POP QUIZ: Would you use Psychotherapy or Coaching to help Sheldon (a fictional character from the TV series Big Bang Theory) with his fear of speaking to large crowds?Leonard: What, to you, is a large crowd?
Sheldon: Any group big enough to trample me to death. General rule of thumb is 36 adults or 70 children.
Hmmm, that's a tricky one. We’ll come back to this in a moment.
People go to see a coach and a therapist for the same reason: they have some kind of problem that they need another person's guidance and support with.
Many therapists are trained as coaches and can draw from a variety of other training as well (such Cognitive Behavioural Therapy) in order to help any type of person, with problems small or large.
However, therapists generally cater for those with more serious problems (helping people who have experienced some kind of trauma, stress, or significant emotional event). Is this way, psychotherapy has distanced itself from dealing with the relatively “healthy” general population, and is much more closely related to counselling than to coaching.
Coaching, unlike psychotherapy, does not attempt to resolve past traumas. It's designed to help already healthy people get even better by working on goals, mapping out their future, and is more concerned with action than talk. Coaches help their clients with creating momentum, prioritising tasks, breaking tasks into smaller pieces, setting time limits and deadlines, and developing accountability.
Coaching is part of the Positive Psychology movement – a recent branch of psychology that aims to progress scientific understanding of how well humans can function and achieve their potential.
So back to Sheldon, and which approach to use: Coaching or Psychotherapy?
The answer: it's hard to say.
Confused?
Coaching and psychotherapy would probably both have a lot to offer Sheldon. The fear of being "trampled" could be rooted in a past 'episode' that could be resolved with therapy, or he may simply lack the speaking experience which a coach could help develop through an action plan to address both skill and confidence issues.
However, fear of public speaking is only one of a very large number of social problems that Sheldon struggles with on the show. Despite the best attempts of his friends to help him understand appropriate social norms, little (if any) progress is made. And this is the point: Sheldon is a very curious case, who seems to demonstrate an unusually low level of social awareness which is not unlike that of an autistic savant.
A lot of people have pointed out that Sheldon's behaviour is consistent with Asperger Syndrome (AS), characterised by abnormalities of social interaction, communication, engaging in repetitive tasks, and sticking to inflexible routines; and/or Obsessive–Compulsive Personality Disorder (OCPD), which can include an obsessive need for cleanliness, preoccupation with orderliness, perfectionism, compulsion to make lists and schedules, as well as inflexibility of beliefs.
OCPD is different from OCD. People with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct.
Series co-creator Bill Prady in response to this has said: "Our feeling is that Sheldon's mother never got a diagnosis, so we don't have one."
Not all therapists and coaches come from backgrounds in medicine and psychology that deal with training on specific types of mental disorders. This would fall to a registered psychologist, family doctor or nurse with special training, or a psychiatrist (someone with a degree in medicine and specific training in the assessment, diagnosis and treatment of mental illnesses) who may be better equipped to determine what is going on with Sheldon.
It's a tricky one.
What do you think?