When Thinking Isn't Enough
Why executive coaching sometimes needs to work with more than the thinking mind
A special report for executive and leadership coaches
Andre DuqueminFounder, Embodied PerformanceMost of us were trained to coach through conversation.
We ask good questions. We help clients step back from a problem, see something they couldn't see before, challenge an assumption, clarify what matters and work out what they're going to do next.
And for a great many clients, this works extremely well.
I want to start there, because this report isn't an argument against cognitive coaching. I've been an executive coach for years, I use these tools in my own practice all the time, and a good question is still one of the most valuable things we can offer a client.
What I've become more and more interested in is a slightly different question.
What happens when the person sitting in front of you doesn't have full access to the thinking those tools depend on?
Perhaps they're overwhelmed and talking at twice their normal speed.
Or perhaps they're the harder client to spot: composed, articulate, and apparently functioning perfectly well, but somehow not quite present and ready to be coached.
You ask a good question and get a perfectly sensible answer, then ask another and get another perfectly sensible answer. The session moves forward, but something about it feels slightly off.
I'm Andre Duquemin. I've spent the last twenty-five years working at the intersection of the nervous system, the body and executive coaching, and I've become convinced that one of the most useful things we can add to our coaching is the ability to notice the state of the person we're working with, and to let that inform where we begin.
The very same coaching question can be extremely useful for one client and land quite differently with another. Often, the difference between asking a question that helps the client move forward and one that simply doesn't land is the state of the person you're asking.
Sometimes a question is exactly the right intervention. Sometimes another way in would be more useful.
The skill is recognising the difference.
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When Thinking Isn't Enough
Why coaching leans towards thinking
Executive coaching has traditionally leaned towards thinking, and for good reason.
Much of what experienced coaches have been trained to do involves thinking: reflection, questioning, perspective, insight, goal-setting, planning, strategy, action, and accountability.
None of that is controversial. It's a large part of what coaching is, and when a client has the capacity to reflect, think flexibly and make use of the coaching conversation, it can be extraordinarily effective.
Where it gets more interesting is when we assume that, because somebody can still think, then thinking must be the best place to begin.
A senior leader can still chair a meeting, make decisions, answer emails and give you an intelligent account of what's happening while operating under considerable physiological and emotional pressure.
But that doesn't tell you how much capacity they have available for the kind of reflection you're asking them to do.
Think about a client arriving after a difficult week. Their organisation has just announced another restructure. They've barely slept. They've been moving from meeting to meeting all day and spent the ten minutes before your session dealing with a problem that's blown up in their team.
They sit down, and you ask:
“What would you like to get from today?”
It's a perfectly good coaching question, and very often it's exactly the right one.
But there's another question worth asking yourself first:
What state is this person in right now?
If they're overwhelmed, shut down, or simply running very close to the edge, you may find that another clever question doesn't get you very far. It may be more useful to help them find a little more capacity first, and then return to the coaching work you already know how to do well.
There's nothing wrong with starting with thinking, provided thinking is accessible.
Why this matters even more now
I'm not going to argue that leaders today are uniquely stressed, that work used to be straightforward, or that the clients we coached fifteen years ago had easier lives.
We can't really prove any of that, and I'm not claiming the research shows it either.
But what we can see quite clearly is the environment in which many leaders are operating now.
And the client who turns up for their session brings the previous ten hours with them.
They bring the meeting they've just left, the argument they had yesterday, the restructure nobody can explain, the inbox they haven't cleared, and the decision they know they need to make but can’t seem to actually act on.
Sometimes they'll tell you all of that, but sometimes they won't.
Which is why I don't think the answer is simply to give coaches more techniques. Most experienced coaches already have plenty. Expertise is knowing when, why and how to use the ones you have.
What we need first is a better way of reading the client's state, and for that it helps to have a map.
Read the State
The Performance Spectrum
The map I use for this is something I call the Performance Spectrum.
Before deciding what work to do with a client, it helps me answer a more basic question:
Where is my client right now?
The horizontal axis represents increasing pressure or stress. The vertical axis represents performance, running roughly from −5 at the bottom to +5 at the top.
At first, increasing pressure can support performance. It can give us energy, focus and momentum. Under the right conditions, we may move towards the top of the curve, into a highly focused state where we're performing at our best.
This matters because the aim isn't to remove all pressure from our clients’ lives or to regulate everyone into a state of calm.
But there comes a point where adding more pressure can stop helping.
As demand continues to increase, performance may start to decline on the other side of the curve. The person might still be functioning perfectly well, but they're having to work harder to do it. Their capacity for perspective may start to narrow. They can become less flexible, more reactive and perhaps more easily distracted or less able to recover when something goes wrong.
Keep going, and eventually the demands placed on the person can begin to exceed the capacity they currently have.
Performance can then fall through zero and into the negative part of the spectrum.
That's where the idea of the Window of Regulation becomes useful.
Underneath the model is the way the nervous system responds to pressure and arousal, but you don't need the physiology to use it. In simple terms, the window is the range within which someone can experience pressure while still having enough capacity available to work with it.
And that word “available” matters.
We're interested in how much of their capacity they can actually access in this particular moment, rather than how capable they are as a person.
This is why I call the Performance Spectrum a map rather than the territory.
The −5 to +5 scale isn't a scientifically validated measurement instrument, and I'm certainly not suggesting you can look at a client and decide they're at precisely −2.6. It's a practical coaching heuristic that helps us orient ourselves to the person we're coaching.
Because the relationship between pressure and performance isn't fixed.
Two executives can face similar organisational demands yet be in quite different places on the spectrum.
Under pressure but energised, thinking clearly and ready to work.
Struggling to access the flexibility and perspective they would normally have.
The organisational problem could be exactly the same, but the place I begin coaching them probably wouldn't be.
Given where this client is right now, where should I enter the work?
But before we get there, there's another part of reading a client's state that's worth looking at.
State and Story
So how do you know where a client is?
You can't know for certain, but you can get much better at noticing the information that's already available to you in session.
I've come to think about this through two things: the client's story and their state.
STORY
What is my client telling me?
This is the part we're already very good at listening to as coaches.
The client tells us what's happening. They describe the difficult relationship with their CEO, the restructure, the decision they can't make or the conversation they're avoiding.
None of that changes, but there's another source of information available at the same time.
STATE
What am I noticing in the person in front of me?
How are they actually showing up while they're telling you the story?
Perhaps they're speaking much faster than usual, jumping between subjects and finding it hard to stay with a question.
Or perhaps it's almost the opposite. Their energy seems unusually low, their voice is flatter, they're giving you very little detail, and something about the conversation feels harder to access.
None of these things tells you, on its own, what is happening.
We're not learning to look at somebody's posture or tone of voice and decide we know more about their experience than they do.
We're simply widening the information we're paying attention to.
And sometimes the interesting part is what happens when those two sources of information don't quite line up.
GAP
Where do the story and the state not quite match?
I had a client I'll call Alice who gave me a very good example of this.
Alice was a senior executive I'd been coaching for some time. She'd been through a difficult period at work involving somebody who had once been a close friend, and the situation had taken quite a toll on her.
Then things changed.
The other person was planning to leave the firm and, when Alice told me about it, her message was essentially that the problem had resolved itself.
She was fine, just tired.
If I'd listened only to the story, there wasn't much more to do.
But something about the way Alice was presenting didn't quite fit.
She offered almost no detail. When I asked how she felt about what had happened, she shut the subject down very quickly. I also noticed my own energy beginning to drop as we talked, something I've learned to pay attention to in my coaching.
It made me curious, and that gap felt worth noticing.
It's worth saying that the story isn't necessarily false, and the state isn't somehow revealing a hidden truth.
A client can genuinely tell you they're doing well while something about the way they're showing up makes you curious. Both things can be true.
Notice enough to become curious.
Know Where to Enter
Three entry pathways, three possible ways in
So, where should I enter?
I use three entry pathways to help me make that decision: Survival, Feeling and Thinking.
These aren't three types of client, and they aren't a fixed sequence. They're three different ways into the work, and the same client can move between them within a single conversation as their state changes.
There isn't a point on the Performance Spectrum that automatically determines the entry pathway.
Where I start depends on what seems to be available to the client I'm working with.
SURVIVAL
Body · State · Protection
The Survival pathway is where I pay particular attention to what's happening at the level of the body and nervous system: breath, posture, energy, and what the client is noticing both inside their body and in the world around them.
This becomes especially relevant when a client is so overwhelmed, activated or shut down that it's hard for them to make good use of the coaching conversation we'd normally offer.
Sometimes the useful place to begin is with the client's state itself, and that's where somatic work comes in. It might mean helping them settle enough to become more present, reconnect with what's happening in their body or simply recover enough capacity to engage with the conversation differently.
The aim is to help create enough capacity for the coaching to become useful again.
And as that capacity returns, you may find the client's emotional experience becomes more accessible too.
FEELING
Emotion · Experience · Meaning
The Feeling pathway is where I pay attention to the client's lived emotional experience of what's happening.
That's not meant as a literal biological sequence. State, emotion, and thought constantly influence each other in both directions. But as a coaching map, I've found the distinction extremely useful.
Because sometimes a client can tell you a great deal about a problem without really having access to their experience of it.
But ask them how they actually feel about it, perhaps even where they notice that feeling in their body, and something often changes.
Sometimes that's where the useful work is.
We're not trying to assign a fixed meaning to an emotion or tell the client what their feelings mean, but we are helping them get closer to their own experience so they can discover what matters to them about it.
This is why I think of Feeling as a bridge between state and story.
Sometimes the client needs enough capacity to access their feelings before they can make useful sense of what has happened.
And sometimes, once they can do that, they're ready to use their thinking in a way that is useful and productive for the coaching to move forward.
THINKING
Perspective · Cognition · Choice
The Thinking pathway is where most experienced executive coaches are already highly skilled.
In fact, with the right client in the right state, it may be exactly where you should start.
If that's who I'm working with, I don't need to take them through a grounding exercise simply because I've learned how to do one.
I coach them.
Embodied coaching can easily become associated with the idea that deeper work means getting somebody out of their head and into their body. I don't see it that way.
Thinking is 100% part of the model too.
It's about range
What you're actually working with is a human being whose state is constantly shifting.
The same executive may need you to enter through Survival in one session, through Feeling in another, and go directly into Thinking the next time you see them. You may even move between all three during the same session.
And this is probably the biggest change the model made to my own coaching.
Before I reach for anything, I want to know who I'm actually working with today, what seems available to them, and where the most useful way into the coaching work might be.
That might be somatic, emotional or cognitive: whichever fits your client in that moment.
So the better question isn't “What tool should I use?” It's:
“Where should I enter?”
Three Clients, Three Entry Points
Let's look at three clients I've worked with, and in particular the decision I made about where to begin with each.
Katie: when Survival came first
Katie was the client who first made me realise I couldn't keep the two halves of my professional life separate.
I'd qualified as an osteopath in 2001 and spent years adding somatic and nervous-system practices to that work. Then I trained as a coach and built a coaching practice alongside it.
Then, around 2016, Katie arrived.
She was a COO at a management consultancy, and she was at the absolute end of her tether. She'd been dealing with months of bullying from a boss who'd clearly crossed a line, and by the time she got to me, she was completely worn down.
She was overwhelmed, had difficulty getting her words out coherently, and frequently burst into tears.
I knew inside the first minute that my usual way into a coaching session wasn't going to work.
So I made a different decision. Rather than continuing to work through questions, I shifted into regulation work.
I helped her settle and ground using some of the nervous-system tools from the other half of my practice. For that first session, we just needed Katie to be able to get her story out into the open without the sensations, feelings and thoughts overwhelming her.
I should add an important qualification here. I was already an experienced clinician by this point, and that experience informed my judgement about what was happening with Katie and whether the work was appropriate. I wouldn't suggest a coach without that background simply makes the same call because they've read about regulation in a report.
Once her state began to settle, other choices became available.
She could start to work with her emotions without being completely flooded by them. Her thinking became clearer, and she could begin to notice her own thoughts rather than simply being swept along by them.
The coaching questions hadn't suddenly become better. Katie had become more able to use them.
I'd always thought of my somatic practice and my coaching as two different kinds of work. Katie made me realise that sometimes the work I'd previously thought of as separate from coaching was precisely what made the coaching possible.
Alice: when the entry point changed
We've already met Alice. Her story was that the problem had resolved itself. She was fine, but really tired.
But something about the way she was presenting made me curious.
That was the Gap.
The question was what to do once I had noticed it.
I didn't start by challenging Alice's account of what had happened or trying to get her to think differently about the situation. I started by working with her state.
We used grounding and regulation work, and as Alice settled, something began to shift. She started to regain some of her energy and, by the end of the session, she could begin to access anger that hadn’t been available to her before.
Regulation gave her enough capacity to get closer to what she was actually feeling.
And once the anger became available, so did its meaning.
As Alice began to talk, it became clear that part of the difficulty was that she didn't feel she had the right to be angry. The colleague who had hurt her had also been a close friend, and being angry at a friend felt disloyal.
She was caught in a genuine tug-of-war. On the one hand, she was grieving a friendship and, on the other, trying to hold on to her own professional standards.
Now we had something very different to work with.
The issue wasn't simply “How do I deal with this difficult colleague?”
Alice could begin to see the conflict underneath it. Feeling had become the bridge between the state I'd initially noticed and the meaning she could now make of what had happened.
And from there, thinking and some powerful decision-making became useful again.
Simon: when Thinking was exactly the right place to start
Katie and Alice could leave you with the impression that I think we should always begin with regulation.
I don’t, and Simon is a good example of why.
He was young, high-performing and going through a restructure at work. His confidence was taking a real hit because his line manager kept undermining him.
So there was plenty of pressure, but Simon was still functioning well within his Window of Regulation. He was present, engaged and able to make good use of the conversation.
I didn't bother with any grounding exercises because he simply didn't need them.
We went straight into Thinking.
We mapped his inner narrator and found a relentless negative monologue running underneath much of what he was experiencing.
What struck me was how unusually cruel that internal voice was. When I pointed this out to Simon, something clicked.
He'd been living with the commentary for so long that he'd lost any useful reference point for it. Once he could see it, he could start putting some distance between himself and those thoughts.
From there we used standard psychological-flexibility work to help him unhook from the thinking and see the situation differently.
There was no need to regulate Simon first, and no prize for getting him into his body.
The judgement is in knowing when.
Same methodology, different starting points
Three clients, three different states, and three different decisions about where to enter.
That's what I mean by range: being able to choose, rather than forcing every client through the part of coaching you happen to know best.
That sounds straightforward when you put the three cases side by side like this. In a live coaching session, of course, nobody tells you which entry point to choose.
You have to notice what's happening, make a judgement and be prepared to change course when the client changes.
How does a coach learn to make these decisions consistently?
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Get the workshop invitationsThe CORE Framework
A repeatable way to work
Those decisions are harder when you're sitting opposite a client and making them in real time.
Over time, I needed a way to make this less intuitive and more repeatable, bringing together what we've looked at so far without turning a coaching session into a checklist.
That's what eventually became CORE.
CENTRE · ORIENT · REGULATE · ENGAGE
It's the process I use to put the pieces we've already covered into practice.
What is happening in me?
Where is my client, and what am I noticing?
Does anything need to shift before useful work can happen?
What becomes possible now?
C: Centre
Read yourself before you read your client.
Before I orient to the client, I start with myself.
If I've come straight out of a difficult conversation, I'm distracted by something happening in my own life, or I'm simply rushing from one session to the next, that's going to affect what I notice and how I respond.
What's happening in me right now?
Am I settled enough to be properly present? Am I bringing something of my own into this session that I need to deal with before I start trying to read my client?
But Centre has another function.
Your own state can also be a useful source of information.
We saw this briefly with Alice. As she talked, I noticed my own energy beginning to drop. I didn't take that as proof of anything happening in Alice, but I did take it seriously enough to become curious.
And if you're not sufficiently aware of your own state, it's much harder to know what belongs to you, what might be happening between you and the client, and what is worth becoming curious about.
Then I orient.
O: Orient
Where is my client?
I listen to the client's story, but I also pay attention to their state.
Is there a Gap between what they're telling me and how they're showing up?
Orient means forming a working hypothesis.
This client seems to have plenty of capacity available. I think we can go straight into the issue.
Or:
Something isn't quite lining up here. I want to slow down before we move on.
The important thing is that the hypothesis remains open to change.
Simon gave me different information. He was under pressure, but he was present, reflective and able to work. My orientation there was essentially: there's nothing I need to regulate.
That's a perfectly valid outcome of Orient. CORE asks the coach to decide whether regulation is actually needed.
R: Regulate
What, if anything, needs to shift before useful work can happen?
Sometimes the answer is nothing.
I wasn't trying to get Katie into some ideal state of calm before she was allowed to be coached. I was trying to help her recover enough capacity to stay with what was happening without being overwhelmed by it.
Sometimes regulation will involve somatic work directly with the body and nervous system, and sometimes the client is already sufficiently regulated and we move straight on.
And if something does need to shift, what is appropriate within the scope of my competence as a coach?
Once enough capacity is available, we don't stay in regulation just because we know how to do it.
We use the capacity we've created.
E: Engage
What happens next?
This is the part that stops Embodied Performance from becoming an interesting conversation about states, emotions and nervous systems.
The client came to coaching because something needs to change.
Engage is where we take whatever has become available through the work and reconnect it to the client's life.
Very often that happens through familiar coaching tools: perspective, psychological flexibility, values, goals, strategy and action.
Sometimes the movement is smaller. The client may need to experiment with something, have one conversation or notice what happens when they respond differently during the week.
We're interested in what they can now do that they couldn't do before.
CORE isn't a script
There's an obvious danger with any framework like this.
You can start by trying to run the client through it.
I've Centred. Now I need to Orient. Now we Regulate. Now we Engage.
That's not how I use CORE.
A real coaching session is much messier than that.
You might orient to a client, begin working cognitively and then notice their state change when you reach a particular subject.
So you orient again.
You may regulate briefly, discover that an emotion becomes available and spend some time there.
Then you engage with what that means for a decision they need to make.
CORE gives me somewhere to come back to when that happens.
Regulation is something I use when the client's state calls for it, rather than something I impose because this is called Embodied Performance.
And Engage keeps the whole process connected to the reason we're there in the first place: meaningful change in the client's life and work.
What CORE gives me is a way of organising my attention so I can keep responding to the person in front of me.
And the more range we develop as coaches, the more important that judgement becomes.
Because being able to work across a wider range of client states also brings greater responsibility.
Range, Responsibility and Boundaries
Greater range requires clearer boundaries
If we're going to increase the range of what we can work with as coaches, we also need to become clearer about the limits of that work.
So it's reasonable to ask: is this still coaching?
For me, the answer isn't determined simply by whether emotion or the body shows up in session.
Emotion has always been part of coaching sessions. So have stress, difficult relationships, fear, grief, anger and the rest of being human.
The more useful question is whether what the client is bringing is appropriate for coaching, and whether I have the competence to work with it.
Knowing when to pause or refer
Sometimes the right decision is to refer.
Referral isn't evidence that coaching has failed or that you've somehow reached the edge of being a good coach.
Range includes knowing where your range ends.
There are times when something about what I'm seeing makes me pause and question whether coaching remains the appropriate place for the work.
Perhaps the client's response seems difficult to understand in the context of what they're describing. Perhaps what is emerging appears to reach well beyond the situation they've brought to coaching. Perhaps we're repeatedly working with their state, but nothing seems to shift. Or perhaps I'm simply unsure whether I have the competence to work safely with what's appearing.
None of those observations tells me what's clinically happening.
They are reasons to slow down.
I might need to explore the situation further with the client, take the work to supervision, consider whether another professional should be involved or, in some circumstances, refer the client elsewhere.
And if I'm genuinely unsure whether something sits within my competence, uncertainty itself is a reason to pause rather than push further.
Sometimes the most professionally responsible thing you can do is recognise that somebody else is better placed to help.
Competence matters
Understanding a model isn't the same as being competent to use everything that sits underneath it.
You can learn to notice that a client appears to be outside their Window of Regulation without automatically being equipped to work deeply with whatever emerges.
And you can notice a Gap between State and Story without deciding that it's your job to uncover whatever you imagine is underneath it.
This is one reason I've been careful throughout this report to describe the Performance Spectrum as a map and Orient as forming a working hypothesis.
We're paying better attention, not diagnosing.
The methodology can help you see more.
Training, practice and supervision help you know what to do with what you see.
Contracting and supervision
Working across a wider range of client states makes good contracting more important, not less.
Clients need to understand the nature of the work they're entering into. And where an organisation is paying for the coaching, there needs to be clarity around confidentiality and what, if anything, goes back to the sponsor.
Then there's supervision.
If you're going to work with strong emotional material and a wider range of client states, you need somewhere appropriate to take your own questions about the work.
Judgement improves when it can be examined, even when nothing has gone wrong.
If you're working regularly with that kind of material, I'd also want supervision from somebody who is comfortable working with it themselves.
This isn't therapy
Embodied Performance isn't an attempt to turn executive coaches into therapists.
Nor is the distinction between coaching and therapy simply that coaches focus on goals while therapists focus on emotions. Real coaching has never been that tidy.
The boundary lies in the nature of the work, the client’s needs, and the practitioner’s competence.
Our role as coaches is not to diagnose mental-health conditions or treat clinical disorders.
Our job is to become better at working with the whole person who arrives for coaching, while recognising when what they need falls outside the work we're qualified to provide.
Greater range requires clearer boundaries.
Developing range means having more choices in how we respond, and enough judgement to know which of them are appropriate.
A Wider Model of Coaching
What happens when the person sitting in front of you doesn't have full access to the thinking your coaching tools depend on?
The answer isn't that we stop using those tools.
Reflection, questioning, perspective, psychological flexibility, goals, strategy, and action remain among the most useful things we can offer our clients.
But they work best when the client can actually access them.
Katie didn't need a better question when she first arrived. She needed enough capacity to be able to use one.
Alice needed me to notice that her story and her state didn't quite match, and to change how we worked as her state changed.
Simon needed something else entirely: for me to leave his nervous system alone and coach him.
Same coach, same methodology, but very different starting points.
None of this asks you to give up the way you already coach. It extends your range, helps you make sense of more of what you're noticing, and brings somatic, emotional and cognitive ways of working together more deliberately.
Think about the clients currently arriving in your own practice.
The one who's overwhelmed and can't seem to gather their thoughts together.
The one who tells you they're fine, but something about the session makes you curious.
And the one who's under considerable pressure, has plenty of capacity available and simply needs some very good cognitive coaching.
How much of that range can you work with?
I don’t mean in theory. I mean in session, with a real client in the room.
Can you recognise when the tools you normally rely on are accessible to the client and when they aren't?
Can you change your entry point without becoming attached to the part of coaching you happen to know best?
And can you do that whilst remaining clear about your competence, your boundaries and when somebody needs something other than coaching?
Executive coaching doesn't need fewer cognitive tools. It needs greater range.
That's what Embodied Performance is designed to develop:
The range to work with the client in front of you.
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“The space between [my clients] coming up with an action and actually doing it is shifting. It’s becoming much shorter… and they seem calmer and able to deal with their emotions better as well.”
About Andre Duquemin
Andre Duquemin is the founder of Embodied Performance.
For more than 25 years, Andre has worked at the intersection of the body, emotions and thinking, first in clinical practice as a somatic therapist, and for the past decade as an executive coach.
Today, he teaches executive and leadership coaches how to integrate nervous system regulation, emotional processing and psychological flexibility into their existing coaching practice, so they have more ways to respond to the clients they work with.
About Embodied Performance
Embodied Performance is a practical coaching methodology for experienced executive and leadership coaches who want greater range in how they work with their clients.
It integrates somatic work, nervous system regulation, emotional processing and psychological flexibility with the coaching approach experienced coaches already use.
The methodology gives coaches practical frameworks for noticing where a client is, deciding where to enter, and responding as their state changes, while remaining firmly within the boundaries of coaching.
Sources and notes
- Gallup. Jim Harter, “Span of Control: What’s the Optimal Team Size for Managers?”, 13 January 2026. Gallup reports that the average number of people reporting to US managers increased to 12.1 in 2025, nearly 50% higher than when Gallup first measured it in 2013; 97% of managers in its US study reported some individual-contributor responsibilities alongside leading others. View source.
- Korn Ferry. Workforce 2025: Power Shifts, based on a survey of more than 15,000 professionals across ten major markets. 41% said their organisation had cut management layers and 37% said the lack of managers had left them feeling directionless. View source.
- Microsoft. “Breaking down the infinite workday”, Work Trend Index Special Report, 17 June 2025. Microsoft reports that, among the top 20% of users by volume in its telemetry data, employees were interrupted every two minutes during core work hours, amounting to 275 meetings, emails or chats across a 24-hour day; its global survey also found that one in three employees said the pace of work over the previous five years had made it impossible to keep up. View source.
- International Coaching Federation (ICF). 2024 ICF Coaching Snapshot: Coaching and Mental Well-Being, commissioned by ICF and conducted by PwC. ICF reports that 44% of coach practitioners had referred one or more clients to a medical professional or therapist in the previous 12 months, reinforcing the importance of recognising professional boundaries and knowing when referral is appropriate. View source. See also ICF’s Guide to Referring a Client to Therapy.