Should I Start Therapy, Coaching, or Both for Residency Burnout?

The debate between therapy and coaching for residency burnout is overrated. You probably need to decide what problem you’re actually trying to solve—not which label sounds nicer.

Here’s the core truth:
If you’re breaking down, feeling numb, or fantasizing about quitting medicine every call shift, you should start therapy.
If you’re functioning but stuck, resentful, or feeling wasted potential, you should consider coaching.
If both are true (which is common in residency), doing both is not overkill. It’s smart.

Let me walk you through how to make a clean, rational choice—without sugarcoating what residency is doing to you.

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1. Start with one brutal question

Ask yourself this, honestly:

“Am I primarily struggling with my mental health, or with what I’m doing and how I’m doing it?”

If your first reaction is, “Both, obviously,” that’s fine. But separate them anyway:

• Mental health = mood, anxiety, sleep, trauma, feeling broken, hopeless, unsafe, out of control.
• Performance / direction = time use, boundaries, career path, leadership skills, conflict with attendings, stepping into being an attending someday without imploding.

Here’s the simple rule:

• Lean therapy if you’re not okay.
• Lean coaching if you’re okay-ish but unsatisfied or stuck.
• Do both if you’re high-functioning but on fire inside.

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2. What therapy actually does for residency burnout

Forget stereotypes about “talking about your childhood for years.” Good therapy for residents is ruthless, practical, and targeted.

Therapy is best when you’re dealing with:

• Persistent anxiety or panic about work
• Depressive symptoms (numb, hopeless, detached, crying in the call room)
• Thoughts like “If I got hit by a bus, that would be easier”
• Moral injury (“What we’re doing to patients feels wrong, and I’m complicit”)
• PTSD-ish stuff (codes, bad outcomes, abusive attendings, repeated trauma)
• Burnout that’s now affecting sleep, appetite, relationships, or self-worth

Therapists can help with:

• Diagnosing real conditions (anxiety, depression, PTSD) that masquerade as “just burnout”
• Medication referrals (if they’re psychiatrists or work closely with one)
• Evidence-based tools (CBT, ACT, trauma therapy) tailored to shifts, call, and clinic life
• Untangling old patterns that residency is brutally exploiting—perfectionism, people-pleasing, fear of authority

Think of therapy as:
Stabilize the system. Reduce suffering. Restore your ability to think clearly about your life.

If any of this sounds uncomfortably familiar, therapy shouldn’t be optional:

• You dread going to work almost every day, and it’s been that way for months.
• You’re using alcohol, weed, or meds to “shut your brain off” most nights.
• You have intrusive memories of specific events (codes, deaths, shaming, lawsuits).
• You’re having thoughts of self-harm or “not wanting to be here.”

That’s not just burnout anymore. That’s mental health damage. And it’s very treatable—with therapy.

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3. What coaching actually does (when it’s done right)

Coaching is not therapy-lite. Good coaching assumes you’re basically okay—but stuck in a bad system, bad habits, or bad assumptions.

Residency coaching is powerful for:

• Career direction: “Do I do fellowship? Switch specialties? Go nonclinical?”
• Boundaries: Saying no to unnecessary committees, extra shifts, endless charting at home
• Time and energy: Finishing notes before leaving, structuring your week, not drowning in inboxes
• Leadership and relationships: Handling difficult attendings, program directors, or colleagues
• Identity: Moving from “overachieving med student” to “actual physician with agency”

Coaching tends to be:

• More future-focused than past-focused
• More about experiments and action steps between sessions
• Less about diagnosis, more about patterns and choices
• Often shorter-term and more structured (e.g., 6–12 sessions)

Think of coaching as:
Upgrade the software. Optimize how you’re working, deciding, and leading.

You might be a good fit for coaching if:

• You’re functioning, but running on resentment and caffeine.
• You want to feel less like a victim of the system and more like an active player.
• You know you want something different from your career but can’t articulate what.
• You’re tired of complaining and ready to actually change how you operate.

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4. Therapy vs coaching: side-by-side for residents

Here’s the cleanest way to compare them.

Feature	Therapy	Coaching
Main focus	Mental health, symptoms, healing	Performance, goals, direction
Best for	Anxiety, depression, trauma, severe burnout	Boundaries, career choices, leadership
Orientation	Past + present + internal	Present + future + practical
Can diagnose/medicate?	Yes (if licensed/psychiatry)	No
Insurance coverage	Often yes	Usually no
Typical duration	Months to years	Weeks to months

If your residency program offers one but not the other, use what’s available now. Perfect is the enemy of “not miserable anymore.”

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5. How burned out are you really? A quick reality check

Let me give you a simple self-scan. No psych degree required.

Answer each of these for the past 2–4 weeks.

Mental health red flags (therapy territory):

• I wake up with dread most days.
• I feel emotionally flat, detached, or like “this is all pointless.”
• I cry during or after shifts at least once a week.
• I avoid friends/family because I have no energy.
• I’m using substances to cope more than I’m comfortable admitting.
• I’ve thought, “If something bad happened to me, at least I’d get a break.”

If you’re saying “yes” to 2–3 of those consistently, stop arguing with yourself. Therapy.

Function / performance pain points (coaching territory):

• My notes and inbox follow me home constantly.
• I can’t say no to anything without feeling like I’ll be punished.
• I have no clear idea what I want from my career anymore.
• I feel stuck in the same conflicts with attendings or co-residents.
• I want to change things but keep falling back into old patterns.

Here, 2–3 yeses? Coaching could actually move the needle.

If you’re high on both lists, that’s not a failure. That’s residency plus a broken system. And it’s exactly when therapy + coaching together makes sense.

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6. When both therapy and coaching make sense

Here’s the scenario I see all the time:

You’re not in crisis, but close. You’re mentally frayed, exhausted, unhappy. You’re still showing up, doing your job, maybe even performing well on paper. PD loves you. Nurses trust you. Inside, you’re thinking: “If this is my life for 20 more years, I’m out.”

If that’s you, here’s a realistic combo:

• Use therapy to:

  • Lower the emotional temperature.
  • Process trauma and moral injury.
  • Address perfectionism, guilt, shame, self-criticism.
  • Shore up sleep, anxiety, and basic functioning.

• Use coaching to:

  • Decide what kind of physician you actually want to be.
  • Build boundaries and say “no” without exploding your evals.
  • Plan your next 1–3 years with intention (fellowship, job search, pivot).
  • Experiment with new ways of working that don’t drain you dry.

Think of it like this:

Therapy gets you back to baseline human.
Coaching helps you become a sustainable physician.

You do not have to sequence them perfectly. You can:

• Start therapy now, add coaching later.
• Do coaching now, then realize “yeah, I need therapy too.”
• Do both for a short period, then taper one.

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7. Practical constraints: time, money, and residency reality

Let’s be blunt: residency doesn’t exactly hand you unlimited free evenings and cash to work on yourself.

Time

You’re thinking: “When am I supposed to do this? Between sign-out and my third admission?”

Here’s how people actually make it work:

• 30–50 minute virtual sessions during admin time, post-call, or lighter rotations.
• Protected wellness time (some programs pretend, some actually allow).
• Early morning or evening telehealth.
• Every 2 weeks instead of weekly if your schedule is brutal.

If a provider does not understand “night float,” “24+4,” or “clinic plus call,” find one who works with medical trainees regularly. You’re not their first resident; you shouldn’t have to educate them on the basics of your life.

Money

Rough ranges you’ll actually see:

Typical Monthly Cost: Therapy vs Coaching for Residents

Category	Value
Insurance therapy	80
Private-pay therapy	600
1:1 coaching	800
[Group coaching](https://residencyadvisor.com/resources/residency-burnout-prevention/how-do-i-build-a-personal-burnout-prevention-plan-that-ill-actually-use)	250

Rough translation:

• Therapy with insurance: Often $10–$40 per session, sometimes fully covered.
• Private-pay therapy: $120–$250 per session depending on city and training.
• 1:1 coaching: $150–$400 per session; some do package pricing (e.g., 6 sessions for $1200).
• Group coaching: Much cheaper ($100–$300/month) and often resident-specific.

Also check:

• GME / hospital wellness benefits (a shocking number of residents do not know what’s actually available).
• EAP programs: short-term, free therapy or counseling—sometimes a decent bridge.
• State or specialty societies with subsidized mental health support.

If money’s tight, my order of operations:

1. Use whatever free / low-cost therapy is already available to you.
2. Then, if you still want more structured performance support, add short-term coaching or a group program.

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8. How to choose the right therapist or coach (not just any warm body)

Here’s the part people mess up: who you work with matters a lot more than which label they use.

For therapists, look for:

• Experience with physicians, residents, or other high-intensity professions
• Familiarity with trauma, burnout, anxiety, depression
• Someone who doesn’t flinch when you say, “I thought about driving into a guardrail yesterday”

You can literally ask:

• “How many residents or doctors have you worked with?”
• “How do you approach burnout and moral injury?”
• “Are you comfortable coordinating with occupational health or my PCP if needed?”

For coaches, look for:

• Actual training or credentials in coaching (not just “I burned out once, now I coach”)
• A clear process or framework—not just random pep talks
• Experience with medical trainees or physicians

Ask:

• “What kind of residents do you usually work with?”
• “What specific outcomes have your clients achieved?”
• “How do you handle it if something feels more like a therapy issue?”

If they get defensive when you ask about their boundaries with therapy vs coaching, that’s a red flag. Move on.

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9. So what should you do this week?

Here’s a straightforward action plan:

1. Decide your primary need right now:

   • “I’m not okay” → Start by finding a therapist.
   • “I’m okay, just stuck/frustrated” → Start by finding a coach.
   • “I’m hanging by a thread but still functioning” → Start therapy; plan to add coaching in 1–3 months.

2. Use existing resources first:

   • GME office / wellness director
   • Hospital or university mental health
   • State physician health programs (confidential in many places)

3. Book one consult in the next 7 days. Not five. One. See how it feels.

4. After 3–4 sessions, reassess:

   • Am I sleeping better? Less overwhelmed? → Therapy’s helping.
   • Am I making better decisions about my time and career? → Coaching’s working.
   • Do I still feel like one big piece is missing? → Consider adding the other modality.

You do not need to architect your entire recovery right now. You just need to stop white-knuckling residency alone.

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Decision Flow: Therapy, Coaching, or Both for Residents

Step	Description
Step 1	Resident feeling burned out
Step 2	Therapy first
Step 3	Coaching first
Step 4	Option to add coaching for goals
Step 5	Adjust therapy or consider higher level care
Step 6	Continue coaching for performance
Step 7	Am I basically OK or not OK?
Step 8	Function and clarity improving?
Step 9	Mental health worsening?

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FAQ: Therapy vs Coaching for Residency Burnout

1. If I start therapy, will it hurt my career or licensing later?
In most places, getting therapy alone does not automatically harm licensure. What boards usually care about is current impairment, not whether you sought help. Many licensing forms are being updated to focus on “current conditions affecting your ability to practice” rather than “have you ever had treatment.” If you’re worried, check your state board’s current language or talk confidentially with a physician health program.

2. Can a coach replace a therapist for burnout?
No, and any coach who implies that is someone you should avoid. Coaches are not trained or licensed to treat depression, anxiety disorders, PTSD, or serious burnout that borders on breakdown. They can be extremely helpful for structure, decisions, and performance—but they should stay in their lane. If you’re struggling to get out of bed or having dark thoughts, that’s therapy territory.

3. What if my program only offers coaching but I clearly need therapy?
Use the coaching if it’s supportive, but do not let that be your only resource. Look for independent therapy through your hospital, university, insurance panel, or community providers. You’re allowed to need both. If cost is an issue, ask explicitly about low-fee or resident-focused services; many large academic centers have them and barely advertise them.

4. Is group coaching or group therapy worth it for residents?
Group formats can be incredibly powerful because you finally see you’re not the only one cracking under pressure. Group therapy is better for emotional processing and support; group coaching is better for skills, strategy, and accountability. Many residents do a mix over time. If schedule or money is tight, groups are often the most realistic starting point.

5. How long should I stay in therapy or coaching during residency?
You do not need a lifetime contract with either. For therapy, aim for a trial of 8–12 sessions before judging it; you can always continue if it’s genuinely helping. For coaching, many residents see real changes in 6–10 sessions, especially if they do the work between meetings. Expect your needs to change as you move from intern year to senior to job/fellowship search.

6. What if I start and just feel awkward or like it’s not helping?
Normal. The first 1–2 sessions are often clunky; you’re giving history, they’re getting oriented. The real test is after about 3–4 sessions: do you feel even slightly more hopeful, understood, or clear? If not, change providers. You’re not obligated to stay with someone who isn’t a good fit. Residents tolerate bad support way too long because they’re used to suffering; you do not need to do that here.

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Key takeaways:

1. If you’re not okay—sleep, mood, safety—start therapy. That’s not negotiable.
2. If you’re basically okay but stuck, resentful, or lost, coaching can help you rebuild how you work and where you’re going.
3. Many residents benefit from both: therapy to stabilize, coaching to strategize. Start somewhere this week; suffering alone is optional, even in residency.