Coaching for Members Who Already Have a Therapist
Covering therapy covers the appointment. It covers very little of the time around it.
Benefits teams that already contract for therapy tend to read coaching as a duplicate. If a member can see a licensed clinician, a coach looks like a smaller version of the same service, bought twice.
That reasoning assumes members in therapy are supported continuously.
How often do members in therapy actually receive care?
Psychotherapy use among US adults rose from 9.5% in 2019 to 13.4% in 2023, an increase of about 41%, with the steepest growth among adults under 40, where use went from 11.9% to 19.5%. That comes from a nationally representative analysis of 147,488 National Health Interview Survey respondents (Gao and Olfson, Psychiatric Services, 2025).
The same analysis found something more useful for benefits design. Both NHIS questions look back twelve months: one asks whether the respondent received any therapy in the past year, the other whether they delayed or went without therapy in that year because of cost. Among adults who answered yes to the first, 19.7% also answered yes to the second in 2021 to 2023. That figure was 19.4% in 2019 to 2020, so it has not moved.
These are the same people, across one year. They had therapy and they also went without some of it: sessions spaced out, or a course stopped earlier than intended.
Adults who reported no psychotherapy at all answered yes to the cost question at 4.0%. Cost-related unmet need is reported roughly five times more often by people in care than by people who are not, which is what you would expect if cost bites hardest on those actively trying to use the service.
Why utilization reports miss therapy frequency
The authors of that study list what the NHIS cannot tell them, and the list is instructive. It contains no information on mental health coverage generosity, network adequacy, or the number of covered sessions.
The largest national survey of US health care does not capture how often people in therapy are actually seen. Neither, in most cases, does an employer's own reporting. Benefits teams know how many members used the benefit and what it cost, which is not the same as knowing whether anyone was seen twice.
A member counted as "in therapy" in a utilization report is not necessarily a member who received care continuously, or who is receiving it this month.
What happens between therapy sessions
A weekly appointment is one hour out of 168.
Therapy introduces skills that have to be practiced where the problem shows up: the workday, the argument at home. That practice happens in the other 167 hours or it does not happen.
Avoidance and low activation run on the same clock. A member who agreed to resume something they have been putting off either moves on it that week or arrives at the next session with the same material and more accumulated evidence that they cannot.
The interval also goes unmeasured. Most outpatient therapy administers no validated symptom measure between visits, so change across those weeks gets reconstructed from what the member can recall once they are back in the room. Wave's approach to measurement-based care is built around closing that particular gap.
Where mental health coaching fits alongside therapy
Wave coaches are National Board Certified Health and Wellness Coaches. They are employed full time and work under ongoing supervision. Coaching is not clinical treatment. Coaches do not diagnose or manage a condition, and they route to licensed care when a presentation calls for it. Our coaching model describes that scope in full.
Inside the interval, the work is specific. Members practice skills against structured between-session content in the Wave app, sequenced from their assessment data and presenting concerns. They can message their coach asynchronously when something comes up midweek. They complete the DASS-21 every 30 days, which produces a symptom trajectory that exists independently of session recall.
A member working on anxiety or low mood gets content matched to that, drawn from Wave's Pathways library.
For members already working with an outside clinician, Wave's care team coordinates through the member's existing providers rather than running a parallel and unaware second track.
Questions to ask a behavioral health vendor about concurrent care
Ask how the vendor handles a member who already has a therapist. The answers vary more than the pitch decks suggest. Some platforms screen those members out. Others enroll them and never contact the clinician.
Then ask what gets measured between appointments, and who sees the result. If the answer is that symptoms are assessed at intake and again at case closure, the benefit has no visibility into the stretch of time where most of the member's life happens.
Wave is a mental health platform serving members through US health plan and employer partnerships. Our outcomes research is published in JMIR Formative Research (Pickover and Adler, 2025).
Want to learn more? Reach out to us at partners@wavelife.io.