Coaching from a psychiatrist
Theodore Germanos, MDTriple board-certified — adult, child & adolescent, and addiction medicinePerformance coaching is training, not treatment. It is for a mind that is working and could work better under load — and that describes most people who come looking. What is unusual here is who is in the chair: a psychiatrist, which means the work stays coaching, and stops being coaching the moment it shouldn’t be.
The difference, stated plainly
Psychiatric treatment is medicine. It begins from a diagnosis, it can involve medication, it creates a medical record, and it is licensed state by state. Its purpose is to treat a condition.
Therapy is also treatment. It works on symptoms, history, and the patterns underneath distress, inside a clinical relationship and a clinical record. Its purpose is to relieve suffering and restore function when something is wrong.
Performance coaching is neither. No diagnosis, no medication, no medical record, no doctor–patient relationship. It starts from what you are already doing and works on execution: rules, routines, decisions under pressure, and the distance between knowing what to do and doing it at the moment it costs something.
Why it matters who is doing the coaching
Most performance coaching is delivered by people who are not equipped to notice the moment a performance problem stops being one. That is not a knock on coaches — it is outside their training and outside their licence. But it is where the real cost sits, because the failure is invisible: someone spends two years and a lot of money being coached through what was depression, or an attention disorder, or a developing gambling disorder, and concludes they lack discipline.
The value of a psychiatrist in this seat is not that the coaching becomes more clinical. It shouldn’t, and it doesn’t. It is that the floor is covered. When what you are describing is a mood disorder, hypomania, ADHD, a stimulant habit, or compulsive gambling, I will recognise it early and say so — rather than sell you another twelve weeks of structure that was never going to hold.
Who this is for
Traders, above all — it is the focus of this work and of psychiatrade.com. Also physicians, founders, attorneys, athletes: people whose work punishes small lapses at scale and who already know their strategy is not the problem. You do not need a diagnosis to be here. You need a real thing you keep doing that you would rather stop doing.
When coaching is the wrong answer
It is the wrong answer when you cannot stop. When the size of a position is set by how the last one felt. When losses are being hidden from the people you live with. When sleep has gone and the trading has not. When something is being used to get into the chair or out of it. Those are not discipline problems and no amount of structure fixes them — they are treatable, and treatment works better the earlier it starts.
If any of that lands, say so in the application and I will tell you plainly what I think you need, including when the honest answer is that it isn’t me. Support for problem gambling is available free at 1-800-GAMBLER and through Gamblers Anonymous.
Where it is available
Anywhere. Because coaching is not medical care, it is not bounded by licensure. Psychiatric treatment is: I see patients by secure telehealth in California only. That single distinction is why the application asks what you are looking for before it asks where you live — and why, if you ask for performance psychiatry from outside California, the application moves you to the coaching route rather than pretending the difference does not exist.
How it works
Apply
A short application — a few minutes, no card required.
Intake
A written intake about your trading, your process, and what you want changed.
Sessions
Scheduled hours, written or live, with work between them.
Is this therapy?
No. Therapy is treatment: it addresses a condition, inside a clinical relationship, with a clinical record. Coaching addresses execution and creates none of those things. If what you need is therapy, I will tell you, and that conversation is free.
Will you diagnose me or prescribe anything?
No. Neither happens in coaching, in any state or country. If I think a diagnosis matters to what you are describing, that is the point at which I say the work should be clinical instead — which, in California, I can provide, and elsewhere I will help you find.
Is there a medical record?
No. Coaching generates no medical record, no diagnosis, and nothing that goes to an insurer. What you write in the intake is held privately as coaching material, not as a chart.
I am not in California. Can I still do this?
Yes. Licensure governs medical care, and coaching is not medical care. Clients outside California — and outside the United States — are common.
I am already seeing a therapist or psychiatrist. Is that a problem?
Not at all, and it is often the best combination. Tell them you are doing this, and tell me they exist. The one arrangement that goes badly is each of us working without knowing about the other.
What if it turns out I need treatment rather than coaching?
Then I say so early, which is most of why a psychiatrist is worth having in this role. Nobody is served by coaching a condition.
Also see: Performance psychiatry · Trading psychiatrist · Gambling & behavioral addiction · Addiction medicine · Telehealth psychiatry in California