High Altitude Wellness

Rocky Mountain National Park, Glacier Gorge.  Photo by M. Arloski

Rocky Mountain National Park, Glacier Gorge. Elevation at Trailhead 9,240 ft.  Photo by M. Arloski

Whether it’s a trek in the Alps or a time to be “Rocky Mountain High”, getting up in the mountains is a great way to be well physically, mentally and spiritually. Being well at higher altitude however requires some important knowledge and sometimes, some caution. The people a wellness coach works with may face some challenges at higher elevation, especially if they are dealing with health challenges to begin with.

Gaining elevation quickly is easy in a place like my home state of Colorado. Say you start your day in Fort Collins where, like Denver we are basically a “mile high” (5,003 ft.). Off you go to Estes Park (7,522 ft.) and suddenly you have experienced an elevation gain of 2,519 feet. Drive into Rocky Mountain National Park and up to Bear Lake (9,450 ft.) for a hike and now you’ve risen 4,447 feet. All the trails from there only go up and you could easily exceed 10,000 feet in altitude as you enjoy the stunning beauty of the area. Top it off later with a ride to the peak of Trail Ridge Road (12,183 ft.) and now you’ve attained 7,180 feet (2,188 meters) in elevation gain. That gain itself is higher than any mountain east of the Mississippi.

When we experience how different it is to walk uphill at these suddenly higher elevations we often blame our lack of conditioning. The reality is based in physics and the resultant effect on our own physiology. This is not a time for a “try harder” attitude, in fact continuing to push may just invite serious trouble.

In Banff National Park, Canada

In Banff National Park, Canada

Simply Less Oxygen

Here is the best explanation of why we experience less oxygen at higher elevation. “The pressure in the atmosphere decreases as you gain elevation. The percent of oxygen is actually the same at all altitudes, 21%; however, it is 21% of a smaller number as one goes higher. The barometric pressure at sea level is 760 mmHg, and at 10,000 ft, it is 534 mmHg. Breathing the air of Telluride (Colorado) is the equivalent to breathing air with only 15% oxygen at sea level, instead of 21%. The net result is that there is 29% less oxygen in the air at Telluride compared with sea level. At 14,000 ft, the air has 43% less oxygen than at sea level. Because of the reduced air pressure at high altitude, the volume of air you breathe into you lungs contains less oxygen molecules in each breath.” http://www.altitudemedicine.org/index.php/altitude-medicine/altitude-physiology.

There are two main things to be concerned about at altitude: Acute Mountain Sickness (AMS) and your current state of health, especially looking at preexisting health conditions. AMS can affect people with symptoms at elevations as low as 6,500 feet, but usually we start to see greater occurrence when we exceed 8,000 feet. The Institute for Altitude Medicine (IAM) in Telluride, CO is an excellent resource for learning about AMS or altitude sickness. “One survey done at a Colorado ski resort at 9,800 ft. found that 60% of visitors developed a headache, the first sign of AMS, and also called high altitude headache. To meet the definition of AMS, other symptoms need to develop, such as loss of appetite, sometimes vomiting, weakness, dizziness, fatigue, and difficulty sleeping. AMS feels exactly like a bad hangover.” (http://www.altitudemedicine.org. )

Preventing AMS is all about a slow ascent and adequate hydration. Treatment strategies depend upon severity but the first step is “go no higher”, rest, hydrate and consider immediate descent if there is no improvement. See the I.A.M. website and learn detailed information.

Preexisting Conditions And High Altitude

Rocky Mtn. N.P. The Ute Trail- elevation 11,466 ft. Photo by M. Arloski

Rocky Mtn. N.P. The Ute Trail- elevation 11,466 ft. Photo by M. Arloski

According to Peter Hackett, M.D., the director of I.A.M., experience at higher elevations can sometimes “unmask” preexisting health conditions that the person was not aware of. Struggling with breath and heart rate, feeling exhausted, can sometimes reveal heart and/or lung disease and is a red flag to get in to see your physician as soon as possible.

People with preexisting conditions such as high blood pressure, heart disease, valve disease, heart failure, heart arrhythmias, diabetes, Sickle Cell disease, and other conditions should know that higher altitude could aggravate their conditions. It is also important to know the effects of the medications you might be taking. For example, metoprolol, a beta-blocker, acts as a governor on your heart, preventing excessive heart rate, and thus inhibiting your athletic performance. This means being incredibly patient with yourself and allowing for more breaks when you are hiking uphill, skiing, etc.

Dr. Hackett says that while living at higher elevations can actually help some conditions (we develop more capillaries, asthma can be easier due to cleaner air, etc.) people with COPD and various lung diseases fair worse as they have difficulty transporting oxygen to the lungs.

The “High Country” does not have to be off limits to you, but knowledge about how altitude affects your condition, your medications, and what to do to make adjustments is vital. Again, the I.A.M. website is a treasure house of information. Enjoy the mountains and all their majesty, just do it wisely and well.

Small head cropped1The Coach’s Take Away

A key part of any coaching Foundation Session is getting to know where your client lives and what their lifestyle is like. Your telephonic client may live in a very different world from the one outside your door. If you discover that they live at or near higher elevation, or they visit such places on skiing or outdoors vacations then helping them understand and deal with “altitude wellness” could be vital.

Being in great physical condition does not make one immune to AMS. In fact it has no correlation whatsoever. The especially fit client may want to maintain their sea-level workout routines or push themselves past wise limits physically as they play in the mountains. They need to play by the rules of elevation gain and energy output like everyone else. There is simply less oxygen available to those well-toned muscles at higher altitude and performance goes down.

The standard wisdom is to gain a thousand feet of elevation a day and build in plenty of rest. Hydration is vital as we produce more red blood cells to absorb the decreasing amounts of oxygen available. This thickens the blood and our bodies steal water from all our cells to maintain proper viscosity. So, we get severely dehydrated if we don’t pound the water. (Again refer to the Altitude Medicine site for guidance.)

As wellness coaches work with clients with preexisting medical conditions this is perhaps the most important area to be aware that altitude often has a significant effect. Clients with diabetes may discover an increased insulin requirement. The Altitude Medicine institute recommends that “Only diabetics experienced with exercise and in good control should attempt vigorous exercise at high altitude.” Clients with high blood pressure, any type of heart condition or disease, anyone with lung disease, etc. can be vulnerable to the effects of high elevation. Coaches should help these clients become familiar with the information on the Preexisting Conditions page of the Altitude Medicine Website. http://www.altitudemedicine.org/index.php/altitude-medicine/preexisting-conditions

Wellness coaching clients may find that their medical condition and/or the medications related to these conditions limit their ability to exercise or do what they used to do. Experiencing these limitations can bring up lots of emotion. The person can feel angry, frustrated, and can even get in touch with grief over what they have lost due to their medical condition. This is where coaches can be the empathic source of support that helps the client process these feelings. Plug in what you know about grief, remembering that a loss of health is a loss. Help your client to grieve what is lost and emotionally move on. And, of course, if this yields greater grief than can be dealt with in coaching, make a good referral to a mental health professional.

A great way to begin with such a client is to inquire about their level of knowledge about both their health and the effects of higher altitude. If, like most folks, there is a lack of this specific information, ask if they could see the value in knowing more about it, then co-create a strategy and accountability for how they can go about finding out what they need to know to be healthy and well in the High Country.

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The Bonus Benefits Of Exercise

Michael Arloski hiking in Conamara N.P., Ireland

Michael Arloski hiking in Conamara N.P., Ireland

Harvard’s School of Public Health (http://www.hsph.harvard.edu/nutritionsource/staying-active-full-story/) is quick to tell of all the prevention advantages of exercise. We know that getting more movement and exercise into our lives can help prevent the onset of heart disease, diabetes, certain cancers, high blood pressure, metabolic syndrome and osteoporosis. Exercise can be vital to positively affect the course of these illnesses once they are diagnosed as well. What is perhaps even more motivating is not just avoiding illness, but discovering how exercise can improve our mental functioning and improve the quality of our lives.

“Exercise is the single most powerful tool you have to optimize your brain sparkfunction” says Harvard psychiatrist John Ratey (Spark: The Revolutionary New Science of Exercise and the Brain). He and fellow neuroscientists are showing us that exercise can combat the toxic effects of stress and make us more resilient. “Adding exercise to your lifestyle sparks your brain function to improve learning on three levels: First, it optimizes your mind-set to improve alertness, attention, mood, and motivation; Second, it prepares and encourages nerve cells to bind to one another, which is the cellular basis for logging in new information; and Third, it spurs the development of new nerve cells from stem cells in the hippocampus.” Research is showing us that exercise can help lift depression, improve memory and mental performance, relieve insomnia, boost immunity, and even help stave off Alzheimer’s.

ExerciseAfAmBicycle
It’s always nice to get a bonus. An unexpected pay-off for some effort of ours puts a grin on our face and increases our chances of continuing that activity. Often we see people create a wellness plan and do their best to increase activity, improve their nutrition, etc., only to find that the changes they hoped to see are slow in coming. The person seeking weight loss may hit a plateau and the scales just stare back at them. Rather than sink into discouragement, we might ask “What else am I noticing?”

When people focus on the scales as the single indicator of success they set themselves up for some real motivational challenges. As we improve our wellness the scales will move in the right direction, but while we are getting there we need to fuel our motivation by noticing what bonus benefits we are gaining. When we take stock of our whole lives we start to realize that we may be sleeping much better, have more energy, feel less fatigued, be able to walk, hike or bike longer, or simply get up off the floor or out of a chair with greater ease.

YogaTaiChiBenefitsFocusing on the benefits of exercise alone, research is showing us astonishing bonuses we didn’t even anticipate. The windfall of advantages we gain can motivate us through that weight loss effort and provide incentive to the person with a slim body type who mistakenly thinks they don’t “need” to exercise.

Diversify the exercise you do. Include flexibility, strength and endurance though a variety of activities and cash your bonus checks often!

Small head cropped1The Coach’s Take Away
Convincing or persuading our clients to exercise is not an effective strategy in wellness programming, or especially in coaching. However, if your client is:

• Someone who is up for increasing their mental performance at work
• On the edge of readiness to begin exercising
• Someone with a slim body but unaware of the multitude of benefits exercise offers
• Someone with or without a “weight problem” but who needs the benefits of exercise to more positively affect the course of a chronic illness
• Someone you are coaching around stress, insomnia, etc.

Then sharing this kind of information may provide just the “tipping point” leverage they need to make some lifestyle improvement.

James Prochaska always says that people underestimate the benefits of change, especially exercise, and overestimate the costs. Help your client tip the scales in a healthy direction. And…don’t forget to be the sharpest coach around by taking advantage of these benefits of exercise yourself!

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The Road Ahead for Wellness Coaching: Trends To Look For

LongAndWindingRoad

Returning from the 2013 National Wellness Conference this month, I continue to be amazed at how wellness coaching has become such a vital part of the wellness field.  The tiny trickle of interest in wellness coaching that began in the late 1990’s is now practically a tsunami of both excitement and action washing the field forward with surprising speed.

Like any flood there is a lot of debris and profound changes that are not fully formed.  Hospitals, corporate wellness programs, disease management organizations, EAP’s, and insurance companies are scrambling to bridge the behavioral skills gap as their nurses, health educators and others seek training in wellness coaching and effective behavioral change methodologies.  Independent coaches still struggle to educate the public on the value and benefits of hiring a wellness coach.   Wellness Coach Training programs are not all equal and not all aspects of the profession define wellness coaching in the same manner making it challenging to measure the positive outcomes of wellness coaching programs.  (see blog post “Wellness Coach Certification: What It Means and the Top Six  Features to Look for in a Wellness Coach Training Program”  http://wp.me/pUi2y-6F)  This new era stretches us to standardize wellness & health coaching as a profession.

To help with the efforts to improve standards and credentials for wellness and health coaches and to continue to help the wellness field grow, I have become committed to three primary efforts: the National Consortium for Credentialing Health and Wellness Coaches – NCCHWC (http://www.ncchwc.org), The National Wellness Institute (http://www.nationalwellness.org) and The International Coach Federation- ICF (http://www.coachfederation.org).

My role as a founding member of NCCHWC has now grown into a position as a member of its Board of Directors. After a long haul getting organized and clear we are now moving forward this year with fund raising and the process of doing both a job task analysis and a curriculum analysis for wellness coaching.

2013 National Wellness Institute Board of Directors

2013 National Wellness Institute Board of Directors

It was also an honor to be elected to the Board of Directors of the National Wellness Institute this year.  This will allow me to help shape the future for this great organization and the wellness field itself. Our board now has five of its eleven positions filled with individuals who include wellness coaching in their professional identity, a true testament to what a central part of wellness programing coaching has become!

Janet Harvey (ICF), Michael Arloski (RBGWS) Magda Mook (ICF) and Linda Gogl (RBGWS)

Janet Harvey (ICF), Michael Arloski (RBGWS) Magda Mook (ICF) and Linda Gogl (RBGWS)

This year at The National Wellness Conference (http://www.nationalwellness.org/?page=NWC2013) we were happy to have two ICF Officers presenting. Janet Harvey (Immediate Past-President of ICF Global) and Magda Mook (Current CEO of the ICF) presented on wellness coaching and leadership as part of the conference’s coaching academy. This showed the increased recognition by the ICF that more and more coaches are identifying themselves as wellness coaches and the field is growing rapidly. The Wellness Coach Training Institute (http://www.realbalance.com)will continue to build its core curriculum around the Core Coaching Competencies that the ICF outlines. We are happy to have more direct contact with its officers as we move forward.

Involvement on these three fronts, combined with the training that our company does both in the U.S.A. and around the world, will continue to position me to have a broad perspective on how the wellness coaching movement continues to grow and move forward.

So! What lies ahead on this road?  Our trail through the wilderness that we blazed years ago has fast become a multi-lane expressway! Looking at our rapidly increasing enrolment, and the proliferation of training programs I would say that the wave we are riding is still cresting and has lots of energy behind it.

Trends arrowsTRENDS

Here are some trends/directions we will continue to see for wellness coaching.

• As 2014 looms for The Affordable Care Act more and more wellness programs will seek to include certified wellness coaches as part of their wellness programs. “Pay for performance” will drive an outcome-based incentive for healthcare delivery, and the programs that include a behavioral/lifestyle medicine approach (delivered through wellness coaching) will see greater success in improving their patient’s conditions and overall health. As a result, more coaches will find a direct role in medical settings.
• Infatuation with highly scalable technology-based coaching methods will reduce as more is learned about effective, though limited, ways emerge to apply these methods.
• Coaches working live with their clients will continue to find effective ways to integrate technology as part of the coaching process and will find that tracking tools such as phone apps, and web-portals for communication can be very helpful.
Positive Psychology will continue to provide validation for the “coach approach” and will help drive a movement away from the old risk-reduction model of wellness programming.
• Wellness programs will find better ways to attract people to wellness programs (and wellness coaching) than to offer a financial discount on health insurance premiums.
• More clarity about an operational definition of wellness coaching will allow for better research parameters and what we might call “true” wellness coaching programs will build a base of positive evidence.

Hopes For The Future

Projecting trends is about keen observation, sharing hopes is more about what comes from the heart. Having nurtured this field of wellness coaching along since infancy I have a lot of love for what we’ve seen it achieve. Reading our student’s case studies showing evidence of literally life-saving coaching efforts and seeing organizations report huge health cost savings has been incredibly rewarding. My hope is that we will see the field grow in its professionalism, recognition and that this will lead to eventual financial coverage by insurance. The value is there. Here are some other small hopes of mine for wellness coaching:
• That we will avoid the temptation to over-train and set the requirement bar higher than it needs to be. If coaches stick to coaching and refer the rest, it can be a profession that remains at an affordable level for organizations.
• That we avoid another temptation…that of over-psychologizing coaching. As a licensed psychologist with many years of clinical experience I can tell you that infusing coaching with complex psychological theories and psychotherapeutic approaches will set those coaches up for disaster. A well-trained psychotherapist has years of in-depth education that allows them to handle psychological emergencies and crisis…a coach does not. If you can’t go there with a client and help them come all the way back, don’t even start that journey…refer!
• That we will continue to see the amazing spirit of collaboration that I have witnessed between the participants in the NCCHWC. Organizations and companies that compete for students have pulled together for the good of all.
That we will continue to coach the whole person, helping them to discover the motivation that a Well-Life Vision and a sense of meaning and purpose can provide.
• That we can take the coaching concept of alliance and spread it world-wide. We can all be Allies For A Healthy World (see more about our efforts in this direction in upcoming posts).

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FAVE ! First Acknowledge, Validate and Empathize.

What really reaches us is empathy.

What really reaches us is empathy.

Effective coach training teaches about   the power of relationship, of person-to-person connection, not just because it’s warm and “nice”, but because all the evidence from coaching and psychotherapy says it works! We each need to feel truly heard by others that we are attempting to be in relationship with. When we share our lives, our experiences and our feelings we truly want to have acceptance, acknowledgement, and validation.

If I share that I have been in pain since an injury and it is breaking my heart that I can’t get out and enjoy the physically active things I love to do, I don’t want someone to consult with me about a solution (“Let’s explore what you can do to exercise now.”). I want someone to say “Wow! That must be so terribly difficult for you to be unable to exercise.” I want them to “get it” that I’m not only in pain, but I’m frustrated, angry, stuck, depressed, and feeling loss. I want to HEAR that they “get it”.

Once I feel like my experience is understood at that heart level, that my feelings have been affirmed, and it’s been conveyed that it’s okay for me to feel the way I feel, THEN I’ll be happy to launch into some great strategic thinking about seeking solutions.

Empathy RogersWhen coaches convey what I love to call The Facilitative Conditions of Coaching (see my previous post: http://wp.me/pUi2y-6i) clients feel the validation, acceptance, acknowledgement that we’re talking about. Coaches have to find the words to convey empathy, acknowledgement, unconditional positive regard, warmth and genuiness. But, they have to remember to do that FIRST, before they jump to solution seeking.

Having trained over 4,000 wellness coaches worldwide, I’m continually amazed by two things: 1) we train some of the warmest, kindest, most caring people on the planet, and 2) when learning the new skill of coaching these same wonderful people so often totally forget to express warmth, kindness and caring. They struggle on the hot seat of
demonstrating/practicing coaching, and in their anxiety of new learning, instead plow right into seeking to “fix” the problem presented. No statements of empathy. No expression of understanding what the client is feeling. Instead one question after another seeking to find a solution (So what types of exercise have you already tried since your injury?). And by the way, we have observed no difference here by gender, probably 85% of the coaches we have trained have been female.

Remember to be a coach, not a consultant. Consultation is all about finding solutions. Consultants name their businesses things like “Totally Amazing Solutions, Inc.”. Coaches help people discover/create their OWN solutions, they don’t just provide them for their clients…that’s consulting. The mindset shift from treatment provider, consultant (medical or otherwise), or educator to that of coach takes repetitive practice. It’s so easy to slip back into the “What wrong and how can we fix it?” thinking, instead of staying in the coach’s “What’s possible?” thinking.

Acronyms can help us remember processes. Let’s try this one: FAVE.

FAVE: First acknowledge, validate and empathize.

As our client’s story unfolds tune into it with the mind of compassion, the mind of understanding and the mind of connection. Some of what works is relaxing into the coaching process and realizing that just by being true to our naturally warm and empathic way of being we are providing that “safe container”. We “hold sacred ground” for our clients to do the exploration they need to do. When solution finding is embarked upon without adequate exploration, the path taken is often unproductive at best and counterproductive at worst.

So, FAVE! First of all ACKNOWLEDGE your client’s experience. Paraphrase, restate and reiterate what they have said. Remember to reflect their feelings. Help them feel that it has been recognized that they have been experiencing the emotions they have been living. Acknowledge the courage it takes to share. Acknowledge the self-caring it takes to seek help and assistance. Acknowledge the depth of your client’s challenges, their strengths, etc. So you haven’t been able to run or bike ride for three months now. How tough it must be to go from being so athletic to hardly exercising at all! Tell me more about what that has been like for you.

As you do this you VALIDATE their experience and their emotions.  Your unconditional positive regard (and therefore lack of judgment) makes it possible for the client to feel that it is okay for them to feel the way they feel. You are affirming that what they have told you has been their reality. You help the client feel that their story is validated, and as you coach further, with that accepting and yet at times challenging coaching presence, you help them learn that they are NOT their story. As you acknowledge, affirm and validate you help them feel well heard. You help them explore their experience and EXPRESS their feelings about it so they can let go of it, put it in the rear-view mirror, and realize they are not trapped by their story.

Our most powerful vehicles to convey this acceptance and affirmation, this sense of support is the EXPRESSION of empathic understanding. That kind look in the eyes, your thoughts of compassion are very sweet, but they are not enough. We have to put it into words (think telephonic coaching!) and COVEY our empathy. So when you have free time you just have to sit there and wish you were able to move like you used to. How challenging! You must miss being active very much. It sounds like you’ve tried to deal with as best you can, but it’s got to be a real loss for you.

It takes courage on the part of the coach to practice FAVE. You’ve got to be okay with emotion, not afraid of it. Empathy is not trying to cheer the person up, quickly reassuring them that everything will be all right, in essence rescuing them. This conveys a message like “Don’t feel they way you’re feeling. Feel the way I’m more comfortable with you feeling. Cheer up!” FAVE is getting down in the mud, or up riding high in the sky WITH our clients…meeting them where they are at, not where we want them to be. I want MY reality acknowledged, not YOUR fantasy!

Creating "Sacred Space"

Creating “Sacred Space”

The thing to remember is that when we allow our clients to feel the way they feel they usually do so and move through it more fluidly. When they are not able to, even after our repeated attempts at providing our best facilitative conditions, it’s probably time to consider referral to a mental health professional (see my previous post http://wp.me/pUi2y-bA.).

Perhaps some of our “rush to solution” is connected to our fear of dealing more directly with feelings. I’m not going to second guess a coach’s intentions and motivations here. I would just love to see coaches serving their clients in the most effective way possible, and that begins with FAVE.

What are some of your thoughts on the idea of making acknowledgement of our client’s experience a priority?  Please leave your comments.

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Access Excess: Always Wired Makes Us Tired and Less Productive

Access Excess!

Access Excess!

Paradox, double-edged sword, blessing and curse combined, mobile devices have made our lives easier and more stressful at the same time. I remember the feeling of relief the day I finally got my calendar synched on my work/home computer, my laptop and my smartphone. Now I could be in a conversation with someone at a conference and set an appointment seamlessly. It helped tremendously using a GPS navigating app to help find a tricky destination. I absolutely love using the travel app “Tripit” to track all my business travel arrangements. Connecting with others is easier than everWhile we can benefit from technology in so many ways, we are also seeing a “dark side” rising far too fast. The accessible anytime and anywhere nature of smartphones, wi-fi enabled tablets, etc. is causing a shift in workplace norms and, sadly, a shift in in the quality of our personal lives as well. A recent cover story in USA Today reveals how the so-called digital lifestyle and work-style may be seriously damaging our health and well-being. “Nearly two-thirds of full-time workers own smartphones, up from 48% just two years ago, according to the Pew Research Center. One-third own a tablet, up from 12%.  The exploding use of these devices — and connected employees never calling it a day — has created a workplace domino effect: If one person answers the boss’s e-mail after hours, others feel compelled to as well.”

cell-phone-stress-300x199When people are under stress for performance it is so easy to create a sense of digital vigilance that never lets down. Our notification alert signal is on full volume 24/7 so we don’t miss that opportunity that just might be calling. As we get more anxious it becomes more common to even get downright obsessive about our need to be accessible.

Some companies are realizing the price they pay in stress and health and are instituting policies to “leave it at the office”. The need for some ground rules is becoming apparent as the demands on the digitally connected worker increase. “Under the Fair Labor Standards Act, employees entitled to overtime pay must receive it when they work beyond a maximum number of hours, such as a 40-hour workweek. The constant technological tether to work is testing what constitutes the standard workweek, and lawsuits are challenging this new world.” Salaried employees have no such limits.

The self-employed have to set their own limits and often don’t. Fear of missing that opportunity for a sale by not responding at light speed keeps the smartphone charged and within easy grasp. The infectious sense of urgency in society is hard to be immune to.Double Cell

The whistle never blows in this world of Access Excess. There are no natural breaks. Time off has disappeared. This of course runs in total opposition to how our mind/body system works. We are wired to deal with stress, but can survive only if we also have what the authors of The Way We’re Working Isn’t Working call “sufficient volume and intensity of recovery”.

Wellness coaching clients almost always list stress as a barrier to them living a healthier life in almost all dimensions of wellness. Coaches can help their clients to consciously work on their fears, communicate and create agreements at work that are healthier. We can also help our clients to determine if their work environment can be changed for the better or if looking for work in a healthier environment is final solution. We can help our clients create experiments to help them see just how digitally healthy they really can be by being less “wired”. We can help them increase awareness of how much they are allowing fear and anxiety to rule them and work consciously on this issue.

Boundary setting is so much harder when it insidiously has become weakened by cultural norms. “Access Excess” has become a norm that no one ever agreed to. Let’s create agreements at work and at home that allow us to make times to be “unplugged” and healthier!

Question?  Is the man in the picture below able to be free to be at this relaxing lake because he can still be connected, or is he there and stressed because he is allowing himself to be connected?

Lakeside Tech

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The Wellness Coach And Referring Clients To A Mental Health Professional: PART ONE – WHEN

When is it time to help a client find a mental health pro to talk to?

When is it time to help a client find a mental health pro to talk to?

A critical issue for all coaches is to be clear about when and how to refer a client who is best served by seeing a mental health professional either instead of coaching, or in conjunction with it. This will be the first of a multiple post series on this vital topic.

Working on lifestyle improvement is going to bring up emotions. How a client feels about their own body is just as important as how they treat it physically. Internal barriers to change rear their ugly head just when a client if finally making some great progress in their efforts to lose weight, manage their stress, quit using tobacco, etc. Internal barriers can include such tricky subjects as one’s belief systems, optimism/pessimism, listening to their own “Inner Critic” or “Gremlin”, and self-defeating self-talk. A good coach can help a client process feelings, but what should a coach do when it seems that coaching is getting “too psychological”?

For approximately twenty-seven years I practiced psychotherapy and thoroughly enjoyed it. I loved seeing people grow, and yes, heal. For over sixteen years now I’ve been working as a professional life and wellness coach. Our company, The Wellness Coach Training Institute (http://www.realbalance.com) has trained over 3,000 coaches worldwide. In doing so we’ve learned that making the distinction between coaching and counseling/psychotherapy is often challenging for coaches. Lets explore what the standards of our coaching profession are about this distinction, and I will also inject my own professional opinion into some of the gray areas.

1) Who NOT to coach! When referral needs to happen up front.

Wellness coaches sometimes find people approaching them for coaching for severe problems that need to be addressed in counseling/psychotherapy. A classic example was the woman who called me saying she had heard good things about my coaching. Immediately she asked if I would coach her about her relationship with her live-in boyfriend. Both of them were self-described alcoholics and he was physically abusing her. What’s more the abuse and alcoholism was precisely what she wanted to “coach” about. I responded empathically, but immediately referred her to her choice of three fine therapists here in town that I personally could recommend. Coaching is just not designed to substitute for therapy. When you are clear that the person you are dealing with has such serious issues gently, but firmly make the referral on the spot and refuse to coach the person.

ConfusionSignAttempting to avoid the stigma of psychotherapy, or even the self-admission that they need serious help, some folks will seek out a coach instead. If the coach takes the bait and sees them there are two dangers: the change they need will not take place (nothing will happen), or, much too much will happen! The in-over-their-head coach could be overwhelmed with potentially dangerous scenarios of behavior.

Having hospitalized clients as a psychologist I have seen what suicidal behavior, psychotic breaks and more really look like. This is the territory for someone with a high level of professional training: masters and doctoral level training in clinical skills and a valid license to practice counseling and/or psychotherapy. Coaches need to respect their own limits and help people who come to them needing more than what coaching can provide to find the real help they need.

2) When to refer a client you are currently coaching.

This question of when to refer falls roughly into two categories; what you might call the “obvious” and the more complex. Let’s look at the more obvious, easier to spot situations.

icflogoHere we draw upon the excellent article written by Lynn F. Meinke, MA, RN, CLC, CSLC , “Top Ten Indicators to Refer a Client to a Mental Health Professional.” This is available free to the public at the ICF Website by following this link http://www.coachfederation.org/articles/index.cfm?action=view&articleID=773&sectionID=27.

The article goes into good detail on each of the indicators listed below and is a MUST READ for any coach.

Make sure you refer your client to a mental health professional when
YOUR CLIENT:

(1) Is exhibiting a decline in his/her ability to experience pleasure and/or an increase in being sad, hopeless and helpless.

(2) Has intrusive thoughts or is unable to concentrate or focus.

(3) Is unable to get to sleep or awakens during the night and is unable to get back to sleep or sleeps excessively.

(4) Has a change in appetite: decrease in appetite or increase in appetite.

(5) Is feeling guilty because others have suffered or died.

(6) Has feelings of despair or hopelessness.

(7) Is being hyper alert and/or excessively tired.

(8) Has increased irritability or outbursts of anger.

(9) Has impulsive and risk-taking behavior.

(10) Has thoughts of death and/or suicide.

The “more complex” times when referral comes into question is when it appears that your client is still functioning fairly well, but the coaching is just not getting anywhere and the reason is in the psychology of your client. This can look a couple of ways:

A) Your client keeps making attempts to change their way of living, but keeps holding themselves back with self-defeating behavior. You may keep coming back to an old issue that still needs healing and is in the way of progress. An example could be a client whose self-doubt stemming from a severely critical parent is so great that they continually will not give themselves permission to risk new behaviors. You try some good process coaching, but still you find that you both just keep coming back to the same stuck spot. A great time to refer.
B) When your client just seems to want to process feelings endlessly. The progress that should be seen processing feelings leading to insight, which is then translated into action steps towards growth, seems blocked.  You may find that you are able to continue to coach your client around wellness and lifestyle improvement while they get their therapy needs met by a qualified counselor/psychotherapist. Your challenge is to again, not take the bait. When your client heads into the therapy realm, say something empathic but then add “You know, that would be a great thing to talk to your counselor about! Therapists can help with that much more than coaching can.”

Next time we’ll explore when to keep on coaching and look at the ethical questions that arise when coaching makes promises it really can’t keep.

An excellent resource to check out: “Coaching or Therapy: A Map For Coaches.”
http://www.benhamconsulting.com/coaching_or_therapy.html

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Healthy At Any Size: Coaching Weight Loss Clients To Be Fit and Healthy

holiday-eating-and-weight-gain

What’s your strategy for the healthiest holidays ever?

The fear of adding those holiday-midwinter pounds often drives people to the bookstore for yet another dieting best-seller. The desire for quick results is understandable and nothing delivers like a low-calorie diet. The infomercials promise miracles and we keep on seeking a solution that we know sounds too good to be true. Of course those same low-calorie diets are impossible to sustain us for the rest of our lives. The pounds usually come back. Our bodies just need more energy.

no-dietingThe truth is, diets don’t work. What does? Sustainable lifestyle improvement. Sorry, we can’t promise that this approach will be fast, but it will work, and it will last.

“Let’s face facts. We’ve lost the war on obesity. Fighting fat hasn’t made the fat go away. And being thinner, even if we knew how to successfully accomplish it, will not necessarily make us healthier or happier.” These words introduce you to the website http://www.haescommunity.org for an organization and an entire movement known as “Health At Every (or Any) Size”. Linda Bacon, a nutritionist at the University of California, Davis, says this new approach came about “to halt “the collateral damage” — food and body preoccupation, self-hatred and eating disorders — that has resulted from the failed war on obesity. H.A.E.S. is based on the idea that “the best way to improve health is to honor your body,” and it supports the adoption of good health habits simply for the sake of health and well-being rather than weight control. (http://6thfloor.blogs.nytimes.com/2011/03/09/health-at-every-size/)

Teaming up with Lucy Aphramor, a National Health Service specialist dietitian of Coventry University in England, they reviewed over 200 studies on weight loss and concluded that the evidence just isn’t there that dieting helps us attain and maintain healthy weights or healthy lives.

Perhaps our notion of our own “healthy weight” needs a total makeover. Instead of focusing only on what the scales tell us, how about looking at our overall wellbeing? “Bacon and Aphramor insist that adjusting lifestyle habits with an eye toward improving markers of well-being like reduced blood pressure, lower cholesterol levels, reduced stress, increased energy and improved self-esteem — independent of any weight loss at all — is a far more desirable goal for people of all sizes to pursue.”

Pursuing being as healthy and vibrant as possible with physical vigor and mental and emotional peace of mind may be what trumps every diet out there. Weight obsession needs to be replaced with both individual awareness of what truly nourishes us on many levels, and the science that focuses on real wellness.

The Coach Approach

When a wellness coaching client tells me “I want to lose 30 lbs.” The first questions I ask are “What will your life be like when you succeed at losing that weight? What will your life look like? What will you be doing and enjoying that you’re not doing now?”

Far too often clients get into self-defeating thinking by seeing the “goal” as the number on the scales, and its easy for coaches to simply fall in line with this simple goal-setting approach. Until the magic number is attained it’s too easy for the client to minimize their weight loss accomplishments with a “Yes, but…” attitude. I will only be successful when I lose all the weight I’m trying to lose. Internal barriers to change are every bit as powerful as external. It’s time to explore better outcome indicators.

Explore with your client the best markers of improved health and well-being would look like for them. Would tracking improvements in the markers Bacon and Aphramor referred to above be smarter? Get an agreement from your client about what they would like to see improve and tie it to their motivation to be well. Help your client notice the richly motivating unforeseen benefits that show up as they make progress. Celebrate improvements such as reduced pain in the knees, better sleep, more energy, etc.

dont-forget-to-love-yourself-2When someone who has struggled to live at a weight that is healthy for them is told that weight loss is simply “calories in and calories out” it is insulting and dismissive of them as a person. We human beings are wonderfully complex and our life journeys are fascinating. Embrace your whole-client, just as you urge them to embrace themselves.

Dr. Michael Arloski is a psychologist, certified wellness coach and a certified wellness practitioner who is the founder and Dean of The Wellness Coach Training Institute where the very best in Wellness & Health Coach Certification Training can be found. http://www.realbalance.com

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