. Ignoring the signs or trying to treat them both break the boundary.

Based on: ICF Core Competencies 2019, Competency 1 Demonstrates Ethical Practice (1.6, 1.7) and Competency 3 Establishes and Maintains Agreements (3.2, 3.11); ICF Code of Ethics 2020, Section I Responsibility to Clients (Standard 8).

An original question in the style of the ACC Exam, written for Robin. Not affiliated with the ICF.

Where this stops

When a client is in immediate danger, this slower conversation is not enough. Follow the safety steps in your coaching agreement, and contact emergency services if someone's life is at risk. The duties that apply depend on the law where you and the client are.

Why this comes up in the ACC Exam

The ACC Exam tests the definition and boundaries of coaching as one of its three topics, and referral is a large part of that topic. The worked questions above are original questions in the style of the exam. There are more in the free ACC practice exam.

Your next step

Boundaries are easier to hold once you have practised the conversation. Peer coaching on Robin is free: you coach another coach and they coach you.

Find a peer coaching partner

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