19.3: A Divide in the Field- Performance Enhancement vs. Mental Health Counseling

With the growth of sport psychology as a field, there have been new divides in professional practice roles. There are two main roles that sport psychology professionals can hold: performance enhancement or mental health counseling. In this section of the chapter, we will provide two short case studies that demonstrate some of the key differences between performance enhancement and mental health counseling.

Riley’s high school volleyball team is tied 13 to 13 in the final set of their match. They cannot give up a point and must score twice in a row to win. The importance of this match is very clear to everyone, and it has been talked about all week. Riley’s team will advance to playoffs for the first time in school history if they are able to come away with this win on their home court. The high stakes of this competition draws a large crowd. The noise in the gym is deafening and there is a constant buzz of excitement from the fans. By chance, Riley is in position to potentially win or lose the match with what could be the final serves. Riley rotates into position to serve and feels sudden increased shoulder tension, sweaty palms, and has some difficulty breathing. Riley’s heart is beating faster and harder than normal, and the idea of unsuccessfully executing these serves becomes an overwhelming thought. Unfortunately, Riley’s mechanics appear to be interrupted and the serve is rushed resulting in the ball going straight into the net. Riley does not walk away with the match winning points, and the team goes on to lose.

In this scenario, we see that the pressure of this big moment got the best of Riley who was not adequately prepared to handle it. Athletes like Riley benefit from applied sport psychology services equipping them with the skills needed to increase their chances of performing optimally. This is an example of when a performance enhancement model of delivery would be most appropriate. A sport psychology professional with a performance enhancement background could help Riley with managing arousal levels and concentration. The goal with performance enhancement is to help athletes like Riley to be able to perform close to the top of their ability levels more consistently, especially in important moments. The psychological factors that can influence performance vary from athlete to athlete and no two experiences are the same. The next scenario also presents a decline in performance but you will notice the source of the psychological stress is different.

Sam has always been a highly competitive soccer player who has been with the same club team for five very successful years. This season is an important one as Sam hopes to be recruited to play college soccer. As a consistently high performing player and a leader on the team, it is no surprise that Sam enters the season with confidence. Early in the season, coaches were suggesting that this confidence was “visible”. This confidence and previous history as a quality player contributed in part to a promising start to the season. After a few successful weeks of training and competition, coaches begin to notice a significant change in Sam. That visible confidence has disappeared, and Sam appears lethargic, unfocused, and more reserved than normal. These behaviors continue and a decrease in Sam’s performance is evident. One day after practice the coaches overhear Sam’s teammates discussing that Sam is having trouble sleeping, struggling in school, and withdrawn during social events. This all seems completely out of character. There is a growing concern by Sam’s coaches and teammates that Sam will miss out on the opportunity to play soccer in college if help is not provided soon.

In this scenario, it is unlikely that Sam’s decline in performance can be credited to something happening within sport. Rather, it appears that something outside of soccer and unrelated to the team may be taking a toll and help is needed. Sport psychology services would benefit athletes like Sam as well, but the approach to providing support would be different. Sam’s needs likely require more of a therapeutic approach or mental health counseling to address the unknown issue affecting performance and behavior across contexts. We provide further distinctions between performance enhancement and mental health counseling approaches to providing sport psychology services in the following section.

19.3.1. Understanding the Performance Enhancement vs. Mental Health Counseling Delivery Models

The development of sport psychology as an applied profession has involved establishing a balance between integrating core principles from diverse disciplines while also distinguishing itself from those same fields. This effort, however, has led to some confusion regarding the services provided by sport psychology practitioners. People tend to think of sport psychology services in one of two ways, namely (a) as a psychological aid to enhance athletic performance or (b) a therapeutic resource to address mental health concerns of athletes. These delivery models will be referred to as performance enhancement and mental health counseling, respectively. In this chapter, we offer simple distinctions between performance enhancement and mental health counseling, differentiate between their respective procedures of practice, and highlight how these models of delivery may realistically operate within sport.

19.3.1.1. Performance Enhancement

The primary goal of sport psychology from a performance enhancement perspective is to help athletes and performers build psychological and emotional skills that can optimize their experiences by consistently performing in the upper range of their capabilities and more thoroughly enjoying the overall performance process (Hays, 2006; Portenga et al., 2017). The performance enhancement model involves implementing systematic and consistent psychological skills training to address a series of psychological factors that account for fluctuations in performance and experience quality. Such psychological skills may include enhancing sport confidence, improving focus and concentration, regulating emotion and arousal, and maintaining motivation and commitment. The techniques used by applied professionals can target individual or even group needs by educating and implementing strategies such as self-talk, energy management, imagery, goal setting, and team building. Psychological skills training is valuable to many and can be provided to a number of diverse individuals and organizations within sport and other performance contexts (e.g., athletes, coaches, officials, soldiers, musicians). Ultimately, these practitioners hope to provide enough training so the performer is able to self-regulate and manage their own thoughts, feelings, and behaviors.

Now that the objectives, procedures of practice, and populations who benefit from a performance model of applied sport psychology have been briefly identified, we can apply this knowledge to our previous example where Riley struggles in a big moment. Following the conclusion of the season, Riley makes the decision to see an applied sport psychology consultant. Meetings with this practitioner help Riley recognize key signs of heightened arousal that lead to suboptimal performance (e.g., increased heart rate, intrusive thoughts, disrupted breathing pattern). With the knowledge that these things need to be managed, Riley and the consultant spend time working on key strategies. For example, the two may focus on self-talk techniques to address the negative thoughts Riley experiences or breathing exercises to manage Riley’s heartrate and other physiological responses in high pressure moments. In working consistently with an applied sport psychology consultant, Riley is now more equipped to manage challenging moments in a match.

The description provided and application to Riley’s scenario should demonstrate that the performance enhancement model is more of a consulting or educational model with a specific focus on performance issues (Aoyagi & Portenga, 2010). Performance enhancement is not concerned with assessing, diagnosing, and addressing mental health difficulties even if they disturb an athletes’ performance. In fact, most sport psychology practitioners following a performance enhancement model of service are not qualified to attend to these concerns. These mental health concerns are the focus of clinical or counseling psychologists (i.e., licensed mental health providers). Just like athletes or performers need help managing psychological performance factors, they may also need mental health support to enhance their general well-being and quality of life.

19.3.1.2. Mental Health Counseling

Broadly speaking, the term mental health counseling in this chapter refers to helping people work through normal developmental life issues and/or serious mental health issues and disorders (Portenga et al., 2012). An individual does not have to meet the full criteria for a particular disorder to qualify for mental health support, but rather experience significant distress or impairment in their life.Such challenges can affect anyone, including athletes and performers, but mental health counseling is not specific to a particular population. Serious mental health concerns licensed professionals address can include grief, anxiety, depression, eating disorders, substance abuse, and personality disorders. Mental health counseling professionals differ from performance enhancement experts in regard to how they deliver their services, who they work with, and their ultimate goals. A performance enhancement professional will often work with individuals as well as groups of people in a variety of settings (e.g., locker rooms, training rooms, on the field), and the structure and timing of these sessions tends to vary (Andersen et al., 2001). These individuals may attend practice and training, sit on the sidelines during competitions, and even travel with the team. The more traditional clinical nature of mental health counseling contributes to a more rigid form of delivery that tends to be restricted to work with a single individual for an hour in a private office setting (Aoyagi & Portenga, 2010; McCann, 2005).

When working with athletes and performers, it can be challenging to determine when referral to licensed mental health professionals is necessary. Considering appropriate action steps for Sam’s scenario may add further clarity. The different people who have observed Sam’s change in behavior clearly have concerns that something serious is causing distress and ultimately impairing performance. Sam’s coaches intervene and recommend Sam see the team’s “mental coach”. They likely make this recommendation assuming all sport psychology professionals provide mental health care, but the individual they consult with only provides performance enhancement services. Sam and the practitioner meet anyway, because neither is fully aware of Sam’s needs. At the conclusion of initial meeting, Sam and the sport psychology practitioner decide it may be best to refer Sam to a licensed mental health practitioner who can provide appropriate care. This decision was made because Sam’s prolonged negative psychological state is disruptive in a number of life domains and the source of the issue is not a sport-related psychological factor. The sport psychology practitioner suspects Sam may be experiencing depression and is not qualified to work with athletes on mental health issues such as this. Fortunately, Sam is able to meet with the licensed mental health professional for an assessment and obtains the appropriate treatment needed.

In many ways, performance enhancement needs and mental health difficulties can be challenging to separate as both have a place within sport and can be present simultaneously. Although the two may overlap in sport and performance settings, it is still necessary performance enhancement and mental health counseling professionals understand the limits of their expertise in order to remain ethical in their practice (see AASP Ethics Code below; Association for Applied Sport Psychology, 2011).The AASP ethics code provides general principles and ethical standards for AASP members, but this ethics code is not universally accepted worldwide. It is worthwhile to search the ethics codes specific to the country where consultants practice. There are, however, some practitioners who have formal education and training in sport psychology and clinical or counseling psychology and are qualified to deliver performance enhancement as well as mental health counseling services. In this chapter, those professional are referred to as clinical sport psychology practitioners. These individuals can offer much broader services as they are able to assess, diagnose, and address mental health difficulties while also implementing psychological skill training programs (Aoyagi et al., 2012). However, far fewer practitioners are qualified to provide services in performance enhancement and mental health counseling. Thus, current and future practitioners must understand some of the most basic distinctions between these two models so they may act within the boundaries of their professional competencies.

While some of the information presented in this section will apply to other territories, many of the issues surrounding practitioner roles and protected titles are specific to the United States. In summary, there exists two primary groups of practitioners in the United States with distinct training and professional competencies who provide different psychological services to athletes and performers, specifically in the United States. While some of the information presented in this section will apply to other territories, these issues around protected titles are specific to the United States. To confuse matters further, both groups of practitioners share the terms “sport psychology” to label what they do.However, it is important to note that there is legal protection around the title of “psychologist”. Only those with counseling and clinical training and licensure may use it, and practitioners trained exclusively in performance enhancement are unable to legally use the title of “sport psychologist”. This is why we see various alternative titles within the profession (e.g., mental performance coach). Aoyagi and Portenga (2010) distinguish performance enhancement from mental health counseling by stating, “Doing therapy with a person who happens to be an athlete is not sport psychology” (p. 254). Those who follow the performance enhancement model of practice utilize an educational approach to help athletes and performers reach optimal engagement and performance success. In many instances, these individuals are not trained from a counseling or clinical perspective which adds limits to their services.On the other hand, those who align with the mental health counseling model deliver more therapeutic focused work for people (some of whom may be athletes) and have received training in more traditional psychological disciplines. Without the aforementioned knowledge about these models of delivery, it is unclear who is qualified to provide particular services. While the field is continuing to develop and address this confusing issue, it is important to understand the current distinction.

Table 19.2. Association for Applied Sport Psychology Ethics Code

Principle A – Competence

AASP members maintain the highest standards of competence in their work. They recognize the boundaries of their professional competencies and the limitations of their expertise... They provide only those services and use only those techniques for which they are qualified by education, training, or experience.

Ethical Standard #2 – Competence

(a) AASP members represent diverse academic and professional backgrounds. These different training histories provide different competencies. Those trained in clinical and counseling psychology must be aware of potential limitations in their sport science competencies. AASP members trained in the sport sciences must be aware of their limitations in clinical and counseling psychology. Individuals from different training backgrounds must deliver services, teach, and conduct research only within the boundaries of their competence.

Note. This Ethics code is based in large part on the American Psychological Association's Ethical Principles of Psychologists and code of conduct (American Psychologist, 1992, V47, #12, pp.1597-1611).