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.

China Embraces Real Balance Wellness Coaching

Real Balance Wellness & Health Coach Certification Class in Shanghai – 2017

Faced with the same lifestyle-based health crisis many other countries are experiencing, China has been searching for a way to help people truly succeed at lasting lifestyle change. Over half of the men in China smoke. The diabetes rate is now higher than the United States, with heart disease, COPD and other “lifestyle diseases” on the rise. Health information campaigns and medical admonition, as elsewhere, has only gone so far. Last month when Real Balance Global Wellness Services, Inc. (https://www.realbalance.com) teamed up with Chestnut Global Partners China EAP (http://chestnutglobalpartners.org) to bring live wellness and health coach certification training to China it was enthusiastically embraced.

The concept of wellness is new to China, and wellness & health coaching is even newer. Though there is a long tradition of Traditional Chinese Medicine that blends with Allopathic Conventional Medicine, these are still remedial treatments and do not address how to help someone improve lifestyle behavior. Smoking cessation programs are vigorous but face a huge challenge in this population. Wellness coaching provides an innovative way to make behavioral change possible for those who need it.

What impressed me most about my entire trip to China were the students in our live training in Shanghai. The class was composed partly of Chestnut Global Partners EAP employees. These were mostly physicians and department directors. The rest of the class was a mix of M.D.’s, dieticians, counselors, Human Resources professionals and even a few independent life coaches. Throughout our grueling six-day training their level of engagement was extraordinary. While all students are faced with the “mindset shift” challenge (going from a prescriptive, consultative way of interacting, to a coach approach), this group did so with less resistance than we anticipated. They really got the concept that when it comes to helping people change behavior, it is very different from treatment or education. Fortunately, the training I delivered was coordinated with my translator and co-trainer, Dr. Li Peizhong, psychologist and V.P. of Chestnut Global China. He performed live translation as I spoke, and added greatly to the interaction and processing.

All of our trainings are highly interactive, and when students shared information and stories of work they had done with patients and clients, the level of humor employed was amazing! Much was “lost in translation” for me, but they were continually breaking out into boisterous laughter. Also, the Chinese students were more natural in their continual use of empathy in their coaching practice. While they tended, like students everywhere (we’ve found), to jump right into problem solving first, they used empathy and spoke of the importance of it, more than any other group I have trained.

Chinese culture is well known for valuing the group. As our training went on, group cohesion increased rapidly. Students supported one another in their learning through a real sense of caring for one another. When one student volunteered to be our client for a round of “fishbowl coaching” practice (where a student works on a real life challenge and is coached by a number of students) she left the exercise still perplexed about a way forward. Students formed a circle around our volunteer student and spent their entire break time collectively discussing with her about how to address her challenge.

The other evidence of this collective spirit was in the almost instant formation of a class group on the app WeChat. Before the training was even finished, and then vigorously once it was complete, they were on WeChat (http://www.wechat.com/en/) connecting, lining up their Buddy Coaching, and then sharing photos and stories of how they were following through on their own lifestyle improvement action steps.

Practicing Tai Chi On The Great Wall

The students were unbelievably appreciative, kind and treated me like royalty. I had integrated some of my Tai Chi and Xi Gung practice into our energy breaks, much to the delight of the students. At the conclusion of the training, at our celebratory class dinner they gifted me with a beautiful white Tai Chi practice suit to show their appreciation.

On To Beijing!

After our training in Shanghai, we flew to the country’s capital, Beijing, for a special Book Release Event. At Peking University (yes, it is spelled differently), Chestnut Global and my publisher, The China Translation & Publishing House, hosted a large gathering of executives from several multi-national corporations, representatives of the Chinese government’s smoking cessation program, and others, to witness the release of my book, Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., (https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml)  in its Mandarin translation. Speakers from Chestnut Global, Peking University, and the government’s smoking cessation program joined me in delivering talks to the very receptive audience. This was followed by one astonishing Chinese banquet.

A World of Wellness

I have been fortunate to take our training to a number of countries around the world and each experience has been special. The beautiful thing is that whether it is a training session in Indianapolis, Sao Paulo, Dublin, Shanghai, or Fort Collins, our students know that this training is going to make their work so much more effective. They know it is going to make their work so much easier, and more rewarding. They know it is going to help them enhance the lives of others.

I’ve stood at the front of the room around the globe, but it is the people who stand behind me that really make it all possible. It’s the allies we’ve formed in other countries and it’s the people right here at home. I’m able to write books and deliver keynotes and trainings because others are operating the office, servicing our students, teaching classes and representing Real Balance to the world as well. I come back from China with a heart full of hope for the people of our planet and with gratitude for those who help me step out there and make it a better place.

Real Balance GLOBAL – Taking Wellness Coaching To China

Taking Wellness Worldwide
Taking Wellness Worldwide

What The World Health Organization dubbed “Lifestyle Disease” is a global phenomenon. The increase of non-communicable disease is going up the fastest in what is sometimes called the developing countries of the world. “Twenty-five years ago, the number of people with diabetes in China was less than one percent. Today, China has more than 114 million people suffering from the disease, the highest number of any country in the world. It is estimated that 11.6 percent of Chinese adults have diabetes, a proportion higher than the U.S. with 11.3 percent. Experts blame the increase in sedentary lifestyles, high consumption of sugary and high-calorie Western diets, excessive smoking and lack of exercise.” (http://www.counterpunch.org/2015/07/24/the-increasing-burden-of-diabetes-in-china/)

From the very start of my work in developing the field of wellness coaching my vision was to bring wellness worldwide. Real Balance Global Wellness Services, Inc. (http://www.realbalance.com) has now trained over 6,000 health and wellness coaches around the globe. We have trainers in Ireland, Brazil and Australia. We have trained people from places like Dubai, Ethiopia, Hong Kong, Denmark, Korea, and many more countries through our fully-interactive webinar trainings.

shanghai0515-cityscapeNow we are continuing with our global mission by TAKING WELLNESS COACHING TO CHINA ! We are proud to announce that Real Balance is teaming up with Chestnut Global China EAP (http://chestnutglobalpartners.org) to bring wellness and health coach certification training to China! I will deliver a certification training in Shanghai March 14-19, and then travel on to Beijing to promote wellness coaching and do a book signing.

2nd Ed Cover - MedThe book I will be signing in Beijing is Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., newly translated into Mandarin and published in China! The challenges of “lifestyle disease” are rapidly increasing in China as more people move to urban areas, diets change, smoking continues to increase, culture shifts and stress increases as well. Helping people gain access to allies that can help them succeed at lifestyle improvement is just as important here as anywhere else.

We are exploring other ways to connect with people around the world to contribute to the health of the planet and its people. Please be a part of creating Allies For A Healthy World.

broadmoorcolospringsBack In The U.S.A.

Please join us in beautiful Colorado Springs, at The Art & Science of Health Promotion Conference (https://www.healthpromotionconference.com).  March 27-31.
Real Balance will be exhibiting there and I will be delivering two workshops: “Five Key Coaching Skills For Motivating Sustainable Lifestyle Improvement”, and “Mastering The Science and Craft of Health & Wellness Coaching: Higher-Level Methods And Skills.” See you there!

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

Just How Directive Do We Need To Be?
Just How Directive Do We Need To Be?

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

Carl Rogers 1902-1987
Carl Rogers 1902-1987

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

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

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

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

The Coach Approach Grew Out Of Being Client-Centered

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

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

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

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

Here’s what effective directive coaching sounds like:

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

continuumdThe Directive-Non-Directive Continuum

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

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

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

Overly Non-Directive Coaching

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

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

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

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

Overly Directive Coaching

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

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

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

The Coaching Spectrum
The Coaching Spectrum

How To Keep Directive Coaching Client-Centered

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

Adjusting To The Client

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

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

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

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

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

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

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

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

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

What they found was frankly, not a lot.

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

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

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

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

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

Healthy Choices For A Lifetime
Healthy Choices For A Lifetime

The Five Keys of Coaching For A Lifetime of Wellness

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

1. Build Self-Efficacy

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

2. Nurture Visionary & Intrinsic Motivationgreen nature_wood path

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

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

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

3. Focus On The Maintenance Stage (TTM)

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

4. Co-create Relapse Prevention Strategies1369010631_url

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

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

5. Coach For Connectedness

Real Balance Faculty At The National Wellness Conference
Real Balance Faculty At The National Wellness Conference

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

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

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

Refining Coaching Linguistics: Verbal Tics, Placeholders and Fingerprint Words

linguistics-660x330
In a recent New York Times article, writer Gregg Easterbrook shared this observation of modern day speech. “The verbal tic of saying “real quick” is surging ahead of “you know” in the American lexicon. “You know” is an empty expression, a verbal placeholder. By contrast, “real quick” has significance, reflecting the continuing acceleration of life. “Good morning, I would like to order an espresso please” now is “real quick can I get an espresso?” People who once said “perhaps we should meet in the conference room to review the project” say “real quick what’s up with the project?” Insertion of “real quick” assures the interlocutor (a person who takes part in a dialogue or conversation) that the pain of actually listening to someone soon will be over, and multitasking can resume.”

I was first shocked into awareness of my favorite placeholder when, as a late teenager, a very astute young woman on the phone with me said “Oh my God! You just said seventeen “you know’s”! It was an embarrassing encounter with a verbal habit I hadn’t even been aware of. As I studied psychology and counseling, tape recordings and videotapes revealed other linguistic repetitions of mine so I could work on jettisoning my reflexive verbal placeholders from my work.

Listening to hundreds of recordings of wellness coaches in action, I’m often reminding Real Balance students to catch their own verbal tics. Saying “Okay”, or some equivalent, quickly after one’s client speaks is often a way to let the client know that we are tracking with them. When psychologist Allen Ivey taught “Micro-Counseling” skills he referred to such words, as well as head nods and “mmhh hmm’s”, as “minimal encourages”. Such responses by the counselor or coach encourage the client to go on. The trouble is…they often do!

person-speaking-to-another-personThe downside of the “Okay” type response, especially when it is reflexive, is that it is a very quick signal to the client to keep on talking. The result with the overly talkative client is like a quick squirt of gasoline on an already hot fire. The client continues to hold the floor, often rambles, and the coach has an extremely hard time saying anything. The conversation is no longer a conversation, but a monologue. The client uses their own “placeholders”, saying “you know”, drawing out words, and speaking in ways that keep the “talking stick” in their own hand. Respectful interruption is needed, but even that may be hard to do after we have already primed the client to keep talking with our “Okay’s”.

Listening to recordings of themselves coaching also helps coaches discover their own“fingerprint words”.

Fingerprint Words
Fingerprint Words

A coach may discover that they have pet words that they use over and over again. Often these words are a bit esoteric and can confuse the client if they are not part of that person’s common usage. Again, we do this without even being aware of it. The fingerprints may have a healthcare flavor, or be the trending words of current business-speak. Leveraging, optimize, or cognizant and the like, are words that, when used habitually not only become like identifying fingerprints of ours, they sometimes are unintended turn-offs to our clients.

On the other hand identifying the fingerprint words of our clients can be very helpful. While the intent of fingerprint words, especially ones that seem to reflect higher levels of education, may be to distinguish one’s self from the common folk, they can also have less snobbish meaning. A very powerful coaching technique is to identify such fingerprint words and when we see them used in a context that reflects emotional and/or strategic importance to our client, and then to feed this back to our client for them to consider. “Are you aware that each time you speak about taking time for self-care in any way you use the word indulgent?”

Our loquacious client’s vocabulary may be abundant, but quite natural for them. Even with Ph.D. behind my name and high scores on vocabulary tests, this American-educated soul was quite humbled reading The London Times in depth (dictionary at hand). Fingerprint words aren’t just unfamiliar words, but ones the client uses often, ones that leave their own “fingerprint” on a conversation. So it’s not usually the “twenty-five cent” words one uses, but more the ones we wear in our conversation like a tattoo on our forehead.

We sometimes pick up fingerprint words when we read or hear them in use and in some way identify with the author or speaker, or the context they are used in. We want to be like them and we start using the same key words, often without even realizing it.

When coaching and we encounter someone whose speech is different than ours, we are faced with a somewhat delicate situation. Sociolinguistics professor Diana Boxer says that in such situations we usually respond in one of two ways. “We either start to mimic them in some way, or distinguish ourselves from their usage.” We want to be careful not to send a message that we are being condescending, or patronizing. We need to ask ourselves how natural it feels to speak in ways that are more similar to our client. In coaching we want to always convey that our relationship is one of allies. Clients realize that there may be differences in speech and expression and don’t expect or even want us to alter who we are in order to communicate with them.

There is more to the ICF Core Coaching Competency of Communicating Effectively (http://coachfederation.org/credential/landing.cfm?ItemNumber=2206) than we often think. Coaches who are developing real proficiency in their work are scholars of language and communication. We study it because we know its power.

 

The Bigger Mindset Shift: Waking Up To Lasting Lifestyle Improvement

Wake up to a whole new way forward!
Wake up to a whole new way forward!

Just back from a whirlwind of professional travel, I’m struck by a pervasive awakening that our health is largely behavioral, and if we truly want to improve health worldwide, we must seek methods that support success at lasting lifestyle improvement. At the Lifestyle Medicine 2015 Conference http://lifestylemedicine2015.org, where I presented, we saw that the medical profession is embracing wellness & health coaching as never before. In Europe we witnessed increasing interest in how to integrate wellness coaching into health systems and medical training. In the large disease management company where I just delivered a week of training, there is truly a mindset shift from a consultant style of helping relationship using simple goal-setting to an integrative model based on the Real Balance Wellness Mapping 360°™ Methodology https://www.realbalance.com.

Real Balance Wellness & Health Coach Certification Training is continually fostering “making the mindset shift” – going from “prescribe & treat” or “educate and implore” to the coaching mindset of “advocate and inspire”. We repeatedly emphasize the importance of shifting from the Consultant role to that of a true Coach. The recognition that assisting people in succeeding in behavioral change is a very different process than sharing medical, educative or other expertise, is starting to take hold stronger than ever.

Making The Mindset Shift is our way of saying Wake Up and realize that co-creating wellness is the way forward.nature-landscape-path-walkway-mist-mountain-grass-sunrise-river-clouds-water-1920x1200

A co-creative way of working with people honors their inner wisdom, acknowledges the contextual factors that facilitate or inhibit lifestyle improvement while honoring and celebrating differences. Co-creation allows a person to be the expert in their own life, and yet does not send them out to climb the mountain alone. It is our commitment to accompany them on the journey providing support, guidance, tools, and our expertise in changing lifestyle behavior.

It is easy to feel overwhelmed by the increasing “lifestyle disease” health statistics documented by the World Health Organization. As we see budgets (whether of families, states, provinces, companies or countries) plundered by chronic illness expenses we are also, finally pulling ourselves out of the floodwaters, reaching for higher ground, gaining perspective, and seeing that more of the same will just continue to drown us. There is a coalition of Wellness & Health Coaching, Wellness & Health Promotion, Lifestyle Medicine and other like-minded people with enough vision to see that lifestyle improvement, individually and collectively, will be what allows us to keep our heads above water, start to swim and return to the healthy place that seems like dry land. Please join us!

“Let’s get together and feel all right.”
One Love
By Bob Marley

Michael & Deborah Arloski in London
Michael & Deborah Arloski in London

Delivering The Behavioral Side Of Lifestyle Medicine Through Wellness Coaching

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

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

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

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

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

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

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

Lifestyle Medicine 2015
Lifestyle Medicine 2015

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

 

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

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

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

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

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

Overlap Of Treatment And Wellness Plans

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

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

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

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

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

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

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

 

Seven Expressions Of Courageous Coaching

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Courageous coaching! What would “courageous coaching” look like for you? There are many ways to approach the subject of courage in coaching. As a trainer of wellness & health coaches here are some of the ways I would like to see courage show up for the coaches we educate.

1. The Courage To Stand For NCRW- Naturally Creative, Resourceful And Whole

In the foundational coaching book Co-Active Coaching (http://www.thecoaches.com/why-cti/buy-the-book) , the authors say “We start with this assertion: people are, by their very nature, creative resourceful and whole.” They finish their paragraph with “In the Co-Active model it more than a belief – it is a stand we take.” I love the courage in that statement. When coaches are functioning at their best, serving their clients to the fullest, they are taking that stand. It is like a line drawn in the sand that coaches will defend against all who would ridicule, diagnose, or demean their clients or disenfranchise them of their human dignity. The power of this stand feels not only like the compassionate expression of unconditional positive regard, but like the solid feeling of someone who stand with you. Standing alone facing those who would treat you as broken, inadequate, and incapable, it is like the feeling of an ally stepping up from behind you and you feel their shoulder touching yours as you face your challenge together. The coach’s courage brings out your own.

The courage of the coach is called forth here as they work in systems that would still adhere to old diagnostic models that label people. The wellness field sometimes deals with its challenge of leveraging large numbers by labeling people as “high-risk”, “obese” (according to completely unreliable BMI charts), or by the tag of their health challenge (diabetic, etc.). Here our courage comes forth as we welcome that client and treat them, despite what others say, or even what the discouraged clients believes about themselves, as naturally creative, resourceful and whole. We may be the first person in a human-helper role who has treated them this way.

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

“You’ve got to REACH, a little bit higher!”

2. Courage To See The Potential In All And To Confront And Challenge

As we take this courageous stand to hold our clients to be naturally creative, resourceful and whole, there are times when we may believe this about our clients more than they believe it about themselves. Our clients come to us with lessened self-efficacy from repeated failure experiences and sometimes lack of support and even discouragement heaped upon them by others who did not see them as capable of much in their lives. From our perspective we may see possibilities and capabilities in our clients not evident to them. Here we can courageously confront and challenge our client to do more. As we demonstrate our belief and faith in our client’s abilities and capacities, they may rise to the challenge and succeed to a degree that surprises them.

Challenging clients to take a next step, to walk three times next week instead of two, to have that crucial conversation with their boss all hinges on the strength and depth of the coaching relationship. I challenge clients very little early on in coaching. As our alliance grows and they know that I am truly their ally, holding that their agenda is the only agenda, then a challenge is welcomed instead of mistrusted.

Coaches may also have to confront the unspoken conflicts that can arise in coaching. One of the bravest things that coaches do is to invite exploration of how can the coaching be improved. Right in the middle of the coaching process coaches will ask how they can work better with their clients. When coaches tune in to the tone of voice, to the increasing resistance, to the “agreements” made to new action steps that are mouthed in lukewarm fashion of compliance instead of embraced with motivation, the wise coach is alerted that the basic coaching relationship needs attention. The courageous coach then talks about “the elephant in the living room” and clears the air.

It may take real courage to make a referral. It’s easier, at first, to just ignore or minimize how our client is struggling. We may fear that our client will be offended, or that they will no longer like or trust us. We may try to fake our competency in areas where we are insufficiently prepared. Such coaches make numerous suggestions for solutions, whether the issues are nutritional questions or more psychological in nature. We have to be courageous enough to say “I don’t know.” We have to hold the client’s safety and wellbeing far above our own fears.

3. Courage To Do Process Coaching4806502-hands-reaching-out-for-each-other

Research tells us that 60% of all decisions are made emotionally, not logically. Emotion permeates the experience of working on changing our behavior. When we strive to change our belief systems (like the person who has always believed they must please others all the time and finally realizes that managing their own stress means saying “no” at times) there is always an emotional component. In wellness & health coaching we almost always encounter the emotional side of life as our clients deal with attempting work no body image, success and failure experiences, etc. Thinking that coaching is just a process of logically formulating plans, setting “goals for the week” and holding people accountable to those goals is not only naive, it is actually condescending, dismissive and disrespectful. So, coaches must be skilled in the art of process coaching, helping people process emotion so they can connect it to motivation and action.

Beyond the skills required for process coaching, is the courage to enter the world of emotions with one’s client. Certainly the confidence that comes from learning and practicing such skills enables the emergence of the courage we need. However, there is more than just confidence involved here. Can the coach face his or her own fears around dealing with emotion? Is the coach grounded enough in their own emotional balance to stay centered as they walk down the path of emotion with their client? Can the coach distinguish between the emotion of the client and their own feelings? Can the coach realize how safe they, themselves, truly are as their client deals with feelings?

We might call it emotional maturity coming from life experience. When one has learned from processing their own feelings, gained insights and applied those insights to their lives, fears around emotion lessen. Overcoming family of origin programming around such fears can be very challenging. If we can just learn that feelings are our allies, not our enemies, we can open up to the growth process that allows us to gain such maturity.

dcaa3213091a04451cbf0aaff27a3f5d4. Courage To Dance In The Moment

When my wife and I go dancing (as we love to do), I often listen to the music for a few bars and decide if it’s a number that suites our style before I propose getting out on the floor. In coaching it’s more like being out on the floor already and going with whatever music is played! As our clients conduct the band, the music can shift at any time. The client who seemed to simply be working on smoking cessation is suddenly talking about the profound sense of loss that has come from avoiding their old smoking companions during breaks. Dance with it!

It takes courage to go “out on the dance floor” when you don’t know what will happen next. Be centered in the confidence you have in your skills, but also draw upon the positive qualities you know you have. Coaching presence and your ability to be non-judgmental, empathic and compassionate will allow you to face, with your client, challenges of all sorts.

Trusting the coaching process is advice I am constantly giving coaches in training. Yet, part of coaching is knowing that the “coaching process” is something much bigger than a “protocol”, a rigid coaching format or worst of all a script. We can’t always anticipate the next move by our dancing client. Part of the true coaching process that we trust is letting go of what we thought was going to be our work today and going in the direction that emerges. Yes, structure is our friend, and our client’s friend as well, however structure has to accommodate flexibility. A client may have a day when resolving a conflict with the coach on direction and how to work together, or a time when a personal crisis takes over. On such occasions, feel free to toss the old agenda of reporting in on action steps out the window and deal with what is right in front of us.

5. Courage To Stand For Transformation

When a client reports that coaching has helped them change their life, that they are a “new person”, that what happened in the coaching process far exceeded their expectations, then we know that we have co-created, with our client, transformative coaching. As our clients work to improve their lifestyle, what is key to remember is that our clients will need to be living that new and healthier way for the entire rest of their lives. Yes, it’s good to reduce blood pressure points, A1C scores and percent body fat numbers. Yet, if all we are measuring is how many times Joe or Martha walked each week for the last few months, have we really helped our client as much as we could have?

Part of what coaches in the world of corporate coaching face is standing for transformation, not just single variable increases that can be conveniently measured and paid for. Coaching the whole person takes time. Yet, if we don’t want to see that client coming back through the revolving door of coaching, or perhaps of the treatment end of the healthcare system (with yet another chronic illness) then working courageously with our clients to help them make sustainable lifestyle improvement just makes good sense. When more than just some change in a measurable behavior takes place, when the person’s self-esteem, self-efficacy and connectedness with additional and lasting support systems can rise, then we know that lasting lifestyle change can thrive. Work to help your clients transform their lives.

6. Courage To Do Your Own “Work”self-reflection_1024x768

The oft-used phrase “knowing when and how to get yourself out of the way” has great import for coaching. When there are issues in our lives that are so unresolved, so demanding of our awareness, that we are distracted by them, influenced by them and/or almost pulled to them unconsciously they will interfere with effective coaching. Such issues are likely to push us into projecting our own feelings on to others. The coach who is carrying around unresolved anger sees more anger in their client’s expression of emotion. We believe that others “need” to work on the same “stuff” that we are wrestling with. The danger continues with such coaches ascribing feelings or beliefs to clients that they really don’t possess. The probability of collusion increases dramatically. We give the struggling client a quick free-pass on their accountability because of our own feelings about their challenge. The border between effective process coaching and the world of psychotherapy/counseling becomes much more ambiguous for such coaches.

In all of my years as a psychologist practicing psychotherapy and working with colleagues in universities, clinics, and private practices, I observed that the truly effective therapists were the ones who were continually working on their own personal growth. They were open to looking at their own shortcomings and how to improve. Socially they were open and easy to get to know. The ineffective therapists were much more defended and resistant to self-examination, much less seeking out of personal growth. They maintained a “clinical presence” with their “patients” and were more socially distant. The lesson for coaches is equally clear.

It takes courage to look at ourselves. Who knows what lies hidden if we crack open Pandora’s Box? A coach who is afraid of not being able to handle the contents is most likely going to coach with the fear of being surprised by what a client might say. Instead of clearly distinguishing then if we can proceed with coaching, or encourage a referral to a mental health professional, such a coach may instead retreat from dealing with feelings altogether and rigidly stick to talking about goals and action steps.

Do we need to finish up all of our unfinished business emotionally before we can coach effectively? Of course not. We all have moved forward effectively in life with some weight left in our backpacks. If, however, we’re carrying an iron anvil in that pack, it definitely will weight us down and get in the way of our coaching work. So, take on the personal challenge if need be, to seek out the ways for you to do the intrapersonal work that you need to do and be a better coach!

“The unexamined life is not worth living.”
Socrates

personalgrowth7. Courage To Grow

When clients realize that wellness is ultimately about personal growth as a whole human being, transformation takes place. Motivation for lifestyle improvement then becomes easy. When a coach realizes that that personal growth is not something to fear, but something to embrace, their professional growth mirrors that unleashing of potential. Growth means change. Change means loss. Scary stuff. Sometimes it is most tempting to hang on to the status quo, even if it is stifling, unfulfilling and stagnating. The personal growth journey is always a twisting path and there is seldom much of a view of what’s around the next bend. So yes, it takes courage to be open to growth and perhaps even more to seek it out.

Growth is about joy, but also about being uncomfortable. Our growing edge is sometimes tender, sometimes a place where pain has taken place. Our inner-critic is always on hand to discourage us, to shake our confidence, to have us consider all of the ways we can fail, or that we are even worthy of the benefits that it might bring.

Yet, when we risk and succeed, when we calculate our leap and then we take it the rewards are great. Personal development and professional development overlap and we thrive. Personal growth opportunities take on many shapes. We grow mostly from being open to experience life and what comes to us. At other times, we know that stretching ourselves might require seeking growth out. Signing up for a new opportunity to socialize or engage in adventure, to travel outside the walls of the “all-inclusive”, or simply to allow ourselves to experiment with that which has been the hardest for us to do, can all yield surprising growth. It might be giving ourselves permission to risk being vulnerable and let an intimate relationship grow. It might be backpacking through Europe solo. The “what” depends upon where your own growing edge is located.

Courageous coaching can show up in many ways as we have seen. Courageous coaching pays off in greater integrity, confidence, personal growth and ultimately in better service for our clients.

In the astonishing book, Facing The Lion, Being The Lion: Finding Inner Courage Where It Lives (http://marknepo.com/books_finding.php) , poet and cancer survivor, Mark Nepo urges us to face things in life. “…facing ourselves, each other, and the unknown. It is something we cannot do without, for facing things is what courage, at its most fundamental level, is all about. Without this, we replay and pass our suffering on to others repeatedly.”

For those who grow, there comes a time to Face The Lion, and by doing so, Become The Lion.
For those who grow, there comes a time to Face The Lion, and by doing so, Become The Lion.

Later this month I will be hosting a Real Balance Free Monthly Webinar (https://www.realbalance.com) with Real Balance Faculty member Joshua Steinfeldt as my guest. His topic will be “What Are Coaches Afraid Of? An Exploration Of Courage And Coaching Mastery”. A recent grad of the Masters Degree Program in Positive Psychology at the University of Pennsylvania where Martin Seligman and others in the Positive Psychology Movement teach, Joshua will be presenting the fascinating work he did on his Masters Thesis.