Achieving skill and talent in health coaching is a continuing and exciting journey. The destination is not perfection, it is increasing proficiency through active practice. Aided by great training and the benefit of experience, one learns how to focus attention, effort and intentionality to make the journey an excellent adventure – for you and your patient partners.
Following are seven essential keys to help make each coaching encounter more effective and achieve higher proficiency in all coaching conversations. It may serve as a reminder of what you have learned or as a guide to your continued coaching journey.
1. Target a Desired Behavior
Effective health coaching conversations focus on a specific target behavior. This is not a focus upon an outcome or a condition such as lowering blood pressure or losing weight. Guide the conversation to a target behavior such as walking or testing blood sugar. Motivational Interviewing is structured moving behaviors – target behaviors. Intentionally focus and guide the conversation by negotiating the agenda, the patient’s agenda rather than yours, early in the encounter.
2. Use Open Ended Questions
Asking questions comes easily to many coaches. However, coaches can best consider questions that open the door rather than the default response when they don’t know where to go next, or are feeling stuck. Utilize open ended questions to elicit change talk rather than gather information. For example, “What do you see as the benefits of making this (name target behavior) change” “How will this (name target behavior) improve your life?”
3. Employ Reflections
Reflections are the foundational skill of Motivational Interviewing. Reflections are what effective coaches use (rather than questions) to guide the conversation. Strive for two or three reflections for each question asked. Reflect all change talk. Reflect what you want the patient to continue talking about. Reflections are “you” language rather than “I” language. Reflections are not an opportunity for the coach to include their personal evaluations. When you feel stuck or lost – reflect. Reflections will help you and the patient to get back in the conversation flow. Complex reflections go beyond the words you are hearing. What is underneath the surface of what the patient has said – the feelings underneath the words? Listen for, and acknowledge the patient’s values. Reflect a hypothesis of what you believe they mean. Reflections are more about getting deeper, rather than getting it exactly right. A good reflection encourages people to think more deeply. They guide the patient’s thinking and strengthens their motivations. As you reflect, allow the space for the patient to think, to discover and to clarify things for themselves.
4. Exhibit Empathy
An empathetic coach is a great facilitator of patient change and self-exploration. Empathy is not that the coach feels the same or identifies with the feeling of the patient. It is acknowledging how the patient is experiencing their own feelings. Suspend your thinking as the coach, so as to hear what the other person understands and feels. Help them to see it for themselves. As with so many of these skills, empathy is useful professionally and personally. “So when you are listening to somebody, completely, attentively, then you are listening not only to the words, but also to the feeling of what is being conveyed, to the whole of it, not the part of it.” Jiddu Krishnamurti
5. Be Evoking
Evoking is the heart of the coaching conversation. The bulk of the conversation time is spent on why the patient would like to change a targeted behavior – walking, taking medications, eating differently, etc. This is best facilitated with a couple of evocative, open-ended questions and more complex reflections. Frequently, the importance and amount of time spent building the motivation for the target behavior change is overlooked by coaches. Build the motivation for the change before problem solving. Invest time on the “whys” before briefly talking about the “hows”.
6. Utilize Scales
Scales are an evoking tool – not an assessment tool. They are to be used to build motivation. Wait until you have a target behavior and scale the change. The scale is not about the number, but the conversation that it elicits. Its purpose is to evoke more change talk.
7. Practice Summaries
Summaries are strategically used in a coaching conversation. They are not used, or should they be confused, with reflections throughout the conversation. They are a thoughtful pulling together of what the patient has been saying over the span of time. Think of presenting a big picture of the many pieces. Each of the pieces has been reflected and explored individually. Then, with a summary, selectively offer back the whole picture. Summaries can be effectively used to manage time, prevent getting too far ahead of the patient or transition to end a session, or to shift to something new, such as planning. These seven keys are offered to as reminders of essential practices for effective coaching through the use of Motivational Interviewing. As you continue your personal coaching journey and build coaching proficiency through practice, offer yourself the same acceptance and compassion you offer your patients. William R. Miller’s personal reflection, the Motivational Interviewing Prayer, is often used as meditative preparation before interacting with a patient or client. May you find it of value in your coaching journey!
“Guide me to be a patient companion, to listen with a heart as open as the sky. Grant me vision to see through her eyes and eager ears to hear her story. Create a safe and open mesa on which we may walk together. Make me a clear pool in which she may reflect. Guide me to find in her your beauty and wisdom, knowing your desire for her to be in harmony: healthy, loving and strong. Let me honor and respect her choosing of her own path, and bless her to walk it freely. May I know once again that although she and I are different, yet there is a peaceful place where we are one.” Motivational Interviewing, Helping People Change by William R. Miller and Stephen RollnickJ