Coaching focuses on accomplishing goals and creating change in the here and now rather than on resolving old conflicts from the past. There are no diagnostic categories, and no reimbursement from insurance companies. Coaching is based on an equal and collaborative relationship between coach and client, while psychotherapy often holds the therapist as the expert in a more medically oriented framework. Psychotherapy tends to focus on pathology, what is 'wrong' with the client, and diagnosis is based on symptoms, as with western medicine. Clients generally come to psychotherapy when they are struggling emotionally with an issue. Clients come to coaching when they are seeking clarity, direction, or accountability in order to move forward. The emphasis in coaching is looking more toward the future and what the client would like to see changed, while the emphasis in psychotherapy is generally more towards resolving emotional and behavioral problems. Both necessitate the skills of listening with open attention, holding the client's best interest foremost, developing measurable goals, and reorganizing thoughts and behaviors to achieve desired results. The primary differences are in the focus of attention, the process, and the nature of the relationship with clients.