Let’s take a closer look at CAM and coaching in clinical and non-clinical practice. Complementary and Alternative Medicine, also referred to as Complementary and Alternative Interventions (CAI) is becoming increasingly more popular both to practitioners and potential clients.
The Assumption of a “Presenting Problem” in Therapy
I attended a presentation about documentation hosted by The Black Sheep Therapist, and a familiar statement surfaced: therapists are required to maintain treatment plans and progress notes regardless of whether they accept insurance, and those treatment plans must be anchored in a presenting problem or diagnosis. That’s generally true. Even therapists who choose not to formally diagnose are still working within a clinical frame—meaning there is something identifiable that warrants care, attention, and intervention. But for those of us who work at the intersection of psychotherapy and complementary or psychospiritual approaches, the conversation doesn’t end there. It actually opens up a more nuanced question: when does something belong inside the frame of therapy, and when does it not?
Therapy Is a Clinical Frame—With or Without a Diagnosis
Therapy, by definition, carries a clinical orientation. With or without a DSM label, it implies that a client is experiencing distress, dysfunction, or impairment that can be assessed and treated. Documentation reflects that arc. A treatment plan isn’t just a formality—it connects the client’s presenting concern to specific interventions and measurable goals. This is true even when those interventions include complementary approaches. Modalities such as Reiki, coaching, intuitive processes, Tarot, or aromatherapy can absolutely be integrated into psychotherapy. The key is that they are not the treatment in and of themselves—they are used in service of a clinical objective. The inclusion of CAM is not inherently outside the bounds of psychotherapy; rather, it becomes ethically sound when delivered within the clinician’s scope of competence, grounded in a clear treatment rationale, and accompanied by informed consent and appropriate documentation.
Differentiating an Experience vs. a Clinical Intervention
Aromatherapy offers a clear example of how this distinction plays out in practice. Outside of a clinical context, someone might use lemon essential oil because it feels bright, uplifting, and energizing. That experience is valid, meaningful, and often beneficial. But within therapy, the intervention becomes more intentional and more precise. Lemon essential oil is not simply used because it “smells good” or “lifts mood.” It is selected and introduced in relation to a clinical concern, such as anxiety, and used to support a specific therapeutic goal like mood activation or increased engagement. A note might reflect that the clinician incorporated lemon essential oil to support affect regulation in alignment with treatment goals related to anxiety, alongside cognitive or somatic interventions. The difference is subtle but important. The oil is no longer the focus—the clinical outcome is.
Choosing Not to Work Inside the Pathology Model
Where things often become blurred is when therapists themselves prefer not to work within a pathology-based model at all. There are practitioners—myself included at times in my own professional evolution—who are less interested in diagnosing and treating mental illness and more drawn to growth, meaning-making, spiritual exploration, and holistic wellness. This is where a different kind of clarity is required. It’s not enough to simply avoid assigning a diagnosis while still operating under the umbrella of therapy. If the work is not being framed as clinical treatment, then it needs to be defined and offered as something else.
When the Responsibility Flips: Screening and Referral
In this orientation, the responsibility actually flips. Instead of asking, “What is the diagnosis I’m treating?” the question becomes, “Is there a clinical issue here that requires referral?” When offering services such as coaching, Reiki, intuitive guidance, Tarot, or aromatherapy outside the clinical frame, the practitioner’s role is not to assess or treat mental health conditions. Even if that practitioner holds an active license, they are not functioning as a therapist in that context. If a client presents with symptoms that suggest depression, trauma, anxiety disorders, or any form of significant impairment, then the ethical course is to refer out to a licensed mental health provider operating within a clinical scope. The presence of a license doesn’t grant permission to blur roles—it increases the responsibility to maintain them.
The Boundary Is Not the Modality—It’s the Frame
This is where the real boundary lives, and it’s not in the modality itself. Reiki, aromatherapy, coaching, and even mediumship can exist on either side of the line. The difference is not what you are doing, but how the work is being framed, contracted, and carried out. In therapy, the frame is clinical: there is assessment, a treatment plan, and documentation tied to a presenting concern. Outside of therapy, the frame shifts toward growth, insight, exploration, or support, without the assumption of pathology or the responsibility to treat it.
Different Frames, Different Outcomes
There is also an important ethical distinction in how outcomes are understood. In clinical work, the practitioner is responsible for monitoring progress related to symptoms, functioning, and treatment goals. In non-clinical work, the outcomes are more experiential or developmental—clarity, alignment, insight, connection. Both are valuable. Both can be transformative. But they are not interchangeable, and they should not be presented as such.
A Simple Question to Keep You Grounded
For practitioners who move between these worlds, the task is not to choose one over the other, but to be explicit about which one you are in at any given time. That clarity needs to be reflected in your informed consent, your agreements, your language, and your documentation. If you are practicing therapy, then your notes should clearly support a clinical rationale—even when using integrative or complementary approaches. If you are offering non-clinical services, then your agreements should clearly state that the work is not therapy and does not involve diagnosis or treatment of mental health conditions.
A simple question can help anchor this: Am I treating a clinical condition, or am I supporting a process of growth, meaning-making, or experience? The answer determines not only how you document your work, but how you define your role and your responsibility within it.
Final Thought
For those of us who work in psychospiritual or integrative spaces, this isn’t about restriction—it’s about precision. The more clearly we can name the frame we are working within, the more ethically and effectively we can serve the people who come to us.
References
Baffa, A. A., Idris, A., Lawal, S., & Bello, H. H. (2025). Empirical Analysis Supporting Synergistic Integration of Complementary and Alternative Medicine (CAM) with Conventional Mental Therapies Discourse. Bayero Journal of Nursing and Health Care, 7(2), 1672-1681.
Gerbarg, P. L., Muskin, P. R., & Brown, R. P. (Eds.). (2017). Complementary and integrative treatments in psychiatric practice. American Psychiatric Pub.
Gonçalves, S., Castro, J., Almeida, A., Monteiro, M., Rodrigues, T., Fernandes, R., & Matos, R. S. (2025). A systematic review of the therapeutic properties of lemon essential oil. Advances in Integrative Medicine, 12(3), 100433.
Heaton-Shrestha, C. (2022). Perspectives on Integrating Aromatherapy with Psychotherapeutic Counselling and Psychotherapy-A Preliminary Enquiry. International Journal of Professional Holistic Aromatherapy, 11(3).
Humphreys, E., Cabrera, E., & Luhrmann, S. D. (2023). The Effectiveness of Treating Anxiety With Reiki. Journal of Behavior Therapy and Mental Health, 2(2), 22-34.
Vitolo, T. (2026). The Black Sheep Therapist. Illumify Media.
