A Therapist Talks Field Coaching

by Eddie Einbinder, LMSW

 

Last week I accompanied a client through a 76-hour session in which we did a round trip from New York City to Hilton Head, South Carolina and achieved his first three days without heroin use in over six months.  It was a journey neither of us will ever forget.

This is only one year after a colleague first realized that one of his clients needed more support and motivation outside the office, and that with my extensive experience engaging youth I was positioned to be a good match for this client’s needs.  My first field session with him took place at a diner in the Bronx a few blocks from his home.

Since I starting working at The Center for Optimal Living in July 2015, I began to notice these types of gaps in treatment while discussing our clients in our clinical meetings and wondered how we could offer more support and structure. Due to our position in the substance use treatment and mental health fields, many of our clients are high risk and in need of extra support and increased individualized treatment.  We decided to call this support outside the office “Field Coaching” and it has taken many forms since then.

The first patient I worked with as a field coach needed support around the house, motivation to start the day, take his medications, and make it to scheduled psychiatry appointments.  For another client it could mean meeting him at the gym five mornings per week, or helping her to develop a schedule or CV over coffee in her neighborhood once a week.  In this sense, it is a complementary service to a client’s individual or group therapy sessions.  

Field coaching is invaluable to clients who are physically or psychologically unable to make it to the office.  For instance, I worked with another young adult who was unmotivated to engage in traditional talk therapy at the office, but would talk over a game of catch in the park.  Another example is my work with a client who was unable to come to the office due to heavy alcohol use but was willing to have me come to his apartment to discuss his swaying motivation to go to detoxification and rehabilitation.  In these situations and many others, the position of field coach is useful and unique. It creates opportunities for therapeutic engagement to exist and to literally meet people where they are.  

One note of caution. I’ve found that it’s important to have clear boundaries in my role as a field coach and I am rarely both the field coach and individual psychotherapist in a client’s life. The boundaries within these overlapping dynamics can too easily be muddled.  

The therapeutic possibilities for field coaching are great and I’m positive that this type of work will grow at The Center for Optimal Living and in the mental health field at large. This modality represents a new frontier for supporting individuals who struggle with substance use, trauma and the full spectrum of mental health issues and I am enthusiastic about continuing to develop and refine this modality.


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