Healthy Boundaries For Health & Wellness Coaches: Part Two

Boundaries Are There For A Reason

Boundaries Are There For A Reason

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

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

Pushing The Edge

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

boundariessoccerflagClient-Generated Boundary Crossings

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

 

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

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

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

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

boundariescalmCoach-Generated Boundary Crossings

 

  • Going Beyond Competency – Beyond Scope of Practice

 

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

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

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

 

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

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

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

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

  • Social Media Boundaries

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

robo-coaching

Organization-Generated Boundary Crossings

 

  • Violating Client’s Right To Confidentiality

 

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

  • Requiring Internal Coaches To Push Sales

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

  • Requiring Internal Coaches To See Too Many Clients

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

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

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

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Healthy Self-Generated Boundaries

  • Knowing And Abiding By Your Own Limits & Boundaries

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

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

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

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Good Fences Make Good Neighbors

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

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

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

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

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

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

masks

Self-Disclosure And Boundaries

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

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

Just how much directives does our client need?

Just how much directiveness does our client need?

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

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

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

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

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

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

Examples – Ronaldo and Hazel

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

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

mappointingdirection“Just tell me what to do!”

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

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

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

Staying True To The Coaching Mindset

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

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

 

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

Just How Directive Do We Need To Be?

Just How Directive Do We Need To Be?

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

Carl Rogers 1902-1987

Carl Rogers 1902-1987

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

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

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

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

The Coach Approach Grew Out Of Being Client-Centered

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

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

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

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

Here’s what effective directive coaching sounds like:

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

continuumdThe Directive-Non-Directive Continuum

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

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

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

Overly Non-Directive Coaching

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

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

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

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

Overly Directive Coaching

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

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

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

The Coaching Spectrum

The Coaching Spectrum

How To Keep Directive Coaching Client-Centered

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

Adjusting To The Client

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

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The Health And Wellness Coach’s Value Proposition

Vp - overall image

Every potential coaching client is looking to have the question ‘What’s in it for me?’ answered. Every coach needs to be able to succinctly answer that question by conveying what they will provide for their client.

Potential coaching clients are rarely familiar with what a coach, especially a health & wellness coach, can do for them. They are used to dealing with educators and consultants, medical and otherwise, not coaches. Usually clients expect to be directed, educated, and led in the best direction for them. All too often they hear a wellness coach tell them something like:

persuade“I’m not going to tell you what to do. I’m not going to tell you what to eat or how to exercise. You’re the one in charge. You’re the one behind the steering wheel. You’ll be making your own wellness plan, and I’ll help you follow it.”

Why should this person become your client when it appears that they,
themselves, are going to be doing all the work?
Our client-centered approach to coaching does not mean we are not providing value, however we have to communicate the value of what we offer, and do it very clearly. What will the client gain from coaching?

This is true for the self-employed coach as well as the coach working for a wellness program, a disease management company, an insurance carrier, or any other organization that provides wellness and health coaching. It is about engagement. When coaches are confronted with the “incentivized” client, who is reluctantly complying with coaching in order to get their prize (or much-needed insurance discount), conveying the Health And Wellness Coach’s Value Proposition is more vital than ever.

Here is my way of presenting The Health And Wellness Coach’s Value Proposition. Please adapt to your own words and use it!

value-proposition

The Health And Wellness Coach’s Value Proposition*

Thank you for your interest in improving your lifestyle and your life. You may be new to coaching, and especially wellness coaching, so let me share with you the value that it brings.

Wellness/health coaching is all about you living the best life possible for you. To do that most people find there needs to be some improvements in their way of living, their lifestyle. Making those improvements, those changes is challenging when you have to do it all by yourself. Perhaps you’ve already had some experience with that.

When I work with someone in coaching I’m here to serve you. You are the one in charge of your life and our work together. It’s your hands on the steering wheel. I’m not going to tell you what to do and give you a pre-maid wellness plan. But, together we can co-create a plan to help you succeed at making the lifestyle improvements that you want to make.

As your coach I will be working with you to get very clear about where you are at with your health and well being right now. We’ll help you take stock of that by exploring together, using some coaching tools that will help give you a more complete picture, and by going over the lifestyle improvement recommendations you’ve gotten from treatment professionals. Then we’ll work together to help you form a clear picture of the kind of life you want to live, your healthiest life possible for you. We’ll compare where you’re at and where you want to be and together form a solid plan to help you get there.

Once we have that plan we’ll work together as allies to help you be accountable to yourself and follow through on the steps you need to be taking on a regular basis to help you achieve the goals you have in your plan. I’ll be with you throughout the journey. I’ll be there to help you strategize over, under, around and through the barriers that come up. I’ll help you with challenges that make it tough for you to live the healthy life you want and together we’ll help you keep on track. Together we’ll help you find and develop the sources of support that will make your changes last. We’ll evaluate our progress and adjust the course along the way as we need to. My goal is to assist you in becoming self-sufficient in your wellness, to be able to live a healthy life in a completely sustainable way.

I bring the value of a professional that knows about succeeding at lifestyle improvement. I bring the value of an ally.”

*(Created by Michael Arloski, Ph.D., PCC, CWP) Please adapt to your own words and use it!  If used intact you must include authorship credit and contact information (web address for Real Balance Global Wellness Services, Inc. https://www.realbalance.com)

Medium5

In two previous blog posts I shared some ideas about Market Development for the self-employed wellness coach. Please check them out for additional resources. The Self-employed Wellness Coach and Market Development – Part One: Closed Doors, Open Doors http://wp.me/pUi2y-9L The Self-employed Wellness Coach and Market Development – Part Two: Being So Much More. http://wp.me/pUi2y-bc

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“Coaching for a Lifetime of Wellness: Five Keys to Sustainable Behavioral Change”

2nd Ed Cover - MedThe theme of the 41st Annual National Wellness Conference was “Spotlight On Sustainability”. While we often think about sustainability and our environmental practices, as a wellness coach and psychologist I immediately thought of sustainable behavioral change. As I prepared for my presentation on this topic my research revealed that we actually know very little about how effective our efforts at helping people improve their lifestyles actually are.

Maintaining success at lifestyle change is often daunting. Most wellness coaching clients have a history of initiating efforts at losing weight, stopping smoking, managing stress, etc. For many, however, there is a trail of failures at maintaining those new ways of living in the long run. The result is a lowering of self-efficacy and lingering feelings of discouragement. As I explored in a previous blog post “Lessons From Albert Bandura For Wellness Coaches” (http://wp.me/pUi2y-dB) there is much for coaches to learn about self-efficacy.

 When we go to trusted sources looking for help with making healthier behavior last, what do we find? Unfortunately, not much. From Harvard Medical School’s online publication Healthbeat I found “The Trick To Real And Lasting Lifestyle Changes”. (http://www.health.harvard.edu/healthbeat/the-trick-to-real-and-lasting-lifestyle-changes) Though this title sounds like the exact resource to look for, all it advised was a simplistic review of SMART Goals.

Turning to the APA Psychology Help Center we find “The key to making lasting lifestyle and behavioral changes: Is it will or skill?” (http://www.apa.org/helpcenter/lifestyle-behavior.aspx) This disappointing short article could only offer this: “Lasting lifestyle and behavior changes don’t happen overnight. Willpower is a learned skill, not an inherent trait. We all have the capacity to develop skills to make changes last,” said Katherine C. Nordal, PhD, executive director for professional practice at APA. “It is important to break down seemingly unattainable goals into manageable portions.” The article mostly talked about how ineffective we are at making any changes in our behavior and did not even address making changes last!

As I deepened my research quest I found that other behavioral scientists had been concerned enough about this issue to establish an impressive research consortium to tackle it. The result was a publication in The American Journal of Health Behavior (2010 Nov-Dec; 34(6): 647–659) entitled The Science of Sustaining Health Behavior Change: The Health Maintenance Consortium. The authors (Marcia G. Ory, PhD, MPH,1 Matthew Lee Smith, PhD, MPH, CHES, CPP,2 Nelda Mier, PhD,3 and Meghan M. Wernicke, MPH4) did a thorough research synthesis of articles spanning 2004-2009, amassed resources and funded twenty-one projects to look at this issue of lasting change in health behavior. Here is what they concluded.

elderly_hikingWhat we are up against when it comes to lasting change.

• How long can positive gains be sustained without additional long-term support?
• In most cases this is unknown because studies only track maintenance for a year or two after the post-intervention phase.
• In the majority of cases, intervention effects on lifestyle behaviors are often strongest in the one or two years closest to active intervention.
• Without additional support, positive effects tend to diminish over time, or treatment differences vanish.

What they found was frankly, not a lot.

• It’s not realistic to expect long-term maintenance based on initial interventions. (Single-variable research)
• Moderate-intensity behavioral interventions may need to be coupled with more environmental changes to sustain long-term effects.
• In other words people need the support of healthier communities and workplaces, peer groups, etc.
• Incorporation of physical activity into the self concept emerged as the strongest predictor, with self-efficacy having a major indirect influence confirming it as an important predictor for both behavioral initiation and maintenance

LongWindingRdIn summary:  The authors conclude that no single mediator makes a large impact; rather, there is a “long and winding road” with maintenance achieved through a multitude of modest interrelated meditational pathways from behavioral initiation to maintenance.

There are many reasons for our scarcity of knowledge. One is that much research of this nature is done by universities where graduate students need short-term projects that allow them to finish up and…graduate! We may learn more from larger sociological and epidemiological studies such as The Framingham Study (https://www.framinghamheartstudy.org) , the work of The Blue Zones, (https://www.bluezones.com) etc. However, here we are not isolating variables. We can’t really say if it was the plant-based diet, the supportive extended family, or the red wine that made the healthy difference. It seems we have to be satisfied with the shotgun approach and put our best bets on culture and environment.

What can we conclude about making positive changes in health and wellness behavior last?

• Changes must be sustainable over a lifetime
• Intrinsic motivation trumps extrinsic every time
• Most research looks at single interventions and doesn’t track more than one or two years
• Long-term studies show that a combination of environmental support and “internal” shifts sustain lifestyle improvement better. Culture, environment, attitude and beliefs!
• We must ask how can coaching support shifts towards “well” attitudes and beliefs?

Healthy Choices For A Lifetime

Healthy Choices For A Lifetime

The Five Keys of Coaching For A Lifetime of Wellness

• 1. Build Self-Efficacy
• 2. Nurture Visionary & Intrinsic Motivation
• 3. Focus On The Maintenance Stage (TTM)
• 4. Co-create Relapse Prevention Strategies
• 5. Coach For Connectedness

1. Build Self-Efficacy

Bandura’s Social Cognitive Theory (formerly AKA Social Learning Theory) shows tremendous congruity between it and the foundational principles of coaching. Bandura deeply explored the concept of Self-Efficacy which is foundational to wellness coaching. (Again see the previous blog post “Lessons From Albert Bandura For Wellness Coaches” (http://wp.me/pUi2y-dB)

2. Nurture Visionary & Intrinsic Motivationgreen nature_wood path

Much of our coaching work is around helping people to envision the outcome they want. When we have a clear picture of both where we are (our current state of wellness) and where we want to be (our Well Life Vision) we can “coach to the gap” between the two and coach around what needs to change to attain that Well Life Vision. Such a positive psychology approach is foundational to coaching and motivates better than just fear and illness avoidance.

We know that when clients experience intrinsic joy in activities they will be more motivated to engage in them. Look at the work of Jay Kimiecik, The Intrinsic Exerciser: Discovering the Joy of Exercise: ( https://www.amazon.com/Intrinsic-Exerciser-Discovering-Joy-Exercise/dp/061812490X) and Daniel Pink’s book Drive: The Surprising Truth About What Motivates Us (https://www.amazon.com/Drive-Surprising-Truth-About-Motivates-ebook/dp/B004P1JDJO/ref=sr_1_1?s=books&ie=UTF8&qid=1467763122&sr=1-1&keywords=Daniel+Pink+drive#nav-subnav).

To COACH for intrinsic motivation:
* Notice! – Help your clients to focus on the enjoyment, the pleasure that they perceive as they are performing the behavior.
* Inquire! – Ask about the details of their experience. When a client reports about taking a walk, hike or bike ride outdoors ask about what they saw, what they experienced, what they felt.
* Inquire about Bonus Benefits. Clients sometimes fixate on their goal of weight loss for example, but what else is happening during their efforts? Are they experiencing more energy? Better sleep? More mental concentration?
* Avoid incentivizing. Incentives tend to decrease intrinsic motivation.
* Take a Kai Zen Approach. (https://www.amazon.com/Small-Step-Change-Your-Life-ebook/dp/B00GU2RHCG/ref=sr_1_1?s=books&ie=UTF8&qid=1467763620&sr=1-1&keywords=robert+maurer#nav-subnav) Coach with your client to set up action steps that are so small that they are very doable and allow continuously successful progress towards their goals.

3. Focus On The Maintenance Stage (TTM)

Of all of the Stages of Change that Prochaska talks about in his Transtheoretical Model of Change (https://www.amazon.com/Changing-Good-Revolutionary-Overcoming-Positively-ebook/dp/B003GYEH2Y/ref=sr_1_1?s=books&ie=UTF8&qid=1467763816&sr=1-1&keywords=prochaska+changing+for+good#nav-subnav), coaching around the Maintenance Stage may be the most vital. Here the coach again takes a positive psychology approach and acknowledges and reinforces what is working. As the old saying from coaching goes “Nothing succeeds like success!” A key in this stage is for the client to see the value in Tracking Behavior and to do it regularly. Avoiding self-deception is key. Use whatever works for keeping track of new healthier behaviors: calendars, charts, apps, activity monitoring devices, etc. Then the Accountability that coaching provides makes the process conscious, deliberate and increases consistency. Lastly, coaches really prove their worth here as they coach their clients through the barriers and the “push-back” that sometimes is received by those who clients were hoping would provide support.

4. Co-create Relapse Prevention Strategies1369010631_url

Relapse happens! Count on it! James Prochaska is fond of back-up plans. We all know that life throws us curve-balls all the time. Our best-laid plans run up against life realities. This is where coaching can get creative! Coach clients to come up with their own back-up plans for then things don’t go as they would like, or when temptation increases. Going to a potluck dinner where the dietary direction of friends tends to be sabotaging of your wellness efforts? Be sure to bring an entrée to share that will satisfy your own needs. Not enough time to do your hour-long exercise routine? Having a quick and simple set of exercises you can do anywhere fills in “better than nothing” and maintains engagement in your program.

Pivotal to this key is self-compassion. There is a real difference between excuse-making and true compassionate understanding. Coach your client to be less self-critical and more forgiving. Help them keep a healthy perspective on their wellness plan.

5. Coach For Connectedness

Real Balance Faculty At The National Wellness Conference

Real Balance Faculty At The National Wellness Conference

In our Real Balance Wellness & Health Coach training (https://www.realbalance.com) we emphasize coaching for connectedness from day one. The amount of time any client spends in coaching is a brief moment compared to the lifetime they have to live in a new way. In addition to the support of the coach, other sources of support must be encouraged, discovered or consciously developed. For each step of action we ask “Who or what else can support you in this?” If our client has little support then making the development of such support a deliberate area of focus to work on in coaching is vital. This is where the role of culture, community, workplace, peer groups, family, friends, and relationships becomes a part of coaching that cements lasting lifestyle change.

Living a wellness lifestyle is a lifetime job! Providing the kind of coaching that goes beyond simplistic goal-setting and allows our clients to transform who they are can build the foundation for a lifetime of wellness.

A PDF of the PowerPoint from my presentation on this topic at The National Wellness Conference and a complete bibliography are available for download at: http://www.nationalwellness.org/page/2016NWCHando

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If It Only Was That Simple: The Illusion Of Explanatory Depth

answersWhen faced with overwhelming, frightening and ultimately complex problems we tend to search for simplistic answers. Perhaps this is an adaptive attempt originating in the deep part of our brain known as the amygdala, where fear triggers our survival instincts (and our flight/fight/freeze response). In our ancestral days near our cave, taking action to freeze, run or fight like hell often served us well. Today, however we are faced with other stimuli that, despite our rationalizations and euphemisms to the contrary, actually do scare us just as much, but in a different way. No longer fleeing Saber-toothed Tigers, today, instead we face frightening foes like global climate change, racism, war and peace, extremist politics and chronic disease.

To combat these foes, we again seek the fastest, and therefore simplest responses that attempt to be solutions. Overly simplistic thinking causes us to latch on to attractive answers that seem to bring us some semblance of relief from the anxiety of overwhelm and the fear of the unknown. We generalize, minimize and seek solace in some quoted study that showed that ten people did one thing, one time, and now are healthy and safe for life. Eat low fat. Eat high fat. Don’t exercise…just drink wine! Chocolate could be one of your basic food groups!

“Psychological scientists have a name for this easy, automatic, simplistic thinking: the illusion of explanatory depth. We strongly believe that we understand complex matters, when in fact we are clueless, and these false and extreme beliefs shape our preferences, judgments and actions—including our votes.” (http://www.psychologicalscience.org/index.php/news/full-frontal-psychology/extremist-politics-debating-the-nuts-bolts.html)

Just diet & exercise...not so simple.

Just diet & exercise…not so simple.

In healthcare and wellness we take something as supremely complex as weight management and leave our critical thinking hats off as we search for some magical Thor’s Hammer that will strike down obesity, diabetes and heart disease with one swift (and don’t forget easy) blow. If it only was that simple!

As a University Counseling Center Psychologist I worked with a great number of victims of rape and abuse. I observed how victims would astonishingly blame themselves and go through a time of attempting to feel safer by saying “If only I hadn’t been in that place at that time”, or “If only I had been doing this instead of that”. The health and wellness equivalent may be when we seek out lifestyle practices that we hope will insulate us from disease and misfortune. I’m not talking about basic health-risk reduction here, but rather the way people grab on to simple all-or-none thinking about diet, exercise, stress management practices, etc. We think that kale, mindfulness, Yoga, coconut oil, or a new Fitbit will be our single-track savior. We want the comfort of the “illusion of explanatory depth”.

Everyday, when we look harder at the research, and that means going back to what we learned in Psychology or Sociology 101 about basic research, we can sift through all of the contradictory data and at least conclude that there is nothing simple about wellness, health and especially challenges like healthy weight management. In this internet-based age we are continually bombarded with headlines sprung from single studies with incredibly small “n’s”. Changing what we eat based on the success of seventeen people who dined while standing on one leg how we are urged to take action by headline-grabbing authors.

We all know how hard it is to get rid of cockroaches once they infest a place. Research publicity sometimes creates myths that persist just as tenaciously. In a brilliant recent blog (https://www.linkedin.com/pulse/beware-cockroach-effect-faulty-data-die-jon-robison?trk=hp-feed-artic) Jon Robison gives us more evidence about not trusting sketchy “evidence”.s-l300

The Cockroach Effect is certainly not limited to weight-related research. Dr. John Ioannidis has spent his career exposing the personal biases, economic pressures and downright bad science that plague medical research. In a seminal paper in PLoS Medicine in 2005 with the intriguing title, “Why Most Published Research Findings Are False,” he presented a model which predicted correctly that 80% of non-randomized studies, 25% of randomized trials and 10% of large randomized trials were refuted by later research. While we expect contradictions as part of science, Ioannidis also found that even when faulty research was debunked, its conclusions typically persisted for years or even decades. The details of his fascinating findings are explored in an article entitled “Lies, Damned Lies and Medical Science” which appeared in the Atlantic Magazine in November 2010.”

As tempting as it is to look for quick relief in simplistic answers, we must take a deep breath and know that health and wellness is a marathon, not a sprint. The progress may be found in a combination of studying both how we change, and how we maintain change.

This June at The National Wellness Conference (http://www.nationalwellness.org/?page=NWC2016) one of the breakout sessions I will be presenting is Coaching for a Lifetime of Wellness: Integrating the Keys to Sustainable Behavioral Change. We’ll look at how to shift our thinking from short-term outcomes to the only kind of study that really counts – the longitudinal study of one’s lifetime. There is a lot to explore about how to help people make lifestyle improvements that will have to last for the entire rest of their lives. The problems we face are multi-causal. The answers we seek need to be holistic and thorough. As many of you have heard me say “I did not write a book entitled “Wellness Coaching For Temporary Lifestyle Change.” See you in St. Paul, Minnesota this June!

Be well! Coach MichaelM-ConamaraDiamond1

 

 

The first rule of sustainability is to align with natural forces, or at least not try to defy them. Paul Hawken

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