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Comment by cauthon | Hacker News Reader

Why do you describe your product as "coaching", and not "therapy"? Is this a marketing decision because of a perceived stigma around the term "therapy"? (The re-branding of CBT/ACT to "coaching" and "training" instead of "therapy" strikes me as odd, I don't understand the emphasis on avoiding the term.)

Will your company be accepting medical insurance? $350/mo (~$90/session) is roughly half of what billed-to-insurance therapy costs have looked like for me ($150-200 per weekly session), which could make this a competitive option for people who are uninsured. However, with insurance I've usually paid $25-40/session out of pocket.

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The closest sister discipline our coaches practice is Health & Wellness coaching, but we also draw on the foundations of positive psychology, CBT, etc. depending on the member's situation. The practices of coaching & therapy, although they have some overlap, are largely different in both practice and outcomes. For example, in the context of ADHD, coaching is very focused on future-oriented outcomes and tactic-oriented skills, whereas therapy is often focused on disentangling thoughts, unpacking trauma, etc. Also, coaching is aimed at taking a person upwards to their goals, and you don't necessarily need a diagnosis of any sort to be here. I may have rambled a bit, but the bottom line is, we don't practice therapy on our platform.

Right now coaching is not covered under most insurance plans, unfortunately. Some members have been able to work with their employer benefits to get Shimmer covered but it's definitely a case by case basis right now. However, we try our best to work with our members (we have a needs-based financial aid package and have something in the works that's a bit bigger than this!) where we can!

> For example, in the context of ADHD, coaching is very focused on future-oriented outcomes and tactic-oriented skills, whereas therapy is often focused on disentangling thoughts, unpacking trauma, etc

Respectfully, in my experience therapy is very focused on outcomes and skills. (A very short list of examples: CBT's thought records, DBT's DEAR MAN, ACT's defusion.)

Is the distinction pedantic, or does it have more to do with the qualifications or certifications the provider holds?

Firstly, it’s a pleasure to meet someone as informed in the current debates across the helping professions as you are.

As a coaching psychologist and a member of Shimmer team, I should firstly confirm that we work in close alliance with the other helping professions in the clinical and psychotherapeutic space and we understand each other’s limitations.

And while each of the helping professions pay attention to the outcomes and skills, ADHD coaching we do at Shimmer is characterised by the relentless focus on the future vision, goals and tactics to help the ADHD folk get there. Think regular coaching supercharged by the power of prospective psychology, coaching psychology, health psychology and neuro-developmental perspectives.

We all stand on the shoulders of helping professions’ giants, but our focal areas are different. And considering the time limits involved in helping, the focal areas do matter.

Let me be more direct: what qualifications do your coaches hold?

Thank you for the clarification.

Our coaches fall in 1 of 2 categories: (1) Coaching or MH professional credentials (ICF, Therapists, Psychiatrists) or (2) Masters-level or equivalent of psychology- or ADHD- related field along with extensive hours of client-facing facilitation & coaching work.

100% of our coaches fall into 1 of the above 2 categories.

From their website: We’re looking for licensed coaches (ICF or NBHWC preferred) or licensed mental health professionals (e.g., PhD, PsyD, LCSW, LMFT, etc.) specializing in ADHD.

Looks like they accept people with coaching licenses (this often means less than 200 hours of training).

My understanding is that coaches are typically qualified to work with people who don't have acute mental health needs. For example a coach might help someone figure out how to eat healthier, but wouldn't be qualified to treat an eating disorder.

Yes! Thank you for that distinction. Exactly. Our coaches are not treating ADHD as a medical condition (which is why they don't diagnose or prescribe) but they are helping people with ADHD gain skills, build systems, etc. to help manage their ADHD symptoms.

The reality is there are often co-occuring conditions in the mix here so we often either refer out or ensure our clients are also working with a therapist on other mental health challenges / issues like eating disorders, OCD, anxiety, and depression.

Yes

I heard of coaching in relation to ADHD over a decade ago, it's not something they invented.

I don't know anything about Shimmer, so I don't know how well they fit the mold, but as I understand ADHD Coaching: The general idea is that the coaches are there to supplement therapy and/or drugs with practical "in the weeds" advice. A Therapist would worry about making you feel better, and might point you in the direction of some resources to learn practical coping skills. A coach is one of the resources to help you learn practical skills.

Yeah, my psych makes sure the meds aren't causing problems and does simple mental wellness checks before writing new scripts.

My coach gave me strategies to fit my life. Usually in the form of me presenting a problem, and getting several tricks to try.

I don't think the meds or the coaching would help in isolation. I don't do the coaching now unless I come across a new problem. I have my book of trivks and triggers that remind me to reach for them.

Thanks for sharing your experience, and glad that coaching has given you some strategies that work for you!

When you say book of tricks and triggers, do you mean a physical book? Curious how other folks hold on to their learnings etc.!

The problems/tactics I have written down in my notebook. The triggers are just repetition with lots of failures. Its like chaining the behavior of walking into a conference room to checking my calendar for my next thing. Or when I feel overwhelmed I check the section on prioritizing, scheduling, delegating, and dropping tasks.

Smartphones and smart watches are your friend. Noise canceling headphones come in a close second. You need to remember while unmedicated to take your medicine so an obnoxious, hard to ignore medical alarm is a good tool.

You need to explicitly request cognitive behavioral therapy alongside medical management. You might need to look for a psychiatrist that understands that as a component of ADHD management.

> However, with insurance I've usually paid $25-40/session out of pocket.

This is what insured people need to keep in mind.

Always look up the actual cost estimation through your insurer's website first. It's not uncommon for health insurance at tech companies to have therapy options that come out to $20-30/session. Worth checking first!

Also, note that the service offered here is explicitly "coaching" and not "therapy" as you'd receive from licensed therapists through your insurance.

Preexisting conditions was torture. I spent way more than I should for therapy and medicine because of it. Look. If aca ever gets repealed, we need to require insurance to be insurance and have the carrier under which you were diagnosed indemnify you. Period.

Coaching probably does not require part 21 compliance. It's like "this is not intended to treat any disorder..." disclaimers on supplements. FDA compliance is exhausting and very difficult/expensive. They might have gone through it. Don't know.

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