In the evolving landscape of health and wellness, certified health coaches help guide their clients toward achieving their wellness goals. In this role, you offer support, motivation and personalized strategies to promote healthy lifestyles. However, it’s imperative that all health coaches recognize and respect their defined scope of practice and avoid encroaching into the territory of traditional therapy or counseling. This article aims to underscore the boundaries between health coaching and therapy, emphasizing the ethical considerations that certified health coaches should prioritize.

The Role of Certified Health Coaches

As a certified health coach, you are an expert in guiding individuals toward achieving and maintaining a healthy lifestyle. You focus on areas such as nutrition, exercise, stress management and overall well-being. You work collaboratively with your clients, empowering them to make sustainable changes in their habits and routines. The primary goal is to enhance overall health and prevent chronic diseases through lifestyle modifications.

For expanded clarity, let’s take a look at two descriptions of the role of a certified health coach:

  • Health coaches are professionals from diverse backgrounds and education who work with individuals and groups in a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness. Successful coaching takes place when coaches apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change [National Board for Health and Wellness Coaching (NBHWC) Certification and Competencies Team definition].
  • Health and wellness coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work, health and wellness coaches display an unconditional positive regard for their clients and a belief in their capacity for change, honoring that each client is an expert on [their] own life, while ensuring that all interactions are respectful and non-judgmental (NBHWC Code of Ethics definition).

Simply stated, a health coach is someone who encourages and collaborates with individuals seeking guidance and support in transforming their behavior and mindset. The aim is to enhance their overall well-being by working toward self-determined wellness goals.

Respecting Scope of Practice

One of the fundamental principles in the healthcare industry is respecting and adhering to one’s scope of practice. Certified health coaches are not licensed therapists or counselors, and it is crucial to recognize the limits of your expertise. Respecting these boundaries ensures ethical and responsible practice, safeguarding both clients and the reputation of the profession.

Differentiating Health Coaching From Therapy

To maintain a clear distinction between health coaching and therapy, it’s essential to understand the core differences between the two roles. While health coaches focus on behavior change, goal setting and lifestyle modifications, therapists and counselors delve into deeper emotional and psychological issues. As a health coach, you should avoid offering therapeutic interventions or engaging in discussions that are better suited for trained mental health professionals.

Here are some common practices that are within the scope of a certified health coach:

1. Emphasizing Goal-oriented Approaches: Maintain a clear boundary by emphasizing goal-oriented approaches. Your expertise lies in helping clients set and achieve specific health-related goals, whether it’s weight loss, improved fitness or stress reduction. By staying focused on these objectives, you can avoid veering into the realm of therapy.

2. Recognizing Signs of Emotional Distress: While you are not a therapist, you should be vigilant in recognizing signs of emotional distress in your clients. If a client exhibits symptoms beyond the scope of health coaching, it is crucial to refer them to a licensed mental health professional. This responsible approach ensures that individuals receive appropriate care for their emotional well-being.

3. Establishing Informed Consent: To maintain ethical practice, establish clear and informed consent with your clients. This includes transparent communication about the nature of the coaching relationship, the boundaries of your expertise, and the acknowledgment that coaching is not a substitute for therapy. Clients should be made aware of the limits of your role from the outset.

4. Referring to Licensed Professionals: When faced with issues that fall outside the scope of health coaching, it is imperative that you refer clients to licensed professionals. This may include psychologists, counselors or therapists equipped to address emotional or psychological concerns. Collaboration with other healthcare providers ensures holistic and comprehensive care for the client.

Navigating Sensitive Topics

As a health coach, you are likely to encounter sensitive topics related to your clients’ lifestyles and habits. While it’s essential to address these matters, you must tread carefully to avoid crossing into therapeutic territory. The key is to focus on practical strategies, behavior change and lifestyle adjustments without delving into deep emotional issues that require the expertise of a licensed therapist.

Below are common action steps you should take to protect your own liability and your clients’ interests:

1. Build Strong Communication Skills: Effective communication is a cornerstone of ethical health coaching. Hone your communication skills to facilitate open and honest discussions with clients. This involves active listening, empathy and the ability to guide conversations towards practical solutions without delving into therapeutic interventions.

2. Set Clear Expectations: Establishing clear expectations from the beginning of the coaching relationship is crucial. Take the time to communicate the purpose, goals and limitations of your services. By setting clear boundaries, clients are less likely to expect therapeutic interventions from you, ensuring a more ethical and professional engagement.

3. Maintain Confidentiality and Privacy: Maintaining client confidentiality is paramount for both health coaches and therapists. Outline your policies on confidentiality and privacy, assuring clients that their personal information will be handled with the utmost care. This commitment builds trust while reinforcing the professional boundaries of the coaching relationship.

Bonus Tips for Expectations and Client Privacy

One of the best ways you can set clearly defined expectations is by writing a coaching agreement that includes the following:

  • The roles and responsibilities of each party (the coach and the client, or the sponsor if the client’s services are paid for by a third party such as an employer)
  • A clear definition of boundaries, including a description of the coach’s scope of practice in a way that tells the client what a health coach does and does not do professionally
  • Compensation structure and expectations
  • Communication expectations
  • A description of how information will be exchanged and how privacy will be respected and secured
  • Confidentiality and privacy policies
  • Terms of the termination of the agreement

The coaching agreement should also be tailored to the individual needs of the client, signed by all parties, and orally reviewed with the client so that any questions can be answered at that time.

When it comes to client privacy and confidentiality, all health and exercise professionals should be aware of Health Insurance Portability and Accountability Act (HIPAA)-compliant practices and how to navigate situations that might jeopardize a client’s information. Unless an exception applies, never disclose the existence of a client relationship or share a client’s identity; nor should you share any information received from, or about, a client, or share anything learned from, or about, a client.

Exceptions to this rule include illegal activity, valid court orders or subpoenas, or imminent threats.

Let’s look at two examples of common “tricky” situations related to client privacy and confidentiality:

Scenario A: Your client asks you for some information and you agree to follow up. You call your client but get their voicemail. Think about how you could navigate this. 

Possible Professional Response: You do not have any way to verify that only your client has access to the voicemail recording. Your best option would be to leave a general message saying “Hi, James, this is Erin. When you have a moment, please give me a call back, as I have a few things I'd like to share with you as a follow-up to our conversation.” It’s also important to ensure that you only use a client’s preferred methods of communication (e.g., client-approved phone numbers, emails or addresses). This should be clarified in the coaching agreement.

Scenario B: You are at a social engagement with a close friend. One of your clients, Sarah, is also attending and approaches you to say hello. Your friend, after your client leaves, asks how you know each other. What do you do?

Possible Professional Response: Here, you and your client have mutual friends. There is no reason to disclose that Sarah is your client. Health coaches do not need to share the existence of the relationship. Instead, keep it short and reply: “Through mutual acquaintances.” The answer need not be long or detailed.

As a certified health coach, you play a vital role in promoting healthy lifestyles and preventing chronic diseases. To uphold the integrity of your profession, it is crucial that you respect your defined scope of practice and avoid encroaching into the domain of traditional therapy or counseling. By understanding the differences between health coaching and therapy, setting clear expectations and prioritizing ethical communication, you can navigate these boundaries with professionalism and integrity. This commitment not only safeguards the well-being of clients but also contributes to the continued growth and credibility of the health coaching profession.


Expand Your Knowledge

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