15 Vital Books for the Wellness Coach – 2020 – Straight Off My Shelf

In the last ten years the field of health and wellness coaching has continued to evolve as a professional filed with standards, credentials (https://nbhwc.org) and a solid evidential base (https://journals.sagepub.com/doi/full/10.1177/1559827619850489). We’ve attained more clarity about what effective health and wellness coaching looks like and more awareness of what all coaches need to learn. Coaches have an ethical obligation to constantly be learning and growing in our profession.

So, what are the “must reads” for the wellness or health coach? Ten years ago, I posted a three-part blog on this topic.

15 Vital Books For The Wellness Coach: Straight Off My Shelf – Part One
https://wp.me/pUi2y-1n. 15 Vital Books For The Wellness Coach: Straight Off My Shelf – Part Two https://wp.me/pUi2y-1z. 15 Vital Books For The Wellness Coach: Straight Off My Shelf – Part Three https://wp.me/pUi2y-1H.

Now, in 2020, what I want to share with you are the top fifteen books that will influence the way you do coaching, the way you prepare for professional exams, and books that you will want to have at arm’s reach. These are the books on my own bookshelf that I find myself recommending over and over again to the thousands of wellness coaches that Real Balance has trained. There are many great resources out there, but here is my own very biased (as you’ll see when I recommend my own books) and opinionated list. In contrast to my own previous blogs this time I’m listing them in rank-order of importance to the coach practicing in the field.

15 Vital Books for the Wellness Coach – 2020 – Straight Off My Shelf

1. Wellness Coaching For Lasting Lifestyle Change,2nd Ed. , Arloski
2. Masterful Health & Wellness Coaching: Deepening Your Craft, Arloski (In Press)
3. Co-Active Coaching, 4th Ed., Whitworth, Kimsey-House & Sandahl
4. Changing to Thrive, Janice & James Prochaska
5. Becoming a Professional Life Coach, Williams & Menendez
6. Motivational Interviewing 3rd Edition, Miller & Rollnick
7. The Coaching Psychology Manual, Moore, Tschannen-Moran and Jackson
8. The Blue Zones, Dan Buettner
9. Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. 1, Arloski
10. Taming Your Gremlin, Rick Carson
11. The Wellness Workbook, Jack Travis & Regina Ryan
12. The Open Heart Companion, Maggie Lichtenberg
13. The Craving Mind, Judson Brewer
14. Raw Coping Power, Joel Bennet
15. The Way We’re Working Isn’t Working, Tony Schwartz


1. Wellness Coaching For Lasting Lifestyle Change,2nd Ed. (2014), Michael Arloski. (https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml) Like I said, a very biased list. Yet, I will have to say that this book (which is now also available in Mandarin) is used by many colleges and universities, as well as other commercial wellness coach training organizations all around the world. The 2014 2nd edition has expanded its coverage of coaching skills and the process of co-creating a wellness plan. The Wellness Mapping 360 Methodology provides the coach with a complete approach to behavioral change that distinguishes this book from others. The integration of what we know from the field of wellness and health promotion is another unique feature of this resource.

2. Masterful Health & Wellness Coaching: Deepening Your Craft, (2020)(In Press) Michael Arloski. (https://wholeperson.com/store/masterful-health-and-wellness-coaching.html) Coaching is both an art and an applied science. In this book my intention is to provide guidance for the health & wellness coaches who wants to go beyond competence to proficiency and embark on a journey towards mastery. The book is divided into four sections, Transformation, How To Be, What To Do, and Coaching People with Health Challenges. We will explore what distinguishes masterful coaches form those who are just learning their craft. Thoroughly substantiated by the evidential literature and providing in-depth lessons on all the major behavioral change theories, Masterful Health & Wellness Coaching will allow the reader to take their coaching to an advanced level.


3. Co-Active Coaching, 4th Ed., (2018)
Laura Whitworth, Karen Kimsey-House, Henry Kinsey-House & Phil Sandahl. (https://www.amazon.com/Co-Active-Coaching-Fourth-transformative-conversations/dp/1473674980/ref=sr_1_1?crid=2E78YGNE10TNG&dchild=1&keywords=co-active+coaching+4th+edition&qid=1601155442&sprefix=Co-%2Caps%2C206&sr=8-1)
THE foundational book of the life coaching field. The authors became the founders of The Coaches Training Institute (CTI) and in this work set down the cornerstones that shape the coaching mindset. A great book to bone up on your coaching skills and to learn what the essence of coaching really is. A true must-read.


4. Changing to Thrive: Using the Stages of Change to Overcome the Top Threats to Your Health and Happiness (2016), Janice & James Prochaska. (https://www.amazon.com/Changing-Thrive-Overcome-Threats-Happiness/dp/1616496290/ref=sr_1_1?crid=24WCWLPXR1KL2&dchild=1&keywords=changing+to+thrive&qid=1601155877&sprefix=Changing+to+thrive%2Caps%2C202&sr=8-1) Replacing the original Changing For Good (1994), this book definitely is in the top four for your bookshelf. The tremendous utility of the Transtheoretical Model for Behavioral Change (TTM, Stage of Change) makes it the coach’s most important behavior change model to know well.

5. Becoming a Professional Life Coach: Lessons from the Institute of Life Coach Training, (2015) Patrick Williams & Diane Menendez. (https://www.amazon.com/Becoming-Professional-Life-Coach-Institute/dp/0393708365/ref=sr_1_1?dchild=1&keywords=5.+Becoming+a+Professional+Life+Coach%2C+Williams+%26+Menendez&qid=1601156765&sr=8-1) Pat Williams is one of the true pioneers of Life Coaching and his earlier book (along with Deb Davis) Therapist as Life Coach was one of my favorites as I made the shift from psychotherapist to coach. Becoming A Professional Life Coach largely supplants this earlier book and provides the wellness coach with not only great skill building but lots of very practical guidance for practicing their coaching.

6. Motivational Interviewing 3rd Ed., (2012) William Miller & Stephen Rollnick. (https://www.amazon.com/Motivational-Interviewing-Helping-People-Applications/dp/1609182278/ref=sr_1_1?dchild=1&keywords=6.+Motivational+Interviewing+3rd+Edition%2C+Miller+%26+Rollnick&qid=1601157105&sr=8-1) This third edition is definitely the best resource on this vital approach to helping people change behavior. Motivational interviewing (MI) is a key tool for the health & wellness coach, especially when working with the ambivalent client. In addition to presenting the MI approach to many of the same skills used in coaching (with their own unique MI terminology), the book contains real gems of learning about the functions many of these skills serve and how to apply them in your coaching.

7. The Coaching Psychology Manual, 2nd Ed., (2015) Margaret Moore, Bob Tschannen-Moran and Erika Jackson. (https://www.amazon.com/Coaching-Psychology-Manual-Margaret-Moore/dp/1451195265/ref=sr_1_12?dchild=1&keywords=The+Coaching+Psychology+Manual%2C+Moore%2C+Tschannen-Moran+and+Jackson&qid=1601157580&sr=8-12) Another foundational book of the wellness coaching field. A comprehensive guide to many of the behavior change theories that coaches use and how to apply them.

8. The Blue Zones: 9 Lessons for Living Longer From the People Who’ve Lived the Longest, 2nd Ed. (2012) Dan Buettner. (https://www.amazon.com/Blue-Zones-Second-Lessons-Longest/dp/1426209487/ref=sr_1_2?crid=1OT3CA9BCUW6O&dchild=1&keywords=the+blue+zones&qid=1601323354&sprefix=The+blue+zones%2Caps%2C202&sr=8-2)  Longevity, we’ve found out is only 20% genetics (at the most) and is really 80% lifestyle (culture, behavior, beliefs, environment). Looking at studies of the hot spots or “Blue Zones” around the world where people live to a ripe old age quite often, common denominators teach us what it takes for an environment to make it easier to be well. The lessons for wellness are profound and based in solid evidence. We have made this part of the Real Balance curriculum since it was first published in 2008.

9. Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. 1, 2nd Ed., (2017) Michael Arloski. (https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml)
A wellness journal for the client, this book outlines an entire wellness coaching process from self-assessment, to visioning, wellness planning, meeting challenges to change, tracking behavior and setting up accountability and support through connectedness for success. Many of the coaches I’ve trained use this with each of their clients either individually, or as a group guide (works very well in a 12-session format). Many coaches love it simply as their own guide for how they coach their clients.

10. Taming Your Gremlin: A Surprisingly Simple Method for Getting Out of Your Own Way (updated edition) (2003), Rick Carson. (https://www.amazon.com/Taming-Your-Gremlin-Surprisingly-Getting/dp/0060520221/ref=sr_1_1?dchild=1&keywords=Taming+Your+Gremlin%2C+Rick+Carson&qid=1601159057&sr=8-1) Whenever the wellness coaching client takes on change their own personal “Gremlin” or “inner-critic” will be there to oppose it, even if it’s the best thing in the world for that person. Our clients have plenty of external challenges to their attempts at change, but the internal ones can be the most devastating. This classic little book shows us how to spot the self-talk of the gremlin early and get it out of the way (as we get out of our own way!). Another true must read. I know of coaches who supply their clients with copies of this book when folks sign on to coaching.

11. The Wellness Workbook, 3rd ed: How to Achieve Enduring Health and Vitality, (2004) John W. Travis and Regina Sara Ryan . (https://www.amazon.com/Wellness-Workbook-3rd-Enduring-Vitality/dp/1587612135) Health & Wellness coaches need a thorough understanding of wellness and health promotion. This is the foundational book to understand what wellness is truly about. Jack Travis is one of the modern-day founders of the wellness movement and he lays out his theoretical foundation and theories in the introductory thirty-six pages which is worth the price of the book alone.

12. The Open Heart Companion: : Preparation and Guidance for Open-Heart Surgery Recovery, (2006) Maggie Lichtenberg. (https://www.amazon.com/Open-Heart-Companion-Preparation-Open-Heart/dp/0977606309) The psychological side of a major health challenge is often ignored. Maggie Lichtenberg, a PCC level coach, went through mitral valve repair surgery, saw a big missing piece and filled it admirably with this excellent book. As a wellness coach, whether you deal with heart patients or not, this book is an ultimate guide to helping your client with self-efficacy and self-advocacy. I make sure anyone I know (client or not) who is headed into any kind of major surgery (but especially heart surgery) either has a copy of this book or knows about it.

13. The Craving Mind: From Cigarettes to Smart-Phones to Love – Why We Get Hooked & How We Can Break Bad Habits,(2017) Judson Brewer. (https://www.amazon.com/Craving-Mind-Cigarettes-Smartphones-Hooked/dp/0300234368/ref=sr_1_1?dchild=1&keywords=The+Craving+Mind%3A+From+Cigarettes+to+Smart-Phones+to+Love+–+Why+We+Get+Hooked+%26+How+We+Can+Break+Bad+Habits%2C+Judson+Brewer&qid=1601319691&sr=8-1) The subtitle says it all. Health and wellness coaches today are quite likely to discover that their clients may be struggling with “device addiction” as well as other habits that work against their health. Understanding how our mind craves these behaviors and how they feed a cycle of addiction is critical to helping anyone take back control of their lives. What makes Judson Brewer’s approach different is that it is based in the practice of Mindfulness and offers an effective way back to wellness.

14. Raw Coping Power: From Stress to Thriving, (2014) Joel Bennett. (https://www.amazon.com/Raw-Coping-Power-Stress-Thriving/dp/0991510208/ref=sr_1_1?dchild=1&keywords=Raw+Coping+Power%2C+Joel+Bennett&qid=1601319602&sr=8-1) Coaching around stress is an inevitable part of health & wellness coaching, so having the knowledge you need to do so is critical. From knowledge to research about stress to the tools and methods you need to apply it, Raw Coping Power’s strengths-based, resilience building approach is the best resource out there.

15. The Way We’re Working Isn’t Working, (2010) Tony Schwartz.  (https://www.amazon.com/Way-Were-Working-Isnt-Performance/dp/1451610262/ref=sr_1_1?dchild=1&keywords=The+Way+We’re+Working+Isn’t+Working%2C+Tony+Schwartz&qid=1601320068&sr=8-1) Our coaching clients are often over-worked and under-supported with ever-increasing demands heaped upon them. Schwartz’s book looks at the systemic problems of the modern-day workplace, but then takes on an approach that individuals can use to cope and hopefully thrive. Think of stress management and time management as energy management. We are wired to deal with stress, but do we have “sufficient volume and intensity” of recovery? A great resource for helping our clients learn how to recover from the stress in their lives.

So, there you have it! Happy reading and keep on learning!

Dr. Michael

Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness (https://realbalance.com) a premier health & wellness coach training organization that has trained thousands of coaches around the world.

 

Wellness Coaching for Better Sleep, Rest and Immune System Functioning



Adequate sleep and rest are like magic. When we have enough of it our immune system is stronger, healing occurs faster, and very importantly we replenish our supply of energy that allow us to function at our best.

The Mayo Clinic tells us that “During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you’re under stress. Sleep deprivation may decrease production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don’t get enough sleep.” (https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of-sleep/faq-20057757) The relationship between sleep, adequate rest and our immune system is solid. We’ve all likely had the experience of catching a cold when we fell behind in our sleep.

Today with the Covid-19 Global Pandemic and its accompanying economic hardships many coaches and their clients may have lots to lose sleep over. Anxiety, fear of an uncertain future, seeing infection rates rise, and all of the stress of the ‘functional paranoia’ it takes to stay reasonably safe can all interfere with our sleep. We may also find ourselves cutting back on needed rest during the day as we juggle children at home, adapting to a new work-at-home routine, etc.

While there is no guarantee that a healthy immune system will protect us from a novel virus like Covid-19, we all need the benefits that sleep, and rest will provide. For information on increasing your probability of staying free of infection see https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public, and https://www.cdc.gov/coronavirus/2019-ncov/index.html .

A Balanced Wellness Plan

Take a good look at the Wellness Plan that you and your client have co-created. Chances are it will have some fairly active components: becoming more active, eating better, expanding friendship circles, etc. Ask yourself if all the efforts your client is making to improve their lifestyle require an expenditure of energy. Does that same Wellness Plan contain elements that replenish energy? Is their Wellness Plan restorative and regenerative? Is there a balance between these active endeavors, and the more passive and relaxing ones? Essentially, is there a Yin/Yang balance? (See The Tao of Wellness Coaching: Part Two – Practical Applications https://wp.me/pUi2y-lT )

Perhaps your client would benefit from combining their more active wellness efforts with ones like relaxation training, meditation, Mindfulness Based Stress Reduction, Yoga, or Tai Chi. They may want to include more direct efforts such as effective napping and sleep hygiene strategies.

The Beauty and Benefits of a Good Nap

What do Margaret Thatcher, Barbara Walters, Winton Churchill, Salvador Dali, Thomas Edison, John F. Kennedy, Theodore Roosevelt, Leonardo da Vinci, and Albert Einstein have in common? They are or were all confirmed nappers!

Adequate sleep and rest are important for all of us and especially for our clients with chronic health challenges. Regular napping has multiple health benefits: reducing stress, improving mood, boosting memory, improving job performance and increasing alertness. The Sleep Foundation (https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity ) suggests “If your sleep schedule is interrupted by a busy workweek or other factors, try to make up for the lost rest with naps. Taking two naps that are no longer than 30 minutes each —one in the morning and one in the afternoon—has been shown to help decrease stress and offset the negative effects that sleep deprivation has on the immune system.”

A key to effective napping is to set an alarm and only nap for 20-30 minutes. That way you can return to full alertness much quicker. Napping is more effective than caffeine at helping us to the same thing. In fact, clients who might have to avoid caffeine for medical reasons might especially find naps more helpful.

Clients who struggle with full-on napping might find that simply allowing their body to go from vertical to some form of horizontal for even short periods of time provides refreshing rest. ‘Putting your feet up’ and closing your eyes while slowing down and deepening breathing may allow for a rejuvenating shift in energy.

Sleep Hygiene

Our client may not know some of the sleep hygiene tips that can make getting to sleep and staying asleep much easier. You can point them in the right direction with resources and have them study these strategies on their own time, perhaps even set up some accountability around doing such homework.

Sleep Hygiene Tips from SleepEducation.org. (http://sleepeducation.org/essentials-in-sleep/healthy-sleep-habits)
Follow these tips to establish healthy sleep habits:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.

Coaching for Better Sleep and Napping

Wellness coaching is about helping your client to transform what to do into how to do it in their life. Educating one’s self about the importance of sleep and rest may be the first step, but then putting strategies into action is where coaching can help. If your client sees the value in attempting some of these sleep hygiene strategies or establishing more frequent naps, we can co-create with them agreed upon Action Steps that they are willing to make a commitment to doing. Establishing a way of tracking sleep will help our clients to be consistent in their sleep practices. We can set up a system of accountability with them where they might report in about it at the next coaching session or use text or email to do so.

Once our client is practicing their sleep hygiene habits it is important to explore their experience with it. Look for ways to increase intrinsic motivation by bringing their attention to how they feel when they are practicing these habits. This exploration can also uncover barriers that arise when your client attempt to improve their sleep or get more rest.

Coaching Through the Barriers to Healthy Sleep and Rest

A great coaching technique is to anticipate barriers before they are encountered. As you and your client select sleep strategies to try, ask them if they would anticipate any things that might get in the way of practicing these strategies. Do they share a bedroom with someone else? Would that person be amenable to these new strategies? Perhaps their partner loves having a television in the bedroom and are a fan of late-night TV. The very first step may be to ask your client if they feel that a conversation with their partner about what they are trying to achieve (improved health and wellbeing) and these sleep strategies they hope to use, would be worthwhile.

Other barriers will arise as your client puts their sleep and rest improvement strategies into action. They may get support or push-back. They may discover that their situation at work or home will require some real creativity to develop strategies that can work. You and your client can then engage in some strategic thinking and possibility thinking to tackle these barriers.

Coaching Through Barriers Related to Stress

The ability to rest and sleep can obviously be interfered with by stress and anxiety. Coaching for effective stress management requires knowledge and skills that can be found in my previous blog posts (The Psychophysiology of Stress – What the Wellness Coach Needs to Know. https://wp.me/pUi2y-nJ) and in recordings of my Real Balance Monthly Webinars: 11/16/18 – Stress! Recovery & Resilience: How the Wellness Coach Can Help – Part 1, 1/19/19 – Stress! Recovery & Resilience: Recovery – Part 2 and 2/15/19 – Stress, Recovery & Resilience: Building Resilience – Part 3. (https://realbalance.com/wellness-resources)  Adequate sleep and rest help our clients to recover from stress and build resilience. Helping them reduce stress and anxiety in the first place may require some form of relaxation training or other strategies that are discussed in the above resources.

Sleep difficulties, including more severe insomnia, may need to be evaluated by more clinical resources. Since difficulty sleeping and relaxing is a major symptom of both physical and mental/emotional conditions, there may be times when your client’s challenges are more appropriate for clinical treatment than coaching.

Sleep and Rest are Keys to Wellness

Many wellness models include healthy sleep as an essential component of a healthy, well-functioning person. Certainly, it is hard to achieve much of one’s potential when sapped of energy by chronic sleep deprivation. The reality is that people in our modern world are frequently sleep-deprived. “Poor sleep health is a common problem with 25 percent of U.S. adults reporting insufficient sleep or rest at least 15 out of every 30 days.” “Adequate sleep is necessary to: Fight off infection; Support the metabolism of sugar to prevent diabetes; Perform well in school; Work effectively and safely. Sleep timing and duration affect a number of endocrine, metabolic, and neurological functions that are critical to the maintenance of individual health. If left untreated, sleep disorders and chronic short sleep are associated with an increased risk of: Heart disease; High blood pressure; Obesity; Diabetes; All-cause mortality.” (https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health)

Making adequate sleep and rest part of a holistic Wellness Plan may make a positive difference in all of our client’s wellness goals. Think of it as energy management. With a well replenished energy supply our client can have what they need to be more fully engaged in their health and wellness.

RESOURCES

Healthy People 2020 (2020) Sleep Health. Healthypeople.gov. 2020 Topics and Objectives. https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health

Olson, Eric J. (2018) Lack of sleep: Can it make you sick? Nov. 28, 2018.
https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of-sleep/faq-20057757

Sleep Foundation (2020). How Sleep Affects Your Immunity. Sleep Foundation.org. July 28, 2020. https://www.sleepfoundation.org/articles/how-sleep-affects-your-immunity

 

For the very best in wellness and health coach training look to REAL BALANCE GLOBAL WELLNESS SERVICES, INC.  Over 10,000 wellness & health coaches trained worldwide.  http://www.realbalance.com 

 

 

For more about effective coaching refer to Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., by Michael Arloski, Ph.D., PCC, CWP, NBC-HWC.   https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml

and to Your Journey to a Healthier Life (Paths of Wellness Guided Journals) by the same author.  https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml 

 

Keys to Coaching Clients Who Overidentify With Their Illness



We like to say that a coach listens to a person’s story and helps them to realize that they are not their story.

For the health-challenged client, their illness, conditions, or health experience is a huge part of their story. “I am a diabetic.” While this is true, how strongly does the person now see themselves through this lens? What effect could it have on someone’s confidence that they can regain their health? How hopeless do they feel if they have framed their health challenge like a prison sentence instead of a challenge to be overcome? How different it might be if the same person could say “I’m a person challenged by diabetes.”

Erik Erikson, the renowned developmental psychologist who coined the term ‘identity crisis’, viewed identity “as the degree to which an individual integrates different self-assets into a coherent sense of self, and such a coherent sense of self translates itself into daily life and guides choices and values.” (Oris, 2018) When we think about a sense of self-guiding choices and values and apply this to making lifestyle choices, illness identity could play a huge role.

What happens to that coherent sense of self when a person is diagnosed with a life-threatening illness? What happens when that person may not only label themselves according to their health challenge, but is labeled by treatment professionals and even friends and family?

“Although most patients succeed in adjusting to their illness, some patients experience difficulties, which can negatively affect their physical and psychosocial functioning.” (Morea, 2008) Much of that difficulty comes when a client has over-identified with their health challenge.
As health & wellness coaches we know that attitudes and beliefs drive behavior. Each of our clients will react to their health challenge in their own unique way, but it may be very helpful for the coach to understand how these reactions or responses may be seen in terms of different dimensions or states of identification with the person’s illness.

Let’s look at keys to understanding and coaching strategy around client identification with their illness.

Key Number One: Understand the degree to which chronic illness dominates the client’s identity and daily life.

In 2016 an international team of scientists sought to understand this concept more deeply. Their work with adolescents dealing with Type One diabetes led this team to develop the Illness Identity Questionnaire and identify four illness identity dimensions or states: engulfment, (Oris, 2018) rejection, acceptance, and enrichment. (L.Oris, 2016)

Think of the term engulfment. Your client may be completely engulfed by their illness. “Individuals completely define themselves in terms of their illness, which invades all domains of life, at the expense of other important self-assets (Morea, 2008).” They may be experiencing continual physical reminders of their condition as symptoms of their illness manifest. If your client feels in the grip of such an illness, how hopeful are they? How disempowered do they feel that they can do anything about it? They may experience great fear that they will never get better. They may just not know what the future holds, but their illness has taken over their lives. It is quite likely that such a client may be in the Precontemplation Stage of Behavior Change when it comes to lifestyle improvement efforts.

Key Number Two: Meet your ‘engulfed’ client where they are at with compassionate understanding.

A client experiencing their illness this way may feel overwhelmed and helpless. The illness is so figural in their life that they seem to process their entire life through the filter of their health challenge. We want to convey sincere empathy but be prepared to have it either well or poorly received. Our client may feel like nobody else could understand what they are going through. Use your process coaching skills to help your client to work through some of the emotional load they are carrying. Slow down on setting up ‘what to do about it’ strategies. Your client is far from the Action Stage.

If your client has been stuck in this stage for months after their diagnosis or health event, consider what else might be going on. They could be experiencing some secondary gain. That is, they may be receiving some kind of reinforcing experience for staying stuck where they are. Family and others could be treating them with such extra kindness that it makes their overidentification rewarding. Be careful how you approach this subject as clients may feel accused and judged if you are too forthright about this. You might instead approach their situation from the angle of nurturing hope.

Part of what can increase hope is learning more about their illness and their prognosis and potentially what they can do about it. Inquire what they know about their health challenge. Share with them the information that patients who know more about their illness and treatments have better outcomes. Let them know that lifestyle improvement may not cure their illness, but it can significantly affect the course of that illness.

Key Number Three: Understand the Rejection Dimension of Illness Identification

While some clients embrace an identification with their illness others do their best to reject it as much as possible. “…rejection refers to the degree to which the chronic illness is rejected as part of one’s identity and is viewed as a threat or as being unacceptable to the self.” (L.Oris, 2016) This client avoids thinking or talking about their illness and they tend to neglect it, which results in poor treatment adherence. Their approach is one of denial and/or minimization. They attempt to go on with life and business as usual to the point where their biometric markers (e.g. blood sugar levels, blood pressure, etc.) worsen.

Attempting to persuade such a person to follow their doctor’s orders and begin improving their lifestyle will almost certainly go nowhere. If you are given the opportunity to coach such a person, instead take a holistic explorer approach. Have them tell you the story of life before their illness and what led up to their diagnosis. Ask them what the experience of hearing that diagnosis was like. Meet them with empathic understanding. Inquire about what it feels like they have lost. Often the experience of a loss of health is central to such a response to a life-threatening illness. (See my blog post “Astonishing Non-compliance – Understanding Grief and Readiness for Change in the Health Challenged Client” https://wp.me/pUi2y-n2)

This client may be the farthest away of all from the Action Stage and firmly entrenched in Precontemplation. Refer to Changing To Thrive, by Janice and James Prochaska (https://jprochaska.com/books/changing-to-thrive-book/) for extensive guidance on how to coach someone through the stage of Precontemplation.

Key Number Four: Coach the accepting client at a higher level of readiness to change

The acceptance dimension of illness identity shows a client who is not overwhelmed by their chronic illness, does not deny it, but rather accepts that this is their reality. “Chronic illness plays a peripheral role in one’s identity, besides other personal, relational, and social self-assets, and does not pervade all life domains.” (Morea, 2008) Such a client will be trying to lead as normal a life as possible without being in denial about their illness. They, to one degree or another, are finding ways to adapt to their illness.

Explore with this client their current level of knowledge about their illness and treatment. Inquire about the lifestyle prescription that their treatment team has recommended and how successful they have been at achieving those recommended lifestyle changes. Explore their motivation that fuels their desire to deal more successfully with their illness. Help them create a fully integrated Wellness Plan for how to move forward and affect the course of their illness in a positive way.

Key Number Five: Partner with the possibility of transformation

The fourth illness identity dimension, enrichment, provides the coach with a unique situation. Here the client has developed to where they frame their illness as an opportunity for growth and transformation. They see positive changes in themselves having taken place as a result of these negative developments in their health. “Such positive changes manifest themselves in different ways, including an increased appreciation for life, changed life priorities, increased personal strength, and more positive interpersonal relationships.” (Tedeschi, 2004) Coaching with a client who has reached this state of identity with their illness would be a delight. Here the focus might be more upon maintaining good self-care and treatment adherence, and possibly upon continued improvement in health. Such a client might be motivated to work on disease reversal through lifestyle improvement such as we see with programs like that of Dean Ornish. (https://www.ornish.com)


Content for the blog has come from Dr. Arloski’s forthcoming book Masterful Health & Wellness Coaching: Deepening Your Craft, published by Whole Person Associates, Inc., and is fully copyrighted.

Stay informed about the book’s publication at https://wholeperson.com/store/masterful-health-and-wellness-coaching.html

REFERENCES:

L.Oris, J. S. (2016). Illness Identity in Adolescents and Emerging Adults With Type 1 Diabetes: Introducing the Illness Identity Questionnaire. Diabetes Care, 757-763.
Morea, J. M. (2008). Conceptualizing and measuring illness self‐concept: 571 a comparison with self‐esteem and optimism in predicting fibromyalgia adjustment. Research in Nursing and Health, 563-575.
Oris, L. L. (2018). Illness Identity in Adults with a Chronic Illness. Journal of Clinical Psychology Medical Settings, 429-440.
Tedeschi, R. G. (2004). Posttraumatic growth: conceptual foundations and empirical 604 evidence. Psychological Inquiry, 1-18.

Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness (https://realbalance.com) a premier health & wellness coach training organization that has trained thousands of coaches around the world.

 

Where The Listening Starts

Where Listening Starts

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?


This blog was taken from a chapter in Dr. Arloski’s forthcoming book Masterful Health & Wellness Coaching: Deepening Your Craft, being published soon by Whole Person Associates. https://wholeperson.com/store/masterful-health-and-wellness-coaching.html

Masterful Health & Wellness Coaching: Deepening Your Craft A New Book by Dr. Michael Arloski, coming in 2020

 

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.

 

Coach training is not a one and done. The best coaches are voracious lifelong learners. In fact, both the ICF (International Coach Federation) and the NBHWC (National Board for Health & Wellness Coaching) include an obligation to continual education and professional development in their codes of ethics. (https://nbhwc.org/wp-content/uploads/2019/04/FINAL-Code-of-Ethics-4_15_19-1.pdf)

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.

The Utility of Self Determination Theory and Motivation in Wellness Coaching – Part One: Motivation

“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.

The life work of psychologists Edward Deci and Richard Ryan (http://selfdeterminationtheory.org) has yielded a theory of human motivation that not only fully supports the coach approach but also adds valuable tools of understanding. In complete alignment with the tenets of humanistic psychology (https://www.amazon.com/Toward-Psychology-Being-Abraham-Maslow/dp/0471293091) , Self-Determination Theory (SDT) views human beings as constantly striving towards actualizing their potential, seeking out ways to foster their growth and development. It is also very much in alignment with the Client-Centered (or Person-Centered) Approach of Carl Rogers (https://www.amazon.com/Becoming-Person-Therapists-View-Psychotherapy/dp/039575531X/ref=pd_lpo_sbs_14_t_0?_encoding=UTF8&psc=1&refRID=3WAH0XRWWQF0SM32MPZJ). Finally, it is easy to see how the way coaches trained in the ICF Core Competencies and the coaching foundations that are laid out in sources such as Co-Active Coaching (https://www.amazon.com/Co-Active-Coaching-Fourth-transformative-conversations/dp/1473674980/ref=sr_1_1?s=books&ie=UTF8&qid=1549473972&sr=1-1&keywords=co-active+coaching) work with clients are entirely congruent with SDT.

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.

MOTIVATIONAL SPECTRUM
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.

Controlled Motivation

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

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

 

Spatial representation of different forms of extrinsic regulation. From Spence & Oades PDF (2011)

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 

 

For more about effective coaching refer to Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., by Michael Arloski, Ph.D., PCC, CWP, NBC-HWC.   https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml

and to Your Journey to a Healthier Life (Paths of Wellness Guided Journals) by the same author.  https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml 

Structure Is The Wellness Coach’s Friend: Seven Ways To Coach Better

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.

I would believe only in a God that knows how to dance. – Friedrich Nietzsche

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.

 

 

 

For more about effective coaching refer to Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., by Michael Arloski, Ph.D., PCC, CWP, NBC-HWC.  https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml and to Your Journey to a Healthier Life (Paths of Wellness Guided Journals) by the same author.  https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml 

 

Wellness Coaching For Medical Compliance/Adherence and Growth

 

A Holistic Approach

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.

Astonishing Noncompliance

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.

RESOURCES

(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

(3) The Impact of Behavioral Coaching on Adherence
by Amanda Rhodes on June 29, 2017 in DTC in Focus, DTC News
http://www.dtcperspectives.com/impact-behavioral-coaching-adherence/#_edn3

Additional Resources

• 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)

The Quandary of Closeness And Compassion in Coaching

“Don’t get too close to your clients.” It may have been my junior year of being an undergraduate psychology major when a professor offhandedly gave this warning to me and a couple of other students. There is always this question about ‘therapeutic distance’. Clearly when a therapist allows their own feelings of attraction or repulsion, insensitivity or caring to interfere with the ability to deliver effective therapy, we have a problem. Therapists may wall themselves off from connecting too closely to protect themselves from the pain of their client’s suffering. At the same time, therapists are exhorted to empathize, to connect genuinely, authentically, to allow a therapeutic closeness to grow. They are often left in this ambivalent quandary of just how “close” to be to their client.

The coaching relationship is not intended to be a therapeutic one, even though it may contribute to a client’s own healing. Many experiences are therapeutic and the experience a person has with coaching may be just that. However, our intent is not to heal the old wounds of our client, but to be their assistant in their personal growth. The coach’s quandary is similar to that of the therapist, but also different. Without the ‘therapeutic distance’, it may, in fact, be even more confusing. If we are not delivering treatment with our client, then, are we more like a friend? We will hear stories of suffering. How do we protect ourselves from feeling their pain as our own?

Coaches may start to find themselves becoming more reluctant to truly engage with their clients. They may find themselves pulling back emotionally and fighting the urge to connect more closely. Hearing another story of difficulty, failure, conflict, or even trauma, abuse and neglect, we may react by diminishing the very coaching presence that is essential to helping our client to work through their challenges. The coach may find their ability to concentrate and really listen to our clients becoming reduced. It may show up physically with difficulty sleeping, a drop in our immune response, headaches, digestive issues, and much more. Our ability to be compassionate may be just worn thin.

An ICF published article by Niamh Gaffney (https://coachfederation.org/blog/are-you-tired-of-coaching) defines Compassion Fatigue as “a combination of physical, emotional and spiritual depletion associated with caring for people in significant emotional pain and physical distress.” The term depletion is perfect in this description. Our own well feels like it has gone dry, or soon will. It may feel like our very soul is being drained. The way out of compassion fatigue is the same as preventing it.

 

Operating From A Coach Approach

Failing to recognize the difference between coaching and counseling or therapy leads coaches to delve into an attempt at therapeutic problem solving. We may disguise it to our client and ourselves as “working on stress”, but if we approach stress management by attempting to solve all of the problems that generate stress in our client’s life, we are engaging in an infinite exercise in futility. Not only does it not work, it is exhausting for both client and coach. Your client may sense the futility before you do and leave coaching entirely.

Maintaining a coaching mindset is essential here. Can we help our stressed-out client to learn how to deal with stress, and to recover from stress instead of infinite problem solving? When coaches ask “What issues do you want to work on?” they are inviting the beginning of a therapeutic expedition. When we see ourselves as our client’s ally, not their doctor, healer, priest or therapist, we take a stance of closeness and caring but with less of a feeling of responsibility for their solutions and ‘cure’.

In wellness coaching, instead of operating on a problem du jour model, we work with our clients to help them take stock of their current health and wellness, create a vision of their best life possible and then co-create with them an effective wellness plan. Operating from a plan is totally different than continual problem solving. Certainly, we engage in strategic coaching with them to address barriers, but our job is not to provide solutions. Compassion fatigue, I believe, comes sometimes from the sense of powerlessness that we may feel when we can’t provide the magic solution for our clients that will make their lives better. When we realize that doing so is not our job, we can allow for more of a healthy compassionate detachment to take place.

 

Compassionate Detachment

Twenty-seven years or so of doing psychotherapy with a wide variety of clients had its joys and challenges. Upon hearing the detailed recount of a young woman or man who had been abused sexually by a parent, I couldn’t just go home saying “It’s only a movie.” Clients come needing to tell their stories to a therapist who is not afraid to go absolutely anywhere with them. A really good therapist learns to be a true warrior/warrioress of the heart who is completely fearless. Yet, the only way they can go into battle again, side by side with their client is by learning something about compassionate detachment.

We practice compassionate detachment for the benefit of our client and for our own benefit as well.

Compassionate detachment is respecting our client’s power enough to not rescue them while extending loving compassion to them in the present moment. Simultaneously compassionate detachment is also respecting ourselves enough to not take the client’s challenges on as our own and realizing that to do so serves good purpose for no one.

Compassionate detachment is an honoring of our client’s abilities, resourcefulness and creativity. We remain as an ally at their side helping them to find their own path, their own solutions. We may provide structure, an opportunity to process, a methodology of change and tools to help with planning and accountability, but we don’t rescue. As tempting as it is to offer our suggestions, to correct their errant ways, to steer them toward a program that we know works, we avoid throwing them a rope and allow them to grow as a swimmer. Sure, we are there to back them up if they go under or are heading toward a waterfall. We are ethically bound to do what we can to monitor their safe passage, but we allow them to take every step, to swim every stroke to the best of their ability.

To be compassionate with a client we have to clear our own consciousness and bring forth our nonjudgmental, open and accepting self. We have to honor their experience.

“Only in an open, nonjudgmental space can we acknowledge what we are feeling. Only in an open space where we’re not all caught up in our own version of reality can we see and hear and feel who others really are, which allows us to be with them and communicate with them properly.” Pema Chodron, When Things Fall Apart

Compassionate detachment is also about giving ourselves permission to protect ourselves. Being in proximity to the pain of others is risky work. There are theories about the high rates of suicide among dentists based on this. Compassionate detachment is also about being detached from outcome. We want the very best for our clients and will give our best toward that goal, but we give up ownership of where and how our client chooses to travel in the process of pursuing a better life. Their outcome is their outcome, not ours.

Compassionate detachment is not about distancing ourselves from our client. It is not about numbing ourselves out mentally, emotionally or physically. It is not about treating our clients impersonally. That is mere detachment alone and more a symptom of burnout than of good work as a coach, therapist or any kind of human helper.

Intimacy is what allows compassion. When we fear closeness, we will hold back. We will be less empathic because we fear connecting with our own feelings. Compassionate detachment is being centered enough in ourselves, at peace enough in our own hearts, to be profoundly present with our clients in their pain and in their joy as well.

 

From Depletion To Replenishment

If compassion fatigue is about feeling depleted, then prevention and recovery is about replenishment. Fatigue comes from the expenditure of energy: physically, emotionally, and spiritually. Coaches must ask themselves what they are consciously doing to restore their own energy supplies. Once again, we are talking about the coach’s own Wellness Foundation.

We often think of wellness in terms of exercise and participation in all kinds of wellness activities. To what degree are these activities an expenditure of energy, and to what degree do they provide an energy return and replenishment. While a workout resulting in a “good tired” feeling my fatigue us physically, it may invigorate us mentally, emotionally, and even spiritually. Once again it is a matter of balance. Are we engaging in mind/body activities that replenish our energy on multiple levels? Mindfulness practices, meditation, Tai Chi, Xi Gong, Yoga, all share the intent of this kind of replenishment.

Our Wellness Foundation is not just about working out and eating well. What we are looking for here is replenishment on the levels at which we are being depleted: more the emotional, mental and spiritual. Re-filling our well on these levels is more about getting our needs met in these areas. Compassion fatigue can generate feelings of isolation, powerlessness and feeling overwhelmed.

  • Are we connecting with meaningful friendships to combat that isolation? Are we expressing ourselves creatively and feeling competent in other areas of our lives?
  • Are we consciously engaging in device-free time, in connection with the natural world, simplifying our lives?
  • Do we feel like we are truly in charge of our own lives?
  • These questions address the three basic human needs that Dicci and Ryan talk about in Self-Determination Theory. (http://selfdeterminationtheory.org)

When we come back to our own center and feel like our needs are getting met, when we feel safe and secure, energized and in balance, we can extend the heart of compassion to our clients and not fear intimacy. We can be the ally they need.  

 

Michael Arloski, Ph.D., PCC, CWP, NBC-HWC – is a psychologist, coach, trainer, author and wellness enthusiast.  CEO and Founder of Real Balance Global Wellness Services, Inc. (https://www.realbalance.com), his company has trained thousands of health and wellness coaches around the world.

Astonishing Non-compliance – Understanding Grief and Readiness for Change in the Health Challenged Client

Coaching Can Help Medical Compliance

Medical noncompliance is a vast and complex issue that results in widespread human suffering and immense healthcare costs. Of the 3.8 billion pharmaceutical prescriptions written each year (USA) it is estimated that more than 50% of them are taken incorrectly or not at all. Medical noncompliance also includes failure to do medical self-care, self-testing and attend follow up appointments with the treatment team.

As wellness and health coaches are given more opportunities to help people, especially people who have, or may soon develop, a chronic illness (heart disease, diabetes, cancer, arthritis, COPD, etc.), we will face again and again what has stymied healthcare professionals for decades; the patient who has heard the diagnosis but has made virtually no changes to improve their health. They have gotten the news but haven’t woken up and smelled the coffee.

The story is far too familiar. You may have seen it amongst the people you work with, your friends or in your own family. It may have been what you have experienced yourself. The person gets a new diagnosis of a life-threatening disease or is warned that such a disease is immanent (e.g. pre-diabetic) unless they make significant lifestyle changes. Or, perhaps they experience a sudden health event like a heart attack. Given medical treatment, they are also given a “lifestyle prescription”. They are told to make lifestyle changes: quit smoking; be more active and less sedentary; improve their diet; manage their stress better, etc. Such immediate lifestyle changes are conveyed as absolutely essential to their continued survival: a low-sodium diet for the hypertensive patient; lower stress levels for the post-heart attack patient; complete restructuring of the diet of the newly diagnosed diabetes patient, etc. Then, far too often, the healthcare professional watches, as do family and friends, in total astonishment, as the patient makes none of these changes. So, when lifestyle changes are necessary what determines a person’s ability to make the needed changes in the quickest way possible?

Readiness For Change


Working with clients around medical compliance and adherence to the lifestyle prescription is the place where Prochaska’s “Readiness for Change”, Elizabeth Kubler-Ross’s “Stages of Grief “, and Maslow’s “Hierarchy of Needs” all intersect. What we, the caregivers often fail to understand is that when a person has experienced a truly life changing event, like the onset or worsening of a health challenge they feel a loss of control that may threaten their safety, they experience grief at the loss of health, ability, or dreams, and often need to redefine their identity.

We have long tried to understand people’s adherence to recommendations for lifestyle improvement through the lense of Prochaska’s Readiness For Change model (Changing For Good, 1994, Changing To Thrive, 2016 (https://www.amazon.com/Changing-Thrive-Overcome-Threats-Happiness/dp/1616496290/ref=sr_1_1?ie=UTF8&qid=1530810645&sr=8-1&keywords=changing+to+thrive+prochaska). This model, though primarily tested with addiction clients, revolutionized how we think about behavioral change in the healthcare world. James Prochaska and his colleagues reminded us that change is a process, not an event and that people change when they are ready to, not before. Furthermore, the change process is made up of six stages, not just ready or not-ready.

Pre-contemplation → Contemplation → Preparation → Action → Maintenance → Termination (Adoption)
This is certainly a helpful way to understand where someone is at regarding a particular behavioral change. Knowing if they are in the Contemplation or Preparation stage, for example, helps us know how to work with them. This single lens, however, is not enough. In the patient/client who astounds us with their level of non-adherence we find we are encountering more than just lower levels of readiness, we are encountering grief and loss.

 

Grief And Loss


A loss is a loss. The loss of a loved one through death, the loss of one’s health, or the loss of the dream held for how life would be, are all perceived as losses to be grieved. To help you understand a person’s reaction to a health challenge, diagnosis, etc., and to help you, as a coach or healthcare provider, respond more compassionately and effectively, put all of it in the perspective of the classic stages of grief. The work of Elizabeth Kubler-Ross, Stephen Levine and others have shown us that the grieving process is a multi-layered experience that affects us powerfully.

Kubler-Ross identified the five stages of grieving that are present for any significant loss: 1) Denial; 2) Anger; 3) Bargaining; 4) Depression; and 5) Acceptance.

I talk about this extensively in chapter ten (“Health and Medical Coaching- Coaching People With Health Challenges”) of my book, Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., 2014 (https://www.amazon.com/Wellness-Coaching-Lasting-Lifestyle-Change/dp/1570253218/ref=sr_1_1?ie=UTF8&qid=1530811214&sr=8-1&keywords=arloski+wellness+coaching). When we see the astonishingly non-compliant patient/client, they are often experiencing this first stage of denial. They minimize the importance of the event, downplay its seriousness, and do all they can to return to “business as usual”. Talking about the event or diagnosis becomes a forbidden subject and the person may become quite defensive. They are angry that this tragedy has befallen them, and understandably depressed about what has happened, and the state they are in. The idea of change has no appeal and they often seek the comfort of the familiar — including self-soothing habits such as smoking, overeating, etc.

 

Survival Level


The experience of a “brush with death”, or even the news that such a threat is imminent, can automatically push us into survival mode. No matter what level we were at in getting our needs met on Abraham Maslow’s Hierarchy of Needs (see Chapter One – “Toward A Psychology of Wellness” in my book, Wellness Coaching For Lasting Lifestyle Change, 2nd Ed. 2014) such an experience necessarily drives us down to the survival need level. We feel profound threat to our “safety needs” and “physiological needs”. Our very physical existence is threatened. Life becomes about the real basics of survival; the next breath, food, water, shelter. It becomes about the basics of safety; feeling secure, going back to the familiar, whatever reassures us that we will be OK.

It is no wonder that people going through such an experience may embrace the status quo, resist change and psychologically minimize the threat that they perceive.

This brings up questions about the health challenged persons readiness to change:
* How long will they stay at these survival levels seeking to meet their physiological and safety needs when they are encumbered by the initial stages of grief?
* How effective can one be at functioning and rising up through both the stages of readiness for change and the lower levels of the needs on Maslow’s model if they are in denial and minimizing, acting out in an angry manner or shackled by depression?

What needs to be considered to work effectively with health challenged clients is the intersection of these three widely accepted psychological theories  Once understood, a Wellness Professional can truly motivate their client towards lasting lifestyle change.

Maslow’s theory of motivation contends that as people get their needs met at the lower levels of the Hierarchy of Needs Triangle they naturally move on up to the higher levels (their being needs). When we encounter a patient/client who fits the picture we are talking about here, do we acknowledge where they are at and do we help them get their needs met at that level? Or, do we demand immediate behavioral change just because the value and urgency of it is so great?

Meet Them Where They Are At

Our first job is to help them feel like they have an ally, someone who supports them and has their best interests at heart. This helps meet their safety needs and even some of their social needs. We then need to check in with the person and see how they are doing at the survival level. Are they receiving the medical care they need? Is their living situation allowing them to cover the basics of shelter, food, and safety? Much of this comes down to how their health challenge affects the security of their way of making a living. How do they perceive (and it is their perception that counts) their health challenge as a threat to their livelihood? Do they fear losing their job, falling behind in production, having their business falter or fail? How much are they into catastrophic thinking about all of this?

What is more frightening than to believe we are powerless? The threat to our very survival is there, like a cave bear at the mouth of our cave, and we believe we can do nothing to stop it. If our patient/client feels powerless to affect the course of their illness, then they wonder why should they make all the effort required to achieve lifestyle improvements? When we feel powerless we often don’t go to fight or flight, we freeze.

The reflexive response to fear is contraction. Hearing a sudden, loud noise, we instantly tense up and contract all our major muscle groups. Feeling scared, we hold on. We reflexively hold on to what we have and to the way things are. Change seems even scarier than what frightened us to begin with. We are like the person in the path of a hurricane who won’t leave the safety of home, sweet home, even though it will probably be flooded and blown away.  For our client to “let go” and trust in the change process their physiological and safety needs have to be met. If they doubt this they may give the appearance of compliance, but their probability of follow-through is questionable.

Beyond the very basics of survival, we can help our client then to get their needs in the next two levels met: Social Needs (sense of belonging, love) and Self-esteem Needs (self-esteem, self-worth, recognition, status). This is where coaching for connectedness plays a priceless role. We know that isolation is a real health risk and at this crucial time the presence and engagement of an extended support system can provide huge benefits. Our client will need the help of others in many practical ways, but they will fare far better if they are getting the emotional support that comes with getting their needs for belongingness, acceptance and compassion met. We, the helper can only provide a very small part of this and some of our best efforts may be to help the person we are working with to find, develop and expand sources of support in their lives. The nature of the support they receive from others is important as well. This person needs understanding, empathy and support, not criticism and pressure to make lots of changes immediately. We need to encourage our client to ask for the support they need in the ways that they need to receive it.

Coaching to improve self-esteem allows the client to move on up through Maslow’s triangle through the next level. We all need to feel good about ourselves, to receive recognition and praise. When one is hit with a health challenge they may feel anything but good about themselves. Perhaps they are framing the health event or onset of an illness as a personal failing. There may be embarrassment and/or shame that they are no longer completely healthy. Their own “inner-critic” may be very harsh on them, filling their mind with self-critical thoughts that, again, cause them to do anything but take action for change. Helping the person to regain a sense of power and control in their life can also reclaim self-esteem. When we feel powerless to control events and circumstances in our lives we feel weak, vulnerable and impotent. When we discover what we can actually do through our own lifestyle choices to affect the course of our illness for the better, we feel empowered and regain confidence and strength.

 

Ten Ways to Effectively Coach the Health Challenged.

When we encounter: the person who has had a heart attack and is still downplaying the importance of it, almost pretending that it didn’t happen; the person diagnosed as pre-diabetic who has made no dietary changes at all and remains as sedentary as ever; the person diagnosed with COPD who is still smoking, etc., we need to respond to them in a more coach-like way. In each step consider that their readiness for change will be determined in part by their stage of grief and where they fall in Maslow’s hierarchy of needs. How quickly they move through the change process will be in part determined by past experiences and in part by the support they have in the present to change.

1) Meet Them With Compassion Not Judgment.
Catch yourself quickly before you criticize their lack of adherence to the recommended lifestyle changes they have been told to do. Bite your tongue, so to speak, and instead of forcefully telling them what they should be doing, and warning them, once again, of the dire consequences of non-adherence, respond with sincere empathy and listen.
2) Acknowledge And Explore Their Experience.
Ask them what it was like when they found out about their health challenge; diagnosis, or what is was like when they experienced this health event. Don’t jump to solutions or start problem solving. Just listen, really listen. Reflect their feelings. Acknowledge what was and is real for them. Explore it with them and see if there isn’t some fear that needs to be talked about here.
3) Don’t Push, Stay Neutral In Your Own Agenda, And Explore More.
While it may feel like this person needs to take swift action with tremendous urgency, be patient. Readiness for change grows at a different rate for each step of the journey.
4) Be Their Ally.
Help them feel that they are not facing this alone. This helps meet their need for safety and even some of their social needs. Does the client understand their health challenge? To what degree does the client understand and buy into the lifestyle changes suggested?
5) Address Survival First.
Make sure they are getting all the medical help and information they need. Explore their fears about maintaining income, job, career, business, and how it all will be impacted by their health challenge. Help them gain a sense of control and feel more safe and secure in all ways. Help them to see that they are not completely helpless and vulnerable, but that there are ways they can affect their situation.
6) Help Them Process The Loss.
Talking through the grief is very powerful. The loss of health is felt to the level that it is perceived. That perception will be part reality and part fear. Help your patient/client to process their feelings, to give a voice to the part of them that is afraid. Accept their initial tendency to minimize but slowly help them feel safe enough to move through the other stages of grief (anger, bargaining, depression and finally, acceptance).
7) Help Them Form A Plan.
Even if it is very basic, help them develop a plan for becoming healthy and well again and how to face their health challenge. Meet them where they are currently remembering that preparing to take action is a vital readiness for change stage. What do they need to know? Having a plan will give them both hope and a sense of purpose and direction, a map to find their way out of their current situation. It is something to hold on to.
8) Coach For Connectedness.
If the basic survival needs feel met the person can reach out to others and will benefit from a sense of belonging. Family and friends need to be inclusive and not critical. Support from co-workers is also extremely helpful. The fear that is brought up by the onset of serious health problems sometimes frightens others and efforts need to be made to break through this initial resistance. Coach them through their own reluctance to asking for support.
9) Build Self-esteem.
Recognize, acknowledge and reinforce all progress. There is no wrong! Help your patient/client to exhibit greater self-efficacy because as they take charge of their health and their life, their self-esteem grows.
10) Nothing Succeeds Like Success.
Help the health-challenged person to take small steps to prepare for change and then experiment with actions where they are most ready. Build on these easier successes and leave the tougher challenges for later after confidence has been built.
Maslow reminds us that “growth forward customarily takes place in little steps, and each step forward is made possible by the feeling of being safe, of operating out into the unknown from a safe home port, of daring because retreat is possible.” (Toward A Psychology of Being, 1962) . To emerge from that home port, our client needs to be in the process of working through their grief, they need to be moving up the spiraling stages of change, and how better to set sail towards the unknown lands of change than with a good ally?

 

Dr. Michael Arloski

Michael Arloski, Ph.D., PCC, CWP, NBC-HWC

The first version of “Astonishing Noncompliance” was originally published in the Real Balance Global Wellness Services, Inc. Newsletter in 2009. It has also been published by a number of other organizations such as the American Holistic Nurses Association (https://ahha.org/selfhelp-articles/astonishing-non-compliance/)

 

References
Arloski, M. (2014) Wellness Coaching For Lasting Lifestyle Change, 2nd Ed. Duluth, MN: Whole Persons Associates.
Kubler-Ross, Elisabeth. (1997) On Death and Dying. NY, NY. Scribner.
Maslow, Abraham. (1962) Toward a Psychology of Being. Princeton, N.J., VanNostrand.
Prochaska, James, and Janice. (2016) Changing To Thrive. Hazelden Publishing.
Prochaska, J., Norcross, J, & Diclemente, C. (1994) Changing For Good. New York, NY: Harper Collins/Quill. 1994 Harper Collins, 2002 Quill reprint.