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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