Wellness Coach - ExitoDigital.com

Wellness Coach
Lesson 6 - The Cosgrove Group
Wellness Coaching Model
113
Learning Objectives for Part 6:
• In general, what are the steps to change behaviors?
• Identify Stages of Readiness
• Identify Coaching Strategies for Each Level of Readiness
• Understand Decisional Balance
• Know the International Coaching Federation (ICF) Coaching Guidelines
In Part 6, we will explore effective coaching
skills to elicit behavior change within the client.
You can view behavior change as the primary
goal of most coaching interactions that you will
enter into with the client in order to facilitate the
client’s growth and those changes are necessary in favor of, or toward a healthy outcome.
The reason for behavior change as a priority to
you as a coach, is due to that it is often required
to support higher levels of health and well-being
within the client’s current behaviors.
Over time different theories have emerged both
within the science of behavior change and in
the research related to what are known as preconditions and the different processes required
to effectively change behaviors. One of the
most significant models proposed and developed is known as the Transtheoretical Model
or TMM. This model has arisen from the field
of behavioral psychology and provides principles and skills in addition to the processes we
employ in our mission each day as a wellness
coach. When we describe the Transtheoretical
Model, you will see that we are emphasizing
those key cognitive, behavioral, and relational
processes of behavior change that you will use
as a coaching template.
114
Your clients will come to you, as a wellness
coach, for various reasons. Maybe the client
has come to realize that they need and want
to start new fitness, wellness, or health related
behaviors. Usually, this type of client is very
committed to the process. But as we already
know, making changes to fitness, wellness or
overall health can be challenging for the client.
If your client felt that they could be successful
on their own, they would probably not be looking for you to help them, or the client may have
already been successful making changes and
sustaining them.
Emerging research has demonstrated that
behavior change is typically seen to be done
in what is known as stages. In general, your
clients will be in different stages, anywhere
from having not even thought about changing
behaviors, on through to the stage of trying to
maintain a certain behavior. This process also
includes thinking about making a change, making plans to change, and using our vision to try
different ways to make behavior change work.
The wellness coach wields a lot of responsibility in this situation. As an example, if the
coach was to use a technique that prematurely encouraged some new behaviors, changing behaviors may be discouraged during the
process. An example would be a client who is
contemplating change, but due to their stage of
readiness, they are not ready to actually move
into a higher stage of readiness - and the pressure to implement behavior strategies before
they are ready could cause the client to withdraw
from the change process overall.
Being able to avoid bad timing of your interventions requires that you understand where the client is relative to the stage of readiness or the
stage of change. This is typically done during the
assessment portion of your interactions, usually
in the first or second session with your client.
When we use this method of identifying stages
of change, we are able to be more specific about
behavior change. This becomes important for
the fact that all of our clients will most likely be
in different stages of change. Being specific is
one form of laser coaching, sometimes used by
wellness coaches. But this process of assessing
stage of readiness, is really done to relate not as
much about the client’s outlooks or perspectives
on life overall, as it is to their specific stage of
readiness to change a certain specific behavior.
their health, fitness or wellness goals on track and
successfully. We also want to coach the client toward lifelong change, to maintain changes made
during the coaching process.
Behavior changes needs and the stages are easily identifiable and pretty critical. Consider the precontemplation stage. During this stage your client
has not yet thought about making any changes
in their behavior. On the opposite of the stages
of change, we have clients who are in the maintenance phase, where changes in behavior have
already been successfully adopted. Within each
stage are characteristics that your client presents
and are very distinct and luckily, recognizable.
The Five Stages of Readiness
to Change
Behavior change is hard. It is viewed mostly as a
stepwise process, whereby the client will show a
capacity to move both forward toward an action,
yet may occasionally relapse back toward an action, or inactivity, during the coaching relationship. If you are effective enough as a wellness
coach, you will know what stage of readiness
your client is in, and that is important- so that you
will be able to employ strategies or techniques
to help change in the specific areas identified.
Your coaching delivery methods must be effective for the stage of readiness that your client is
in. Different applications of strategies or specific
techniques during each stage along the way will
allow you to coach the client toward reaching
Precontemplation (not ready
for change yet)
Contemplation (thinking about
making a change)
Preparation (preparing
for behavior change)
Action (executing an action plan)
Maintenance (maintaining
a change for good behavior)
115
It is important for you know your client’s stage of
readiness. Most of your clients, or prospective
clients, will have one area of focus, or concern
that they would be considered to be in the contemplation stage, (either fitness level, weight control, their nutritional intake, stress levels, mental
or even physical health) and your goal is to bring
the client to the maintenance phase of sustaining a new behavior change, consistently, within a
12 to 24 week time frame of coaching interventions. As you meet your client on a weekly basis,
you will be able to help your client move forward
in different areas where they might be pre-contemplative - but only when an opening presents
itself during coaching conversations. Remember
that when your client shows progress toward
one behavior change, their confidence level in
self-change and self-efficacy grows, and the client becomes more prepared to move forward in
another change effort.
Precontemplation
Let’s consider that you have someone who is
not even thinking about adopting healthy behaviors, or making a change to their risky behaviors.
From the client perspective they’ll most likely fall
into one of two categories... those who won’t or
the client who can’t. Those who say they won’t
make a behavior change are those who are not
interested in making a behavior change because
they don’t feel they have a problem to begin with.
If we were to ask your clients friends and family,
they would probably feel differently, and might
even be expressing concern to the client at regular intervals - yet the client still fails or refuses to
acknowledge that there is any behavior problem
that needs to be changed or any problem in general. The client most likely to say “I can’t”, would
be someone who would like to change but they
don’t feel that it is possible for them. They do not
believe in it. Although these are completely different reasons for being stuck in the pre-contemplation phase, both types of client are not contemplating any behavior changes at this time, let
alone executing a plan to work on making behavior changes in any particular area in their life
116
Precontemplation Stage Coaching
If your client is in the pre-contemplation stage
for some wellness issues, it is important to show
sincere empathy toward the client. At this point,
your (prospective) client will need to experience
sincerity and empathy from the coach in order
for them to move forward. During this time, it is
ideal to use reflections in conversation with the
client, to demonstrate that you have heard, understood, and respect their feelings and what
their wellness needs are. This skill of being able
to recognize and accept that your client may not
intend to change a certain behavior is important
in terms of how future interactions and behavior change possibilities occur. The coach does
not ask the client to move ahead in the behavior
change process at this time but instead chooses
to focus on understanding the client at a deeper level, without any judgment or fear of openly
communicating.
One of the most important messages we can provide for a client who is stuck in the “I wont” mode
of thinking is to state that you understand that
your client is not ready at this time for a certain
behavior change. ”That is fine. Here is my card
and I want you to contact me if you decide that
you would want to make a change one day about
this”. In the end, you have now a client who feels
good about their interaction with you, because it
has been positive, so the client will think about
you in a positive manner. During this time you
are careful to not judge your client or make them
feel inadequate, and this is very empowering for
the client.
Those who are likely to say “I cant” are your
clients who are probably aware that they have
some problems and some needs to change,
but remember, this client believes that behavior
change is not possible for them. This could be
due to them believing that it’s too difficult or too
complicated. The client may have tried and failed
when trying to make this behavior change in the
past. More so than the “I won’t” client, this client
is very aware of their barriers and obstacles and
most likely needs help to look at these barriers
and obstacles in a more positive and rational
manner so that the client can learn from them,
how to work around them or how to avoid them.
Quite frequently, this type of client feels anxiety
or overwhelmed from the negative emotions attached to having failed certain behavior change
in the past.
Using a wellness coach, your client is able to
sort out barriers and obstacles into those that
are excuses, or those that can be overcome
with sufficient motivation, or those barriers that
might be exaggerated. Your client will also reveal to you some real obstacles and barriers.
Taking real barriers, for which time may have
to pass before the client can resolve them,
off of the agenda, is important. When you do
this, the client’s emotional guard is lowered
and the client doesn’t feel like they still need
to convince you about the reality of their barriers or obstacles. In turn, this acceptance
shows the client that you’re on their side and
they are more ready to work with you, because
you have shown skills as well as signs of being
positive and motivating. It is important for the
client to realize that the changes they are working on with you will give them something that
they really want in the end. In these situations,
clients are far more motivated to work on finding realistic solutions to obstacles and barriers
that have held them up before, or contributed
to their failure.
Contemplation
The contemplation stage is characterized by
the term “I may”. During this stage your client
might be thinking about changing an unhealthy
or risky behavior, or even adopting a healthy
behavior. In addition to this, your client is also
considering taking action within the next six
months on this behavior, be it healthy or unhealthy. With good wellness coaching, your
client is aware of benefits tied to changing a
certain behavior, while also being less satisfied
with their present state of health and wellness.
A client in this state might express a fair amount
of reticence about changing a certain behavior, possibly thinking that changing this behavior would be too difficult or even impossible
for them to achieve. Some people can remain
in this stage of readiness for a long time and
become what we call chronic contemplaters,
because they can never imagine seeing themselves behaving in a different way and furthermore they do not know how to change. Sometimes this client is still weighing the benefits of
changing the behavior against those of what
efforts it would take to be successful.
During coaching interventions, when your client
opens a statement with” I might”...... express
interest in wanting to explore your client’s most
positive experience or their best experiences
with behavior change in the past, as well asnoting any of the more positive motivations for
making a particular behavior change in the future, as part of their vision. When your client is
able to focus on their values and their vision,
they’re more likely to come to appreciate how
behavior change would improve their life or
their wellness, overall. At the appropriate time,
a wellness coach can share scientific facts that
are important for the client to know, if they relate
117
to the benefits of a behavior change while helping clients to learn and discover the “pros” that
tend to serve as positive motivators for change.
help the client to see a clear vision of what they
want. In this case, the coach can suggest new
reasons for behavior change or even new supportive relationships for the client to rely upon as
motivation.
We will talk about decisional balance as a coaching concept later in this section, but during this
exercise, the coach can help the client examine
not only the upsides, but also the downsides, of
changing old behaviors for new, healthy behaviors.
Contemplation Stage Coaching
To move a client forword in the contemplation stage, try connecting them to their natural
strengths and abilities - while encouraging them
to get motivated about behavior change. As your
client discovers their strengths, this alone may
be enough to move them into a later stage of
change. This may be due to increasing the client’s awareness of the compelling reasons for
a behavior change and then getting the client to
connect with other people who have been able
to make a behavior change successfully. It may
also be due to motivational strategies that you
use as a coach during this stage, or a combination of both.
Another strategy to help your client through the
contemplation stage is to make connections between the changes they are trying to make and
the values that they have presented. Creating
the proper setting for behavior change, within
this larger context, tends to make change more
meaningful, significant and hopefully longer-lasting.
If your client has not been able to properly identify their own personal motivators needed to drive
change, the coach may need to intervene and
118
As with any behavior change, encourage clients to identify and accomplish small goals every week, based on realistic thinking and sound
goal setting. This will empower your client to be
more confident in their ability to change a certain
behavior. Acknowledging successful outcomes
is also vital to this process, as it will also build
your client self-efficacy. During the contemplation stage, the coach and client are laying a
foundation for other more important, or difficult,
behaviors to change and this stage may involve
small goals such as reflection, listening, discovering or deciding. It does not necessarily have to
be characterized by doing a behavior.
Preparation Stage
The preparation stage can be exciting for the client, as well as the coach. During this stage, language from your client might include statements
like “I will” or “I can”. Any trace of reticence, or
ambivalence from your client has been overcome and they have become strengthened by
the motivation to change behavior. At this point,
your client is planning to take action right away.
With the strong motivation the client has found,
they also are aware of their barriers and obstacles, and have come up with some ideas for how
to resolve them. If your client has not been able
to think through solutions for barriers, then they
may still be in the contemplation stage. The main
characteristic of the Preparation phase, consists
of encouraging your client to experiment, or to
try different solutions, and to be mindful (can be
a reflection used later) of ideas that were not as
successful.
Preparation Stage Coaching
One of the best strategies to help the client in
the preparation stage is to have them solidify
what their plans are toward behavior change.
Journaling, or other forms of written reflections
represent formal statements from your client
about what they are committing themselves to
do, and hopefully will contain specific details for
behavior change.
During this process you may need to help your
client to identify some of the small steps that they
can take before undergoing major change. This
will require some brainstorming as well as taking
a realistic approach to the preparations made.
This activity should be done with both the coach
and client coming up with ideas, together.
All of your clients will not move through the stages of change at the same timeframe, and furthermore, stages of change tend to show a little
bit of overlap. For instance, a client who is still
reticent or ambivalent to the process of change
might need to be encouraged to explore benefits
to changes in behavior; while they may be ready
for a specific change, successul changes related
to the overall vision may still be stuck in other
stages of readiness. During this time it is also important to encourage your client and avoid telling
your clients what to do.
In order for your client to properly prepare for behavior change, it is vital to identify situations that
could be problematic for the client, once they
begin behavior changes. Being able to identify
these from the onset will allow you and your
client to develop strategies and coping mechanisms before problems arise.
Action
How would you describe a client in the action
phase? This would be characterized by your client using the term “I am”, as your client has identified behaviors to change (including new behav-
iors), or those that they would like to adopt or
establish as part of a goal or successful outcome.
During this stage your client is actually doing the
behavior while building up to be an acceptable
level of proficiency (target level).
As an example, you may have the client who is
working on a particular change related to physical activity. After assessing your client’s needs,
you develop an exercise program design for the
client. Using scientific principles of exercise programming, you determine that your client should
do resistance training 3 to 4 times per week, for
60 minutes at a time. Exercise science, combined with wellness coaching, has helped your
client understand that they need to work out at
a moderate to high level of intensity to make it
to their goal. This will most likely represent a
change in your client’s behavior. As a result, your
client will come to feel more empowered, more
effective and more confident, in part, due to the
work done in earlier stages to set them up for the
action phase.
It is during the action stage that your client is at
their highest risk for relapse or lapse back to earlier stages (pre-contemplation or preparation).
Your ability to coach your client with techniques
to manage these challenging situations that put
them at risk for relapse or lapse is very important
to the process at this time. A lapse is defined as a
single slip in a certain behavior that could potentially lead to a relapse. Whether a lapse becomes
a total relapse depends on your client’s response
to the lapse, as well as the client’s perceived loss
of self-control.
We know that behavior change is hard and the
coach can help clients by exploring their challenging situations and to learn from them. Use
coaching skills that encourage your client to
share more of challenging situations with you.
For instance, what were they doing, what was
going on, who are they with, what were their
feelings during the time? Have the client troubleshoot by asking them what they could do differently the next time a challenge presents itself.
119
The main goal of your conversation skills should
be geared toward the formation of a plan to help
your client prevent a relapse. With this sort of
feedback, your client may be able to refer back
to strategies the next time they are faced with a
situation or scenario that challenges a behavior
change they are trying to make.
Another consideration of your client during this
time are the relationships with people they are
developing as part of any change effort. Coaches should encourage clients to develop relationships with other people who share common interests, as this could make a significant difference
with your client. This type of “modeling” and support is important to your client because they will
come to feel that they are not doing this process
alone or by themselves, or that they will have to
find their way for themselves.
Should your client experience a relapse, they
may easily be driven toward a downward spiral.
Since lapses can trigger an unwanted response
from your client, the relationships and support
networks that your client has in place will help to
supplement the relationship they have with you,
as their coach. In this way, behavior change is
most successful when multiple interests are able
to support behavior change. The wellness coach
should always encourage new relationships as
allies.
Action Stage Coaching
Coaching in the action stage is all about making
connections - connect your clients strengths and
values and their ideal environments, situations or
scenes. Simply put, the more modes of support
within your clients network that they can identify
with, the more likely they are to be successful in
the behavior change process.
Smaller, gradual changes that are targeted are
characterized by small achievable steps that
your client should attempt first, in order to feel
successful about pending behavior changes as
part of their vision. Action items for the wellness
coach to encourage during the action stage may
include all of the following:
120
action phase coaching
Developing friendships with people
sharing similar behaviors, interests and
goals
Prepare for potential lapses
Use framing as a learning tool to help
your client learn from mistakes
Work toward helping your client to
change their thought process about
their goals. The all or none approach
tends to only lead to negative thinking
Talk about situations that could be challenging to your client once behavior
change has begun. Discuss strategies
around coping with the situations
Maintenance Stage
If the action stage is characterized by the words “I
am”, then the maintenance stage would be best
summed up by the praise “ I still am”. This stage
is defined by any behavior change that has become a habit for your client and is now done as
part of their second nature or, automatically. Keep
in mind the time frame for behavior change; this
can take anywhere from 12 to 24 weeks for your
average client. In this stage, clients can show
a new level of confidence because they have
maintained a new behavior. This new confidence
will also help maintain other behavior changes
due to the inherent self- efficacy built into reaching the current stage of behavior change. This
self-reinforcing quality of maintaining a behavior
change is just the beginning. It does not mean
that there won’t be more work to do as it relates
to eliminating all risky behaviors toward a goal of
peak wellness.
Never underestimate the complexity of the maintenance phase. Your client will need to work hard
to maintain this behavior change. With maintaining a behavior change, there are certain risks involved - including boredom or the realities and
dangers of gradually slipping back into old behaviors that might be risky.
Once again we turn our conversation to explore
lapses. This is defined as when the client temporarily will abandon or stop any behavior change,
and can occur during the maintenance phase
just as easily or quickly as it does in the action
phase. Should your client find themselves in the
midst of a relapse, they may need to reassess
and redefine their goals, in addition to some refocusing.
One strategy that the coach can use in a lapse
situation is to redirect the client, and to suggest a new strategy or to try a different type of
change. In general, this can be easier during the
maintenance phase, than if trying it in the action
phase, due to the success of their experiences
and from the value and benefits they have already noticed or observed as part of the change
process. Lapses during the maintenance phase
are not seen as either permanent or significant
changes in terms of the benefits from changing
a certain behavior. This is important because the
coach should encourage the client to get back
on track, because it will be easier and quicker
if done responsibly. In fact, making adjustments
to your client’s behavior change strategies is an
indicator that your client is in the maintenance
stage of their behavior change.
In coaching, relapses are more problematic than
lapses during the maintenance phase. When
your client has a total relapse in their behavior
change goals, they have abandoned efforts to
maintain their attempt. In order to coach the client through a relapse, it is vital to reconnect the
client with their strengths, values, resources,
visions, goals, and any compelling motivators.
For this type of client, it is preferred to restart
them in the preparation stage, while trying to
move them back into the action stage with appreciative inquiry, reflection and listening, without judgment. If your client is able to remember
and connect their ability to use their strengths
for behavior change, it is then possible for them
to regain their self-efficacy as well as a sense
of control.
Maintenance Stage Coaching
Reconnections are important skills to use during the maintenance stage of behavior change.
It might be useful to help your client to reconnect and value a behavior as it relates to realizing their vision. During the maintenance phase,
when all seems to be going well with your client,
try challenging your client with the behaviors to
allow for personal growth, with goals that are
creative, interesting, attainable and meaningful.
If your client has mentioned compelling motivators, it is important to remember those now, at
this stage of behavior change - and if your client
can share their healthy behavior change goals
with others in their support network, it may act
as a motivator to realign them with positive role
models in this way.
Avoiding judgment, encourage your client to get
back on track when a lapse occurs. Ideally this
should be done as quickly or as early in the process as possible. When you’re able to get your
client back on track toward their desired behavior change goal, it is now time to re-strategize
to prevent relapses going forward. The reflection process may be as vital to this as any other
form of communication, as you learn exactly
why or how the relapse occurred initially.
Now that we have described the stages of
change for wellness coaching, we have set the
stage to work with clients, while moving our
clients through the different stages, toward a
successful or healthy outcome. Remember that
121
our clients may not know the science of behavior change, and may not refer to the stages by
name, themselves. Therefore it may be difficult
to use your “listening for” skills to assess the
descriptive statements that your client may use
with regard to behavior change.
Once you have begun to work one-on-one with a
client, it is likely that you will be establishing both
rapport and trust, while focusing attention around
their positive core values. Through skilled conversation, we want our clients to be able to indicate what stage of readiness they are in, once
areas of focus have been identified (physical
activity, eating, weight management, mental or
emotional health, and stress management). But
these main areas or concerns will not always be
something tied to exercise science or mental/
emotional wellness topics. Essentially any life issue or concern related to the client’s own health
and wellness should be on the table.
Once the client has revealed what stage of readiness they believe they are in, it is a good opportunity for the coach to continue and expand
upon this conversation. This could include questions about what goals or behavior changes the
client wants to focus on, as a priority, as they
move forward. Once the stage of readiness has
appropriately been identified and first steps are
defined, you can practically apply coaching concepts, skills or techniques, that are appropriate
for the client’s current stage for the readiness to
change.
122
With experience, you will be able to assess your
clients positive core - made up of their character
strengths, core values and the primary motivators for change. Using this information, combined
with the stage of change identified, try deciding
on one or more small, yet appropriate behavior
change goals for your client. This will require you
to develop strategies that will encourage small,
doable steps that build your client’s self-efficacy
toward behavior change.
Obstacles and barriers, or other challenges
should be discussed with the client if you feel
that there is risk for these items to inhibit behavior change. Once revealed, problem solve, brainstorm or troubleshoot possible solutions to prevent barriers and obstacles from getting a client
to the desired behavior change. This will require
that each client commits to the steps that they’ll
need to take and/or the efforts that they will need
to make to be effective. In a weekly coaching time
frame, these commitments should be followed up
in the next weekly session. If your coaching intensity or interventions are less frequent, there
is a risk of too many goals not being reached,
due to lack of follow-up with the client “not being present in the moment”, during the gaps that
constitute your sessions.
Use reflection to communicate back to the client,
confirming that you have their commitment for
their readiness to change and to move forward
into other more salient goals.
The Transtheoretical Model
In the fields of wellness and health psychology,
the transtheoretical model is used to assess a
clients readiness to act on a new healthier behavior and was described somewhat previously.
This model provides strategies for processes of
change and is used in wellness coaching to guide
the client through various stages of change toward action and maintenance. It is interesting
to see a sixth stage of behavior, now added to
the original transtheoretical model (TTM). This
stage, called termination, and is defined by the
client having absolutely zero temptation and
100% self-efficacy... in this stage, the client is
certain that they will not return to an old, unwanted behavior.
motivation or drive to change their behavior, due
to the effects of leaving things unchanged.
During these cognitive processes, coach your
client to be aware of how an unwanted behavior
might be affecting others close to them in their
lives. Examples would include the attitudes or
values of a spouse who does not care for a certain unwanted behavior (smoking) or what your
client’s family might be experiencing as they observe behavior change and your client.
Your client’s self-image is also another point of
cognition during the change process. Seeking
relevance between your client’s vision, behaviors and values is one way to supplement integrity within their mindset, a key to having or developing a healthy self-image.
When you coach, you are really trying to learn
how your client thinks. Our actions are tied to
our beliefs and thoughts.
When Prochaska and DiClemente defined the
transtheoretical model, the goal was to identify
what processes work best for behavior change
during different stages. The TTM involves five
cognitive and five behavioral processes involved in changing behavior.
Cognitive Processes
The cognitive processes that our clients choose
to change their behavior involve a wide range
of reflective/learning processes, in which the
clients begins to sort out their own thoughts,
desires, and feelings related to a particular behavior change. Over a period of 3 to 6 months,
cognitive processes began to take hold and
your client should be encouraged to reflect
about these processes.
The first step of cognitive processes involved in
change include the client getting more information, as they explore the benefits of changing a
particular behavior. Your client will also be affected emotionally as they develop a heartfelt
In addition to the connections made between
your client’s vision, values and behaviors, we
want to reinforce the social aspect of the cognitive phase while learning a new behavior. This
is done by encouraging your client to talk with
or spend time with people who are like-minded
or those working on the same behavior change
(such as a support group).
Behavioral processes
The behavior based processes that our clients
use represent a wide range of learning processes
that tend to be more action oriented. During this
time your client will most likely be experimenting with some new healthy behaviors. Part of the
coaching process involves encouraging the client to permanently adopt those changes in behaviors that develop. This can be accomplished
by simply having your client write down exactly
what behaviors they have seen to be part of their
change efforts in journal reflections.
Since behavior change processes can be influenced by where your client operates, creating
an environment conducive to behavior change
should be planned. This can be done by using
mental reminders as cues to facilitate change
when in certain environments (work, home, etc).
123
Replacing unwanted or risky behaviors is most
easily done using substitutions. Try swapping
out an older, risky behavior with one that is new,
health promoting and feasible. An example
would be a client who is trying to quit smoking
- the client may find success in using a nicotine
patch or gum to get over the initial challenge of
changing a smoking habit.
Using decisional balance takes into consideration
both the pros or cons, for your client to consider,
as they contemplate behavior change. Personal
gains, gains for others (family or friends), approval
of others, and even self approval would all be items
considered while performing a decisional balance
activity. The other side of decisional balance takes
into consideration all the cons or losses of a certain behavior, if left unchanged. This would include
We have demonstrated the need for getting the losses experienced for your client themself - losses
client to have a strong support network. Being seen in others they are exposed to, disapproval
able to recruit support from family and friends from others and even self disapproval.
is just the first step... this must be paired with
coaching that instructs the client to specifically
ask family or friends for what is needed. This
practice will require that the client think carefully
as to how to proceed with what questions they
would ask and then actually asking someone to
provide support from within their network. Even
learning to ask for help may be a significant behavior change for your client.
With any attempt to change behavior, it is vital
to have a reward structure in place. Make sure
that your client has set up appropriate rewards
for completing weekly commitments. This,
again, will positively reinforce behavior changes
that are made while also increasing self-efficacy
and confidence in your client.
Decisional Balance
In wellness coaching, we have a great, yet simple tool to help our clients find solutions to decisions that tend to linger or make them unclear
on how to proceed. We call this decisional balance.
Decisional balance is an effective way to engage your client in the process of behavior
change, especially impacting the cognitive processes that are undergone as part of behavior
change. Our goal, in using decisional balance,
is to have our client weigh both sides (pro or
con) of a particular desired behavior or behavior change. Research studies show that weighing both sides of a wellness concern tends to
increase the chance of a successful behavior
change.
124
Naturally the pros, benefits and motivators are the
more positive components about changing a behavior, or adopting a new healthier behavior. Pros,
etc. are the rewards your client will have once they
successfully begin a healthy behavior. The wellness coach helps to move the client from a more
general, nonspecific pro, such as, ”I want to stop
drinking because I’m starting to not like the way I
feel in the morning”, to a more specific clarification
such as “I really want to quit drinking because I’m
afraid my family will eventually reject me and I also
feel that my productivity isn’t where it should be on
the days after I drank”. This is a more specific way
to define the pro’s of a behavior change.
Cons, challenges or barriers are those things that
tend to make changing a new behavior difficult for
your client. In these situations, the coach should
assist the client to discover which barriers are real,
which barriers might change over time and which
barriers are to be avoided. Some clients will use the
cons as a form of both formulating and presenting
excuses, and still other clients will be able to easily see how some of their cons could be overcome
with a strong enough pro motivator.
PRO
decisional balance
no change- weight
remains the same
change- weight loss
is maintained
enjoy ice cream and
fast food.... don’t
have to exercise
feel great, buy new
clothes, healthier,
more self-esteem
focused on their barriers and all those
reasons why they could not possibly
make a behavior change. Although it
may be difficult for the wellness coach,
the client should be encouraged to
move forward with praise for knowing
what their obstacles and barriers truly
are.
CON
There are three main tasks to an intervention in the early stages with your
client. These include cultivating moticost of gym memvators, recognizing and understanding
feel embarrassed, bership, cost of new
barriers and then to come up with posno confidence, can’t clothes, give up fasible solutions around barriers or obstafit into clothing
vorite foods and TV
cles. The client with the “I can’t” attitude
just for exercise
or beliefs set is one who has already
completed one of the three tasks of
the initial or early stages of the coaching relationship. This client is acutely aware of
the obstacles and barriers that get in the way of
their progress. The wellness coach must ensure
If you have the client before you, who is conthat the other two tasks (cultivating motivators
templating making a change in behavior, try
and solutions to barriers) are completed with the
asking the following questions:
client in order for behavior change to move forward.
1. Why is it that you would like to
change this behavior?
2. Why shouldn’t you try to change
this behavior?
3. What would it take for you to
change the behavior?
The best strategy for earlier stages along the
continuum for change, are those that involve
cognitive processes. By helping clients to articulate powerful, personal, detailed, positive motivations, the wellness coach can truly help clients
prepare for the action phase. The coach is also
instrumental in helping the client to discover not
only what the barriers and obstacles are, but any
possible solutions that can be deployed as a
workaround.
Self-efficacy
As wellness coaches, one of our main missions
is to increase the client’s sense of self-efficacy
through observation of the TTM, and the use of
health guidelines, fitness, and wellness coaching principles.
When we have a sense of self-efficacy, we demonstrate a belief that we have the capability to
initiate or sustain a desired behavior (change).
Self-efficacy describes a circular relationship between beliefs and actions. Most often, our beliefs
and throughts drive our actions. The more your
client believes that they can do something for
themselves, the more likely they are to do it. The
more your client experiences doing something
successfully, the more they will believe that they
will be able to do it again.
Once you and your client have decided on beSometimes we see clients who are stuck in the havior change goals, it is important to be sure
“I can’t” mode of thinking, and tend to be very that these goals are appropriate and that they do
125
not run the risk of failing an attempt toward this
goal. With this in mind it should be plain to see
why it is also important to correctly assess your
client’s stage of readiness to change. It could
be considered risky to let a client in the “I may”
stage make late stage behavior change goals.
Remember, as stated, the appropriate goals
for someone in the precontemplation stage are
those that are more closely tied to their thoughts
and feelings. Connecting the client with their
positive values and core, finding motivations,
and revealing obstacles and barriers are great
ways to improve your client’s self-efficacy. To
help you assess your client and their stage of
readiness, you could again, ask the client why
they are wanting to make this particular change
now. You might also ask what the client wants
to get for making this behavior change. This will
serve as the motivator. To determine obstacles,
ask the client what could possibly get in the way
of them reaching their goal. Once these have
been revealed, the coach should follow up with
“What are some of the ideas that you might try
to overcome or avoid barriers?”. This is a good
way to protect your client from setting inappropriate goals.
Avoid making suggestions that your client could
interpret as being told what to do, or what they
should do. If your client needs a suggestion, they
will most likely ask you for it. Only then can you
work together to brainstorm ideas, taking turns
to generate different suggestions as possibilities. Then, ask your client to choose from all the
possibilities that have been discussed, leaving
the decision-making process in the hands of
your client.
Behavior and Consequences
The process of learning through positive and
negative reinforcement is known as operant conditioning. This type of conditioning is an effective
way to engage clients in the process of coaching
them through their behavior changes and focuses on the direct relationship of a certain behavior
and its consequences. A fundamental of coaching involves the belief that it is often easier to resolve antecedents to a certain behavior instead
of trying to modify their consequences (if they
126
The timeline for each client to successfully
change will vary, based on the client and the
level of intensity of changes undergone.
are negative). Antecedent behavior is something your client will probably experience frequently. An example would involve a client trying to adopt a new, healthy behavior, but finding
it unpleasant to be in the gym, difficult to drive
by favorite restaurants, having a stressful day
or forms of negative self talk. A client who has
not yet learned about consequences for certain
behaviors might state that “I am generally overwhelmed and cannot deal with all of this behavior change at once”. This sort of thinking may
contribute to lapses, relapses and more negative thinking. Try to be helpful in creating a goal
that helps your client release stress (or other
barriers/obstacles) during the day so that the
client can feel confident that they are on track
and not at risk for a lapse.
Negative Thinking
During the coaching experience, you should be
tuned into the words, statements and thoughts
conveyed by the client. Your conversations
should be open, however understand that like
all people, your clients will also most likely engage in self-talk at certain times. During this
time of self-talk, we have the ability to be positive or negative, and we tend to go one way or
the other. In general, when possible, we want
to elicit what is known as change talk from our
client. But sometimes when we need to assess
our client for their stage of readiness for a certain behavior change, we encounter concerns
due to issues or topics that have not even been
The Timeline for Change
What is your client’s positive core made up from?
Knowing this will help you in your intervention strategies.
recognized from the client’s perspective. An example would be someone who has never contemplated doing any physical activity, for whatever the reason. Now, they realize that, as part
of their wellness vision, it is a necessary change,
and a required step.
At times, we encounter someone with negative
thinking or values; sometimes we consider this
person to be pre-contemplative. In this way, if
your client is pre-contemplative, they may not
be interested in change because they don’t even
acknowledge that there is a need to change anything about their behaviors. Consider, however,
that you can use your skills to connect PA to
some part of your client’s positive core. Another
scenario involves that client who never thought
about behavior change because they just don’t
come to think that it’s possible for them. Again, for
whatever the reasons, these types of clients are
pre-contemplative. One thing these two people
have in common is even though the reasons may
be different both people are not thinking about
working on making a change when it comes to a
specific area in their life, lifestyle or possibly, risk
factors to their health. Sometimes we go further
and label people like this as “in denial”. While
we would of course refrain from any labeling in
a professional environment, it goes without saying that we all know people in our lives who fit
this description. Your skill set will include refining your ability to identify anywhere your client
presents negative thinking in terms of readiness
to change, and to discourage its use, as it is not
congruent with behavior change goals.
Typically, clients will seek your services when
they are in one of the earlier stages of behavior change. Being able to move clients from the
early stages of change into the maintenance
stage can take anywhere from 12 to 24 weeks
- sometimes longer, depending on your client.
More challenging behaviors can take up to a
year for the client to reach a maintenance stage.
Some clients will have special needs, others will
have concerns that arise out of everyday life, affecting their ability to be successful at moving
through behavior change within the time frames
that we’ve described. It is not at all unusual for
coaching relationships to endure well beyond
the time needed to simply change one behavior.
Change, in itself, can take more than a year if
the goal or behavior change is a deeply rooted
behavior, or if the client lacks both understanding and or compliance.
Wellness Coaching and the TTM
It is one thing to know of the transtheoretical
model and to appreciate the history of its incorporation in the field of wellness coaching and
behavior change. It is another to practically apply these concepts to your client.
Again, your clients are looking for you to connect their positive core, their strengths, attitudes,
values and resources for learning and growth to
127
their efforts related to behavior change. Doing
so will help the client to maintain a positive relationship to the idea of changing their behavior.
Since behavior change is known to be difficult, it
is best to remind your client that this is a normal
feeling, for them to step outside of what they are
comfortable with while seeking to make an important, conscious effort at change.
Reassuring clients that lapses occur during the
earliest stages of change may help clients with
their self-confidence and self-efficacy; this requires that the coach be encouraging and supportive in the early stages of intervention.
Professional
wellness coaches use guidelines
and references
from multiple
sources to coach
clients. Standards for coaching competencies
are in a state of
evolution as we
define rules and
applications with
this variety in
mind.
Again. if you observe your client having difficulty
with the process of behavior change, reassure
them that what they are experiencing is very normal and part of the change process overall. It is
best to remind the client at this time that they
are doing something that would be difficult for
anybody, not just them. It may also be helpful to
remind the client of their past success stories.
Since most people will tend to underestimate their
own abilities to change behaviors while lacking
the tools and processes to facilitate change, the
coach plays an instrumental role in helping the
client to raise their confidence level. This is done
128
by never losing sight of what the client’s positive
core is. Clients who are able to develop internal
motivation and focus less on external motivators
are more successful at behavior change, due to
looking inside of themselves (internal) and focusing on changing behaviors for themselves and
not for someone else (external). It is when our
client relies on motivation from external sources,
that they encounter anger, frustration or even
guilt. This can lead your client to simply give up.
If your client can honestly say “I am doing this
because it will help ME to feel good and to feel
positive about myself”, then you have been successful in terms of being able to bring the client
to move to a higher stage of readiness. This is
also a sign that goals set with the client are appropriate and on track.
In an effort to appease their coach, sometimes
clients will use guilt to express themselves.
Statements like ”I should have done this or that”,
are counterproductive. By helping your client
to focus on their internal motivations, the pressures attached to any external motivators are
lessened.
As you “listen for” cues from your client during
consults, assess your client’s motivation. Do
they have a tendency to say things such as “I
don’t know if I really want to do this”, or “I can’t
do this”, “I don’t have the time to do this”, “This
seems like it will be too difficult for me” or “I won’t
be able to do........(other activities) if I make this
change”?
When your client ultimately takes control and responsibility for their own well-being and health,
the change process overall and becoming connected with their own motivators, you should
consider this a breakthrough, because this will
unleash their internal motivators and inner power
to coach them through the obstacles of change.
If your client has conflicting and coexisting feelings about a behavior change (ambivalence), it
is best to resolve this, due to it being a major
factor that tends to inhabit your client’s motivations. Ambivalence is fairly common and pretty
normal, and as such, coaches should encourage their clients to simply accept their ambiva-
lence rather than to struggle against it, and to
work their way through it, instead. Your client’s
level of ambivalence does not need to be completely resolved in order for them to get started
and then to be successful with behavior change.
As an example most people might show ambivalence toward taking away from television viewing
time to exercise, but they readily do it because
they recognize the intrinsic rewards as making it
worthwhile. Or, the client may simply change how
they feel about something. We all do that! We
would probably describe this type of change as
being by osmosis.
Ambivalence can be a dealbreaker. If your client presents with ambivalence, they may even
be questioning their own commitment to behavior
change. A healthy dose of ambivalence can turn
into a positive experience if you are able to turn
your client’s thinking around to a point where they
can get back on track and feel confident once
again. Grounding your client to their positive core
and reestablishing goals may be the best tools
for dealing with your client’s ambivalence.
When your client changes one area of their life, it
can have a mobilizing effect on behavior change
in another area. In other words, when your client experiences success in one area where their
stage of readiness is relatively high, they might
progress past earlier stages in the more difficult
areas of change, fueled by new self-efficacy and
self esteem.
Coaching interventions involve a lot of thought
and planning on the coaches part. If, at the end
of a session, you feel your client is not respond-
ing in a manner required for positive behavior
change, you may need to stop and step back to
think... “Is my client really in the stage of readiness that I think that they are in”, or “Have they
regressed to an earlier stage”?. “Do I need to
help them set more of the thinking/feeling goals
instead of behavioral goals (early stages of versus late stages)”? The dynamic dialogue and
conversations that you share with your client will
reveal to you their level of commitment and connectivity to the process.
If you observe a client not making significant
steps toward progress or change with smaller
goals over the first 30 day period, first determine
if the goals are realistic or not. If they are not
realistic, reassess goals and redirect your client.
If the goals are realistic, you might need to honestly question whether or not your client has truly
committed to the goal of behavior change. It is
always good to be mindful of this sort of scenario, as your client may want to change their goals
over time or may even want to try a different approach. Your client may feel that they would benefit from a different style of intervention. Openly
discussing and communicating this type of situation with your client is appropriate and helpful if
they seem like they are in a “stuck” place.
The International Coaching Federation (ICF)
has developed core coaching competencies to
support greater understanding of skills and approaches for wellness coaches in the field. In the
pages that follow we will summarize these core
coaching competencies.
129
co -creating the coaching relationship
table one
130
Establishing Trust and Intimacy with the Client - Ability
to create a safe, supportive environment that produces
ongoing mutual respect and trust
Shows genuine concern for the client's welfare and future,
Continuously demonstrates personal
integrity,honesty and sincerity
Establishes clear agreements and keeps promises
Demonstrates respect for client's perceptions,
learning style, personal being
Provides ongoing support for and champions
new behaviors and actions, including those
involving risk taking and fear of failure
Asks permission to coach client in sensitive, new areas
Coaching Presence - Ability to be fully conscious and
create spontaneous relationship with the client, employing
a style that is open, flexible and confident
Is present and flexible during the coaching
process, dancing in the moment
Accesses own intuition and trusts one's inner
knowing - "goes with the gut"
Is open to not knowing and takes risks
Sees many ways to work with the client, and
chooses in the moment what is most effective
Uses humor effectively to create lightness and energy
Confidently shifts perspectives and
experiments with new possibilities for own action
Demonstrates confidence in working with strong
emotions, and can self-manage and not be overpowered or
enmeshed by client's emotions
table two
Active Listening - Ability to focus completely on what the client
is saying and is not saying, to understand the meaning of what is
said in the context of the client's desires, and to support client selfexpression
communicating effectively
Attends to the client and the client's agenda, and
not to the coach's agenda for the client
Hears the client's concerns, goals, values and
beliefs about what is and is not possible
Distinguishes between the words, the tone
of voice, and the body language
Summarizes, paraphrases, reiterates, mirrors back what
client has said to ensure clarity and understanding
Encourages, accepts, explores and reinforces the client's expression
of feelings, perceptions, concerns, beliefs, suggestions, etc.
Integrates and builds on client's ideas and suggestions
"Bottom-lines" or understands the essence of the client's
communication and helps the client get there rather than engaging in
long descriptive stories
Allows the client to vent or "clear" the situation without judgment or
attachment in order to move on to next steps
Powerful Questioning - Ability to ask questions that reveal the
information needed for maximum benefit to the coaching relationship
and the client
Asks questions that reflect active listening and an
understanding of the client's perspective
Asks questions that evoke discovery, insight, commitment or action
(e.g., those that challenge the client's assumptions)
Asks open-ended questions that create
greater clarity, possibility or new learning
Asks questions that move the client towards what they desire, not
questions that ask for the client to justify or look backwards.
Direct Communication - Ability to communicate effectively during
coaching sessions, and to use language
that has the greatest positive impact on the client
Is clear, articulate and direct in sharing and providing feedback
Reframes and articulates to help the client understand from another
perspective what he/she wants or is uncertain about
131
Uses language appropriate and respectful to the client (e.g.,
non-sexist, non-racist, non-technical, non-jargon)
Uses metaphor and analogy to help to illustrate
a point or paint a verbal picture
communicating
effectively
(cont.)
Clearly states coaching objectives, meeting agenda,
purpose of techniques or exercises
Creating Awareness - Ability to integrate and accurately evaluate multiple
sources of information, and to make interpretations that help the client to
gain awareness and thereby achieve agreed-upon results
Goes beyond what is said in assessing client's concerns, not getting
hooked by the client's description
Invokes inquiry for greater understanding, awareness and clarity,
Identifies for the client his/her underlying concerns, typical and fixed ways
of perceiving himself/herself and the world, differences between the facts
and the interpretation, disparities between thoughts, feelings and action
Helps clients to discover for themselves the new thoughts, beliefs, perceptions, emotions, moods, etc. that strengthen their ability to take action
and achieve what is important to them
Communicates broader perspectives to clients and inspires commitment
to shift their viewpoints and find new possibilities for action
Helps clients to see the different, interrelated factors that affect them and
their behaviors (thoughts, emotions, body, background)
Expresses insights to clients in ways that are useful and meaningful for
the client
Identifies major strengths versus major areas for learning, growth and opportunity; identifies what is most important to address during coaching
process
Asks the client to distinguish between trivial and significant issues, situational versus the current behaviors, when detecting a separation between what is being stated and what is being done
132
facilitating learning and results
table three
facilitating learning and results (cont.)
Designing Actions - Ability to create with the client opportunities for
ongoing learning, during coaching and in work/life situations, and for
taking new actions that will most effectively lead to agreed-upon coaching results
Brainstorms and assists the client to define actions that will enable the
client to demonstrate, practice and deepen new learning
Helps the client to focus on and systematically explore specific concerns and opportunities that are central to agreed-upon coaching goals
Engages the client to explore alternative ideas and solutions, to evaluate
options, and to make related decisions
Promotes active experimentation and self-discovery, where the client applies what has been discussed and learned during sessions immediately
afterwards in his/her work or life setting
Celebrates client successes and capabilities for future growth
Challenges client's assumptions and perspectives to provoke
new ideas and find new possibilities for action
Advocates or brings forward points of view that are aligned with client
goals and, without attachment, engages the client to consider them
Helps the client "Do It Now" during the coaching
session, providing immediate support
Encourages stretches and challenges but also a comfortable pace of
learning.
1 Planning and Goal Setting - Ability to develop and
maintain an effective coaching plan with the clientclient
Consolidates collected information and establishes a coaching plan and
development goals with the client that address concerns
and major areas for learning and development
Creates a plan with results that are attainable,
measurable, specific and have target date
Makes plan adjustments as warranted by the coaching
process and by changes in the situation
Helps the client identify and access different resources
for learning (e.g., books, other professionals)
Identifies and targets early successes that are important to the client
133
facilitating learning and results (cont.)
Managing Progress and Accountability - Ability to hold attention
on what is important for the client, and to leave
responsibility with the client to take action
Clearly requests of the client actions that will move the
client toward their stated goals
Demonstrates follow through by asking the client about those actions
that the client committed to during the previous session(s)
Acknowledges the client for what they have done, not done, learned or
become aware of since the previous coaching session(s)
Effectively prepares, organizes and reviews with client
information obtained during sessions
Keeps the client on track between sessions by holding attention
on the coaching plan and outcomes, agreed-upon courses of
action, and topics for future session(s)
Focuses on the coaching plan but is also open to adjusting
behaviors and actions based on the coaching process
and shifts in direction during sessions
Is able to move back and forth between the big picture
of where the client is heading, setting a context for what
is being discussed and where the client wishes to go
Promotes client’s self-discipline and holds the client accountable
for what they say they are going to do, for the results of an
intended action, or for a specific plan with related time frames
Develops the client’s ability to make decisions, address key concerns,
and develop himself/herself (to get feedback, to determine priorities and
set the pace of learning, to reflect on and learn from experiences)
Positively confronts the client with the fact that
he/she did not take agreed-upon actions
Tables 1, 2 and 3, p.127-131 from: The International Coach Federation; retrieved June, 2010. http://www.coachfederation.org/research-education/icfcredentials/core-competencies/
134