Coaching in a crisis. Part 4 – Breaking the silence

Joint Highly Commended, Best Article/Series 2018.
Coaching at Work Awards 2018. 

First published as an article in Coaching at Work, August 31 2017
By Liz Pick and Neil Atkinson

In the final part of a series of articles exploring coaching and mental illness, Liz Pick and Neil Atkinson offer pointers for adapting your practice to include people with mental health conditions.

Mental health directly impacts work performance so surely it makes sense for coaches to talk about it with every client, whether they’re happy and healthy or living with mental or physical illness? Yet when it comes to mental illness, the coaching world seems to be reinforcing stigma through its silence.

This silence is not surprising given the absence of mental health from most coach training, but in our experience, the benefits of talking far outweigh the risks. And while clients are likely to open up to us because of the confidentiality of coaching, their sponsors often have no idea of the impact that talking about mental health can have on achieving coaching goals.

So we want to share some of the approaches we’ve developed. We hope you find them useful in your day-to-day coaching and that, over time, coaches’ potentially crucial role in supporting people with mental health conditions will be fully recognised.

The big issue

The issue of mental health in the workplace has arguably never had such a high profile. Many coaches report a sharp increase in clients with symptoms of stress and anxiety which directly relate to work performance. Yet stigma around mental health is still rife in the workplace and employers – and coaches – often struggle to respond adequately.

As coaches contracted to support the performance of employees, we can feel out of our depth and opt all too quickly to refer clients who disclose mental health conditions on to other helping professionals.

Yet as Liz Pick and Liz Hall argued earlier in this series (Part 1 – Working with mental health issues) this is no longer enough. Why should these clients be denied the same development opportunities their colleagues enjoy? And do you even risk doing harm by ending your work with someone who discloses their condition, possibly after several sessions building up trust?

The coach’s role

Thankfully, more and more coaches are seeing the benefits of incorporating health in general, and mental health in particular, into what they are prepared to explore in their practice.

So, what role can a coach play to support people with conditions ranging from stress to long-term mental health illness, to succeed in their roles, build resilience – and possibly avoid a more serious condition from developing further down the line?


Taking an inclusive approach to mental health starts with broadening your definition of who you’ll work with.

Coaches are traditionally taught to maintain a strict boundary when it comes to mental health (including mental illness), and that people with a mental health condition should only be helped by psychologists and therapists. But arguably a clear boundary between the mentally ‘well’ and mentally ‘ill’ doesn’t really exist.

Coaches should instead focus on whether the client is willing and able to engage in the coaching process to achieve the work-related performance goals they contracted to work towards.

Disclosing any mental health condition is likely to be a big step for your client. They might not feel able to talk about it at work for fear of being stigmatised, having it on their work record, affecting perceptions of them (even unconsciously) should opportunities arise in the future. And if they disclose, how you as coach respond can either enable your client to engage more productively with coaching, or prompt the end of the coaching programme altogether.

In the case of a client disclosing, a coach needs to make it clear that while they won’t work on the condition itself, they can help the client develop ways to manage the impact of their condition on their work performance, or of their work on their mental health. Just for it to be factored into the conversation and acknowledging it as part of the picture can be useful.

It’s also possible to coach a client while they’re also seeing a therapist or counsellor, as long as there’s a clear differentiation about the purpose of both – with the therapist focusing on the treatment of the condition to benefit the person, and the coach focusing on performance at work.

If therapist and coach are to work in parallel, the therapist should be consulted about whether coaching is suitable at the same time. And the coach and client should also discuss the pros and cons of working with a coach and therapist concurrently.

After all, we’re likely to have clients with mental health conditions whether we’re aware of it or not. The challenge is what steps we take to refine our coaching practice to meet their needs.


The fact that you take an integrated approach to mental health can be signalled in your first communication with your client, for example by referencing in your profile your willingness to work on wellbeing and health issues. This can be reiterated in the Introductory/chemistry sessions.

A simple way to do this is to talk about your willingness to include anything the client thinks is relevant to their performance at work, including issues outside work which impact their performance, such as their physical and mental health. It’s important here to be clear that it’s the client’s choice what they bring to the session, as long as it’s relevant to the goals you agree at the start.

Whether you explicitly make the same point when speaking with a sponsor is a matter of choice, and can be neatly explained as your belief that wellbeing is closely linked to performance, and that physical and mental health conditions are common but often not discussed with line managers. In these cases, the impact of coaching on performance is greater when the scope includes how work impacts the rest of the client’s life and vice versa.

Of course, confidentiality is critical and covering this can be part of your explanation of how the content of the conversation remains between you and the client, and that it’s down to the client whether to disclose what they share to their sponsor.

Either way, the role of coach is neither to encourage nor discourage clients from disclosing, but to help them consider their options and consequences if they so wish.

Figure 1 below can help in describing the coaching agenda to clients. The Blue section is agreed in the three-way contracting, and that’s what the sponsor is paying for and will judge the success on.

The sponsor can be told that, if relevant to the agreed agenda, the coach may confidentially address any of the other areas as part of achieving the work-specific goals.

Figure 1: Our multi-layered approach to coaching ensures we identify and address any items that act as barriers to achieving the formal coaching agenda

Creating a lifeline

If you’re able to get important information about a client surfaced in the first session, you can save time, build trust and normalise conditions such as mental health if they’re part of the picture.

Asking a client about their ‘lifeline’ (Figure 2) is a technique one of the authors of this article – Liz Pick – has fine tuned over many years of coaching. It can be used as a questioning prompt in the first session, in which the coach invites the client to consider what might influence how they work today from their past, in the present and in the future, one period at a time.

Figure 2: The ‘Performance +’ coaching model

For many people, this is the first time they consciously reflect on the aspects of their past or present which affect how they are at work or how their personal life might influence future career choices. Health and wellbeing issues often come to light, which might not otherwise have been mentioned until a much later coaching session – if at all. See Possible ‘lifeline’ questions below for possible questions, and Figure 3 for a map of this approach.

Figure 3: The three Rs to Performance

Getting to know your client

A helpful way of ensuring that all the relevant aspects of a client’s life are considered while the coaching programme continues, is to invite the client to keep in view:

  • all the roles they play, which might include being a parent, carer or partner
  • all the resources they need to play those roles – mental, physical, emotional
  • how any current or proposed changes might affect their resilience.

While the sponsor is focused on the client’s role at work, the client has to manage their limited resources across all their roles, which can impact their resilience, decision-making and stress levels – all of which can have an effect on work performance.

As Liz Pick’s ‘Three Rs to Performance’ mobile (Figure 3) illustrates, if there is a change in one area, it’s likely to influence the other areas. Equilibrium is hard to maintain and if we ignore some areas, problems can arise later and can then be harder to address.

Working through this model with a client can help identify issues in context and distil the coaching agenda into the areas of greatest impact.


Ensuring you have the right supervision support is essential for you as a coach and for your clients if you’re working with mental health. A simple first step is to check whether your supervisor is happy to work with you on clients with mental health conditions. If not, make sure you have access to one that does – maybe not for all your work, but to know that if a mental health condition is part of the equation with any client, you can access appropriate supervision.

Supervisors who are also qualified therapists can be especially good at helping coaches avoid being drawn into counselling and keeping their boundaries.


Despite recent increases in awareness about mental health, including high-profile support in the UK from the Duke and Duchess of Cambridge and Prince Harry’s involvement in the Heads Together Charity, and the ground-breaking work of organisations such as Minds at Work to destigmatise mental health in the workplace, many people still fear the consequences of disclosing a mental health problem to their boss.

And they have good reason to be cautious, with managers often ill-equipped to offer support and potential negative consequences once an issue is ‘on the record’. The result? People are likely to inform their employer about a mental health condition only when they need adjustments at work – or they reach a point when they have no choice.

Coaches, on the other hand can offer confidentiality without consequence. Our unique relationship of trust and belief in people’s inherent resourcefulness, creativity and ability to make constructive decisions when provided with the right conditions, leave coaches well placed to offer support to someone balancing the demands of their work with a mental health condition. And while maintaining client confidentiality, we can also feed back to the organisation patterns we see with their employees and ideas on how to improve things.

Stigma thrives on silence so let’s talk more about mental health.

Liz Pick has been a coach for 23 years and set up Performance & Wellbeing Ltd in 2009, because so many of her clients needed to manage issues that impacted on their work, such as stress, physical and mental illness and burnout.

Neil Atkinson is a UK-based executive coach with a particular interest in health and wellbeing. He developed a successful coaching practice after many years working at senior level in business.

Possible ‘lifeline’ questions


  • What from your past has a strong influence on your working life?
  • What from your childhood, academic life and career so far is relevant to how you work today?
  • Give me a quick summary of your roles as a child, at home, at school and work
  • Why did you take those roles?
  • Where does your motivation come from?


  • What’s most important to you in work and outside work (people, home, security, etc)
  • Are you able to balance the demands of work with other demands in your life?
  • What’s currently happening in your life that affects you at work?
  • Does your health and wellbeing affect your performance in any way?
  • How does work affect your health and wellbeing?
  • What gives you energy/causes you stress?


  • What plans or dreams for the future do you have that might influence your working life now?
  • What might happen in the future that could have a bearing on your career choices?
  • When and how do you want to stop work/be financially secure?

Case study

Promotion versus Wellbeing

‘Peter’, a director of a professional services organisation, was due to be assessed for partnership. He’d been identified as a high flier and suitable for promotion. However, during a recent visit to a client with his line manager, Peter had shown signs of suffering from stress, which caused concern.

In our first meeting, through using the multi-layered agenda, Peter told me about his current priorities and challenges. Having reassured him that our conversations were confidential, he described a range of issues:

  • His ambition to become a partner
  • The long hours he was working, both in the office and at home
  • His relationship with his line manager
  • A health condition
  • His relationship with his wife
  • Caring responsibilities for family members
  • His high stress levels
  • His agoraphobia – which he’d never told anyone at work about.

We separated these items into the various sections and discussed how they interrelated. To provide context, I asked Peter to tell me about his life, using the Lifeline, from which we learned that he enjoyed his role and was ambitious, his agoraphobia started when he was 10, but he’d told few people about it and that he had worked hard at the expense of his social life. He rarely asked for help and tried to hide any ‘vulnerabilities’, although he often felt stressed.

We then used the 3Rs diagram (Figure 3) to identify the issues challenging him in his different roles and clarified those he needed to address on his own and those we could address together. He saw that if we focused on enabling him to spend less time working and thinking about work, this could free up time to address the other issues himself.

Initially Peter was adamant that he had little control over his working hours, however he started our second session saying that a couple of his clients were angry because he had delivered work after the deadline.

We identified that Peter sometimes prioritised interesting work over urgent work. He was amazed, amused and embarrassed by this observation but also relieved because he recognised, he could change it. We also developed strategies for him to be more efficient at work and reduce the number of hours he worked and his ability to switch off.

By the end of our coaching programme, he rarely worked at home, which reduced the tension with his wife, he took time to address his medical problems and asked for help with his family caring. Although he didn’t want to address his agoraphobia at that time, he did identify a good source of therapy and his reduced stress levels made episodes less frequent and less severe. Most importantly he became more focused and confident at work, informed his manager of his agoraphobia and asked for help and understanding, which they were happy to provide.

He made gradual progress with the occasional relapse, and found that the changes he made improved his overall productivity and the perception of his performance by his managing partner.

After we finished our work together, his feedback included: “[Coaching] has helped me to transform the way in which I work – constant long hours and stress are a thing of the past… .” In my view, this was only possible through getting to know him in depth.