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This article addresses the challenging conundrum of when to offer psychotherapy versus mental skills training. To highlight aspects of this dilemma, we describe actual cases that illustrate different ways in which clients present and practitioners may respond: (1) mental skills training shifting to therapy; (2) therapeutic work shifting to mental skills training; (3) simultaneous work between two practitioners; or (4) alternating services from the same practitioner. A variety of intervention methods are used based on a number of theoretical orientations and perspectives. The article concludes with some recommendations that may assist the performance-oriented practitioner in decision-making regarding the delicate balance between therapy and mental skills training. Suggestions relate specifically to the nature of the referral, the client’s preferences, the practitioner’s perspective and skill sets, a continuous process of appraisal and adaptation, and the central importance of the athlete-practitioner relationship.

We hypothesize that the neuromuscular system is designed to function effectively in accomplishing everyday movement tasks. Since everyday movement tasks may vary substantially in terms of speed and resistance, we speculate that agonistic muscles contribute differently to varying movement tasks such that the mechanical, structural, and physiological properties of the system are optimized at all times. We further hypothesize that a mechanical perturbation to the musculoskeletal system, such as the loss of an important joint ligament or the change of a muscle’s line of action, causes an adaptation of the system aimed at reestablishing effective function. Here. we demonstrate how the specificity of the cat ankle extensors is used to accommodate different locomotor tasks. We then illustrate how the loss of an important ligament in the cat knee leads to neuromuscular adaptation. Finally, we discuss the adaptability of skeletal muscle following an intervention that changes a muscle’s line of action, moment arm, and excursion.