15 Vital Books for the Wellness Coach – 2020 – Straight Off My Shelf

In the last ten years the field of health and wellness coaching has continued to evolve as a professional filed with standards, credentials (https://nbhwc.org) and a solid evidential base (https://journals.sagepub.com/doi/full/10.1177/1559827619850489). We’ve attained more clarity about what effective health and wellness coaching looks like and more awareness of what all coaches need to learn. Coaches have an ethical obligation to constantly be learning and growing in our profession.

So, what are the “must reads” for the wellness or health coach? Ten years ago, I posted a three-part blog on this topic.

15 Vital Books For The Wellness Coach: Straight Off My Shelf – Part One
https://wp.me/pUi2y-1n. 15 Vital Books For The Wellness Coach: Straight Off My Shelf – Part Two https://wp.me/pUi2y-1z. 15 Vital Books For The Wellness Coach: Straight Off My Shelf – Part Three https://wp.me/pUi2y-1H.

Now, in 2020, what I want to share with you are the top fifteen books that will influence the way you do coaching, the way you prepare for professional exams, and books that you will want to have at arm’s reach. These are the books on my own bookshelf that I find myself recommending over and over again to the thousands of wellness coaches that Real Balance has trained. There are many great resources out there, but here is my own very biased (as you’ll see when I recommend my own books) and opinionated list. In contrast to my own previous blogs this time I’m listing them in rank-order of importance to the coach practicing in the field.

15 Vital Books for the Wellness Coach – 2020 – Straight Off My Shelf

1. Wellness Coaching For Lasting Lifestyle Change,2nd Ed. , Arloski
2. Masterful Health & Wellness Coaching: Deepening Your Craft, Arloski (In Press)
3. Co-Active Coaching, 4th Ed., Whitworth, Kimsey-House & Sandahl
4. Changing to Thrive, Janice & James Prochaska
5. Becoming a Professional Life Coach, Williams & Menendez
6. Motivational Interviewing 3rd Edition, Miller & Rollnick
7. The Coaching Psychology Manual, Moore, Tschannen-Moran and Jackson
8. The Blue Zones, Dan Buettner
9. Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. 1, Arloski
10. Taming Your Gremlin, Rick Carson
11. The Wellness Workbook, Jack Travis & Regina Ryan
12. The Open Heart Companion, Maggie Lichtenberg
13. The Craving Mind, Judson Brewer
14. Raw Coping Power, Joel Bennet
15. The Way We’re Working Isn’t Working, Tony Schwartz


1. Wellness Coaching For Lasting Lifestyle Change,2nd Ed. (2014), Michael Arloski. (https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml) Like I said, a very biased list. Yet, I will have to say that this book (which is now also available in Mandarin) is used by many colleges and universities, as well as other commercial wellness coach training organizations all around the world. The 2014 2nd edition has expanded its coverage of coaching skills and the process of co-creating a wellness plan. The Wellness Mapping 360 Methodology provides the coach with a complete approach to behavioral change that distinguishes this book from others. The integration of what we know from the field of wellness and health promotion is another unique feature of this resource.

2. Masterful Health & Wellness Coaching: Deepening Your Craft, (2020)(In Press) Michael Arloski. (https://wholeperson.com/store/masterful-health-and-wellness-coaching.html) Coaching is both an art and an applied science. In this book my intention is to provide guidance for the health & wellness coaches who wants to go beyond competence to proficiency and embark on a journey towards mastery. The book is divided into four sections, Transformation, How To Be, What To Do, and Coaching People with Health Challenges. We will explore what distinguishes masterful coaches form those who are just learning their craft. Thoroughly substantiated by the evidential literature and providing in-depth lessons on all the major behavioral change theories, Masterful Health & Wellness Coaching will allow the reader to take their coaching to an advanced level.


3. Co-Active Coaching, 4th Ed., (2018)
Laura Whitworth, Karen Kimsey-House, Henry Kinsey-House & Phil Sandahl. (https://www.amazon.com/Co-Active-Coaching-Fourth-transformative-conversations/dp/1473674980/ref=sr_1_1?crid=2E78YGNE10TNG&dchild=1&keywords=co-active+coaching+4th+edition&qid=1601155442&sprefix=Co-%2Caps%2C206&sr=8-1)
THE foundational book of the life coaching field. The authors became the founders of The Coaches Training Institute (CTI) and in this work set down the cornerstones that shape the coaching mindset. A great book to bone up on your coaching skills and to learn what the essence of coaching really is. A true must-read.


4. Changing to Thrive: Using the Stages of Change to Overcome the Top Threats to Your Health and Happiness (2016), Janice & James Prochaska. (https://www.amazon.com/Changing-Thrive-Overcome-Threats-Happiness/dp/1616496290/ref=sr_1_1?crid=24WCWLPXR1KL2&dchild=1&keywords=changing+to+thrive&qid=1601155877&sprefix=Changing+to+thrive%2Caps%2C202&sr=8-1) Replacing the original Changing For Good (1994), this book definitely is in the top four for your bookshelf. The tremendous utility of the Transtheoretical Model for Behavioral Change (TTM, Stage of Change) makes it the coach’s most important behavior change model to know well.

5. Becoming a Professional Life Coach: Lessons from the Institute of Life Coach Training, (2015) Patrick Williams & Diane Menendez. (https://www.amazon.com/Becoming-Professional-Life-Coach-Institute/dp/0393708365/ref=sr_1_1?dchild=1&keywords=5.+Becoming+a+Professional+Life+Coach%2C+Williams+%26+Menendez&qid=1601156765&sr=8-1) Pat Williams is one of the true pioneers of Life Coaching and his earlier book (along with Deb Davis) Therapist as Life Coach was one of my favorites as I made the shift from psychotherapist to coach. Becoming A Professional Life Coach largely supplants this earlier book and provides the wellness coach with not only great skill building but lots of very practical guidance for practicing their coaching.

6. Motivational Interviewing 3rd Ed., (2012) William Miller & Stephen Rollnick. (https://www.amazon.com/Motivational-Interviewing-Helping-People-Applications/dp/1609182278/ref=sr_1_1?dchild=1&keywords=6.+Motivational+Interviewing+3rd+Edition%2C+Miller+%26+Rollnick&qid=1601157105&sr=8-1) This third edition is definitely the best resource on this vital approach to helping people change behavior. Motivational interviewing (MI) is a key tool for the health & wellness coach, especially when working with the ambivalent client. In addition to presenting the MI approach to many of the same skills used in coaching (with their own unique MI terminology), the book contains real gems of learning about the functions many of these skills serve and how to apply them in your coaching.

7. The Coaching Psychology Manual, 2nd Ed., (2015) Margaret Moore, Bob Tschannen-Moran and Erika Jackson. (https://www.amazon.com/Coaching-Psychology-Manual-Margaret-Moore/dp/1451195265/ref=sr_1_12?dchild=1&keywords=The+Coaching+Psychology+Manual%2C+Moore%2C+Tschannen-Moran+and+Jackson&qid=1601157580&sr=8-12) Another foundational book of the wellness coaching field. A comprehensive guide to many of the behavior change theories that coaches use and how to apply them.

8. The Blue Zones: 9 Lessons for Living Longer From the People Who’ve Lived the Longest, 2nd Ed. (2012) Dan Buettner. (https://www.amazon.com/Blue-Zones-Second-Lessons-Longest/dp/1426209487/ref=sr_1_2?crid=1OT3CA9BCUW6O&dchild=1&keywords=the+blue+zones&qid=1601323354&sprefix=The+blue+zones%2Caps%2C202&sr=8-2)  Longevity, we’ve found out is only 20% genetics (at the most) and is really 80% lifestyle (culture, behavior, beliefs, environment). Looking at studies of the hot spots or “Blue Zones” around the world where people live to a ripe old age quite often, common denominators teach us what it takes for an environment to make it easier to be well. The lessons for wellness are profound and based in solid evidence. We have made this part of the Real Balance curriculum since it was first published in 2008.

9. Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. 1, 2nd Ed., (2017) Michael Arloski. (https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml)
A wellness journal for the client, this book outlines an entire wellness coaching process from self-assessment, to visioning, wellness planning, meeting challenges to change, tracking behavior and setting up accountability and support through connectedness for success. Many of the coaches I’ve trained use this with each of their clients either individually, or as a group guide (works very well in a 12-session format). Many coaches love it simply as their own guide for how they coach their clients.

10. Taming Your Gremlin: A Surprisingly Simple Method for Getting Out of Your Own Way (updated edition) (2003), Rick Carson. (https://www.amazon.com/Taming-Your-Gremlin-Surprisingly-Getting/dp/0060520221/ref=sr_1_1?dchild=1&keywords=Taming+Your+Gremlin%2C+Rick+Carson&qid=1601159057&sr=8-1) Whenever the wellness coaching client takes on change their own personal “Gremlin” or “inner-critic” will be there to oppose it, even if it’s the best thing in the world for that person. Our clients have plenty of external challenges to their attempts at change, but the internal ones can be the most devastating. This classic little book shows us how to spot the self-talk of the gremlin early and get it out of the way (as we get out of our own way!). Another true must read. I know of coaches who supply their clients with copies of this book when folks sign on to coaching.

11. The Wellness Workbook, 3rd ed: How to Achieve Enduring Health and Vitality, (2004) John W. Travis and Regina Sara Ryan . (https://www.amazon.com/Wellness-Workbook-3rd-Enduring-Vitality/dp/1587612135) Health & Wellness coaches need a thorough understanding of wellness and health promotion. This is the foundational book to understand what wellness is truly about. Jack Travis is one of the modern-day founders of the wellness movement and he lays out his theoretical foundation and theories in the introductory thirty-six pages which is worth the price of the book alone.

12. The Open Heart Companion: : Preparation and Guidance for Open-Heart Surgery Recovery, (2006) Maggie Lichtenberg. (https://www.amazon.com/Open-Heart-Companion-Preparation-Open-Heart/dp/0977606309) The psychological side of a major health challenge is often ignored. Maggie Lichtenberg, a PCC level coach, went through mitral valve repair surgery, saw a big missing piece and filled it admirably with this excellent book. As a wellness coach, whether you deal with heart patients or not, this book is an ultimate guide to helping your client with self-efficacy and self-advocacy. I make sure anyone I know (client or not) who is headed into any kind of major surgery (but especially heart surgery) either has a copy of this book or knows about it.

13. The Craving Mind: From Cigarettes to Smart-Phones to Love – Why We Get Hooked & How We Can Break Bad Habits,(2017) Judson Brewer. (https://www.amazon.com/Craving-Mind-Cigarettes-Smartphones-Hooked/dp/0300234368/ref=sr_1_1?dchild=1&keywords=The+Craving+Mind%3A+From+Cigarettes+to+Smart-Phones+to+Love+–+Why+We+Get+Hooked+%26+How+We+Can+Break+Bad+Habits%2C+Judson+Brewer&qid=1601319691&sr=8-1) The subtitle says it all. Health and wellness coaches today are quite likely to discover that their clients may be struggling with “device addiction” as well as other habits that work against their health. Understanding how our mind craves these behaviors and how they feed a cycle of addiction is critical to helping anyone take back control of their lives. What makes Judson Brewer’s approach different is that it is based in the practice of Mindfulness and offers an effective way back to wellness.

14. Raw Coping Power: From Stress to Thriving, (2014) Joel Bennett. (https://www.amazon.com/Raw-Coping-Power-Stress-Thriving/dp/0991510208/ref=sr_1_1?dchild=1&keywords=Raw+Coping+Power%2C+Joel+Bennett&qid=1601319602&sr=8-1) Coaching around stress is an inevitable part of health & wellness coaching, so having the knowledge you need to do so is critical. From knowledge to research about stress to the tools and methods you need to apply it, Raw Coping Power’s strengths-based, resilience building approach is the best resource out there.

15. The Way We’re Working Isn’t Working, (2010) Tony Schwartz.  (https://www.amazon.com/Way-Were-Working-Isnt-Performance/dp/1451610262/ref=sr_1_1?dchild=1&keywords=The+Way+We’re+Working+Isn’t+Working%2C+Tony+Schwartz&qid=1601320068&sr=8-1) Our coaching clients are often over-worked and under-supported with ever-increasing demands heaped upon them. Schwartz’s book looks at the systemic problems of the modern-day workplace, but then takes on an approach that individuals can use to cope and hopefully thrive. Think of stress management and time management as energy management. We are wired to deal with stress, but do we have “sufficient volume and intensity” of recovery? A great resource for helping our clients learn how to recover from the stress in their lives.

So, there you have it! Happy reading and keep on learning!

Dr. Michael

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

 

Keys to Coaching Clients Who Overidentify With Their Illness



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

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

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

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

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

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

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

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

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

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

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

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

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

Key Number Three: Understand the Rejection Dimension of Illness Identification

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

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

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

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

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

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

Key Number Five: Partner with the possibility of transformation

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


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

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

REFERENCES:

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

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

 

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.  

 

Social Distancing – Not Social Isolation: Coaching for Connectedness in the age of COVID-19

 

 

We all still need each other. Even in the age of COVID-19, our health continues to depend upon healthy supportive relationships. Real Balance https://realbalance.com has always stressed what we call Coaching for Connectedness.  We‘ve seen lifestyle improvement occur and last more often when people receive support for the changes they are making to live healthier lives.  When a coaching client sets up an action step we ask “Who/what else can help support you in this?”. Research on what makes health behavior last points primarily to two factors: a shift in self-concept and community support.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753403/  It’s also a well-established fact that people who are more socially isolated have significantly higher rates of all major chronic illnesses.  https://www.apa.org/monitor/2019/05/ce-corner-isolation

Our challenge in the midst of a pandemic situation is how we distance from each other while remaining connected to each other. Yes, follow the CDC guidelines for social distancing. We can still greet each other with elbow bumps, and then go for a walk, a bike ride, a cruise in kayaks, etc., and continue to avoid the proximity that puts us at any risk. We can connect via phone and receive the nourishment of live, interactive conversation that texting and e-mail don’t quite match. We can climb on board a web-based platform such as Zoom and Skype provide where we are face-to-face for our conversation. We also have all sorts of apps such as Facetime, WeChat, and many more that allow us to have face-to-face interaction for live conversations.

As coaches we can continue to work remotely with our clients, as the majority of coaching is already done. As we do, explore the feelings that the changes brought about by social distancing are bringing out in your clients. Empathize. Explore. When people talk about their fears, the intensity of those fears almost always lessens. As people become less afraid, their thinking improves. They aren’t so quick to jump into dismissive all-or-none thinking. They are then able to engage in strategic thinking with their coach to find unique solutions to staying healthy.

• The fitness center is shut down. How can you shift to working out at home? Use stretch bands. Modify a spare room into a place to do Yoga, floor exercises, etc. Spring brings better weather allowing more cardio outdoors.
• Do more outdoor exercise/activity with other people – just keep your proper distance.
• Encourage clients to find new ways to electronically visit their friends, grandchildren, and others. Play online games together.
• Check in with your clients to make sure they have CDC information/WHO information about how to stay safe during the COVID-19 pandemic.https://www.cdc.gov/coronavirus/2019-ncov/index.htmlhttps://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Take heart at how people are showing concern for each other during this time. Younger people who are at somewhat less risk are engaging in social distancing, handwashing, etc. not only for themselves, but for the older and more vulnerable people who could be affected by the contact they are having. People in neighborhood chatlines are volunteering to go pick up groceries and prescriptions for older or more sickly neighbors. Hopefully what will come out of all of this is a greater sense of how we are all in this together. Distancing does not mean isolating. The truism of Jack Travis is still valid: Connection is the Currency of Wellness.

Be well and stay well!

Coach Michael

Michael Arloski, Ph.D., PCC, NBW-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc.

 

Where The Listening Starts

Where Listening Starts

An essential part of any wellness coach training is focusing on developing competency in what the ICF (International Coaching Federation) calls Active Listening – Paraphrase and Restatement; Reflection of Feeling; Request for Clarification; the use of Silence and Intuition; Summarization. Yet the active listening skills that we talk about aren’t really skills about how to listen more effectively. They are critical skills for how we give evidence to our client that we are listening and truly hearing them. They are skills that further the coaching conversation. They are how we respond to our client when we take in their communication. This is the active part of listening: what the coach says and does. But, what allows us to truly listen at a deeper level, to pick up on even more of what is really being communicated?


Deep Listening – “I can hear tears.”

What is it that allows masterful coaches to become aware of things that most people miss in a conversation? How do they tune in to their client in such a way that the coaching conversation becomes rich, productive and even enlightening?

In a class discussion about listening, one of my Real Balance students, who demonstrated she was an already accomplished coach, shared with us the poignant statement “I can hear tears.” She was referring to coaching over the phone where the visual nonverbal cues are absent. She was picking up on both the client’s subtle vocal cues, and to a large degree, the context of the conversation. At such a tender moment, a client may make an effort to be as silent as possible. The vocal cues like a voice that breaks in tone, or speech that stammers are not even there for the coach to perceive during such a silence. The context can certainly tip the coach off that it would be natural for a client to cry upon sharing a painful experience or talking about a profound loss. Yet people react to experience and emotion in many different ways, from hysteria to stoicism. How does a more masterful coach hear tears that silently run down the cheek?

The powers of observation of a more masterful coach are as keen and sharp as a razor. They don’t miss much. They notice. They are mindfulness in action. They also don’t allow judgment to interfere and throw their subsequent observations into a prejudiced direction blinding them to the full picture of what is unfolding. They stay on pace with their client instead of ahead of them. They stay more out of their head. These practices allow them to stay in the present and in touch with all of their senses. Doing so they are not rushing ahead with their own imagined conclusions about where the dialogue is going. By maintaining a coaching mindset, they are able to facilitate the client’s work instead of attempting to do the work for their client like a consultant would do. By not engaging in that headwork (analyzing, deducing, imagining, problem solving, continually thinking of the next question to ask, etc.) they are able to be here now with their client and hear more. This way of being, combined with providing The Facilitative Conditions of Coaching is the very essence of Coaching Presence.

Observing by Scanning

One aspect of effective observation is what I call scanning. If you ever take a nature walk with a trained naturalist, or perhaps the type of experienced hunter who is keenly in touch with the natural world, you realize that they are constantly scanning the landscape as you move through it. I remember reading Barry Lopez’s magnificent book Artic Dreams. https://www.powells.com/book/arctic-dreams-imagination-desire-in-a-northern-landscape-9780375727481?p_isbn&partnerid=35409 He spoke of his time with the Inuit people who were out on a hunting expedition. They walked over the tundra all day, slowly, silently. Then, at night around a campfire they spoke about all of the things they had seen. Lopez, one of America’s greatest nature writers who has developed intense powers of observation himself, was amazed at what these indigenous people had picked up on, down to minute detail of the land and its creatures. They had been constantly scanning both the horizon, the place where they were about to set their feet and everything in between. They had been scanning visually, looking for movement, shifts, changes, anything out of order in shape or color. They had been scanning auditorily hearing birdsong, wind, twigs snapping. They had been scanning olfactorily smelling the scent of whatever flowers, animals, carrion, or people might be in the region. And, they had been doing all of this effortlessly. It was simply how they hunted.

As you coach, are you constantly scanning the horizon and where you are about to set your feet? Are you effortlessly scanning with all of your senses and noticing? Just like our friends in Lopez’s book, we want to be noticing shifts, changes, anything out of the ordinary. While the Inuit hunter might spot the movement of a partridge in a bush, we may notice the shift in our client’s tone of voice, in their posture, in the speed with which they are now talking. When we listen beyond words, beyond content we hear more. The verbal content is important. It’s like the landscape itself; it is the context of the conversation. Yet, what’s important is what is happening on that landscape. What movement is there in the bushes, so to speak? What is the client thinking and feeling regarding that content about which they are speaking?

The novice coach, new to the coaching landscape, may focus mostly on the content of our client’s communication. Yet, they progress in their coaching so much more when they realize that the client is not just speaking to them about a subject, they are communicating! It’s not just what they say, it’s how they are saying it. The content might sound like “I’ve walked only two times this week.” All the while the client is attempting to convey to their coach that they are becoming very worried that they will never get their lung capacity back after their acute heart failure if they don’t exercise more often. Did the coach see the frightened bird that just froze on the tree branch, or were they lost looking at the trees? What is my client communicating?

What Are We Listening For?

Just like the skilled naturalist, or the Inuit people that Lopez observed, the more masterful coach has learned what to look for in our coaching landscape. The novice coach may travel the same landscape and not notice half of what the more masterful coach will pick up on. They have learned how to read the signs, to distinguish a track from a mere depression in the soil. So, to deepen your listening ability what can you tune in to? Within the content of what is being said and beyond the content, what will help our coaching be more productive?


This blog was taken from a chapter in Dr. Arloski’s forthcoming book Masterful Health & Wellness Coaching: Deepening Your Craft, being published soon by Whole Person Associates. https://wholeperson.com/store/masterful-health-and-wellness-coaching.html

2010-2020 A Decade of Growth for Wellness Coaching

After years of building a foundation, health and wellness coaching has flourished in the last decade. At the beginning of this last decade the International Coach Federation was only fifteen years old and the National Board for Health and Wellness Coaching hadn’t even been thought of yet. My book, Wellness Coaching for Lasting Lifestyle Change, had been on the market for only three years, and The Coaching Psychology Manual, for only one. Thousands of people were already trained and working as health and wellness coaches, but the numbers were nowhere near where they are today. Wellness coaching was being used by employee wellness programs, disease management and insurance companies but had not made its way into the clinical world much at all. There was considerable success where wellness coaching was being applied, but the research to back it up was lagging. As the decade moved along towards 2020, everything shifted. Health and wellness coaching has truly arrived!

In the last ten years we have seen the profession of health and wellness coaching grow both in its application and as a true profession with standards and credentialing. Early in 2010 the National Consortium for Credentialing Health & Wellness Coaches was formed to develop and establish those standards and a system of credentialing. After an untold number of hours of work by dedicated coaching professionals this evolved into the National Board for Health & Wellness Coaching that we have today. Now, in addition to certification that coaches can receive by the organization that trained them, they can apply to become certified through the NBHWC by qualifying for and passing an examination administered by the National Board of Medical Examiners. Prospective coaches can now choose to be trained by qualified organizations that have earned approval by the National Board, ensuring great quality for their educational experience.

Importantly the critical research evidence backing up the incredible effectiveness of health and wellness coaching has mushroomed. We now have hundreds and hundreds of solid peer-reviewed journal articles making the case for health and wellness coaching.

My observations over the past decade is that the growth of health and wellness coaching has particularly accelerated in three areas: universities, the international arena and clinical/lifestyle medicine. Let’s look at the role Real Balance Global Wellness has played in each.

Loma Linda University

Early in the decade only a handful of schools were offering programs that included health and wellness coaching. These were mostly schools of Integrative Health or related areas. Leaders such as The California Institute of Integral Studies, Duke University, and the University of Minnesota were such innovators. As more and more schools discovered that health and wellness coaching offered their students a practical skill set and a needed certification in the field, actual training in health and wellness coaching became highly desirable. Real Balance began to partner with schools of Public Health, Nursing, and a variety of programs to not only deliver direct training, but to train college and university faculty to become Real Balance Trainers and be able to deliver our curriculum and certification. Our program nurtures such schools along until they are ready to apply to the National Board to become an approved program in their own right.

China!

As lifestyle diseases have replaced infectious disease as the number one cause of premature death, the value of health and wellness coaching is being increasingly recognized around the world. Interest is growing fast in Europe, Asia and Latin America. Real Balance truly became Real Balance GLOBAL Wellness in this last decade. We developed training programs in Ireland/UK, Brazil, Australia, and China. We delivered keynotes and programs in the Azores Islands of Portugal, and the Philippines. Students from around the globe continue to become trained as health and wellness coaches through our live webinar classes.

The third area of growth for health and wellness coaching that has ballooned especially in the last few years of our past decade is primary care/lifestyle medicine. The recognition that a large component of our health is behavioral has led to the greater openness to the role of health and wellness coaching in direct medical services. Health and wellness coaches are helping patients to be more successful at medical compliance/adherence, and at accomplishing the directives of the lifestyle prescription recommended by their treatment team. The tremendous growth and increasing acceptance of the principles of lifestyle medicine has helped health and wellness coaches to be seen as a very practical solution for the behavioral changes sought by physicians and other healthcare practitioners. The recent granting of a Level Three CPT Code for health and wellness coaching is a huge step forward. Though direct reimbursement is a ways off, the new code helps legitimize health and wellness coaching in the eyes of the medical world and opens doors.

Health and wellness coaching enters this new decade with an earned respect. We have the evidence of our effectiveness, solid professional credentialing and standards, international awareness, and a recognition that we can play a key role in improving health and wellbeing all around the world. Be a part of helping us take it forward!

Michael & Deborah Arloski

Masterful Health & Wellness Coaching: Deepening Your Craft A New Book by Dr. Michael Arloski, coming in 2020

 

The profession of health and wellness coaching is fully engaged in a process of transformation. As we grow to be of service to wellness programs, lifestyle medicine practices, employee assistance programs, insurance carriers, disease management companies, and all manner of healthcare providers, around the globe, the demand for greater quality coaching only builds. We are moving from a need for competent coaches to a need for proficient and even masterful coaches.

In 2006 Whole Person Associates published my book, Wellness Coaching For Lasting Lifestyle Change, with an updated version in 2009 and a completely revised and expanded Second Edition in 2014. (https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml) This ground-breaking book is used as the primary text in many wellness coach training programs and college and university courses and has had a powerful impact around the world. It has even been published in Mandarin! In 2009, Whole Person Associates also published Your Journey To A Healthier Life: Paths of Wellness Guided Journal, Vol. I. (https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml) I wrote this book primarily to be used by wellness coaching clients in either individual or group coaching as a personal workbook/journal through the coaching process. Many coaches have found it to be a valuable coaching guide for both their client and themselves. As much as these books covered, the need to provide a deeper dive into the advanced topics of coaching such as collusion, self-disclosure, etc., and to help coaches truly polish their craft became self-evident.

Real Balance Global Wellness has trained thousands and thousands of wellness coaches around the world. As I delivered many of these trainings, read case studies and listened to hundreds of recordings of coaches in action, I learned so much. I learned what coaches need to learn. I discovered where their challenges were, what skills they tended to underutilize, or overutilize. I saw how they shined and how they struggled. I saw what distinguished the effective coaches from the rest. The more masterful coaches were evident in both their way of being with their clients, and with their knowledge of what to do. As I learned from my students I continued to coach, to teach our certification and our advanced classes, and to mentor, continually accumulating more and more grist for the mill that would become my next book.

 

Coach training is not a one and done. The best coaches are voracious lifelong learners. In fact, both the ICF (International Coach Federation) and the NBHWC (National Board for Health & Wellness Coaching) include an obligation to continual education and professional development in their codes of ethics. (https://nbhwc.org/wp-content/uploads/2019/04/FINAL-Code-of-Ethics-4_15_19-1.pdf)

Just as psychotherapy has been described (https://psycnet.apa.org/record/2006-20286-000), coaching is both an art and a science. The thing that I believe distinguishes a more masterful coach is that they are an artist practicing a craft. Beyond doing a job, they see their wellness coaching career as the career of a craftsperson. They see their work as a combination of evidence-based science, theory and technique, but also as craft.

 

“If one really wishes to be master of an art, technical knowledge of it is not enough. One has to transcend technique so that the art becomes an ‘artless art’ growing out of the Unconscious.”
D.T. Suzuki – Introduction to Zen In The Art Of Archery

 

From Chapter Two of the forthcoming book:

Witnessing the craftsperson in action we see a continuous desire to improve. This is the truly professional waiter/waitress studying the food production and delivery systems, the seating floor plan and the nature of the clientele in the restaurant to calculate their most efficient table delivery routes and provide the best customer service experience. This is the university professor reading about how to teach, not just more about the science of their subject matter. This is the wellness coach spending hours listening to recordings of their own coaching and reviewing where their competencies need improvement. This is about the transformation of competencies into proficiencies and beyond.

Most wellness coach training is aimed at developing competencies. Competency implies an adequate and acceptable level of skill and knowledge. Every client certainly wants his or her coach to be competent. Yet, wouldn’t every client want their coach to be not just competent, but truly proficient or even masterful at his or her craft? How does a coach move up a notch to a level where they are coaching beyond the basics, where they are fluidly implementing what they have learned and can now think on their feet, ‘dance in the moment’, and be creative?

 

Thoughts To Ponder On The Mastery Path

WHO do I want to be as a coach?
How do I create a default mind of curiosity?
How can my values shape my desire for mastery?
How can I be inspirational?

 

Masterful Health & Wellness Coaching: Deepening Your Craft will explore advanced topics such as collusion, self-disclosure, motivation, coaching with difficult clients, building self-efficacy, meaning and purpose, coaching effectively with emotions and much deeper looks at major theories of behavior change and how to implement them in the coaching process.

As my new book approaches completion, we expect that publication will take place in early 2020. By subscribing to the Real Balance Newsletter on our website (https://realbalance.com) you can be kept up to date on its release date.

The Utility of Self Determination Theory and Motivation in Wellness Coaching – Part One: Motivation

“Don’t ask how you can motivate others. Ask how you can create the conditions within which others will motivate themselves.”
Edward L. Deci

The motivation of the coaching client for change is usually seen as the foremost factor in the coaching process, yet many coaches lack adequate knowledge of this concept. Some coaches believe that is it somehow their responsibility to motivate their client. This can come across as an attempt to convince or persuade the client to become engaged in a lifestyle improvement process, urged on by a cheerleading coach. As coaches become more experienced, they usually discover that effective coaching is about helping the client to get in touch with what motivates them from the inside and build on that. One theory that can help coaches grasp the nature of human motivation and then implement it well is Self-Determination Theory.

The life work of psychologists Edward Deci and Richard Ryan (http://selfdeterminationtheory.org) has yielded a theory of human motivation that not only fully supports the coach approach but also adds valuable tools of understanding. In complete alignment with the tenets of humanistic psychology (https://www.amazon.com/Toward-Psychology-Being-Abraham-Maslow/dp/0471293091) , Self-Determination Theory (SDT) views human beings as constantly striving towards actualizing their potential, seeking out ways to foster their growth and development. It is also very much in alignment with the Client-Centered (or Person-Centered) Approach of Carl Rogers (https://www.amazon.com/Becoming-Person-Therapists-View-Psychotherapy/dp/039575531X/ref=pd_lpo_sbs_14_t_0?_encoding=UTF8&psc=1&refRID=3WAH0XRWWQF0SM32MPZJ). Finally, it is easy to see how the way coaches trained in the ICF Core Competencies and the coaching foundations that are laid out in sources such as Co-Active Coaching (https://www.amazon.com/Co-Active-Coaching-Fourth-transformative-conversations/dp/1473674980/ref=sr_1_1?s=books&ie=UTF8&qid=1549473972&sr=1-1&keywords=co-active+coaching) work with clients are entirely congruent with SDT.

A core contribution of SDT is the way it demonstrates how it is the type of motivation, not the quantity of motivation that is key to success with behavioral change. According to Self-Determination Theory there are two types of motivation, controlled motivation and autonomous motivation. SDT presents a ‘motivational spectrum’ with amotivation, or total indifference at one end and intrinsic motivation, doing something for its own intrinsic satisfaction at the opposite end. In between these two extremes lies extrinsic motivation with its own motivational spectrum from the most externalized (controlled) to the most internalized (becoming autonomous) types of motivation.

MOTIVATIONAL SPECTRUM
A client is viewed as potentially having different types of motivation related to different behaviors, similar to what we have seen in the Transtheoretical Model of Change, (http://jprochaska.com/books/changing-to-thrive-book/) Your client may be in the “Action Stage” when it comes to improving their nutrition, but in the “Contemplation Stage” regarding beginning an exercise program. Likewise, in the SDT model, your client may feel Controlled Motivation from and Extrinsic source (e.g. pressure from physician and spouse) to begin exercising, and yet possess Autonomous Intrinsic Motivation to improve their nutrition because of a life-long fascination with and enjoyment of healthy eating.

Coaches certainly encounter clients who are indifferent to making changes in some areas of their lives. This would be referred to as Amotivation, or simply lacking motivation. SDT looks at the process of motivation as part of the behavior change process, rather than a pre-requisite for coaching. The client does not have to be “ready” for coaching, rather, it is within the coach’s function to help the client get in touch with the motivation they need for change and resolve ambivalence Again, it our job to meet our client where they are at.

Controlled Motivation

All too frequently the wellness coach encounters clients who are feeling the pressure of Controlled Motivation. This is the “carrot and stick” approach to motivation. It means doing something in order to get a reward or to avoid punishment. It is characterized by feeling seduced (towards a reward) or coerced (to avoid negative consequence). Either way there is a perception of being pressured, obligated or even forced. A perfect example is the coaching client coming to fulfill a requirement for a wellness program incentive plan. The client feels forced into coaching to receive the reward of a 10-20% discount on their health insurance premium (and to avoid the implied penalty of missing this discount). Deci has emphasized that this approach has negative consequences for both performance and well-being. Deci and Ryan also noticed that individuals coming from controlled motivation tend to take the shortest path to the end result. They often complete the wellness program requirement and immediately quit the program.

Autonomous Motivation

Autonomous motivation has two aspects. The first is interest and enjoyment. If these two are present, so is motivation because I don’t have to be convinced to do what I love doing. The second type has to do with deeply held values and beliefs. Behaviors that are in sync with values and beliefs are coherent with one’s sense of self. According to Deci, the research demonstrates that when behavior comes from autonomous motivation people are more creative and better at problem solving. When confronted with challenges or obstacles they are more able to think ‘outside the box’. Overall, performance is better especially around hands-on learning and people feel better about themselves. All in all, “autonomous motivation is associated with both physical and psychological health.”

Autonomous behavior is about choice. Deci, in an effective video interview (https://youtu.be/m6fm1gt5YAM) , points out that it is not the same as independence. A person can be experiencing autonomous motivation (operating out of their own volition) when they choose to seek out a walking group to participate in. Autonomous motivation can drive both individualistic and collectivistic behaviors.

SDT also acknowledges that there is often a process experienced by people whereby their motivation may progress from Controlled External Motivation to eventually become a choice that they fully embrace — Autonomous Intrinsic Motivation. What may begin as

 

Spatial representation of different forms of extrinsic regulation. From Spence & Oades PDF (2011)

a requirement of a program (see a wellness coach to get an incentive) — External Controlled Motivation — may move to compliance with a program (continue to see the coach out of an ‘introjected’ sense that they ‘should’ do so). However, if the coach is effective at creating a true coaching alliance with their client and helps them to see the benefits that they may have to gain by continuing coaching, the motivation shifts through a sense of “identification”, to that of Autonomous Motivation — the client is truly choosing to be involved in coaching. Finally, as the client experiences the benefits of coaching and enjoys the coaching, they have fully ‘integrated’ the process and are experiencing Autonomous Intrinsic Motivation to engage genuinely in coaching.

In effective coaching we always refer to co-creating with our client ‘self-determined goals’. The message to the client is that they are the ones in the driver’s seat, choosing their own Wellness Plan with our assistance. As we coach our clients through the journey of change we can draw upon SDT to remind us to stay client-centered, to continuously move towards building client autonomy and towards motivation that is more intrinsic in nature. It’s just good coaching!

In Part Two on the topic of Self-Determination Theory, we’ll look at how we can incorporate the Three Innate Psychological Needs of SDT — the needs for autonomy, competence and relatedness into more masterful coaching.

 

For the very best in wellness and health coach training look to REAL BALANCE GLOBAL WELLNESS SERVICES, INC.  Over 8,000 wellness & health coaches trained worldwide.  http://www.realbalance.com 

 

For more about effective coaching refer to Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., by Michael Arloski, Ph.D., PCC, CWP, NBC-HWC.   https://wholeperson.com/store/wellness-coaching-for-lasting-lifestyle-change.shtml

and to Your Journey to a Healthier Life (Paths of Wellness Guided Journals) by the same author.  https://wholeperson.com/store/your-journey-to-a-healthier-life.shtml 

Wellness Coaching For Medical Compliance/Adherence and Growth

 

A Holistic Approach

Most clients who struggle with medical adherence and/or the lifestyle improvements recommended by their treatment team (the Lifestyle Prescription) benefit from the structure that wellness coaching provides as well as the power of the coaching alliance. Clients are attempting to adopt new behaviors, shift from old unhealthy behaviors, and often reorganize their lives radically to do so. They benefit from co-creating, with their coach, a well-designed plan that addresses their overall, total wellness, and makes medical adherence a part of it. It becomes just one Area of Focus in a fully-integrated Wellness Plan.

Health and wellness coaches who work with clients challenged by chronic illness, and even more acute medical challenges, are counted upon to help with medical compliance and adherence. The clients themselves count on them because they struggle with medical self-testing, taking medication properly, following up with appointments, exercising, and whatever the recommendations of their “lifestyle change prescription” are. Coaches are also counted upon by those providing healthcare services, insurance services, employee benefits and more, to help manage costs through better overall patient compliance/adherence. This often becomes a large part of a wellness coach’s job.
The job is valued because the need is great. First of all, when clients fail to take their medication properly, manage their blood sugar levels well by doing their self-testing regularly, etc., they suffer. There are more hospitalizations and trips to the emergency room, more chance of complications and usually more progression of progressive diseases.

The Network for Excellence in Health Innovation calls improving patient medical adherence a $290 Billion Opportunity. (https://www.nehi.net/bendthecurve/sup/documents/Medication_Adherence_Brief.pdf) that’s what is lost in U.S. healthcare spending each year due to poor medication adherence alone. The same source goes on to say that “when patients with severe or chronic conditions do not take their medications, the consequences can be extreme. Clinical outcomes are highly affected by non-adherence. For example, those with 80-100 percent adherence rates are significantly less likely to be hospitalized than their counterparts.”

Lack of follow through on medications, and other types of “following doctor’s orders” can be due to many different reasons, some of which are not the fault of the patient. Cost of prescriptions and supplies in the United States is often a big factor. Inadequate instructions from the healthcare provider, a lack of self-care education, access to treatment and/or education, plus costs, account for about 31% of the reasons for poor adherence. The other “69% of the problem is behavioral, such as perceived benefits, poor doctor-patient relationship, medication concerns, or low self-efficacy.” (http://www.dtcperspectives.com/impact-behavioral-coaching-adherence/#_edn3).

A note on terms:

Non-compliance — not complying with medical directives, prescriptions, etc.
A patient decides that their physician is basing a prescription on inadequate information and decides not to take prescribed statins.
Non-compliance — More of a refusal, a decision. Can be medical or lifestyle prescriptions. May be due to external causes (like cost). More authoritarian.
Non-adherence — not following through consistently with the treatment plan including the “lifestyle prescription”. Not adhering to the plan. More likely due to inabilities, difficulties executing the plan, etc.
You will also find that the terms are sometimes interchangeable in the professional literature.

Research on health and wellness coaching has shown significant effectiveness in improving this problem. Unfortunately, most of the research narrowly focuses on one research variable, one aspect of medical compliance/adherence – medication adherence. In a study of the impact of health coaching with patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia, “Health coaching by medical assistants significantly increases medication concordance and adherence.” (1) Ruth Wolever and Mark Dreusicke (2) found that integrative health coaching led to an increase in medication adherence and that better adherence correlated with a greater decrease in HbA1c (blood sugar measure).

Many of the studies are gleaning what appear to be the coaching methods that make a real difference in effectiveness. Wolever and Dreuskicke concluded that “Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders.” So, though helpful, clients/patients often need more than just text messages sent on their smart phones. Amanda Rhodes, in a 2017 article (3) takes on a more corporate perspective in showing how coaching is beneficial to both patients and the pharmaceutical and healthcare companies that serve them. What their research emphasized was how client-centered the whole approach needs to be. “Patient-centered behavioral coaching is designed to help patients determine the way in which THEY believe they need to change their behaviors to achieve their goals. Patients who feel listened to are more comfortable with the care they receive and are more likely to adhere.”

Alliance Over Compliance

For the health/wellness coach and the client they serve, the heart of the matter is the coaching alliance. As seen in the articles we’ve spotlighted here, adherence comes not from medical admonishment or authoritarian directives. It comes from a client/patient developing self-determined goals that they are motivated to pursue. It comes from having an ally to help them navigate through the barriers that they face to achieving the high level of health and wellness that all people want. The coach may be well aware of the medical urgency for a client to, for example, quit smoking, or take their medication properly. But, as we’ve learned from all forms of behavioral change efforts, the process, ultimately, must be self-directed. That is, the client has to see the value in making the change, be ready to make it, and have both a concrete plan of action and the support they need to achieve it. Tempting as it may be for the coach to become extremely directive and take over the action planning, they must remain in a true coaching mindset and be the ally the client needs in their own process. This requires patience, but as is often the case, patience pays off.

A Fully Integrated Wellness Plan

The client and coach work together to determine what the other Areas of Focus will be, based upon Readiness for Change Theory, the directives of the Lifestyle Prescription, the values and interests of the client, and all of the exploration and assessment that the coach and client have done together. Other Areas of Focus could include such things as: Attaining & Maintaining A Healthy Weight; Smoking Cessation; Achieving Greater Social Support, etc.

Areas of Focus break down into Goals and the specific Action Steps that the client will engage in to achieve those goals. All of this is co-created, not dictated.

 

 

Coaching Does What It Is Good At

In the focus on medical adherence, coach and client co-create a way to identify the specific behaviors that are needed to either develop or change. They then, strategize the best Action Steps that will be an optimal starting point for success. They develop tracking strategies, so the client will know when they are being successful at doing their self-testing regularly, taking medication on time, staying organized enough to follow through on medical appointments, etc. The key to tracking, whether done on phone apps, or good old pencil and paper is following up with Accountability on it. Sending the coach app or text messages, or simply reporting in at the next coaching appointment will help the client feel accountable to themselves to achieve what they, themselves, want to get done. The coaching alliance also takes on the myriad barriers, both internal and external that get in the way to solid medical adherence. Strategizing through barriers such as a lack of family or workplace support, checking out fearful assumptions (especially about side-effects), all increase the likelihood of success.

Astonishing Noncompliance

There are times when we see a complete shutdown of efforts to follow the directives of the treatment team, especially around the lifestyle changes that are urgently needed to shift. This refers to a client paralyzed by grief over their perceived loss of health. To understand this check out our previous blog post – “Astonishing Non-compliance – Understanding Grief and Readiness for Change in the Health Challenged Client” (https://wp.me/pUi2y-n2 ).

The Many Faces of Medical Adherence

Coach with your client to determine what the components of medical adherence are for them. Don’t just focus on medication. Help them see that their best strategy is to live their healthiest life possible in all dimensions of their wellness.

RESOURCES

(1) Thom D, Willard-Grace R, Hessler D, DeVore D, Prado C, Bodenheimer T, Chen E. The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial. J Am Board Fam Med. 2015 Jan-Feb;28(1):38-45. doi: 10.3122/jabfm.2015.01.140123

(2) Ruth Q Wolever, Mark H Dreusicke.
Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence. Clinical care/education/nutrition/psychosocial research. https://drc.bmj.com/content/4/1/e000201

(3) The Impact of Behavioral Coaching on Adherence
by Amanda Rhodes on June 29, 2017 in DTC in Focus, DTC News
http://www.dtcperspectives.com/impact-behavioral-coaching-adherence/#_edn3

Additional Resources

• Sforzo, Kaye, Todorova, et al. (2017). Compendium of the Health and Wellness Coaching Literature. American Journal of Lifestyle Medicine,1559827617708562. http://journals.sagepub.com/doi/full/10.1177/1559827617708562
• Ruth Q. Wolever, Making the Case for Health Coaching: How to Help the CFO Understand — Real Balance Coach Center – April 2018 Free Monthly Webinar.
https://ichwc.org/resources/ “A Systematic Review of the Literature on Health and Wellness Coaching: defining a Key Behavioral Intervention in Healthcare” (Resources section for ICHWC)

The Quandary of Closeness And Compassion in Coaching

“Don’t get too close to your clients.” It may have been my junior year of being an undergraduate psychology major when a professor offhandedly gave this warning to me and a couple of other students. There is always this question about ‘therapeutic distance’. Clearly when a therapist allows their own feelings of attraction or repulsion, insensitivity or caring to interfere with the ability to deliver effective therapy, we have a problem. Therapists may wall themselves off from connecting too closely to protect themselves from the pain of their client’s suffering. At the same time, therapists are exhorted to empathize, to connect genuinely, authentically, to allow a therapeutic closeness to grow. They are often left in this ambivalent quandary of just how “close” to be to their client.

The coaching relationship is not intended to be a therapeutic one, even though it may contribute to a client’s own healing. Many experiences are therapeutic and the experience a person has with coaching may be just that. However, our intent is not to heal the old wounds of our client, but to be their assistant in their personal growth. The coach’s quandary is similar to that of the therapist, but also different. Without the ‘therapeutic distance’, it may, in fact, be even more confusing. If we are not delivering treatment with our client, then, are we more like a friend? We will hear stories of suffering. How do we protect ourselves from feeling their pain as our own?

Coaches may start to find themselves becoming more reluctant to truly engage with their clients. They may find themselves pulling back emotionally and fighting the urge to connect more closely. Hearing another story of difficulty, failure, conflict, or even trauma, abuse and neglect, we may react by diminishing the very coaching presence that is essential to helping our client to work through their challenges. The coach may find their ability to concentrate and really listen to our clients becoming reduced. It may show up physically with difficulty sleeping, a drop in our immune response, headaches, digestive issues, and much more. Our ability to be compassionate may be just worn thin.

An ICF published article by Niamh Gaffney (https://coachfederation.org/blog/are-you-tired-of-coaching) defines Compassion Fatigue as “a combination of physical, emotional and spiritual depletion associated with caring for people in significant emotional pain and physical distress.” The term depletion is perfect in this description. Our own well feels like it has gone dry, or soon will. It may feel like our very soul is being drained. The way out of compassion fatigue is the same as preventing it.

 

Operating From A Coach Approach

Failing to recognize the difference between coaching and counseling or therapy leads coaches to delve into an attempt at therapeutic problem solving. We may disguise it to our client and ourselves as “working on stress”, but if we approach stress management by attempting to solve all of the problems that generate stress in our client’s life, we are engaging in an infinite exercise in futility. Not only does it not work, it is exhausting for both client and coach. Your client may sense the futility before you do and leave coaching entirely.

Maintaining a coaching mindset is essential here. Can we help our stressed-out client to learn how to deal with stress, and to recover from stress instead of infinite problem solving? When coaches ask “What issues do you want to work on?” they are inviting the beginning of a therapeutic expedition. When we see ourselves as our client’s ally, not their doctor, healer, priest or therapist, we take a stance of closeness and caring but with less of a feeling of responsibility for their solutions and ‘cure’.

In wellness coaching, instead of operating on a problem du jour model, we work with our clients to help them take stock of their current health and wellness, create a vision of their best life possible and then co-create with them an effective wellness plan. Operating from a plan is totally different than continual problem solving. Certainly, we engage in strategic coaching with them to address barriers, but our job is not to provide solutions. Compassion fatigue, I believe, comes sometimes from the sense of powerlessness that we may feel when we can’t provide the magic solution for our clients that will make their lives better. When we realize that doing so is not our job, we can allow for more of a healthy compassionate detachment to take place.

 

Compassionate Detachment

Twenty-seven years or so of doing psychotherapy with a wide variety of clients had its joys and challenges. Upon hearing the detailed recount of a young woman or man who had been abused sexually by a parent, I couldn’t just go home saying “It’s only a movie.” Clients come needing to tell their stories to a therapist who is not afraid to go absolutely anywhere with them. A really good therapist learns to be a true warrior/warrioress of the heart who is completely fearless. Yet, the only way they can go into battle again, side by side with their client is by learning something about compassionate detachment.

We practice compassionate detachment for the benefit of our client and for our own benefit as well.

Compassionate detachment is respecting our client’s power enough to not rescue them while extending loving compassion to them in the present moment. Simultaneously compassionate detachment is also respecting ourselves enough to not take the client’s challenges on as our own and realizing that to do so serves good purpose for no one.

Compassionate detachment is an honoring of our client’s abilities, resourcefulness and creativity. We remain as an ally at their side helping them to find their own path, their own solutions. We may provide structure, an opportunity to process, a methodology of change and tools to help with planning and accountability, but we don’t rescue. As tempting as it is to offer our suggestions, to correct their errant ways, to steer them toward a program that we know works, we avoid throwing them a rope and allow them to grow as a swimmer. Sure, we are there to back them up if they go under or are heading toward a waterfall. We are ethically bound to do what we can to monitor their safe passage, but we allow them to take every step, to swim every stroke to the best of their ability.

To be compassionate with a client we have to clear our own consciousness and bring forth our nonjudgmental, open and accepting self. We have to honor their experience.

“Only in an open, nonjudgmental space can we acknowledge what we are feeling. Only in an open space where we’re not all caught up in our own version of reality can we see and hear and feel who others really are, which allows us to be with them and communicate with them properly.” Pema Chodron, When Things Fall Apart

Compassionate detachment is also about giving ourselves permission to protect ourselves. Being in proximity to the pain of others is risky work. There are theories about the high rates of suicide among dentists based on this. Compassionate detachment is also about being detached from outcome. We want the very best for our clients and will give our best toward that goal, but we give up ownership of where and how our client chooses to travel in the process of pursuing a better life. Their outcome is their outcome, not ours.

Compassionate detachment is not about distancing ourselves from our client. It is not about numbing ourselves out mentally, emotionally or physically. It is not about treating our clients impersonally. That is mere detachment alone and more a symptom of burnout than of good work as a coach, therapist or any kind of human helper.

Intimacy is what allows compassion. When we fear closeness, we will hold back. We will be less empathic because we fear connecting with our own feelings. Compassionate detachment is being centered enough in ourselves, at peace enough in our own hearts, to be profoundly present with our clients in their pain and in their joy as well.

 

From Depletion To Replenishment

If compassion fatigue is about feeling depleted, then prevention and recovery is about replenishment. Fatigue comes from the expenditure of energy: physically, emotionally, and spiritually. Coaches must ask themselves what they are consciously doing to restore their own energy supplies. Once again, we are talking about the coach’s own Wellness Foundation.

We often think of wellness in terms of exercise and participation in all kinds of wellness activities. To what degree are these activities an expenditure of energy, and to what degree do they provide an energy return and replenishment. While a workout resulting in a “good tired” feeling my fatigue us physically, it may invigorate us mentally, emotionally, and even spiritually. Once again it is a matter of balance. Are we engaging in mind/body activities that replenish our energy on multiple levels? Mindfulness practices, meditation, Tai Chi, Xi Gong, Yoga, all share the intent of this kind of replenishment.

Our Wellness Foundation is not just about working out and eating well. What we are looking for here is replenishment on the levels at which we are being depleted: more the emotional, mental and spiritual. Re-filling our well on these levels is more about getting our needs met in these areas. Compassion fatigue can generate feelings of isolation, powerlessness and feeling overwhelmed.

  • Are we connecting with meaningful friendships to combat that isolation? Are we expressing ourselves creatively and feeling competent in other areas of our lives?
  • Are we consciously engaging in device-free time, in connection with the natural world, simplifying our lives?
  • Do we feel like we are truly in charge of our own lives?
  • These questions address the three basic human needs that Dicci and Ryan talk about in Self-Determination Theory. (http://selfdeterminationtheory.org)

When we come back to our own center and feel like our needs are getting met, when we feel safe and secure, energized and in balance, we can extend the heart of compassion to our clients and not fear intimacy. We can be the ally they need.  

 

Michael Arloski, Ph.D., PCC, CWP, NBC-HWC – is a psychologist, coach, trainer, author and wellness enthusiast.  CEO and Founder of Real Balance Global Wellness Services, Inc. (https://www.realbalance.com), his company has trained thousands of health and wellness coaches around the world.