CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is President of the Board of Directors of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.
We all still need each other. Even in the age of COVID-19, our health continues to depend upon healthy supportive relationships. Real Balance https://realbalance.com has always stressed what we call Coaching for Connectedness. We‘ve seen lifestyle improvement occur and last more often when people receive support for the changes they are making to live healthier lives. When a coaching client sets up an action step we ask “Who/what else can help support you in this?”. Research on what makes health behavior last points primarily to two factors: a shift in self-concept and community support. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753403/ It’s also a well-established fact that people who are more socially isolated have significantly higher rates of all major chronic illnesses. https://www.apa.org/monitor/2019/05/ce-corner-isolation
Our challenge in the midst of a pandemic situation is how we distance from each other while remaining connected to each other. Yes, follow the CDC guidelines for social distancing. We can still greet each other with elbow bumps, and then go for a walk, a bike ride, a cruise in kayaks, etc., and continue to avoid the proximity that puts us at any risk. We can connect via phone and receive the nourishment of live, interactive conversation that texting and e-mail don’t quite match. We can climb on board a web-based platform such as Zoom and Skype provide where we are face-to-face for our conversation. We also have all sorts of apps such as Facetime, WeChat, and many more that allow us to have face-to-face interaction for live conversations.
As coaches we can continue to work remotely with our clients, as the majority of coaching is already done. As we do, explore the feelings that the changes brought about by social distancing are bringing out in your clients. Empathize. Explore. When people talk about their fears, the intensity of those fears almost always lessens. As people become less afraid, their thinking improves. They aren’t so quick to jump into dismissive all-or-none thinking. They are then able to engage in strategic thinking with their coach to find unique solutions to staying healthy.
• The fitness center is shut down. How can you shift to working out at home? Use stretch bands. Modify a spare room into a place to do Yoga, floor exercises, etc. Spring brings better weather allowing more cardio outdoors. • Do more outdoor exercise/activity with other people – just keep your proper distance. • Encourage clients to find new ways to electronically visit their friends, grandchildren, and others. Play online games together. • Check in with your clients to make sure they have CDC information/WHO information about how to stay safe during the COVID-19 pandemic.https://www.cdc.gov/coronavirus/2019-ncov/index.html. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
Take heart at how people are showing concern for each other during this time. Younger people who are at somewhat less risk are engaging in social distancing, handwashing, etc. not only for themselves, but for the older and more vulnerable people who could be affected by the contact they are having. People in neighborhood chatlines are volunteering to go pick up groceries and prescriptions for older or more sickly neighbors. Hopefully what will come out of all of this is a greater sense of how we are all in this together. Distancing does not mean isolating. The truism of Jack Travis is still valid: Connection is the Currency of Wellness.
Be well and stay well!
Michael Arloski, Ph.D., PCC, NBW-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc.
An essential part of any wellness coach training is focusing on developing competency in what the ICF (International Coaching Federation) calls Active Listening – Paraphrase and Restatement; Reflection of Feeling; Request for Clarification; the use of Silence and Intuition; Summarization. Yet the active listening skills that we talk about aren’t really skills about how to listen more effectively. They are critical skills for how we give evidence to our client that we are listening and truly hearing them. They are skills that further the coaching conversation. They are how we respond to our client when we take in their communication. This is the active part of listening: what the coach says and does. But, what allows us to truly listen at a deeper level, to pick up on even more of what is really being communicated?
Deep Listening – “I can hear tears.”
What is it that allows masterful coaches to become aware of things that most people miss in a conversation? How do they tune in to their client in such a way that the coaching conversation becomes rich, productive and even enlightening?
In a class discussion about listening, one of my Real Balance students, who demonstrated she was an already accomplished coach, shared with us the poignant statement “I can hear tears.”She was referring to coaching over the phone where the visual nonverbal cues are absent. She was picking up on both the client’s subtle vocal cues, and to a large degree, the context of the conversation. At such a tender moment, a client may make an effort to be as silent as possible. The vocal cues like a voice that breaks in tone, or speech that stammers are not even there for the coach to perceive during such a silence. The context can certainly tip the coach off that it would be natural for a client to cry upon sharing a painful experience or talking about a profound loss. Yet people react to experience and emotion in many different ways, from hysteria to stoicism. How does a more masterful coach hear tears that silently run down the cheek?
The powers of observation of a more masterful coach are as keen and sharp as a razor. They don’t miss much. They notice. They are mindfulness in action. They also don’t allow judgment to interfere and throw their subsequent observations into a prejudiced direction blinding them to the full picture of what is unfolding. They stay on pace with their client instead of ahead of them. They stay more out of their head. These practices allow them to stay in the present and in touch with all of their senses. Doing so they are not rushing ahead with their own imagined conclusions about where the dialogue is going. By maintaining a coaching mindset, they are able to facilitate the client’s work instead of attempting to do the work for their client like a consultant would do. By not engaging in that headwork (analyzing, deducing, imagining, problem solving, continually thinking of the next question to ask, etc.) they are able to be here now with their client and hear more. This way of being, combined with providing The Facilitative Conditions of Coaching is the very essence of Coaching Presence.
Observing by Scanning
One aspect of effective observation is what I call scanning. If you ever take a nature walk with a trained naturalist, or perhaps the type of experienced hunter who is keenly in touch with the natural world, you realize that they are constantly scanning the landscape as you move through it. I remember reading Barry Lopez’s magnificent book Artic Dreams. https://www.powells.com/book/arctic-dreams-imagination-desire-in-a-northern-landscape-9780375727481?p_isbn&partnerid=35409 He spoke of his time with the Inuit people who were out on a hunting expedition. They walked over the tundra all day, slowly, silently. Then, at night around a campfire they spoke about all of the things they had seen. Lopez, one of America’s greatest nature writers who has developed intense powers of observation himself, was amazed at what these indigenous people had picked up on, down to minute detail of the land and its creatures. They had been constantly scanning both the horizon, the place where they were about to set their feet and everything in between. They had been scanning visually, looking for movement, shifts, changes, anything out of order in shape or color. They had been scanning auditorily hearing birdsong, wind, twigs snapping. They had been scanning olfactorily smelling the scent of whatever flowers, animals, carrion, or people might be in the region. And, they had been doing all of this effortlessly. It was simply how they hunted.
As you coach, are you constantly scanning the horizon and where you are about to set your feet? Are you effortlessly scanning with all of your senses and noticing? Just like our friends in Lopez’s book, we want to be noticing shifts, changes, anything out of the ordinary. While the Inuit hunter might spot the movement of a partridge in a bush, we may notice the shift in our client’s tone of voice, in their posture, in the speed with which they are now talking. When we listen beyond words, beyond content we hear more. The verbal content is important. It’s like the landscape itself; it is the context of the conversation. Yet, what’s important is what is happening on that landscape. What movement is there in the bushes, so to speak? What is the client thinking and feeling regarding that content about which they are speaking?
The novice coach, new to the coaching landscape, may focus mostly on the content of our client’s communication. Yet, they progress in their coaching so much more when they realize that the client is not just speaking to them about a subject, they are communicating! It’s not just what they say, it’s how they are saying it. The content might sound like “I’ve walked only two times this week.” All the while the client is attempting to convey to their coach that they are becoming very worried that they will never get their lung capacity back after their acute heart failure if they don’t exercise more often. Did the coach see the frightened bird that just froze on the tree branch, or were they lost looking at the trees? What is my client communicating?
What Are We Listening For?
Just like the skilled naturalist, or the Inuit people that Lopez observed, the more masterful coach has learned what to look for in our coaching landscape. The novice coach may travel the same landscape and not notice half of what the more masterful coach will pick up on. They have learned how to read the signs, to distinguish a track from a mere depression in the soil. So, to deepen your listening ability what can you tune in to? Within the content of what is being said and beyond the content, what will help our coaching be more productive?
After years of building a foundation, health and wellness coaching has flourished in the last decade. At the beginning of this last decade the International Coach Federation was only fifteen years old and the National Board for Health and Wellness Coaching hadn’t even been thought of yet. My book, Wellness Coaching for Lasting Lifestyle Change, had been on the market for only three years, and The Coaching Psychology Manual, for only one. Thousands of people were already trained and working as health and wellness coaches, but the numbers were nowhere near where they are today. Wellness coaching was being used by employee wellness programs, disease management and insurance companies but had not made its way into the clinical world much at all. There was considerable success where wellness coaching was being applied, but the research to back it up was lagging. As the decade moved along towards 2020, everything shifted. Health and wellness coaching has truly arrived!
In the last ten years we have seen the profession of health and wellness coaching grow both in its application and as a true profession with standards and credentialing. Early in 2010 the National Consortium for Credentialing Health & Wellness Coaches was formed to develop and establish those standards and a system of credentialing. After an untold number of hours of work by dedicated coaching professionals this evolved into the National Board for Health & Wellness Coaching that we have today. Now, in addition to certification that coaches can receive by the organization that trained them, they can apply to become certified through the NBHWC by qualifying for and passing an examination administered by the National Board of Medical Examiners. Prospective coaches can now choose to be trained by qualified organizations that have earned approval by the National Board, ensuring great quality for their educational experience.
My observations over the past decade is that the growth of health and wellness coaching has particularly accelerated in three areas: universities, the international arena and clinical/lifestyle medicine. Let’s look at the role Real Balance Global Wellness has played in each.
Early in the decade only a handful of schools were offering programs that included health and wellness coaching. These were mostly schools of Integrative Health or related areas. Leaders such as The California Institute of Integral Studies, Duke University, and the University of Minnesota were such innovators. As more and more schools discovered that health and wellness coaching offered their students a practical skill set and a needed certification in the field, actual training in health and wellness coaching became highly desirable. Real Balance began to partner with schools of Public Health, Nursing, and a variety of programs to not only deliver direct training, but to train college and university faculty to become Real Balance Trainers and be able to deliver our curriculum and certification. Our program nurtures such schools along until they are ready to apply to the National Board to become an approved program in their own right.
As lifestyle diseases have replaced infectious disease as the number one cause of premature death, the value of health and wellness coaching is being increasingly recognized around the world. Interest is growing fast in Europe, Asia and Latin America. Real Balance truly became Real Balance GLOBAL Wellness in this last decade. We developed training programs in Ireland/UK, Brazil, Australia, and China. We delivered keynotes and programs in the Azores Islands of Portugal, and the Philippines. Students from around the globe continue to become trained as health and wellness coaches through our live webinar classes.
The third area of growth for health and wellness coaching that has ballooned especially in the last few years of our past decade is primary care/lifestyle medicine. The recognition that a large component of our health is behavioral has led to the greater openness to the role of health and wellness coaching in direct medical services. Health and wellness coaches are helping patients to be more successful at medical compliance/adherence, and at accomplishing the directives of the lifestyle prescription recommended by their treatment team. The tremendous growth and increasing acceptance of the principles of lifestyle medicine has helped health and wellness coaches to be seen as a very practical solution for the behavioral changes sought by physicians and other healthcare practitioners. The recent granting of a Level Three CPT Code for health and wellness coaching is a huge step forward. Though direct reimbursement is a ways off, the new code helps legitimize health and wellness coaching in the eyes of the medical world and opens doors.
Health and wellness coaching enters this new decade with an earned respect. We have the evidence of our effectiveness, solid professional credentialing and standards, international awareness, and a recognition that we can play a key role in improving health and wellbeing all around the world. Be a part of helping us take it forward!
The profession of health and wellness coaching is fully engaged in a process of transformation. As we grow to be of service to wellness programs, lifestyle medicine practices, employee assistance programs, insurance carriers, disease management companies, and all manner of healthcare providers, around the globe, the demand for greater quality coaching only builds. We are moving from a need for competent coaches to a need for proficient and even masterful coaches.
In 2006 Whole Person Associates published my book, Wellness Coaching For Lasting Lifestyle Change, with an updated version in 2009 and a completely revised and expanded Second Edition in 2014. (https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml) This ground-breaking book is used as the primary text in many wellness coach training programs and college and university courses and has had a powerful impact around the world. It has even been published in Mandarin! In 2009, Whole Person Associates also published Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. I. (https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml) I wrote this book primarily to be used by wellness coaching clients in either individual or group coaching as a personal workbook/journal through the coaching process. Many coaches have found it to be a valuable coaching guide for both their client and themselves. As much as these books covered, the need to provide a deeper dive into the advanced topics of coaching such as collusion, self-disclosure, etc., and to help coaches truly polish their craft became self-evident.
Real Balance Global Wellness has trained thousands and thousands of wellness coaches around the world. As I delivered many of these trainings, read case studies and listened to hundreds of recordings of coaches in action, I learned so much. I learned what coaches need to learn. I discovered where their challenges were, what skills they tended to underutilize, or overutilize. I saw how they shined and how they struggled. I saw what distinguished the effective coaches from the rest. The more masterful coaches were evident in both their way of being with their clients, and with their knowledge of what to do. As I learned from my students I continued to coach, to teach our certification and our advanced classes, and to mentor, continually accumulating more and more grist for the mill that would become my next book.
Just as psychotherapy has been described (https://psycnet.apa.org/record/2006-20286-000), coaching is both an art and a science. The thing that I believe distinguishes a more masterful coach is that they are an artist practicing a craft. Beyond doing a job, they see their wellness coaching career as the career of a craftsperson. They see their work as a combination of evidence-based science, theory and technique, but also as craft.
“If one really wishes to be master of an art, technical knowledge of it is not enough. One has to transcend technique so that the art becomes an ‘artless art’ growing out of the Unconscious.” D.T. Suzuki – Introduction to Zen In The Art Of Archery
From Chapter Two of the forthcoming book:
Witnessing the craftsperson in action we see a continuous desire to improve. This is the truly professional waiter/waitress studying the food production and delivery systems, the seating floor plan and the nature of the clientele in the restaurant to calculate their most efficient table delivery routes and provide the best customer service experience. This is the university professor reading about how to teach, not just more about the science of their subject matter. This is the wellness coach spending hours listening to recordings of their own coaching and reviewing where their competencies need improvement. This is about the transformation of competencies into proficiencies and beyond.
Most wellness coach training is aimed at developing competencies. Competency implies an adequate and acceptable level of skill and knowledge. Every client certainly wants his or her coach to be competent. Yet, wouldn’t every client want their coach to be not just competent, but truly proficient or even masterful at his or her craft? How does a coach move up a notch to a level where they are coaching beyond the basics, where they are fluidly implementing what they have learned and can now think on their feet, ‘dance in the moment’, and be creative?
Thoughts To Ponder On The Mastery Path
WHO do I want to be as a coach?
How do I create a default mind of curiosity?
How can my values shape my desire for mastery?
How can I be inspirational?
Masterful Health & Wellness Coaching: Deepening Your Craft will explore advanced topics such as collusion, self-disclosure, motivation, coaching with difficult clients, building self-efficacy, meaning and purpose, coaching effectively with emotions and much deeper looks at major theories of behavior change and how to implement them in the coaching process.
As my new book approaches completion, we expect that publication will take place in early 2020. By subscribing to the Real Balance Newsletter on our website (https://realbalance.com) you can be kept up to date on its release date.
One of the first things we learn about in the fields of Wellness & Health Promotion and Health & Wellness Coaching, is that our lifestyle choices are a primary determinant of our health and wellbeing. It seems straightforward that making the right or healthy choice is a rational process based upon having the best information. We often then address how challenging it is for a person to put that choice into practice by looking at their social support, environmental conditions, etc. Much of the focus for wellness coaching becomes helping our client to create a wellness plan based upon those healthy choices and implementing with support and accountability. Let’s stop and take a closer look at those decisions.
Anyone in the healthcare or wellness fields is keenly aware that clients don’t always opt for the best, or healthiest choice. They also often observe clients changing these choices for no apparent reason. One day our client is convinced to start working towards a largely plant-based diet, and on another day, they show little if any desire to do so. We can explore ambivalence, of course, but what is really going on in our client’s decision-making process?
Applying what we know about the role that emotions play in decision-making can be extremely useful to the wellness coach. Learning how to coach our client in this emotional realm is often critical to their success. (See my previous post: “The Great Utility of Coaching In The Emotional Realm”, https://wp.me/pUi2y-lA)
Emotions and Making Lifestyle Choices
Making lifestyle choices are like any other decision-making process – they are more complex than it seems at first. Understanding how our emotional bias fits into this process may help coaches to be less perplexed by some of the self-defeating lifestyle choices we see that our clients have made and continue to make.
Emotions emerge as a response to external stimuli, or the recollection of it, or the imagining of it. “That stimulus generates an unfelt emotion in the brain, which causes the body to produce responsive hormones. These hormones enter the bloodstream and create feelings, sometimes negative and sometimes positive… So, to review, it’s stimuli, then emotions, then hormones and, finally, feelings. In other words, your emotions impact your decision-making process by creating certain feelings.” (Whitener, 2018)
How we interpret or frame those feelings and how we respond to them results in our choices executed in our behavior.
In this model it is not the emotions that we are aware of, it is the resultant feelings that we feel. When our clients contemplate making lifestyle changes, they often experience a variety of feelings. They may experience positive anticipation or dread. The memory of past failures may bring up the emotion of fear resulting in feelings of embarrassment, regret, shame or guilt. Likewise, a history of more pleasant experiences may lead to positive anticipation. What Stage of Change the client is in may be heavily influenced by the feelings they are experiencing.
Expand Your Emotional Vocabulary
Psychologist Paul Ekman’s research on emotions opened a huge doorway to understanding how people express themselves. A key from his work that can help the coach is to look at how (as in our model above) emotions generate feelings and how those feelings differentiate. Researcher Tiffany Watt Smith has listed 154 different worldwide emotions and feelings. (1). Studying Ekman’s Wheel of Emotions can help a coach to expand their own knowledge and use of emotional terminology. As you coach with your client you can explore more possibilities to help your client clarify exactly what they are feeling.
Ekman’s Wheel of Emotions
How The Coach Can Help: Coaching With Emotions and Feelings
1. Coaching Presence – Your coaching presence sends an ongoing message that either gives permission to explore feelings or denies it. 2. Notice – Be keenly observant of the emergence of feelings on the part of your client. Be continually scanning not just their words, but how they say them. Hear the changes in tone of voice, volume, rapidity, etc. Notice all of the nonverbal information you can gather. 3. Contact – Help you client to connect with their feelings. Use the Active Listening Skill of Reflection of Feelings. Share observations of patterns you see. “I’m noticing that each time you talk about taking time for self-care you begin speaking about your partner.” 4. Name it – Help you client to name their feelings. As we saw above emotions can generate a wide variety of feelings. Expand your own emotional vocabulary and help your client to drill down to what they are truly experiencing. “Well, it’s not really anger, it’s more like resentment.” 5. F.A.V.E. – First Acknowledge the client’s experience and what they have been through. Then Validate their feelings. It’s okay for them to feel the way they feel about it. (Regardless of how rational or appropriate their feelings may seem.). You absolutely must not judge their feelings. Most importantly Empathize. Show real empathy and compassion and put it into words. 6. Process – Help your client to explore and process their feelings. Allow them to expand and talk about them. Once the initial release has taken place, they will usually start to analyze what is going on for them, looking to make sense (and meaning) out of their feelings. 7. Insight – Is your client able now to gain some insight from what they have learned in this process? 8. Application/Integration – Are they able now to take their insights and turn them into action? Now you can coach your client on ways they can modify their behavior or create experiments in their lives to improve their lifestyle.
Note – If you find that you are answering the questions in items 7 & 8 with the negative, your client may benefit more from counseling instead of (or in addition to) coaching. That is, if they just continue to process feelings, and process feelings without it leading to insight, or if they are unable to put their insights into action, and instead return to processing feelings (and emoting), then begin to explore the alternative of counseling. See my blog on this topic – Coaching a Client Through To A Mental Health Referral Using The Stages of Change (https://wp.me/pUi2y-lp).
A wellness coach may think that it is their job to get their client to make the right lifestyle choices. When coaching deteriorates into convincing or persuading, we are stepping away from the coaching process. We can certainly warn our clients about misinformation they may have about fad diets, or unproven remedies, etc. However, effective coaches honor their client’s autonomy. The reality is that after a coaching session, our clients will go on living their lives doing what they choose to do despite our urging. Trust the coaching process. Help your client to factor in their emotions in a more conscious way so that the lifestyle choices they make are working for them instead of against them.
(1) Tiffany Watt Smith. “The Book of Human Emotions: An Encyclopedia of Feeling from Anger to Wanderlust” (PDF). Anarchiveforemotions.com. Retrieved 2017-05-28.
(2) Ekman, Paul (1999), “Basic Emotions”, in Dalgleish, T; Power, M (eds.), Handbook of Cognition and Emotion (PDF), Sussex, UK: John Wiley & Sons.
As health and wellness coaches work with their clients to help them live their healthiest lives possible, an understanding of the basics of Self-Determination Theory of Edward Deci and Richard Ryan (http://selfdeterminationtheory.org), is very useful. In the Part One blog posting on this subject we looked at how this theory addresses human motivation. (https://wp.me/pUi2y-nT). Here we will look at how coaches can benefit from understanding the significance of the theory’s identified three innate psychological needs that we all have.
The Three Innate Psychological Needs
At the heart of Self-Determination Theory (SDT) is the underlying assumption that there is an inherent human need for fulfillment and self-actualization through personal growth, development and mastery (competence), for connectedness (relatedness) and for the experience of behavior as self-determined and congruent with one’s sense of self (autonomy). These three needs are considered universal and essential for well-being. Whatever supports the positive experience of competence, relatedness and autonomy promotes choice, willingness and volition, interest, full engagement, enjoyment and perceived value — the inherent qualities of intrinsic motivation. It also leads to higher quality performance, persistence, and creativity.
The degree to which these needs are either supported or compromised and thwarted has a significant impact on both the individual and the individual’s “social context” (the physical and social setting in which people live and work and the institutions with which they interact). If all three needs are satisfied “people will develop and function effectively and experience wellness” and if not, “…people will more likely evidence ill-being and non-optimal functioning.” (http://selfdeterminationtheory.org/theory/)
“We believe that all human beings have a set of basic psychological needs. The needs that we feel are important are the need for competence. That is to say to feel confident and effective in relation to whatever it is you’re doing. Second, to feel relatedness, that is to say to feel cared for by others, to care for others, to feel like you belong in various groups that are important to you. And the third need is autonomy… Human need is something that must get satisfied for optimal wellness and optimal performance. If they don’t get the need satisfied, then there will be negative psychological consequences that follow.” (https://www.youtube.com/watch?v=m6fm1gt5YAM)
Coaching In Support of Autonomy
People have a need to feel they are operating their lives out of their own choice. Supporting the client’s need for autonomy is considered one of the primary tasks of a coach. The client-centered nature of coaching supports client autonomy throughout the coaching process. Coaching operates on mutual agreements between client and coach. Agendas are co-created with the client always in the lead. In wellness and health coaching this is especially true as client-generated goals have more inherent “buy-in”, that is, more motivational connection. The coaching cornerstone stance that the client is “naturally creative, resourceful and whole” (NCRW)( https://coactive.com/why-cti/buy-the-book) fosters autonomy as the coach works to evoke the inner wisdom of the client. Rather than operating from an expert point of view, the coach provides support for the client’s own decision making, even though they assist in the process.
Coaching In Support Of Competence
This NCRW stance also supports the other key human need according to SDT, of seeking to achieve competence. Again, in line with the tenets of humanistic psychology and the more recent developments in positive psychology, clients are treated as though they are indeed capable and possessing great potential. The strengths-based, positive psychology nature of coaching emphasizes acknowledging and building upon the client’s attributes and qualities they already possess. A key here is acknowledgement. Client’s often minimize or fail to recognize their strengths and achievements. If their self-efficacy is already low, having been brought down by previous failure experiences, they may tend to overlook what they are accomplishing, or to downplay it. The active listening skill of acknowledgement needs to be used by coach whenever it can be genuinely utilized. As client and coach work on self-determined goals and break it down into doable action steps, leading the client to enjoy more and more successful experiences. As they do so, they begin to feel more competent in the area of improving their lifestyle, which naturally builds their feelings of self-efficacy.
Coaching In Support of Relatedness
The heart of coaching is the coaching relationship itself.Creating that alliance supplies the client with a trusted resource for support that can be relied upon unconditionally. As the coach exhibits the qualities that make up great coaching presence (supplying the facilitative conditions of coaching) (https://wp.me/pUi2y-6i) the client feels accepted, acknowledged and cared for. Often our clients are lacking relationships in their lives where they experience adequate empathic understanding and are free from judgment.
For the client, it is not only refreshing to relate to someone who provides unconditional positive regard and validates their experience and feelings, it may actually free the client up to explore their lives with new openness and independence. Perhaps they have been holding themselves back from making some of the lifestyle changes they need to make because of the fear of losing connection, to some degree, with others. Perhaps with the support of the coach, the client may be willing to take such risks to live in a healthier way.
The Real Balance approach to coaching has long recognized the importance and power of coaching for connectedness. We realize that coaching is a very brief moment in someone’s life and that lasting lifestyle improvement often hinges upon finding the support of others for the changes clients need to make. As we help our clients choose action steps in their Wellness Plan, we continually ask, Who else can support you in doing this? Building in strategies to seek out and gain support for wellness goals and the action steps needed to achieve them is often critical to success.
Of course, not all of our clients enjoy lives rich in connectedness at home, work and in their communities. As we co-create the Wellness Plan with our clients, we may want to include developing more connectedness as an Area of Focus to be consciously worked on. Part of that process may be exploring ways in which the client holds themselves back from reaching out and making more interpersonal connections in their lives. As clients feel empowered by the autonomous nature of choice in the coaching process, they may be more willing to increase their connectedness.
As coaches reflect upon their work, not only with a single client, but will all of the people they coach, they can benefit from asking themselves if their coaching process addresses and supports the fulfillment of these three innate psychological needs. The self-vigilant coach may want to listen to session recordings and ask themselves “Am I coaching in a way that really supports my client’s autonomy, or am I being too prescriptive or too directive? Am I using acknowledgement enough to help my client realize how their sense of competency is increasing? Am I remembering to ‘coach for connectedness’ and help my client expand their circles of support?”
Deci and Ryan see the fulfillment of these needs as paving the way towards optimal functioning — essentially making the wellness way of life much easier.
For the very best in wellness and health coach training look to REAL BALANCE GLOBAL WELLNESS SERVICES, INC. Over 8,000 wellness & health coaches trained worldwide. http://www.realbalance.com
“Don’t ask how you can motivate others. Ask how you can create the conditions within which others will motivate themselves.”
Edward L. Deci
The motivation of the coaching client for change is usually seen as the foremost factor in the coaching process, yet many coaches lack adequate knowledge of this concept. Some coaches believe that is it somehow their responsibility to motivate their client. This can come across as an attempt to convince or persuade the client to become engaged in a lifestyle improvement process, urged on by a cheerleading coach. As coaches become more experienced, they usually discover that effective coaching is about helping the client to get in touch with what motivates them from the inside and build on that. One theory that can help coaches grasp the nature of human motivation and then implement it well is Self-Determination Theory.
A core contribution of SDT is the way it demonstrates how it is the type of motivation, not the quantity of motivation that is key to success with behavioral change. According to Self-Determination Theory there are two types of motivation, controlled motivation and autonomous motivation. SDT presents a ‘motivational spectrum’ with amotivation, or total indifference at one end and intrinsic motivation, doing something for its own intrinsic satisfaction at the opposite end. In between these two extremes lies extrinsic motivation with its own motivational spectrum from the most externalized (controlled) to the most internalized (becoming autonomous) types of motivation.
A client is viewed as potentially having different types of motivation related to different behaviors, similar to what we have seen in the Transtheoretical Model of Change, (http://jprochaska.com/books/changing-to-thrive-book/) Your client may be in the “Action Stage” when it comes to improving their nutrition, but in the “Contemplation Stage” regarding beginning an exercise program. Likewise, in the SDT model, your client may feel Controlled Motivation from and Extrinsic source (e.g. pressure from physician and spouse) to begin exercising, and yet possess Autonomous Intrinsic Motivation to improve their nutrition because of a life-long fascination with and enjoyment of healthy eating.
Coaches certainly encounter clients who are indifferent to making changes in some areas of their lives. This would be referred to as Amotivation, or simply lacking motivation. SDT looks at the process of motivation as part of the behavior change process, rather than a pre-requisite for coaching. The client does not have to be “ready” for coaching, rather, it is within the coach’s function to help the client get in touch with the motivation they need for change and resolve ambivalence Again, it our job to meet our client where they are at.
All too frequently the wellness coach encounters clients who are feeling the pressure of Controlled Motivation. This is the “carrot and stick” approach to motivation. It means doing something in order to get a reward or to avoid punishment. It is characterized by feeling seduced (towards a reward) or coerced (to avoid negative consequence). Either way there is a perception of being pressured, obligated or even forced. A perfect example is the coaching client coming to fulfill a requirement for a wellness program incentive plan. The client feels forced into coaching to receive the reward of a 10-20% discount on their health insurance premium (and to avoid the implied penalty of missing this discount). Deci has emphasized that this approach has negative consequences for both performance and well-being. Deci and Ryan also noticed that individuals coming from controlled motivation tend to take the shortest path to the end result. They often complete the wellness program requirement and immediately quit the program.
Autonomous motivation has two aspects. The first is interest and enjoyment. If these two are present, so is motivation because I don’t have to be convinced to do what I love doing. The second type has to do with deeply held values and beliefs. Behaviors that are in sync with values and beliefs are coherent with one’s sense of self. According to Deci, the research demonstrates that when behavior comes from autonomous motivation people are more creative and better at problem solving. When confronted with challenges or obstacles they are more able to think ‘outside the box’. Overall, performance is better especially around hands-on learning and people feel better about themselves. All in all, “autonomous motivation is associated with both physical and psychological health.”
Autonomous behavior is about choice. Deci, in an effective video interview (https://youtu.be/m6fm1gt5YAM) , points out that it is not the same as independence. A person can be experiencing autonomous motivation (operating out of their own volition) when they choose to seek out a walking group to participate in. Autonomous motivation can drive both individualistic and collectivistic behaviors.
SDT also acknowledges that there is often a process experienced by people whereby their motivation may progress from Controlled External Motivation to eventually become a choice that they fully embrace — Autonomous Intrinsic Motivation. What may begin as
a requirement of a program (see a wellness coach to get an incentive) — External Controlled Motivation — may move to compliance with a program (continue to see the coach out of an ‘introjected’ sense that they ‘should’ do so). However, if the coach is effective at creating a true coaching alliance with their client and helps them to see the benefits that they may have to gain by continuing coaching, the motivation shifts through a sense of “identification”, to that of Autonomous Motivation — the client is truly choosing to be involved in coaching. Finally, as the client experiences the benefits of coaching and enjoys the coaching, they have fully ‘integrated’ the process and are experiencing Autonomous Intrinsic Motivation to engage genuinely in coaching.
In effective coaching we always refer to co-creating with our client ‘self-determined goals’. The message to the client is that they are the ones in the driver’s seat, choosing their own Wellness Plan with our assistance. As we coach our clients through the journey of change we can draw upon SDT to remind us to stay client-centered, to continuously move towards building client autonomy and towards motivation that is more intrinsic in nature. It’s just good coaching!
In Part Two on the topic of Self-Determination Theory, we’ll look at how we can incorporate the Three Innate Psychological Needs of SDT — the needs for autonomy, competence and relatedness into more masterful coaching.
For the very best in wellness and health coach training look to REAL BALANCE GLOBAL WELLNESS SERVICES, INC. Over 8,000 wellness & health coaches trained worldwide. http://www.realbalance.com
Stress gets blamed for most everything, and much of time deserves the accusation (60 percent to 90 percent of health-care professional visits are stress-related – https://www.apa.org/monitor/2008/10/relaxation.aspx ). Wellness and health coaching clients inevitably recognize that excess stress in their lives is affecting their quality of life, performance at work, and their very health in negative ways. Finding a way to deal more effectively with stress becomes part of most client’s Wellness Plan.
Wellness coaches all too often approach stress by working with their clients to strategically attack the sources of stress in their client’s lives. While there may be some specific gains made by that approach, all too often the result is temporary and band-aid-like, as yet another source of stress emerges. Solution-seeking as a stress management strategy is like flirting with infinity.
For over twenty-five years I worked as a psychologist and devoted much of my focus to helping people with stress-related disorders. I was an early adopter of the use of biofeedback and relaxation training methods. Combining those modalities with psychotherapy, my work was able to be of great value to clients suffering from muscle-tension and migraine headaches, a wide variety of gastrointestinal disorders, insomnia, Raynaud’s Disease, and many more issues. I delivered hundreds of stress management workshops and became so involved in the field that I eventually became President of The Ohio Society For Behavioral Health and Biofeedback.
Both my clinical work and my years of coaching showed me that ‘managing stress’ requires the clinician or coach to understand the mechanisms of stress, its psychophysiology. I use the term psycho-physiology here because, perhaps nowhere else is there such a demonstration of how our thoughts and emotions have direct effect on our body. This is the center of the mind-body connection. Just thinking about taxes, a strained love relationship, a scary health condition, etc., can immediately result in an increase in blood pressure, the secretion of stomach acid, the constriction of blood vessels in our extremities, the release of cortisol into our bloodstream, and more. Understanding the psychophysiology of stress is vital to being able to develop coaching approaches that will allow our clients to recognize stress, recover from it, and develop the resiliency that they need to live their best possible lives.
The Psychophysiology of Stress
The human body operates on an amazing system grounded in the principal of homeostasis. This self-correcting process allows us to bring ourselves back into balance whenever it is required. When we overheat, we sweat and cool down. When our blood becomes too thick, mechanisms bring more water from our cells and thin our blood down to its proper viscosity. When we are under stress this homeostatic principal seeks to bring us back into balance. Let’s take a look at how our nervous system operates this.
From this graphic, focus upon the Autonomic Nervous System. You will see that it is composed of two parts, the Sympathetic and Parasympathetic Nervous Systems. When we are under threat, or stress, the Sympathetic Nervous System (SNS) kicks in and arouses us to either fight, flee or freeze. This is the classic Fight or Flight Response.
When we are under real threat, like a stranger jumping out of van and confronting us as we approach our car in an isolated parking lot, this response may be vital to our survival. Suddenly our heart rate goes up, our adrenal glands release adrenalin and noradrenalin, cortisol and other stress hormones enter our bloodstream, our eyes dilate (allowing us to see better in low light), blood leaves our extremities and pools to our body core (minimizing bleeding in case our arms or legs are cut, and protecting our vital organs), our digestion shuts down (we need our energy elsewhere), the bronchi dilate increasing our ability to take in oxygen, and more glucose is made available to the blood to provide a supply of instant energy for both cognitive and physical purposes. So, you can see that this remarkable response does a fantastic job of equipping us to deal with muggers, Saber-toothed Tigers (back in our days in the cave), and other acute threats.
Unfortunately, in our modern-day world, we often trigger SNS arousal to a greater or lesser degree, by what might be called ‘false alarm states’.
As any wellness coach can recognize, these false alarm states are often the drivers of the very issues that bring our clients to coaching. Stress has a tremendous effect upon these and many more health challenges. When we are in a chronic state of SNS arousal we will see more headaches, insomnia, difficulty managing chronic pain, more tendency towards unhealthy coping mechanisms (including addictive behaviors), and difficulty managing anxiety, anger and our emotions. It’s easy to see how a client with weight issues might have improved eating and exercise/movement but is still struggling losing weight as they continue to live a high-stress life. Thus, while we are wired to handle acute stress in a potentially adaptive way, chronic stress is our nemesis.
The Relaxation Response
Back to the all-ruling principal of homeostasis. The nervous system’s answer to Sympathetic Nervous System arousal is to counter-balance it with Parasympathetic Nervous System (PNS) arousal. To counteract all of this activation for action we need a way to slow down the heart rate, reduce the blood pressure, calm the breathing, bring blood back into the extremities, quiet down the release of stress hormones, get the digestive system back online, and essentially bring us back to our baseline level of tension/arousal, or even dip below it. In contrast to ‘fight or fight’, this response is sometimes referred to as ‘rest and digest’.
For thousands of years people have found ways to bring about this PNS arousal. Methods of meditation, breathing, movement, prayer, chanting, etc. all have the potential to bring about this state of profound relaxation. Harvard cardiologist, Herbert Benson, coined the term ‘Relaxation Response’, and his groundbreaking 1975 book by that title created a whole new way to approach dealing with stress. His research since then has continued to demonstrate the profound utility of bringing out this quieting response through mind-body practices. Benson managed to demystify meditation and to distinguish it from religious practices. In more recent times, Jon Kabat Zinn has done the same with Mindfulness Based Stress Reduction techniques. Bringing out the Relaxation Response allows us to recover from stress. I will be delving into how to coach clients to do this in my next blog posting.
Actions of The Relaxation Response
Stress And Distress
Coaches often encounter a client who will claim to “thrive on stress”.
We actually do require a certain level of stress to bring out our best performance. Think of how some of the greatest performances in music and sports have occurred in the most high-stress moments. We look to experience ‘optimal stress’, or what is called Eustress.
There is, of course, a point where the stress becomes excessive and this is where we see this positive stress become Distress. This is where one’s stress related disorder may kick in. The headache comes on, the difficulty sleeping begins, the gastrointestinal problems start, the skin reacts, etc. Practicing some kind of method that brings out our Relaxation Response on a regular basis may, however, bring our baseline level of stress down enough for us to remain in eustress longer and perhaps not cause us to cross over into distress. Thus, the wellness coach may work with a client to help them find a way to integrate some kind of regular practice that brings out the Relaxation Response. Performing such practice could be an activity the client keeps track of and sets up accountability agreements about with the coach.
Caution Coaching With The Relaxation Response
As a wellness coach working with a client who has chosen to practice some form of relaxation training or meditative practice, you need to inquire about your client’s health concerns and all forms of medical treatment that they may be under. The chief concern is that as a client develops more competency with bringing out their Relaxation Response, it may alter their psychophysiology in a positive way, but in a way that must be accounted for with potential medical adjustments. Specifically, if your client is, for example, taking medication for hypertension, such practices may reduce their need to this medication and the dosage may need to be adjusted.Have your client inform their treatment team of their practices that may affect their medication needs. The Wellness Plan always supports the Treatment Plan. Make sure your efforts are coordinated with your client’s treatment team.
In two subsequent blogs I will be addressing how we can coach around the need to recover from stress, and how we can build greater resiliency to stress.
Great coaching finds a balance between structure and spontaneity, customization, “dancing in the moment” and organization. While some large coaching organizations err on the side of too much structure, using scripts and ridged protocols, some coaches “wing it” way too much. Listening to hundreds of coaching recordings, done with real clients, I’m continually amazed at how loosely many coaches go about their work. Observing the variance in structure, or lack thereof, led me to create some suggestions for how you can discover the benefits of coaching structure for your coaching sessions.
1. Every Session Is A Small Part Of A Whole
Think of each coaching session as part of the larger coaching process and relationship. Keep the individual session in the context of the entire work you are doing with that client.
First sessions, or what we often call Foundation Sessions, or Discovery Sessions, are unique in that they are all about Co-Creating the Coaching Alliance. In this first session there is a lot to do in addition to listening to the client’s story. Typically, two to three times longer than a regular subsequent session, these sessions allow for getting acquainted, creating agreements about the coaching, familiarization with the client’s story, their concerns, etc. The number one error in Foundation Sessions is to get caught up in the story and take a problem-solving approach right out of the gate. Clients benefit much more from you two building the coaching alliance, taking stock of their wellness, and getting clear about how coaching works.
Regular coaching sessions also need to be thought of by the coach in terms of the larger coaching process. Is this one of the early sessions, or are we starting to work towards termination? Coaching does not go on forever and many coaching contracts involve a limited number of sessions. Also, how does this session fit in to the overall Wellness Plan that you and your client have formulated? How does the “issue” that they just brought up today have relevance to their Wellness Plan?
2. Co-Create The Agenda At The Beginning Of Every Session
Certainly, one of the most common errors coaches make is to start a session with a vague invitation like “So! What do you want to talk about today?” Most often client’s immediately think of some sort of barrier they would like to deal with and coach and client instantly begin a problem-solving discussion. I’ve actually heard coaches begin a session with the even more vague request, “What’s up?”. If a specific problem doesn’t jump to the client’s mind, the client might flounder for a while until lighting upon a topic to discuss.
This approach conveys to the client that the coach is a consultant with whom to solve problems instead of an ally in a process of growth and development. This is where some co-creating the agenda first sends a very different message as well as setting up the session for success.
What works best is a discussion of what all will be talked about in the session and what the client wants to get out of the meeting together. ICF (International Coach Federation) examiners are looking for this kind of review and agreement at the beginning of every coaching session. Just like in a team business meeting, co-creating the agenda means taking in all of the topics to be discussed and then setting an agenda based upon strategy and priorities. It’s best to go with a reasonable blend of urgent and important, remembering that not everything is, in fact, urgent and important.
3. Make Checking-In About Wins And Go Beyond Just Hearing Reports
Begin with Wins!“Tell me about some progress you made in improving your lifestyle since we last talked?” Coaching is an inherently Positive Psychology approach designed to build upon strengths. Make good use of that. Acknowledge those wins. Don’t just say “Okay.” Inquire more about them, request clarification.
Transition from Wins into checking-in on the accountability agreements that were made last time on action steps. As you do, urge your client to go beyond just reporting what they did. Begin to help them explore those actions to gain greater understanding of what worked and can be reinforced, what didn’t and what got in the way. Look at how you can facilitate your client’s exploration of their actions and themselves. Head into new territory and watch your client grow!
4. Once You’ve Got A Wellness Plan Navigate By It
The map you navigate by, once you co-create it with your client, is the Wellness Plan. Now, whatever comes up in coaching is always put in the context of its relevance to the Wellness Plan. The plan is flexible, changeable, but if you want to get results, you continue to follow it. This is where time is saved by steering back away from tangents and irrelevant topics. This is where “What do you want to talk about?” becomes obsolete. Ask yourself, and perhaps your client “Are we still on the map?”
5. Process – But Don’t Get Lost In It
The bulk of most coaching sessions is about processing the client’s efforts at implementing the Wellness Plan. You and your client can have a lot of fun strategizing through barriers, coming up with creative approaches to making progress on goals, and more. The mistake most coaches make it to use 90% of the session doing just this and not leaving enough time for Next Steps. It’s so easy to “get into the weeds” where “the devil is in the details” and get lost. Stay focused and get back to the backbone of the process – the Wellness Plan. Problems become about relevance to the plan. Problems from the past become about relevance (how are they affecting implementing the Wellness Plan in the here and now), not about resolution (that’s the job of therapy).
6. Leave Time For Next Steps
Effective coaches are watching the clock and know to leave about one-third of the session for Next Steps. Processing until there are only five minutes left is a sure way to set your client up to struggle instead of leaving with a clear plan of how to move forward and make progress. Look at what’s working and what needs to be adjusted. Create agreements about the action steps the client is committing to for the time between now and the next session. It often comes down to Reset, Recommit, or Shift. Will they benefit from resetting the level of the action step – going from walking 5x/week to 3x/week? Or, is the best strategy to re-commit to the same action step at the same level for this week? Or, is it best to strategize a shift to a whole new action step? That will require adequate time to do well.
7. Pick The Music But Stay Light On Your Feet
Coaching structure provides the framework for progress. It is like the music that the coaching couple picks to dance to. Coaches perpetually use the expression “dancing in the moment” for good reason. Don’t be afraid to let go of the structure of a session in order to deal with what is more important. Your client may need your support in dealing with a very emotional issue. There may be something that needs to be confronted about the way the two of you are coaching together that may be critical to progress, or even the continuation of coaching. If the coaching seems stuck and progress is lacking, have the courage to explore with your client how the two of you can work better together. Shift the dance of coaching to deal with what has emerged, but then, get back to the music and the structure that will facilitate the progress your both want to make.
Most clients who struggle with medical adherence and/or the lifestyle improvements recommended by their treatment team (the Lifestyle Prescription) benefit from the structure that wellness coaching provides as well as the power of the coaching alliance. Clients are attempting to adopt new behaviors, shift from old unhealthy behaviors, and often reorganize their lives radically to do so. They benefit from co-creating, with their coach, a well-designed plan that addresses their overall, total wellness, and makes medical adherence a part of it. It becomes just one Area of Focus in a fully-integrated Wellness Plan.
Health and wellness coaches who work with clients challenged by chronic illness, and even more acute medical challenges, are counted upon to help with medical compliance and adherence. The clients themselves count on them because they struggle with medical self-testing, taking medication properly, following up with appointments, exercising, and whatever the recommendations of their “lifestyle change prescription” are. Coaches are also counted upon by those providing healthcare services, insurance services, employee benefits and more, to help manage costs through better overall patient compliance/adherence. This often becomes a large part of a wellness coach’s job.
The job is valued because the need is great. First of all, when clients fail to take their medication properly, manage their blood sugar levels well by doing their self-testing regularly, etc., they suffer. There are more hospitalizations and trips to the emergency room, more chance of complications and usually more progression of progressive diseases.
The Network for Excellence in Health Innovation calls improving patient medical adherence a $290 Billion Opportunity. (https://www.nehi.net/bendthecurve/sup/documents/Medication_Adherence_Brief.pdf) that’s what is lost in U.S. healthcare spending each year due to poor medication adherence alone. The same source goes on to say that “when patients with severe or chronic conditions do not take their medications, the consequences can be extreme. Clinical outcomes are highly affected by non-adherence. For example, those with 80-100 percent adherence rates are significantly less likely to be hospitalized than their counterparts.”
Lack of follow through on medications, and other types of “following doctor’s orders” can be due to many different reasons, some of which are not the fault of the patient. Cost of prescriptions and supplies in the United States is often a big factor. Inadequate instructions from the healthcare provider, a lack of self-care education, access to treatment and/or education, plus costs, account for about 31% of the reasons for poor adherence. The other “69% of the problem is behavioral, such as perceived benefits, poor doctor-patient relationship, medication concerns, or low self-efficacy.” (http://www.dtcperspectives.com/impact-behavioral-coaching-adherence/#_edn3).
A note on terms:
Non-compliance — not complying with medical directives, prescriptions, etc. A patient decides that their physician is basing a prescription on inadequate information and decides not to take prescribed statins. Non-compliance — More of a refusal, a decision. Can be medical or lifestyle prescriptions. May be due to external causes (like cost). More authoritarian. Non-adherence — not following through consistently with the treatment plan including the “lifestyle prescription”. Not adhering to the plan. More likely due to inabilities, difficulties executing the plan, etc. You will also find that the terms are sometimes interchangeable in the professional literature.
Research on health and wellness coaching has shown significant effectiveness in improving this problem. Unfortunately, most of the research narrowly focuses on one research variable, one aspect of medical compliance/adherence – medication adherence. In a study of the impact of health coaching with patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia, “Health coaching by medical assistants significantly increases medication concordance and adherence.” (1) Ruth Wolever and Mark Dreusicke (2) found that integrative health coaching led to an increase in medication adherence and that better adherence correlated with a greater decrease in HbA1c (blood sugar measure).
Many of the studies are gleaning what appear to be the coaching methods that make a real difference in effectiveness. Wolever and Dreuskicke concluded that “Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders.” So, though helpful, clients/patients often need more than just text messages sent on their smart phones. Amanda Rhodes, in a 2017 article (3) takes on a more corporate perspective in showing how coaching is beneficial to both patients and the pharmaceutical and healthcare companies that serve them. What their research emphasized was how client-centered the whole approach needs to be. “Patient-centered behavioral coaching is designed to help patients determine the way in which THEY believe they need to change their behaviors to achieve their goals. Patients who feel listened to are more comfortable with the care they receive and are more likely to adhere.”
Alliance Over Compliance
For the health/wellness coach and the client they serve, the heart of the matter is the coaching alliance. As seen in the articles we’ve spotlighted here, adherence comes not from medical admonishment or authoritarian directives. It comes from a client/patient developing self-determined goals that they are motivated to pursue. It comes from having an ally to help them navigate through the barriers that they face to achieving the high level of health and wellness that all people want. The coach may be well aware of the medical urgency for a client to, for example, quit smoking, or take their medication properly. But, as we’ve learned from all forms of behavioral change efforts, the process, ultimately, must be self-directed. That is, the client has to see the value in making the change, be ready to make it, and have both a concrete plan of action and the support they need to achieve it. Tempting as it may be for the coach to become extremely directive and take over the action planning, they must remain in a true coaching mindset and be the ally the client needs in their own process. This requires patience, but as is often the case, patience pays off.
A Fully Integrated Wellness Plan
The client and coach work together to determine what the other Areas of Focus will be, based upon Readiness for Change Theory, the directives of the Lifestyle Prescription, the values and interests of the client, and all of the exploration and assessment that the coach and client have done together. Other Areas of Focus could include such things as: Attaining & Maintaining A Healthy Weight; Smoking Cessation; Achieving Greater Social Support, etc.
Areas of Focus break down into Goals and the specific Action Steps that the client will engage in to achieve those goals. All of this is co-created, not dictated.
Coaching Does What It Is Good At
In the focus on medical adherence, coach and client co-create a way to identify the specific behaviors that are needed to either develop or change. They then, strategize the best Action Steps that will be an optimal starting point for success. They develop tracking strategies, so the client will know when they are being successful at doing their self-testing regularly, taking medication on time, staying organized enough to follow through on medical appointments, etc. The key to tracking, whether done on phone apps, or good old pencil and paper is following up with Accountability on it. Sending the coach app or text messages, or simply reporting in at the next coaching appointment will help the client feel accountable to themselves to achieve what they, themselves, want to get done. The coaching alliance also takes on the myriad barriers, both internal and external that get in the way to solid medical adherence. Strategizing through barriers such as a lack of family or workplace support, checking out fearful assumptions (especially about side-effects), all increase the likelihood of success.
There are times when we see a complete shutdown of efforts to follow the directives of the treatment team, especially around the lifestyle changes that are urgently needed to shift. This refers to a client paralyzed by grief over their perceived loss of health. To understand this check out our previous blog post – “Astonishing Non-compliance – Understanding Grief and Readiness for Change in the Health Challenged Client” (https://wp.me/pUi2y-n2 ).
The Many Faces of Medical Adherence
Coach with your client to determine what the components of medical adherence are for them. Don’t just focus on medication. Help them see that their best strategy is to live their healthiest life possible in all dimensions of their wellness.
(1) Thom D, Willard-Grace R, Hessler D, DeVore D, Prado C, Bodenheimer T, Chen E. The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial. J Am Board Fam Med. 2015 Jan-Feb;28(1):38-45. doi: 10.3122/jabfm.2015.01.140123
(2) Ruth Q Wolever, Mark H Dreusicke.
Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence. Clinical care/education/nutrition/psychosocial research. https://drc.bmj.com/content/4/1/e000201
• Sforzo, Kaye, Todorova, et al. (2017). Compendium of the Health and Wellness Coaching Literature. American Journal of Lifestyle Medicine,1559827617708562. http://journals.sagepub.com/doi/full/10.1177/1559827617708562
• Ruth Q. Wolever, Making the Case for Health Coaching: How to Help the CFO Understand — Real Balance Coach Center – April 2018 Free Monthly Webinar.
• https://ichwc.org/resources/ “A Systematic Review of the Literature on Health and Wellness Coaching: defining a Key Behavioral Intervention in Healthcare” (Resources section for ICHWC)