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Health coaching, also referred to as wellness coaching, is a process that facilitates healthy, sustainable behavior change by challenging a client to listen to their inner wisdom, identify their values, and transform their goals into action. Health coaching draws on the principles of positive psychology and the practices of motivational interviewing and goal setting. The terms “health coaching” and “wellness coaching” are used interchangeably.
Coaching involves a conversation where one person listens and then advises another person on any subject matter. Over time this term has been used for coaches in education, athletics and music. Through his book The Inner Game of Tennis, Tim Gallwey changed the perspective of coaching when he shifted the focus of coaching. Rather than teaching a skill or technique, his process encouraged individuals to explore their inner strength and wisdom, improving their confidence and making changes and improvements from within. The health coaching model is embedded in the fields of psychology, social work, nursing, eastern philosophy, holistic health and wellness management.
The roots of health coaching began with psychologists treating persons addicted to alcohol. In the early 1990s, The National Institute on Alcohol Abuse and Alcoholism conducted a study that compared several methods of treatment for alcohol addiction. They included: cognitive behavioral therapy, a twelve-step program approach similar to Alcoholics Anonymous, and motivational interviewing.
The findings demonstrated that while all the treatment methods were equally effective, motivational interviewing was the most cost-effective and timeliest in reaching the desired results.
Due to the success of this project and others, researchers have been keenly interested in using this approach and studying how its use may affect health behavior change in persons with chronic conditions. Studies are likely to continue in this arena as this is a relatively new approach for many healthcare providers.
The health coaching model follows a process:
The process begins with engagement. Engagement and building trust with the client is established by building rapport. Many factors are included in this process. Essential traits to building rapport include: genuineness, eye contact, good energy, warmth, good quality of voice, a feeling of connectedness, being comfortable and relaxed in the exchange, mindful listening, being supportive and positive body language and physical gestures. Rapport is fundamental not only in the initial coaching session, but also in each coaching session thereafter. Although rapport is important, a coach may want to avoid becoming too close with client. Becoming too close to a client can create a barrier for a successful coaching process by being too emotionally attached, having a personal agenda and falling into assumptions based on personal relationships or experience.
Once a coach has established rapport, building strong communication strategies is essential. An effective tool used in health and wellness coaching and other clinical work is motivational interviewing. Motivational interviewing is a process used in psychotherapy, social work, medicine, addiction and other fields. The basis for support for this method is that motivational interviewing gives shape to the inner-knowledge gained, which then encourages behavior change. Research shows knowledge alone does not promote change, but when an understanding of motive is added to the knowledge base, change is likely to occur.
Motivational Interviewing is also characterized by a focus on the present rather than the past. The emphasis is on the communication that is conducted with clients, concentrating on internal motivating factors and an exploration into individual core values and goals. This allows the client to express their desire to change their lifestyle and identify it themselves rather than having it come from the health coach.
A wellness vision is a creative statement by the client that reveals his/her highest potential and can include physical, emotional, social, spiritual and financial realms of their life. A new life vision empowers one to see new possibilities along with a specific and clear direction, which can be manifested through inner creativity, wisdom and power. It allows one to activate their imagination and then think, feel, speak and ultimately see the manifestation of their unified highest potential. A wellness vision is a tool a health coach uses to help the client move to new levels of wellbeing by connecting the client to their own truth and wisdom that is held within.
The manifestation of a wellness vision is done through the process of goal setting. Goal setting is a collaborative behavior change technique used between the coach and the client. During the motivational interviewing process, after strengths, values and desires are determined and the client’s vision is set in place, specific goals are set so the client is able to move in the direction of his/her newly formed desires.
Goals promote behavior change through a collaborative process, which includes the coach making a plan to track and evaluate progress. The coach can help the client focus on the success the client has had, even if goal is not yet achieved. Evaluating strengths and what is successful helps the client move forward. Positive feedback helps the client progress and move through any negative self-talk, ambivalence, resistance and other hurdles. Although self-regulation is a powerful behavior change tool, the client may lapse. When the coach promotes the principles of positive psychology and goal setting through the motivational interviewing process, the coach helps the client continue to improve self-efficacy, which supports behavior change.
Coaching and psychotherapy both are rooted in person-centered psychology. Today, many therapists are now coaches or are concurrently practicing both disciplines. Health coaching and psychotherapy can take place in individual and group sessions, and both use similar methods of inquiry. A clear difference between psychotherapy and coaching is therapy focuses on a problem while coaching focuses on the solution, driven by the client’s inner strength and wisdom.
Social workers are skilled in the field of helping individuals overcome obstacles that inhibit their growth potential. Both coaching and social work fall under the mental health field. Coaching and social work have similar elements. Both practices rely on motivational interviewing. Both are focused on the client being the expert, and both work with the client without judgment, allowing the client to be in control. The essential difference between social work and coaching is that social work is more oriented to the client’s relationship to community life and social ethics, whereas coaching is focused on an individual’s personal dreams, desires and goals.
The traditional approach to patient teaching and education is one that directs information "at" the patient. In essence, the goal is to have the patient do the things prescribed for them to do. Healthcare professionals have the knowledge about disease processes, exercise guidelines, special diets, and medications that must be imparted to the patient and caregivers in many forms: booklets, pamphlets, audio CD's,and the like.
Several Health Maintenance Organizations (HMO) are now using health coaches as a selling point for their health care services. Healthcare professionals that are entering the field of health coaching may include counselors, social workers, health education specialists, nutritionists, psychologists, nurses, respiratory therapists, physical therapists, pharmacists, nurse practitioners, physician assistants, nursing case managers, occupational therapists, and Oriental medicine practitioners.
Several studies have shown health coaching to be effective in improving various aspects of health. One study on type 2 diabetes concludes that after 6 months, individuals who were coached showed improvement in medication adherence. Coaching had a positive effect on patient’s knowledge, skill, self-efficacy and behavior change while a non-coached control group did not show any improvement. Additionally, coached participants with a hemoglobin A1C over 7% showed significant improvement in A1C.
A study on coronary heart disease indicated that patients in a coaching program achieved a significantly greater change in total cholesterol of 14 mg/dl than the non-coached patients, with a considerable reduction in LDL-C. Those involved in the coaching program showed improvements in secondary outcomes such as weight loss, increased exercise, improved quality of life, less anxiety, and improvement in overall health and mood.
Another study shows that telephonic coaching is an effective program for assisting individuals with self-efficacy and weight loss. Confidence to lose weight increased from a baseline of 60% to 71% at three months, 76% at 6 months and 79% at 12 months. The average BMI significantly decreased during this interactive coaching study. Average Baseline was 32.1%, and then documented at 3 months (31.4%), 6 months (31.0%), and 12 months (30.6%).
A study on tobacco cessation concluded that after 12 months, the coached participants had a 32% quit rate compared to 18% for nonparticipants. Those that participated in the program, who acknowledged that they were ready for change, had the highest rate of quitting at 44%. Additionally, 11% of participants who did not quit reported reduction in tobacco use. This is considered a positive outcome, because other studies have shown that when individuals reduced their tobacco usage, they find increased motivation to quit entirely in the future.