Choosing a focus area and exploring readiness to change

So far, I have covered the first three stages of the health coaching process:

  • identifying the client’s vision for optimal health and wellbeing
  • exploring values and what is important to them about their health
  • assessing current health through Current and Desired States questionnaire and other available data such as lab and diagnostic tests or a health risk assessment

At this point, the client is usually ready to identify a focus area, i.e., a part of their vision of health they want to begin working on. This can be a particular domain from the Wheel of Health, such as nutrition or exercise, or it may be something like weight loss, which can encompass several areas of the Wheel. There are several factors that may influence where a client chooses to start, including:

  • the long-term importance of the focus area to them
  • the immediate benefits of making the desired change
  • the client’s current willingness to take on the challenge of the desired change

In my experience, that last factor typically plays a key role in how successful the client will be in making the change. That is why the next step in the process is so critical: assessing the client’s readiness to change. Just because a client has prioritized a focus area does not mean they are fully ready to make the change.

A client’s readiness to change can be influenced by many potential factors, but the two primary factors tend to be importance and confidence. Ideally, we want both of those factors to be relatively high before moving into goal setting and action steps. Oftentimes, clients want to jump right into action, but it will increase their chances of success to slow down and explore readiness to change before moving into action.

Typically, a client chooses a focus area because it is important to them at some level, but there may be other competing values or priorities that could interfere with the client’s attempt to change. And even if the selected focus area is of high importance, the client may have doubts about their ability to change. Perhaps they have tried in the past and failed, or they are not sure what steps they need to take to achieve the desired change. There are a number of strategies that coaches can use to assess readiness to change. Typically, we explore the importance of making the change before assessing confidence. After all, if it’s not important to the client, it is not really worth spending a lot of time on their confidence to change.

One of my favorite tools for exploring importance is a 1-10 number scale (with 1 being low importance and 10 being high). Asking the client to place the importance of making the change on a number scale allows them to think about all the factors that go into selecting the number. In general, a client is usually ready to move forward if they rank themselves as a 7 or higher. If a client ranks themselves lower than a 7, there are follow up questions I usually ask to explore the reasons why it is important for them to change. For example, if a client ranks themselves a 5, I may ask “What makes it a 5 versus a lower number like 3?” This allows the client to verbalize the reasons why they rated it as high as they did while also acknowledging any competing priorities that may keep it from being the most important area for change.

Another strategy for assessing the level of importance is to help the client explore the pros and cons of changing vs. staying the same. Having a client verbalize the pros and cons of changing may help them identify the positive benefits they will experience if they change. On the other hand, it may bring to light any competing priorities that could make it difficult for the client to change. All of this information is critical to helping the client determine if the focus area is of high enough importance to address at this time.

When the client determines that the change is important enough to move forward, the next step is to assess and support their confidence to make the change. In my work with clients, I have often found that importance is typically high, but confidence is usually on the low side. If a client is lacking in confidence around making the change, it can make the rest of the change process quite challenging. Thus, it is critical to adequately assess and help build the client’s confidence before moving into action. Lack of confidence often comes from the client’s previous attempts to change without success. For this reason, it is beneficial to acknowledge when the client has had at least partial success and more importantly, to help the client learn from the times they were both successful and unsuccessful.

Coaches use some of the same or similar strategies and tools to assess client confidence. For example, I often use the 1-10 number scale to assess confidence level (with 1 being low confidence and 10 being high). Again, we typically want the client’s confidence to be a 7 or 8 before moving into action. If a client ranks themselves lower, I will often ask one of the following questions:

  • “What makes it a {6} versus a lower number?”
  • “What would it take to increase your confidence from a {5} to a 7 or 8?”
  • “What number would it have to be for you to begin making the change?”

These questions can help a client verbalize what makes them confident about making the change as well as what challenges they believe may get in their way.

If a client’s confidence is low and they are not feeling ready to move into action, there are strategies a coach can use to help build their client’s confidence level. One of the most effective ways to do so is to explore the client’s strengths and past successes. Perhaps they have lost weight in the past and can tap into the tools and resources they previously used. Or this may be an opportunity to look at a client’s successes in other areas of their life and how those strengths and skills can apply to the current focus area.

If a client has made several attempts to change in the past without success, they may feel discouraged about attempting to change one more time. In a case like that, it is beneficial to have the client think about the time when they had the greatest amount of success, even if they did not accomplish all they hoped. If the client is concerned about barriers that prevented their success in the past, the coach can help the client strategize how to overcome those barriers should they arise again (this will be done in the action planning stage as well). Having a plan for addressing barriers may help increase the client’s confidence in attempting the desired change one more time.

After thoroughly exploring importance and confidence, the client and coach together will determine if the client is ready to move forward into Goal Setting and Action Steps. If confidence is still low, the client may want some time to think about it between sessions and then revisit confidence the next time. Or it may be that they need to consider a different focus area at this time. Even if the client and coach decide that moving forward with the current focus is the way to go, importance and confidence can shift throughout the coaching process. Thus, the coach may revisit either or both if they sense changes based on the client’s words or actions.

Assessing current health

Once a client has identified their vision of optimal health and wellbeing and why it is important for them to make changes in their health behaviors, it is helpful to perform a more comprehensive health assessment. This assessment can include input from a number of different sources including medical lab tests and diagnostics, a health risk assessment, recommendations from healthcare providers as well as any number of self-assessments around physical and mental health.

Even if a client comes to coaching with a specific focus area in mind, I find it is beneficial to have them complete a comprehensive self-assessment. Doing so may clarify what area(s) they most want to work on, or it may provide insight into areas that they did not realize were impacting their health. So many of our health behaviors are inter-connected, so taking a step back to look at the big picture can actually help a client identify the most important area(s) in need of change.

The self-assessment tool that I use with clients is the Current and Desired States Questionnaire. This self-assessment asks clients to rate their current and desired states of health on a scale of 1-10 for each area of the Wheel of Health. Doing so provides valuable input to clients as they prepare to select an area of health and wellbeing to focus on and set specific goals. In addition to rating each area, clients can document the reasons why they chose their current rating as well as what changes they could make to help them get to their desired level.

I usually give clients the questionnaire prior to our first meeting so they have time to complete it beforehand. This allows us to discuss the results in our time together. Before jumping into the specifics, I often begin with questions that ask the client about their experience completing the assessment and looking at their health in this way. For example, I may ask:

 

  • What was your experience in completing this assessment? What stood out most to you?
  • What, if anything, surprised you about your responses?

 

After discussing the general experience of completing the questionnaire, I then help the client explore specific areas on the assessment to help them prepare for the next step in the process, which is choosing a specific focus area. We often don’t have time to review each question in detail, so I typically use more general inquiry such as:

 

  • What are the areas in which you feel strong? What supports those areas of strength?
  • What are the areas where you would like to see some improvement or change?

 

Many times, clients will have more than one area in which they would like to improve. Given that behavior change takes time and can be difficult, I emphasize to clients that they do not have to take on all of their desired changes at one time. In fact, clients are strongly encouraged to work on only one area at a time. Studies have shown that the greatest success comes from choosing a focus area where the client will achieve results that are important to them and they are most likely to do well. Achieving a series of small wins in the early stages of behavior change can help a client stay motivated on their path to improved health and wellbeing.

As you can imagine, health assessment is not a static part of the coaching process. Depending on how long a client stays engaged in coaching, I will have them revisit and reassess their status along the way. Repeating the Current and Desired States Questionnaire at the end of the coaching process is also a wonderful way for the client to assess and celebrate the progress they have made and look at what changes they may want to continue with in the future.

Using one or more assessment tools is an excellent way to help clients clarify and prioritize what area of their health they want to focus on, particularly if there are multiple areas they want to change or improve. Self-assessment can also be an insightful part of the self-discovery journey that unfolds as part of the coaching experience.

james-gardner-quote-life-is-an-endless-process-of-self-discovery

 

Finding your “why”

In continuing to explore the various stages of the health coaching process model, today I will review the second stage: identifying and prioritizing the elements of the client’s vision that are most important to them and reflect significant values in their life.

The purpose of exploring client values is twofold:
1. it sets the stage for determining specific areas the client would like to address, and
2. it helps establish their real motivation for behavior change

As most of us know, behavior change can be very difficult. It takes time, effort and discipline to establish new habits or break old habits. Therefore, connecting the behavior change to those things that are most important to the client will help them embrace the change and work through the obstacles and barriers they may encounter along their journey. I like to call this stage “finding your ‘why’” as it gets at the true reason(s) the client wants to change.

The values associated with a client’s health and wellbeing may include things like spending time with family, serving their community, or being a role model to their children. Their values may also tie into their faith and spiritual beliefs. The desire to change may be tied to short-term plans or longer-term goals. For example, a mother may desire to lose weight now in order to look and feel good at her child’s upcoming wedding, but she may also want to do so to have the energy to run around with her future grandchildren.

To help a client articulate their values, I typically ask one or more of the following questions:

  • What is important to you about your health and wellbeing?

 

  • What really matters to you in your life?

 

  • What brings you joy and happiness?

 

  • What values are you honoring as you move toward your vision of optimal health and wellbeing?

Some clients may initially find it difficult to answer these questions. Many times, they may seek coaching because they feel they “have to” or “should” change a particular behavior (e.g., lose weight, start exercising, stop smoking). By exploring values and what is most important to them about their health, they may identify a different area or behavior they want to change. Clients are more likely to be successful if they choose an area they want to change versus one they feel like they need to change for external reasons.

As mentioned earlier, one of the most important reasons to help a client identify their “why” is to help them work through the challenges and obstacles that are likely to arise on their way to better health. When a client is knee deep in the action phase, perhaps waking up at the crack of dawn to fit in their daily exercise, there are bound to be days when they don’t want to do it. It is on those days and at those times of lagging motivation when the client can pause and ask themselves, “Why am I doing this again?” – and they will have their answer.

 

what is your why

It all starts with a vision

Happy New Year! I hope that you all had a wonderful holiday season and are optimistic about the new adventures that 2019 will bring. I thought it would be helpful to kick off the new year by reviewing the stages of the health coaching process model, beginning today with the first stage: creating an optimal health vision.

Laying the foundation

As a health and wellness coach, my primary purpose is to help individuals learn how to optimize their health and wellbeing, with an emphasis on the latter. Miriam-Webster defines wellbeing as “the state of being happy, healthy, or prosperous.” Obviously, there is some subjectivity in that definition as health, happiness and prosperity may look different for everyone…which is one reason why the initial stage in the coaching process is for the client to identify their vision of optimal health and wellbeing.

The visioning stage provides an opportunity for the client to take a broad look at their current state of health and wellbeing in preparation for developing a personalized health plan, with goals and action steps. Visioning allows clients to think about the “big picture” of health and wellbeing in their life and helps serve as part of the motivation for change.

There are a number of different strategies that coaches can use to help clients identify their optimal health vision, such as:

  1. Sending written questions regarding vision to the client to complete ahead of time and then discuss during the next session. This approach may be helpful for clients that like to take time to think things through and process questions before sharing with the coach.

 

  1. Asking open-ended questions regarding vision during the coaching session. This method may be better suited for clients who do not like “homework” and/or enjoy processing by talking things through as they go. Some example questions include:

 

  • What is your vision of yourself in your greatest health?
  • What do you look like? How do you feel?
  • What inspires you about this vision of optimal health and wellbeing?
  • What does achieving your vision of optimal health make possible in your life?

 

  1. Offering a short, guided imagery exercise to assist the client in developing their health vision. I often use the “future self” exercise, in which clients are asked to imagine themselves sometime in the future when they have achieved their vision of optimal health. Clients then paint a picture of what that looks like by describing how they look and feel, the activities they are enjoying, who they are with and what health behaviors they are engaged in (e.g., exercise, eating healthy). If the client tends to be a visual person, I invite them to capture their vision on paper with words and/or images.

For many clients, identifying their vision of optimal health may be linked with a personal mission or life purpose. It may stimulate a sense of who they are meant to be or how they want to contribute to their community and beyond. Visioning allows clients to see how their specific focus of change serves their larger intention for themselves. And perhaps most importantly, it sets the stage for identifying specific goals and action steps that will help the client achieve their vision.

Although coaches help elicit a vision at the beginning of the coaching process, we return to visioning throughout the change process, especially after a client has initiated action. Behavior change is rarely a linear process and a client’s motivation to change will ebb and flow. It can be helpful to revisit the client’s vision after they have experienced positive changes, to reinforce how their action is serving their overall vision. Or revisiting the vision may help reignite their desire to change when they are feeling stagnant or stuck. Visioning is a key thread woven throughout the entire coaching process.

Stay tuned for the next part of the coaching process which is helping clients identify what they value most about their optimal health and wellbeing, which is key to establishing the real motivation for change.

vision quote

 

 

The Gift of Patience

Patience. It’s something I have been thinking about a great deal, especially this time of year when there are extra things that need to get done for the holidays on top of my usual responsibilities. A quick internet search produced the following definition:

Patience: the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.

I like that definition as I have come to learn that patience really is about acceptance and tolerance of things that are not quite the way you want them to be.

There are several things that have been testing my patience lately. I have a morning ritual that includes reading the newspaper – and I am an old-fashioned girl who likes to read the actual paper version, not the e-edition I can access online. For some reason, the carrier has been delivering the paper almost an hour later than usual…which is too late for me to read before I head to work. This has forced me to choose between reading the e-edition or skipping it altogether, neither of which I prefer. I’ve opted for the e-edition for now. I do plan to reach out to the carrier after the holidays, to see if this is just a short-term change or if this will be the new norm, but for the time being, I have had to accept that this is just the way it is.

Another situation that has tested my patience for the past several months is related to health insurance coverage. After several years of having to purchase health insurance on our own, I feel fortunate that my family and I have access to more affordable health insurance through my part-time position as a wellness coach. However, I have been wrangling with the insurance company since the spring regarding payment for the anesthesiology services provided during my colonoscopy. Turns out, the facility where I had my procedure is in-network, but the anesthesiology practice is not. (Yes, head-scratcher, isn’t it, considering you can’t bring your own in-network anesthesiologist to your colonoscopy – and I can’t choose where my gastro performs the procedure!) The insurance company initially denied the claim from the anesthesiologist, who in turn appealed the decision on my behalf.

I was excited to get the initial letter saying that the appeals committee agreed to process the claim as in-network, only to be followed by a more detailed letter explaining that they would only cover the “maximum allowable amount” and the anesthesiologist could balance bill me for the difference. From reading the EOB, it appears that the maximum allowable amount is only about 10% of what the anesthesiologist actually billed (incredulous and I will be calling the insurance company about this but not today). Fortunately for me, the anesthesiologist is only charging me a small portion of the remainder of the bill. I have decided to go ahead and pay it as the poor provider deserves to be compensated for her time especially given that the colonoscopy was back in May…but this is just one example of our broken healthcare system. I just don’t have the time or energy to fight the insurance company any longer. I’ve come to accept that this is just the way it is, right or wrong.

As I mentioned earlier, the holidays are another time when my patience often gets tested. This happened last night, as I was trying to finish up shopping for gifts before we travel to visit family. I didn’t really have a hard time with the shopping itself but rather the frustration that the responsibility was all falling on me while my husband and daughter were home watching a movie. I could feel the resentment building by the time I finished up at the last store. When I got home, I calmly informed them that I didn’t appreciate the fact that I was the one doing all the work while they were having all the fun. I could tell they felt a little guilty, and I will be sure that the holiday tasks get divided up more evenly next year. However, I also realized that I took on a lot of the responsibility myself and did not ask for help when I started to feel a little overwhelmed with everything on my plate. Lesson learned.

One thing that I am grateful for is that I am much more patient than I used to be – and I credit that change to my mindfulness meditation practice. I used to have a very short fuse and blow up over the “small stuff” as they say. I didn’t like that about myself and I knew it was really only hurting me and my wellbeing. I still consider myself a work in progress and that is why my wish for the new year is to cultivate even more patience – with myself and with others. We are all human and we all make mistakes now and then. Treating myself and others with compassion is the greatest gift I can give myself.

I wish you and your loved ones a wonderful holiday season and a happy, healthy New Year!

 

ralphwaldoemerson1-2x

Mindful Gift Giving

I had the opportunity this week to step in for a colleague and present her wellness seminar on “Decluttering Your Life: Taking Control of Your Space.” This is a favorite topic of mine, partly because it is an ongoing challenge for me and my family and I am always looking for new strategies to help manage our “stuff.” We have made a concerted effort over the last several years to reduce the amount of material things that we possess, but I’ll admit it is still a work in progress.

If there is one thing that the decluttering presentation reminded me, it is that Americans have too much stuff. Did you know that 1 out of every 10 Americans rents an offsite storage unit? Offsite storage units have been the fastest growing segment of the commercial real estate industry over the past four decades. I believe it, as it seems like there is one on every corner here in Raleigh – and many of them are directly across the street from each other! It astounds – and saddens me – every time I drive by them.

Given this cultural obsession with stuff and knowing that many of my friends and family members have also reached a point of not needing or wanting any more material possessions, I intentionally seek out gift ideas that won’t contribute to the clutter epidemic. Given that the holidays are upon us, I thought I would share some gift giving ideas for those of you who also wish to shop more mindfully. Most of these ideas apply to adults, but I think there are many children who also would enjoy an outing or an experience over another toy that they will be bored with in a few weeks.

For the foodies in your life:

  • Restaurant gift cards – you can never go wrong with a gift certificate to someone’s favorite restaurant, or perhaps a new restaurant they’ve wanted to visit. Even more budget-friendly options like fast casual restaurants (think Panera Bread) will be a welcome gift for those nights when they just don’t feel like cooking.

 

  • Cooking classes – a great experience for anyone trying to hone their culinary skills. Many restaurants and culinary stores (e.g., Williams Sonoma) offer classes throughout the year.

 

  • Tasting tours – many cities have food tasting tours, where you visit multiple restaurants, talk with chefs, learn about the culinary landscape of the city, and enjoy delicious food and drink. As a bonus, many of these tours are walking tours so you get in some physical activity too!

 

  • Grocery store gift cards – whether it’s for their favorite grocery store or a more high-end store where shopping might be a real treat, they’re sure to be grateful for the nourishment.

 

For fitness-oriented friends and family:

  • Membership to the local YMCA or other fitness facility – or if they already belong to a fitness center, offer to pay for the renewal

 

  • Gift certificate to try out classes like yoga, Pilates, martial arts or indoor rock climbing

 

  • Pay for a round of golf on their favorite course, or maybe a new course they’ve wanted to try

 

  • A day pass for skiing or snowboarding at a nearby resort

 

For the entertainment junkies:

  • Movie gift certificates – let them escape reality for a couple hours and throw in a little extra for some concession snacks (Note: Consider Fandango if you don’t know their local movie theater chain)

 

  • Tickets to a concert, play, or sporting event – so many options at the high school, college or professional level. If your budget doesn’t allow a big splurge like Broadway or the NFL, staying closer to home is a great way to support local theaters, performers and athletes.

 

  • Membership to a local museum – whether it’s art, history, or natural sciences, you are giving the gift of exploration

 

These are just some ideas to hopefully spark your imagination! Whether the gifts you give are large or small, store-bought or homemade, those who truly love you know that it’s the thought that counts.

 

 

The-Greatest-Gift-TMM

Gratitude: Every Cloud has a Silver Lining

I recently facilitated a stress management program and one of the sessions was about resilience, the ability to bounce back in the face of adversity. We discussed the ABCDE tool, which is helpful in shifting one’s perspective about an event or situation that would typically prompt a negative response or reaction. The equation is simple: A + B = C (+ D = E), which is based on Albert Ellis’ model:

The “C” (consequences, typically negative emotions) stem not directly from the “A” (adversity or activating event) but from the “B” (one’s beliefs about the adversity or event). The key is to “D” (dispute the initial beliefs or thoughts) to therefore generate “E” (a new energy or more positive outcome or consequence). One of the suggestions for disputing the initial belief or thought is to find something to be grateful for about the adversity or event. It’s not always an easy thing to do, but I know personally, when I do it, I usually feel better about the situation.

As I was thinking about Thanksgiving and the things I am grateful for, this tool reminded me of a poem I had seen in the past about being thankful for life’s less glorious moments. A quick internet search turned up the following, which I think sums up the sentiment I wish to convey today.

i-am-thankful-for

On Thanksgiving, and hopefully every day, I will strive to see the silver lining in the difficulties and hardships that may arise, knowing there is always something for which I can be grateful.

I wish you and your loved ones a safe, relaxing and Happy Thanksgiving!