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.

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Getting Yourself Out Of The Way: The Self-Vigilant Coach – Part Two – Projection In Health & Wellness Coaching

Projection – A Freudian Classic

Our previous blog post: Getting Yourself Out Of The Way: The Self-Vigilant Coach – Part One (https://wp.me/pUi2y-mu)  explored the many ways in which the coach can interfere in the coaching process and “get in the way” of the client’s own coaching work. Our own agendas, attitudes, beliefs, prejudices, projections and unfinished emotional business can all impede the coaching process. In this second part of the two-part series we’ll examine the complex concept of projection in coaching.

Projection

Another pitfall for the coach to be aware of is our tendency to project onto other people emotions that are really our own. A classic defense mechanism, psychological projection is when we attribute to others feelings of our own that we find unacceptable. The most common example is when we have unwanted feelings of anger and instead see hostile and aggressive qualities in the behavior and affect of others.

A broader understanding of projection, and a less pathological one, is that we project onto others not only negative qualities (anger, guilt, shame, etc.), but positive ones as well. These are positive qualities that we do not believe that we fully possess, but we ascribe them to the other person (successfulness, popularity, self-confidence, etc.). We can also include in projection the type of hopes, beliefs and dreams we have. We may want to believe that our client feels as passionately about exercise or meditating as we do! We may proceed with our coaching operating as though our client is fully on board with our wellness prescription for them. Conversely, as we have struggled for years with weight loss or smoking cessation, we project the same degree of difficulty onto our client’s experience, when, perhaps for them, that challenge is nowhere near as great. We fall into the trap of making assumptions, believing that other see the world just as we do.

 

We can also project our prejudices. If we come from a blue-collar working-class upbringing, we may think that our wealthy upper-class client has an easy life and knows little of heartache and struggle. We may withhold our empathy when it is really needed. We may completely underestimate the potential of our client because of their social status, gender, race or ethnicity and not treat them as being “naturally creative, resourceful and whole.” (http://www.coactive.com/learning-hub/fundamentals/res/FUN-Topics/FUN-The-Co-Active-Model.pdf)

 

If It Were Me…

A basic human tendency is to attempt to understand others by asking ourselves How would I feel/What would I do, if I was experiencing that? We put ourselves in their situation, and instead of going into a place of empathic understanding, we project our own feelings, conclusions, solutions onto the other person. We “know” what they ought to do! Perhaps our own work history includes supervisors who were bullies. Without realizing it we may hear our client’s story of conflict with their team leader and translate what we hear into a story of brutal abuse. We may then operate on the feelings this generates and steer the client towards taking extreme action to deal with a rather mild situation. For the client it was what we might call at one-dollar item, but we project a situation worth $100.00 plus change!

 

Our Own “Stuff”

Coaches may also project onto their clients the struggles and growth processes that they are currently engaged in and faced with. The coach who is exploring healing their own family of origin issues may see a need for this in many of the clients that they see. They may mistakenly think that the therapeutic process that is helping them so much is the panacea for all clients. They may start bleeding the techniques of their favorite self-help therapy book into the coaching that they do. The self-deception is that they may still think that they are doing coaching.

Perhaps the most disastrous type of interactions occurs when we project in such a way that we relate to another person as though they were someone else. Perhaps you’ve had this happen to you in your own life. Someone you’ve met recently keeps ascribing to you qualities that you exhibit very little of. They see you as self-centered, a braggart, trying to impress others, when all you did was share a couple of tidbits of what you knew about some subject. The problem is, you remind them of their brother, sister, ex-partner, former employer, second grade teacher, college roommate, army buddy, etc. who continually played the know-it-all role. Now all of the terrible qualities of that other person get projected onto you whether you deserve them or not!

Could the client who seems to bother us in ways that we find hard to explain be the unfortunate recipient of our projection? Do they remind us of someone else; a personal relationship from our past, or perhaps even a former client who struggled with the same issues? Do we begin coaching as though we expect this client to struggle the same way our other client did? Are we bringing our own unfinished emotional business into the coaching relationship?

 

Client Projections

When we are on the receiving end of our client’s projections, how do we handle it? A client who treats us as the high and mighty expert may cause us to overcompensate by being so informal and friendly that we now come across as a “buddy” or “pal” instead of a professional coach. The client who projects a parental role onto us may bring out our overly professional, even stiff and impersonal side. Such a client may become unexplainably resistant to even the best form of coaching accountability. The coach who is working with a client from a company who incentivizes employees to seek coaching to receive by promising a discount on health insurance, etc., may find their client unusually hostile. Such a client may be projecting their own issues around authority onto the innocent coach. The list goes on.

 

Minimizing Projection

The central problem with our own projection is that it is operating outside of our awareness. We make our assumptions without even realizing them. We slip into feeling that we do know best for our client, and on and on. Let’s look at ways to minimize the occurrence of our projection.

• Coach with a sense of self-monitoring. Check in with your own affective and bodily sensations and determine what they are telling us.
• Set clear boundaries and expectations for the coaching relationship as you create the coaching alliance.
• Draw a clear distinction between coaching and therapy. This includes operating from a coaching mindset, not an analytical, diagnostic mindset in our relationship with our client.
• Be vigilant for parental feelings that arise where you believe that you know what is best for your client
• Reflect upon the client who brings out unusual feelings in you that are hard to explain or understand. Listen to recordings and examine your responses to your client.
• When client reactions to coaching interactions seems extreme, consider what else might be going on that has nothing to do with the here-and-now coaching experience. Inquire gently “Does this remind you of any other experiences you’ve had?” “What’s this coaching like for you? Is it similar to anything else you’ve done?”
• Seek out mentoring/supervision to explore puzzling client relationships that “don’t feel right”.
• Do your own work! Your own personal journey of personal growth and healing may need some attention if it is leaking into your coaching work. Don’t let your own “unfinished business”, get in the way!

 

Dr. Michael Arloski

Learn more about projection in coaching and how to stay out of your client’s way at the Real Balance Global Wellness YouTube Channel —
Getting Yourself Out of the Way – Mastery for the Wellness Coach with Dr. Michael Arloski https://www.youtube.com/channel/UCp-aNFdbWwnX38fdLgr52eg?view_as=subscriber

Motivation Plus Mobilization: Coaching For Success At Lifestyle Improvement

Just can’t seem to get moving?

“I just don’t seem to have the motivation to really make changes.” This is a lament frequent to the ears of health and wellness coaches. Our clients are often puzzled by a lack of success in their efforts to start living a healthy lifestyle, or keep such efforts going. They blame it on either a lack of motivation to get started, or that their motivation fades as old habits reassert their rule.

Coaches help their clients examine and re-examine whatever sources of motivation they have mentioned. They help their clients revisit their desire to change and what drives it. They look at fear-based motivations such as not wanting to have an illness get worse, or not wanting to develop the maladies that have been prevalent in their family. They look at the love-based motivators like caring enough about ones self, wanting to be there for their grandchildren as they grow up, the intrinsic joy of dancing, swimming, tasting delicious and nutritious food, etc.

Perhaps the coach concludes, like their client, that these motivators just ‘aren’t enough’. The next step is to begin a usually fruitless search for additional motivators. Their client runs out of ideas and coaching descends into ‘what about this?’ suggestion after suggestion. What is really going on? What’s a more productive avenue to explore?

Got the gas, but no car?

Your client may have enough motivation. They may in fact, have listed three, four or more reasons they want to change. They may possess a terrific combination of motivators. Motivation is like the fuel for a vehicle to run on. The problem might not be the fuel, but the lack of an actual vehicle! The vehicle is a methodology, a structure, and a process that facilitates change. To get where they need and want to go, the client needs both a vehicle to carry them and the fuel to put in it.

How do we mobilize motivation? By providing our client with methodology. I’ve always been amazed at how simple successful change can sometimes be when clients have a well-developed way of achieving it.

Coaches often hear their client’s frustration at wanting to improve their lifestyle, but not having much of a history of success at it. If we inquire if they have ever started their change efforts by first taking stock of their health and wellness in a really clear way, we find they rarely have. If we ask if they have ever begun by first developing a thorough plan as to how they will make their changes happen, we often find them admitting that they usually just get their will powered amped up and set some sort of goals. Rarely have they ever carried out their change efforts with the help of an ally who helped them with support and accountability. And, all too seldom have they ever keep track of their efforts at change and actually written it down.

A mentee of mine was recently coaching a middle-aged woman who complained of a lack of motivation holding her back. As we began listening to the recording, the coach helped the client describe at least four strong motivators that had propelled her into action. She realized that when her children were younger playing with them had provided her with more activity and energy. Now her energy was low and she wanted to reclaim that. She also talked about hoping for grandchildren and wanting to be a very active part of their lives. The client was concerned about her advancing age and not wanting to lose the health she had. She didn’t want to become a burden to anyone. She went on to list at least two more motivators.

As the client described her lack of success at change, her conclusion was that she was just lacking motivation. She described coming home from work tired and just fixing a quick (though not necessarily healthy) meal and watching television in the evening. “I just don’t have the motivation I need” the client lamented. She intended to be more active and intended to eat better. All she had for a plan were intentions.

Doing a great job of coaching, my mentee gently confronted his client and recited the substantial list of motivators that she did, in fact, have. He questioned whether it was a ‘lack of motivation’, or something else that was missing.

Clients try to figure out what is keeping them stuck. Unless it’s a matter of identifiable internal or external barriers, clients often say it’s a lack of motivation. They are looking for an explanation and, frankly, they often don’t know what else to call it.

Co-Creating The Coaching Alliance

An often ignored part of coaching is the work it takes to Co-Create The Coaching Alliance. In addition to getting acquainted with our client and hearing their story, an important part of our first session with a client is to convey to the client just how coaching works. Clients are used to meeting with consultants, not coaches. They expect to be able to provide the consultant with lots of great information and hear the expert recommendations. We spoke about this from the coach’s point of view in our last blog post: “Making and Maintaining The Shift To The Coaching Mindset” https://wp.me/pUi2y-m3. The client also needs to make a mindset shift to get oriented to this new way of working with someone.

Coaching is about co-creating agreements. We co-create with our client agreements about how we are going to work together. Some aspects of our working together are negotiable and can involve compromise. However, we are not going to compromise the nature of our coaching relationship. That is, we are not going to agree to just be our client’s educator, and let go of the role of coach.

Part of what an effective coach does is to explain, in a succinct fashion, exactly how coaching works, how it is structured and what the benefits of this structure are. The client-centered nature of coaching is conveyed with real reassurance that the client remains the one in the driver’s seat.

Part of the coach’s job is to facilitate the client’s use of the coaching structure. The coach does this by showing the client how advantageous it can be to operate with a solid plan, to track one’s progress at making changes, etc. The coach provides tools that make these processes easier. Mobile apps for tracking can be recommended and then, importantly, integrated into the coaching accountability.

Mobilizing Motivation

Motivation can be puzzling and elusive, but when it is present a methodology, a structure, is what the client needs in order to mobilize it. By providing our client with the vehicle, we help them get where they want to go.

Word Origin – Coach: In the 15th Century the Hungarian village of KOCS was the birthplace of the true carriage or “coach” as the word evolved in English.

In other words we might define both types of coaches as:
A coach takes you from where you are at, to where you want to be!

Making and Maintaining The Shift To The Coaching Mindset

The Coaching Mindset Means Leaving The Consulting Mindset Behind

We meet our coaching client with the very best of intentions. We want to help. And help sometimes means throwing ourselves into doing what the client seems to be unable to do themselves up to this point – figure out solutions. Instead of empowering our clients to come to their own solutions, we seek to fix it for them. We draw upon our knowledge, our wisdom, our intelligence, and put effort into guiding the conversation to this goal of helping the client to live better and be healthier. We take on more than our share of responsibility for outcome. Perhaps we even let our own needs for control influence what is going on.

Your client is speaking about a very challenging situation in their complex life. You are fully engaged – in trying to figure it out. You sincerely want to help. You are curious, in a detective sort of way. Your internal chatter is racing: ‘What’s going on here?’ ‘How can the client handle this better?’ ‘What should the client do?’ ‘The client is not dealing with this effectively.’ ‘The client is engaging in self-defeating behavior or irrational thinking.’

So, you ask questions. Really good questions. You delve deeper into the problems. You seek solutions. You analyze. But, you’re not coaching. The more you think the less you feel. The more you analyze and use deduction, the more you step away from your client and all that they feel and all that they are. You, the coach, forget to empathize. You may even forget to use your Active Listening Skills, like paraphrasing and reflection of feeling. You forget to neutrally help your client explore and to do the work themselves. You have become your client’s consultant, taking on the work that belongs to your client.

As James Prochaska loves to say about change; making the “Mindset Shift” to the Coaching Mindset is a process, not an event. The shift did not happen that day when you completed a Wellness Coach Certification Course, and then become locked in place. We all keep going back to our default setting, be it treatment provider, educator, or consultant. What reinforces the old mindset is that many of our clients expect us to be the consultant, the trusted expert. They are used to working with consultants of every stripe and they often come to coaching with feeling of low self-efficacy and seek the guidance of experts who can point the way for them.

In Our Heads

The more we are in our own heads, the more we miss about what is going on for our client. Our analyzing and wondering about where to go next removes us from what is happening right here and right now. Perhaps our client is talking about what they had for breakfast, and the greater context is that they are having breakfast alone for the first time after their children have gone to live with their former spouse. We are missing the undercurrent in their voice of loneliness. We miss inquiring about their emotions, and, instead focus on the cholesterol content of what was on their plate. We miss reflecting our client’s feelings because we don’t notice what they were feeling. We miss an opportunity to express empathic understanding.

Trust The Coaching Process

To quit our consulting job and truly coach we must trust the coaching process. It is a leap of faith to let go of our urge to help and instead to assist. We have to trust not only the coaching process – that it is valid and potentially effective – but also trust our client. As The Coaches Training Institute http://www.coactive.com teaches, when we feel it “in our bones” that the client truly is “naturally creative, resourceful and whole” we can finally coach. When we apply this “Cornerstone of Coaching” we don’t rescue our client by finishing their sentence. We don’t provide for them what they may actually be capable of creating themselves.

Most importantly we don’t interfere in our client’s lives. Think about it! What right do we have to interfere in anyone’s life (and I’m referring to way of living, not intervening in an emergency, etc.)? Do our coaching “interventions” actually constitute an act of interference in how someone is choosing to live their life? Coaching is NOT an intervention!

Back To Center – Back To The Present

So, how do we stay in the moment with our client, yet provide the structure that is an absolutely essential part of effective coaching? It comes down to the proverbial “dancing in the moment” that coaches are so fond of referring to, but it also acknowledges that we have made an agreement with our client about the music.

An effective coach operates within an evidence-based, theoretically grounded coaching structure. We provide a methodology that allows facilitation of the client’s success at improving their lifestyle and therefore, their life. As we follow that “music” (our agreed upon coaching structure) we put our attention into the process of awareness. We listen with ears, eyes and heart. We pick up on the nuance of speech that reveals what may be going on beyond the surface. We explore without preconceived notions of what the client’s experience is. We may just simply say to the client we observe with the tight voice and the furrowed brow: “Are you aware of your forehead right now as you say that?” Let them do the work. Coach!

The Tao of Wellness Coaching: Part Two – Practical Applications

Photo by Michael Arloski

When the best leader’s work is done the people say ‘We did it ourselves.’                                Lao Tzu

In Part One –  In the previous post “The Tao of Wellness Coaching – Part One – What Centers Us?”   http://wp.me/pUi2y-lN   we grounded ourselves in the history and context of The Tao and the concept of Centered Coaching. We examined how relevant the practice of Tai Chi can be.

Essential Concepts

Effective wellness coaching is, inherently, very much in harmony with the Tao. Let’s look at two key Taoist concepts and how they apply to wellness coaching.

Yin-Yang Balance

Fundamental to Taoist thought and foundational to Chinese Medicine is the concept of Yin and Yang. These are the polar opposite, yet complementary, forces of the world that, for health and wellbeing to exist, must be in balance. The Yang forces are active, positive, hot, overt, masculine, light, and hard. The Yin is passive, yielding, negative, cool, quiet, feminine, dark, and soft. In the classic symbol the Yang rises to the top and is represented by the light area with the black dot in it, while the Yin sinks to the bottom and is represented by the black area with the white dot in it.

The key is to understand that the two are opposite, yet interdependent, complementary and interconnected. When we experience having too much of one and not enough of the other, we experience dysfunction whether it is at the physical, psycho-emotional or behavioral and practical level. Regaining balance becomes the return to a level of healthy homeostasis.

As coaches work with clients to achieve a wellness lifestyle the goal of achieving a healthy balance is paramount. We must rest, but not become lethargic. We must move and exercise, but not to the point of exhaustion and fatigue. We must find a way to take in sufficient calories, but find the right level for our optimal health, etc.

As coach and client co-create a wellness plan the concepts of Yin and Yang can be very useful. Our culture tends to reinforce and promote the Yang forces while not supporting those of the Yin. We are urged to be productive, work hard, play hard, achieve, accomplish, try harder and push. Seldom are we reinforced, much less accommodated for self-care activities such as getting adequate sleep, relaxing, taking time to get a massage, meditate, or enjoy our leisure. In fact, we may face criticism for such ‘indulgence’.

Many components of a wellness plan involve greater frequency of self-care activities. As clients look at their health and wellbeing through a more holistic lens, they often see the value of taking more time to meet these needs to balance their lives. Often these same clients have been admonished by their healthcare providers to engage in more self-care activities in order to improve their health. Many times wellness coaches work with clients who have been foregoing their medical self-care, such as taking time to do self-testing (e.g. diabetes), following up on medical appointments, doing rehabilitation exercises, etc. Instead they have been consumed and distracted by the Yang-style demands of their work, and their own belief systems.

When wellness coaches work with their clients to construct ways to manage stress more effectively, they are inevitably working to achieve Yin-Yang balance. Without ever speaking of the terms (Yin and Yang), we might consider how all actions possess either Yin or Yang energy and help our clients to decide how much to include in their lives. There may be great stress management wisdom in exploring strategically with our clients when it is best to push, and when to yield.

At a fundamental level our clients are often in a state of ambivalence about change that displays the push-pull of Yin and Yang forces. Should I, the client, change my way of living, or not change? When we really examine the ambivalence resolution methods of Motivational Interviewing (MI) we can see a Taoistic stance taken by the therapist or coach. The coach does not “pull” for one path to be taken over the other. Instead, they neutrally allow the client to explore and experience both energies; change and no change. The coach using this MI approach remains as centered and non-judgmental as possible helping the client to weigh the pros and cons (again a Yin/Yang process).

Wu Wei – Effortless Effort

Living in harmony with the Tao is about letting nature take its course and not interfering with the natural order of things. The concept of Wu Wei conveys the idea on ‘non-doing’, ‘non-action’, or ‘non-intervention’. This concept seems antithetical to Western thinking. In Western culture we are taught to make things happen. In Western Medicine the expert seeks to find the best intervention and implement it as soon as possible. To accomplish a desired outcome by ‘allowing’ things to simply be and progress on their own seems either too slow or doomed to failure. Yet think for a moment. Have you ever needed to relax and unwind and the harder you tried to do so, the more anxious and tense you got? There is only one way to relax; you have to allow yourself to do so. When we intervene medically to treat a wound, the actual healing that follows is something we have to patiently allow to happen.

Wu Wei is perhaps best thought of as living in a state of effortless harmony and alignment with the natural cycles and ways of nature. We are truly ‘going with the flow’, and able to respond to whatever comes our way. As coaches allow such a way of being our ability to ‘dance in the moment’ is maximized. We aren’t there to intervene, to fix things. We are not attached to a therapeutic agenda, to a treatment-oriented course of action. The client is in the lead and we are able to effortlessly dance with them.

Keeping It Client-Centered

At the heart of all coaching is the client-centered approach. From the psychotherapeutic roots of Carl Rogers this ‘person-centered’ way of interacting has become the basis for the coaching alliance.

“There have been parallels made regarding Carl Rogers’ person-centered theory and the way of doing nothing in Taoism (1). Rogers suggested that the most therapeutic counseling occurred when the therapist was authentic and real in the relationship and placed trust in the client to discern what was best for himself without interference from the therapist (2). A central concept of Taoism is doing nothing and being natural. Both Rogers’ theoretical beliefs and Tao philosophy maintain that when these conditions are achieved successfully in therapy, the human organism will develop almost spontaneously (3).”

An excellent review of this is found in “East Meets West: Integration of Taoism Into Western Therapy” by Rochelle C. Moss and Kristi L. Perryman. (4)

Coaches following these principles ‘get themselves out of the way’ and trust in the wisdom of their clients. We see our work as helping to bring forth, or evoke, the inner wisdom of our clients. When we are not attached to rigid protocols, yet operating out of grounded principles and methodology we can serve as guides to help our clients get to where they want to go.

Coaches and clients walk down a pathway together at night in the forest. The coach’s job is hold the flashlight and illuminate what is before them.

The client’s job is to choose how the path will be followed.

Neutrality allows the coach to operate without bias, without their own judgments and prejudices. This allows the client to be in the lead, making their own choices. This is where wellness coaches must adhere to the ethics of coaching and not be promoting their own products or particular courses favorite ways to eat, exercise, and so forth.

The highest virtue is to act without a sense of self
The highest kindness is to give without a condition
The highest justice is to see without a preference
Lao Tzu

Coaches who find value in the concept of Wu Wei see the value in yielding. In Western society yielding is often seen as failure, as giving up. Yet, some of the most storied successes on both Eastern and Western battlefields came because of strategic retreat. In wellness coaching this may take the form of allowing a client to set their own levels of accountability. For example a client may state that they can perform a certain behavior, such as walking, five times in the coming week. The coach may suggest that going from not exercising at all to doing so five times a week may be less likely to be successful. The client insists that they can hit this target of 5x/wk. The patient coach then allows the client to go ahead with their experiment rather than argue and let the client experience what the Adlerian psychologists would call natural consequences.

The power of yielding may also be something for our clients to discover. Often people approach situations with only one option in mind; to win! The wise person approaches any situation wanting to have all options at their disposal. In dealing with conflict, in managing stress, the option of yielding often pays off better than pushing for one’s initial desires.

At the heart of both the coaching process and Maslow’s theories of self-actualization and personal growth is the principle stance that human beings are inherently moving towards health and wholeness. With barriers removed and balance achieved, people will naturally make progress towards their highest good. The continually accumulating evidence from the Positive Psychology research substantiates this position. Such a way of looking at human beings and their experience in life is in complete alignment with Taoistitc principles of the interconnectedness of all things, synchronicity and the let it be attitude of Wu Wei.

The Centered Wellness Coach

Drawing upon what may be called “Philosophical Taoism” as opposed to any kind of religious or institutional Taoism, the wellness coach can find wisdom that does not necessarily contradict any other beliefs they, or their client may have. What we find is real alignment with the principles of growth and self-actualization that form the foundation of the wellness field. What we also find are very practical guidelines for practicing as an effective coach.

1. Practice What Centers You In Your Life
The wellness of the coach is the foundation all else is built upon. When we embrace whole-person wellness that includes, body, mind, spirit and our relationship with our environment, we practice a lifestyle that moves us towards optimal functioning. The key here is the word “practice”. Coaches are usually very caring people who place the needs of others far above their own. That can easily result in a lack of self-care, a neglect of the very well-living practices that we encourage in our clients. Find what “centers” you and practice it with regularity. Connect with friends, read novels, garden, hike, bike, walk, dance, meditate, do Yoga, Tai Chi, go fishing, enjoy your grandchildren, play with your photography or poetry, pray, volunteer at a non-profit, scrapbook, quilt, take your neighbor’s child for a day in the park. Do whatever gets your healthy needs met and gives you meaning and purpose.

When you get knocked off-center, accept how this is simply part of the normal human experience. The centered person does not tip-toe through life like they were on a balance beam. The idea is that of reducing our  “center-recovery time”. If we are practicing what centers us in our lives we can come back to center more quickly.

2. Practice effortless effort.
The primary mistake I notice when I observe coaching students who are learning the craft, is that they work too hard. The coach is working much harder than the client. When coaching does not go well it is usually when the coach is trying to make things happen. The coach is busy “fixing” the situation and/or the client, instead of facilitating the client doing their own work. The coach is busy attempting to convince or persuade the person to be well. The centered coach is patient.

3. Embrace Paradox
By trusting their coaching methodology, and by trusting their client the coach is able to offer a “coaching presence” that is: calm, yet lively; supportive, yet challenging; accepting and nonjudgmental, yet discerning; empathic, yet not colluding; compassionate, yet firm. Again, it is from this centered “stance” that such paradox can exist.

4. Know When To Push And When To Yield
We have a culture obsessed with “interventions”, with taking action. The Tao teaches us that there is a time for both action and non-action. I’ve observed coaches attempting to appear “powerful” by pushing for action whether the client is “ready” or not. When we use Prochaska’s Readiness For Change Theory we are actually acknowledging the reality of the energetic state our client is in. An old Gestalt Therapy expression is “Don’t push the river”. But, we also know the need to paddle when we are in a dead-calm lake! There is a time in coaching to forward the action through request. The Tao is as much about taking action as it is about pivoting and moving with no resistance. Again, the coaching metaphor of “dancing in the moment” means know when to push and when to yield.

5. An Effective Wellness Plan Is About Balance

A well-crafted wellness plan, co-created with our client would resemble the Yin/Yang symbol of Taoism. Ideally there would be as much involvement in active steps to build energy and there would be for more passive steps to help one relax, restore energy and achieve more balance. One side would balance out the other.

The reality is that as coaches we have been practicing The Tao of Wellness Coaching all along whether we called it that or not. Taoistic principles have already been infused in psychology, psychotherapy, business, leadership and more. Being more conscious in their application expands the coach’s repertoire of options and helps them nurture their own wellness as well.

References

1. Hermsen, E. (1996). Person-centered psychology and Taoism: The reception of Lao Tzu by Carl C. Rogers. The International Journal for the Psychology of Religion, 6(2), 107 – 125.

2. Hayashi, S., Kuno, T., M
orotomi, Y., Osawa, M., Shimizu, M., & Suetake, Y. (1998). Client- centered therapy in Japan: Fujio Tomoda and Taoism. The Journal of Humanistic Psychology, 38(2), 103-124.

3. Hayashi, S., Kuno, T., Morotomi, Y., Osawa, M., Shimizu, M., & Suetake, Y. (1994). A reevaluation of client-centered therapy through the work of F. Tomoda and its cultural implications in Japan. Paper presented at the Third International Conference on Client-Centered and Experimental Psychotherapy, Gmunden, Austria.

4. Rochelle C. Moss and Kristi L. Perryman
“East Meets West: Integration of Taoism Into Western Therapy”
https://www.counseling.org/resources/library/vistas/vistas12/Article_33.pdf taken from web 1.13.17)

The Tao of Wellness Coaching – Part One – What Centers Us?

What can today’s health and wellness coach learn from The Tao that will make their job easier and more effective?

When I let go of what I am, I become what I might be.
Lao Tzu

History and Context

It is said that the legendary Chinese sage, Lao Tzu, rode off on the back of an ox when leaving the Middle Kingdom. Before a sentry guard would let him pass out of the city gates, he asked the sage to write down his teachings for the good of all. The result was the seminal text, The Tao Te Ching. Lao Tzu then rode off into the wilderness, never to be heard of again.

The wisdom of this book was never lost from those times (5th-6th Century BCE), but instead spawned a philosophy that holds real merit for our lives today. Our challenge is to bring the Tao, or “the Way”, into those busy lives and, ultimately into every aspect of our being. When we do, we operate very differently. We engage in our work in a different way. We experience stress but respond to it more effectively. We coach differently.

The Tao is a concept cloaked in mystery for most of us. Sage sayings that sound like one conundrum after another leave us puzzled. “Those who know do not speak. Those who speak do not know.” “Yield and overcome; Bend and be straight.”― Lao Tzu, Tao Te Ching. Yet, there is a strong appeal because we often covet the apparent peace of mind that practitioners of the Tao seem to have. They seem, so “centered”. They seem to have a quite confidence that guides them. They know just what to do.

When we speak of the Tao and wellness coaching we are not implying that to know the Tao one must study and adopt the more religious form of Taoism. Taoism is most often defined as a philosophical tradition that is all about living in harmony with life, or literally translated, “The Way”. One can pursue living in harmony with the way of life without necessarily becoming involved in a religious pursuit, per se. Carolyn Myss tells us that living in harmony with the Tao is a way to “reduce the friction inherent in most of life’s actions and to conserve one’s vital energy.” (1) Studying the philosophy of Taoism, the Way of the Tao, however, holds great potential benefit for coaches.

The bookstores of the world are packed with books with titles such as The Tao of Business, The Tao of Golf, The Tao of Leadership, The Tao of Physics and an infinite list of variations on this theme. Clearly many find value in this ancient wisdom and have found ways to make it relevant and advantageous. Psychologist Wayne Dyer studied the Tao for an entire year and provided us with a deep resource with his book Change Your Thoughts – Change Your Life: Living The Wisdom of the Tao (2009)(2). There are many translations of The Tao Te Ching, but for the Westerner, Dyer’s book may be the best introduction because it explains so many of the concepts in ways we can apply to our everyday, and professional lives.

What Centers Us In Life

There are many things that ‘center’ us in our lives. Being centered is about living our lives in a healthy balance and getting our needs met so that we have vitality. Many things do this for us. Ask yourself: what keeps you in balance, what centers you. You may say getting regular exercise, gardening, reading fiction, connecting regularly with friends, getting out in nature, getting enough rest, etc. All of these activities and more help us to be more in balance, to live a wellness lifestyle, to be in harmony with the Tao. It all seems to be saying the same thing.

Our wellness lifestyle forms the foundation for this centered way of living, but any number of mindfulness practices can help us take it further for even more benefits. Practicing Yoga, various forms of meditation, Mindfulness Based Stress Reduction, Contemplative Prayer, and other methods can all help ‘center’ us and not only teach us the ways of the Tao, but actually alter our psychophysiology in a positive way. All of these practices have the potential to help us shift our nervous system more into what is know as the Relaxation Response (Benson, 2000), the activation of the parasympathetic branch of our autonomic nervous system. This results in a lowering of heart rate, blood pressure, etc., and therefore makes it easier for us to be calm and less reactive to stress, in other words, more centered.

The Tao In Movement

Practicing Tai Chi On The Great Wall

Tai Chi is a Taoist inspired soft martial arts practice, a moving meditation actually, that embodies many principles of the Tao. The health benefits of Tai Chi are well documented. “Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.  “There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems.” (http://www.health.harvard.edu/staying-healthy/the-health-benefits-of-tai-chi) (3) The benefits one can derive from such a practice, however, go well beyond the psychophysiological.

For me, practicing Tai Chi has been a non-cognitive way to study the Tao. It is ‘centering practice’. I was fortunate in the late 1980’s, to learn the short form of the Yang Style of Tai Chi taught by a physician from China. My practice since then has been consistent, if not as frequent as I would like. The result of regular practice is a centered way of moving, and, to an increasing degree, a centered way of being. This is living in harmony, with the Tao. For me it has been a thirty-year journey in somatic learning.

When we move from center we are always in balance. Think of the martial artist in action, such as a practitioner of Karate, Aikido, or Tai Chi Chuan. For them to be effective in combat they must move from center. If they aggressively lean too far forward they land on their face, or if they are too afraid and lean backwards they end up on their backside. Think of how this same principle applies to a sales person attempting to make a sale, an instructor attempting to get a point across, an encounter that you may have attempting to resolve conflict with someone. Think of how this applies to our coaching. The metaphor holds up. If it did not go well, we might realize that we weren’t very centered.

Centered Coaching: What The Tao Has To Teach Us

When I observe masterful coaching the style of the coach may vary, but one thing is always present: centeredness.

A centered coach speaks less and listens more. They can “dance in the moment” effortlessly, going wherever the client needs to go, no matter how unexpected. They are not attached to outcome, but are focused on results. A centered coach can shift into new directions, but remains grounded in structure and the foundations of coaching. Such a coach has no need to impress or appear powerful. They don’t work at being powerful, yet they are. Centered coaches do not push their own agenda, yet they do not collude with their clients either. They know when to push, to confront, and have the courage to do so. They also know the power of yielding.

Mastering others is strength. Mastering yourself is true power.
Lao Tzu

In Part Two

Effective wellness coaching is, inherently, very much in harmony with the Tao. In Part Two we will look at two key Taoist concepts and how they apply directly to wellness coaching: Ying/Yang balance, and the concept of Wu Wei or Effortless Effort.

References

1. (Carolyn Myss, https://www.myss.com/free-resources/world-religions/taoism/philosophical-and-religious-taoism) – taken from web 7.5.17)

2. Dyer, Wayne. (2009) Change Your Thoughts – Change Your Life: Living The Wisdom of the Tao. Hay House.

3. “The Health Benefits of Tai Chi”. Harvard Women’s Health Watch. Harvard Health Publications.
(http://www.health.harvard.edu/staying-healthy/the-health-benefits-of-tai-chi

The Great Utility of Coaching In The Emotional Realm

According to Plato: Human behavior flows from three main sources: desire, emotion, and knowledge.

Coaches often cautiously retreat from the affective level with their clients for fear of crossing the line into therapy. Other coaches with a professional mental health background are comfortable going in this direction, but don’t often know how to shift from a therapeutic approach to a coach approach. Unfortunately, we also find coaches who have no professional mental health qualifications who are all too eager to dive deeply into the world of emotions. In two of my previous blog posts I address the critical distinctions between coaching and counseling/psychotherapy, coaching scope of practice, and how to facilitate referrals when needed. (Process Coaching: Yes, Coaches “Do Emotions” http://wp.me/pUi2y-dL) (Coaching a Client Through To A Mental Health Referral Using The Stages of Change http://wp.me/pUi2y-lp)

There is naturally much valuable work written about emotions, from Emotional Intelligence, to Neuroscience, Positive Psychology, and more. In this post let’s focus on how a coach, especially a health and wellness coach, can enhance the coaching process by working effectively with affect.

What the authors of Co-Active Coaching (2012) (Whitworth, et.al) call “process coaching” has been co-opted by a wide variety of writers and practitioners, each with their own disparate definitions. The definition that Whitworth, et.al, provide is worth repeating here: “Process coaching focuses on the internal experience, on what is happening in the moment. The goal of process coaching is to enhance the ability of clients to be aware of the moment and to name it… Sometimes the most important change happens at the internal level and may even be necessary before external change can take place.” Their message here for coaches is that unless we address the affective component, we often struggle to see real progress. When coach and client dance around feelings, the exploration can stay superficial and goal setting, strategies for change, etc., often lack a sufficient motivational driver. An internal barrier to change may still remain. So, how do we work with emotions and stay within our scope of practice as a coach?

A client may speak of any manner of unresolved conflicts, a history of trauma, even abuse that they have experienced. It may be about family of origin issues, or any sort of unfinished emotional business. This does not immediately indicate the need for a referral. The reality is that many, if not most, people carry around their unfinished business such as this and function quite well. The challenge for the coach is not to take the bait of problem solving and coach seeking to resolve these old issues.

Resolution Vs. Relevance

The key here is to seek how the emotions of the client are relevant to the progress they are attempting to achieve in coaching. Perhaps a coach and client create action steps in their wellness plan composed of various self-care activities, yet the client repeatedly holds himself or herself back from engaging in these. As this is discussed in coaching, an internal barrier is identified that traces back to their family of origin. Perhaps a critical parent harshly enforced that all work must be done before one does anything for one’s self. Doing process coaching around this, the savvy coach seeks not the resolution of all of the feelings and unfinished business with that parent (be they dead or alive). Instead, they coach to help their client gain insight regarding how these past learning’s are holding them back today. If the client is able to gain such insight and translate it into action (moving ahead with self-care) then the process coaching is achieving its goal. If the client continues to only process feelings and does not gain insight or does not succeed in shifting their behavior, then, we have probably identified an issue that is significant enough to warrant the encouragement of referral to a counselor or therapist.

Putting It Into Words

Client: You know, I love this idea of taking time for myself to do just what I enjoy, but every time I do I just feel really guilty.
1) Coach: Tell me more about how this guilt shows up.
Client: Well, like last week when I said I would connect with one of my good friends on the weekend and go do something fun. The whole time we were hanging out together I kept thinking about all of the things on my to-do list at home, and how I probably should be doing things for my family instead.
2) Coach: That must have really taken some of the pleasure out of being with your friend and trying to have fun. You sound really disappointed.
Client: Yeah. I am. We were just trying to relax and enjoy the day and I was only about half into it.
3)Coach: Has that happened before, when you’ve been unable to fully enjoy the moment like that?
Client: Definitely! It seems to happen all the time. I keep thinking of what I didn’t get done around the house, and about what is still hanging incomplete at work. It’s almost like I can hear my parents, years ago, always pushing me hard to get all of my work done before I could do anything I wanted to do. They were really strict and on top of that they would forbid me to do most of the things I wanted to do anyway.
4) Coach: It must be extremely frustrating having thoughts like that get in the way today.
Client: Frustrating indeed. When I think about them, and the hard time they gave my siblings and me I really can get upset.
5) Coach: Your tough upbringing was very real. It sounds painful to remember those experiences. Tell me more about how it gets in the way of you giving yourself permission to practice more self-care.
Client: I guess it keeps me from either planning something good for myself, like how I cancelled getting a massage again last week. Or, when I’m finally out there doing something I want to do to relax and unwind, I distract myself thinking of what I ‘should’ be doing.
6) Coach: Are you hearing how you are allowing all of that history to get in your way today, in the present?
Client: Yeah. That’s exactly what I’m doing.
7) Coach: How can I support you in making your own decisions about what’s good for you?

Looking At The Coaching

In this example our coach begins (1) by requesting clarification in a very neutral way. This allows the client to go further without having to go in the direction a question would have taken them. The coach then (2) responds empathically and reflects feeling. This gives the client permission to go further into the affective level. Attempting to help the client identify a pattern (3) the coach inquires about past experience with the same thing. The coach again (4) expresses empathy and reflects feeling. The coach is conveying to the client that they can handle talking about feelings. This enhances the coaching alliance and builds trust. The coach is also not jumping into problem solving and thereby dampening down the affect. Next (5) the coach validates the client’s reality and empathizes. The coach then requests clarification but does so in a directive way that nudges the client back to relevance to their Wellness Plan. The coach follows the client’s examples (6) by not asking for details, but instead by sharing an observation in a gentle confrontation with the client. Finally (7) the coach empowers the client to own their decision making power and enquires how they can provide support. More coaching would then follow.

Reflection of Feeling

Witnessing coaching being practiced in our Real Balance trainings (https://www.realbalance.com) and listening to hundreds of recordings of our students coaching, I can conclude that there is no doubt what coaching skill shows up the least: Reflection of Feeling. Coaching students, often blindly focus on problem solving and seem to continually make two huge blunders: 1) they forget to express empathic understanding, and 2) they seldom reflect feeling. By not doing these two things they miss tremendous opportunities to enhance the coaching process. When we do express empathy and reflect feeling we open the coaching conversation to the emotional realm. This provides a number of important advantages:

Acknowledging the Affective:

1) Builds trust and builds the coaching alliance. The client knows that they have a true and courageous ally who is not afraid to deal with what the client is feeling. The client doesn’t have to hide, they can be true to themselves. When the feelings of the client are honored and met with unconditional positive regard, instead of judgment, the coaching alliance deepens.
2) Validates what is figural for the client. In the Gestalt sense of awareness, the emotional component, when strong, is often figural (in front, most aware, occupying more of one’s consciousness). If this is avoided, coach and client struggle to focus on the “background”. This is acknowledging what is “real” for the client.
3) Taps into energy! Emotion is often described as energy in motion = E-motion. When the client makes more contact with their emotion, more energy is accessed and can be utilized in the coaching process.
4) Connects with motivation! We move on what we are passionate about. We also can address the fear that often results in lack of movement. Clients are not going to progress towards action when they are frozen with fear. Affect provides the fuel that allows values and priorities to be expressed.
5) Builds self-efficacy. One of Bandura’s four ways to build self-efficacy is termed Physiological States. Emotions, moods, physical reactions and stress levels influence our levels of confidence and our own personal evaluations of our abilities. Anxiety can foster self-doubt thereby lowering self-efficacy. As we help our clients to safely contact feelings and explore their life-relevance, the client learns that they have more control over emotions, and how to interpret and evaluate their emotional states. All of this can have a positive effect on their self-efficacy. As we know, self-efficacy, the degree to which one believes that they can affect change in their life, is pivotal to success in lifestyle improvement.

Reviewing these advantages we can see that when coach and client stick to just goal setting, reporting and accountability, and steer away from the emotional element, the result is a process that diminishes the coaching alliance, focuses on what is less important, lacks energy and motivation and fails to maximally build self-efficacy.

Find out more about coaching with emotions in these recources:

Kimsey-House, H., Kimsey-House, K., Sandahl, P., Whitworth, L. (2011) Co-Active Coaching: Changing Business, Transforming Lives. 3rd Ed. Nicholas Brealey America.

Williams, P. & Menendez, D. (2015) Becoming a Professional Life Coach: Lessons from the Institute for Life Coach Training, 2nd Ed. New York: W.W. Norton & Co. pp. 202-213.