Part 4: Coaching uncovered: The ingredients in a recipe for behavior change

How do Coaches promote sustainable change in our health & well-being?

Now that you have the what and the who, let’s go one layer deeper. Exactly how do those superpowers and process steps come together? How do they help in the moment and over the long-term? As Dr. Meg Jordan says in her 2013 book, How To Be A Health Coach, Coaching is a “confluence of evidence-based frameworks with a humanistic perspective.” Coaches understand that behavior change is hard, harder than most expect, and leverage support, process, and accountability to facilitate their clients’ success.

The most effective coaches anchor their work in evidence-based theories and frameworks, including the Transtheoretical Model for Behavior Change (Prochaska & DiClemente), Motivational Interviewing (Miller & Rollnick), Positive Psychology (Seligman), Appreciative Inquiry (Cooperrider), and Cognitive Behavioral Therapy (Beck). Coaches also work with biometrics and other quantitative data and use the principles of measurement-based care to understand and track progress. In practice, this all comes together like a french braid (yes, like how you do with hair)…the coach weaves multiple data points together into the braid to personalize the coaching experience.

Common approaches include:

• A strong focus on relationship and rapport-building: The coach spends time asking questions to get to know the client and learn what brings them to coaching.
• Understanding the client’s unique context and situation: The coach explores the emotions behind the client’s interest and motivation and how making health changes could benefit them.
• Exploring the desired change: The coach guides the client in an unbiased and non-judgemental way through an exploratory conversation about how the client making changes in their life might help them live the life the client wants to live.
• Visioning: The coach and client collaborate to paint a picture of how the client would like their life to be in the future. The client can fill in details about how they would like to feel, what their environment is like, who they are surrounded by, and what they want their day-to-day to look like.
• Co-creating a strategy to pursue the desired change(s): The Coaching Conversation enables the coach to collaborate with the client to set goals and help them focus on small steps, one at a time. This process often draws from behavior change theories such as:

The Transtheoretical Model of Behavior Change (TTM): Suggests that behavior change occurs in stages and is often not linear. The Coach modifies and adjusts their approach based on which of the stages of change the client is in.

Appreciative Inquiry: Created initially to address sustainable change in organizational development, this process addresses change by focusing on a client’s strengths. Coaches use the 5-D Cycle:

• Define — What is the desired outcome?
• Discover — What strengths are already present in the person/system?
• Dream — What would work well in the future?
• Design — What action is needed to make this happen?
• Destiny & Delivery— Begin to take identified action(s). This process supports client engagement since it focuses on what the client wants more of, rather than what they want less of.

Motivational Interviewing (MI): MI is a way to explore and understand the pros and cons of change on an individual level.

• MI involves two primary communication and active listening techniques: OARS (Open-ended questions, Affirmations, Reflections, Summaries) and DEARS (Developing discrepancy, Express empathy, Amplify ambivalence, Roll with resistance, Support self-efficacy).
• The coach uses these tools to help the client articulate their own desire and motivations for change.
• Instead of focusing on the issue/challenge/problem at hand, the intention is to help the client understand how and why pursuing that change can help them. There is a big difference between being told you need to lose weight and being asked ‘how might your life be different if you lose the weight you would like to lose?’

Make an action plan: The Coach works with the client to name and commit to specific and actionable goals. Using the SMART framework, Coaches help patients create a Specific, Measurable, Attainable/Actionable, Relevant, Time-bound set of steps and/or a habit.

Check in, iterate, and repeat: In scheduled follow up calls, Coach and client discuss the plan’s effectiveness, including any changes that would help optimize the client’s behavior change plan.

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So, it turns out Coaching for health & wellbeing is popular for good reason. Coaching up-levels our ability to prevent and manage chronic disease and improve well-being across physical and behavioral health. As trained professionals, Coaches bring a unique skill set and practice flexibility that increases care access and reduces cost. The field is on track to develop an even more robust evidence base since its beginnings in the ~1960s and to gain sustained interest from both supply side (coaches) and demand side (patients/clients). Coaching is still a young field, but it’s one standing on strong legs, poised to weave its way into many, if not most, care delivery models in the U.S.