Why I work this way

And why you might like to too…

There’s more research all the time showing that writing is just as effective as — and often less stressful than — in-person counseling for addressing a wide range of concerns. Here’s a recent example showing how effective writing is for treating trauma, for instance.

Early on in my career as a psychotherapist, clients would email me between sessions with substantial kinds of concerns. I noticed these email exchanges often led to big leaps in progress, which was ironic because at the time my email work was entirely unpaid and also somewhat frowned upon by the psychotherapy field.

And yet I kept noticing that where people got stuck in live sessions, I saw them get unstuck in email. Clients said it helped to have tangible words to refer back to, that they could take in ideas and respond in their own time, that it felt more effective to engage around things as they were happening and not whenever the next scheduled session was. And for some people, removing the social/performative demands of in-person sessions enabled them to go deeper as well as to talk about hard things in a less stressful way.

I sought out special training to work with people by email and more clients asked me to work with them that way. I started to charge for my time because it had become a considerable part of my practice — and a part I really enjoyed. Meantime, research came along that supported the efficacy of working asynchronously and in some cases, insurance now covers it. Covid accelerated our ability to access expertise from more far-flung places, but it also led to a lot of video fatigue. Working with people asynchronously preserves the benefit of expanded access to expertise without the drain of more Zoom meetings.

Some people find working by email fits their life circumstances better because they travel for work, their schedule is unpredictable, or they have demands that make it easier for them to do personal work in smaller chunks of time. As people have wanted to work with me from other parts of the world, doing it asynchronously overcame time zone differences. Other people have careers that make them sensitive to privacy concerns and appreciate working via disappearing text and not having to worry about a diagnostic paper trail.

For my part, I was ready to move out from under the medical model of “treating mental illness” to work with people in a more spacious and contemplative way. Which is why I’m now doing this work as a trusted advisor/coach/guide and not a psychotherapist.

What’s the difference between advising/coaching and psychotherapy?

I wholeheartedly support access to good mental healthcare and getting a clear diagnosis where it’s useful. I’ve moved outside of that work because that’s where I want to be, not because I see no value in it. I work with a lot of people who also see mental healthcare providers or who have mental health diagnoses — the work I do is adjacent to that, not instead of it.*

Here are a few ways advising/coaching and psychotherapy are different:

  • Psychotherapy diagnoses and treats “mental disorders” as found in the DSM — advising/coaching does not. Psychotherapists are licensed healthcare providers; advisors/coaches are not.
  • Advisors/coaches help people move towards a very wide range of personal goals; psychotherapists tend to be focused on goals that are seen as medically necessary for a person’s normal functioning.
  • Advisors/coaches bring outside resources and information to help enhance a situation — whether that’s an individual’s life, a group, or an organization. Psychotherapists do some of this, though within the more constrained focus of a treatment plan.
  • Psychotherapists are responsible for doing ongoing assessment of a client’s risk of harm (to self or others); advisors and coaches don’t do this and clients need to contact their primary healthcare providers if they feel at risk that way.
  • Psychotherapists are obligated to keep an extensive paper trail on their patients/clients. Advisors and coaches do not have to maintain a paper trail.

* I do still provide psychotherapy (also asynchronously) for Maine residents. If you’re in Maine and want to know more about that, drop me an email. It may be covered by your insurance.