Counseling the Elite Athlete

By Chris Carr, Ph.D.
May 15, 2014 - Last updated: July 28, 2015

I have spent 20 years providing counseling and consultation for clients in the world of sports. From sports organizations to teams to individual athletes, my clientele reflects a diverse and varied set of presenting issues, concerns and dynamics.

To assume that I would be prepared to deal with this myriad of concerns based solely on my academic preparation as a counseling psychologist would have been a gross mistake. The “world” of sports is a unique and complex environment that impacts greatly the clinical manifestations of mental health issues and presenting concerns

The purpose of this article is to briefly highlight some recommendations and suggestions for clinicians that have an interest in working with athletes as clients or who may have an athlete present to them in their clinical practice.

It is important that as a licensed psychologist, one understands that a license to practice covers their practice within their “competencies” (related to education, training and experience). However, in the field of sport psychology I have seen individuals that believe being a “fan” denotes a competency to practice within sport … a belief that I would challenge emphatically.

But I also realize that often a client presents with unique characteristics that we may not be well-trained enough to address. Here are a few recommendations for the practicing clinician:

A) Establish a referral network of providers that have experience/training in sport psychology and also treat athletes as clients. The United States Olympic Committee (USOC) Sport Psychology Department has a list of providers nationwide called their USOC Sport Psychology Registry; clinicians can contact the USOC and inquire/ request a list of providers in their area. Also, licensed psychologists that are members of APA Division 47 (Exercise and Sport Psychology) may also have requisite training/experience. It is imperative that if you do not feel competent in treating an athlete client that you find a suitable referral.

B) If you are interested in treating athletes as clients, begin continuing education/training. APA Division 47 has workshops, posters and presentations annually at the APA convention. Check your state and regional psychological associations for workshops on sport psychology. Read books. (APA, Oxford University Press and Human Kinetics Publishers are a few companies that offer clinical texts in sport psychology.)

C) Develop collegial consultation with professionals that are well-trained in the treatment of clinical issues (e.g. depression, anxiety) with athlete clients. Over the past 15 to 20 years, there has been an increase of counseling and clinical psychology Ph.D.’s that have academic preparation in the field of sport psychology/exercise science.

During doctoral training 20 years ago, I created a minor in sport psychology with my counseling psychology program. This consisted of graduate courses in sport psychology, exercise psychology, motor learning, exercise physiology and sociology of sport.

These courses gave me information that I would not have received in a general counseling/clinical program; this academic preparation has greatly enhanced my counseling and consultation skills within the variety of sports that I have worked with over my post-Ph.D. career. I believe it is imperative that as a practicing psychologist it is professionally competent to create a referral network for a variety of presenting issues and clients, including athletes

If a clinician feels competent to treat and provide counseling for athlete clients, there are some relevant issues to understand and address. Athlete clients can range developmentally from the youth sports to elite sport level of participation. There are “athletes” that are 30-year-old competitors and 15-year-old Olympic athletes.

Understanding developmental aspects of both personality and sport (e.g. youth sports development) is at the core of effective therapy for athletes. Elite athletes present with psychological “issues” that may not be presented at initial intake. In my five years as the psychologist for athletics at the Ohio State University Athletics Department, more than 95 percent of student-athletes seen by me or one of my postdoctoral fellows presented with a “performance” (e.g. can’t focus) issue at intake. Yet, less than 30 percent of our counseling sessions focused on “performance-enhancement” techniques and 70 percent and more focused on typical counseling/ therapy issues.

In other words, athletes are sensitive to being seen as “psychologically weak” or in need of psychological care. However, I have noticed a tangible increase in requested sport psychology services by both athletes and coaches over the past 10 to 12 years, especially at the collegiate and professional levels. So, the clinician’s own experience and training in counseling athlete clients is very important in implementing a therapeutic relationship with the client.

It is important to recognize some “taboos” for working with athlete clients (particularly relevant at the collegiate/ professional/Olympic level). These behaviors are almost guaranteed to diminish any therapeutic alliance that can be created with an athlete client. Here are a few recommendations:

  • Don’t ask your athlete client for an autograph or photo. It is quite typical in sports medicine clinics to see photos of athlete patients that they have treated; however, due to the nature of psychological counseling boundaries, it would be discouraged
  • Don’t ask your athlete clients for tickets, passes or “perks” related to their role on their team. In my experience, once someone seeks these types of benefits, the therapeutic alliance (if any) crumbles and trust is impacted.
  • Create a “safe” atmosphere, especially for highly recognizable athlete clients. Find later times when your waiting area is empty or have a back entrance for your client. This will generate comfort and lets your athlete client know you are respectful of his/her public identity. I have had experiences where my athlete client was approached by another patient (within a sports medicine setting) for an autograph and questioned, “Why are you here?” If at all possible, I prefer initially to create a safe atmosphere for my athlete clients until they feel comfortable with the process.
  • Be aware of the media’s influence on athlete clients. If you are asking intake questions that sound similar to a post-game interview, be prepared for the “canned” response. I find that just exploring these process-related issues is often helpful for the athlete client, especially in the initial session.

These suggestions are just a few from my experiences in treating athletes as clients as my primary practice over the past 20 years. I would encourage any professional that has an interest in sport psychology, performance psychology or the psychological counseling of athlete clients to pursue continuing education, collegial consultation and professional involvement so you can provide the most optimal care of your future clients.

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Chris Carr, Ph.D., is coordinator of sport and performance psychology services at St. Vincent Sports Performance ( in Indianapolis, Ind. He has a Ph.D. in counseling psychology with a minor in sport psychology from Ball State University. Carr was a graduate assistant football coach at Ball State during his masters training and was a collegiate football player at Wabash College. He spent a year as a clinical research assistant in sport psychology at the United States Olympic Training Center in Colorado Springs. He has been the psychologist for the athletic departments at Washington State University, Arizona State University, Ohio State University and Indiana University and is currently the consulting sport psychologist for the Purdue University Athletics Department where he coordinates the sport psychology and mental health services for student-athletes. He is also the consulting psychologist for the Indiana Pacers (NBA) and Indiana Fever (WNBA); he was the USA Olympic Diving Team sport psychologist at the 2008 Summer Olympic Games in Beijing and was the USA Alpine Ski Team sport psychologist at the 2002 Winter Olympic Games in Utah. He was the president of APA Division 47 between 2007 and 2009 and has published book chapters and articles for sports organizations. He has been on the USOC Sport Psychology Registry since 1992. He may be reached by email at

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