Wellness Coach - ExitoDigital.com
Transcription
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