THERAPIST OR COACH? KNOWING WHEN TO REFER

INTRODUCTION

Knowing when to refer a client to therapy vs. coaching is a crucial skill for anyone working in abortion recovery. In the webinar “Therapist or Coach? Knowing When to Refer,” abortion healing providers gained practical tools to confidently assess client needs, avoid harm, and ensure the most effective support. This expert-led session offered a clear, compassionate roadmap for making informed referrals, rooted in real-world experience and ethical care. Whether you’re a peer facilitator, coach, or counselor, this conversation delivers the clarity needed to navigate complex client situations with confidence.

To guide the conversation, Kylee Heap welcomed featured speaker Lisa Rowe, a licensed mental health professional in private practice and certified life coach with over two decades of experience in trauma recovery. Lisa is a co-author of the original Unraveled Roots book and the former CEO of Support After Abortion. Her expertise spans complex issues such as abortion, foster care, addiction, codependency, sexual abuse, trafficking, and more.

“Her passion,” Kylee shared, “is revealing the root of dysfunctional behavior and helping people find freedom from early childhood trauma.”

This webinar was a collaborative, conversational exchange between Kylee and Lisa — an immersive experience for attendees to reflect, learn, and grow in their ability to support clients by identifying when and how to make referrals to therapy or coaching.

Key Topics Include:

Distinguishing when clients benefit more from therapy vs. coaching
Essential self-reflection for peer providers and spotting trauma indicators
Best practices for warm referrals and defining what “coach” means
Navigating cases where abortion isn’t the presenting issue
Ethical boundary-setting and ongoing training for providers

Lisa opened the interview by expressing her gratitude and sense of full-circle connection in returning to the Support After Abortion platform. “I’ve been watching the comments in the chat and so many new friends and old friends… I’m grateful to be back here with you and to experience this chat out loud,” she said.

Kylee acknowledged that the topic was “long overdue” and increasingly relevant, pointing out the complexity of cases coming through Support After Abortion’s After Abortion Line. These cases, she explained, often surpass what can be addressed in peer counseling settings, whether one-on-one or in a group.

THERAPY VS. COACHING: CLIENTS SEEKING HEALING AFTER ABORTION

To launch the core discussion, Kylee asked Lisa to describe the key differences between therapy and coaching specifically for clients navigating abortion recovery.

Lisa began by emphasizing the importance of authenticity in her approach.

“It’s really important for me that you know how much I care before you know how much I know,” she said, underlining the role of humanity in her work.

Her professional background as a therapist is in uncovering the psychological “why” behind client behaviors. While at Support After Abortion, she completed coursework and training to also become a certified life coach. That helped her better understand the differences between therapy and coaching.

Lisa shared a foundational distinction she learned:

“A lot of times therapists are asking ‘why’ questions… trying to get underneath it. And coaches are looking to move forward and they’re asking different questions. They’re asking what and how questions.”

She explained that therapy tends to explore root causes and unresolved trauma, while coaching focuses on goal-setting and future-oriented growth from the client’s present state.

This shift in perspective was pivotal for Lisa, particularly as she reflected on her earlier roles in pregnancy centers and in executive leadership. She recalled questioning whether staff and peer liaisons in such settings were truly equipped to address clients’ emotional needs.

Her conclusion?

“It’s a ‘both, and.’ It’s ‘yes, it’s no,’ and it’s sometimes ‘maybe,’” indicating that the answer isn’t always clear-cut and often depends on the individual client’s situation and readiness.

3 QUESTIONS TO ASK YOURSELF AS YOU CARE FOR CLIENTS

This section of the webinar focused on essential self-reflection for lay people and peer liaisons working in abortion healing. Kylee invited Lisa to help articulate how someone without formal clinical training can support clients — and know when they may be stepping beyond their capabilities.

Lisa responded by grounding the conversation in compassion and caution:

“We don’t want to do harm. And I think in our own maybe limited understanding, in our limited healing, sometimes what we think is helping people can be actually hurting people.”

She emphasized the need for training, discernment, and clarity of role, particularly when supporting someone through trauma or emotionally intense situations. Lisa offered a three-pronged self-assessment that peer counselors and support volunteers should use before engaging with clients.

1. What is your intent behind helping people?

Lisa encouraged listeners to reflect deeply:

Is your motivation based on personal experience, such as “somebody helped me, so I want to help others”?
While admirable, that motivation alone isn’t enough. “It’s not about you,” Lisa reminded the audience.
Instead, explore “what about helping people helps people?” and whether your presence is truly focused on the client’s growth.

2. What work have you done to equip yourself?

She emphasized that unprocessed personal issues can limit your effectiveness:

“You can’t sit with somebody else’s junk if you haven’t sat with your own.”

Lisa explained that your ability to walk with others is directly tied to how far you’ve gone in your own healing journey. Without that depth, it’s easy to unintentionally cause harm or become overwhelmed.

3. What is your training and plan for when you don’t know what to do?

Lisa urged every support provider to ask:

Do I know where to go when I’m out of my depth?
What happens when a conversation becomes uncomfortable or revealing?
Do I have a clear referral plan or a support network to lean on?

Without this preparation, the risk is that “you walk out of that room and not have anywhere to go — and that client is left to their own defenses.”

Kylee reflected on how impactful Lisa’s guidance had been for their team in the past, especially the phrase:

“Check your motivation.”

She noted that while the idea sounds simple, it’s a practice that requires constant revisiting.

“We were constantly as a team checking in with our motivation on each client, on each scenario,” Kylee shared, emphasizing that the alignment of intention and action was a shared responsibility.

Lisa agreed, broadening the application of this principle beyond client care:

“This goes everywhere: before you respond to an argument, before you discipline your child… get connected to yourself. What is my motive? And if it’s not pure, then we need to do some interior work.”

She concluded by reminding viewers that Support After Abortion is available to walk with them through this kind of reflection and discernment. For anyone wrestling with these questions, reaching out for guidance is both welcomed and encouraged.

THERAPY OR COACHING? WHAT TO LOOK FOR BEFORE REFERRING

Kylee guided the conversation toward the practical side of client care, asking Lisa to identify key indicators that help determine whether a client could benefit from therapy or coaching.

Lisa responded by stressing the importance of comprehensive pre-engagement assessment, rooted in understanding the client’s full story:

“We believe in knowing where people are coming from. What’s their history? What’s their history with suicidal ideation, what’s their history with violence?”

She explained that past patterns of behavior — especially involving trauma, abuse, or mental health issues — can be strong indicators of whether a clinical mental health approach is necessary. Revisiting trauma like abortion without this insight, she warned, could risk doing more harm than good.

Key indicators that suggest a need for therapy include:

History of suicidal ideation
Exposure to violence or abuse
Ongoing involvement in dysfunctional family dynamics
Substance abuse
A pattern of trauma responses repeating over time

Lisa gave a pointed example shared by multiple women involved in after abortion healing retreats. Many reported experiencing freedom and relief during the retreat, only to return home to unchanged, harmful environments — such as a violent partner or chaotic family system:

“If we don’t understand that those things are going on, it’s very hard to navigate whatever’s next.”

This context, Lisa stressed, is crucial for setting expectations and planning follow-up care. Otherwise, providers may be left wondering, “Why didn’t the client call us back?”

On the other hand, coaching may be appropriate when:

The client is functioning well in most areas of their life
The abortion experience resurfaces spontaneously due to a story, video, or personal trigger
There are no active safety risks or unresolved complex trauma interfering with daily life

Lisa described this as “an entirely different conversation,” where the client is ready to move forward and simply needs a space to process what’s come up.

“That’s where I would see more of a coaching circumstance, Kylee.”

Kylee then introduced a real-life scenario from the After Abortion Line:
A woman was grieving years after her abortion but continued to function in her everyday life. She asked Lisa whether this pointed more toward therapy or coaching.

Lisa answered:

“If this client is really firing on most cylinders in their life… and it really just feels like this resurrected itself in the abortion space, I’d say a coaching experience would be perfectly suitable.”

Her response highlighted the importance of contextual assessment, not just emotional presentation. A client’s capacity for stability and self-awareness plays a critical role in choosing the appropriate support path.

COACHING OR THERAPY: IT’S NOT BLACK & WHITE

Kylee paused the discussion to draw attention to the language she and Lisa were intentionally using—specifically the phrasing “benefit more from therapy than coaching” or vice versa. She emphasized that these distinctions are not meant to be absolute, but rather to guide thoughtful consideration.

Lisa affirmed this nuanced approach, deeply appreciating Kylee’s sensitivity to word choice:

“When I say benefit more, it’s not either/or, it’s both and more.”

Lisa reiterated that determining whether a client would benefit more from therapy or coaching isn’t always a clear-cut decision.

Instead, it involves considering a range of contextual factors, such as:

The client’s preferences and readiness
The timing and availability of services
Whether the setting is faith-based or secular
Whether the healing is for an individual, couple, or group
The specific expertise of the available provider

In speaking to client preferences, Lisa shared that “there are so many pathways that we can take,” and some help is better than no help. So while a client may prefer one type of care — for example a “focused abortion healing group” — what’s available may be different — for example a therapist with specialization in abortion healing. And that is still a valuable option.

Ultimately, Lisa reminded attendees that this work is rarely about drawing hard lines. It’s about meeting people where they are, making thoughtful referrals, and staying flexible.

WHAT’S A “CERTIFIED COACH”?

Continuing the theme of precision in language, Kylee asked Lisa to explain what she means when she uses the term “coach,” given the term’s broad and sometimes ambiguous usage. Kylee noted that in today’s culture, “coach” can refer to everything from youth sports leaders to internal organizational mentors—so it’s important to clarify the professional context in which Lisa uses the term.

Lisa responded by highlighting a significant challenge in the coaching world:

“Coaching still is highly unregulated.”

She explained that many individuals identify as coaches based solely on personal experience — such as recovering from addiction or navigating life transitions — without any formal training. While she acknowledged that this isn’t always a negative thing, Lisa advocated for greater standardization and oversight. She shared that she personally did not feel comfortable referring to herself as a “coach” until she was credentialed.

Lisa detailed her experience earning a credential from the Professional Christian Coaching Institute (PCCI), describing it as a rigorous process akin to a semester of graduate school. She completed four courses, 18+ months of study and extensive practicum experience.

She was one of the few participants with an advanced degree, noting that others came from diverse backgrounds — pastors, second-career professionals, and parents returning to the workforce.

Lisa emphasized that when someone identifies as a coach, it’s fair — and necessary — to ask,

“Where did you get your training? What creates the coach in you?”

SCENARIO: CLIENT SEEMS OKAY EMOTIONALLY, BUT STUCK

Kylee then presented a common group dynamic scenario: A client appears outwardly fine, consistently attends the group, but avoids discussing her abortion experience. She may joke or change the subject when it’s mentioned, yet continues to return week after week. Kylee asked how facilitators might discern what this means.

Lisa approached the question from her therapist perspective, emphasizing that behavioral patterns often signal deeper emotional defenses:

“How we do one thing, we do all things.”

The client’s avoidance of emotional engagement and use of humor as a deflection suggested to Lisa that the individual had likely developed this coping strategy long before the abortion.

She explained:

This could be a defense mechanism formed in childhood
It may indicate a history of trauma, even if not overt abuse
The emotional disconnection may appear in many areas of the client’s life, not just abortion

“There’s something way deep underneath the surface. The root of that behavior started decades before we encountered her.”

BIG T TRAUMA VS. LITTLE T TRAUMA

To provide further context, Kylee asked Lisa to define the difference between “Big T” and “little t” trauma — an important distinction in trauma-informed care.

Lisa explained:

Big T Trauma:

Typically single, significant events
Examples: A car accident, the sudden loss of a caregiver, or abandonment by a trusted teacher
These experiences may reshape a person’s entire perception of safety and trust

“It doesn’t have to be abuse… It’s all about perception.”

Little t Trauma:

Chronic, repeated experiences that create emotional wounds over time
Examples:
- A parent repeatedly calling a child “stupid”
- A parent consistently breaking promises or failing to show up
This is what Lisa described as “a cut by a thousand paper cuts”

“Little t traumas… create a deep wound inside of you that leads you to not trust people, not trust yourself, and find alternative ways of coping.”

SCENARIO: CLIENT CRYING BUT SAYING THEY’RE FINE

Kylee presented another scenario — one many peer support group facilitators have encountered. A participant regularly cries during the group but insists she’s fine. She shows little progress over time. Kylee asked Lisa how a facilitator should approach this situation.

Lisa offered two interpretations:

“It could be really positive, it could also be detrimental.”

1. This could be genuine grief:

The client may be experiencing emotional safety for the first time
Her crying could be an authentic release of long-suppressed feelings
In abortion healing, disenfranchised grief is common — communities often fail to hold space for it

“Maybe nobody has ever held emotional space for them.”

2. Or it could be a maladaptive coping mechanism:

The tears may mask an inability to verbalize pain
It could reflect emotional avoidance rather than processing

Lisa stressed that facilitators must discern not only the individual’s needs but also the group’s dynamics.

“It’s group over the individual in our abortion healing spaces.”

If one person’s persistent crying hinders the group’s progress—particularly among members with people-pleasing or codependent tendencies—it may be necessary to explore alternative support options for that individual.

“We might want to consider the group in that situation and… what the other alternatives might be to support her.”

This approach ensures that both individual care and group healing are honored in the process.

PERMISSION TO PIVOT FOR ABORTION HEALING GROUP FACILITATORS

Kylee emphasized a powerful takeaway for group facilitators: the permission to pivot. Even with a well-designed intake process and thorough vetting, new information can emerge that shifts the trajectory of a client’s healing journey.

“With new information, sometimes we need to do new things—not necessarily jump to a new conclusion,” Kylee explained.

Lisa affirmed this mindset, noting that rigid agendas can limit authentic, transformative encounters:

“If we have an agenda, and the only thing we’re worried about is answering those 10 questions at the end of the chapter, we are going to miss the mark.”

She encouraged facilitators to come in with a loose structure, but stay present to what unfolds:

Be willing to follow emotional depth over scripted questions.
Stay attentive when clients reveal significant new details, such as disclosing a second abortion for the first time.

“If you go back to question number three after a moment like that… oh man, we’ve missed it,” Lisa cautioned.

Practical advice for facilitators:

Engage in one-on-one follow-ups outside group settings when deeper needs arise.
Address disruptive or emotionally overwhelming patterns with care and clarity, even in front of the group: “We want to hold space for you, but maybe there’s a different place or way that we can do that.”

Lisa reassured facilitators that this kind of direct but loving boundary-setting is not only acceptable — it’s often appreciated, sharing that clients will sometimes say:

“Thank you for finally naming what I’ve got going on with love and kindness.”

She reminded attendees that part of growing as a facilitator means seeking support and mentorship when faced with challenges beyond their current skills.

WHEN ABORTION ISN’T THE PRESENTING PROBLEM

Lisa offered a candid reflection from her own experience:

“Most of the folks that come to me, [abortion’s] not the presenting problem.”

Lisa explained that, while clients in pregnancy centers often arrive ready to address their abortion experiences directly, in private practice or general coaching environments, abortion and pregnancy loss are rarely what clients lead with. Instead, they may present with:

Relationship issues
Parenting struggles
Identity challenges in motherhood

These clients may not even realize that unresolved abortion, miscarriage, or adoption experiences are contributing to their current emotional or relational pain.

“They’ve stuffed those things so far down inside of them… it doesn’t even occur to them that their abortion, their miscarriage, their stillbirth, their adoption experiences would even be what is occurring for them in this current season of their life.”

Lisa explained that while these clients might check a box on intake acknowledging a past abortion, they often quickly minimize it:

“That was 20 years ago…”

“That doesn’t bother me…”

“It was necessary…”

But as the therapeutic or coaching relationship deepens, Lisa may revisit that part of their story:

“Remember the conversation we had? How does that maybe impact [what you’re experiencing now]?”

This approach can be revelatory for clients, who often hadn’t connected their current struggles to that earlier loss:

“Whoa, I didn’t even put that together.”

Lisa’s insights underscored a crucial truth for abortion healing providers: the deeper issues related to abortion often emerge gradually, and healing often begins in places the client least expects.

WHEN CLIENTS SAY “THERAPY DIDN’T WORK”: WHAT TO DO NEXT

Kylee raised a common challenge for providers: how to respond when a client resists a therapy referral by saying, “I’ve already been to a therapist and it didn’t work.”

Lisa offered a reflective approach:

“Holding space… allowing them to tell us what’s going on.”

Rather than immediately countering the client’s reluctance, Lisa suggested gently exploring their past experience.

Ask open-ended questions like:

What happened during that time?
What didn’t work for you?
What was it like for you?

These questions often help clients hear themselves more clearly—and may lead them to recognize that the issue wasn’t therapy itself, but the circumstances around it. Common examples include:

Only attending one or two sessions
Not connecting with the therapist’s gender or approach
External life stressors (e.g., divorce, moving) that interfered

Once a client begins to identify those factors, Lisa recommended a subtle reframe:

“What might it feel like to challenge that thought and consider the referral we’re making?”

She emphasized that this kind of breakthrough happens not through persuasion, but through curiosity, presence, and listening—what Kylee called one of Support After Abortion’s hallmark phrases: “Remain curious.”

HOW TO ASSESS A CLIENT’S EMOTIONAL AND MENTAL HEALTH FOR THERAPY

Kylee then asked how Lisa evaluates whether a client is in the right emotional and mental space for therapy.

Lisa explained that her practice begins with a structured initial consult that includes key screening questions. This helps determine whether her team’s services align with the client’s needs.

She outlined clear boundaries for cases her team is not equipped to serve, including:

Clients in active addiction
Clients with ongoing suicidal ideation
Clients with severe mental illness

“We are just very good about defining what our specialties are, what our gifts and talents are, and not going outside of that.”

Lisa spoke candidly about her own introspective process as a clinician, identifying moments where the work feels natural, aligned, and not burdensome. This inner clarity helps her and her team stay grounded in their purpose.

“We just know who we serve. Period. End of story.”

Even when facing pressure — such as a former client pleading for help for a loved one — Lisa remains firm if the fit isn’t right:

“It’s a no, because I don’t want to do more harm, and I don’t want to lead people on.”

This discernment, she explained, stems from a commitment to authenticity, vulnerability, and transparency. Clients know what they’re signing up for, and there’s no bait-and-switch.

“What I’m hearing is a therapist is not a therapist is not a therapist. A coach is not a coach is not a coach,” Kylee stated.

Each provider’s style, training, and boundaries are unique — and clients deserve to find the right fit.

Lisa closed the section with a vulnerable and important example: she receives therapy inquiries from men her age, many of whom are not appropriate clients.

She shared that through real-life experience, she’s had to draw firm lines:

She does not serve men individually
She will work with men only as part of a couple’s dynamic connected to an existing female client

This boundary is not only for her own safety, but for the integrity of the therapeutic space:

“The minute that’s breached, because there’s ulterior motives, we’re not going to get any work done.”

Lisa’s transparency served as a powerful reminder to fellow providers: it is not only acceptable — but essential — to define your scope, protect your practice, and honor your limits in the service of ethical, effective care.

BEST PRACTICES IN REFERRING CLIENTS TO THERAPY

Lisa opened this section with a practical question: What makes a good referral to a therapist? Drawing from her experience at Support After Abortion, she emphasized that the process of referral should feel integrated and warm—not abrupt or disconnected.

“You can have the most perfect intake… and then when you get into it, you learn new things… With new information, sometimes we need to do new things.”

Lisa described a common client reaction: they share deeply with a coach or group, and then feel disheartened when asked to start over with a therapist. The experience can feel like a cold handoff if not handled carefully.

Instead, Lisa recommended:

Making the referral feel like a continuation of care, not a restart
Contacting the therapist ahead of time or helping the client make the first call
Avoiding giving a client an impersonal list of providers to contact whenever possible

Kylee affirmed that Support After Abortion uses a “warm handoff” model, where staff contacts the therapist before the introduction and communicates clearly with the client about what to expect.

She stressed the importance of addressing stigma around therapy, especially within the abortion healing space:

“We make sure that connection is going to be successful because of all of the stigma attached to seeking mental health help.”

Lisa added that follow-up is essential:

Ask clients: “Did you make the connection? How’s it going?”
Stay accountable and supportive

Kylee expanded on this by sharing that two-way communication is often what creates the best outcomes. When a therapist or coach gives feedback—positive or negative — it helps the team continue learning and refining the referral process.

“Sometimes we could have anticipated that… Other times, something came out in a consult that [the client] didn’t tell us.”

Kylee noted that not all clinicians feel equipped to handle abortion-related issues:

“We receive requests from clinicians who don’t feel that they have the capacity to serve somebody with their after-abortion support needs.”

HOW AFTER ABORTION TRAINING HELPED ME SUPPORT MY CLIENT

In closing this segment, Kylee invited Lisa to offer guidance for therapists and coaches seeking to better understand the unique needs of clients processing abortion.

Lisa’s answer was direct:

“My immersion was through Support After Abortion.”

She credited the organization’s comprehensive training and collaborative experiences — particularly co-leading groups with seasoned facilitators — as foundational to her own growth.

While personal experience with abortion can bring empathy, Lisa emphasized that training matters just as much — if not more:

“I think that there’s this real essence of the training that we’ve developed at Support After Abortion that has really given a handle to all of this that I hadn’t seen anywhere else in my industry.”

For mental health professionals ready to deepen their knowledge and better serve clients with abortion in their history—even when it isn’t the presenting issue—Lisa recommended starting with the valuable training Support After Abortion offers providers.

Q&A

The webinar concluded with a thoughtful and candid Q&A session, where Kylee posed several audience-submitted questions to Lisa, offering a deeper dive into the practical realities of supporting clients in abortion healing.

Q: How can we find a local therapist or coach who understands abortion healing?

A: Lisa suggested a multifaceted approach:

Build local connections: She emphasized reaching out to local churches, pastors, and women’s ministry leaders. “I’ve sat down with many pastors… and we’ve really gotten to know each other in that way.”
Online directories: Psychology Today and local Chamber of Commerce listings can be useful starting points, even if abortion healing isn’t explicitly listed as a specialty. Making a call can uncover more than a website reveals.
Community involvement: Some regions host therapist roundtables or monthly gatherings. Lisa encouraged providers to attend — or even present — to raise awareness of abortion healing needs.

“The majority of therapists are not inclined to say they have training in abortion healing.”

Q: Is it okay for someone to be in both a support group and therapy at the same time?

A: Lisa answered affirmatively, but shared a few caveats:

The services should be complementary, not contradictory.
Consider the client’s emotional bandwidth and ensure they aren’t overwhelmed.
In some cases, clients may process new insights in therapy that emerge during the group, creating a productive feedback loop.

“If it’s elevating the experience, go for it… But make sure the client understands what they’re signing up for.”

Kylee added that Support After Abortion practices transparency with therapists:

“When we are placing people in groups, we ask [if they are currently seeing a therapist]. And we also ask, to make sure that there’s transparency, that the therapist is aware that they’re in a group. We have found that to be very beneficial.”

Q: What if a team member is emotionally over-invested in a client?

A: This question sparked one of Lisa’s most urgent responses:

“We are absolutely… responsible to uphold the ethics of our profession and our clients.”

She explained that when a team member is too attached or unable to maintain professional boundaries, action must be taken to protect the client — even when it’s difficult. This includes:

Acknowledging blind spots and inappropriate behavior
Activating protocols and safeguards
Prioritizing client safety over personal relationships

“You’ve got to see the client’s safety first. Not your colleague. Not your peer.”

Lisa and Kylee reflected on their own experience navigating similar scenarios, emphasizing the value of having a Code of Ethics and clear policy frameworks in place.

Kylee referred to the Code of Ethics for Abortion Healing Providers that Support After Abortion offers.

“Because the last thing that you want to do is to be in the situation that you’re trying to correct, building policy and protocol. And so one of the things that feels very safe is to already have that framework.”

WRAP UP

As the session came to a close, Kylee invited Lisa to share parting thoughts.

Lisa’s closing message was both personal and motivational:

“You’re not here on accident… Whatever piece of today stuck with you — a positive challenge, whatever it is — don’t ignore it.”

She encouraged providers to stay curious, reflect on what they learned, and take action:

Ask: What did I need to hear today?
Examine systems and personal readiness if clients aren’t showing up
Remember: “When we sit with our stuff… we can then sit with other people.”

“I hope that there’s something that each one of you can take away from today that will encourage you or support you moving forward.”

NEXT STEPS

Click here to watch the video of this webinar.

Click here to explore our Code of Ethics resource.

Click here to register for the next Abortion Healing Provider webinar.

Click here to access Support After Abortion’s Resource Library.

Click here to explore Support After Abortion’s services, resources, and training for Abortion Healing Providers.