Assessing Action

When the client is in the action stage, they are doing and learning and adjusting action steps based on that learning. They may face challenges or obstacles, some of which they may overcome, others which may trip them up at least temporarily. The path to change is rarely a straight one so support and encouragement are critical to helping clients along this journey.

The next step in the coaching process is to help clients assess their progress and determine how to continue moving forward. Some key tasks include:

  • Acknowledging client successes
  • Helping the client learn from their experience, whether they were fully successful, partially successful or not successful
  • Supporting the client in identifying any barriers to change and strategies to address those barriers
  • Determining how the client wants to move forward (e.g., initiating new actions or refining current action steps)

I typically encourage clients to fill out and return a brief coaching session prep form prior to their session. This form allows them to capture successes, challenges, lessons learned and what they want to focus on in their session. It helps both of us prepare for an effective session and gives us both insight into potential areas to address during the session.

At each session during the action stage, I typically check in with the client about how things went since the last session. There are usually three possible outcomes:

  • Action was completed successfully
  • Action was partially completed (some lapses occurred)
  • Action was unsuccessful (client was unable to accomplish plans or relapsed)

The approach I take with the client depends on the outcome achieved. For example:

If action was completed successfully, I typically:

  • Acknowledge the client’s success and help celebrate little or big “wins”
  • Explore what the client learned through their successes
  • Review where the client is in the process of reaching their long-term goal/outcome and their vision of optimal health and wellbeing
  • If client goal/outcome is not yet met, determine additional action steps needed to keep the client moving forward

If action was partially completed or some lapses occurred, I do most of the above but also:

  • Help the client explore what was different on the days they were successful and the days they were not
  • Review action steps to see if any adjustments need to be made
  • Explore with the client what they will do if they encounter similar barriers or obstacles again

If action was unsuccessful in terms of the client’s plans and intent, I will:

  • Acknowledge the client’s attempts (if applicable) while recognizing the lack of meeting their goals
  • Assess what they learned from the experience and how to use that information going forward
  • Ask questions to determine whether we need to return to an earlier stage in the process (e.g., revisiting readiness to change or doing further work in preparing for action)

 

As I stated earlier, the path to change is seldom straight and easy. There will be twists and turns as well as successes and setbacks. A client may start off strong and then find themselves struggling when they face an unexpected obstacle. Another client may initially struggle to get momentum but then soar once they hit their stride. Each client is unique and thus, the process will be different for each one. It is my job as the coach to help the client navigate along this winding path, sharing in the peaks and valleys, reminding them that they have the power to change and make the choices necessary to reach their vision of health and wellbeing.

 

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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.

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.

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