Keys to Coaching Clients Who Overidentify With Their Illness



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

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

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

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

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

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

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

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

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

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

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

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

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

Key Number Three: Understand the Rejection Dimension of Illness Identification

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

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

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

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

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

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

Key Number Five: Partner with the possibility of transformation

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


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

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

REFERENCES:

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

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

 

Wellness in a Time of Crisis: Serving Others/Caring for Ourselves

 

Maintaining strong immune systems and helping people to manage their current illnesses is part of the vital work that health & wellness coaches are doing every day. COVID-19 is causing much higher mortality rates among people with chronic health challenges – the very population that health & wellness coaches and wellness professionals serve. The world needs the work you do now more than ever.

There are two issues at play during this pandemic crisis: how can we best serve our clients/members, etc.; and how can we remain healthy and well enough to be of service and maintain our own wellness?

Serving Your Clients/Members/Patients

As wellness professionals face the new realities and restrictions of the pandemic and our responses to it unique challenges confront us.

  • Remaining in contact with your clients/members/patients while both you and they are working remotely.
  • Adjusting to remote contact when you’ve always worked in-person with those you serve.
  • Helping people who work on the frontlines of the medical world’s response to the pandemic.
  • Dealing with clients, members, or patients who are reporting more stress, depression and anxiety.
  • Helping people who feel frightened and helpless in the face of this crisis.
  • Helping people get the services they need, including your own, when those services are overwhelmed.

At the end of this piece I’ve listed some great resources to help with some of these challenges.

What Do You Need Now?

Many of us who are in the human-helping business tend to step up and be there for others with little hesitation.  The other side of this is our own tendency to not attend enough to our own needs during this time. What kinds of demands are you facing in your workplace?  Some wellness and coaching services are under greater demand and stress. Independent coaches, fitness trainers, etc., may be facing a reduced number of clients. What are you up against?

What are you doing for your own wellness and self-care now?
As each of us reach out to our clients and others to be an ally we also need to nourish ourselves.  In time of crisis, when it seems that we don’t have time for our own care, it is actually time for extreme self-care.  Stress has a terrible toll on the immune system and that is exactly what we all need to work on maintaining right now.

We are also not invulnerable to the same fears, anxieties and stresses that our clients and members are facing.  Perhaps you are working at home trying to juggle your work obligations with having a house full of family members trapped by social distancing guidelines.

Secondary Trauma

Be compassionate with yourself.  As you work with others during this crisis the emotional toll it takes upon you may be not just exhausting, it may be traumatic.  Secondary traumatization takes place when we are exposed to the trauma that others are going through.  It can have many of the same symptoms and effects upon us as direct exposure to trauma.  Here is an excellent resource for learning more about this. Emergency Responders: Tips for taking care of yourself.  (https://emergency.cdc.gov/coping/responders.asp)

Seeking Connection

People that go through any kind of wellness training always develop a wonderful appreciation for their fellow classmates.  We see this when we all attend professional conferences and feel the support of like-minded colleagues.  Attempts to keep in touch are usually hard to maintain as everyone returns to their busy lives.  Now, with the cancelation of live conferences and such, we are left without that usual opportunity for rejuvenation and support.  You may be feeling alone, but you are not.

We know that the way through crisis, the way to build resilience is through CONNECTION, through reaching out and support.  As you saw in my previous blog post, (Social Distancing – Not Social Isolation: Coaching for Connectedness in the age of COVID-19 https://wp.me/pUi2y-p5 ) social distancing is not the same as social isolation.  Reach out to friends, but also reach out to your wellness colleagues.  They are going through many of the same experiences as you and can be primary sources of support.

Let me invite you to connect in many ways. One way is to GET A SUPPORTIVE CONVERSATION GOING by engaging in conversation about your concerns, fears, hopes and stresses that you are experiencing right now with COVID-19 happening worldwide. 

Connect on Facebook with the REAL BALANCE STUDENTS, ALUMNI & FRIENDS GROUP – https://www.facebook.com/groups/1581133502099770/  This group is open to all wellness-related professionals.

Connect on Linkedin with the Real Balance Wellness Coach Training Institute Group:https://www.linkedin.com/groups/3808651/   This group is also open to all wellness-related professionals.

Let’s make these forums one place where we can do that. Please contribute to these conversations. Building COMMUNITY takes participation.

Another opportunity will be April 24th. Our April Free Monthly Webinar will be: Wellness Coaching in the Time of Covid 19: Self-care and Helping Others with very special guests James and Janice Prochaska and Pat Williams. 

 

RESOURCES for helping others and helping ourselves during this crisis:


Also, please feel free to contact us by email (deborah@realbalance.com) or phone (1-866-568-4702) to let us know how we may be of support at this time.

Be well and stay well!

Coach Michael

 

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

Coaching Can Help Medical Compliance

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

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

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

Readiness For Change


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

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

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

 

Grief And Loss


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

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

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

 

Survival Level


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

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

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

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

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

Meet Them Where They Are At

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

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

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

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

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

 

Ten Ways to Effectively Coach the Health Challenged.

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

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

 

Dr. Michael Arloski

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

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

 

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

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

Delivering The Behavioral Side Of Lifestyle Medicine Through Wellness Coaching

Wellness Coaching: Bringing Light To Lifestyle Medicine
Wellness Coaching: Bringing Light To Lifestyle Medicine

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”
Hippocrates 420 B.C – 370 B.C.

Healthcare providers have been prescribing lifestyle improvement for thousands of years. The evidence has been built from the observations of Hippocrates all the way to the neuroscience of today. We know, from mountainous reams of data, that lifestyle affects the course of an illness or health challenge. The challenge for the healthcare provider of today is to see the “lifestyle prescription” translated into lasting lifestyle change. Many well-intentioned healthcare professionals have attempted to educate and admonish their patients into losing weight, ceasing the use of tobacco, managing their stress better, getting more sleep, being medically compliant/adherent, etc. Seeing actual success in behavioral change happening far too seldom, many have abandoned such efforts and just reach for the pharmaceutical prescription pad.

In recent years, however, there has been an exciting movement in the field of medicine that looks at how to use “lifestyle interventions” as first-line treatment.

“Recent clinical research provides a strong evidential basis for the preferential use of lifestyle interventions as first-line therapy. This research is moving lifestyle from prevention only to include treatment–from an intervention used to prevent disease to an intervention used to treat disease.”
The American College Of Lifestyle Medicine

The Lifestyle Medicine Movement has done much to establish an evidence base and it continues to examine research that distinguishes what appears to work for lifestyle improvement. Much of its attention has focused on nutrition, but more and more the field is realizing the importance of health and lifestyle behavior.

Wellness and health coaching has become the delivery mechanism for wellness programs, and its potential for the same vital role is being seen in Lifestyle Medicine. The reality is that the vast majority of clients that most wellness/health coaches see are already health-challenged in some way. They may already have a chronic lifestyle-related illness, or multiple risk factors that set them up for needing serious preventative help. Wellness/health coaches that work for disease management companies, insurance companies and many corporate wellness programs are already working with caseloads populated primarily by lifestyle medicine patients.

Lifestyle Medicine 2015
Lifestyle Medicine 2015

At Lifestyle Medicine 2014 (the annual conference of the American College of Lifestyle Medicine http://www.lifestylemedicine.org) I presented on “Wellness Coaching And Lifestyle Medicine: Covering The Whole Continuum”. This year I presented “Delivering The Behavioral Side Of Lifestyle Medicine: Wellness Coaching Skills & Concepts” at Lifestyle Medicine 2015 in Nashville. Together with other presenters on wellness coaching we have experienced a strong positive response from an audience made up primarily of physicians.

 

One of the key concepts of my talk that was especially well received was the idea of how the Treatment Plan needs to be integrated with the Wellness Plan.
TP-WP

Co-creating a Wellness Plan with our clients is one of the primary tasks for the wellness coach. Together we work with a structure that insures the client’s plan for lifestyle improvement will lead to success. A key part of that Wellness Plan will always be the “Lifestyle Prescription” that the client’s treatment team is recommending. What is key is that the Wellness Plan supports The Treatment Plan.

I will be talking further about this concept in my forthcoming book on the more advanced skills and methods of wellness coaching, but here is a sketch of the two plans and the way they overlap.

Treatment Plan
• Diagnostically Derived
• Treatment Provider Devised
• Prescriptive
• Responsibility on Provider to administer, responsibility on client to follow
• Usually does not accommodate patient’s circumstances or abilities, may accommodate patient’s capacities.
• Problem solving, solution finding oriented
• Purposed for resolution of illness and disease, reduction of symptoms, healing
• “Lifestyle Prescription” focuses on recommended behavioral changes leading to Lifestyle Medicine outcomes
• Dependent greatly upon medical compliance/adherence

Wellness Plan
• Derived through exploration and self-assessment combined with treatment recommendations.
• Co-created by “client” and “coach”
• Non-prescriptive – client centered
• Responsibility on client to follow with coach’s accountability and support
• Not only accommodates, but is derived from client’s circumstances, abilities and capacities.
• Designed to eliminate barriers and develop additional support
• Possibility, growth and self-actualization oriented.
• Purposed for behavioral change and lifestyle improvement
• Includes assisting client with medical compliance/adherence

Overlap Of Treatment And Wellness Plans

• The Wellness Plan (WP) supports the Treatment Plan (TP)
• TP identifies critical areas for recommended lifestyle improvement
• Through “client-centered communication” WP aligns with the goals of the TP
• Client engages, with coaching support, in lifestyle improvement behaviors that positively affect treatment outcomes
• WP helps client with organization, accountability, etc., improving attendance for medical appointments and management of medications, self-testing/self-care
• WP helps client make best us of medical appointments (self-advocacy)
• WP helps client report more accurately to treatment team about changes in lifestyle behavior (providing more data for treatment decisions)

so_healthcoaching_1When clients are operating on a Wellness Plan that they have truly helped co-create with their own buy-in, the opportunity for weaving in Areas of Focus, Goals and Action Steps that support what their treatment team wants to see becomes obvious. Clients then have the structure and support they need to carry out the goals of the Lifestyle Prescription.

Physicians and other healthcare providers can already start making use of wellness and health coaching as a delivery mechanism for the behavioral change they would love to see. Many of their patients already have wellness coaching as an employee benefit. Their company’s wellness program may already provide it, or they may contract with a wellness coaching provider company. More and more employees have wellness/health coaching available through their insurance provider.

© Copyright 2011 CorbisCorporationWise medical organizations and practices are hiring wellness coaches to become part of their staff or are outsourcing to them. Healthcare providers are sometime “wearing two hats” and combining their treatment work with coaching. Others are becoming more “coach-like” in their interactions and are then handing the patient off to the wellness coach for the longer process of lifestyle improvement.

The Real Balance Wellness & Health Coach Certification curriculum (http://www.realbalance.com) has included how coaches fit into the Lifestyle Medicine approach for over a decade. Our students come to us as a resource for learning how they can help deliver the lifestyle improvement that their Lifestyle Medicine clients seek.

Wellness Coaching to support Lifestyle Medicine is not just an idea whose time has come, it has already arrived!

Michael Arloski, Ph.D., PCC., CWPMedium5

 

Wellness Coaching And Chronic Lung Disease

DandelionbreathIt surprises many people to discover that the third leading cause of death in the United States, behind heart disease and cancer, is chronic lower respiratory diseases. These conditions take twice as many lives annually as does diabetes. Yet, unless COPD (Chronic Obstructive Pulmonary Disease), or another such disease is part of your life or family, the seriousness of this public health challenge seems to seldom get our attention.

It’s estimated that over 15 million people in the U.S. suffer from COPD. The two main diseases that are associated with COPD are emphysema and chronic bronchitis. Approximately 22 million people in the U.S. are affected by asthma. Pneumoconiosis, also known as Black Lung Disease, is an occupational lung disease caused by inhaling coal dust. This affects more people in coal producing areas such as Appalachia and Northern Wyoming. All of these respiratory diseases have much in common, but for this article our focus will be on COPD and the ways in which lifestyle improvement can be relevant.

The most common cause of COPD is cigarette smoking and can also be related to ongoing exposure to indoor, outdoor and occupational air pollution. The preventative implications are obvious and wellness, health and safety programs can play a significant role. Like other chronic illnesses once thought to present a health challenge that we were helpless to do much about, COPD has a behavioral component that can affect the course of the illness and improve quality of life. The lifestyle medicine approach is illuminating ways in which the COPD patient can affect their condition for better or worse. Wellness and health coaching is emerging as a delivery mechanism to support COPD patients in succeeding with the lifestyle improvements that their treatment team wants to see.

271813-exhaleThe Behavioral Side Of COPD

COPD normally develops slowly and is the cumulative effect of decades of exposure. Any damage that is done to the lung tissue is irreversible. There is no cure for COPD and so treatment goals aim to slow the progression of the disease and to reduce symptoms. Once properly diagnosed the most immediate behavioral interventions are environmental: (reduction in exposure to workplace or living environment pollutants, e.g. a person working in an industrial pottery who is daily exposed to clay dust); strategic: an effort to immediately cease smoking; and medically behavioral: compliance/adherence to medical treatment (e.g. bronchodilator treatments, regular medical appointments).

The overall wellness of the client is important on a number of fronts. As treatment continues, lifestyle changes, physical exercise, and regular practicing of breathing exercises may also help to improve a person’s ability to remain active, prevent exacerbations and improve one’s overall health. A good nutritious diet is very important in order to avoid infections and to keep their lungs as healthy as possible. Maintaining a healthy weight is an important factor for a person that has lung disease. If a person is overweight it can make it difficult to move around and make it even harder to breathe. Being underweight though is actually a worse prognosis than being overweight. As lung disease progresses a person will become more short of breath and fatigued. Even eating can become a lot of work and a person might find it very difficult to get all the nutrients and calories that they need.

Improving a person’s overall strength and exercise tolerance is also a goal. The patient photo3063should speak first with their physician to determine what exercise or activities would be safe for them to do. Even though activity can make a person feel more short of breath it is vital to strengthen their muscles so that they will be able to continue to do the things they enjoy and be able to care for themselves. An individual will greatly benefit from participating consistently in a local pulmonary rehabilitation program.

Raising self-efficacy is vital to the COPD patient. Clients/patients benefit greatly from learning as much as possible about their disease and how to manage their symptoms, work properly with their medications and make the best use of supplemental oxygen. In fact, in a study of Mindfulness training and COPD (Mindfulness: A New Approach To Reduce COPD Hospitalizations Discovery’s Edge, Mayo Clinic’s Online Research Magazine, Volume 8, Issue 1
http://www.mayo.edu/research/discoverys-edge/mindfulness-new-approach-reduce-copd-hospitalizations) researchers found that the patient’s perception of their disease was the greatest predictor of frequency of hospitalizations. (70% of the medical costs associated with a COPD patient come from hospitalizations).

Comorbidities

The majority of people that experience COPD also
have other chronic conditions too. Researchers aren’t sure
why, but for some reason COPD patients seem to have more
comorbid conditions than patients with other types of diseases.
In a recent study of over 1,500 people with COPD, researchers found
patients averaged having four other types of comorbid conditions whereas those that didn’t have COPD averaged less than two other
problems. This study confirmed that comorbidities are very
common in people with COPD. Some of these conditions
included heart disease, high cholesterol, high blood pressure,
diabetes, osteoporosis, arthritis, depression and cancer. These
comorbid conditions increase the likelihood of a COPD patient
being hospitalized and can also result in death (WebMD.
(2014a). COPD comorbid conditions: Heart disease, osteoporosis,
and more. Retrieved from
http://www.webmd.com/lung/copd/the-importance-of-
comorbidities.)

Older-Adults-Support-TeamCoaching And Coping

When we review the behavioral changes that facing the challenge of COPD requires we begin to realize what a huge potential role successful lifestyle improvement has. Wellness and health coaches have been finding effective ways to assist COPD patients in their quest for a healthier life with their illness. In a cooperative study with Duke and Ohio State Universities (Coping Techniques Help Patients With COPD Improve Mentally, Physically http://psychcentral.com/news/2014/09/28/coaching-copd-patients-on-coping-helps-boost-quality-of-life/75448.html) “147 COPD patients participated in coping skills training. Psychologists provided regularly scheduled phone sessions, offering patients and their caregivers general information about COPD, step-by-step instructions in relaxation techniques such as deep breathing, tensing and releasing muscles, and ways to manage their reactions to stressful events.
Another group of 151 patients also received regular phone consultations, but only on topics such as medication and nutrition. They did not receive specific coping techniques. Participants who received training in coping skills reported improvements in their overall mental health, and lessened depression, anxiety, fatigue and shortness of breath when compared to the other group, according to the study’s findings.
Although there were no improvements in COPD-related hospitalizations or deaths, the study suggests that the low-cost approach could enhance quality of life, reduce distress and somatic symptoms, and improve physical functioning for patients, according to the researchers.” While not coaching per se, this combination of instruction and a very coach-like relationship with the psychologists who provided the phone sessions, proved the value of lifestyle improvement in increasing quality of life for COPD patients.

At the Mayo Clinic, researcher Roberto Benzo, M.D. is using Mindfulness Training (as mentioned and referenced earlier in this article) and a coach approach to not only increase client self-efficacy (and the key factor of their perception of their illness), but has shown outstanding results in reducing the number of days his subjects have needed to stay in the hospital when they are hospitalized, and reduced the overall number of needed hospitalizations.

“Patients in Dr. Benzo’s clinical trials undergo an active eight-week rehabilitation program. A wellness coach uses motivational interviewing, a style of communication, to identify an appropriate exercise and develop an individualized plan. Participants are also trained to become aware of their body sensations and motions as they exercise. Active coaching is followed by monthly calls to keep them motivated.
“Daily practice is the core of the rehabilitation,” Dr. Benzo says. “This means carving out a special time to be present with what is going on with their body and coming to terms with their life as it is.” (http://www.mayo.edu/research/discoverys-edge/mindfulness-new-approach-reduce-copd-hospitalizations) As is found in most work with chronic illnesses, a combination of education and coaching was successful.

Dr. David Hinton Thom at the University of California, San Francisco is currently conducting a two-million dollar grant-funded study to bring the coach approach to patients in underserved communities who are challenged by COPD. “The most comprehensive disease self-management programs, i.e., “pulmonary rehabilitation,” are generally not available to patients who are seen at community clinics. While self-management educational programs are more generally available, they are not often accessed by patients and do not provide personalized, sustained support. Health coaching by trained medical assistants or health workers has emerged as an effective model to provide individualized, patient-centered information, decision and self-management support, and coordination of care to improve outcomes for patients with chronic conditions. Health coaching provides patient support and reinforcement for self-management skills and activities, strategic approaches to effect behavior change, and a platform to improve comprehensiveness and quality of care. For the management of COPD, health coaches, for example, could assist patients with getting vaccinations, prescriptions, engaging in a graded exercise program, responding to exacerbations of their COPD, learning correct inhaler technique, and coordinating care between the patient’s primary and specialty providers.” (Health Coaching to Reduce Disparities for Patients with Chronic Obstructive Pulmonary Disease http://www.pcori.org/research-results/2013/health-coaching-reduce-disparities-patients-chronic-obstructive-pulmonary.) Here we see how the role of a coach can become incredibly practical and strategic, assisting patients/clients with their medical self-care and self-advocacy.

177859857Ways Coaches Can Assist With Lifestyle Modification For COPD:

• Smoking cessation
• Securing and attending a Pulmonary Rehab Program
• Securing education about proper breathing techniques from doctor, respiratory therapist or nurse to help reduce shortness of breath, and then tracking and accountability through coaching to ensure consistent practice
• Securing education about different cough techniques and breathing positions that are more effective.
• Explore various stress management tools and relaxation techniques, learning and practicing with coaching accountability.
• Tracking the intake of water (at least 8 glasses/day), to help hydrate secretions to be able to clear them from the airway.
• Tracking, follow through and accountability re: exercising regularly to improve overall strength and cardiovascular reserve. Client should speak first with their health care provider for specific instructions.
• Assisting client with nutritional/eating goals such as:
o Eat smaller meals more frequently to diminish shortness of breath.
o Eat healthy foods and maintain a normal weight.
• Securing support for their lifestyle improvement through family, friends, workplace, and others. Coaching for connectedness.
• Securing more support through group wellness coaching and finding a greater sense of community amongst others challenged with the same illness.

The Power Of An Ally In Lifestyle Improvement

Beyond all of the concrete behavioral steps involved in lifestyle improvement nothing exceeds the importance of having a solid coaching alliance between patient, now client, and coach. Having an ally through the behavioral change process is a boost to the motivation of the client and can help them to feel that a better life is possible.

Coaches also need to be aware that clients could experience more irrational feelings and “Gremlin talk” when short of breath and oxygen level are low. Decreased oxygen levels can cause people to feel fatigued and confused, which can have a direct effect on self-efficacy. When this is suspected, once again, a referral back to the client’s treatment team is in order.

Coaches can help their clients to process the grief they feel around their loss of health. This could be directly related to diminished feelings of self-efficacy and increased helplessness. (See “Astonishing Non-compliance” in Wellness Coaching For Lasting Lifestyle Change, 2nd Ed. http://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml by the author.)

Facing the challenge of COPD while seeking one’s best life possible means integrating a well-coordinated treatment plan with a wellness plan focused on lasting lifestyle change. Taking the journey to one’s best health may best be done with an ally walking side-by-side with us all the way.

Stress Coaching Part II – Recovery From Stress

Time to be still...priceless!
Time to be still…priceless!

What we refer to as “stress” is quite a mystery. Ill-defined by most everyone except psychological researchers, we ascribe devastating levels of power to it, and often feel helpless to cope with it. We know that stress is linked to worsening health, greater risk of illness and the exacerbation of most any condition we find ourselves with.

Wellness and health coaches find their clients almost always struggling to manage stress. Clients often recount how they had been successful at lifestyle change, often losing weight, stopping tobacco use, etc., until…a stressful event or change occurred in their lives. Once the stress hit the weight was regained, the smoking revived and so forth.

stress-illnessWhen we experience chronically elevated levels of stress the Stress Response of the Sympathetic branch of the Autonomic Nervous System maintains unsustainable levels of arousal in several bodily systems. This causes digestion to be inhibited, heart rate and blood pressure to remain elevated causing extra strain on the circulatory system, and higher levels stress hormones (corticosteroids) to be produced. Cortisol levels rise and research has linked this in particular to extra weight gain and more difficulty in weight loss. (http://www.simplypsychology.org/stress-immune.html)

Medical researchers aren’t exactly sure how stress increases the risk of heart disease, diabetes, cancer, and many other health challenges, but it does. For many researchers the findings don’t always put the finger on stress per se, as we can see more directly in the case of increased hypertension, but on the resultant changes in lifestyle behavior. Under more stress people tend to engage in more unhealthy behaviors – smoking, drinking, overeating, more sedentary activity, depression, and to engage in less healthy behaviors – exercise, sleeping well, taking time to eat well. It’s felt that these shifts in lifestyle contribute to the disease processes. There is also lots of evidence that higher stress has a negative effect on the immune system. (http://www.discoverymedicine.com/Frans-Pouwer/2010/02/11/does-emotional-stress-cause-type-2-diabetes-mellitus-a-review-from-the-european-depression-in-diabetes-edid-research-consortium/) (http://www.medicinenet.com/stress_and_heart_disease/article.htm)

The Health-Challenged Client And Stress

Many, if not the majority, of clients that wellness and health coaches work with are challenged by some kind of chronic illness. For these clients stress management is a vital part of the Lifestyle Medicine approach that hopes to positively affect the course of their illness.

The wellness plan supports the treatment plan.
The wellness plan supports the treatment plan.

First of all your health challenged client must be under currently active medical care. Your work with them around stress management may have an effect – albeit positive – on their physiology. This means that your coaching efforts must be coordinated with your client’s treatment team. For example, practicing relaxation training may succeed in lowering blood pressure. A client on hypertensive medication will need to have their dosage adjusted as their blood pressure changes.

To help our clients create their own way of managing stress we need to be their ally and help them to build the self-efficacy and confidence that their stress can be successfully dealt with. On a realistic level few coaches are equipped to help a client with a complex cognitive restructuring process that is more the prowess of a counselor or psychologist. We can help our clients address barriers in their lives, but we may find that a “problem solving” approach to stress may be flirting with infinity. Another brush fire springs up not long after the last one was finally extinguished.

Instead we may want to proceed with a more holistic, lifestyle-oriented, positive approach. We could divide this approach into four components:

#1 Recovery From Stress
#2 Development Of Recovery-Enhancing Skills And Strategies
#3 Lifestyle Strategies For Reducing Stress Increasers
#4 Environmental Strategies

#1 Recovery From Stress

In our previous post (http://wp.me/pUi2y-e9) we spoke about how change today has increasingly shifted from episodic change (which we are psycho-physiologically set up to deal with) to continuous change. Despite the seemingly constant barrage of information, demands and pressures today, we are still very human creatures with a nervous system that requires recovery and repair. The alternative is having stress show up in the weakest link in our chain in the form of a stress-related disorder. These often begin with milder symptoms such as headaches, insomnia, etc., but if there is insufficient frequency and intensity of recovery we often see an increase in the severity of symptoms leading to increasingly serious stress disorders such as hypertension, gastro-intestinal disorders, and even symptoms of heart disease and more.

The body has it’s own built-in counterpart to the “stress response”. It’s called the “relaxation response” (as made famous by Harvard researcher Herbert Benson (http://www.relaxationresponse.org). Eliciting this response calms the body and mind. Heart rate and blood pressure are reduced, as is the production of stress hormones. Recovery with a “capital R” would mean bringing out the stress response in some way.

Part of recovery, however is with a “small r” and that means engaging in activities that people find “relaxing” and also getting sufficient and sound rest. Taking the time to read a novel, go for a hike, play music or your favorite sport, go fishing (often a great choice for the client resistant to anything that sounds too exotic), have a cup of coffee/tea or glass of beer/wine with friends and chat, garden, or anything that the client considers fun and relaxing fills this part of the prescription. Multiple health benefits come from such activities meeting needs on physical, intellectual, creative, social and even spiritual levels.

How To Coach #1

Ask your client to list the things that they like to do to relax. Then ask them the last time they engaged in those activities. This often brings up regret and sadness. Empathize and explore. See what they may be attracted to re-engaging in and set up support and accountability to help them succeed.images

Exploring fears and assumptions about taking the time to recover may be a necessary step. Engaging in recovery time is meaningless if you’re client has too many internal barriers in the way and won’t give themselves permission for self-care. Coach them around exploring their beliefs and assumptions about taking time for themselves. Help them identify what triggers their fears and develop a different response. Are they making any assumptions about their situation at work? How safe would it be to check these assumptions out? Can new agreements be made?

It’s not unusual for clients to discover that working on improved sleep and rest becomes an important part of their wellness plan. This may become an area of focus for them and setting up goals and action steps to work on this may contribute greatly to their stress recovery.

#2 Development Of Recovery-Enhancing Skills And Strategies

There are numerous ways that your client may choose to use, once they are aware of alternatives, to enhance their ability to recover from stress and “inoculate” themselves against further effects of excessive stress. The key is not to prescribe, but to help your client find a method that is a great fit for them. Personal values, beliefs, and even prejudices that your client holds need to be respected. One person may jump at the chance to learn Yoga or Tai Chi while another person may be repelled by the same opportunity.

How To Coach #2

Biofeedback can be simple and very effective.
Biofeedback can be simple and very effective.

Help your client to explore such options as: Mindfulness-Based Stress Reduction (MBSR) (http://www.umassmed.edu/cfm/); recordings of relaxation training methods such as progressive and autogenic relaxation training; recordings of guided visualizations for relaxation; biofeedback training supplied by a qualified biofeedback therapist; meditation training; classes in Yoga, Tai Chi and Xi Gung may also be of interest to your client. Coach them through the process of finding out adequate information and following through with selection and engagement. The key is to keep coaching them and make the practice of these skills part of the coaching.

#3 Lifestyle Strategies For Reducing Stress Increasers

Too much of a good thing?
Too much of a good thing?

Some big advantages in living a healthy lifestyle are the ways in which itcontributes naturally to stress reduction. Smart wellness coaches help their clients to look at how their diet is working for or against their stress level. Excess caffeine over-stimulates and can contribute to insomnia. Too much sugar causes energy ups and downs. Excess salt causes edema, and drives hypertension. Inadequate nutrition or not following a prescribed dietary program (such a for a person with diabetes) can also contribute greatly to stress. Indeed medical noncompliance can be a terrific source of stress as medications are not able to perform adequately to maintain homeostasis or deliver proper treatment.

How To Coach #3

Help your client to examine their current lifestyle behavior and explore their potentially ambivalent feelings about making changes such as modifying their diet. Coaches can use Motivational Interviewing techniques to help resolve such ambivalence. Drawing upon all a coach knows about Readiness for Change theory (TTM) will also help the client to approach change in a stage-matched way that is more likely to succeed. Simple behavioral tracking that is combined with support and coaching accountability can often empower clients to finally make the changes they need to their diet, activity levels, and self-care behaviors.

Work with your client to examine their approach to time management and organization in their lives. It’s been astonishing how many times coaches discover that clients have not been making use of such simple tools as working with a calendar, operating off of a written (versus mentally kept) to-do list. Help your client to take charge of their life by consciously working on organization and time management.

#4 Environmental Strategies

Nothing better than a place to put your feet up!
Nothing better than a place to put your feet up!

There is such an emphasis in stress management work around cognitive approaches and relaxation methods that we often overlook the environment the client experiences every day. Home and work environments can aggravate or alleviate our stress levels.

How To Coach #4

Have your client describe a “day in the life” so to speak. That is, have them walk you through their typical day with an emphasis on where they are, not what they are doing. Does it put them in touch with stress sources? Are they facing a daunting daily commute by car in high-stress traffic? Is there neighborhood safe enough to walk and recreate in? Is there household cluttered (stressful in itself) or relaxing and peaceful?

While many of our clients are faced with economic realities that may make relocating unrealistic, other times this may be a real option. Can they move closer to work and eliminate the commute? What would it take to consciously make their home more of a relaxing haven? Could they even make one room such a refuge? Other times, through coaching, clients discover that even though moving is out of the question, there are things they can do environmentally to improve their situation and reduce sources of stress.

I love to say that “A coach’s job is to remind people that they have choices.” Sometimes under the burden of stress we forget this.

Connecting with family, friends, our greater community and the natural world also helps tremendously to relieve stress. Getting our social needs met requires…well, socializing! Exercising outdoors provides more documented benefits than exercising indoors. Spending time in nature feeds the soul.

One of the most beneficial activities a person can engage in is totally unstructured time. “Drift time” allows a person to let go of the “To Do List”, let go of expectations, roles and responsibilities. Whether it looks like hammock stretching, wandering through a shopping district on your own, fishing in a river, or whatever suits your fancy, the tension seems to fade as the day goes on.

Have A Back-Up Plan

No matter what the strategy you and your client are co-creating, have a back-up plan. Something may show up and get in the way of the best-laid plans. Coach your client to come up with an answer ahead of time to the question: “What will you do if…?” Having a fall-back strategy can allow your client to still achieve their goal. Can they modify their plans? Can they exercise for 15 min. instead of not at all? Can they go for a walk during the noon hour in their work clothes instead of a trip to the gym? Do they have food stocked in the refrigerator that will allow them to prepare a quicker meal than the one they had planned?

Maybe Stress Management Is More Simple

Pioneering Life Coach Thomas Leonard was fond of saying that “A coach’s job is help people to Eliminate Tolerations and Get Their Needs Met.” Perhaps this maxim could better guide all of us in reducing stress in our lives and being well. Coach your clients around what they are tolerating, whether it is an annoying source of aggravation like a door that sticks, or the way their colleague treats them at work. Have them list all of their tolerations and explore the list together. You’ll find that a lot of what they are tolerating often results in them not getting their needs met. Under stressful demands people often put their own needs last on the list and seldom get to them. Unmet needs lead to depression, resentment, anxiety and the experience of stress. Help your client explore this and see what they are ready to do to begin prioritizing their own health and well-being.

New 2nd Edition Of Wellness Coaching For Lasting Lifestyle Change

New Second Edition!
New Second Edition!

In 2007 Wellness Coaching For Lasting Lifestyle Change became the first comprehensive health and wellness coaching book published. Written expressly for the practitioner, it quickly became the foundational book of the field and has remained so to this day. Updated in 2009 it has served as the go-to book for independent coaches, health care and wellness professionals, and is often used as a text for college and university classes.

I’m now proud to announce that our fully revised and updated Second Edition of Wellness Coaching For Lasting Lifestyle Change has been released by my publisher – Whole Person Associates (http://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml) Copies are available through Whole Person (with quantity discounts available with bulk orders), and through Amazon and Barnes and Noble. Just look for the beautiful new color design on the book cover image.  2nd Ed Cover - Med

Since the last update of Wellness Coaching For Lasting Lifestyle Change our company, Real Balance Global Wellness Services, Inc., (http://www.realbalance.com), has trained thousands and thousands of health and wellness coaches around the world. I’ve personally trained many, taught advanced wellness coaching classes, done mentor coaching with students on the ICF Path, reviewed hundreds of case studies and listened to hundreds of coaching session recordings. I drew upon what I learned from these experiences in my revisions of the book and feel that the new edition provides enough new material to warrant recommending the purchase of this second edition by those who already have the first. Many pages were deleted and the new total is over fifty pages greater than the old edition…over 300 pages!

All of that teaching and mentorship helped me realize where coaching students, and practicing coaches, need more guidance when it comes to coaching and to wellness coaching in particular. I found the places where students get confused, where they are unsure how to proceed, where they get stuck, where their progress slows down. Those thousands of hours taught me what coaches need to know more about.

In the new edition there is more on the actual coaching skills that wellness coaches need to be effective. Both the mindset, the facilitative conditions of coaching that create “coaching presence”, and the techniques that increase coaching effectiveness are elaborated upon. I found that coaches often need help going beyond exploration and must have skills and methods to “forward the action”.

The most important and complete revisions are found in Chapter Eight. We are told over and over again that the Wellness Mapping 360° Methodology ™ is what coaches find most valuable and in this new edition we’ve refined it much further. So many coaches just do “goal setting” with their clients. Here we show how to really co-create a fully integrated wellness plan for lasting lifestyle change. This structure and methodology allows the coach or coaching program to “get behavioral about being holistic”. We work with the whole person, including mind, body, spirit and environment (real wellness), and yet “put legs under it” with a behavioral process and tools that allow for greater tracking, accountability and support.

Wellness Coaching For Lasting Lifestyle Change has touched lives around the world. It is so gratifying when I hear from people across the United States and Canada about how powerful the book has been for them, both personally and professionally. Additionally phone calls, emails and wellness coach training class registrations show up from Australia, Brazil, Portugal, the Philippines, Russia, Poland, Ireland, and all over. I am both touched and excited to know that through its international distribution, we truly are CREATING ALLIES FOR A HEALTHY WORLD.

Wellness Coaching For Lasting Lifestyle Change, 2nd Edition
(http://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml)

Michael Arloski, Ph.D., PCC, CWP
Michael Arloski, Ph.D., PCC, CWP

Yes, We ARE Getting Healthier!

How Does Your State Rank?
How Does Your State Rank?

In the midst of the healthcare crisis, America’s actual health, in many ways, is improving! It’s easy to feel discouraged by the political struggles, obesity and diabetes “epidemics”. Hearing that the U.S. has a worse life expectancy than Slovenia and Chile is very disheartening. Yet, despite some huge challenges that aren’t going away, there is an upside.

The 2013 Annual Report by America’s Health Rankings® is in and the word is better than we may have expected. The longest running annual assessment of the nation’s health on a state-by-state basis, America’s Health Rankings has spent 24 years assembling health data to help us see our progress and challenges. (http://www.americashealthrankings.org)

The almost twenty-five year trend of increasing obesity appears to have leveled off since 2012. The scientists aren’t ready to predict which way the scales will tip on this one, but at least it’s not another increase. In 1990 almost thirty percent of Americans smoked. In the last year we finally edged just under twenty percent with seventeen states showing a decrease in smoking.

Healthier Hearts

Healthier Lifestyles, Healthier Hearts
Healthier Lifestyles, Healthier Hearts

A real eye-opener is learning that cardiovascular deaths have declined 36 percent since 1990 and each year continues to see a 2-3 percent decrease. We’re also doing a better job of helping people avoid ending up in the hospital when it could have been prevented. “Preventable hospitalizations continue to decline. In 2001, there were 82.5 discharges per 1,000 Medicare enrollees; in 2013, there were 64.9 discharges per 1,000 Medicare enrollees.”

The American workplace is also becoming safer. “Occupational fatalities have declined slightly in the last 6 years from 5.3 deaths in 2007 to 3.8 deaths per 100,000 workers in the 2013 Edition. Rates have reached a 23 year low.”

Though most of the decline happened between 1990 and 1999, infant mortality is 39 percent less than it was in 1990. Though not dropping much recently, there has been no increase in recent years. At the same time though, the number of children living in poverty continues to increase with the 2013 report telling us that slightly more than one in five American children live below the poverty line.

As you look at the state-by-state maps in the report the geographic and other disparities are painfully obvious. A close to home example show us this. “The prevalence of physical inactivity varies from a high of 52.8 percent of adults aged 25 and older who did not graduate high school in Arkansas to a low of 6.7 percent of college graduates aged 25 and older in Colorado.”

While challenges remain and stats like those found in the America’s Health Rankings report can help drive the changes we will need to improve our country’s health, the progress needs to be hailed. The knowledge that we can and in fact are being successful in improving the health of populations helps empower us all. When we see that a state like Nevada can lead the nation in decreased smoking there’s motivation to do more in our own neck of the woods!

Dr. Arloski
Dr. Arloski

The Coach’s Take Away

Many wellness coaching clients are discouraged not only by their own failure experiences, but also by the never-ending barrage of negative press that spotlights one problem after another. While a head-in-the-sand approach to life only leads to more problems, and we do need to increase our vigilance about the food we eat, etc., everyone needs to know that our country-wide wellness efforts are paying off. We talk about the client’s “self-efficacy”; their degree of belief that it is possible to positively affect their own health. Stats like America’s Health Rankings can show that there is reason to increase our collective sense of health & wellness efficacy. Positive psychology works!

Wellness Is About The Big Picture!
Wellness Is About The Big Picture!

Coaches also need to be involved in wellness beyond the one-on-one or small group work that they do. In a company, the key to a successful wellness coaching program is for it to be part of a larger comprehensive wellness program. Such programs provide not only coaching, but education, wellness skill building, opportunities to be well (healthier food access, physical fitness access, built-in movement throughout the day, etc.), and a thorough effort at establishing a culture of wellness throughout the organization at all levels. The natural extension of all of this is community and environmental wellness. Demonstrated progress can show decision makers in both industry and government that wellness works, and most importantly, is worth funding. Coaches who care about wellness can benefit by caring about the bigger picture as well.

Forging A New Wellness Path: Leaving Health Risk Reduction Behind

It's time to cut a new trail...innovate wellness!
It’s time to cut a new trail…innovate wellness!

Attending Lifestyle Medicine 2013 (http://lifestylemedicine.org/lifestylemedicine2013) in the Washington, D.C. area this week I was heartened to be around so many enthusiastic people from the medical world who have embraced the realization of just how behavioral health is. The conference was “small but mighty” and had doubled in size since the previous year.

Dean Ornish (http://www.ornishspectrum.com) spoke for two riveting hours. While he started out with the obligatory review of his professional research on the reversal of heart disease, etc., his last hour was spent focusing almost entirely on how the really key ingredients in health are social support, connectedness, and a person’s spiritual connection or meaning in life.

Dr. Dee Edington
Dr. Dee Edington

We heard from some of the real innovators and leaders in the field like David Katz, Caldwll Esselton, James McDougal and others. Someone on the schedule that I was really looking forward to hearing was Dee Edington  (http://www.edingtonassociates.com/index/aboutus)  It would not be exaggerating to call him the “Godfather Of The HRA” (health risk assessment). His thirty-five years at the University of Michigan Health Management Research Center (http://www.hmrc.umich.edu) forged much of what we know today about health risk assessment and the tons of data that came from researching this field. As wellness programs developed during the 1980’s they all started with giving their populations an HRA and building their wellness programs around the results. HRA’s are still in widespread use as there is tons of evidence that when you can help a population reduce their number of health risks everyone is healthier and healthcare costs are significantly reduced.

HRA’s are hugely incentivized by employers who will offer health insurance premium discounts and/or hundreds of dollars in cash to employees for merely completing them. One upside is that HRA’s today are often what get someone through the wellness coach’s door as they do a follow up interpretation session.

Over the years however, many of us have seen little value in HRA’s from the client’s perspective. Being told that if you eliminate a number of your risky (and often much-loved) lifestyle behaviors will add about 7.2 years to your life usually falls far short of providing what you would call stimulating motivation for change! Most of the coaches that I have trained who are already out there working with clients say three things about HRA’s: 1) we love them for the aggregate data they provide; 2) client’s do not find them motivating (fear based motivation is easy to deny and just doesn’t last); and 3) so many employees do not trust their employers to keep it confidential that they “fake good” on them when they fill them out.

So, for me, Edington’s talk was much anticipated. Dr. Edington began slowly talking boldly about how upon visiting the Lifestyle Medicine website he was disappointed to see that their definition of Lifestyle Medicine was not about health…it was about disease.

“Lifestyle Medicine (LM) is the use of lifestyle interventions in the treatment and management of disease.” (http://lifestylemedicine.org/define)

He then went on to remark how despite accomplishments in many areas, the impact of all our work in medicine, health promotion, etc. the health of the nation is in many ways no better today than it was thirty-five years ago when he began this work. The obesity epidemic and all the chronic diseases (lifestyle driven) that go with it are killing us. Looking back disheartened, he said that our health-risk reduction approach was a mistake. Looking back over thirty-five years and 12 million HRA’s administered, he said “I’d like to take most of them back. I was part of the problem.”

Here was the man everyone listened to for years and who lead an approach to wellness programming that thousands of companies and organizations followed, admitting that we have been on the wrong track all this time. What a huge realization, and what a huge admission!

“We’re in the mud, the muck, talking about risk factors and disease.” he said. What about health? What about real wellness? He urged us to consider instead of running away from healthcare costs, to run toward health!

It was another speaker who quoted Einstein that day (Arthur Franks) but it could just have easily fit into Dee’s Powerpoint presentation.

einstein-quotes-solve-problemsThe big challenge we face according to Dee is this question:

“How can you beat the natural flow of decreasing population health status?” His research was not all for naught. It showed us that if we provide nothing for the healthy people in a population to help them stay healthy they will become those high risk individuals with increasing health problems.

“Disruptive innovation!” is what Dee Edington is calling upon all of us in the health and wellness fields to do. We clearly need some new thinking if we are truly going to make a dent in the health problems we face. Innovate. Be bold.

Dee even chided the Holy Grail of “Evidence Based Medicine”. If you are oh-so-carefully following EBM he reasoned, “You are a follower. Be a leader!” he urged.

The outcome measures we should be shooting for are not these fearful risks, they should instead be things like “Engagement in life! Love, compassion and resiliency.”

Lifestyle medicine by it’s very nature is a form of “disruptive innovation”, as the wellness field was in it’s early years. What I now question is have we forgotten our innovative roots? In the late 1970’s when we got this wellness field moving it was indeed revolutionary. We shook up the status quo of remedial care and found more and more effective ways to look at what really influences health. Behavior. Culture. Belief. Connection.

As the years passed and every wellness program struggled for funding, and as the business model conquered the healthcare field with chilling completeness, we embraced the statistics, the algorithms, the data and, I think in many ways lost our way.

I would stand with Edington and ask us all “What is our vision of health and wellness?” What is our way forward so that we might once again embrace the whole person; mind, body, spirit and environment? We began this wellness journey almost forty years ago on the shoulders of Abraham Maslow and others who looked for ways we could help people live their best lives possible. When people are in fact on that journey to live their best possible life they are on the path of wellness. Let’s be the allies that help people find their way.

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