Utilizing Motivational Interviewing and Theoretical Foundations in Wellness Coaching

What is wellness coaching?

A growth-promoting relationship that elicits autonomous motivation, increases the capacity to change, and facilitates a change process through visioning, goal setting, and accountability.

Health Coaches work with clients in a

client- centered, thought-provoking and creative process to inspire and support them to maximize potential and achieve self-identified health goals.

Coaches honor the client as

the expert in their own life and believe everyone has the potential to be creative, resourceful, and whole.

Coaches

-clarify what the client wants to achieve
-encourage self-discovery
-elicit client-generated solutions
-hold spaces for accountability

coaching is NOT...

-primarily advising, educating, or analyzing root problems

-the "expert approach"

-ordering, commanding or directing goals and strategies

-judging, criticizing, disagreeing, or shaming

-humoring, sympathizing, or consoling

how can coaching help with PT?

-reminder to listen
-helps them gain independence (they're not with you forever)

transtheroretical model of change

pre-contemplation, contemplation, preparation, action, maintenance

provides coaches with an understanding of how and when behaviors can be adopted and sustained and why clients may struggle, fail or quit

understanding what stage they are in helps you apply techniques for facilitating change specific and effective for that stage

pre-contemplation

-I won't: not interested in change, need to be understood and have full autonomy over choices (may be beneficial to validate the unhealthy behavior and needs they they need or how they help them cope)

-I can't: aware they need to change but believe it is too complicated (need to look at barriers in a positive way so they can learn from them)

two aspects of change in pre-contemplation

1. mindset shift: must happen first in order to have a behavioral shift

2. behavioral shift

three D's of pre-contemplation

1. don't know how (lack of awareness)
2. demoralization (fear of failure)
3. defending (blaming self, projecting)

in pre-contemplation in order to move forward a client needs to

-experience empathy and unconditional acceptance
-assess healthy stress management
-make a decision to change o not

skills to use for pre-contemplation

1. consciousness raising
2. dramatic relief
3. generate hope (helps with demoralizing)
4. transform defending into coping

contemplation

-"I May": considering making changes within next 6 months but still senses doubt

what tool is helpful in contemplation stage?

decisional balance tool: clients weigh the benefits and the pros must outweigh the cons to move to the next stage

2 D's in contemplation

-doubt
-delay

in contemplation you should help the client do what?

decrease the cons and notice their effects on others

what keeps a client from moving forward from contemplation?

-chronic contemplation
-wanting total certainty
-rushing into action

preparation

-"I will.": motivation has strengthened and ambivalence has been overcome for the most part
-preparing to make changes within 30 days

in preparation, clients are aware of barriers and have come up with possible solutions

-decrease barriers to build habit
-increase barriers to break habit

good tools in preparation phase

action planning sheet and SMART goal sheet

D of preparation

dread of failing
-utilize guided learning
-self re-evaluation: emphasize the Pros
-self-liberation

not all about how but how can you increase power?

go public (accountability), increase health coping choices, dont focus on past mistakes

action

-"I am": working on building new relationships and establishing new behaviors/habits (6 months of more)
-decided on behavior and been building on it consistently
-increasing support and connection is crucial

what is key to action?

adequate preparation (it is okay to tell the client they are not ready)

in preparation it is important to

anticipate situations that could be problematic and assist with possible solutions ahead of time to lead to better success when/if they come across a setback

maintenance or lapse/relapse

-"I still am": maintenance stage when they are not longer tempted or behavior now comes naturally

3 criteria for termination of old behavior and adoption of new

-zero temptation
-full confidence and self efficacy
-so comfortable they don't have to make an effort to keep from relapsing

what is the biggest barrier to success in maintenance?

distress

controlled motivation

-external
-driven to please others, gain approval or respect or out of fear of consequences
-can lead to defiance

autonomous motivation

-internal
-clients control their own choices and act to their own interest

why do clients perform best when they are free to make autonomous choice?

-new behaviors persist longer
-more flexible and creative
-experience more enjoyment and higher quality physical and personal relationships

self motivation

i want to do it

self efficacy

i believe i can do it

social cognitive theory

describes the influences of individual experiences, actions of others, and environmental factors on individual health factors

-provides opportunities for social support through instilling expectations, self-efficacy, and using observational learning and other reinforcements to achieve behavior changes

self efficacy

belief that an individual has control over and is able to execute a behavior

behavior capability

understanding and having the skill to perform a behavior

expectations

determining the outcomes of behavior change

expectancies

assigning a value to outcomes of behavior change

self control

regulating and monitoring individual behavior

observational learning

watching and observing outcomes of others or modeling the desired behavior change

motivational interviewing

supports the eliciting of autonomous motivation (encouraging a client to find their own reasons to change)

involves pro change talk and avoids triggering resistance

used to elicit THEIR reasons to change, not to install our reasons why they should

four processes of MI

Engaging
Focusing
Evoking
Planning

engage

develop growth promoting and relationship building strategies that support the clients autonomy

focus

help clients develop more clarity around their values and goals

evoke

generate a connection to the clients autonomous motivations and drives

plan

design action plans that support the building of self-efficacy

guiding principles of motivational interviewing

1. Express empathy
2. Develop discrepancies
3. Roll with resistance
4. Support self-efficacy

express empathy

-understanding of the clients perspective and acceptance of their situation
-noncritical, nonjudgmental way

develop discepancy

-working with them to identify the difference between current and future states and recognize goals to be achieved
-enhance ability to become more familiar with what desirable behaviors look like
-tools like decisional balance and reflections

roll with resistance

-allow client to verbalize resistance to change and share the experienced concerns or challenges
-accept their behavior
-do not: advise, educate, console, explain, correct, story tell, one up

Support Self-Efficacy

-affirm client successes no matter how small
-identify strengths
-clients should be able to learn how to sustain their goals after they move on