Maintaining the gains

As I discussed in my previous post, the path to change is seldom straight and easy. Even after a client has succeeded in sustaining their chosen health behavior over a period of months, they may still be susceptible to lapses or minor slips. During those times, it is critical for a coach to continue offering support and help the client determine what they have learned from their experience.

Maintenance occurs when a client has been regularly practicing the new behavior or action with no more than a few lapses or an occasional relapse after which they quickly and successfully return to regular practice. What started out as a goal has become a new habit. At that time, there are a few pathways for the client to consider:

 

  • The client may be ready to explore deeper commitment in the same focus area. For example, a client who went from being inactive to walking 3 days/week may wish to increase that practice to walking 5 days/week. Or they may choose to register for an activity such as a charity 5k walk.

 

  • The client may be ready to take on a new goal in a completely different area. Success in small goals often gives the client confidence to tackle more challenging behavior changes. For example, a client who is a casual smoker who increases their physical activity level may decide to quit smoking completely. Or a client who successfully reduces the amount of meat they consume may decide to go further and adopt a vegetarian or vegan diet.

 

  • The client may choose to complete coaching at this point now that they are able to successfully maintain the behavior change. Of course, the door is always open for them to return to coaching in the future if and when they want to take on a new focus area. However, I believe that the coaching process can also equip the client with the skills necessary to address future changes on their own. The skills they learn through the coaching process can be transferred to any habit or behavior they wish to change.

 

In the end, coaching is really a journey of self-discovery and exploration that empowers you, the individual, to achieve your highest level of health and wellbeing. There is no greater gift of self-love.

I hope you have enjoyed this series about the stages of the coaching process. Stay tuned for future posts about your favorite health and wellness topics!

 

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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.

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.

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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.

 

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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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National Board Certification for Health & Wellness Coaches

I’m taking a brief detour from my journey around the Wheel of Health to share some exciting news! I found out yesterday that I passed the new national certification exam for health and wellness coaches. I am now officially a National Board Certified Health & Wellness Coach (or NBC-HWC, for short). I am very proud to be one of the inaugural coaches to hold this distinction – and I want to share a few thoughts on why this national certification is so important.

Until now, anyone could essentially hang a shingle and call themselves a health coach regardless of whether they have had any education, training or experience as a coach. There are many individuals who are passionate about health and wellness, and long to share that passion with others based on their own experience and self-study. I think that passion is wonderful and that’s where I started back as a young adult in high school and college, taking ownership of my health and wellbeing for the first time.  However, I quickly realized that there was a lot that I did not know when it came to health and the science of behavior change, so I chose to pursue formal education and training in that profession.

I earned undergraduate and graduate degrees in Public Health, with a concentration in Health Behavior and Health Education, and I have held the Certified Health Education Specialist (CHES®) credential since 1998. I have always identified as a health educator even when my official title may not have reflected that role. A few years ago, I decided to pursue additional training as a health coach. I have to admit that before I completed my coach training at Duke Integrative Medicine, I thought a health coach was essentially the same thing as a health educator. I would advise people about how to improve their health. I would share resources and essentially tell them what changes they needed to make around their diet, exercise, sleep and so on to be healthy. Boy, was I wrong.

My health coach training was eye-opening, even for someone who has been in the healthcare field for 20 years. I learned that coaching is a client-centered process – that the client is the expert on his or her own health, not me. As a coach, I am the expert in the process of health behavior change, but I am here as a partner and a guide for my clients. I help them define their personal vision of optimal health, create goals and action steps to achieve that vision, and provide support and encouragement as they incorporate new health behaviors into their lives. I don’t tell them what to do to be healthy, I empower them to find the answers within themselves. And I do this mostly by listening carefully and asking key questions to help reveal those answers. Simple, yet so powerful.

I share all this to help you understand that there is still great variability among health coaches right now, as these new national certification standards are just starting to be implemented. For this reason, I encourage you to do your homework and review the credentials of any coach with whom you may consider working. Although this is not medical care, where you could be harmed if treated by a professional that does not meet minimum professional standards, it is in your best interest to work with a coach who has had adequate training. After all, you want to achieve the best outcome possible – to be in your best health – especially if you are paying out of pocket for your coaching experience.

The International Consortium for Health & Wellness Coaching (ICHWC) has been working since 2010 to create these national standards for health and wellness coaches. In 2016, they partnered with the National Board of Medical Examiners (NBME) to establish a national certification for individual health and wellness coaches. The NBME  has been credentialing medical professionals for 100 years, and they applied the same rigor to the health and wellness coach exam as they have for other medical professional credentialing exams. Therefore, this national certification will allow proficient coaches to stand apart from coaches who have not received adequate coach training or assessment of their coaching skills and knowledge.

You can learn more about the Consortium and the National Board Certification of Health & Wellness Coaches here. The Consortium will soon be creating an online registry to include all health and wellness coaches who are National Board Certified, making it easier to find a qualified coach to assist you on your journey to optimal health. After all, if you are going to invest in your health, why not choose a partner who can best help you succeed?

Hello World

Hey there.  I know what you’re thinking…not another “healthy lifestyle blogger”?!  I know, I know, it seems like we are a dime a dozen these days – BUT I encourage you to keep reading. You’re here already so you might as well stick around to see what I have to say, right?

Yes, there are many, many people in the “blogosphere” who write about health. Some are professionals or experts. Others are individuals who are passionate about health and wellness. They learn as much as they can about topics of interest and then share that knowledge with others. Where do I fall on the spectrum? I combine the best of both worlds – I took my passion for wellness and turned it into a professional career. The path was not straight and narrow, but I am incredibly excited that it led me here today.

So…why include me as a “go to” source for health-related information? Three reasons:

Credentials. I have a Master’s degree in Public Health with a focus on Health Behavior/Health Education from the UNC School of Public Health. I am a Certified Health Education Specialist (CHES®), a Certified Professional in Health Quality (CPHQ) and a Certified Integrative Health Coach (through Duke Integrative Medicine). I am also sitting for the brand new, national health and wellness coach certification exam in September so I hope to add one more credential as a National Board Certified Health & Wellness Coach. I realize that’s a lot of letters behind my name, but my degrees and certifications are all from accredited universities and reputable professional associations.

Experience. Throughout my career in healthcare, I have worked in and/or with most of the major types of facilities in our system including a rural health department, skilled nursing facilities, a large hospital system and a primary care physician practice. Even when my primary “paid” role did not include a focus on wellness, I found a way to get involved with prevention and promoting a healthy lifestyle. I am so grateful that my career path has led me to my current role of health and wellness coach, where I am privileged to partner with individuals on their journey to optimal health.

My personal health journey*. I’m a real person who deals with many of the same health issues and concerns as you. I have struggled with weight management, emotional eating, work-life balance, stress and anxiety, to name a few.  Have I nailed all of my healthy living habits? Heck no, but my point is that I can relate to many of the challenges you may face in taking care of your physical and emotional health.

Just one last thing – my promise to you is that I will be a trusted, credible resource for you on your journey. I will strive to share information that comes from reputable sources based on sound scientific research. If I do share anything that is more anecdotal in nature, I will state that upfront. No fake news – Girl Scout promise.

*For those of you who are interested, I have included details about my health journey in my next post.