Coaching a Client Through To A Mental Health Referral Using The Stages of Change

Times arise when it becomes apparent to a wellness coach that their client would benefit from working with a mental health professional. The need for referral may be urgent and involve client safety as when there is a threat of harm to self or others. That rare situation is usually more clearly recognized, referral is made and coaching is usually terminated. (“Top Ten Indicators to Refer a Client to a Mental Health Professional.” This can be found in the Wellness Resources section of the Real Balance website:https://www.realbalance.com/wellness-resources ) (See also this previous post: The Wellness Coach And Referring Clients To A Mental Health Professional: PART ONE – WHEN (http://wp.me/pUi2y-bA) )

More common is the situation where the client raises issues where there is no immediate danger or threat, but rather, there is either a history of unfinished emotional issues, or there are current circumstances that are creating barriers for the client’s effectiveness at succeeding at lifestyle improvement. In such situations, having a thorough working knowledge of the difference between coaching and therapy is essential for a professional coach. The best possible resource for this is this article by Meg Jordan and John Livingstone (https://www.realbalance.com/wellness-resources).

Resolution Vs. Relevance

How is the past affecting the present?

The first step would be for the coach to explore with the client to see if they are currently in therapy for these kinds of issues, or have been in the past. Then, the coach and client may be able to explore if they can coach about these issues, not to resolve them, but to see how they obstruct progress in the client’s efforts at lifestyle improvement. Can they be accounted for and worked with in coaching, or are the challenges so great that they will actually prevent progress in the coaching?

Well-trained coaches can do process coaching. The key here is to seek how the emotions of the client are relevant to the progress they are attempting to achieve in coaching. Perhaps a client repeatedly holds themselves back from engaging in the wellness/self-care activities that the coach and client create as action steps in their wellness plan. As this is discussed an internal barrier is identified that traces back to their family of origin. Perhaps a critical parent harshly enforced that all work must be done before one does anything for one’s self. Now, the goal of doing process coaching around this is not the resolution of all of the feelings and unfinished business with that parent (be they dead or alive). Instead, it is to gain insight regarding how these past learning’s are holding them back today. If the client is able to gain such insight and translate it into action (moving ahead with self-care) then the process coaching is achieving its goal. If the client continues to only process feelings and does not gain insight or does not succeed in shifting their behavior, then, we have probably identified an issue that is significant enough to warrant the encouragement of referral to a counselor or therapist.

In such cases or if the issues are beyond the scope of coaching and are interfering with client progress, then exploring making a referral needs to begin. How to make this referral successfully is not as simple as explaining the benefits of therapy and providing resource information. Very often clients are ambivalent, or even outright resistive to a referral to a mental health professional. The thought of reconnecting with all of the unpleasant emotion involved in working directly on their issues in therapy brings up fear. Unfortunately, coaches sometimes drop such a client quickly when they are not ready to jump into action and seek out the therapy they would benefit from. This is where a client would benefit from a coach who implements a Stages of Change approach (The Transtheoretical Model of Change developed by James Prochaska).

In the new book by James and Janice Prochaska Changing To Thrive (https://www.prochange.com/uncategorized/2017/02/prochaskas-new-book-changing-thrive-published), they make the point that most of the people we all work with are not in the action stage of change on any particular behavior. They estimate that only about 20% are actually ready to jump into action. Why would this be any different when it comes to engaging in counseling or psychotherapy? Yet, so often, when the client balks at following through on a psychological referral, coaching is abandoned. Instead, think of it as our job to help the person to weigh the pros and cons of engaging in counseling as they sit in the Contemplation Stage of Change. We are helping them with Decisional Balance. Taking a page from Motivational Interviewing, we coach as they work through their Ambivalence. We want to “roll with resistance” instead of accepting it as a rejection of our referral recommendation.

Coach THROUGH to referral!

Coach: So, I hear your hesitance when I suggest that counseling might be the best way forward with this.
Client: Well, yes. I’ve been in counseling before and I don’t know if I want to open up that whole issue again.
Coach: Sounds like you possibly have some fear about talking about such uncomfortable subjects again.
Client: Yeah. Growing up in my home was not a pleasant thing!
Coach: I know it holds a lot of negative memories for you. You’ve shared some stories about how bad it was. Yet, I also hear you saying that it’s frustrating to have these things hold you back from doing what you want to do today to be healthy and well.
Client: Right! It’s really frustrating! I know I need to get more active and take more time to eat right, but then I feel so guilty when I take time for myself.
Coach: So, on the one hand you really want to make these improvements to your lifestyle, but when you attempt to do so, these barriers, these thoughts get in the way.
Client: Exactly! I appreciate your help, but it seems like whenever we set up action steps, I never follow through on them, even though I know I need to.
Coach: Yes, we’ve explored how it’s all related, but we still seem stuck. What do you think would be the benefits if you did get back into counseling about this?
Client: Well, I guess I could really open up about it and try to unload some of this frustration. I’m just so tired of having the past hold me prisoner!
Coach: So a counselor could actually help you explore that and really make some progress in this area, perhaps result in some relief.
Client: Yeah. Okay. So what’s next?
Coach: Well, let’s work together on reconnecting you with some counseling. Let’s see what steps you can take to find the resources you need.

In this example the coach meets the client where they are. They help their client to Contemplate the idea of returning to counseling. Acknowledging the client’s fears and validating their feelings, the coach helps the client to begin to weigh the reasons to return to counseling and the reasons to avoid it. The family of origin stories are referenced, but not delved into. Instead, the emphasis is on relevance. How the past is getting in the way of the present is the essence of the contemplation. Then, at the end of the example we begin to move into the next Stage of Change; Preparation.

Coaching works because we are the client’s ally through the whole behavior change process. When referral comes up, we remain their ally. Then to help them actually follow through and make it to the referral resource, we help them with the process of identifying such resources, making the appointment, and attending the appointment. We offer support and accountability with all of the action steps required to achieve this preparation. We acknowledge the courage, the valuing of one’s self that is required for each step along the way.

James & Janice Prochaska with Michael Arloski

Take what you know about the Transtheoretical Model of Change (Stages of Change) and apply it to the referral process. Be your client’s ally when they need you the most.

 

SPECIAL ANNOUNCEMENT:  James and Janice Prochaska will be Dr. Arloski’s guests on the Real Balance Free Monthly Webinar – May 26 at Noon Eastern Time.  This will be a special one-hour webinar where the Prochaska’s will be sharing their breakthrough work from their new book CHANGING TO THRIVE.

“Changing To Thrive: Using the Stages of Change to Overcome the Top Threats To Your Health and Happiness” An Interview with James and Janice ProchaskaRegistration URL: Registration URL: https://zoom.us/webinar/register/bd820be2db187da1c5b9141539e44ee6

Posted in Boundaries in coaching, health coaching, Health Coaching Scope of Practice, wellness, wellness coaching, Wellness Coaching Scope of Practice | Tagged , , , , , , , , , , , ,

China Embraces Real Balance Wellness Coaching

Real Balance Wellness & Health Coach Certification Class in Shanghai – 2017

Faced with the same lifestyle-based health crisis many other countries are experiencing, China has been searching for a way to help people truly succeed at lasting lifestyle change. Over half of the men in China smoke. The diabetes rate is now higher than the United States, with heart disease, COPD and other “lifestyle diseases” on the rise. Health information campaigns and medical admonition, as elsewhere, has only gone so far. Last month when Real Balance Global Wellness Services, Inc. (https://www.realbalance.com) teamed up with Chestnut Global Partners China EAP (http://chestnutglobalpartners.org) to bring live wellness and health coach certification training to China it was enthusiastically embraced.

The concept of wellness is new to China, and wellness & health coaching is even newer. Though there is a long tradition of Traditional Chinese Medicine that blends with Allopathic Conventional Medicine, these are still remedial treatments and do not address how to help someone improve lifestyle behavior. Smoking cessation programs are vigorous but face a huge challenge in this population. Wellness coaching provides an innovative way to make behavioral change possible for those who need it.

What impressed me most about my entire trip to China were the students in our live training in Shanghai. The class was composed partly of Chestnut Global Partners EAP employees. These were mostly physicians and department directors. The rest of the class was a mix of M.D.’s, dieticians, counselors, Human Resources professionals and even a few independent life coaches. Throughout our grueling six-day training their level of engagement was extraordinary. While all students are faced with the “mindset shift” challenge (going from a prescriptive, consultative way of interacting, to a coach approach), this group did so with less resistance than we anticipated. They really got the concept that when it comes to helping people change behavior, it is very different from treatment or education. Fortunately, the training I delivered was coordinated with my translator and co-trainer, Dr. Li Peizhong, psychologist and V.P. of Chestnut Global China. He performed live translation as I spoke, and added greatly to the interaction and processing.

All of our trainings are highly interactive, and when students shared information and stories of work they had done with patients and clients, the level of humor employed was amazing! Much was “lost in translation” for me, but they were continually breaking out into boisterous laughter. Also, the Chinese students were more natural in their continual use of empathy in their coaching practice. While they tended, like students everywhere (we’ve found), to jump right into problem solving first, they used empathy and spoke of the importance of it, more than any other group I have trained.

Chinese culture is well known for valuing the group. As our training went on, group cohesion increased rapidly. Students supported one another in their learning through a real sense of caring for one another. When one student volunteered to be our client for a round of “fishbowl coaching” practice (where a student works on a real life challenge and is coached by a number of students) she left the exercise still perplexed about a way forward. Students formed a circle around our volunteer student and spent their entire break time collectively discussing with her about how to address her challenge.

The other evidence of this collective spirit was in the almost instant formation of a class group on the app WeChat. Before the training was even finished, and then vigorously once it was complete, they were on WeChat (http://www.wechat.com/en/) connecting, lining up their Buddy Coaching, and then sharing photos and stories of how they were following through on their own lifestyle improvement action steps.

Practicing Tai Chi On The Great Wall

The students were unbelievably appreciative, kind and treated me like royalty. I had integrated some of my Tai Chi and Xi Gung practice into our energy breaks, much to the delight of the students. At the conclusion of the training, at our celebratory class dinner they gifted me with a beautiful white Tai Chi practice suit to show their appreciation.

On To Beijing!

After our training in Shanghai, we flew to the country’s capital, Beijing, for a special Book Release Event. At Peking University (yes, it is spelled differently), Chestnut Global and my publisher, The China Translation & Publishing House, hosted a large gathering of executives from several multi-national corporations, representatives of the Chinese government’s smoking cessation program, and others, to witness the release of my book, Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., (https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml)  in its Mandarin translation. Speakers from Chestnut Global, Peking University, and the government’s smoking cessation program joined me in delivering talks to the very receptive audience. This was followed by one astonishing Chinese banquet.

A World of Wellness

I have been fortunate to take our training to a number of countries around the world and each experience has been special. The beautiful thing is that whether it is a training session in Indianapolis, Sao Paulo, Dublin, Shanghai, or Fort Collins, our students know that this training is going to make their work so much more effective. They know it is going to make their work so much easier, and more rewarding. They know it is going to help them enhance the lives of others.

I’ve stood at the front of the room around the globe, but it is the people who stand behind me that really make it all possible. It’s the allies we’ve formed in other countries and it’s the people right here at home. I’m able to write books and deliver keynotes and trainings because others are operating the office, servicing our students, teaching classes and representing Real Balance to the world as well. I come back from China with a heart full of hope for the people of our planet and with gratitude for those who help me step out there and make it a better place.

Posted in coaching, health coaching, Lifestyle Medicine, wellness, wellness coaching, wellness travel, World Health | Tagged , , , , , , , , , , , , ,

Real Balance GLOBAL – Taking Wellness Coaching To China

Taking Wellness Worldwide

Taking Wellness Worldwide

What The World Health Organization dubbed “Lifestyle Disease” is a global phenomenon. The increase of non-communicable disease is going up the fastest in what is sometimes called the developing countries of the world. “Twenty-five years ago, the number of people with diabetes in China was less than one percent. Today, China has more than 114 million people suffering from the disease, the highest number of any country in the world. It is estimated that 11.6 percent of Chinese adults have diabetes, a proportion higher than the U.S. with 11.3 percent. Experts blame the increase in sedentary lifestyles, high consumption of sugary and high-calorie Western diets, excessive smoking and lack of exercise.” (http://www.counterpunch.org/2015/07/24/the-increasing-burden-of-diabetes-in-china/)

From the very start of my work in developing the field of wellness coaching my vision was to bring wellness worldwide. Real Balance Global Wellness Services, Inc. (http://www.realbalance.com) has now trained over 6,000 health and wellness coaches around the globe. We have trainers in Ireland, Brazil and Australia. We have trained people from places like Dubai, Ethiopia, Hong Kong, Denmark, Korea, and many more countries through our fully-interactive webinar trainings.

shanghai0515-cityscapeNow we are continuing with our global mission by TAKING WELLNESS COACHING TO CHINA ! We are proud to announce that Real Balance is teaming up with Chestnut Global China EAP (http://chestnutglobalpartners.org) to bring wellness and health coach certification training to China! I will deliver a certification training in Shanghai March 14-19, and then travel on to Beijing to promote wellness coaching and do a book signing.

2nd Ed Cover - MedThe book I will be signing in Beijing is Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., newly translated into Mandarin and published in China! The challenges of “lifestyle disease” are rapidly increasing in China as more people move to urban areas, diets change, smoking continues to increase, culture shifts and stress increases as well. Helping people gain access to allies that can help them succeed at lifestyle improvement is just as important here as anywhere else.

We are exploring other ways to connect with people around the world to contribute to the health of the planet and its people. Please be a part of creating Allies For A Healthy World.

broadmoorcolospringsBack In The U.S.A.

Please join us in beautiful Colorado Springs, at The Art & Science of Health Promotion Conference (https://www.healthpromotionconference.com).  March 27-31.
Real Balance will be exhibiting there and I will be delivering two workshops: “Five Key Coaching Skills For Motivating Sustainable Lifestyle Improvement”, and “Mastering The Science and Craft of Health & Wellness Coaching: Higher-Level Methods And Skills.” See you there!

Posted in coaching, health coaching, Lifestyle Medicine, wellness, wellness coaching, World Health | Tagged , , , , , , , , , ,

Healthy Boundaries For Health & Wellness Coaches: Part Two

Boundaries Are There For A Reason

Boundaries Are There For A Reason

In our last post we featured Part One on this topic:

A New Code of Ethics For Health & Wellness Coaches: Healthy Boundaries Part One   http://wp.me/pUi2y-kb There we introduced the new NCCHWC Code (National Consortium for Credentialing Health and Wellness Coaches) and began the discussion of boundaries with a look at ethics, appropriate relationships, touch and self-disclosure. We talked about the establishment of a trusting environment and how coaches show respect for boundaries by asking permission to explore sensitive areas. In this blog we’ll take a deeper dive into some specific areas where coaches often have questions about how to proceed.

Pushing The Edge

In health and wellness coaching boundaries can be pushed by either the coach or the client. When is a client asking for too much? When is a coach straying either beyond their Scope of Practice (see NCCHWC website: http://www.ncchwc.org/wp-content/uploads/2015/03/Final-NCCHWC-Health-Coach-Scope-of-Practice.pdf) or enters territory that simply feels uncomfortable for either party, or both?

boundariessoccerflagClient-Generated Boundary Crossings

  • Asking for reminders, contact beyond appointments, services not in the contract and personal inquiry.

 

When clients co-create with their coach agreements about action steps and accountability they frequently begin by asking for the coach to remind them to perform that action step. This is not an outrageous request and one that some coaches are okay with. What works better, however, and is much less of a burden on the coach, is for the client to agree to contact the coach (via email, text) to let them know when they did, in fact, perform the action step. This keeps the client more responsible and allows the coach to avoid falling into the role of nag or authority. Coaches should always agree only to what they are willing to do when setting accountability agreements.

Clients may also ask for additional contact beyond the agreed upon appointments. This request can arise out of a variety of intentions. Clients may desire more of a friendship relationship instead of a professional coaching relationship. This could even have romantic intentions. This is where using direct communication is a coaching skill that can pay off. The coach should gently inquire about the client’s intention in making such a request. This brings things out into the open and can lead to a helpful coaching conversation about where else in the client’s life they could get such needs met. The coach can gently, but firmly explain the advantage for the client in keeping the coaching relationship on a professional level.

I once trained a coach who had gotten into a coaching relationship where she would come to the client’s house, wake her up at 6:00 am and go jogging with her as part of the coaching service. I asked if their agreement was for coaching or for services as a personal assistant! There is quite a difference to say the least. Stick to coaching! When clients make excessive requests, explain the roles of a coach and explore how else the client might get these other needs met.

The other area coaches are often unclear about is how much to disclose about their own personal lives. We address self-disclosure in coaching very thoroughly in my previous blog post: “Self-Disclosure in Coaching – When Sharing Helps and Hinders” (http://wp.me/pUi2y-8m). To quote from that post: “Coaches choose to share certain biographical information with their clients to help build the coaching alliance. The coach who comes across as secretive about whether they have ever had children, are in a relationship with a partner, etc., is going to be trusted less. The challenge here is to maintain good professional boundaries while also being willing to relate to the client as an ally, an authentic human being, not an impersonal and distant professional.”

boundariescalmCoach-Generated Boundary Crossings

 

  • Going Beyond Competency – Beyond Scope of Practice

 

In Part One on this topic we addressed professional scope of practice. (See NCCHWC Health & Wellness Coach Scope of Practice http://www.ncchwc.org/wp-content/uploads/2015/03/Final-NCCHWC-Health-Coach-Scope-of-Practice.pdf You can also find copies of both the Code of Ethics and the Scope of Practice in the Wellness Resources section of the Real Balance website (https://www.realbalance.com/wellness-resources)

Looking more closely at what happens at times in coaching, we see that the edge that is pushed here is often done subtly and usually without intent to go beyond coaching. The number one concern I hear about in training coaches is the distinction between coaching and therapy. Again, look to the Wellness Resources section of the Real Balance website listed above for a copy of the definitive article on this subject by Meg Jordan and John Livingstone Coaching versus Psychotherapy in Health and Wellness: Overlap, Dissimilarities and the Potential for Collaboration.”

What I observe more frequently is when coaches pursue a line of inquiry into a client’s psycho-emotional history, into their family of origin issues, etc., and sometimes do so based upon methods and techniques that they have read about in various self-help books. Without a mental-health professional background, even attending a workshop with a famous self-help author does not prepare a coach to do such work. Such inquiries usually do not develop into dire mistakes, but do have the potential to urge the client to go somewhere emotionally that they and the coach are not prepared for. The number one brake here is for the coach to catch themselves when they realize they are engaging in this line of inquiry more out of their own curiosity/fascination instead of a solid coaching rational. When clients push to pursue this inquiry it’s time for the coach to state their own lack of qualifications to go there and to suggest how the client could be better served by speaking with a counselor, therapist, etc.referrals

 

Going beyond one’s competency can also occur outside of the mental/emotional dimension of wellness. It’s so easy for a coach to blur the line between providing some helpful wellness/health education and being more directive. Coaches should refrain from recommending, imploring, strongly suggesting, or arguing for the benefits of a particular course of action (such as a specific diet, exercise plan, or any form of conventional or non-conventional type of treatment) if they are not qualified to do so as a licensed professional in that field. The coach who can “wear two hats” can offer the wisdom of that other profession that they are part of when they clearly inform their client that they are doing so. This step “over the edge” can occur easily when the coach is not aware of how they are pushing their own agenda for change.

  • The Coach Acts Out Of Their Own Needshands-of-couple-reaching-for-each-other-resize

A boundary is crossed when the coach is no longer acting with the good of the client remaining primary. Coaches are fallible human beings like everyone else. Unmet interpersonal needs for intimacy, whether sexual, romantic, or simply the desire for closeness, can influence the coach’s actions at levels that require keen awareness to detect. Part of being a health and wellness coach is living a wellness lifestyle and that means acknowledging one’s needs and seeking healthy ways to get them met. Unmet needs for power and control, for self-worth through showing competency can also be expressed by coaches at an unhealthy level that once again causes the coach to no longer be acting with the wellbeing of their client as primary.

Coaches can also put their own needs first on the financial front. The coach who is facing severe financial stress may consciously or unconsciously strive to create more dependence in the coaching relationship instead of fostering independence in their client. Coaches who also sell wellness products, such as supplements, etc., may pressure clients to make purchases (a clear violation of the Code of Ethics).

  • Social Media Boundaries

Clients sometimes actually brag about having a coach and are proud to tell the world about the wonderful services that Coach X is providing for them. Coaches however must respect their client’s confidentiality and not identify any client on Social Media (Facebook, Twitter, etc.). It is also not a good idea to “friend” clients on Social Media. Clients can share information using more private methods of communication than a Social Media format that provides no privacy.

robo-coaching

Organization-Generated Boundary Crossings

 

  • Violating Client’s Right To Confidentiality

 

Most organizations are careful to avoid violating the privacy of their employees but this can happen when coaches working within an organization are asked to give specific reports on their clients. HIPPA regulations (https://www.hhs.gov/hipaa/index.html) protect the health information of a client. The request for information about “how a client is doing” may come innocently enough out of genuine concern for the client. Still, this request should be met with a recommendation that the person inquiring ask the client directly.

  • Requiring Internal Coaches To Push Sales

An organization may require the coaches that work for them to promote the sales of products or services within the context of the coaching. While this may be framed as a low-pressure offering that clients can easily decline, it is potentially an exploitation of the unique trusting relationship that the coaching process develops.

  • Requiring Internal Coaches To See Too Many Clients

Another boundary is that of setting healthy expectations/requirements for the number of clients a coach can see in one hour and in one work day. Some disease management and other large coaching services make excessive demands of their coaches in terms of quantity of clients seen, lack of break times, and lack of times to do coach notes, etc. The result is both a health risk for the coach and inevitably a diminishment of quality of services for the clients.

Organizations and coaches share in the responsibility and potential liability of working with the people they serve. They must always act with the good of the client (and the coach) – their health and wellbeing – as foremost in all policies and procedures.

Coaches also need to think about how they may at times be putting themselves at risk. One example would be if a coach meets a client in a building where they are the only occupants, or especially if the coach opened a locked building to meet with the client there.

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Healthy Self-Generated Boundaries

  • Knowing And Abiding By Your Own Limits & Boundaries

Perhaps the most rewarding benefit of Healthy Boundaries is the self-care that they provide for the coach themselves. We benefit from all of the healthy boundaries described above, but we also need to reflect on the boundaries that we need to set for our own mental, emotional and spiritual health and wellbeing. Sometimes coaches work in settings where excessive demands are made of them as we noted above. Independent coaches however, need to set their own limits and achieve healthy boundaries in order to preserve their own wellness and continue provide the highest quality services. Part of the self-employed challenge here is having enough confidence in your own ability to create a successful business that will support you to allow  you to invest in the time it takes for self-care and personal and professional renewal.

Boundaries are there for good reasons. Just like a football game or match would become chaotic without those “out-of-bounds” markers, professional and personal relationships thrive on clear and healthy boundaries.

Posted in Boundaries in coaching, coaching, Code of Ethics for Coaching, ethics, health coaching, Health Coaching Ethics, Health Coaching Scope of Practice, NCCHWC, wellness, wellness coaching, Wellness Coaching Ethics, Wellness Coaching Scope of Practice

A New Code of Ethics For Health And Wellness Coaches: Healthy Boundaries Part One

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Good Fences Make Good Neighbors

The old New England expression that “good fences make good neighbors” applies to the world of professions as well as it does to rows of piled rocks in the old fields and forests of places like Vermont and Maine. The concept of professional boundaries seems to expand the more you look into it. In this and a following post we will look at role definition, ethics and scope of practice, boundary crossings and violations, self-disclosure, and other issues from the unique perspective of the health and wellness coach.

icflogoSince its inception just over twenty years ago the ICF (International Coaching Federation) has developed a Code of Ethics (http://coachfederation.org/about/ethics.aspx?ItemNumber=854) which it revises on a regular basis. The ICF also maintains an Ethics Community of Practice (http://coachfederation.org/members/landing.cfm?ItemNumber=2108) where you can bring ethics questions and learn from presentations.

Law & Ethics in Coaching: How To Solve And Avoid Difficult Problems In Your Practice (2006) by Patrick Williams and Sharon K. Anderson houses considerably valuable information from the chief authors and other contributors. (https://www.amazon.com/Law-Ethics-Coaching-Difficult-Problems/dp/0471716146)

With the development and growth of the field of health and wellness coaching, the question of ethics and scope of practice emerged with the realization that such coaches often face unique situations, sometimes interacting with the medical world, that require a fresh look. While the ICF Code of Ethics is to be embraced by all coaches, the need for something more became evident.

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As an Executive Team member of The National Consortium for Credentialing Health and Wellness coaches (http://www.ncchwc.org) I was honored to chair a committee last summer of extraordinary coaches who are part of our NCCHWC Council of Advisors. Through our efforts “in August 2016, the NCCHWC created the
Code of Ethics and Health & Wellness Coach Scope of Practice to serve as a reference for health & wellness coaches and faculty. The NCCHWC expects all credentialed health and wellness coaches (coaches, coach faculty and mentors, and students) to adhere to the elements and Principles and ethical conduct: to be competent and integrate NCCHWC Health and Wellness Coach Competencies effectively in their work.” Please download the NCCHWC Code of Ethics and Health & Wellness Coach Scope of Practice here: NCCHWC Code of Ethics (http://www.ncchwc.org/wp-content/uploads/2015/05/Final-Code-of-Ethics-Oct-3.pdf)  NCCHWC Health & Wellness Coach Scope of Practice (http://www.ncchwc.org/wp-content/uploads/2015/03/Final-NCCHWC-Health-Coach-Scope-of-Practice.pdf)

rblogoYou can also find copies of both documents in the Wellness Resources section of the Real Balance website (https://www.realbalance.com/wellness-resources)
Codes of ethics such as these serve as the primary guides to help form professional boundaries that we can adhere to. In Section Three of the NCCHWC Code of Ethics we find most of the references to boundaries. The most obvious boundary here is #23 – to avoid any sexual or romantic relationship with current clients, sponsor(s), students, mentees or supervisees. But, we also see in other items in this section, that much of the issue of boundaries also refers to creating clear agreements with our clients about the nature of coaching, how it works, confidentiality, financial agreements, etc. The client-centered nature of coaching is emphasized along with complete transparency, spelling out the rights, roles and responsibilities for all involved.
The issue of boundaries is more directly addressed in item #22. Hold responsibility for being aware of and setting clear, appropriate and culturally sensitive boundaries that govern interactions, physical or otherwise, I may have with my clients or sponsor(s). Here we are looking at how we create a safe environment for our client where they feel respected, comfortable and safe. While most individuals are at least somewhat sensitive to this in most social interactions, the coach must be especially sensitive about it because of the trusting nature of the coaching relationship. While not on the same level as clinical relationships, coaching clients must feel free to express themselves at a trusting level. The health and wellness coaching client who is attempting to gain insight about how they hold themselves back from being successful at weight loss, for example, needs to feel that they can reveal information about relevant feelings and experiences without feeling vulnerable. This shows up mostly in two areas, the appropriateness of touch, and self-disclosure.
While not inherently wrong, behaviors such as giving/receiving a hug from/with a client after a triumphant moment in coaching, may be misconstrued in its intention. For one client it may, according to some authors, “engender healthier relationships”, while for another it may feel like a boundary crossing, which other authors would argue, might “pave the way to a boundary violation.”  Coaches learn early on in their training to ask permission. Seeking permission first and respecting our client’s wishes can avoid such boundary crossings/violations. We avoid the pitfalls of assumptions and honor our client’s personal and cultural boundaries in this way.

masks

Self-Disclosure And Boundaries

Self-disclosure also has different boundaries in different cultures and with different individuals. We looked closely at this topic in a previous blog post “Self-Disclosure in Coaching – When Sharing Helps and Hinders” (http://wp.me/pUi2y-8m). We can remember from that post that coaches who do not self-disclose at all are not trusted, while those who disclose “too much” are thought to be incompetent. Our own self-disclosure, should never put undue pressure on our client to also self-disclose. Differences in culture, social class, family upbringing, etc. all can set very different boundaries around the issue of appropriate self-disclosure.
In our next post we’ll look further at the issues of healthy boundaries for health and wellness coaches and address some very specific questions.

Posted in coaching, health coaching, Uncategorized | Leave a comment

Client-Centered Directiveness: An Oxymoron That Works – Part Two: Adapting To Your Client

Just how much directives does our client need?

Just how much directiveness does our client need?

Effective wellness and health coaching adapts in many ways to the client we are working with. As we assist a person in finding ways to live a healthier life there are many adjustments that need to be made to deliver a customized experience that will work best for that individual.

In this post we will examine how to take into account several key client determinants that will guide our choices about just how directive to be with our wellness coaching clients. Truly one size of coaching does not fit all.

In our last post – Client-Centered Directiveness Is Not An Oxymoron – Part One (http://wp.me/pUi2y-jO), we explored how coaches vary in the degree to which they are directive or non-directive. We looked at how there is a Directiveness Continuum that allows for an effective range of coaching in the middle and ineffective coaching at the extremes. We explored the Coaching Spectrum of techniques and methods that ranged from listening and understanding to ways that we might not consider coaching such as directly telling people what to do. We also looked at all of the ways that coaches are, in fact, engaging in directive work with their clients, and how to do so effectively.

Wellness coaching clients vary tremendously on both mental/emotional and environmental variables. One client may be highly motivated to improve their lifestyle and very open to and welcoming of coaching. They may have abundant resources at their disposal and great support from other people in their lives. Or they may be the mirror image of all of these qualities. Some of our clients may be familiar with coaching from experiences with business/life coaching, or from having had some form of telephonic wellness coaching as a benefit from their employer or insurance company. Many, of course, will be very unfamiliar with wellness coaching and how it works.

One way to adjust to what our client needs it to see where they fit into the following matrix:

slide18

If we just look at the variables of Experience, Control, Motivation and Ability we can see how we might work with these combinations in either more directive, less or non-directive and blended approaches. Experience may refer to more or less experience with coaching or with the process of changing lifestyle behavior. Control may refer to the client’s own needs for control, or how “in charge” they like to be. Motivation may refer to motivation to engage in the coaching process, and/or motivation to improve one’s lifestyle. Ability may refer to intellectual ability, or to environmental circumstances that limit the client’s ability to engage in lifestyle improvement efforts. The matrix is not perfect. We could, for example have a client who is of Low Ability and Low Motivation, but who has High Needs for Control. In such situations we would have to decide which variable trumps the others. In this case, I personally would recommend honoring the High Needs for Control as paramount. Perhaps this illustrates that someone will always have their own unique position in the matrix and require us to adjust the degree to which we are directive or non-directive. We might imagine their location being plotted like somewhere on a graph, as in our example, near the top of the Directive Quadrant, closer to the border with the Blended Quadrant. In other words we are not advocating a simplistic four-quadrant approach to coaching, but again, honoring the unique position of each of our clients on the matrix.

Examples – Ronaldo and Hazel

Let’s say our client, whom we’ll call Ronaldo, is an industrial design team leader who has had some experience with leadership coaching. He’s struggling with stress, sleeping well and his biometric markers have hit an alarming borderline zone with his blood sugar, blood pressure and blood lipid levels. He’s very concerned about this and highly motivated to engage in coaching and make some positive, and immediate lifestyle improvements. He clearly fits somewhere in our Non-Directive Quadrant on our matrix. Coaching with Ronaldo will most likely proceed, as it would with all of our clients, building a strong coaching alliance, using an effective coaching methodology and structure. Ronaldo will want to feel like he is definitely the one with his hands on the steering wheel. All of our steps together will be CO-CREATED. Ronaldo will need little in the way of suggestions or even education, but he may benefit tremendously from a great ally to strategize with, a strong system of support, and what we might call “gentle” accountability.

Another client of ours, whom we’ll call Hazel, is a hardworking housekeeper with a large hotel chain. She has never had any experience with coaching and is unfamiliar with what it can offer. She’s finding that despite her high level of physical activity she still continues to gain weight. She is also very discouraged from many failed attempts at crash dieting. Accurate information about how to eat better has been lacking for her. She finds learning new systems difficult and doesn’t really like change. Her family situation also contributes to making lifestyle improvement challenging. Hazel would fall somewhere more into our Directive Quadrant. Again, we would be treating Hazel with the same high level of honor and respect that we would with all of our clients in building a powerful coaching alliance. We would avoid stereotyping Hazel or making assumptions about her abilities. We would however, be realistic in meeting her where she is at. Hazel would most likely appreciate a more directive approach. She may benefit from recommendations for nutrition education resources. If the coach is a qualified dietician or nutritionist, they may want to create an agreement to combine these roles into the coaching that is done and “wear two hats.” The coach may take on a role where they are guiding the client through the coaching methodology more carefully, yet keeping it client-centered with Hazel still being in charge of choosing each step that she wants to do. Accountability agreements may need to be adjusted more closely to make sure that Hazel is clear about the agreements, and sees the value in them for her.

mappointingdirection“Just tell me what to do!”

There are times when clients more like our “Hazel” really ask the coach to simply tell them directly what to do. How should I exercise? What should I eat? Usually such clients are discouraged by past failure experiences and their own self-efficacy is so low that they have no faith in their own ability to create an effective way to change. They seek consultation more than coaching. They want a real “expert” to direct them on the “right” path. A great coaching response to such requests goes something like this:

“So, when you’ve asked the experts about what you should do, and followed their advice, how did that work for you?”

Almost always the person will think for a moment, sigh, and then have to admit that while such expert advice may have worked for a short amount of time, eventually it didn’t work at all. That’s when you can lightheartedly suggest that you and your client defy the so-called definition of insanity – doing the same thing again, and expecting different results! We need to meet our client’s request for complete direction (to the point of consultation, not coaching) with empathy and understanding. Keeping them in charge, remaining client-centered can still be done, even though we may coach them in a more directive style.

Staying True To The Coaching Mindset

No matter how directive or non-directive we are with our client, we still will be coaching from a stance where we hold them to be Naturally Creative, Resourceful and Whole. (http://www.coactive.com/learning-hub/fundamentals/res/FUN-Topics/FUN-The-Co-Active-Model.pdf) Our task is still to Evoke our client’s Inner Wisdom. Some of our client’s may have gotten to the point of doubting they even have such wisdom and strength. This is where it is good to remember the famous quote from Goethe.

“If you treat an individual as he is, he will remain how he is. But if you treat him as if he were what he ought to be and could be, he will become what he ought to be and could be.” Johann Wolfgang von Goethe

 

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Client-Centered Directiveness: An Oxymoron That Works – Part One

Just How Directive Do We Need To Be?

Just How Directive Do We Need To Be?

At its very foundation, coaching is client-centered. The work of Carl Rogers profoundly influenced the founders of the life coaching profession. Yet, among the thousands of health and wellness coaches we have trained at Real Balance (http://www.realbalance.com), the question of how directive or non-directive to be remains an area of unsureness and anxiety.

Carl Rogers 1902-1987

Carl Rogers 1902-1987

As time marches on it is easy to put the contributions of Carl Rogers into the seldom-read chapters of psychology history books thereby missing an important appreciation for the etymology of how the way we work with people today in both psychotherapy and in coaching came to be. When Rogers began his work as a psychologist and psychotherapist the theories of psychoanalysis dominated. The “therapeutic relationship” was seen as either a non-factor, or a blank slate upon which the patient (not client) would project their issues. As he worked with children, families and adults Rogers found great value in the newer “relationship theories” and related work developing in the 1930’s. In 1942 he crystalized his new take on how to work with people in psychotherapy with the publication of his groundbreaking book Counseling and Psychotherapy. It was actually Rogers who popularized the term “client”, urging, even then, a mindset shift away from treating people in therapy like “patients”.

Initially in the 1940’s and 1950’s, Rogers’ non-directive methods assiduously avoided asking questions, making suggestions, giving advice or any other directive methods. It relied on skillful listening and reflecting feelings back to the client without judgment, allowing them to explore and work with those feelings more deeply. He soon realized that even more important than the techniques used, was the attitude of the counselor/therapist. Feelings needed to be reflected with genuine acceptance and conveyed with empathic understanding for therapy to be effective. Thus Rogers began development of the “core conditions” that what would become known as the “Facilitative Conditions of Therapy”: Genuiness or Congruence, Empathic Understanding, Unconditional Positive Regard, and Warmth.

“What clients need, said Rogers, is not the judgment, interpretation, advice or direction of experts, but supportive counselors and therapists to help them rediscover and trust their own inner experience, achieve their own insights, and set their own direction.” (http://adpca.org/content/history-0)

Rogers continued his work through the 1960’a, 1970’s and 1980’s and his “Person-centered” approach continued to contribute to the flourishing human potential movement and was completely congruent with the self-actualization work of Abraham Maslow and others. Rogers’ influence on our field of coaching is extensive. Many of his students and colleagues took this foundational work and evolved other client-centered approaches often used in coaching today, such as Appreciative Inquiry, Non-violent Communication and Motivational Interviewing.

The Coach Approach Grew Out Of Being Client-Centered

The pioneering work of the authors of Co-Active Coaching, (Whitworth, Kimsey-House, K., Kimsey-House, H., and Sandahl.)(https://www.amazon.com/Co-Active-Coaching-Changing-Business-Transforming/dp/1857885678) was steeped in the client-centered tradition. Their foundational “Cornerstone of Coaching” that the client is held to be “naturally creative, resourceful and whole” orients the coach to a mindset that is non-judgmental, accepting, and relies on the inherent drive towards self-actualization that Rogers and others spoke of. It puts the client in charge of the agenda. It introduces the concept of “co-creation” to the coaching process. And, here it shows us the beginning of a shift from purely non-directive to a shared experience of growth and change where the coach contributes more than just great listening.

Beginning coaches take the client-centered foundation of coaching very seriously. In fact they are often hesitant to offer their own perspective, to challenge their clients, or to make any suggestions. They sometimes over-compensate by being overly client-centered. Effective, and more experienced coaches, have found a way to remain true to these client-centered roots as they integrate more directive methods with their coaching.

Coaching Practice, In Reality, Is More Directive Than You Might Think

coaching-sessionCoaches do ask questions, plenty of them.
As coaches we share our observations with the client of what we are noticing. Sometimes referred to as “saying what is so”, we point out patterns in our client’s speech and affect that we observe. Have you noticed that each time you speak about taking time for yourself to exercise, that you immediately go into a story about your partner?
• Coaches challenge their clients. When our client offers a commitment of practicing a mindfulness or meditational method only once a week, the effective coach will ask if that will produce the results the client desires, rather than simply accepting what the client has offered.
Coaches use tools. The moment we suggest using a coaching tool we are being directive, even if we’ve asked our client for permission to make the suggestion.
Wellness coaches often make the suggestion of resources for healthy living information, for practicing various stress-management methods, for seeking out social support for their goals, etc. The challenge for the coach is to know just how directive to be, and with whom!

Here’s what effective directive coaching sounds like:

• “Have you considered keeping track of your behavior?” (a question, yet really a suggestion)
• “When my clients write it down on a calendar or enter it into an app they are often more successful.”
• “What I see you doing here is…”
• “Let me give you my best thinking here…”
• “I have a coaching tool here I’d like you to…”
• “Have you ever worked with myplate.gov?”
• “So what is your well-life vision?”
• “If you only practice relaxation twice a week, will that really give you the results your want?”
• “Tell me what another perspective on that would be?”
• “If you could work your best possible day, what would it look like?”

continuumdThe Directive-Non-Directive Continuum

When we examine the work of both beginner and master coaches we see them all operating somewhere on a continuum from non-directive to very directive.

Operating as a coach on the extreme non-directive end of this continuum is probably more theoretical than actual. In some way coaches will demonstrate at least a degree of directedness. On the other extreme of complete directedness, coaching transitions from being coaching to, in fact, consulting. We are no longer coaching, we are being the expert/consultant who is advising and directing. In between the extremes there is lots of room for variation that still can qualify as effective coaching.

Where the coach operates on this continuum is, in part, determined by the personality and style of the coach themselves. “Be yourself” in coaching is very important to authenticity. Watch films of some of the great psychotherapists of our time and you’ll see that to a great degree their approach in therapy reflected simply who they were. Rogers really was a kind and gentle soul. Fritz Perls, while actually much more caring and empathic than many may think, was a truly irascible fellow, Albert Ellis really was a brash New Yorker. Likewise great coaches let their true selves work for themselves and for the benefit of their clients. So give yourself permission to let your own gifts show through. However, never think that “being yourself” is an excuse for not serving the client well. The timid coach may need to stretch themselves and be more actively involved. The domineering coach may need to realize when they are being overly controlling just to feel “in charge”.

Overly Non-Directive Coaching

When coaches take being non-directive too far they end up not providing as much as they can for their clients. Without any structure or guidance, many of our clients flounder for direction. In an extensive workshop with James Prochaska I once asked him about just how client-centered a coach needed to be. He said:

“Be client-centered. But, don’t be so client-centered that you are not helping someone as much as you possibly can.” James Prochaska

The overly non-directive coach:
• Doesn’t share observations about their client and the coaching process
• Doesn’t “say what is so”.
• Doesn’t make any suggestions (even with permission)
• Doesn’t challenge their client.
• Provides little if any structure
• Doesn’t share what has worked for others

The overly non-directive coach essentially is not providing as much value to the client as they could be. We might even go so far as to say they are avoiding responsibility for contributing anything to the coaching process that might influence it.

Overly Directive Coaching

The overly directive coach is usually operating out of a consulting mindset whether they realize it or not. They may still be relying on an educational/informative model. Perhaps their background is more of a health educator, or a holistic health practitioner who is still being quite prescriptive. Perhaps they have a business-consulting background and believe that their clients want to be told what to do.

The overly directive coach:
• Acts more as a consultant/expert.
• Provides solutions (instead of coaching for the client to find their own solutions)
• Has a “ready to go” wellness plan for their client.
• Makes LOTS of suggestions.
• Is often rigid about structure instead of co-creating it.
• Presents lots of opinions instead of observations.
• Often doesn’t listen well and include the client point of view.
• Sometimes thinks falsely that being directive saves time.

Most all of the techniques and methods that coaches use fall somewhere on the “Coaching Spectrum”.

The Coaching Spectrum

The Coaching Spectrum

How To Keep Directive Coaching Client-Centered

• Maintain the “coaching mindset” – NCRW! (The client is held to be naturally creative, resourceful and whole.)
• Facilitate the client’s process – evoke inner wisdom.
• Don’t rescue! Work with the client to help them explore more instead of providing suggestions prematurely.
• Introduce suggestions so the client truly knows they can decline them.
• When clients decline, respect their decision. Explore it, but go with it.
• Clients are always accountable to themselves, not to you!
• All planning and accountability is co-created! Every “inch” of it.
• Record, review and count your suggestions in each session.
• Have a rational for making a suggestion.
• A “ready to go” wellness program is wellness, but not wellness coaching!

Adjusting To The Client

The other major factor contributing to how directive/non-directive an effective coach needs to be is adjusting our coaching to fit the needs and make-up of our individual client. One size truly does not fit all. We’ll look at how we make these adjustments in Part II in our next blog post.

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