How Much Coaching is Enough: A Look at the Dose-Effect Relationship in Counseling and Psychotherapy

Those who engage in "coaching"--whether it be "life coaching", "executive coaching", or the coaching of traders in financial markets--are quick to point out that they do not engage in counseling or psychotherapy. This is understandable, as most coaches lack training in these fields. (How they can adequately distinguish those who need clinical vs. coaching services without such training is a question we'll leave to another day). Still, it is not clear that the interpersonal helping processes that are part of effective coaching are any different from those that typify effective counseling. Both are verbal, interpersonal vehicles for effecting targeted changes in thought, feeling, and behavior. Both begin with an initial assessment and progress through the development of a plan and the introduction of helping methods. Structurally, coaching and counseling are identical.

This similarity suggests that issues that have long interested counselors and psychotherapists are relevant to coaches. One of these is the dose-effect relationship: how much coaching is needed on average to achieve a particular change? Fortunately there is a rich research literature in this area that is relevant to coaches and those who purchase their services. In this and subsequent posts, I will explore the implications of this research.

My review of this literature back in 1994 found that the dose-effect relationship in the helping fields is a function of many different factors, including the following:

* Severity, Duration, and Complexity of Presenting Problems - On average, it takes longer to achieve a given level of benefit for people with severe problems (those that greatly impair functioning), chronic problems (those with longstanding concerns), and complex problems (those that manifest themselves in multiple, interacting ways).

* Nature of the Changes Sought - On average, changes in mood and attitude are achieved earlier than changes in actual functioning. With good coaching, for instance, a trader will start to feel better about his work before he actually starts to trade and perform better.

* Motivation and Involvement of the Person Being Helped - On average, those who are more motivated for change and who are more highly involved in the helping process achieve gains more quickly than those who are ambivalent about change or who are less engaged in change efforts.

* Readiness for Change - On average, those who clearly identify specific changes they wish to make and are ready to take action on those benefit from assistance more rapidly than those who need time to explore their thoughts, feelings, and behaviors and come to greater self-understanding prior to formulating targeted goals.

* Duration of Changes Sought - On average, changes can be initiated in a relatively brief time span, but it takes a greater dose of helping to achieve changes that will be longstanding. This is because of the phenomenon of relapse: if helping is too brief, changes aren't truly internalized and the risk of relapse increases significantly.

Research by Kenneth Howard and colleagues conducted in the mid-1980s--and later replicated by a variety of investigators--found that about half of all people seeking assistance in therapy achieve their gains within eight sessions. Once again, these favorable short-term outcomes were more common among those with less severe and less chronic problems than among those with pervasive and longstanding concerns. Indeed, when we look just at people with relatively mild and recent presenting complaints, the number achieving significant change within eight sessions soars to 75%. It is precisely for this reason that we should expect coaching to be an ideal medium for brief change, as coaching is explicitly aimed at non-clinical populations.

What this research suggests is that, if coaching is truly appropriate for an individual, it should be able to proceed in a relatively brief manner to achieve targeted changes. Long-term coaching may be as much an indication of practitioner shortcomings (or client dependency) as practical necessity.

One variable not commonly addressed in this research is the competence of the person providing helping services. An interesting recent study conducted at a training clinic (and therefore utilizing less experienced helpers) found an attenuated dose-effect curve overall: it took more sessions to achieve a given level of average benefit. An earlier investigation at a training clinic found that only 22% of clients achieved significant gains after 8 sessions, compared to the 50% reported in the literature. The first study also found reliable differences among helpers: some just seemed to yield better outcomes than others. It may well be that training and experience (as well as helping skill) enable helpers to more quickly establish good working relationships with others; target problem areas; and introduce methods for addressing these areas.

This is an important research finding, given the lack of substantive credentialing and experience among many who hold themselves out as coaches. With coaches as with traders, skill and experience appear to make a significant difference in generating outcomes.

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