Why is it so hard to "live" our wellness? What factors may or may not play a role in living our wellness?
Lack of Knowledge??: there is no relationship
... [Show More] between a client's or patient's knowledge about the need or means for change and
subsequent behavior change.
Health Care Providers Fault??: individual's with low self efficacy/low self
esteem or competing needs may not feel, or literally may not be, capable of doing what they're told
it sends subtle message that you arent in charge and arent responsible
Our current health care system is not currently
providing long term consistent behavior change
support needed for successful chronic disease
management
Lazy??: we may overwhelmed, over-worked, or over-stimulated and we choose comfort rather than more stimulation
what is Moore's definition of health and wellness coaching?
"Health coaching is a collaborative and co-creative partnership through which a well facilitated conversation
transforms chaos to order, confusion to clarity,
uncertainty to
action."
what are the objectives of coaching techniques and skills associated with the process of coaching?
Through the use of evidence based methodology,
coaches create a collaborative and co
creative partnership with clients that:
Connects health and wellness to what
clients value
most without a heartfelt higher purpose, deep and lasting change is rarely achieved
Reconnects clients to their
inner and outer
strengths
Allows clients to become
consciously aware of
challenges that could impede success
Facilitates the development of a plan for change
that is personally tailored
to the client's desires, challenges and strengths.
what information is important to know regarding the process of coaching?
Coaches employ a variety of techniques
and skills grounded in evidence
-
based theories (to be discussed later) shown to facilitate lasting change.
•
Objectives of the coaching process:
-
Assessment: clients must know where they are before they can work on where they want to be
-
Effective Communication:
skills designed to enhance
collaboration and creative thinking
-
Exploration:discover what a client really wants and values and the resources to achieve both. Although
the objectives of the coaching
process are universal, the execution of it is not
. There is no set or best formula.
How this process evolves is individual and organic.
what are the pillars of the collaborative and co-creative partnership?
Address the client's whole life-All 5 SPICES of wellness
honor the wisdom, resourcefulness and
creativity within each client
A coach honors the fact that people are naturally creative, resourceful and whole
The agenda always comes from the client
encourages clients' personal accountability
and responsibility to themselves and their
plan
support, model and encourage healthy change
listen when clients express concerns and allow
them to articulate what information they need
facilitate change talk evokes transformation
what are the outcomes delivered by a collaborative and co-creative partnership?
1.creating a plan for change that promotes:
Attainment of a higher level of well being
Sustainable behavior change
2.increasing self-awareness and personal clarity
3.Acquiring new knowledge and skills
4.Increasing self-efficacy
what are the differences between health experts and health coaches?
Health Expert: Authority, educator, defines agenda, feels responsible for clients health, solve problems, Focus on what's wrong, has the answers, interrupt if off topic, working harder than client, wrestle with client
Coach: Partner, facilitator of change, elicits clients agenda, client is responsible for health, foster posibilities, focus on what's right, co-discover the answers, learn from clients story, client working as hard as coach, dance with client
Know how to complete the following statement: "a health coach is. . ."
engaging and energizing
possesses exceptional listening and communication skills
Demonstrates: respectfulness, cultural and social sensitivity, genuieness, empathy
Acts as a: sounding board, challenger, cheer leader, expert resource
what are the qualities of a masterful coach?
cannot summon an ounce of judgment, displaying an
unwaveringconfidence in the client's ability to change.
•
Has the ability to "sniff out" client strengths, values, and desires.
•
prefers to listen rather than talk, listening until they don't exist.
•
loves and enjoys client stories.
•
reflects the positive side in ways that facilitate growth.
•
"holds up the mirror" to the client with courage when necessary.
•
celebrates clients' successes and encourage understanding
of clients' challenges.
Has the patience to allow clients to sit in the muck without succumbing to the urge to rescue.
-
gently challenges clients to achieve more than they otherwise might.
-
elicits Aha! moments through a dynamic called relational flow
the coach and client are highly engaged in the coaching
process, they are challenged, and stretched to the outer edges of their abilities.
What is the difference between directive and non-directive coaching?
Historically, the term coach means tutor or someone who directs, instructs and/or trains, either an individual or a group of
people, to attain certain goals and
objectives.
Tim Gallway, author of The Inner Game of Tennis (1974), introduced a different, non-directive coaching approach. Coaching is the art of creating an environment through conversation and a way of being, that facilitates the process
by which a person can move towards desired goals in a fulfilling manner. It requires 1 essential ingredient: caring not only for the external results, but for the
person being coached."
Tim Gallway
What is personal coaching? What are the challenges associated with personal coaching?
Personal Coaching: To help clients
improve their quality of life by aligning their goals and values with their work and home
lives then making changes so that their lives become more fulfilling.
•Types of Personal Coaching
- business, executive, financial, life, dating, career
Challanges:
Basis not founded in health sciences or evidence-based research
No standardization of process, technique or training
Certification of skills and abilities not required or standardized
Little oversight, other than ICU
what is coaching psychology? Upon what is coaching psychology founded?
Most popular evidence-based
theories and fields of study from
which coaching psychology draws
influence:
Transtheoretical Model for Behavior
Change
- Motivational Interviewing
- Humanistic and Positive Psychology
- Cognitive-behavioral therapy
coaching psychology: the
science of coaching relationships
designed to optimize health and well being.
Coaching psychology is founded upon evidence-based theories and fields of study: increases efficacy, standardization, measurability and credibility of health coaching.
what are the issues surrounding information exchange between patient/health care provider
communication?
Conflict often arises concerning agenda of visit. HCP assumptions about patient. HCP begins interaction with a set agenda in mind
Creates a climate of
» Mistrust by patient of HCP > missed visits
» Dependence on HCP to tell patient what to do
- 50% of patients leave their physician's office visit
without understanding
what advice their physician
gave.
HCP assumptions
- This patient needs to change
- This patient will never change
- If they do not change, I have failed
• These assumptions are based on previous experience and/or the current model of medical
training, not patient interactions
what is patient-centered medicine and what does it work to combine?
Introduced by Balint and colleagues in 1970: Refers to an approach that moved from a disease-centered medical model to an "overall
diagnosis" based on understanding the patient from a humanistic, bio-
psycho-social perspective.
• Reflective of the client
-centered therapeutic approach
Puts a strong focus on patient participation in clinical decision making by taking into account
the patients' perspective, and tuning medical care to the patients' needs and preferences.
Works to combine:
- physician ethical values
- Client
-centered therapeutic techniques:
psychotherapeutic theories on facilitating patients' disclosure
of real worries
negotiation theories on decision making
Although effective, these techniques are often time
consuming
What is the definition of motivational interviewing?
Why was this method thought to be
superior to other methods, even though all were equally effective?
a directive, client-centered counseling style for eliciting
behavior change by helping clients explore and resolve
ambivalence.
MI was initially used with problem drinkers, for whom motivation to quit is a common obstacle. Client success was profound, not because it was better than other methods, but instead more efficient.
In the early 1990s, the National Institute on Alcohol Abuse and Alcoholism conducted the research project, MATCH, which compared 3 treatments for alcoholism:
cognitive behavioral therapy
a 12-step approach such as that used by Alcoholics Anonymous
motivational enhancement therapy ("Motivational Interviewing," 2005).
•
The results of the MATCH project showed that all 3 treatments were equally effective, but that MI took less time and cost less.
This finding, in addition to favorable results that could be reproduced in subsequent studies, prompted other trials using this method with chronic conditions including diabetes,
hypertension, and cardiovascular disease and diet
what is the definition of empowerment?
The discovery and development of one's inborn capacity to be responsible for one's own life.
"Encouraging people to participate as equal partners in decisions about the health care they receive."
What is the cornerstone of empowerment?
The cornerstone of empowerment is recognizing that an individual is completely responsible for managing his or her own
wellness. The patient's responsibility is non-negotiable, indivisible and
inescapable.
what do empowered patients have? Be able to recognize an empowered patient
- enough knowledge to make rational choices
- enough control
- enough resources to implement their decisions
- enough experience to evaluate the effectiveness of their actions and live with the consequences of those actions
How should coaches uphold and insure cultural competency in their coaching practice?
coach training programs should incorporate education in cross
-cultural issues - generally and specifically where the coach is likely to work within a cross-cultural context, multicultural society, and with indigenous peoples, ongoing cultural competency training should occur.
Coaches should use modalities and tools that are appropriate for use within the cultural context specific to their clients. It is the responsibility of the coach to learn what
modalities, communication approaches and tools are appropriate.
Before coaching commences, an open dialogue should occur between the coach and client concerning: the coach's approach to coaching, a discussion on the appropriateness of their approach with that client.
When coaches are working cross
-culturally and with indigenous peoples, the coach should ideally be supervised by an appropriate cultural advisor.
Why is client confidentiality crucial in a coaching relationship?
Be able to list 3 of the confidentiality policies included in the coach-in-training confidentiality policy.
The coaching relationship is built on a foundation of confidentiality and trust.
Clients need to know that the information they share with their coach will not be divulged
inappropriately.
The coach should make this clear both orally and in writing.
Your clients' personal disclosures and discoveries are the material with which you and your clients
work.
You need to create a safe place by establishing a policy of confidentiality from the very beginning.
1. Coaches are bound by HIPAA regulations regarding a client's health information, session files and communications
2. Personal health information generally may not be
used for purposes not related to health care, and covered providers may use or share only the
minimum amount of protected information needed for a particular medical or health-related purpose.
Patients must sign a specific authorization before a covered provider could release a patient's medical information to a life insurer, a bank, a marketing firm or another outside entity for purposes not
related to their health care.
3.Under the Privacy Rule, patients can request that their doctors, health plans and other covered
providers take reasonable steps to ensure that their communications with the patient are confidential.
What is liability?
Legal responsibility for one's acts
or omissions.
Failure of a person or entity to meet that legal responsibility leaves that person or entity open to: a lawsuit or a court order to perform
What is personal disclosure? Be able to recognize an example of an appropriate personal disclosure by a coach.
What is a generalized disclosure?
•Sharing generalized client experiences of success, failure,
and the process towards both, in an effort to assist a stuck client and improve their self-efficacy or capacity for change
• What is self-disclosure?Sharing personal experiences of success, failure, and the process towards both, in an effort to assist
a stuck client and improve their self-efficacy or capacity for change or to build rapport
What to disclose
- Personal experiences can often
• Build a rapport between the coach and the client assist clients in feeling less alienated
• help clients see the possibilities of change
• Helps relay health information in a non-"expert" way
When to disclose
Disclosures are appropriate and valuable when it serves
the best interests of the client and the coaching relationship, not because a coach feels compelled to share their expertise, the personal successes of their
other clients, be understood, etc.
•Before you disclose:
- Assist the client in exploring all their options FIRST before sharing personal or generalized client
experiences
- Ask yourself as a coach:
• Is self-disclosure really necessary? Can a generalized
disclosure work as well?
• How will what I disclose impact rapport and trust?
•
Remember, using disclosure too often shifts the focus from the client to the coach.
What are the ethical responsibilities of a coach regarding liability and client goals?
Relay current recommendations based on your expertise
Attempt to develop a compromised goal with patient client
Document all communications concerning recommendations given and choices made by the client
What do Moore, M. & Tschannen-Moran, B. (2009) recommend you do to insure you are upholding ethical guidelines?
If you are working with paying clients, coaches should carry professional liability insurance to cover coaching services.
As a coach or coach trainee, you should create and utilize informed consent and coaching contracts to
facilitate transparency and accuracy of the coaching agreement
What is informed consent? What should an informed consent include?
Obtaining written consent from a client prior to participating in coaching is an important ethical and legal step in the coaching process
- ensures client knows and understands the risks
associated with different health behaviors.
- Reduces liability of the coach
- a statement indicating that the patient has been given an opportunity to ask questions
about the program
- An indication that the participant has sufficient information to give consent
- A statement indicating that the participant is free to withdraw consent at any time
What does a coaching contract allow both coach and client to do?
agree and commit to some key principles regarding their coaching relationship.
• Allows both the coach and the client to:
- align their goals and expectations surrounding the coaching process, relationship and its potential benefits and outcomes
- Uphold the ethical guidelines of the coaching relationship
what is "the bottom line" on coaching ethics?
Never
- Diagnose a patient's or client's medical status (unless you are a medical professional)
- Act outside your own documented expertise
- Judge a patient's social or cultural reality based on your own
- Divulge a client's personal health information without their permission
• Always
- Respect your client's privacy
- Document all coaching session content
- Discuss and obtain an Informed Consent and a Signed Coaching Contract before you begin
what do clients build through the coaching mechanisms of action?
Through coaching mechanisms, clients build a new brain network and, in turn, the capacity for sustained change
what are the 4 coaching mechanisms of action? What is the result of facilitating the process of
change?
Cultivate a Growth-Promoting Relationship
Relational skills > builds a new brain network
Stimulate Motivation
Illuminate Capacity
Facilitate the Process of Change:
Insight (motivation/capacity) > Action (behavioral goals) > Insight > Action. . .
(chaos > order > chaos > order)
Increases the capacity for sustained change
what are being skills? What are doing skills? How do "doing" skills help to build a new brain
network?
"being" skills: presence, empathy, peace, awareness, authenticity, respect.
"doing" skills: listening, inquiring, and reflecting from a place of positivity
Through "doing" skills, coaches encourage a client's creative process by alternating inquiry and reflection
Inquiry > Reflection > Inquiry > Reflection
Inquiry: activates the prefrontal cortex
Reflection: activates the limbic system
The "doing" skill most valuable to this process is positivity
Keeps the limbic system activated so
creativity and possibility can bubble to the surface
Especially important in clients with low self-efficacy
the coach can bravely, but respectfully, illuminate discrepancy in ambivalent clients
upon what theories is the coaching process based?
The Coaching Process (insight>action) draws from a variety of theories and models that have been found effective in facilitating awareness and lasting change
Appreciative Inquiry
Transtheoretical Model for Behavior Change
Goal-setting theory
Social Cognitive Theory
what is the self-determination theory? What are the 3 basic biological needs described in the
theory? Do we need to consciously engage these needs?
Self-determination theory posits that there are 3 basic biological drives or needs which, when met, allow humans to thrive
The need for competence or mastery of our environment
Includes self-regulation and self-awareness. Reflects our life's purpose is being pursued
The need for autonomy or ownership of our behaviors and choices and their consequences
The need for relatedness or feeling that we are connected to others and to society in general
We need relatedness so much, we will give up our autonomy to achieve it
These drive are unconscious so when we feel they are threatened or oppressed, we react unconsciously.
Rebellious teens, resistance to change
What is social baseline theory? How does it affect our need for relatedness?
Humans "outsource" their self-regulation, and psychic resources (how much of their psychic resources they will use on psychological and behavioral tasks, completing a task, etc.) based on the perceptions and availability of their social relationships
Our brains integrate trusting, reliable relationships as a part of our own psychic resources, reducing the amount of psychic energy expended
This is solely dependent upon whether or not we perceive the relationship as trusting and reliable
How does self-determination theory influence health behavior?
Respect and uphold a client's Self-determination needs, especially autonomy
People are generally better persuaded by the reasons which they have themselves discovered, than by those which have come into the mind of others. (Pascal's Pensees)
If you want someone to learn how to drive, you must put them in the driver's seat. (Margaret Moore CEO, Wellcoaches)
How are the 3 basic biological needs outlined in the social determination theory upheld by
coaches who subscribe to the following statement: "
If you want someone to learn how to drive,
you must put them in the driver's seat.
" (relate each need to this statement)
The need for competence or mastery of our environment
Includes self-regulation and self-awareness. Reflects our life's purpose is being pursued - basing the practice off of previous experience
The need for autonomy or ownership of our behaviors and choices and their consequences- letting the client decide what to do
The need for relatedness or feeling that we are connected to others and to society in general
We need relatedness so much, we will give up our autonomy to achieve it- let them know you are here for them and supoprt them. THEY THRIVE
what is mindfulness?
Paying attention to something in a particular way, on purpose, in the present moment and without judgment
What is emotional intelligence?
to be psychologically and emotionally whole, not excluding any feeling or emotion, but rather, embracing your full range of feelings and emotions
what is acceptance commitment therapy?
A form of cognitive behavioral therapy which assists clients in developing psychological flexibility
What is psychological flexibility?
the ability to consciously and emotionally connect to the present moment more fully so one can change, or persist in, behavior that is done in the of service of valued ends.
What are the main components of ACT?
Mindfulness- one cannot be psychologically flexible in the moment if they are focused on "hoping for a better past" or controlling the future
Acceptance- Observe, without judgement, the content of one's thoughts and feeling for what they are, data not facts, accepting their existence resisting the urge to assign them the equivalent weight of helpful thoughts, personal scripts, mental images and emotions that will move them in their valued direction
Committed Action- consciously choosing to take action in a direction that is congruent with values, regardless of whatever thoughts and feelings occur, while accepting the cognitive and emotional discomfort that may go along with doing so
What factors contribute to psychological INflexibility? What is the definition of experiential avoidance?
Experiential Avoidance-
Humans' tendency to believe they must avoid or rid themselves of unhelpful thoughts, personal scripts, mental images and emotions.
When faced with these experiences, humans become transactional and abandon mindfulness and intention.
This is An Evolutionary Survival Mechanism:
We are wired for mental in-agility- conflation of, and fusion with, our thoughts: I acted badly = I AM bad. Why? Our ancestors could not "evaluate" a perceived threat and still survive, they had to react
Cognitive fusion- When individuals are "fused" with unhelpful thoughts personal scripts, mental images and emotions, the thoughts are automatically presumed to be truth.
Allowing outmoded personal scripts and learning methods to dominate behavior
Attachment to the conceptualized self- the internalized picture one has of one's self as compared to others and societal standards
Examples: Mother, teacher, honest, middle class
Lack of clarity concerning values
Inaction and impulsivity - a result of the lack of clarity regarding values
Rigidity- the opposite of flexibility; keeps clients in their comfort zone
"Although comfortable, nothing ever grows in the comfort zone."
What is positive psychology?
A domain of psychology that investigates what makes people thrive and flourish:
Optimism, hope, contentment, gratitude, love
Draws on the humanistic belief that people are whole (not broken and needing to be fixed), creative, resourceful, resilient, and able to gain control of their health and wellness.
Positive emotions can
transform people for the better, help them to build more resources
How do negative emotions impact our brain? Why? How do positive emotions impact our brain?
How can we facilitate positive psychology?
Negative emotions move lightning fast and stick like VELCRO, hijacking brain resources
Why? Evolution created this process to alert us to danger.
Why we can more easily express and focus upon the negative
These emotions will continue to demand your attention until you address the source
Positive emotions are fleeting and "stick" like TEFLON
BUT, they increase brain resources causing our brains to light up, our thinking to be more creative, integrative, flexible and open to information
Modulate the ratio of positive to negative emotions
Ensure basic life needs and being met
Know and use strengths to gain mastery
Energizes motivation
Increase experiences of goal-directed flow
Flow- an enjoyable state involving intrinsic motivation in which a person becomes fully in a goal-directed activity that matches their skills level and provides immediate feedback
Increase a sense of meaning and purpose
doing something for the greater good beyond its benefit to you personally [Show Less]