Busting Out of Precontemplation: TTM and Wellness Coaching

James and Janice Prochaska were kind enough to edit the section of my new book Masterful Health & Wellness Coaching: Deepening Your Craft https://wholeperson.com/store/masterful-health-and-wellness-coaching.html that conveys how coaches can make use of their model for behavioral change – The Transtheoretical Model. I am deeply grateful to them for this. While many coaches are familiar with their work on the “Stages of Change” model, there is still much to be learned about how to apply it, especially when we look at the first stage of change – Precontemplation.

Here is a small section of the chapter from my book that addresses this coaching challenge.

The Precontemplation Stage

Imagine that your client has come to you as a referral from their physician or is there because of an employee wellness program incentive that will save them 20% on their health insurance premium. They are not enthused to see you and, despite some serious medical conditions, are not optimistic about coaching helping them to accomplish better health –something they have struggled with for years. They reluctantly tell a story of repeated failure attempts at weight loss, smoking cessation, etc. They would rather not even be talking about trying again to make changes happen. They know that their lifestyle habits are working against their health, but they have no confidence that another wellness program will help, or that they, themselves, would be successful at it.

They have not given up entirely. They do walk their dog every day and have joined friends in participating in a hiking group that gets out every other weekend. They are worried about the effect that secondhand smoke may have on their grandchildren whom they watch two days a week and are seeking more information about using nicotine patches as part of a tobacco cessation program. Yet, they believe that there is no way to change their eating habits and don’t even want to discuss this. They have made many attempts at dieting with the classic ‘yo-yo’ effect of weight loss followed by immediate regaining of those pounds. In TTM terms we could help our client to realize that they are in the Action Stage with becoming more active, and in the Preparation Stage with smoking cessation. When it comes to improving their diet as part of a weight loss effort however, they are entrenched in Pre-contemplation.

This illustration shows us that every client is a person with a complex set of attitudes, beliefs, behaviors, and experiences. Sometimes our clients are full of contradictions and paradoxes. Sometimes they are angry, frustrated, sad, dejected, or experiencing any combination of emotions. As we apply TTM theory we must remember that this theory aknowledges this complexity and as we help our clients to become aware of where they are at with the process of change, we must do so with compassion and sensitivity as well. This is especially true with Pre-contemplation.

A common misunderstanding about this stage is the belief that individuals don’t want to change. Rather, in Pre-contemplation individuals do not have the intention to change. “There is a big difference between wanting and intending (Prochaska J. a., 2016).”

“People in precontemplation are often labeled as being uncooperative, resistant, unmotivated, or not ready for behavior change programs. However, our research showed us that it was the health professionals who were not ready for the precontemplators.” (Prochaska J. a., 2016)

What is really going on for the precontemplator? As I heard a speaker at a lifestyle medicine conference put it, “the dream of better health goes to sleep”. The person may have reached a point in life where they stop evaluating how they have been living. Their self-efficacy is usually very low when it comes to changing a particular behavior, or a group of behaviors that might be necessary for improved health and wellbeing. What often gets in the way is what the Prochaskas have identified as ‘The Three D’s’.

The Three D’s of Precontemplation

1. Don’t know how: This is characterized by a lack of awareness or understanding of how the behavior change may benefit the individual or a lack of awareness of how not improving their lifestyle may bring them harm. The person may benefit from some healthy-living education. The Prochaskas make the point that education is not intended to result in Action. It is intended to move someone into Contemplation. The client may also not know what to do to begin a process of change. Their attempts at change in the past may have been lacking any real plan, support, or accountability.

2. Demoralization: Often our clients are stuck in uncertainty about their ability to change or they fear failure. This frequently arises from repeated attempts to change which have resulted in failure. They may identify causal attributions or reasons why they can’t change. (Not having enough willpower, not having the right genes, low self-efficacy based on repeated failure.). Our client is so discouraged that they don’t even want to consider taking on another attempt at change.

3. Defending: Sometimes our clients feel criticized by people in their lives about the way they are living an unhealthy lifestyle. Their tendency may be to defend or protect their current risky behavior. Defensive behavior is in fact most often a way of protecting independence or autonomy. They may do this by:

a. Turning inward: blaming themselves and/or retreating inward. We may see them withdrawing interpersonally and dis-attending (tuning out). They may internalize their blame, which leads to lower self-esteem and yet more demoralization.

b. Turning outward: blaming others, outward circumstances, etc. We may see them projecting the blame onto others. “My family won’t change the way they eat, so, how can I?” They may displace their own frustration by being angrier and more critical of others.

c. Coaches often hear their clients explaining away risky behaviors. They may rationalize why it is okay for them to maintain the status quo. We sometimes hear intellectualizing, using facts and data to justify bad habits. Everyone seems to know some person who lived to a ripe old age and reveled in exhibiting all of the health-risk behaviors they could.

One of the causal attributions that coaches frequently hear from the client in Precontemplation is that they lack motivation. As we saw in Chapter Six, our clients often have plenty of sources of motivation, but have been lacking the “vehicle” – the behavioral change methodology, the structure that coaching can provide – to put that motivation to work. They have usually participated in action-oriented programs that urged them to start making huge changes in their lives quite suddenly.

The beauty of the TTM approach is that it honors where the person is and helps them gradually progress to where action and success can happen. The Prochaskas direct us to provide hope for our clients. Having a behavioral change ally and the support of that coaching alliance combined with a solid behavioral change process can offer so much more hope than simply trying again to change as our client has before.

By honoring client autonomy, we can avoid bringing out defensiveness in our clients. The last thing a client wants to hear is someone telling them that they are living their lives in the wrong way. There is a story behind every behavior. Our client may have any number of Social and Environmental Determinants of Health that make lifestyle improvement very challenging. The key is to help our client frame these factors as just that – challenges ‒ and offer our coaching alliance as a way to co-create strategies to deal with them.

Perhaps another strategy to consider for reducing defensiveness is to move away from the health-risk reduction approach to wellness. Instead focus on building healthy behaviors that the client is attracted to. Help them build on their strengths and engage in experiments that will result in easily achieved success at behavior change. Help them to examine their own belief systems and get in touch with positive sources of motivation.

Masterful Moment

When the more masterful coach hears justifications coming from their client, they are alerted to reflect on how they have been coaching with this person. Have they been saying anything to bring out a defensive posture? Have they been pushing their own agenda of reducing health risks too hard? Are they becoming too directive and not co-creating the conversation with their client?

Creating Forward Momentum – From Precontemplation to Contemplation

In Precontemplation our client most likely considers lifestyle improvement ever so briefly, then dismisses it.  How do we get our client not to jump into swift action, but to merely give change serious consideration, to contemplate it?  TTM offers three primary methods to help coaches tackle this imposing challenge: raising the pros while reducing the cons of change; dramatic relief; and consciousness raising.

The First Principle of Progress: Increasing Pros to Move from Precontemplation to Contemplation

Why would anyone begin to change when the reasons against such an endeavor outweigh the perceived benefits that might result?  How do we do so without a campaign of persuasion (which most likely will not work)?   Have you ever tried to convince someone to be well?  Clearly the pros of changing must outweigh the cons, but how do we help our clients to discover this?  This is where considerable coaching skill is required.

At the start of Precontemplation the cons are high, and the pros are low.  This is how our client perceives themselves and their situation.  As we begin coaching, we start with an open phase of exploration and encourage the client to engage in a process of self-assessment.  By not rushing to set up goals and action steps we avoid pushing the client beyond their stage of readiness.  The more coach and client explore together the more apparent the stage of change emerges for each behavior that is being considered for change.  The Precontemplation Stage shows up in our client’s language.  We hear our client make the case for why they believe they cannot change a particular behavior and/or do not want to.  The list of cons is recited sometimes with a sense of helplessness, sometimes defensively.  This part of the client’s story needs to be met with compassionate understanding, but not collusion.  That is, the coach can empathize but not agree with the client that change is so terribly difficult.  Reframing it as a challenge can be important here.

The coach proceeds in the coaching conversation not with the goal of stimulating the client into action, but simply to get them thinking – to weigh the pros and cons.  We can do so by:

  1. Offering education. The Prochaskas do this by providing clients with extensive lists of the benefits of various lifestyle improvements.  The wellness coach may offer other resources or help the client to find more information on their own and make those efforts part of the coaching process.
  2. Challenging assumptions. James Prochaska is fond of saying that people too often underestimate the benefits and overestimate the costs of change.  If our client appears to be operating on an assumption about what would be involved in making changes, it’s a perfect time to call out the assumption.  Again, a great line for the coach is “So, how do you know that to be true?”  This can build into a powerful coaching conversation about re-evaluating their pros and cons.
  3. Engaging in Decisional Balance.  In the context of coaching, this would be a coaching conversation exploring with our client the pros and cons of change.  We can help our client to list the advantages and benefits of change that they are aware of.  We can help them list the ways in which change may lead to disadvantages or penalties in their life.  The Prochaskas were able to develop brief assessments of six to eight questions to help with this process (Prochaska J. a., 2016).  As they researched decisional balance they came to an important realization.  “Although we didn’t realize it for some time, we were also discovering that making the decision to change one’s behavior for improved health was nowhere near as rational and empirical as we had assumed.  Nor was it nearly as conscious.” (Prochaska J. a., 2016)

 Prochaska, James, and Prochaska, Janice (2016). Changing to Thrive: using the stages of change to overcome the top threats to your health and happiness. Center City, MN: Hazelden Publishing. https://jprochaska.com/books/changing-to-thrive-book/  

Find much more about how to coach someone from Precontemplation to Contemplation in Chapter Eight of Masterful Health & Wellness Coaching: Deepening Your Craft, by Dr. Michael Arloski https://wholeperson.com/store/masterful-health-and-wellness-coaching.html.

Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness – a world leader in health and wellness coach training.  (www.realbalance.com). Doctor Arloski is a pioneering architect of the field of health and wellness coaching. He and his company have trained thousands of coaches around the world.


Positivity and Perspective Needed in These Times

What we see depends upon our perspective.

It is easy to feel under bombardment today with news of COVID-19, economic chaos, and all of the fallout that reaches into our communities, our families and our lives. There can be a sense of negative overwhelm that can seem inescapable. This is true for us as well as for our wellness coaching clients. We all know that dwelling on the negative is not good for our mental or physical health, yet how can we deny reality?

Positivity is not about denying the challenges we face, the losses we suffer and the pain we feel. It is not about self-deception. It is, however about the ratio of our negative thoughts to our more positive thoughts. Researcher Barbara Fredrickson pioneered what is known as the Positivity Ratio (https://www.positivityratio.com). She contends that we do need to accept that negative emotions are quite real. She also admits that our more positive emotions are often rather fleeting. Rather than focus on how they come and go, she urges us to notice their quantity. The key is to balance the negative thoughts and feelings with the positive ones. While her positivity ratio of three positive thoughts to one negative thought has come under critique, there can be no doubt that seeking some kind of more positive balance can contribute to our wellbeing.

As you go about your day more mindfully:

Begin your day with a morning ritual that includes calm awareness of your surroundings; a practice of gratitude; a kind and gentle transition as you wake up.
Focus on positive information as you check in with the rest of the world. Don’t ignore the news but consider whether you want to begin your day with all of the heart-breaking stories that lead.
• As your day unfolds remain in a state of gentle self-vigilance about your thought patterns. Seek that balance of positive to negative. Catch yourself when you find sarcasm and cynicism emerging.
As you deal with negative events seek to put them into perspective. Recall how you have been resilient enough to make it through difficult times in the past. Realize that all things will pass.

Coaching has developed the skill of re-framing to help our clients to see things from new perspectives. Re-framing is, again, not self-deception. It is not about denial. It is about seeking out the upside, the potential for viewing and experiencing an event through the lens of new and other possibilities. We have all experienced blessings in disguise. Unfortunately, the disguises are sometimes quite painful at first. Then we see how they may have worked out for our best.

Before we re-frame it is critical to acknowledge what is real. For ourselves and when we coach with a client, First Acknowledge, Validate and Empathize (https://wp.me/pUi2y-bZ). Allow feelings to be felt, honored, and validated. It’s okay to feel the way you feel. Then, you can move on to seeking a way to re-frame. Pushing to re-frame too quickly is often perceived as dismissing one’s feelings. “Come on. Cheer up!” No one wants to hear that when we are in the midst of pain. Once feelings have been honored, then you can help the person (or yourself) to gain a new perspective and move forward with their (our) lives.

On the Real Balance Global Wellness homepage you will find the video of the Real Balance April Free Monthly Webinar: “Wellness Coaching In The Time Of Covid -19: Self-care and Helping Others” with special guests Drs. James & Janice Prochaska and Dr. Pat Williams (https://realbalance.com).  Be sure to watch this excellent hour-long video.  CEU’s are available upon completing watching it.  For further questions re: this inquire to deborah@realbalance.com.  


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.


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)

Coaching a Client Through To A Mental Health Referral Using The Stages of Change

Times arise when it becomes apparent to a wellness coach that their client would benefit from working with a mental health professional. The need for referral may be urgent and involve client safety as when there is a threat of harm to self or others. That rare situation is usually more clearly recognized, referral is made and coaching is usually terminated. (“Top Ten Indicators to Refer a Client to a Mental Health Professional.” This can be found in the Wellness Resources section of the Real Balance website:https://www.realbalance.com/wellness-resources ) (See also this previous post: The Wellness Coach And Referring Clients To A Mental Health Professional: PART ONE – WHEN (http://wp.me/pUi2y-bA) )

More common is the situation where the client raises issues where there is no immediate danger or threat, but rather, there is either a history of unfinished emotional issues, or there are current circumstances that are creating barriers for the client’s effectiveness at succeeding at lifestyle improvement. In such situations, having a thorough working knowledge of the difference between coaching and therapy is essential for a professional coach. The best possible resource for this is this article by Meg Jordan and John Livingstone (https://www.realbalance.com/wellness-resources).

Resolution Vs. Relevance

How is the past affecting the present?

The first step would be for the coach to explore with the client to see if they are currently in therapy for these kinds of issues, or have been in the past. Then, the coach and client may be able to explore if they can coach about these issues, not to resolve them, but to see how they obstruct progress in the client’s efforts at lifestyle improvement. Can they be accounted for and worked with in coaching, or are the challenges so great that they will actually prevent progress in the coaching?

Well-trained coaches can do process coaching. 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 client repeatedly holds themselves back from engaging in the wellness/self-care activities that the coach and client create as action steps in their wellness plan. As this is discussed 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. Now, the goal of doing process coaching around this is not the resolution of all of the feelings and unfinished business with that parent (be they dead or alive). Instead, it is to 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.

In such cases or if the issues are beyond the scope of coaching and are interfering with client progress, then exploring making a referral needs to begin. How to make this referral successfully is not as simple as explaining the benefits of therapy and providing resource information. Very often clients are ambivalent, or even outright resistive to a referral to a mental health professional. The thought of reconnecting with all of the unpleasant emotion involved in working directly on their issues in therapy brings up fear. Unfortunately, coaches sometimes drop such a client quickly when they are not ready to jump into action and seek out the therapy they would benefit from. This is where a client would benefit from a coach who implements a Stages of Change approach (The Transtheoretical Model of Change developed by James Prochaska).

In the new book by James and Janice Prochaska Changing To Thrive (https://www.prochange.com/uncategorized/2017/02/prochaskas-new-book-changing-thrive-published), they make the point that most of the people we all work with are not in the action stage of change on any particular behavior. They estimate that only about 20% are actually ready to jump into action. Why would this be any different when it comes to engaging in counseling or psychotherapy? Yet, so often, when the client balks at following through on a psychological referral, coaching is abandoned. Instead, think of it as our job to help the person to weigh the pros and cons of engaging in counseling as they sit in the Contemplation Stage of Change. We are helping them with Decisional Balance. Taking a page from Motivational Interviewing, we coach as they work through their Ambivalence. We want to “roll with resistance” instead of accepting it as a rejection of our referral recommendation.

Coach THROUGH to referral!

Coach: So, I hear your hesitance when I suggest that counseling might be the best way forward with this.
Client: Well, yes. I’ve been in counseling before and I don’t know if I want to open up that whole issue again.
Coach: Sounds like you possibly have some fear about talking about such uncomfortable subjects again.
Client: Yeah. Growing up in my home was not a pleasant thing!
Coach: I know it holds a lot of negative memories for you. You’ve shared some stories about how bad it was. Yet, I also hear you saying that it’s frustrating to have these things hold you back from doing what you want to do today to be healthy and well.
Client: Right! It’s really frustrating! I know I need to get more active and take more time to eat right, but then I feel so guilty when I take time for myself.
Coach: So, on the one hand you really want to make these improvements to your lifestyle, but when you attempt to do so, these barriers, these thoughts get in the way.
Client: Exactly! I appreciate your help, but it seems like whenever we set up action steps, I never follow through on them, even though I know I need to.
Coach: Yes, we’ve explored how it’s all related, but we still seem stuck. What do you think would be the benefits if you did get back into counseling about this?
Client: Well, I guess I could really open up about it and try to unload some of this frustration. I’m just so tired of having the past hold me prisoner!
Coach: So a counselor could actually help you explore that and really make some progress in this area, perhaps result in some relief.
Client: Yeah. Okay. So what’s next?
Coach: Well, let’s work together on reconnecting you with some counseling. Let’s see what steps you can take to find the resources you need.

In this example the coach meets the client where they are. They help their client to Contemplate the idea of returning to counseling. Acknowledging the client’s fears and validating their feelings, the coach helps the client to begin to weigh the reasons to return to counseling and the reasons to avoid it. The family of origin stories are referenced, but not delved into. Instead, the emphasis is on relevance. How the past is getting in the way of the present is the essence of the contemplation. Then, at the end of the example we begin to move into the next Stage of Change; Preparation.

Coaching works because we are the client’s ally through the whole behavior change process. When referral comes up, we remain their ally. Then to help them actually follow through and make it to the referral resource, we help them with the process of identifying such resources, making the appointment, and attending the appointment. We offer support and accountability with all of the action steps required to achieve this preparation. We acknowledge the courage, the valuing of one’s self that is required for each step along the way.

James & Janice Prochaska with Michael Arloski

Take what you know about the Transtheoretical Model of Change (Stages of Change) and apply it to the referral process. Be your client’s ally when they need you the most.


SPECIAL ANNOUNCEMENT:  James and Janice Prochaska will be Dr. Arloski’s guests on the Real Balance Free Monthly Webinar – May 26 at Noon Eastern Time.  This will be a special one-hour webinar where the Prochaska’s will be sharing their breakthrough work from their new book CHANGING TO THRIVE.

“Changing To Thrive: Using the Stages of Change to Overcome the Top Threats To Your Health and Happiness” An Interview with James and Janice ProchaskaRegistration URL: Registration URL: https://zoom.us/webinar/register/bd820be2db187da1c5b9141539e44ee6

Nine Keys To Readiness For Change And Improving Your Lifestyle

Are we "ready" or are we "stuck" when it comes to change?

“People don’t change until they are ready to.”
James Prochaska

Lifestyle improvement is all about change, as we explored in our last post. When it comes to changing our thoughts, beliefs, and our behavior, the big question immediately becomes “How ready are you to change?”. The answer is not a simple yes or no, and extensive theories have arisen around this question.

The most important step for the person looking to improve their lifestyle (or the wellness pro helping them) is to ASK THE QUESTION: “How Ready Am I to Change?”. If we ignore the factor of “readiness” and forge ahead with a “call to action” we may just fall on our faces. The Transtheoretical Model of change (TTM) or “Stages of Change Theory” (best explored in Changing for Good, by James Prochaska, Carlo DiClemente, and James Norcross) dominates the wellness and health promotion field, as well as the addictions field, and for good reason. This model provides vital understanding of some fundamental aspects of change. For an excellent exploration of it in depth check out this great blogpost by Temple Univ. prof. Jonathan Singer: http://socialworkpodcast.blogspot.com/2009/10/prochaska-and-diclementes-stages-of.html

“Theory is extremely useful, because your theory determines what you can see.” Albert Einstein

I’ll be honest. When I first heard about Readiness for Change Theory and heard James Prochaska speak at The National Wellness Conference, I was not impressed. It seemed so simple and obvious that to bother stating it all in an elaborate theory hardly seemed worth the effort. “People don’t change until they are ready to.” Well, duhhhh! Then it hit me. Wait a minute. In healthcare, and all related fields, that’s not what we are saying to our clients and patients. We’re saying “Change now!” and completely ignoring looking at where they are truly at in this process of change.

As I became trained as a professional life coach I realized that the coaching field was ignorant of this theory as well. We were taught to “request action” much too early in the process. Today, competent life coach training schools such as The Institute for Life Coach Training (www.lifecoachtraining.com) and wellness coaching schools such as Real Balance Global Wellness Services (www.realbalance.com) have caught on and have integrated TTM into their curriculum.

“Change is a process, not an event.” James Prochaska

So what does “Readiness For Change” theory mean for the “man (or woman) on the street” who wants to improve their lifestyle? Here’s some basics to keep in mind as you work on change and growth.

1. There are six stages of change and it’s important to give each stage it’s due.
* Pre-contemplation – Haven’t even thought about change, am unaware of any need to change
* Contemplation – Am giving it some thought
* Preparation – Am preparing to change, finding out more information, checking resources and options
* Action – Actually making the change
* Maintenance – maintaining the change
* Termination (or Adoption) – the new behaviors/thoughts are part of me now, I don’t need to constantly “work at it”.

• 2. We can be at a different stage of change for each different behavior. I may, for example, be ready to start improving my activity level and improving my diet, but I’m not ready to quit smoking. Change is not a light switch. We aren’t as a whole person either “ready” or “not ready” to change.

• 3. The change process is often like a spiral staircase. We ascend up from pre-contemplation to contemplation and then to preparation, etc. We also can get discouraged, slip and spiral back down to earlier levels where we have to “pick ourselves up, dust ourselves off, start all over again” (to quote an old song).
• 4. Change is not just about will power and determination. It is a process that takes time to do right. Especially when we are talking about lifestyle behaviors that may have been in place for many years, just getting up a bunch of will power and thinking that we can suddenly change may be a very disappointing route to go. Instead see it as a process and give yourself credit for moving through each stage of change.
• 5. If you’re stuck at one stage, get an ally to help. The “forever-contemplating” or “forever-preparing” person may look like they are working on change, but the truth is they are stuck! Talk about it with people who you know will be supportive of your growth, not negative or pushing their own agenda of how you “should” change. Get a coach!
• 6. To maintain the change keep track of it! Taking action is great, but the key is maintaining it. I’ve had a number of wellness coaching clients tell me “I’m great at losing weight! I just can’t seem to keep it off.” Recording your new behavior, in someway that works for you, is a real secret of successful change. Don’t let it be a subjective estimation, get serious about self-monitoring and you’ll see more results.
• 7. Start where there’s motivation, readiness and likelihood of success. Don’t start climbing mountains by choosing the “Mount Everest” of your life first! Go for the more achievable and attainable goals where you are motivated to change first. Gain confidence and self-efficacy there and then take on the more challenging climbs.
• 8. Nothing succeeds like success! When you’ve achieved real progress in one area of your life, look at how ready you are now to improve your lifestyle in another area. Once you’ve seen success in being more active and eating better, take on getting more sleep or practicing relaxation training, etc. Take yourself through the Stages of Change from wherever you start, on up that spiral staircase.
• 9. No model has it all figured out. Even the much-revered TTM has it’s critics. We don’t always go through these stages of change in a nice neat manner. Sometimes change does happen as what seems like an event! We’ve all seen times when circumstances and motivation peaked and “cold turkey” success was achieved with great pride! So no single model can explain this incredibly complex phenomenon of change.

We’ll continue to explore more about what it takes to improve your lifestyle and succeed at change in future posts. We’ll also explore other areas of wellness and keep it grounded in what can really make a difference in your life.

“I don’t want to hear any philosophy that won’t grow corn.”
Sun Bear, Native American Teacher