Successful Coaching Behaviors: Challenges and Opportunities in Relationships

Abstract

Health and wellness coaching is a valuable intervention to help individuals improve their long-term physical, psychological, and social well-being. Coaches, individuals who employ motivational strategies through trusting relationships, have shown success in supporting individuals’ pursuit in creating and sustaining healthy lifestyle changes. We discuss the theoretical principles underlying coaching practices and present essential coaching behaviors that influence the quality and strength of the client–coach relationship. We acknowledge scenarios in which the client–coach relationship has grown stale or is incompatible; in these cases, we propose lateral referrals, which we define as identifying and redirecting clients to another coach possessing similar abilities to continue the coaching relationship. This strategy need not be exclusive to coaching as it would likely be beneficial for other health care professionals. Lateral referrals are promising as they provide an opportunity to meet individuals’ unique needs and enhance the likelihood of sustained changes.

“Health and wellness coaching is a promising intervention that can facilitate lasting positive lifestyle changes and lead to improved health and well-being for clients.”

Introduction

Health and wellness coaching is a powerful strategy to enhance learning and growth of individuals. ¹ In this issue, Berzins et al, ² noted that group health coaching is promising for improving health behaviors in cancer patients and survivors. Similar results have been found in numerous other groups (e.g., older adults and youth with obesity).^3,4 Specifically, coaches employ motivational strategies to guide and empower clients to achieve long-term positive behavior changes through self-discovery and meaningful goal setting.^2,5,6 Though there are a variety of theories and strategies underlying health coaching, it has shown efficacy in the prevention and management of chronic diseases.^2,7 However, sensitivity is needed regarding factors that influence the strength and quality of the client–coach relationship. Here, we explore variables in positive client–coach relationships and steps for change when relationships have become stale or incompatible.

Rationale and Background

Coaching has been shown to be an effective intervention for numerous chronic conditions.^7-11 An investigation of individuals with type 2 diabetes who received six months of coaching via fourteen, 30-minute telephone sessions revealed that, compared to the control group, perceived barriers to medication adherence decreased, and participants with elevated baseline HbA1c significantly reduced their HbA1c levels. ⁹ Results also showed improved self-reported adherence, exercise frequency, stress, and perceived health status. ⁹ Another study investigating coaching for weight loss in clients at overweight and obese levels utilized both in-person and telephone coaching sessions for 2 years. ¹² Health coaching was associated with a mean loss of 7.24% initial weight after 12 months and 6.77% after 24 months. Coached patients were more likely to achieve ≥5% of initial weight loss at both 12 and 24 months. ¹²

Individuals increasingly expect and value behavioral counseling from their primary care providers. ¹³ However with limited time, provider visits often prioritize acute care and minimal lifestyle medicine. ¹⁴ Less than half (40%) of hypertension visits involve behavior counseling, and the limited information given focuses on brief, close-ended style strategies. ¹⁴ Such prescriptive approaches follow a more conventional medical model in which experts educate or intervene. ¹⁵ However, these approaches contrast the principles underlying behavioral change and have been shown to be largely ineffective in helping clients change their behaviors. ¹⁵

While health coaching is distinct from other behavioral health specialists, there are notable areas of overlap among these providers. All strive to form strong relationships with their clients and facilitate positive change through similar approaches including motivational interviewing and self-reflection. ¹⁶ Two key factors in driving sustained change are the provider–client alliance and the provider’s mental and emotional state. ¹⁷ The alliance alludes to the strength and quality of the provider–client relationship and depends on both the client’s personal characteristics and the provider’s interpersonal attributes and style of relating. ¹⁷ Ackerman et al found that providers who are flexible, respectful, trustworthy, confident, affirming, and open are more likely to form positive alliances. ¹⁸ The provider’s personal state of being (i.e., attitudes towards clients) underlies alliance. ¹⁷ When such attitudes are genuine, acknowledge the humanity of the client, and convey that the provider values the unique individual needs of the client, there is potential to build a strong alliance. ¹⁸

Coaching Behaviors and Interpersonal Characteristics

Framework

Coaching draws upon well-established theories and strategies that include motivational interviewing, the transtheoretical model of change, self-determination theory, the social ecological model of change, and positive psychology. ¹⁹ Each of these approaches provides important foundational behavioral strategies for successful coaching. Motivational interviewing incorporates collaboration and compassion while the transtheoretical change model defines the individual’s stage of change and subsequent tailored coaching approaches.^20,21 Self-determination theory emphasizes intrinsic motivation, the social ecological seeks to understand the mechanisms by which social connection can inform potential intervention strategies, and positive psychology focuses on utilizing character strengths for healthy behaviors.^22-24 These theories provide a strong framework for the client–coach relationship.

Shared Experiences

In examining client–coach relationships, multiple components that impact positive client–coach interactions have been identified. These may include cultural and demographic characteristics (e.g., age, sex, community), as well as individual characteristics and religious beliefs.^25,26 For example, one study found that a shared set of common values, beliefs, language, and cultural identity, as well as a shared immigrant experience, aided in building trust and understanding between coaches and clients. For example, shared identities are often interpreted as coaches better understanding and supporting attempted behavioral changes. ²⁵ Clients feel more comfortable when the coaching relationship is “peer-like” in nature. ²⁵ Coaches’ “down-to-earth” qualities (e.g., friendliness, being respectful and non-judgmental) make clients feel at ease, which can further be underscored when an equal power dynamic and mutual respect is present. ²⁷

Communication

The foundation of establishing trusting client–coach relationships is client-centered communication, which promotes individual expression and partnership formation.^28,29 While coaches are tasked with sharing knowledge, it is important to do so judiciously and ask permission to assess readiness to accept or relay new information. ¹⁹ One way to practice this is through open-ended questions, which enhances the ability to learn individuals’ core values and observe for subtleties, such as changes in vocal tone, facial expressions, and body language. ¹⁹ Communication should also be centered around the client’s self-created intrinsic goals. Acknowledging that seemingly small achievements can enhance ongoing change as the path to sustained behavioral modifications is challenging and often nonlinear. ¹⁹ Descriptions of the success can serve as powerful reminders of the individual’s strengths and abilities and may support the development of creative problem-solving skills for future successes. ³⁰

Summary

A strength of coaching is reliance on client-centered approaches. Coaches who possess strong interpersonal skills to facilitate and not dictate are more likely to support clients in their attempts of change. This is achieved by helping individuals establish intrinsically important goals through exploration and active learning. Respecting the clients’ expertise in their life is a vital factor to maintaining trust and healthy client-coaching relationships. ⁶

Behavioral Recommendations: When the Relationship Does Not Work

As with any partnership, a client–coach pairing can fail to progress positively. Despite best efforts from both parties, a subset of relationships grow stagnant or incompatible. This may arise from mismatched personalities or shifts in personal circumstances, goals, or needs. For example, the client–coach dynamic may be effective initially, but as the client transitions to a new job or develops aspirations beyond their coach’s expertise, challenges may arise. Alternatively incongruent interpersonal styles can impede the development of strong connections. There are a variety of indicators that suggest a client–coach partnership is no longer serving its intended purpose. Notably, changes in the momentum of a client’s progress and disinterest in collaboration from either the client or the coach should prompt a reassessment of the relationship followed by either action to remedy the situation or to affably end the partnership.

However, both coaches and clients may feel ill-equipped to navigate these challenging scenarios. While some literature discusses potential problems within mentor–mentee dynamics, these are primarily explored within academic health care settings. ³¹ The paucity of guidance regarding when and how to dissolve these relationships may stem in part from a sense of obligation to persevere or from a fear of acknowledging some failure when a partnership is no longer fruitful. We propose that the recognition and amicable conclusion of these relationships is critical for achieving the goals of both the client and coach. Consequently, this practice should be widely adopted in the health and wellness coaching industry. Therefore, we present the concept making a lateral referral, which we define as leveraging one’s professional network to identify and redirect clients to another coach possessing similar abilities to seamlessly continue the coaching relationship. While the context of this article relates to coaches, this concept may be generalized to other health professionals as well.

Early Compatibility Assessment

Proactively and continually assess compatibility early in the client–coach relationship is important. Given their diverse backgrounds—ranging from licensed health care professionals, health promotion, education, fitness training, to wellness management—coaches often differ significantly in their content knowledge and coaching methodologies.^6,16 Therefore, coaches should regularly engage in self-reflection to evaluate the alignment of their coaching style and expertise with the specific needs, preferences, and expectations of their clients.

Collaborative Client–Coach Dialogue

When considering a lateral referral, it is critical for coaches to maintain professionalism and minimize any potential harm to the client’s emotional well-being. Coaches should initiate a non-judgmental, empathetic dialogue with their clients, presenting open-ended questions and emphasizing the shared goal of meeting the individual’s unique needs. Using shared decision-making, coaches and clients should arrive at a decision as a team. Through these discussions, coaches can empower clients to actively shape their coaching journey.

Robust Professional Networks

To facilitate effective referrals, coaches must cultivate robust professional networks consisting of individuals with a diversity of expertise, backgrounds, and coaching styles. A comprehensive network with a variety of colleagues allows coaches to identify suitable alternatives for their clients, ensuring a more thoughtful and successful transition. Continuity of care, while often invoked in medical contexts, is an essential component of lateral referrals. Coaches should prioritize continuity of coaching by actively facilitating the transfer of pertinent information and client goals to the incoming coach. This approach ensures progress is preserved and enables the next coach to build upon the foundation established in the preceding client–coach relationship. One of the best predictors of overall health is long-term attempts at change. Coaches and other health care professionals should actively seek ways to support clients’ long-term engagement in health promotion.

Conclusions

Health and wellness coaching is a promising intervention that can facilitate lasting positive lifestyle changes and lead to improved health and well-being for clients. While substantial research has defined the theoretical foundation of coaching, there is a lack of guidance for cases where the client–coach relationship proves ineffective. Utilizing lateral referrals is a promising strategy and generalizable to other health professionals. When health care professionals remain focused and committed to client-centered care, it can have a profound effect on not only improving the well-being and satisfaction of the client but the health care professional as well.