Many of the leaders I see have had a coach before me, and the coaching was not wasted. It took them as far as the surface goes. In my experience, the decision point comes when the same pattern keeps returning no matter how good the plan is.Dr. Prerna Kohli

At some point you decided this needed outside help. The temper in reviews, the Sunday-night dread, the presentation that went wrong, the third missed family dinner this week. Then you met the market: coaches, mentors, counsellors, therapists and psychologists, all promising transformation, most of them indistinguishable from a website.

The choice is not cosmetic. Pick coaching for a clinical problem and you can spend a year reorganising your calendar while the real issue compounds. Pick therapy when all you needed was structure and a sparring partner, and you will wonder what the fuss is about. What follows is the map I give people who ask, from someone who sits on one side of the line and refers across it in both directions.

Executive coaching vs therapy: the real difference

The difference is training, scope and accountability, in that order. No licence stands behind the title "coach": anyone may use it, a point the largest coaching body itself concedes, and the certificates behind it are private credentials of very uneven depth. A psychologist's title rests on a university training in how minds work, what goes wrong with them, and what treatment helps, in my case a PhD and M.Phil in clinical psychology and more than thirty years of practice.

Scope follows from that. Coaching is built for functioning people pursuing defined goals: better delegation, a stronger board presence, a smoother first year in a bigger role. Therapy is built for the things goals cannot touch: a mood that has flattened, sleep that has broken, anger that keeps escaping, panic, grief, a drinking habit that is quietly growing, a marriage under strain. Coaching asks where you want to go. Therapy also asks what keeps stopping you, and has tools for the answer.

And accountability differs. A psychologist works under professional ethics, keeps clinical confidentiality within the usual ethical and legal limits, and is answerable for treating what presents. A credentialled coach carries an ethics code too; the practical difference is that a coach's engagement runs on the contract, and a psychologist's duties do not depend on the contract or on who pays.

What a good coach does well

I have no quarrel with good coaches, and some of my clients keep one alongside our work. Coaching earns its keep when the problem is truly forward-looking and the person is well:

• Structure and accountability. A standing appointment with someone who asks whether you did what you said. For busy people this alone is worth money.
• A new role. First hundred days, a bigger remit, a move from operator to leader: coaching frameworks exist for exactly this.
• Skills. Running better meetings, giving feedback, presenting to a board. Observable behaviour, practised and polished.
• An outside view. Someone unentangled in your politics who can say what nobody in the building will.

If that list covers your situation and nothing below does, hire a coach, a good one, and you will likely be well served.

What only therapy can reach

Some problems wear a performance costume and are not performance problems. In my practice these are the signs the work belongs with a psychologist:

• The body has joined in. Broken sleep, appetite changes, headaches, a heart that races before meetings. Goals do not treat physiology.
• The mood has changed colour. Flatness, dread, irritability that your family comments on, little pleasure in wins. That cluster deserves an assessment, not a development plan; burnout and depression are told apart here.
• The pattern is old. The same conflict with every co-founder, the same freeze with every authority figure, the same disappearing act at home. Patterns with history have roots, and coaching tools stop at the surface the roots feed.
• It follows you home. If the problem shows up with your spouse and children as much as with your team, it is not a workplace skill gap.
• Something is being used to cope. Alcohol on more nights than not, or anything else that has quietly become load-bearing. Where dependence may be forming, a doctor or psychiatrist joins the assessment early.
• Panic, fear or grief are in the room. A panic attack before presentations, a fear that has started dictating decisions, a loss that will not settle. These are treatable, and they are treated, not coached; the presentation-panic piece explains how.

One rule sits above that list: new physical symptoms, a racing heart above all, get a medical check first. Broken sleep and appetite changes can have medical causes too, so psychological explanations are adopted after a doctor has ruled those out, never instead of that. Chest pain, fainting or severe breathlessness are urgent medical matters, not booking decisions.

How to decide in practice

Five questions, in order. They are the ones I would ask you in an assessment anyway.

1. Say the problem in one sentence. If the sentence is about reaching something ("I want to delegate better"), that leans coaching. If it is about escaping something ("I can't switch off", "I keep exploding"), that leans therapy.
2. Ask where else it shows up, and how hard it hits. A skills gap confined to work leans coaching. Anything that follows you home, into your sleep or into your body leans clinical, and so does anything intense in one specific room; panic that strikes only in board meetings is still panic.
3. Check how long it has been true. Since the new role, it may be the role: a skills challenge, a stress response, or the start of something clinical, and timing alone does not settle which. As long as you can remember, in different jobs and relationships: roots.
4. Notice who is paying and who reports. Company-paid coaching exists in a triangle of you, the coach and the sponsor, and what, if anything, reaches the sponsor is set by the contract, so read it before you disclose anything personal. Private therapy has no triangle. For problems you would not want summarised to anyone, the choice makes itself.
5. When in doubt, assess down, not up. A psychologist's assessment can conclude "this is a coaching problem" and send you off cheerfully; I do it regularly. Coaching training is not designed to detect that a performance problem is a depression, though well-trained coaches are taught to refer out when something looks clinical, and in my experience the costly errors run in that direction. That assessment can be booked directly.

Can one person do both?

My view, held for a long time and stated plainly on this site: a psychologist can do coaching-style work, because the deeper training contains the lighter work. A coach cannot do therapy, because the reverse is not true. So with leadership clients my sessions often look coaching-shaped for stretches, goals, behaviour, accountability, and then reach into the clinical layer the moment it is needed, without a handover, a new intake, or a second confidentiality conversation.

That does not make coaches redundant. It means the order matters. Start with the assessment when anything on the clinical list is present, and add structure afterwards; structure on top of an untreated problem is scaffolding on wet ground. And if you already have a coach you rate, keep them. The two kinds of work share a border, not a battlefield, and I have both received referrals from honest coaches and sent clients back to them once the clinical work was done.