How do we allow ourselves to enter the zone of compassion, and what holds us back from going there? How do we keep our “coherent sense of self” that Erik Erikson talked about intact when we connect with the ‘other’? (Allow me to use the term ‘other’ to refer to a person or persons, clients, or otherwise throughout this piece.).
“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.”
The more I consider this subject though, the deeper it is. There is almost a myth in our thinking about compassion that some people buy into – that entering the zone of compassion is not safe. The danger is to feel too much, to connect too completely with the feelings of the other. It is a myth because it does not have to be true.
My Own Compassionate Center
When I am feeling secure in myself, grounded in who I am, more centered in my life, physically and emotionally, I am more able to be compassionate. When I am not, does it feel like I have more to protect? Will connecting with the other appear like a threat to what I have left? So, to access my compassion, to enter that Zone of Compassion, one of the best things I can do is be compassionate with myself and regularly engage in self-care.
One thing that can hold us out of that Zone is the fear that the burden of the other will become too much for me to bear. The Zone of Compassion is joining the other person as an ally, not as a co-owner of the burden that person feels. Compassionate detachment allows us to be there with the other without taking on the burden with them.
Judgment Separates Us
Judgment can be a defense to avoid connecting with the feelings that know compassion. When we judge we instantly separate ourselves from the other person. We put distance between ourselves and them. We may shudder at the thought of being in the other’s predicament, in living a life like theirs, and so we pull back.
In health and wellness coaching it is often easy to spot the self-defeating behaviors that work against our client’s health and wellbeing. We then can quickly move to judge the person’s character, values, etc.
Making a distinction is not the same as making a judgment. We can distinguish between the person and the person’s behavior. We can distinguish between high-risk health behaviors and behaviors that enhance one’s health. The key is what do we do with our awareness in making that distinction. How do we communicate that awareness to the other?
Sharing an Observation
Trust your client to work with what you share with them. When we see someone engaging in some sort of self-defeating behavior, we might simply share what we are observing without judgment. “As you told me about your weekend, I noticed that you mentioned passing up opportunities to connect with others three times?” Such a sentence must be said without a tone that implies judgement. Judgement can slip into our conversation in very sneaky ways! Just share the observation and let your client work with it. If they don’t, refrain from pushing. The time may not be right to explore it. Remember, we are their ally, not their inquisitor.
Empathy as a Conduit of Compassion
Expressing empathic understanding allows the other to feel like they are not alone facing their burden. Empathy conducts connection which allows compassion to be felt.When empathy is transmitted well and received well, it is like there is an infusion of energy into the person receiving empathic understanding. They light up! And often lighten up. Empathy turns on a light that allows a person to often gain a new perspective very different from the one they experienced when they felt all alone in the darkness.
Far too often we reach for the fix-it tool instead of first connecting with the other through empathy. We really want to help, and we try to make things better.
“Because the truth is, rarely, can a response make things better. What makes things better is connection.” Brené Brown
A key to compassion is to imagine it like an image of two people together, standing, or sitting, side by side. If the person expressing compassion projects an image of being above the other, ‘helping’ them, the attempt at compassion will come across like sympathy, not empathy. Compassion is shoulder to shoulder, side by side, heart to heart.
Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness – a world leader in health and wellness coach training (https://realbalance.com/). Doctor Arloski is a pioneering architect of the field of health and wellness coaching. He and his company have trained thousands of coaches around the world.
January 2022! Welcome to a New Year and all of its potential. Ready to put the stresses and the tragedies of 2021 in the rearview mirror it’s a time to set intentions for a better year ahead. Hopefully you had some respite over the winter holidays and are ready to charge ahead in a positive way. Yet, the carryover, perhaps hangover, from that last year is very real for many people including ourselves and the clients we serve.
As we listen compassionately to stories of loss, grief, and challenges of all kinds, we need to find a way to be there for our clients and yet care for ourselves as well. Compassion fatigue is a common experience when we are exposed to too many stories of strife and trouble. How can we refill our own cup when it seems at times like this, others are draining it? I address this issue in Chapter Five of my new book. I offer this to you in my own spirit of compassion.
From Chapter Five – Masterful Health & Wellness Coaching: Deepening Your Craft, by Michael Arloski
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 thoughts and feelings, 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 what seem to be their errant ways, to steer them toward a program that we know works, we don’t. 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 physicians and dentists based on this phenomenon. 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 theirs, not ours.
Compassionate detachment is not about distancing ourselves from our client. It is not about becoming numb mentally, emotionally, or physically. It is not about treating our clients impersonally.
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.
Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Dr. Arloski is a pioneering architect of the field of health and wellness coaching. He and his company have trained thousands of coaches around the world. Dr. Arloski’s newest book is Masterful Health & Wellness Coaching: Deepening Your Craft
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.
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.
“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.
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.
The 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.
What 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
In 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
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 Motivation
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.
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 Strategies
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
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
Effective coach training teaches about the power of relationship, of person-to-person connection, not just because it’s warm and “nice”, but because all the evidence from coaching and psychotherapy says it works! We each need to feel truly heard by others that we are attempting to be in relationship with. When we share our lives, our experiences and our feelings we truly want to have acceptance, acknowledgement, and validation.
If I share that I have been in pain since an injury and it is breaking my heart that I can’t get out and enjoy the physically active things I love to do, I don’t want someone to consult with me about a solution (“Let’s explore what you can do to exercise now.”). I want someone to say “Wow! That must be so terribly difficult for you to be unable to exercise.” I want them to “get it” that I’m not only in pain, but I’m frustrated, angry, stuck, depressed, and feeling loss. I want to HEAR that they “get it”.
Once I feel like my experience is understood at that heart level, that my feelings have been affirmed, and it’s been conveyed that it’s okay for me to feel the way I feel, THEN I’ll be happy to launch into some great strategic thinking about seeking solutions.
When coaches convey what I love to call The Facilitative Conditions of Coaching (see my previous post: http://wp.me/pUi2y-6i) clients feel the validation, acceptance, acknowledgement that we’re talking about. Coaches have to find the words to convey empathy, acknowledgement, unconditional positive regard, warmth and genuiness. But, they have to remember to do that FIRST, before they jump to solution seeking.
Having trained over 4,000 wellness coaches worldwide, I’m continually amazed by two things: 1) we train some of the warmest, kindest, most caring people on the planet, and 2) when learning the new skill of coaching these same wonderful people so often totally forget to express warmth, kindness and caring. They struggle on the hot seat of
demonstrating/practicing coaching, and in their anxiety of new learning, instead plow right into seeking to “fix” the problem presented. No statements of empathy. No expression of understanding what the client is feeling. Instead one question after another seeking to find a solution (So what types of exercise have you already tried since your injury?). And by the way, we have observed no difference here by gender, probably 85% of the coaches we have trained have been female.
Remember to be a coach, not a consultant. Consultation is all about finding solutions. Consultants name their businesses things like “Totally Amazing Solutions, Inc.”. Coaches help people discover/create their OWN solutions, they don’t just provide them for their clients…that’s consulting. The mindset shift from treatment provider, consultant (medical or otherwise), or educator to that of coach takes repetitive practice. It’s so easy to slip back into the “What wrong and how can we fix it?” thinking, instead of staying in the coach’s “What’s possible?” thinking.
Acronyms can help us remember processes. Let’s try this one: FAVE.
FAVE: First acknowledge, validate and empathize.
As our client’s story unfolds tune into it with the mind of compassion, the mind of understanding and the mind of connection. Some of what works is relaxing into the coaching process and realizing that just by being true to our naturally warm and empathic way of being we are providing that “safe container”. We “hold sacred ground” for our clients to do the exploration they need to do. When solution finding is embarked upon without adequate exploration, the path taken is often unproductive at best and counterproductive at worst.
So, FAVE! First of all ACKNOWLEDGE your client’s experience. Paraphrase, restate and reiterate what they have said. Remember to reflect their feelings. Help them feel that it has been recognized that they have been experiencing the emotions they have been living. Acknowledge the courage it takes to share. Acknowledge the self-caring it takes to seek help and assistance. Acknowledge the depth of your client’s challenges, their strengths, etc. So you haven’t been able to run or bike ride for three months now. How tough it must be to go from being so athletic to hardly exercising at all! Tell me more about what that has been like for you.
As you do this you VALIDATE their experience and their emotions. Your unconditional positive regard (and therefore lack of judgment) makes it possible for the client to feel that it is okay for them to feel the way they feel. You are affirming that what they have told you has been their reality. You help the client feel that their story is validated, and as you coach further, with that accepting and yet at times challenging coaching presence, you help them learn that they are NOT their story. As you acknowledge, affirm and validate you help them feel well heard. You help them explore their experience and EXPRESS their feelings about it so they can let go of it, put it in the rear-view mirror, and realize they are not trapped by their story.
Our most powerful vehicles to convey this acceptance and affirmation, this sense of support is the EXPRESSION of empathic understanding. That kind look in the eyes, your thoughts of compassion are very sweet, but they are not enough. We have to put it into words (think telephonic coaching!) and COVEY our empathy. So when you have free time you just have to sit there and wish you were able to move like you used to. How challenging! You must miss being active very much. It sounds like you’ve tried to deal with as best you can, but it’s got to be a real loss for you.
It takes courage on the part of the coach to practice FAVE. You’ve got to be okay with emotion, not afraid of it. Empathy is not trying to cheer the person up, quickly reassuring them that everything will be all right, in essence rescuing them. This conveys a message like “Don’t feel they way you’re feeling. Feel the way I’m more comfortable with you feeling. Cheer up!” FAVE is getting down in the mud, or up riding high in the sky WITH our clients…meeting them where they are at, not where we want them to be. I want MY reality acknowledged, not YOUR fantasy!
Creating “Sacred Space”
The thing to remember is that when we allow our clients to feel the way they feel they usually do so and move through it more fluidly. When they are not able to, even after our repeated attempts at providing our best facilitative conditions, it’s probably time to consider referral to a mental health professional (see my previous post http://wp.me/pUi2y-bA.).
Perhaps some of our “rush to solution” is connected to our fear of dealing more directly with feelings. I’m not going to second guess a coach’s intentions and motivations here. I would just love to see coaches serving their clients in the most effective way possible, and that begins with FAVE.
What are some of your thoughts on the idea of making acknowledgement of our client’s experience a priority? Please leave your comments.
What’s your strategy for the healthiest holidays ever?
The fear of adding those holiday-midwinter pounds often drives people to the bookstore for yet another dieting best-seller. The desire for quick results is understandable and nothing delivers like a low-calorie diet. The infomercials promise miracles and we keep on seeking a solution that we know sounds too good to be true. Of course those same low-calorie diets are impossible to sustain us for the rest of our lives. The pounds usually come back. Our bodies just need more energy.
The truth is, diets don’t work. What does? Sustainable lifestyle improvement. Sorry, we can’t promise that this approach will be fast, but it will work, and it will last.
“Let’s face facts. We’ve lost the war on obesity. Fighting fat hasn’t made the fat go away. And being thinner, even if we knew how to successfully accomplish it, will not necessarily make us healthier or happier.” These words introduce you to the website http://www.haescommunity.org for an organization and an entire movement known as “Health At Every (or Any) Size”. Linda Bacon, a nutritionist at the University of California, Davis, says this new approach came about “to halt “the collateral damage” — food and body preoccupation, self-hatred and eating disorders — that has resulted from the failed war on obesity. H.A.E.S. is based on the idea that “the best way to improve health is to honor your body,” and it supports the adoption of good health habits simply for the sake of health and well-being rather than weight control. (http://6thfloor.blogs.nytimes.com/2011/03/09/health-at-every-size/)
Teaming up with Lucy Aphramor, a National Health Service specialist dietitian of Coventry University in England, they reviewed over 200 studies on weight loss and concluded that the evidence just isn’t there that dieting helps us attain and maintain healthy weights or healthy lives.
Perhaps our notion of our own “healthy weight” needs a total makeover. Instead of focusing only on what the scales tell us, how about looking at our overall wellbeing? “Bacon and Aphramor insist that adjusting lifestyle habits with an eye toward improving markers of well-being like reduced blood pressure, lower cholesterol levels, reduced stress, increased energy and improved self-esteem — independent of any weight loss at all — is a far more desirable goal for people of all sizes to pursue.”
Pursuing being as healthy and vibrant as possible with physical vigor and mental and emotional peace of mind may be what trumps every diet out there. Weight obsession needs to be replaced with both individual awareness of what truly nourishes us on many levels, and the science that focuses on real wellness.
The Coach Approach
When a wellness coaching client tells me “I want to lose 30 lbs.” The first questions I ask are “What will your life be like when you succeed at losing that weight? What will your life look like? What will you be doing and enjoying that you’re not doing now?”
Far too often clients get into self-defeating thinking by seeing the “goal” as the number on the scales, and its easy for coaches to simply fall in line with this simple goal-setting approach. Until the magic number is attained it’s too easy for the client to minimize their weight loss accomplishments with a “Yes, but…” attitude. I will only be successful when I lose all the weight I’m trying to lose. Internal barriers to change are every bit as powerful as external. It’s time to explore better outcome indicators.
Explore with your client the best markers of improved health and well-being would look like for them. Would tracking improvements in the markers Bacon and Aphramor referred to above be smarter? Get an agreement from your client about what they would like to see improve and tie it to their motivation to be well. Help your client notice the richly motivating unforeseen benefits that show up as they make progress. Celebrate improvements such as reduced pain in the knees, better sleep, more energy, etc.
When someone who has struggled to live at a weight that is healthy for them is told that weight loss is simply “calories in and calories out” it is insulting and dismissive of them as a person. We human beings are wonderfully complex and our life journeys are fascinating. Embrace your whole-client, just as you urge them to embrace themselves.
Dr. Michael Arloski is a psychologist, certified wellness coach and a certified wellness practitioner who is the founder and Dean of The Wellness Coach Training Institute where the very best in Wellness & Health Coach Certification Training can be found. http://www.realbalance.com
It’s lonely at the top, especially when you are the whole mountain!
Profitable corporations have embraced wellness programs as a way to effectively hold down healthcare costs, boost productivity, creativity and reduce absenteeism and turnover rates. If you are one of the more than sixteen million self-employed people out there, what’s your wellness program look like? When you are self-employed and you become really ill, it’s like Hewlett Packard locking the gate and turning off the lights…you’re out of business! Making conscious investment in your company’s biggest asset, you and your health, is critical.
About one out of every nine people in the American workforce is self-employed and 90% actually chose to become so. Corporate-culture refugees are often happier on their own, but this new territory comes with it’s own particular stresses and challenges. Nobody tells you to stop working for the day. There is no schedule other than the one you make yourself. Couples who have their own business together must become communication experts with each other. There is tremendous freedom and potentially tremendous pressure.
There is certainly an upside though…many of them in fact. When you see that the temperature at noon will be in the nineties, you can get your walk or run in at 9:00 am and work through your noon hour. You may commute just across the hallway. There is no pay-scale, and no glass ceiling.
The big challenge is work-life balance. How does the self-employed person achieve a wellness lifestyle and one that is both personally and financially rewarding? How do we really apply the old adage “work smarter, not harder”?
Let’s look at the Top Ten Wellness Strategies for The Self-Employed.
1. Identity. Realize that you are not your work. Your business is something you own, not vise-versa. The key is to “have a life” and to, in fact, nurture a well-rounded, full and meaningful life. Meaning and purpose in both work and life ensure motivation to be well and to be successful. When your work is in alignment with your values and beliefs conflict and stress are minimized and energy emerges to get the job done. 2. Boundaries and flexibility. The old joke that being self-employed is only half-time work…you can work whatever 12 hrs./day you want to work, is much too real. It’s a double-edged sword you want to take conscious command of and have it cut for you instead of against you. Track your work hours by writing them down if need be. Set alarms. Give yourself days off. When things pop into your head, jot them down for discussion later and then return to being back in the present moment. Make agreements with partners to create some hours each day and some times each week when business is not discussed. 3. Confidence. Overcome the fears that drive you to over-work by building your confidence and belief in your ability to be successful. You do not have to be available 24/7 to be productive. Know that your skills, abilities, and investments in your work can allow you to take time off and still thrive.
“I have so much to accomplish today that I just meditate for two hours instead of one.” M.K. Gandhi
4. Self-care/Self-permission.Give yourself permission to take fantastic care of yourself. Confront outdated and fearful personal beliefs about putting yourself last on your list. It may feel strange, but practice what feels like “extreme self-care” and it will probably be about right! 5. Investment. Invest in your own wellness. Get all of your medical check-ups on time. Invest in your own physical health with regular exercise and high quality fuel (food). Invest in your own mental health by expressing your creativity and having fun with others.
7. Organization.Your to-do list won’t magically go away while you’re doing all of this wellness stuff! Your work has to be efficient, not just excessive effort. Educate yourself about what organizational systems will work for you like GTD (Getting Things Done) (http://en.wikipedia.org/wiki/Getting_Things_Done) or ZTD (Zen To Done) (http://zenhabits.net/zen-to-done-ztd-the-ultimate-simple-productivity-system/) . Experiment with HOW you work, not just working harder to find out what really catalyzes your productivity. Delegate. Repeat, delegate! Hire an IT person (even just one time) to help your technology work for you instead of bogging you down. Use the famous Urgency/Importance Matrix (easily found online) to prioritize and streamline tasks while eliminating what really doesn’t matter.
8. Self-compassion. Be kind, patient and self-forgiving. “Rome wasn’t built in a day.” May sound cliché, but it’s true. Keep lifting your head from where your nose is on the grindstone and see the bigger picture of your progress and that of your business. (http://well.blogs.nytimes.com/2011/02/28/go-easy-on-yourself-a-new-wave-of-research-urges/) 9. Connection.Self-employment can be very isolating and this can boost self-doubt, depression and pessimism. Get out and connect with other professionals at organization meetings. Do some work at coffee shops and go ahead and talk with people! 10. Get a Coach. It’s lonely at the top, especially when you are the whole mountain! Invest in an ally who specializes in helping entrepreneurs and folks like you. A business/life coach may give you the support and accountability you need to create a plan for success and effectively pursue it. A wellness coach may help you find the life/work balance you are looking for, help prevent burnout, and help you find a totally sustainable way of living and working that maximizes your health and well being, allowing you to actualize more of your wonderful potential.
What’s your experience either being a self-employed person seeking wellness, or a coach who has helped people in this way? Please leave a comment here on the blog. Thanks!
Self-awareness may be the best antidote to collusion.
Whenever I’m training wellness coaches and use the term “collusion” a definition is required. The term can have a variety of meanings and a search done on “coaching and collusion” will yield an array of articles that seem to add to the confusion. While murder mysteries love to portray collusion as two of the bad guys conspiring to evil ends, the collusion we’re talking about in coaching is more subconscious, more unintended, than conscious or deliberate.
Collusion occurs when a coach somehow merges with their client’s view of themselves and the world instead of helping their client explore it. Let’s examine what appearance collusion takes on, what results from it, what can be motivating it in the coach, and most importantly, how to avoid it.
Appearance: What Collusion Looks Like
While coaching is a client-centered process the colluding coach may allow the client to meander rather than explore. The client’s wanderings may not be productive or hold much focus, but the coach gives them totally free reign and never challenges or helps with focus. The coach is going far beyond a client-centered approach. This lack of challenging may be on more specific issues. There is a reluctance to give honest feedback, a lack of what we call in coaching “truth telling”.
There may be a “softening of accountability” regarding coaching commitments. “Oh, that’s okay. I know it’s hard to keep track of all of this.” At it’s worst, the colluding coach’s unique perspective meshes with the client’s and a valuable coaching tool is lost. The client no longer benefits from the point of view of someone other than themselves. The coach buys the client’s story about themselves and fails to help the client discover how they no longer need to be a prisoner of that story. Coaching is no longer about possibility thinking.
Live out of your imagination, not your history.
Stephen Covey
Results Of Collusion
When a coach colludes with their client the biggest result is a lack of progress by that client. They are stuck and the coach’s interaction with them is aiding the stuckness instead of spurring “forward momentum”. The coach and client go round and round in a combination of story telling, commiserating and endless attempts to “fix the problem”.
The hopeful and growing part of that client, who would have appreciated being challenged more, gets discouraged and usually drops out of coaching. In wellness coaching, the lifestyle behavior doesn’t change and the health consequences mount.
Collusion happens outside the coach’s awareness. Often it is motivated by a desire to “protect” the client. There is a confusion between empathy and sympathy. The coach feels sorry for the client and their plight and may extend great caring and kindness, but also wants to shelter their client from how tough life can be. A client capable of so much more, but doubting themselves, proposes taking an action step that is far below their capacity and the coach accepts it without question or challenge. A client begins to become emotional talking about their body image and the coach “rescues” them by talking about how most people their age and sex have issues with body image. The client is whisked away from processing their feelings and encouraged to get intellectual about the subject of their emotion.
“We collude with a client’s illness, not their wellness.”
Michael Arloski
Be empathic, but don't "rescue".
Collusion can also occur when the coach over-identifies with their client and their experience. This is the classic error in the human-helping professions of failing to get your self out of the way! The middle-aged male coach with the mid-riff bulge is quick to discount the importance of their client’s desire to loose their belly fat. The single-mom coach is quick to agree with their client that their parenting stresses make self-care almost impossible. The coach may become quite tolerant of their client’s resistance to change because they resist similar changes in their own life.
Even more serious collusion may occur when the coach shares a wound similar to their client and it has become a “blindspot”. The coach may have not done their own emotional healing work in this area and blindly colludes with any client who has experienced something similar to them.
How To Avoid Collusion
Like the definition of self-deception, sometimes we don’t know what we don’t know! In our Wellness Mapping 360°™ Wellness Coaching Methodology (www.realbalance.com) , “Ongoing Evaluation” is a key component. We encourage the coach to work with their client to be evaluating how coaching is going throughout the course of coaching, not just at the end. Have coaching conversations with your client about the coaching’s effectiveness as well as the client’s progress. Get and give feedback.
Here are some quick tips for how to increase coaching awareness and avoid collusion.
1. Listen to your gut. If it doesn’t “feel” right it probably isn’t.
2. Supervision. Engage it this at least occasionally.
3. Work on your own stuff! Gather your courage and face your own demons through counseling or whatever works for you.
4. Self-examination. Listen to recordings of your sessions.
5. Look carefully at client progress/stuckness.
6. Stick to the coaching process. Stay professional, remain a coach.
7. Be aware of clear professional boundaries.
8. Don’t be afraid to challenge your client. Examine your own reluctance to do this.
9. Be very clear about the distinction between sympathy and empathy.
10. Look for patterns in your coaching process with this particular client. Collusive behavior repeats.
11. Have clear agreements, not expectations. Your client is not here to live up to your expectations.
12. Be real. Be authentic, genuine, true to yourself.
Please feel free to comment and add your thoughts to this very important topic.
Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness – a world leader in health and wellness coach training (https://realbalance.com/). Doctor Arloski is a pioneering architect of the field of health and wellness coaching. He and his company have trained thousands of coaches around the world.
Key Number Three: Understand the Rejection Dimension of Illness Identification
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.
“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
4) Be Their Ally.
The 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.
What we are up against when it comes to lasting change.
In 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.
The truth is, diets don’t work. What does? Sustainable lifestyle improvement. Sorry, we can’t promise that this approach will be fast, but it will work, and it will last.
When someone who has struggled to live at a weight that is healthy for them is told that weight loss is simply “calories in and calories out” it is insulting and dismissive of them as a person. We human beings are wonderfully complex and our life journeys are fascinating. Embrace your whole-client, just as you urge them to embrace themselves.
Advancing The Craft Of Health & Wellness Coaching 