Whole Health Coaching Participant Manual.Feb19.2021

WHOLEHEALTHCOACHINGParticipantManual

CreatedundercontractwithTechWerks,LLC

VHA Office of Patient Centered Care and Cultural Transformation

• Assist the Veteran in developing a per-sonalized health plan that is based on what matters most to the Veteran; the plan is based on the Veteran’s own goals, values, preferences, and lifestyle. The agenda is the Veteran’s.

• Partner with the Veteran with proactively taking action toward behavior change that is present- and future-oriented.

• Recognize that health is much broader than the absence of disease. The emphasis is on health enhance-ments/strengths rather than disorders/weaknesses.

• Support the Veteran in achieving their standard of optimal health that takes into account the mental, physical, and social well-being of the Veteran.

TIME COMMITMENT: Pre-Course Orientation - 1 hrSession 1 - 25 hrsBetween session Triad Calls - 6 hrsSession 2 - 24 hrsAsynchronous Learning - 5 hrsSession 3 - 25 hrsPost-Course Triad Calls - 6 hrsAsynchronous Learning - 15 hrs

The virtual Whole Health Coaching course integrates principles of change theory and practice to support Veterans in realizing their health potential.

LEAVE WITH THE SKILLS TO:

VHA WHOLE HEALTH COACHING

COURSE FORMAT:

Virtual learning (Zoom)Class discussionWH coaching practice Skills practiceSmall groups

*Daily tech support will be available

Participants wishing to receive CEUs and a cer-tificate of completion re-quired for their application for NBC-HWC certifica-tion must attend all three weeks of training (75 hrs), all 12 hours of triad prac-tices, and all 20 hours of asynchronous training.

COURSE ACCREDITATION:

NBHWC

Register HEREFor more information, contact: [email protected]

WHY WHOLE HEALTH COACHING?

Whole Health Coaches play an integral role in Veterans’ behavior change and the radical redesign of health care, and the OPCC&CT is committed to providing optimally trained Whole Health Coaches for Veterans.

Health coaches can provide individual and group coaching services not only within the Well-being Program but also within Whole Health Clinical Care.

VHA Office of Patient Centered Care and Cultural Transformation

WHO SHOULD APPLY TO ATTEND?Dedicated Health Coaches, PACT members, social workers, RNs/LPNs, pharmacists, peer support specialists, medical assistants, residents, physical therapists, kinesiolo-gists, dietitians, and individuals associated with behavior change programs, to name a few. Non-clinicians are encouraged to attend, especially those interested in serv-ing in a health coaching role. CME accreditation is available for physicians, non-phy-sicians, pharmacists, dietitians, nurses, psychologists, and social workers.

• VA staff in a Whole Health Coach PD

• VA staff who are connected to the local Whole Health Program and want to support the evolution of Whole Health at their medical center.

FINAL CONSIDERATIONS• To be eligible to apply for the national board exam, participants must complete

an approved training program and submit a log of 50 coaching sessions along with their certificate of completion from the course. Participants may start documenting sessions after meeting all course requirements and receiving their certificate of completion. The recommended time to complete the coach-ing sessions is 6 months.

• This is not an exam preparation course; however, attending this program will better prepare participants for the national board certification exam along with a rigorous independent study plan.

• In order to use the new 2020 American Medical Association Health Coach CPT code, health coaches need to be NBHWC certified. Non-certified coach-es cannot use CPT codes.

For more information about NBHWC, please visit their website: www.nbhwc.org

WHOLEHEALTHCOACHINGPARTICIPANTMANUAL

VHA/OfficeofPatientCenteredCareandCulturalTransformation|3

Whole Health Coaching Virtual Course-Agenda Sessions I-III

SESSION I Session I Day 1

Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Welcome & Overview of the Course 11:00 – 11:45 AM ET Group Guidelines, Virtual Practices, Participant Resources 11:45 – 12:05 PM ET Participant Introductions 12:05 – 1:05 PM ET Lunch Break 1:05 – 1:35 PM ET What is Whole Health Coaching 1:35 – 2:30 PM ET Introduction to Mindful Awareness & Practice 2:30 – 3:45 PM ET Introduction to Mindful Communication 3:45 – 4:20 PM ET Daily Q&A and Feedback 4:20 – 4:30 PM ET Adjourn 4:30 PM ET

Session I Day 2 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Coaching Skill: Mindful Listening & Speaking 11:15 – 12:15 PM ET Lunch Break 12:15-12:45 PM ET Coaching Skills: Reflections, Acknowledgments & Inquiry 12:45 – 2:45 PM ET Overview of WHC Process; Introduction to Stage 1 2:45 – 4:20 PM ET Daily Q&A and Feedback 4:20 – 4:30 PM ET Adjourn 4:30 PM ET

Session I Day 3 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Continue Stage 1: MAP, Values, & Values Conflicts 11:15 – 12:00 PM ET Stage 1 Demo & Debrief 12:00 – 12:45 PM ET Lunch Break 12:45 – 1:15 PM ET Set up Triad Practice 1 1:15 – 1:45 PM ET Triad Practice 1 + Break 1:45 – 4:00 PM ET Triad Practice 1 Debrief 4:00 – 4:15 PM ET Daily Q&A and Feedback 4:15 – 4:30 PM ET Adjourn 4:30 PM ET

Session I Day 4 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Introduction to Stage 2 11:15 – 12:00 PM ET Stage 2 Demo & Debrief 12:00 – 12:45 PM ET Lunch Break 12:45 – 1:15 PM ET Set up Triad Practice 2 1:15 – 1:30 PM ET Triad Practice 2 + Break 1:30 – 3:40 PM ET Triad Practice 2 Debrief 3:40 – 3:55 PM ET


4|VHA/OfficeofPatientCenteredCareandCulturalTransformation

Triad Practice 2 Debrief 3:40 – 3:55 PM ET

Daily Q&A and Feedback 3:55 – 4:00 PM ET

Adjourn 4:00 PM ET

Session I Day 5

Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET

Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET

Introduction to Stage 3 11:15 – 12:15 PM ET

Stage 3 Demo & Debrief 12:15 – 1:00 PM ET

Lunch Break 1:00 – 1:20 PM ET Set up Triad Practice 3 1:20 – 1:30 PM ET Stage 3 Triad Practice + Break 1:30 – 3:35 PM ET

Triad Practice 3 Debrief 3:35 - 3:45 PM ET

Introduction to Phone Triad Practice 3:45 – 4:15 PM ET

Final Q&A, Closing 4:15 – 4:30 PM ET

Adjourn 4:30 PM ET



SESSION II Session II Day 1

Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Welcome Back, Ice Breaker & Mindful Awareness Practice 11:00 – 11:45 AM ET Review of Between Session Practice, Skills, & Process 11:45 – 12:05 PM ET Introduction to Stage 4 12:05 – 12:35 PM ET Stage 4 Demo & Debrief 12:35 – 1:05 PM ET Lunch Break 1:05 – 1:35 PM ET Set up Triad Practice 4 1:35 – 1:45 PM ET Triad Practice 4 + Break 1:45 – 3:50 PM ET Triad Practice 4 Debrief 3:50 – 3:55 PM ET Daily Q&A and Feedback 3:55 – 4:00 PM ET Adjourn 4:00 PM ET

Session II Day 2 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Introduction to Barriers Strategies: Brainstorming & Values Conflicts 11:15 – 1:15 PM ET Lunch Break 1:15 – 1:45 PM ET Barriers Strategies Continued: EPE & Limiting Beliefs 1:45 – 3:45 PM ET Daily Q&A and Feedback 3:45 – 4:00 PM ET Adjourn 4:00 PM ET

Session II Day 3 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Review of Barriers Strategies 11:15 – 11:35 AM ET Set up Triad Practice 5 11:35 – 11:55 AM ET Triad Practice 5 + Lunch Break 11:55 – 2:25 PM ET Triad Practice 5 Debrief 2:25 – 2:40 PM ET Revisit Course Requirements, NBHWC Certification 2:40 – 2:55 PM ET Break 2:55 – 3:05 PM ET How & When to Refer & Suicide Prevention 3:05 – 3:50 PM ET Daily Q&A and Feedback 3:50 – 4:00 PM ET Adjourn 4:00 PM ET

Session II Day 4 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Introduction to Group Coaching 11:15 – 12:00 PM ET Group Coaching Demo & Debrief 12:00 – 12:35 PM ET Lunch Break 12:35 – 1:05 PM ET Group Coaching Practice 1 1:05 – 3:35 PM ET Group Practice 1 Debrief 3:35 – 3:50 PM ET Daily Q&A and Feedback 3:50 – 4:00 PM ET Adjourn 4:00 PM ET

Session II Day 5 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET



Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET

Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET

Coaching Within Your VHA Role 11:15 – 1:15 PM ET

Lunch Break 1:15 – 1:45 PM ET Group Coaching Practice 2 1:45 – 3:45 PM ET Group Practice 2 Debrief 3:45 – 3:55 PM ET

Final Q&A, Closing 3:55 – 4:00 PM ET

Adjourn 4:00 PM ET



SESSION III Session III Day 1

Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Welcome Back & Overview of Session III 11:00 – 11:30 AM ET Review Course Requirements, WHC Process Model, Coaching Skills 11:30 – 12:00 PM ET Coaching Presence & Mindful Awareness 12:00 – 1:00 PM ET Lunch Break 1:00 – 1:30 PM ET Advanced Skills: Interrupt/Redirect, Metaphor, Decisional Balance 1:30 – 2:55 PM ET Advanced Skills: Exploring Perspectives 2:55 – 3:50 PM ET Daily Q&A and Feedback 3:50 – 4:00 PM ET Adjourn 4:00 PM ET

Session III Day 2 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Coaching Structure Session 1 – Initial Session 11:15 – 12:00 PM ET Lunch Break 12:00 – 12:30 PM ET Triad Practice #1 – Initial Session + Break 12:30 – 3:45 PM ET Triad Practice 1 Debrief 3:45 – 3:55 PM ET Daily Q&A and Feedback 3:55 – 4:00 PM ET Adjourn 4:00 PM ET

Session III Day 3 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Coaching Structure Session 2 – Routine Ongoing Session 11:15 – 12:00 PM ET Lunch Break 12:00 – 12:30 PM ET Triad Practice 2 – Ongoing Session + Break 12:30 – 3:30 PM ET Triad Practice 2 Debrief 3:30 – 3:35 PM ET Coaching Structure: Final Session 3:35 – 3:55 PM ET Daily Q&A and Feedback 3:55 – 4:00 PM ET Adjourn 4:00 PM ET

Session III Day 4 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Coaching Theories 11:15 – 12:15 PM ET Lunch Break 12:15 – 12:45 PM ET How to Coach Around Stages of Change 12:45 – 1:55 PM ET Ethics & Scope of Practice 1:55 – 3:40 PM ET Certification Exam Prep 3:40 – 3:55 PM ET Daily Q&A and Feedback 3:55 – 4:00 PM ET Adjourn 4:00 PM ET

Session III Day 5 Participant Sign-In & Registration (check on virtual connection) 10:30 – 11:00 AM ET Overview of the Day & Mindful Awareness Practice 11:00 – 11:15 AM ET Group Coaching – Group Design, Structure, Demo & Debrief 11:15 – 12:15 PM ET Lunch Break 12:15 – 12:45 PM ET



Lunch Break 12:15 – 12:45 PM ET Group Coaching Practice 12:45 – 2:55 PM Group Practice Debrief 2:55 – 3:00 PM ET Asynchronous Logistics, Phone Triad Setup 3:00 – 3:45 PM ET Final Q&A, Closing 3:45 – 4:00 PM ET Adjourn 4:00 PM ET



TableofContents

SESSIONI&IICONTENT..................................................................................................................12

WELCOME.................................................................................................................................................................13INTRODUCTION.....................................................................................................................................................15FUTUREOFHEALTHCOACHINGINTHEVHA...........................................................................................17HEALTHCOACHCERTIFICATION...................................................................................................................18CHAPTER1:PRINCIPLESOFHEALTHCOACHING....................................................................20COACHESARENOTTHEONLYEXPERTSINTHEROOM......................................................................20THREEHELPINGSTYLES....................................................................................................................................21SPECIFICVHAHEALTHCOACHINGPRINCIPLES.....................................................................................24CHAPTER2:QUALITIESOFAWHOLEHEALTHCOACH..........................................................26THEDESIREDQUALITIESOFAWHOLEHEALTHCOACH....................................................................26MINDFULAWARENESS.......................................................................................................................................28CHAPTER3:ACTIVECOMMUNICATIONSKILLSFORCOACHING.........................................32LISTENING................................................................................................................................................................32SIMPLE&COMPLEXREFLECTIONS...............................................................................................................32INQUIRY.....................................................................................................................................................................37DIRECTCOMMUNICATION................................................................................................................................39CHAPTER4:THEHEALTHCOACHINGPROCESS.......................................................................40HOWTOUSETHEHCPM.....................................................................................................................................41STAGESANDPHASESOFTHEHCPM.............................................................................................................43WHENUTILIZINGTHEFULLCOACHINGPROCESSISNOTFEASIBLEORPOSSIBLE...............59CHAPTER5:ENHANCINGYOURWHOLEHEALTHCOACHINGSKILLS...............................61UTLIZINGAPEERSUPPORTGROUP..............................................................................................................62SUGGESTIONSFORCREATINGAHEALTHCOACHINGENHANCEMENTPROGRAM................63ESTABLISHINGAHEALTHCOACHINGSUPPORTNETWORKATYOURLOCALSITE...............63WHOLEHEALTHCOACHINGTRAININGIMPLEMENTATIONASSESSMENT...............................64CHAPTERSIX:GROUPCOACHING.................................................................................................67OPPORTUNITIESWITHGROUPCOACHING...............................................................................................67SETTINGUPAGROUP–SOMECONSIDERATIONS..................................................................................69DEALINGWITHDIFFICULTGROUPBEHAVIORORGROUPPROCESSES.......................................74CHAPTER7:PRE-SESSION,FIRSTSESSION,ANDLASTSESSIONCONSIDERATIONS..............................................................................................................................76PRE-SESSION...........................................................................................................................................................76FIRSTSESSION........................................................................................................................................................77LASTSESSION.........................................................................................................................................................77



SESSIONIIICONTENT.......................................................................................................................78

CHAPTER8:MINDFULAWARENESSANDCOACHINGPRESENCE........................................79HOWMINDFULAWARENESSSUPPORTSTHECOACHINGPROCESS.............................................79STEPSFORGUIDINGAMINDFULMOMENT...............................................................................................81MINDFULAWARENESSVS.MINDFULNESS–VHARESOURCES.......................................................81MINDFULAWARENESSSCRIPTS....................................................................................................................82CHAPTER9:ADVANCEDCOACHINGSKILLS...............................................................................90METAPHOR..............................................................................................................................................................90INTERRUPT&REDIRECT...................................................................................................................................91DECISIONALBALANCE........................................................................................................................................94PERSPECTIVES.......................................................................................................................................................96CHAPTER10:COACHINGSTRUCTURE......................................................................................100COACHANDVETERANRESPONSIBILITIES/EXPECTATIONS.........................................................108CHAPTER11:OUTCOMEVS.BEHAVIORALGOALS................................................................110CHAPTER12:COACHINGTHEORIES..........................................................................................112TRANSTHEORETICALMODEL:SIXSTAGESOFCHANGE..................................................................112TRAVISILLNESS-WELLNESSCONTINUUM.............................................................................................114SELF-DETERMINATIONTHEORY................................................................................................................115SOCIALCOGNITIVETHEORY.........................................................................................................................115GROWTHMINDSET...........................................................................................................................................116CHAPTER13:THETRANSTHEORETICALMODEL–COACHINGAROUNDSTAGESOFCHANGE.........................................................................................................................117PRECONTEMPLATION......................................................................................................................................117CONTEMPLATION..............................................................................................................................................118PREPARATION.....................................................................................................................................................119ACTION....................................................................................................................................................................120MAINTENANCE....................................................................................................................................................121TERMINATION/ADOPTION(RELAPSE/RECYCLE).............................................................................122CHAPTER14:THEETHICSOFCOACHING.................................................................................124FACTORSCONTRIBUTINGTOCHOOSINGETHICALACTION..........................................................124AREASOFCOACHINGREQUIRINGETHICALCONSIDERATION.....................................................127COMMONETHICALBLINDSPOTS...............................................................................................................129APPROACHINGETHICS:KEYPOINTS........................................................................................................130SOURCESFORINFORMATIONINTHISCHAPTER................................................................................130CHAPTER15:GROUPCOACHINGCONTINUED........................................................................131ESSENTIALELEMENTSOFGROUPCOACHING......................................................................................131BEGINNINGTHEGROUP–INITIALSESSION..........................................................................................134



ROUTINE-ONGOINGGROUPSESSIONSTRUCTURE............................................................................135THEFINALSESSION..........................................................................................................................................136CHAPTER16:EXAMINATIONPREPARATION.........................................................................138WHYPURSUECERTIFICATION?...................................................................................................................138EXAMPREP............................................................................................................................................................139RESOURCES&REFERENCES..........................................................................................................143WHOLEHEALTHWEBSITE............................................................................................................................143COMMUNITYOFPRACTICECALLS.............................................................................................................144OTHERVARESOURCES....................................................................................................................................144SUGGESTEDWEBSITES....................................................................................................................................145SUGGESTEDREADINGMATERIALS............................................................................................................145



SESSIONI&IICONTENT



WELCOME

WelcometotheWholeHealthCoachingProgram,anApprovedHealthandWellnessCoachTrainingandEducationProgrambytheNationalBoardforHealthandWellnessCoaching(NBHWC).

VeteransHealthAdministration(VHA)establishedtheOfficeofPatientCenteredCareandCulturalTransformation(OPCC&CT)in2011toleadoneofthemostmassivechangesinthephilosophyandprocessforhealthcaredeliveryeverundertakenbyanorganizedhealthcaresystem.TheUndersecretaryforHealthdescribestheidealsystemasoneinwhich“patientsareincontroloftheirhealthcare,andthesystemisdesignedaroundtheneedsofthepatient.”Toaccomplishthisrequiresaparadigmshiftfromproblem-baseddiseasecaretoWholeHealthCare,basedonthewholeperson.

VHAdefinesWholeHealthaspatient-centeredcarethataffirmstheimportanceofapartnershipbetweentheclinicianandpatient.Thefocusisonthewholepersonwhileco-creatingapersonalized,proactive,andpatient-drivenexperience.Thisapproachisinformedbyevidence,andmakesuseofallappropriatetherapeuticapproaches,healthcareprofessionals,anddisciplinestoachieveoptimalhealthandwell-being.

ThehealthcareteambeginswiththeVeteranasanindividualandwhatmatterstotheVeteranintheirlife.TheteamutilizesinformationfromthePersonalHealthInventory,atoolthathelpsVeteransexploretheirvisionoflivinglifefully,theirvalues,andtheirpriorities.APersonalHealthPlaniscreatedbydrawingonthePersonalHealthInventoryandriskassessmenttools,establishingsharedpatientandclinicalgoals,employingevidence-basedtraditionalandnon-traditionalinterventionsandtreatments,andleveragingsupportsystemswithinandoutsideofVHA.Corecompetenciesinteam-basedinter-professionalcollaborationarecritical.

Additionally,newprocessesandnewrolesareneeded,notonlyforthehealthcareteambutfortheVeteran.Thisincludesbuildingskillsandconnectingwithsupportandresourcesforsustainablebehaviorandlifestylechangeandimprovedhealthoutcomes.

Keycomponentsofthisapproachtohealthcareincludethefollowing:

• Personalvisionandmissionforlifeandhealth.• Personalizedhealthplanning.• Integrativemedicineandself-careskillbuildingandknowledgeacquisition.• Lifestyleandbehaviorchangestrategies.• Supporttosucceedwithandfromsignificantothers,healthcareteammembers,and

thecommunity.



TheWholeHealthCoachingProgramisa15-dayintensivetrainingincommunicationandcoachingskillsdividedintothree,five-day,virtualsessions,withstudyandpracticesessionsrequiredbetweenSessions1and2,andafterthecompletionofthethirdsessionoftraining.

WholeHealthCoachingteachesandtrainsindustrybestpracticesforintegratedhealthcoaching,strategies,andmethods.ItisaprofessionaltrainingprogramthatistailoredtotheVeteranpopulation.WholeHealthCoachingcorecompetenciesincludeunderstandingtheroleofthehealthcoach,coachinginvarioussettings(face-to-face,individual,groups,telecommunicationvenues,etc.),establishingtrustingrelationshipsandeffectivecommunication,creatingawareness,designingactions,planning,settinggoals,managingprogressandaccountability,coachingstructure(initialandroutineongoingsessions),documentmanagement,andinterfacingwiththeclinicalteam.

Itisoursincerehopethatyourexperienceinthistrainingnotonlyenhancestheskillsandcorecompetenciesyoualreadypossess,butalsoprovidesyouwithapersonalizedexperiencethatwillenrichyourlife.



INTRODUCTION

ThismanualisdesignedtosupplementthehealthcoachtrainingdevelopedanddeliveredforVeteransHealthAdministration(VHA)employees,muchlikeatextbook.Itcontainsdescriptionsofthekeytrainingconcepts,skillsandstrategiesthatareofferedinvirtualtrainingandreferencesandresourcesforadditionalinformation.Themanualcontainsthesameinformationasdeliveredinthevirtualtrainingbutisorganizedbytopicsanddoesnotalwayscoverthematerialinthesameorderaspresentedinthetraining.

Throughoutthemanual,thetermVeteranorcoachingpartnerisused,usuallyastherecipientofcoaching.Inothervenues,thetermpartner,client,orpatientmightbeused.TheuseofVeteraninthismanualisnotintendedtobeinclusiveofonlyVeterans,norisitintendedtoexcludeanyoneelse,suchasReservists,ActiveDuty,orfamilymembers.Tobelesscumbersome,thetermVeteranorpartnerisusedtoaddresseveryonereceivingcoaching.Similarly,thetermsWholeHealthCoach,healthcoach,orcoachareinterchangeableandusedthroughoutthisdocument.AllrefertothoseprovidingcoachingtotheVeterans.

WHYHEALTHCOACHTRAINING?

“TheVHAVisionPlanwasreleasedinDecember2020.TheplanestablisheskeystrategiesandconceptscentraltoVA’stransformationintoaHigh-PerformingIntegratedDeliveryNetwork(HPIDN).ItalignstoVA’sconcurrentstrategicplanninginitiatives,suchastheVAStrategic

Plan,VHALong-RangePlan,andVHAModernizationPlan,preparingthewayforimplementationofdiscrete,data-drivenactionplans.ThismarksthenextstepinVA’stransformation,demonstratingtheorganization’scommitmenttosafetyandVeteran

experience.ThisnetworkwillhelpVAattainandsustainapositionasthemostconvenientandaccessiblehealthcaresysteminhistory.”

BenjaminKigler,MD,MPHExecutiveDirectorOPCC&CT

HealthCoachingisanimportantlinktohelpingtheVHAachievetheirStrategicGoalsandObjectivesfor2013-2021.TheseGoalsareto:

1. ProvideVeteranspersonalized,proactive,patient-drivenhealthcare(andsupporttosuccessfullyimplementtheirpersonalhealthplans).

2. Incentivizemeasurableimprovementinhealthoutcomes.3. AlignresourcestodeliversustainedvaluetoVeterans.



Onfurtherexamination,itcouldbesaidthatthesecondandthirdgoalsarereallyinsupportofthefirstgoal.Giventhis,healthcoachingisbeingdisseminatedandtrainedwithintheVHAto“provideVeteranspersonalized,proactive,patient-drivenhealthcare.”

Furthermore,whenconsideringthedefinitionoftheabovetermsinGoal1,itbecomesclearerhowhealthcoachingsupportsthatgoal.Thedefinitionsofthesetermsare:

PERSONALIZED

Adynamicadaptationorcustomizationofrecommendededucation,preventionandtreatmentthatisspecificallyrelevanttotheindividualuser,basedontheuser’shistory,clinicalpresentation,lifestyle,behavior,andpreferences.

CoachesassisttheVeteranindevelopingaplanthatisbasedonwhatmattersmosttotheVeteran;theplanisbasedontheVeteran’svalues,preferences,andlifestyle.

PROACTIVE

Actinginadvanceofalikelyfuturesituation,ratherthanjustreacting;takinginitiativetomakethingshappenratherthanjustadjustingtoasituationorwaitingforsomethingtohappen.

CoachesassisttheVeteranintakingactionthatispresentandfutureoriented.TheyassisttheVeteraninengaginginlife/healthenhancingendeavorsthatarenotjustreactivebutproactiveintakingresponsibilityforwhattheVeteranwants.

PATIENT-DRIVEN

Anengagementbetweenapatientandahealthcaresystemwherethepatientisthesourceofcontrolsuchthattheirhealthcareisbasedintheirneeds,values,andhowthepatientwantstolive.

CoachesrecognizetheVeteranasthesourceofcontrolforhowtheywanttolive,andinwhatchangestheywanttoengageandwhen.CoachespartnerwiththeVeteranstosupporttheminachievingtheVeteran’sgoals,needsandbehaviorsthatsupporttheirvalues.

HEALTH

Astateofcompletephysical,mental,andsocialwell-being,andnotmerelytheabsenceofdiseaseorinfirmity.(WorldHealthOrganization)

CoachesrecognizethathealthismuchbroaderthantheabsenceofdiseaseandthathealthisimpactedbymanyfacetsofaVeteran’slife,andthathealingcanexistdespitethepresenceofdisease.CoachesseektosupporttheVeteraninachievingoptimalhealth,by



theVeteran’sstandardthattakesintoaccountthemental,physical,andsocialwell-beingoftheVeteran.

PERSONALHEALTHPLAN

Auniquelypersonalizedplanforhealththatisbuiltuponeachpatient’svalues,conditions,needsandcircumstanceswhichusesthemostappropriateinterventionsandstrategies.Itaddressestheskillsandsupportneededtohelpengagedpatientsmanagetheirdisease,inordertoregainandmaintainoptimalhealthandwellbeingandmanagechronicdiseaseanddisabilitytothegreatestextentpossible.

CoachesassisttheVeteraninplanningfortheirhealth,notsimplyreactingtothemostcurrenthealthconcern.Again,thePersonalHealthPlanisdesignedbytheVeteranwiththesupportoftheCoaches.

FUTUREOFHEALTHCOACHINGINTHEVHA

TheOfficeofPatientCenteredCare&CulturalTransformation(OPCC&CT)recognizesthatWholeHealthCoaching(WHC)buildsonexistingcoachtrainingintheDepartmentofVeteransAffairs(VA)andcontinuestoevolvetobefullyintegratedwiththeotherprograms.Sinceitsinitialcourseofferingin2013,WHChasbecomeasignificantcomponentoftheWholeHealthSystem–itisacoreserviceofboththePathwayandWell-beingProgramsandagrowingcomponentofClinicalCare.AnationallyclassifiedPositionDescriptionwasdevelopedandadoptedin2015.Atthestartof2020,nearly2,300VAWholeHealthCoachesworkwithVeteransnationwidetohelpthemsetgoalsbasedontheirhealthprioritiesandpersonalhealthplans.Coachesalsooffersupport,encouragement,andattentiontohelpVeteransstayontracktomeettheirhealthandwell-beinggoals.

VAhasachievedamilestoneinhealthcaretrackingadvancingthefutureofhealthcoachingasatreatment.In2019,VAsuccessfullyappliedtotheAmericanMedicalAssociation(AMA)tocreatenewCategoryIIICurrentProceduralTerminology(CPT®)trackingcodesforHealthandWell-beingCoaching.Toaccomplishthis,VAteamedwiththeNationalBoardforHealthandWellnessCoaching(NBHWC),thenon-profitorganizationthatcreatedthenationalstandardsforhealthCoaches.VAanticipatesuseofthecodeswillincreaserecognitionofHealthCoachingasavaluableservice,makeitsusagemorecommonthroughouthealthcareandsupportitsbenefitasaserviceinthefuture.



HEALTHCOACHCERTIFICATION

ThroughtheeffortsoftheNationalBoardforHealth&WellnessCoaching(NBHWC),formerlyInternationalConsortiumforHealthandWellnessCoaching(ICHWC),anationalcertificationprocessisnowinplace.

In2016,theVHAwasapprovedasaTransitionallyAccreditedHealthCoachingProgrambyNBHWC.Tomeetthisrequirement,PracticalSkillsEvaluations(PSA)wereaddedtothementoringprocess.Allcourseparticipantswhometthetransitionalprogramrequirementsofattendingallsessionsofthetrainingandparticipatinginallthreebetweensessiontriadpractices,andwhoreceivedaCertificateofCompletionfollowingthecoursewereeligibletoapplyforthenationalexam.

TheWholeHealthCoaching(WHC)programexpandeditscurriculumtoadheretonationalcredentialingstandards,establishedbyNBHWC.Inadditiontotheexisting2-weekFoundationscourse,OPCC&CToffereda3rdCertification-focusedweek.ParticipantsregisteringfortheWHCCertificationcoursemusthavecompletedtheFoundationscoursetobeeligible.TheSession3CertificationcoursewaspilotedinFY20.

InMarch2020,OPCC&CTappliedtoNBHWCforpermanentphaseprogramapproval.Followinganonlineinterviewandreviewprocess,OPCC&CTreceivednoticeinApril2020thattheVHAWholeHealthCoachingProgramwasapprovedbyNBHWCfortheeducationandtrainingofhealthandwellnesscoaches.InFY21,theseparate2-weekFoundations,and1-weekCertificationofferingwerecombinedtoofferone3-weekcomprehensiveWholeHealthCoachingProgram.

AsanoverviewofWHCprogramofferedinFY21,thefirsttwoweeksofthe3-weekprogramcontinuetoofferacomprehensivecurriculumoffoundationalandessentialcoachingskillsandstrategiesthatbothdedicatedhealthcoachesandVAemployeesmayuseandapplytotheirrespectivejobrolesthroughouttheVHA.RecentadditionstoitsexistingcontenttothefirsttwoweeksinFY20include:

• ExperientialpracticesforbarriersoftenencounteredbyVeterans.• Enhancedinstructionaroundgroupcoaching.• Moretimeforpersonalizedfacultymentorfeedback.

Session3ofthevirtual3-weekWHCtrainingfocusesonadvancedskillsandtheintroductionandpracticeofcoachingstructure(initialandroutineongoingsessions)relevanttodedicatedWholeHealthCoaches.Week3curriculumhighlightsinclude:



• CoachingSessionStructure(coachingagreements,howtoconductaninitialsession,routineongoingsessions,closingsessions).

• HowtouseMindfulAwarenesstohelpsupportcoachingpresenceandthecoachingrelationship.

• Advancedcoachingskillsandstrategies(includinginterrupt/redirect,perspectives,coachingaroundstagesofchange).

• Coachingethics.• Groupcoachingtips&techniques,includinghandlingchallenginggroupdynamics.

NBHWCCERTIFICATIONEXAMINATION

ToearntheNationalBoardCertification,healthandwellnesscoachesmustmeettheeligibilityrequirementsofthe3-weekWholeHealthCoachingProgram,receiveaCertificateofCompletion,andpasstheNationalBoardCertificationExamination.TheexaminationisbasedupontheNBHWCJobTaskAnalysis/ContentOutline.ThewrittenexaminationisadministeredthroughouttheUnitedStatesandinseveralinternationallocations.

NATIONALCERTIFICATIONREQUIREMENTSANDELIGIBILITY

Itisvitalthatany/allWHCparticipantswishingtoseeknationalboardcertificationtakeadvantageoftheNBHWCwebsiteinseekingoutinformationpertainingtotheeligibilityrequirements,documentationprocess,andanyotherNBHWC-relatedinformationorquestions.WHCfacultystronglyrecommendallcertificationseekingcoachesusethisasthePRIMARYsourceofinformationforallthingscertificationrelated.TherehavebeenanumberofchangesoverthepastseveralyearsregardingthecertificationrequirementsandtheNBWHCwebsiteisthebestpossiblelocationtokeepupdatedandaware.AnyquestionsregardingthenationalcertificationprocessarealsobestansweredbytheveryresponsiveNBHWCfaculty.

RequirementsforcredentialingcanbefoundonlineattheNBHWCwebsite:https://nbhwc.org.



CHAPTER1:PRINCIPLESOFHEALTHCOACHING

ThischapterisdevotedtothehealthcoachingprinciplesthathavebeendeemedsignificantforVHAstafftopossessinmovingforwardwithhealthcoachtraining.Thisisnotnecessarilyacompletelist,asotherprogramsmayincludeadditionalideologies;however,theseprovideasolidfoundation.

COACHESARENOTTHEONLYEXPERTSINTHEROOM

Coachesaretrainedtoelicitthe“expertise”fromtheVeterans.ThisprincipleassumesthattheVeteranisthebestpersontodecidewhatisintheirbestinterest,bothintermsoftheagendaforthecoachingsessionsaswellasthetimingandstrategiesofgettingtotheVeteran’sgoalsandactions.TheVeteranmaydecidethattheyneedfurtherinformationoreducation,andthecoachcanassisttheVeteraningettingtheinformationtheyneed.Thecoach’sexpertiseliesinguidingthechangeprocess.Inaddition,coachesmayhaveexpertiseinagivencontentarea.InthewholehealthcoachingtrainingofferedbytheVHA,coacheswillbeprovidedaformatforsharingtheirexpertise,ifappropriate.Thisprocessiscalled,“Elicit,Provide,Elicit.”

THEAGENDAISTHEVETERAN’S

CoachesoperateontheprinciplethattheagendaforthetrainingsessionscomesfromtheVeteran.Althoughthishasbeenstatedabove,itwarrantsaseparateprinciple.CoachesmayhavemanyopinionsaboutwhattheVeteranshouldidentifyastheagendaforcoaching.Coachesmayhaveopinionsaboutwhere,when,andhowmuchefforttheVeteranshouldbeexpendinginacertaincontentarea.However,thisisnotuptothecoachestodecide.TheremaybepressurefromthemedicalteamorotherprovidersastowhatshouldbethefocusoftheVeteran’scoachingsessions.Coachesneedtoartfullyaddressthesepressures.Intheend,itistheVeteranwhowilldecidetheagendaandcourseofaction,orresistancewillbeencounteredandtheeffortto“change”theVeteranwillbethwarted.

HEALTHCOACHINGISPRIMARILYPRESENTANDFUTURE-FOCUSED

TheemphasisinhealthcoachingismovingfromwheretheVeterancurrentlyistowheretheywanttobe.Thisisapresentandfutureorientation.Generallyspeaking,thereislittleemphasisonexploringpasthistoryorpasteventsasameanstounderstandingtheVeteran’scurrentsituation.Attimes,coacheswillwanttoexplorepastsuccessesorbarrierstochangebutwillmoveveryquicklytotheimplicationsforthepresent.



EMPHASISISONHEALTHENHANCEMENT,STRENGTHS,ANDASPIRATIONS

HealthcoachingplacesmoreemphasisonenhancingtheVeteran’swellnessandwholehealthaccordingtotheirvalues,interests,andaspirations,ratherthanfocusingondeficits,deficiencies,ordisorders.TheyalsoseektodrawontheVeteran’sstrengthsratherthanattemptingtoshoreupdeficiencies,unlessthatisthedirectiontheVeteranwantstogoaspartofmovingforward.

THREEHELPINGSTYLES

HEALTHCOACHINGUSESAGUIDINGSTYLE,RATHERTHANDIRECTINGORFOLLOWINGSTYLE

Nurses,physicians,healthcareproviders,nutritionists,psychologists,andcounselorsoftenencourageVeteranstodohealthpromotingbehaviors(i.e.,takeyourprescriptionasprescribed,exercise,stopsmoking,decreasesubstanceuse,makeappointmentsforcare,followadiet).

Mosttimesthisencouragementtakestheformofadirectinghelpingstyleincludingadvice.Veteransmayrespondsilentlyorexplicitlytothiswell-intendedandaccurateadvicewith“Yes,but...”describingreasonsnottochange.

• AdirectinghelpingstyleisverytemptingifthehealthcareproviderassumestheVeterandoesnotknowwhattheyneedtoknowordoesnotcaresufficientlyaboutthehealthrisks.

• Aguidinghelpingstylemightincludemoreofthepatient’sexperienceandyetstillmovetowardahealthgoal.

• Afollowinghelpingstylesimplyfollowswhateverthepartnerchoosestobringup.

WholeHealthCoachingcanbeconsideredaspecializedversionofaguidinghelpingstylethathelpsVeteransaccesstheirownreasonsanddesirestodothehealthpromotingbehavior.

Thefollowingdiagramsservetoillustratethedifferencesbetweenadirectingstyleandaguidingstyleintermsofwhoisdoingthespeaking,aswellashowmuchlisteningasopposedtoinformingisdoneinthesessions.



Adirectinghelpingstyleisprobablythemostcommonapproachusedinhealthcare.Ifyouwanttoexperimentwithusingacoachingstyle:

Insteadofdoingthis: Trythisandseeifyouliketheresults:

Explainingwhyhe/sheshoulddothehealthpromotingbehavior.

ListenwiththegoalofunderstandingtheVeteran’sdilemmaofdoingthehealthpromotingbehavior.

TeachingtheVeteran,tellingtheVeteranwhattodo,orgivinghim/heradvice.

AskwhattheVeteranknows,providesomeadditionalinformation,andthenaskhowthatfitswithhis/herlife.

Describingspecificbenefitsthatwouldresultfromdoingthehealthpromotingbehavior.

Ask,“Whatmightbethebenefitofdoingthishealthpromotingbehavior?”

Tellinghim/herhowtodothehealthpromotingbehavior.

Ask,“Whatareyoualreadydoingthatwouldmakeitpossibleforyoutodothishealthpromotingbehavior?Howmightyoudothishealthpromotingbehaviorsoitfitsinyourlife?”

EmphasizinghowimportantitisfortheVeterantodothehealthpromotingbehavior.

Ask,“Whatmightbeimportanttoyoutothinkaboutordothishealthpromotingbehavior?

TellingorinspiringtheVeterantodothehealthpromotingbehavior.

Ask,“Whatisimportanttoyouaboutenhancingyourhealth?

OTHERMODELSTHATSHAREPRINCIPLESINCOMMONWITHWHOLEHEALTHCOACHING

Thereareotherinterventionmodelsthatshareprinciplesincommonwithhealthcoaching.Threeexamplesofsuchare:

1. MotivationalInterviewing(MI)2. AppreciativeInquiry(AI)3. PositivePsychology



MOTIVATIONALINTERVIEWING

TheSpiritofMI,asidentifiedbelow,canalsobefullyappliedtohealthcoaching.(Miller,W.R.andRollnick,S.{2012}.MotivationalInterviewing:HelpingPeopleChange{3rdEd.}.NewYork:Guilford.)ThesefourSpiritsofMIandcoachingare:

1. Collaboration=comingalongside,joiningup,orlookingattheVeteran’slifeorsituationwiththeVeteran;partneringwiththeVeterantoconsideradifficultsituation.

2. AcceptingtheVeteran=empathizingwithandrecognizingthatitistheVeteranwhohastodothehealthpromotingbehavior;supportingthattheVeterancandecidetochangenow,orlater,ornotatall,believingtheVeteraniscapable,competent,andexpertintheirownlife.

3. Curiosity=helpingtheVeteransayoutloudhis/herdesireandreasonsfordoingthehealthpromotingbehavior;acting“asif”youdon’tknowinordertohelpyourselfsolicitandlearnwhattheVeteranknows.

4. Compassion=dedicationtotheVeteran’swelfareandwell-being.

APPRECIATIVEINQUIRY

AppreciativeInquiryisdesignedforenhancingorganizationaldevelopment.However,theprinciplescanbeappliedtoindividualenhancementsaswell.ThefollowingprinciplesarefromRichardSteele’sarticleonAppreciativeInquiry(IntroductiontoAI.(2008,January12).NewParadigmOrganizationConsulting.https://www.new-paradigm.co.uk/introduction_to_ai.ht)

• Discover=Theidentificationoforganizationalprocessesthatworkwell.• Dream=Theenvisioningofprocessesthatwouldworkwellinthefuture.• Design=Planningandprioritizingprocessesthatwouldworkwell.• Destiny(orDeploy)=Theimplementation(execution)oftheproposeddesign.

POSITIVEPSYCHOLOGY

PositivePsychologyisanewerbranchofPsychologythatfocusesonhumanthrivingratherthanmentalillness.ThefollowingquotesarefromthePositivePsychologywebsiteattheUniversityofPennsylvania(http://ppc.sas.upenn.edu/):

1. “PositivePsychologyisthescientificstudyofthestrengthsandvirtuesthatenableindividualsandcommunitiestothrive.Thefieldisfoundedonthebeliefthatpeoplewanttoleadmeaningfulandfulfillinglives,tocultivatewhatisbestwithinthemselves,andtoenhancetheirexperiencesoflove,work,andplay.



2. “PositivePsychologyhasthreecentralconcerns:positiveemotions,positiveindividualtraits,andpositiveinstitutions.Understandingpositiveemotionsentailsthestudyofcontentmentwiththepast,happinessinthepresent,andhopeforthefuture.Understandingpositiveindividualtraitsinvolvesthestudyofstrengthsandvirtues,suchasthecapacityforloveandwork,courage,compassion,resilience,creativity,curiosity,integrity,self-knowledge,moderation,self-control,andwisdom.Understandingpositiveinstitutionsentailsthestudyofthestrengthsthatfosterbettercommunities,suchasjustice,responsibility,civility,parenting,nurturance,workethic,leadership,teamwork,purpose,andtolerance.”

LikeAI,itiseasytoseetheoverlapbetweentheprinciplesofhealthcoachingandtheprinciplesofPositivePsychology.Bothareconcernedwithidentifyingtheaspirationsofindividualsandassistingtheminworkingtowardthese—notfocusingonthenegativeandthepast,butthepositiveandthefuture.

SPECIFICVHAHEALTHCOACHINGPRINCIPLES

ThereareprinciplesthatmaybemorespecifictotheVHAsettingsincethishealthcoachtrainingisbeingofferedtosupportWholeHealth.Theseprinciplesincludethefollowingconcepts.

CULTURALSENSITIVITY&CULTURALCOMPETENCE

GiventhatallVeteranswhowillbecoachedonceservedinthemilitary;itbehoovescoachestobeasfamiliaraspossiblewiththemilitaryculture.TherearetrainingopportunitieswithintheVHAtogainfurthermilitaryculturalcompetency.Thathavingbeensaid,likeanyhelpingprofessional,itisimportanttoalsobeculturallysensitivetotheindividual(s)withwhomcoachesarecoaching.Thismeansbeingawareof,andsuspending,anyprejudgmentsaboutthepersonbeingcoached,includingsuchfactorsasrace,religion,appearances,communityassociationsandanyotherstatuses.

TEAMCARE:PACTS&PROVIDERS

Coacheswillmostfrequentlyworkwithothercareteamprovidersandmustbefullyawareoftheirfunctionwithintheteamapproach.CoachesmustlearntheroletheyprovideandhowtheycanbeofsupporttooverallteamcareoftheVeteran.

Insummary,thefollowingquotesmayhelptothinkabouttheprinciplesofhealthcoaching:



• “Peoplearegenerallybetterpersuadedbythereasonswhichtheyhavethemselvesdiscoveredthanbythosewhichhavecomeintothemindofothers.”(Pascal,Blaise,{1623-1662}.Pascal’sPensées.NewYork:E.P.Dutton,1958).

• “Youcan’ttugonacornstalktomakeitgrowfasterortaller,andyoushouldn’tyankamarigoldoutofthegroundtoseeifithasroots.Youcan,however,tillthesoil,pulloutweeds,addwaterduringdryspells,andensurethatyourplantshavethepropernutrients.”EtienneWenger(Wenger,E.&Snyder,W.{2000}Communitiesofpractice:Theorganizationalfrontier.HarvardBusinessReview,78{1},139-145.)

• “Thereishealingmorethantherearehealers.”AndrewWeil,MD.• “Peopledon'tcarehowmuchyouknowuntiltheyknowhowmuchyoucare.”John

Maxwell



CHAPTER2:QUALITIESOFAWHOLEHEALTHCOACH

AWholeHealthCoach(WHC)ideallydemonstratescertainqualitieswhilecoaching.Thesequalitiescanbedevelopedwithpractice.Inadditiontodemonstratingthequalitiesdescribedthatfollow,aWholeHealthCoachutilizeswholehealthcoachingCommunicationSkillsasdescribedinChapterThree;andbecomesfamiliarwithaWholeHealthCoachingProcessasdescribedinChapterFour.

THEDESIREDQUALITIESOFAWHOLEHEALTHCOACH

ALISTENER

PerhapsthisisthemostimportantqualityaWholeHealthCoachcandemonstrate.AneffectiveWHCsetsasidehis/herownagendastofullylistentotheother.Effectiveuseofcommunicationskillsandthecoachingprocesscanonlycomefromeffectivelistening.Effectivelisteningcanbefurtherdevelopedbypracticingmindfulawarenessasdescribedlaterinthischapter.ACoachisnota“teller,”norinclinedtogiveadviceorinstruct/educatetheother.AWHCisfirstandforemostalistenerthatallowstheinnerwisdomofthecoachingpartnertosurface.

RESPECTFUL

AWholeHealthCoachhonorstheuniqueagenda,resourcesand“innerwisdom”ofanother.AWHCmustself-managetokeepinchecktheirownvalues,thoughtsandbeliefsandsupportthevalues,thoughts,andbeliefsofthecoachingpartner.

FULLYPRESENT

BeingfullyavailablefortheotherisanimportantqualityofaneffectiveWHC.Acoachcannotlisteneffectively,norfullyunderstandthecoachingpartner,unlesstheyarefullypresent.Beingfullypresentcanbecultivatedbypracticingmindfulawareness,whichisheavilyemphasizedthroughouttheWHCtraining.Afurtherdescriptionofmindfulawarenessandsuggestionsforpracticeandcultivationareprovidedattheendofthischapter.

EMBODIESTHEATTITUDESOFMINDFULNESS

Inadditiontobeingfullypresent,aWHCcoachwillconsistentlypracticetheNineAttitudesofMindfulnessasarticulatedbyJonKabat-Zinn(Kabat-Zinn,J.{2004edition},Fullcatastropheliving:Howtocopewithstress,painandillnessusingmindfulnessmeditation,London:PiatkusPublishing).(Thiseditionincludesthepreviouslynoted“SevenAttitudes”



butnottheadditionalTwo,spokenofbyKabat-Zinninamorerecentvideobutnotinwritingasofthisdate).

• Beginner’sMind—Asacoach,beingcuriousandnotassumingthatyoualreadyknowsomething.Askingquestionsandbeingexcitedabouthowyourmindworks,askingquestionslike:Whoisseeing?Whoisthinking?

• Non-judging—Agentlestateofnon-judgment,beingkindtoyourself,andallowingwhatis.Tryingnottocompare,label,orfindfault.

• Patience—Letthingshappenastheyneedtoandintheirowntime.Lettinggooftheideathatyouhaveto“getsomewhere,dosomething,ormakesomethinghappen.”

• Non-striving-Mindfulawarenessisaboutbeing,notdoing,ifitfeelslikeyou’reworkingtoohardyouprobablyare.It’sawayofbeing,beingawaketowhatishappeninginyourliferatherthanwhatishappeninginyourmind.

• Acceptance-Seeingthingsastheyare.Itiswhatitis.Trytobewiththingsastheyare.Letgoofthestoriesthemindcreatesandacceptthepresentmomentforwhatitis.

• Lettinggo—Nothavingasetagendaforwhat“should”happen.Beingopentoallpossibilitiesandoutcomes.

• Trust—Asawarenessgrows,sodoestrustinone’semotionsandintuition;beyourselfineveryway.Havefaithinhowyoumovethroughtheworld.Trustyourselfandwhatyouknow.

• Gratitude–Theabilitytobringgratitudetothepresentmoment,nottakingthings,eventhesmallestofthings,forgranted.

• Generosity–Thepowerofgivingyourselfovertolife,tobringjoytoothers’lives.Givingyourtimeandattentiontolifeandothersenhancesinterconnectednessanddemonstratesthatyoucare.

APARTNER

AWholeHealthCoach“goesalongside,”orpartnerswith,theotherontheirjourney.Coachesarenotexperts,outinfrontleadingfromtheirownvalues,thoughts,andbeliefs.Theyprovideaguidingstyleintermsofleadingaprocess,buttheydonotattempttoinstilltheirvalues,thoughts,andbeliefs,butrather,drawthemfromthecoachingpartner.

ARTICULATE&SUCCINCT

AneffectiveWHCusesaclearandsuccinctcommunicationstyle.Theyuseasfewwordsaspossiblewheninteractingwiththecoachingpartner.InaWHCconversation,themajorityofthewordsshouldcomefromthecoachingpartner.Attimes,beingsuccinctisreferredtointhecourseasbottom-lining.



WILLINGTOLEARN&BEOPEN

Insomecases,WholeHealthCoachtrainingcanruncountertohowhealthcareproviderswerepreviouslytrained.AneffectiveWHCiswillingandabletoassumeadifferentapproachtobeingwiththeother,thatmaydifferfromtheirprevioustraining.AneffectiveWHCiscognizantofwhentheyareusingacoaching,guidingstylevs.adirectingstyle.Inadditiontobeingopentoadifferentapproach,WHCoachesapproacheachencounter,andeachmomentoftheencounter,with“beginner’smind.”Inordertopracticebeginner’smind,coachesmustcomefromaplaceof“notknowing”andbeingvulnerableandopentothemoment.

EMPATHIC

WholeHealthCoachesseektofullyunderstandandbepresentwiththeexperienceofanother.Thisisattherootofbeingempathic.Attimes,empathyisthoughtofasaquality,“Icanrelate—I’vebeenthere,too.”However,thatapproachcanactuallyhinderacompleteunderstandingoftheother.Toassume“Icanrelate”becauseofasimilarexperiencemaynottakeintoaccounthowtheotherhasinterpretednormadesenseoftheirownexperience.Oftentimesacknowledgingtheemotionsandexperienceofanotherisenoughtoconveyempathywithphraseslike“Thatsoundsrough”or“Thatmusthavebeenapainfulexperience”.

INTERESTINHEALTHENHANCEMENT&EDUCATION

AlthoughWholeHealthCoachesarenotnecessarily“experts”inallareasofhealth,theyvaluehealthenhancementandeducationandseektobecomeasinformedaspossibleinallareasofhealth.Whenbecomingmoreeducated,WHCsholdtheirknowledgewithadegreeofhumility,knowingthatknowledgewithinthefieldcanchangewithfurtherresearchandgreaterawareness.Impartinginformationisnottheprimaryroleofawholehealthcoach.Attimes,havingmoreknowledgecanactuallyimpedeawillingnesstoassistthecoachingpartnerinassessingtheirownknowledgeorseekingoutinformationontheirown.

MINDFULAWARENESS

MindfulawarenessisakeypartoftheComponentsofProactiveHealthandWell-Being(alsoreferredtoastheCircleofHealth)andthefirstlevelaround‘ME’onthecircle.Itispayingattentiononpurposetowhatishappeninginthepresentmomentwithoutjudgment.Itistheintentiontopayattention.Mindfulawarenessisnoticing,awareness,andattention.Mindfulawarenessisnotguidedimagery,relaxation,normeditation.

Whatdoesmindfulawarenesshavetodowithourhealth?Ourbodiesandmindssendusmessagesallthetime,butoftenwe’renotlistening.Researchshowsthatpracticingmindful



awarenesscanlowerstressandhelpstress-relatedhealthproblems,aswellashelpusimproveourmood,mentalwell-being,andqualityoflife.

Mindfulawarenesshasseveraldistinguishingfeatures.Theseinclude:

• Beingawareinthemoment,withcompassiontowardselfandothers. • Noticingexternalstimuli(sights,sounds). • Bringingattentiontointernalsensations(breath,body)andourresponsestothem. • Bringingattentiontoourmentalphenomena. • Listeningtothepersonal,innerwisdomofourowninterconnectedself-carecircles.

Practicingmindfulawarenessinyourcoachingcomeswithsomeimportantconsiderations:

• Mindfulawarenessmaytriggerthoughts,emotions,andevenphysicaldiscomfortforsomecoachingpartners.Beawareofthementalhealth“warmhandoff”atyoursite.

• Coachingaclientwithrespiratorydifficulties/COPDmightmeanchoosingadifferenttypeofmindfulawarenesspracticeunrelatedtothebreathorbreathingexercise.

• Mindfulawarenessisnotrequiredineverycoachingsession. • Askingpermissiontopracticemindfulawarenessinacoachingsessionisimportant

inestablishingtrustandrapportandencouragingautonomyfortheclient.Checkinginwiththeclientonwhattheynoticedcanbeenlighteningforthecoachandtheclient.

TheOfficeofPatient-CenteredCareandCulturalTransformation(OPCC&CT)makesadistinctionbetweenmindfulawarenessandMindfulness.MindfulnessfacilitationandinstructionrequiresspecializedtrainingandisbeyondthescopeofWholeHealthCoachtraining.ForcoacheswhoareinterestedinfacilitatingMindfulness,thereareresourcesinternalandexternaltotheVAthatwouldbehelpfultoexplore.Inparticular,trainingintrauma-sensitiveMindfulnessisespeciallyimportant,sothatpractitionerscanbehelpfulwithoutcausingharmtotheVeteranswithwhomtheywork.

ItisnotanexpectationthatyoufacilitatemindfulnesswithyourVeterans.MindfulnessfacilitationisbeyondthescopeoftheWHCtraining.Coachesinterestedinpracticing,oroffering,amoreformalmindfulnesspracticecanaccessbothinternalVAandexternalresources.(VACALM,MBSR,etc.)



BASICINSTRUCTIONS:MINDFULAWARENESSOFTHEBREATH

• Settleinandfeelthesupportofthechairorfloor. • Ifyoulike,allowyoureyestoclose,orsetasoftgazesomewherearoundtheroom. • Rememberattitudesofnon-striving,non-judging,andpayingattention. • Thisisanopportunitytoletgoofbusinessorlife’sconcerns. • Nowpayattentiontoyourbreathwhereveryouexperienceit.Don’ttrytochangeit,

justpayattentiontoit.Feelthebreathascompletelyaspossible,theinhaling,pausing,andexhalingofthebreath.Itmaybeeasiertofocusonyourabdomenastheexperienceofbreathing.

• Whenyounoticeyourattentionissomewhereelse,congratulateyourselffornoticingandgentlyreturntothebreath.Noticingthatyourmindhaswanderedisthepractice.

• Noticeanystrugglesandgentlyletthemgo. • Ifyounoticeoutside(orinside)distractions,simplynoticethem,andbreathewith

them.Donottrytochangeit.Letgoofanyfightingthedistraction. • Practicethiswayaslongasyouwish. • Allowyourselftorestandlookmoredeeplyasyousettleintothis. • Whenready,youmayendyourmindfulawarenesssessionbysimplyopeningyour

eyes.

FORMALPRACTICE

• SetaSmartGoalforyourself.Forexample,youmaywanttostartwith2-5minutesandeventuallymoveupto20or30minutesforeachsession.

• Youmayexperienceresistancetodoingthepractice;simplynoticethis. • Youdon’thavetolikeyourexperience,butyoudohavetodoitifyouwantto

experiencepresencethatcomesfrommindfulawareness. • Practicedailyor5daysoutof7. • Evenifyouarenotinyourregularroutineorplace,practicemindfulawareness

whereyouare. • Usetapesorguidanceifitishelpful.

INFORMALPRACTICE

• Taketimetonoticeyourbreathingthroughoutyourday. • Thismaytakeeffortandwork. • It’snothidingordisconnectingbutpayingattentiontoyourbreathasawayof

payingattentiontothepresent. • Thinkofpayingattentiontobreathingasafriend,notachore.



• Practiceindifferentsituations.

Youmayfeelcalmer,andyoumaynot.That’sOK.It’samatterofpayingattentiontothemomentandbecomingaware.

AWHCshouldbepreparedtodevelopstrategiesandtrainpartnersinmindfulawareness.Atfirst,theymaysimplywanttouseascriptliketheonesfoundintheresourcesectionatthebackofthismanual.Eventually,manyhealthcoacheswillbecomeproficientinusingmindfulawarenesswithouttheuseofscripts.



CHAPTER3:ACTIVECOMMUNICATIONSKILLSFORCOACHING

Mostcoachingisdoneusingtwoprimarycommunicationskills:reflectionsandinquiry(orquestioning).Attimes,coachesmightwanttoshareinformation,providedirection,ormakedisclosures.However,thebulkofeffectivecoachingwillbebuiltonreflectionsandinquiry.AsdescribedinChapter2,QualitiesofaWholeHealthCoach,listeningisthefoundationforthesetwoactivecommunicationskills.

LISTENING

Listeningstartsbybeingfullypresent.(SeeChapter2,QualitiesofaWholeHealthCoach.)Withoutbeingfullypresent,listeningeffectivelyiscompromised.Forthisreason,coachesareencouragedtofullydeveloptheirmindfulawarenessinordertobefullypresentfortheVeteranpartner.

Attimes,coachescanbeeffectivelistenersbysimplylisteningwithoutinterjectingquestionsorreflections.(ParticipantsintheWholeHealthCoachingTrainingwillhaveanopportunitytoexperiencethis.)SimplylisteningwithoutspeakingcanhaveaprofoundimpactontheVeteranpartner.“Holdingthespace”forapartnertohearthemselvesandreflectonwhattheyaresayingisaphrasethatdescribesthisofferingtothepartner.

Listeninginvolvespayingattentiontowhatthepartnerissaying,ornotsaying,bothverballyandnon-verbally.Inadditiontosilentlylistening,coachesalsouseactivelisteningskillsofsimpleandcomplexreflections.

THEPAUSE

Whenutilizinganyofthecommunicationskills,itisimportanttonotonlybeawareoftheskillbeingused,butalsothepaceatwhichtheyareused.Duringthecoachingsession,thetimeandspacewithoutwordscanbeasimportanttothereflectiveprocessasthetimewhenwordsarebeingspoken.Provideamplemomentsofsilenceandpausesthroughoutthecoachingsessionsinordertoallowpartnersadequatetimetoreflect.Itisinthesemomentsofsilencethatsomeofthedeepestinsightsandreflectionsarerealized.Fillingthesepauses/momentsofsilencewithwordsmaydetractfromthepartner’sabilitytogaingreaterinsight.

SIMPLE&COMPLEXREFLECTIONS

Simpleandcomplexreflectionsarethemostfrequentlyusedwholehealthcoachingcommunicationskills.Thinkofofferingtwotothreereflectionsforeveryquestionasked



whencoaching;astheyarejustaseffectiveindeepeningtheconversation,exploration,andforwardmovementasinquiry.Reflectionsarepowerfultoolsforallowingacoachingpartnertofurtherreflectonwhattheyaresaying.Reflectionsprovidea“mirror”forthecoachingpartner,whichinturn,mightprovidefordeeperreflectionandinsightintovalues,beliefs,andbehavior.

SIMPLEREFLECTIONS

Simplereflectionsmirrorbacktothecoachingpartnerwhattheyhavesaid.Simplereflectionsaddverylittle,ifany,meaningtowhathasbeensaid.Yet,theycanbeverypowerfulastheycapturetheessenceofwhatisbeingsaid.Thereare3typesofsimplereflectionstrainedintheWholeHealthCoachingcourse.Theyare:

• Parroting—usingafewofthepartner’sexactwords. • Paraphrasing—usingdifferentwordswithoutchangingthemeaningofwhatthe

partnerhassaid. • Summary—offeringasummarystatementthatcapturestheessenceofwhatthe

partnerhassaid.

Itshouldbenotedthatacoachdoesnotneedtoreflecteverythingapartnerhassaid.Decidingwhattoreflectisimportantinguidingthecoachingprocess.Forinstance,ifthetopicbeingdiscussedcentersonvalues,thencoacheswillwanttoreflectwhatvaluesthepartnerisidentifying.Reflectingtangentialthoughtsmaytaketheconversationinadirectionthatisnotasusefultothepartner.

COMPLEXREFLECTIONS

Complexreflectionsareeffectiveindeepeningtheconversation,exploration,insight,andforwardmovementoftheVeteran.Theyreflectthemorenuancedlanguage,tone,feelings,emotions,andmeaningofacoachingpartner’swords.Thismightbeinmeaningorperhapsinemphasis.Genuinelyinterestedandcuriouslistening–towhatisandisnotbeingsaid,andwhatismeant–iskeyinofferingreflectionsthatgobeyondthesimpleholdingupofthe“mirror”.

Thereareseveralformsofcomplexreflections.Therearetwocomplexreflectionsfocusedoninthiscourse:

• Double-sidedreflections—Reflectingtwosidestoanissuethepartnerhasraised,oftenfocusedonavaluesconflict.Thesereflectionsareoftenintheformof“ontheonehand…ontheotherhand”.Double-sidedreflectionsshouldendwiththesecondsideofthereflectionendingonthesideofchange(orpositivedirection).



• Intuitiveordeepermeaningreflections—Addingahunch(orintuition)orgoingbeyondwhatthepartnerhassaidtostimulatefurtherinsightintowhathasbeensaid.

Thefollowingscenariosoffersomeexamplesofeachofthetypesofreflections.Remember,therearemanypotentialreflections;theintentistoreflectinawaythatwillforwardthecoachingprocessandagendabydeepeningtheconversation,insight,andexploration.

EXAMPLE1

TheVeteransays,“I’msad,lonely,depressed.Ithinknobodylovesme…somedaysitseemsthatnobodycaresaboutme.Iwanttodie.So…becauseI’mfeelingthisway,I’mgonnasay,maybeabottleofvodkawilltakecareofit.So,bam!Imixitin.Mixitinwiththevodka&thenI’mfeelingsogoodI’mdrinking2morebeers.MaybeI’llsmokeajoint.MaybeI’llfeelbetter.Andthen,thenextdayafterallthehappiness&funisgone,darkholeagain.Itsortofcontinues.Itdoesn’tstop.Anditgetsworse.Itmakesittoughtochangemydietandgetmoving…it’ssohardtodoandIdon’tknowifit’sworthitwhenI’mfeelingsobadanyhow.Yet,somedaysI’mnotreadytogiveup…IhavesomethingsIwanttoaccomplishinlife,andIknowIwon’thavetheenergyifIdon’tchangesomethings.”

Somepotentialreflectionsbythecoachmightbe:

• Parroting—“You’renotreadytogiveup.” • Paraphrasing—“Thisisreallyadifficultsituationforyou.” • Summary—“You’redownbecauseofyourlifesituation,butyou’renotreadytogive

upbecauseyouhavethingsyouwanttoaccomplish.” • Double-sided—“Ontheonehandyou’renotsureit’sworththeefforttomake

changes,yetontheotherhandyouhavethingsyouwanttoaccomplishyetinlife.” • DeeperMeaning—“You’reheretodaybecauseyoureallywanttofulfillyour

aspirationsorpurposeinlife.”

EXAMPLE2

TheVeteransays:“IwassoexcitedaboutmydecisiontocutbackthenumberofhoursIwasworking.ButnowI’mreallystrugglingwithmakingendsmeet.It’salmostasstressfulaswhenIwasworkingsomuch.I’mnotsurewhatthebestroutetogoisatthispoint.”

Somepotentialreflectionsare:

• Parroting—“You’renotsurewhatthebestrouteisatthispoint.” • Paraphrasing—“It’sstillastressfulsituationthatyouwouldliketoresolve.” • Summary—“Youwereexcitedaboutyourdecision,butyoustillhavestressandare



notsurewhattodoatthispoint.” • Double-sided—“Ontheonehand,you’vecreatedsomenewstressors,butonthe

otherhandyouwereabletomakesomechanges.” • Deepermeaning—“Itseemsthatreducingstressisareallyhighvalueforyouand

onethatyou’rewillingtotackle…justnotsurewhichdirectiontogo.”

EXAMPLE3

TheVeteransays:“MydocthinksIneedtocutbackonmyovereatinganddropsomeweight.Shemayberight,butI’mnotconvinced.Sofar,I’vebeenabletomanagewithouttoomanyconsequences…Shedoesn’tseemtounderstandhowmuchpleasureIgetoutofcookingformyfamilyandeatingwiththem.Itmaybeanissuesomeday,butthereasonstochangerightnowdon’toutweighallthereasonstocontinue.”

• Parrot—“Morereasonstocontinuethanchangerightnow.” • Paraphrase—“Inspiteofwhatyourdocissuggesting,youdon’tseeaneedto

changerightnow. • Summary—“Yourdocwouldlikeyoutocutback,butyouenjoycookingandeating

andyou’renotseeingreasonstocutbackrightnow,althoughsomedaytheremaybemorereasonstochange.”

• Double-sided— “On the one hand you enjoy it toomuch and there aren’t enoughreasonstochange,butontheotherhand,you’vebeenprovidedreasonsyoumaywanttocutbackonyoureating.”

• Deepermeaning—“Pleasureisahighervaluetoyouthananyriskstoyourhealthyourovereatingmaybecausing.”

METAPHOR

Metaphoristheuseofanalogies,figuresofspeech,orimages(intheformofareflection)thatfurtherassisttheVeteraninfeelingunderstoodandcanbeusedlikeacomplexreflection.Muchofourlanguageincludestheuseofmetaphor–weoftenuseittoillustrateourthoughts,ourbeliefs,ourperspectives.Acoach’sabilitytolistenformetaphorintheVeteran’slanguage,ortocreatemetaphorfromtheVeteran’swords,canbeimpactfulinlettingtheVeteranknowtheyarebeingheard.Here’sanexample:

Veteran:“Iamsotiredofcarryingtheburdenofcaringformyagingparentswithnohelpfrommybrothersandsisters.”



Coach:“You’recarryingtheweightoftheworldonyourshouldersandnooneisofferingafingertolightentheload.”

ACKNOWLEDGMENT

Anacknowledgmentisacoachingskillthatrecognizesandbringsattention(oftenintheformofareflection)totheclient’squalities,strengths,efforts,learnings,progress,andsuccesses.Thereispowerintheprocessofacknowledgingwhatyou,thecoach,hears/seesinyourVeteran’slanguage.

Manyhealthprofessionsteach/offerpraise,cheerleading,andencouragements–oftenofferedtocreateease,optimism,comfort,support,orpositiveregard.Thecoachingmodelofofferingacknowledgmentislessaboutthetemporary“feelgood”moment.ItisabouttappingintotheVeteran’sinternalmotivation.Thelastingimpact,effect,andshiftoccurswhenlessofwhatthecoach“thinks/feels”ispresentinthesession,andmorefocus/lightisshoneonacknowledgingthecoachingclient.

ADDITIONALCOMPLEXREFLECTIONS

AdditionalreflectionsworthnotingarefoundinMotivationalInterviewing(MI).Thoughtheyarenottaught/practicedinthiscoursetheyarenotableandusefulinthecoachingprocess.

• AmplifiedReflection–Reflectingwhatthecoachingpartnerhassaid,inanamplifiedorexaggeratedform.Acoachmightuseanamplifiedreflectionwitharesistant,or“stuck”clienttomovethemforwardtowardspositivechange.Becauseoftheexaggeratedtoneofthisreflection,itmustbedeliveredwithempathyandpatience.Anyhintofsarcasm,irony,impatience,orincredulitycanelicitahostileorresistantreaction.Anexample:

o Veteran:“Idon’tknowwhatmydocisworriedabout.I’vegotahandleonmyeatingandmybloodlevelsdon’tseemthathigh.”

o Coach:“So,yourdoctorisworryingneedlessly.”

• ShiftingFocusReflection–Shiftingfocusattemptstogetarounda“stuck”pointbysimplyside-stepping.Anexample:

o Veteran:“I’mjusttoobusy,Idon’thavetimetogetoutandexercise.”o Coach:“Soundslikeyouareprettybusy.Whatdoyouliketogetoutanddo?”



INQUIRY

Nexttolisteningandreflections,inquiryisprobablythenextmostusedcommunicationskillbycoaches.Inquiryisused,notsomuchtogaininformationfromthepartner,buttohelpthepartnerreflect,furtherself-explore,andbecomemoreinsightfulandawareoftheirownthoughts/feelings.Genuinelycurious,open-endedinquirycanassistthecoachindeepeningtheconversationandexplorationwiththeVeteran.

Inquiryshouldalwaysbebalancedwithlisteningandreflections.Ifinquiryisoverutilizedthecoachingsessionwilltakeontheformofaninterrogationorintakeassessment.

TherearetwotypesofquestionstaughtanddemonstratedintheWholeHealthCoachingtraining:closed-endedandopen-endedquestions.

CLOSED-ENDEDQUESTIONS

Closed-endedquestionstendtoelicitonewordorshortresponsesandfrequentlydonotleadtohigh-levelinsights.Therearesomeusesforclosed-endedquestions(likeaskingpermissiontooffersomeinformationorbrainstorming)andcoachesshouldbeawareofclosed-endedquestionsinordertomakeconsciouschoicesaboutwhentousethem.

Someexamplesofclosed-endedquestionsare:

• Areyoureadytomoveforward? • Wereyousuccessfulinmeetingyouractionstep/goal? • Areyouencouragedwithyourprogress? • Doyoufindthecoachinghelpful?

Althoughtheabovequestionsmaynotbeashelpfulasopen-endedquestions(alltheabovecouldbeeasilychangedtoopen-endedquestions(byaddingHoworWhat),therearetimeswhenclosed-endedquestionsmaybehelpful.Closed-endedquestionsaregenerallyusefulwhen1)makingtransitionsor2)askingpermission.

Moreexamplesofclosed-endedquestionsare:

• MayIofferyousomeresourcesthatI’mawareof?(FirstpartofElicit-Provide-Elicit) • Areyoureadytomoveon? • WereyouabletocompletetheWorksheets? • Isthereanythingelseyouwanttoaddresstoday?

OPEN-ENDEDQUESTIONS

Byfar,themostfrequentlyusedformofinquiryinWholeHealthCoachingistheuseofopen-endedquestions.Mostoften,thesequestionsbeginwith“What”or“How.”Sometimes



“Why”questionscanbeusedeffectivelytoelicitadditionalreflection.However,“Why”questionscansometimesbeperceivedasaskingforjustification,whichmayelicitdefensivenessfromthepartner.Forinstance,asking“WhydoyouwatchsomuchTVatnight?”mayelicitadifferentresponsethan“WhatvaluesareyouhonoringbywatchingTVatnight?”

Rememberthatquestionscomeoutofyourlisteningtoyourcoachingpartnerandguidingtheprocess.Forthesakeofprovidingsomeexamples,herearesomeopen-endedquestionsthatareassociatedwitheachStageoftheHealthCoachingProcessModel,introducedlaterinChapter4:

STAGEONE

• Whatreallymatterstoyouinyourlife?• Whatdoyouwantyourhealthfor?• Whatisyourmission,aspiration,orpurposeinlife?• Whataresomeofyourhighestvalues?• Whenareyourbehaviorsnotalwaysconsistentwithyourhighestvalues?• Whatwilllifebelike3yearsfromnowifyoudon’tmakechanges?• Whatwillitbelikeifyoudo?

STAGETWO

• AsyoucompletedthispartofthePHI,whatstoodoutforyou?• Whichareaswouldyouconsiderstrengths,orareasyou’redoingwellin?• Whatisanareathatyoumightwanttoenhance?• Whatmadethatareaa“2”foryou?• Whatmakesita2andnota1ora0?• Howcouldyouraiseittoa2.5?• Howimportantisittoyoutomakeachangeinthisarea?• Howconfidentareyouthatyoucouldmakeachangeinthearea?

STAGETHREE

• Wherewouldyouliketobe3monthsfromnowwhenyouthinkaboutmakingthischange?

• Whatactionstepsareyouwillingtoconsiderstartingwiththisweek?• Whatbarriersorchallengesdoyouanticipateencounteringasyoutakeonthese

actionsteps?• Whatwillbeyourplanofactionwhenyouencounterthischallenge?Howdoyou

wanttobeaccountable?



STAGEFOUR

• Howdiditgoforyouthislastweek?• Whatdidyoulearnaboutyourself?• Whatchallengesdidyouencounter?• Howwouldyouliketochangeyouractionstepsfornextweek?• Howisthiseffortsupportingwhatyousaidwasimportanttoyou?

DIRECTCOMMUNICATION

Attimes,itmaybenecessarytomakestatements,directtheprocess,orprovideresources/information.Inallofthesecases,coachesareencouragedtousesimpleanddirect“I”Statements.

Someexamplesofdirectcommunication,or“I”Statementsare:

“I’dlikeyoufilloutthisformfornextsession.”

“Iwanttoexploresomepotentialbarriersyouthinkyoumayencounter.”

“Itseemstomeyou’vemadesomerealprogresssincelastsession.”

“Iwanttoprovideyouamomentofsilencetoreflectonthisnextquestion.”

“Iwanttosharewithyousomeofmythoughtsonwhatcoachingisandwhatitisnot.”

Whenusingdirect“I”statements,andwhenprovidinginformationorresources,coachesareencouragedtousethe“Elicit-Provide-Elicit”strategy(describedinChapter4)inordertominimizeresistancetohearinginformation.



CHAPTER4:THEHEALTHCOACHINGPROCESS

Thefollowingdiagramshowsthevariousstagesofthehealthcoachingprocessforthistraining:

WerefertothisdiagramastheHealthCoachingProcessModel(HCPM).ItisimportanttonotethatthismodelservesasatrainingtoolandseldomwillaneffectiveandVeteran-centeredcoachingexperiencefollowthismodelexactly.Thoughtheindividualstagesaretaughtinalinearfashioninthetraining,rememberthattheHCPMisacircle–adynamic,circularprocessinwhichstagescanbevisited,andrevisited,duringanycoachingsession.Therearesomefurtherconsiderationsinutilizingthismodel.

EventhoughtheagendaforthecoachingsessionsistheVeteran’s,itisimportanttorememberthatthecoachistheholderoftheprocess.TheVeterandeterminesthedirectionhe/shewishestogo,andthecoachsupportstheminthatdirectionbykeepingthesessionsfocusedandmovinginaproductivedirection.Attimes,theVeteranwillbesharingstoriesofhis/herlifeandthestory’spurposemaynotbeclear.Itisthecoach’sresponsibilitytointerruptanon-productivestory,orflowofthesession,inordertobringtheprocessbacktoaproductivepath.Thisstrategyiscalleddirectand/orredirecttheprocess.CoachesmaythinkthattheyarebeingdisrespectfultotheVeteranincarryingoutthisresponsibility.



However,allowingnon-productive,lengthystoriestocontinueisnotservingtheVeteranandtheircoachingexperience.CoachesshoulddevelopastyleofinterruptingandredirectingthatnotonlyisconsistentwiththeircoachingstylebutisdoneinsuchamannerthattheVeterandoesnotfeeldisrespected.Interruptingcanbedoneinagentleandrespectfulmanner.Onewaytosuccessfullydothatistomakeitpartoftheco-createdgroundrulesforthecoachingsessions.AskingtheVeteranhowtheywouldliketobeinterrupted,shouldtheneedarise,goesalongwayinpreparingthemforthepossibility.

Itisimperativethatcoacheshavetherequisitecompetenciestoconducteffectivecoaching.Initially,coachesmayalsovalueamapordirectiontowheretheyaremovingwiththeVeteran.ThisHCMPservesasthatmap.ThefollowingisabriefoverviewoftheHCPM.Amorecompletedescriptionofelementsofthismodelwillfollowthebriefoverview.

Stage1:DevelopAPersonalMission.Inthisstage,theVeterandevelopsa“personal”mission,aspirations,orpurposestatement(MAP)thatnotonlycontextualizesanyfuturechanges,butalsoguidestheoverallpersonalizedhealthplan.Thismayalsobethoughtofasa“statementofpurpose”oranoverall“healthvision.”Asapartofthisstage,VeteransalsoexplorethevaluesembeddedinthispersonalMAP.ItisalsohelpfultoexplorewhatothervaluesoftheVeteranimpedeorconflictwiththese“ideal”values.

Stage2:Assess&Focus.Inthisstage,theVeteranispreparingforactionby:

• AssessingtheirhealthinavarietyofareasasoutlinedintheCircleofHealth/PHI.• Definingafocus,orwheretheywanttostarttoenactachangeconsistentwiththeirimmediateinterestsandvalues.• Self-assessingandbuildingtheirreadinessforthepotentialchange.

Stage3:PlanforAction. Inthisstage,theVeteransetsgoals,developsactionsteps,identifiesbarriersandbackupplans,establishesaccountability,andidentifiessupport.Withoutthesestepsoftheplan,sustainedactionislikelytofail.

Stage4:ExecutetheAction.Thisstageiswhere“therubbermeetstheroad”andtheVeterancarriesouttheplanbasedontheirpreparationsandpersonalmission.Oncetheactionisattempted,theVeteranevaluateshowtheactionwasorwasnotsuccessful,whatwerethelessonslearned,whatre-planningneedstotakeplace,andwhatfurtheractionswillbeexecuted.

HOWTOUSETHEHCPM

Thereareseveralconsiderationstokeepinmindwhenutilizingthismodel:



TheHCPMisamap(ofsorts),notascript.Itisnottoberigidlyfollowed.TheVeteran’sprocessshouldultimatelyindicatewhereacoachneedstobeinthisprocess.However,foratrainingtool,ithelpsthenewcoachthinkabout

wheretheyareintheprocessandwhatmayneedtobeaddressedbeforeproceeding.Forexample,aVeteranwhohasnotcommittedtoaclearfocus,orwhattheywanttotakeonintermsofachange,maybewastingtimedevelopinggoalsandactionsteps.AnotherexamplewouldbeifaVeteranischoosingafocus,orareatowork,buthasnotgivenmuchthoughttohowthischangefitsintowhatreallymatterstothem.Withoutthisarticulationoftheirpurpose/missionorwhatreallymatterstothem,theyarerobbingthemselvesofimportantmotivationtosustainthechange.

Coachesmaywanttorevisitastage.AstheVeteranmovesthroughtheprocess,coachesmayfindithelpfultorevisitastage,especiallyiftheVeteranisencounteringdifficultiesinmakingthechange.Forexample,assumethattheVeteranhashadafewweeksinwhichtheyseemedunabletoenacttheiractionsteps.Itmaybenecessarytorevisitthe“settingactionsteps”phasetoseeiftheactionstepsweretooambitious,orifotheractionstepsmaybemoreimportantatthistime.Inotherwords,thisisnotastaticprocessofvisitingthestageonceandthenneverreturning.It’sadynamic,unfoldingprocessthatmaymeanvisitingaparticularstagemanytimes.

Thetimeframeforthestagesisflexible.CoachesmaywanttokeepinmindthetimeframetheyhavewiththeVeteran.Iftheencounterisonlyfor½hour,coacheswillwanttothinkaboutwhereintheprocesstofocustomaximizetheimpactfortheVeteran,giventhetimeconstraints.Ifcoacheshave8-9sessionswiththeVeteran,theycanbemuchmorethoroughateachstageandthinkaboutreturningtoeachstagemorefrequently.

TheHCPMisatrainingtool.CoachesshouldrememberthatthisisatrainingtooltohelpnewcoachesthinkaboutwheretheymightwanttogonextintheprocessofcoachingwiththeVeteran.Oncecoachesgetfamiliarwiththeprocess,wheretogonextwillbecomemore“secondnature”withafocusonwhataretheimmediateneedsoftheVeteraninthismoment.Likepracticingscalesinlearningmusic,itmaybeusefultohaveastructureinthebeginning.

However,mostmusicianswillsoonleavethescalepracticingtomakemusic...andtheymayreturntopracticingscaleswhentheyseetheutilityindoingso.



STAGESANDPHASESOFTHEHCPM

Inthissection,wewilldescribethestagesandphasesoftheHCPMprocess.Inaddition,wewillprovideastrategy,orstrategies,forhowtoaddressthephaseofeachstage.Wewillstartwiththemission/purposestageandcontinuearoundthewheelinclockwisedirection.

STAGEONE

STAGEONE,PHASE1–CREATEAVISION

CreateaVisionStrategy.Atthisstage,coachesassisttheVeteranindevelopingamission,aspiration,orpurposestatement(MAP),ortheirvisionoftheiroptimallife.(coachesshouldexplorewhichtermbestsuitstheVeteran.)TheVeteranmayhavegivenmuchpreviousthoughttothisquestionorverylittle.Usingtheskillsofreflectionandexploratoryquestions,timeshouldbegiventotheVeterantoexplorethisquestionwithoutrushingtothenextstageorphaseoftheprocess.

ThereareseveralwaystoassisttheVeteraninexploringtheirMAP.Thefirst5questionsofthePHIbegintheprocessofhavingtheVeteranconsidertheirlivesandwhatmatterstothem.

AnsweringthesequestionscanbeapowerfulexperiencefortheVeteran.Itcanalsobeatimeofuneaseordiscomfort,astheVeteranmightbesurprisedbytheirresponses.ItisnotunusualfortheVeterantoexpressdiscomfortwiththinkingaboutthequestionsforthefirsttimeinaverylongtime,orever.

ItcanbehelpfultohavetheVeteranvisualizetheirfuturebyguidingthemthroughvisualization.HavetheVeteranpaintavividpicture,intheirmind’seye,oftheirfutureincludingsuchfactorsashowtheyfeel,howtheylook,theactivitiesinwhichtheyareengagingandenjoying,whoiswiththemandwhathealthbehaviorstheyarepracticing.Havethemwalkthroughatypicaldayintheiridealfuturewhentheyarelivingaccordingtowhatmattersmost.

Askinggenuinelycurious,exploratory,open-endedquestionsallowstheVeterantoarticulatetheirMAPandwhatmattersmosttothem.ItisimportanttohavetheVeteranvocalizewhatmatterstothem.Writingitdownhasimpactandarticulatingthestatementstoanotherperson(inthiscase,thecoach)canhaveanevenmorepowerfulimpact.

ThepurposeofhavingtheVeteranarticulatetheirMAPandwhatmatterstothemistwofold:First,itprovidesamotivationforanysubsequentchangeinitiatives,givingthemareasontoparticipateinthechangeprocessandsustainitwhenthegoinggetsdifficult.



Second,itallowsthemtofeelmorefullyunderstoodbythecoachandallowsthemtobeknownatadeeperlevelthantheyareprobablyusedtosharingwithahealthcareprovider.

ThisexplorationshouldbeofferedasanopportunityandnotimposedontheVeteran.Whenofferedtheopportunity,mostVeteranswillprobablywanttoparticipate.Imposingthisasanecessarystepincoachingmaytriggerresistance.

Thereisalsothequestionofwhentoofferthisopportunity.SomecoacheshavefoundithelpfulfortheVeterantocompletethePHIquestionsaftertheyhavehadtheopportunitytomeetwiththecoach,establishtheinitialrelationshipandexplorethevalueofcompletingthePHIwiththecoach.Althoughitisusuallycompletedbytheendofthefirstsession,thismaynotalwaysbethecase,dependingontheuniquecircumstancesofeachcoachingencounter.

OthercoacheshavefoundithelpfultooffertheVeterantheopportunitytocompletethefirstfivequestionsofthePHIbeforecomingtotheinitialsession—eitherbysendingacopyviamail,orhavingtheVeterancompleteitonline.Theadvantageofdoingthisallows1)theVeterantotaketimetothinkaboutthequestions,and2)itcanpreparethemfortheinitialcoachingsession.

ThedisadvantageisthattheVeteranmaynotyetknowwhatcoachingis–andthePHIquestionsmightbeoff-putting.TheVeteranmaynotunderstandwhythey’vebeenaskedtocompletethePHI,andpossiblywhythey’vebeensenttoseeacoach.CompletingthePHImaynotbeofinteresttotheVeteranbeforearrivingatthecoachingsession.Theymayquestionwhetherthisiswhatthey“signedupfor”.Theymayhaveanticipateddealingdirectlywiththeirpresentingissue.

ThecoachmightfindithelpfultofirstaddresstheVeteran’spresentingissueasameansoffocusingonwhatisimportanttothematthatmoment.Veteranscometocoachingforavarietyofreasons;theymayhavebeenreferredbyanotherhealthcareproviderforaspecificfocus,suchaslosingweightorstoppingsmoking.TheVeteranmayhaveself-selectedtocometocoachingforaspecificfocus.Or,theymaybecomingforgeneralizedhealthenhancement,notsurewhattheywanttoworkoninitially;theyjustknowtheywouldliketobelivingamorefulfillinglife.Eachofthesepresentationsinfluencehowthecoachingbegins.WhenaVeteranispresentingforaspecificissue,itisbesttostartwiththatissueratherthanimmediatelyhavingthemcompletethePHI.Iftheyarecomingwithoutaspecificfocusoranunclearfocus,itmaydictatethatthecoachmovestothePHIsoonerintheprocess.



Inallcases,completingthisfirstelementofthePHI,developingaMAP,isanimportantstageinthehealthcoachingprocessandshouldbeofferedatsomepointintheinitialsessionsofcoaching.Theexperienced,artfulcoachwillmakeitanaturalpartoftheflowofthecoachingprocess;byofferingitwhentheVeteranhasexpressedinterestinexploringthecontextforthebehavioralchangesheorshemaybeinterestedinmaking.

STAGEONE,PHASE2–DISCOVERINGVALUESANDVALUESCONFLICTS

ExploringValuesandValueConflictsStrategies.OncetheVeteranhasarticulatedtheirMAP,itmaybeusefulforthemtoexplorewhatthatsaysabouttheirvaluesorwhatisimportanttothem.TheVeteranmaywanttoidentifyatleast3valuesthatcomeoutoftheirMAPs.Itisimportantthatthisdiscoveryprocessnotberushed.Itmaybehelpfultoreflectthevaluesheardandgivequiettimetoreflect.Seeminglysimplequestionssuchas“Whatelseisimportanttoyou?”or“Isthereanothervaluebehindthevalueyoujustidentified?”areoftennotsosimple–andcanbethoughtprovokingandprofound.Forinstance,iftheVeteransaysthatonevalueis“havingenoughmoneytonotbeworried”,theremaybeanothervaluebehindthisvalue.Thevalueof“freedomfromworry”or“mentalpeace”maybethevalue.Inthesecases,thesimplequestionsof,“Whatelsematters?Or“Whatothervaluemaybebehindthisvalue?”becomepowerfulquestions.Powerfulquestionsarethosequestionsthatleadtogreaterinsight,orthenext“ah-hah”momentfortheVeteran.

Itisimportant,inthisstage,toexploreValuesConflicts.Valuesconflicts,thosethingsthatareimportanttousthatmightbeinconflictwithotherheldvalues,areameaningfulandusefulareaofexplorationfortheVeteranandthecoach.IdentifyingthattheyhaveothervaluesthatconflictwiththeiridealvaluesisanimportantpartoftheVeteran’sself-discoveryprocess.ItallowstheVeterananopportunitytolookatwhattheygetoutoftheircurrentbehavior,evenwheninconsistentwiththeirhighestvalues.This,inturn,allowsthemtomakeinformedchoicesaboutwhichbehaviorstheywanttocontinueandwhichonestheymaywanttolookatchanging.Itisallbasedontheirself-assessmentofwhattheysayismostimportanttothem.IdentifyingvaluessetsthestageforexploringwhentheVeteran’sbehaviorsarenotalwaysconsistentwithwhattheysayismostimportant.Explorationofvaluesconflictsisimportantintwoways:1)itallowsVeteranstolearnaboutvalueconflictsthatwillbecomeevenmoreimportantastheymovedownthepathofattemptingtochangeabehaviororachieveagoal,and2)itallowsthemtoexplorethediscrepancybetweentheirbehaviorsandtheirvalues.

Examplesofquestionsthatcoachesmaybeutilizingatthisstageinclude:

• WhenyouthinkaboutyourMAP,whatcomestomindaboutwhatreallymatterstoyouinyourlife?



• Youstatedwhenyoucameinthatyouwantedtoworkon...HowwouldworkingonthissupportyourMAPandwhatisimportanttoyouaboutdoingthat?

• ThinkoftimeswhenyouarenotachievingyourMAP?WhatotherthingsbecomeimportantthatmayhinderyoufromlivingaccordingtoyourMAP?

• Howisyourcurrentbehaviorconsistentorinconsistentwithwhatyousayisimportanttoyou?Isthissomethingyouwanttofurtherexplore?Whatwouldyoubegivingupifyouchangedthisbehavior?(Thiswillgetatconflictingvalues.)

STAGETWO

STAGETWO,PHASE1–CONDUCTASELF-ASSESSMENT

ConductingaSelf-AssessmentStrategy.AftertheVeteranhasexploredtheirvaluesandvaluesconflicts,itmaybeusefultoconductaself-assessmentthatlooksatalltheareasoflifeaffectingtheVeteran’shealthandwell-being.ThiscanbedoneutilizingtoolsfromthePHI,includingtheWhereYouAreandWhereYou’dLiketoBehandout,(Handoutpages6-9),whichrelatestotheCircleofHealth.Again,coachesmayofferthisasanotheropportunitytolookatwhatmatterstothemintermsoftheirhealthandassesswheretheyareandwheretheymaywanttobeinthevariousareasoftheirlifethatimpacttheirhealth.ImposingthisontheVeteranmayengenderresistance.Ideally,itworksbesttoofferthisatatimewhentheVeteranhasindicatedtheyarewillingtolookatissuesotherthanthepresentingissuethatmaybeimpactingtheirlives.

ThepurposeofthisstageistohelptheVeteranfurtherclarifywhatismostimportant,orwhatisofgreatestinterestforthemtobeworkingonatthistime.ItisnotunusualforaVeterantocometocoachingwithapresentingissue,andbythetimetheyhavegivenfullconsiderationtoallareasimpactingtheirlife,decidethattheyarereallymoreinterestedinworkingonanotherissue.Forexample,aVeteranmaycometocoachinghavingdecidedthattheyneedtohavemorephysicalactivityintheirlife.Aftercompletingtheassessment,theVeteranmaydecidethattheyreallyaremoreinterested,atthepresentmoment,inworkingatreducingtheirstress.-Itmaybethattheywanttoworkonacombinationofboth.Ineithercase,itismorelikelythattheVeteranwillachievesuccessiftheyworkontheareathatisofmostinteresttothem.Successbreedssuccess.Aftersomesuccessinonearea,theymaybemoremotivatedtotakeonanotherarea.

TheVeteranwillhavelearnedskillsandstrategiesforbehavioralchangeintheinitialundertakingthattheycannowapplytothenextchallenge.



Attheassessmentphase,thecoachisnotlookingforacommitmenttochange.TheyaresimplyaskingtheVeterantoself-assessthevariousareasoftheirlivesthatimpacttheirwell-being.

ThereareotherformsofassessmentstheVeteranmayhaveavailabletothemandmaywanttoconsideraswell.Forexample,thesecouldbeothermedicalassessments,psychologicalassessments,andstressassessments.

STAGETWO,PHASE2–SELECTINGAFOCUS

SelectingaFocusStrategy.Allthecoach’sinteractionswiththeVeteranhavebeenleadinguptothispoint.ItiscriticaltonotaskaboutanareaoffocusuntilthecoachsensesthattheVeteranisreadytohomeinonanarea.Prematurelyaskingfortheareaoffocusmayevokeresistance.Ontheotherhand,theVeteranmaybeanxioustogetonwiththecoachingintheareaoffocuswithwhichtheyinitiallypresented.TheseinterveningphasesmayhavehelpedconfirmfortheVeteranthatthisiswheretheywanttomakechanges.

ItisimportantforcoachestorealizethatVeteransmaynotnecessarilywanttostartwithanareathattheyscoredthemselvesthelowestinwhencompletingtheWhereYouAreandWhereYou’dLiketoBehandout.TherearemanyfactorsthatgointotheVeteransdecidingwhichareatheywanttoaddressfirst.

Theseconsiderationsinclude:

• Theimportanceoftheareatotheminthemoment.• Theconfidencetheyhavetomakechangesinthatarea.• Theenergyandtimetheyfeeltheyhavetotakeonthatchallenge.• Theimmediatebenefitstheymayperceivewillbeforthcoming.• Thelong-termbenefitsofmakingthechange.• Theexcitementtheyhaveformakingthechange.

Coachesmustself-managetomakesuretheyarenotintentionally,orunintentionally,steeringtheVeteransinthedirectiontheythinkwouldbebestfortheVeteranstoaddress.

STAGETWO,PHASE3–ASSESSINGREADINESS

AssessingReadinessStrategies.BeforeproceedingtothenextstageofPlanningforChange,coacheswillwanttoassessiftheVeteranisadequatelymotivatedtotakeonthechallengeofchange.OnewaytodothatistoassesstheimportanceofthischangetotheVeteranaswellastheconfidencetheVeteranhasthattheycanmakechangesinthisarea.

Typicalquestionsthatcoachesmayfindthemselvesaskingatthisphaseare:

• Whatmakesthemostsenseforyoutothinkaboutchangingatthistime?Howdo



youwanttogoaboutprioritizingwhereyouwanttostart?• Whatwouldyoubemostexcitedaboutchangingatthistime?• Whatisitthatyouthinkyoumayhavethetimeandenergyforchangingatthis

time?• Whatwouldbethemostimportantareaforyoutothinkaboutchangingatthis

time?Onascaleof1to10,howimportantistoyou?• Inwhatareadoyouthinkyouhavethemostconfidenceforbeingabletomakea

change?Onascaleof1to10,howconfidentareyouthatyoucanmakeachangeinthisarea?

STAGETHREE

STAGETHREE,PHASE1–SETTINGAGOAL

Goalsettingisusuallycriticalforsuccessfulandsustainedaction.AgoalnotonlyenhancesmotivationforchangebutprovidestheVeteransameasureforhowtheyareprogressing.

However,settinganeffectivegoalisimportantand,ifnotdonewell,canalsohavetheimpactofdemoralizingtheVeteran.Itisimportantthatgoalsettingnotbedonehastily,butthatallelementsofsettinganeffectivegoalarecarefullyconsideredbeforemovingaheadintheprocess.

SettingaSMARTGoalStrategy.Thereisnotaspecifictimeframeforsettingagoal,butgenerally3-6monthshasbeenmostfrequentlyutilized.ThetimeframeshouldtakeintoaccounttheinterestoftheVeteran.Agoalthatistoofaroutinfrontmayseemtoodistanttoberelevant;agoalthatistoocloseintimemaynotallowtheVeteranstoexperiencethenon-linearmovementtowardthegoal,resultinginthegoalnotbeingobtained.Inotherwords,mostVeteranswillexperiencehighsandlowsintheirmovementtowardagoal;itisimportanttoallowenoughtimetomakeitthroughthispartoftheprocess.

CharacteristicsofeffectivegoalsettingfollowtheacronymSMART,whichstandsfor:

Specific—Agoalshouldbeclearandconcise.Itisdifficulttoknowwhenactiontowardagoalhasbeenstartedandwhenithasbeencompletedifitisnotspecific.

Measurable—AgoalshouldbemeasurablesothatVeteranscantracktheirprogress.Veteransneedtohaveclearcriteriaforprogressandcompletionwhentakingactiononagoal.Keepingtabsonprogresscanbeinspiring.

ActionOriented—Agoalshouldincludeaction.AndthatactionshouldbeindirectcontroloftheVeteran.



Realistic—AgoalshouldbelargelywithinthereachoftheVeterans.Itisbesttoworkonsmalllifestylechangesthataredoable.AvoidthepitfallsofhavingVeteransseeonlythebigpictureandnotthesmallsteps.

Timed—Agoalshouldbetiedtoatimetableforcompletingspecific,measurable,andrealisticaction.

ThereareseveralquestionsthatcoachesmaywanttohaveVeteransconsiderwhensettingagoal.Theseare:

• IsthegoalasignificantenoughstretchfortheVeteranthatitcreatesexcitementinachievingtheoutcome?OrisittoogreatastretchthatitbecomestoomuchofareachfortheVeteranandthemotivationisdecreased?

• IsthissomethingtheVeteranreallywants,oristhisimportantenoughthattheVeteraniswillingtoengageinactionstepstowardthegoal?Inotherwords,doesthisgoalreallymattertothem?

• WhatdailypromptsorremindersarehelpfultotheVeteraninkeepingthegoalinmindonaregularbasis?

• DidtheVeterancommittheirgoaltopaper?Goalscaneasilybeforgottenormodifiedinadvertentlyovertimeifnotwrittendown.

• Isthegoalclearlyinlinewith,andinsupportof,theVeteran’smission/purposeandvalues?ItmaybeusefultohavetheVeteranverbalizeandwritedownhowthisgoalwillhelptheminfulfillingtheirmission/purpose.

• DoestheVeteranneedmoreinformationinhelpingthemestablishagoal?Forinstance,whatisareasonableamountofweightonecanexpecttoloseinagiventimeframe?Whatadditionalmealplanningdotheyneediftheirgoalistoeatanutritionallybalancedmeal4outof5meals?

Attimes,Veteranshaveoptionsinhowtheymaywanttomeettheirgoal.ItmaybehelpfultohaveVeteransbrainstormwaysofmeetingthegoal.Forinstance,let’sassumethataVeteranwantstodecreasehisweightby5%overthenext3months.BeforeassistingtheVeteraninestablishingactionsteps,itmaybehelpfultothinkofoptionstheVeteranhasforreducingweight.Inassistingthem,avoiddoingthebrainstormingforthem.Allowthemtimetoreflectanddotheirownbrainstorming.Asmuchaspossible,allowtheideastobetheirown.Thiswillhelpmaximizesuccessincarryingouttheactions.Someexamplesofwhattheymightcomeupwithinclude:

• Eatlessofwhattheycurrentlyeat.• Eatdifferentfoodsthanwhattheyarecurrentlyeating.• Increasetheirlevelofregularphysicalactivity,suchaswalkingupstairsand



parkingtheircarfurtherawayinaparkinglotordancingmore.• Increasethekindsofactivitiestheydothatincluderegulartripstoafitnesscenter

orwalkingseveralmiles3timesaweek.• Reducethesugarydrinksintheirdietordrinkmorewater.• Takeweightlosssupplements.• Dealwithstressorsthatleadtoovereating.• Eatmoremindfully.

ThisbrainstormingmayhelptoexpandthelimitednumberofwaystheVeteranwasthinkingtheycouldloseweightandtheymaycomeupwithaplanthatismorelikelytosucceed.

STAGETHREE,PHASE2–ESTABLISHINGACTIONSTEPS

EstablishingActionStepsStrategies.AnotherveryimportantpartofthePlanningStageisestablishingactionsteps.ActionstepsarethoseinitialandongoingbehaviorsthatwillhelptheVeteransachievetheirgoals.Actionstepsarethosebehaviorsthatareestablishedforthenextweek,orashortdurationoftime.Actionstepsarewhere“therubbermeetstheroad.”

ActionStepsshouldbeestablishedaccordingtothesameSMARTCriteriautilizedforsettinggoals.(SeeSMARTcriteriaunderStage3,Phase1GoalSetting)Again,itisimportantnottorushestablishingactionsteps.TheVeteran’smotivationforcontinuingthechangeprocesscanbeenhancedordiminishedbytheirinitialsuccessesinachievingtheiractionsteps.

ItisimportantforcoachestorealizethatinitialactionstepsmaybeobtainingmoreinformationthatwillhelptheVeteranestablishfutureactionsteps.Forinstance,iftheVeteran’sgoalcentersoneatingmore,healthyfoods,theVeteran’sinitialstepmaybeobtainingmoreinformationaboutwhatfoodstheywanttobepurchasing.Or,theymaywanttoexplorewhichrestaurantsservethefoodsthatmeettheirspecificationsfor“healthy.”Or,theymayhavetospendthefirstweeklearningtoreadlabelsingrocerystores.

Anotherexampleofgatheringinformationmightcenteronaddingmoreactivitytotheirlives.Theymayhavetoexplorethefollowingfactorsbasedontheirinterests.Thesefactorsmayincludethefollowing:

• Determiningwhatadditionalgear/clothing/shoestheymayneedtogetstarted.• Determiningasafeplacetowalkifthatispartoftheirplan.• Findinganotherpersonoragroupofpersonstowalkwith.• Findingouttheadvantagesofjoiningafitnessclubvs.havingequipmentathome.



• Becomingfamiliarwithanyrisksassociatedwiththeirpreferredchoiceofmovement.

ItisimportanttorememberthatestablishingactionstepsaccordingtotheSMARTcriteriacanmakeorbreakthesuccessoftheVeterans’endeavors.Plancarefully.

STAGETHREE,PHASE3–IDENTIFYINGANDEXPLORINGPOTENTIALBARRIERS

IdentifyingBarriers/ChallengesandContingencyPlansStrategy.BarrierstosuccessfulactionmayariseinallstagesandphasesofthecoachingprocessthattheVeteranmayneedtoovercome.ThissectionwilllookatthekindofbarriersaVeteranmayidentifyandstrategies,orbackupplans,fordealingwithpotentialorrealizedbarriers.

WeareintroducingbarriersherebecauseitcanbeavaluableexperiencetohaveVeteransanticipatebarriersbasedontheirknowledgeofthemselvesandpreviousexperiences,aswellastheexperiencesofothers.Onceactionstepsareinitiated,andduringeachsubsequentcoachingsession,itmaybeusefultocontinuetoexplorewhatbarrierstosuccessfulactionaroseduringtheweekandmakeplansforovercomingthem.

Therearetwobroadcategoriesofbarriers—internalandexternal.ThisdistinctionislargelybasedontheVeteran’sperceptionsbecausemostperceivedexternalbarriersarereallybarriersbasedontheVeteran’sinternalperspectivesandresponsestothosebarriers.Examplesmayfurtherclarifythis:

AVeteranmayidentifygoingtoabarwherealcoholisservedandbeingaroundpeoplewhoaredrinkingasanexternalbarriertohis/herachievingsobriety.AlthoughthismaybeperceivedbytheVeteranasanexternalbarrier,itmaybeusefulfortheVeterantonoticethatitishis/herresponsetotheexternaldrinkingenvironmentthatalsoplaysintotheirabilitytoresist.Inthiscase,itbecomesmoreofaninternalbarriertoplanfor.

OtherVeteranswhowanttoslowdownandlimittheamountoftimespentatworkmayperceivetheirdebtloadasanexternalbarriertolimitingtheamountoftimeatwork.Onfurtherexploration,itmaybewhattheyaretellingthemselvesabouttheirdebtthatisthebarriertoslowingdown.

Itisimportanttonotethatalthoughthereareplansthatcanbeestablishedtoworkaroundtheperceivedexternalbarriers(i.e.,nothangingoutinbars,choosingcarefullywhoonechoosestohangoutwithindrinkingsituations),therearealsoopportunitiestodevelopplanstodealwiththeinternalbarriers(i.e.,rehearsingrefusalskills,visualizingwhatitwillbelike3hoursfromnowifIdodrink).Mostofthetime,Veteranswillperceivethemselves



ashavingmorecontroloverinternalbarriersthanexternalones.Externalbarriersareoftenperceivedas“onesIcannotcontrol”;onesimplyneedstocontroltheirproximitytotheexternalbarrier(person,place,thing,orevent).

IDENTIFYINGANDDEALINGWITHINTERNALBARRIERS

Internalbarriersgobymanynamesanddescriptions.ChoosetheonesthatarerightforyouortheVeteransyouserve.Eachofthesewillhavethesameoutcomesifappliedeffectively.

ItisimportanttonotethatyoudonotneedtoidentifythebarriersbyanylabeltoeffectivelydealwiththeVeterans.CoacheslistenforandsimplynotewhenVeteransarediscussingbarrierswithouthavingtonamethem.Forinstance,aVeteranmaysay“IwishIhadstartedthiswhenIwasyounger.ItwouldbemuchsimplertodoifIwereyounger”.ThecoachmaysimplycallthatstatementtotheVeteran’sattentionandaskthemtoexplorehowthatstatementmaybeservingthem,ornotservingthem,intermsofmovingforwardwithanactionplan.

Eachofthesewaysofperceivingbarrierswillbebrieflyidentifiedinthefollowingsections.

DEVELOPINGPERSPECTIVES

Aperspectiveisonewayofviewingasituation.Veteransmightidentifytheirperspectiveasthe“truth,”ortheonlywayofperceivingthesituation.Manytimes,limitingone’sperspectivelimitsthealternativesfordealingwithaspecificsituation.

ChangingperspectivesissimilartotheworkofAlbertEllisandtheSPCmodelthatflowsfromhiswork.(ThisisalsocalledCognitiveBehavioralTherapy(CBT),inwhichmanymentalhealthprofessionalswithintheVHAhavebeentrained.)ThefollowingbrieflydescribestheSPCmodel:

‘S’standsforSituation—Asituationisdescribedinobjectiveterms—who,what,whenandwhere.ThesituationisthefocusforexploringtheVeterans’perspectivesandresultantbehavior. DoorwayorMirror?

‘P’standsforPerspective—Perspectivesarederivedfromthethoughtsandbeliefsaboutthesituation.Thoughtsaretheinterpretationsoftheeventorwhattheysaytothemselvesaboutthefacts.Thesethoughtsarebasedonthebeliefsthatpertaintothesituation.



‘C’standsforConsequences,eitheremotionalorreactions(behaviors)—EmotionsarewhatVeteransfeelasresultoffilteringtheactivatingeventthroughtheirthoughtsandbeliefs.

Reactionsarewhattheydoinresponse.

PerspectivescanbeproductiveorcounterproductivetotheVeterans’progressinmakingchange.ItisimportanttoassistVeteransinrecognizinghowtheirperspectivesareservingthemornotservingthem.Veteransmaybeunawarethattheremaybeanotherlensthroughwhichtoviewthesituation,andthisdifferentviewcouldinfluencetheirbeliefs,feelings,andactions.

AnothertermthatmaybeusefultotheVeteranissubstitutingtheword“story”for“perspective.”Astoryiswhatsomeonetellsthemselves,orothers,aboutasituation.Again,thestorytellermayseetheirwayoftellingtheirstoryasthe“truth.”

However,frequentlyitistheirinterpretationoftheevent.Veteransmaybeinvitedtothinkabouthowtherecouldbeanotherstoryabouttheeventsandaskedtothinkabouthowtheycouldchangethestoryinawaythatwouldservethemdifferently.

SomeexamplesofperspectivesorbeliefsthatmayhaveimpactonVeteransmovingforwardinthechangeprocessmaybe:

• Myworthisdependentonwhatpeoplethinkofme.• Everyonemustlikemeandmyideas.• IfImakeamistake,peoplewillloseconfidenceinme.• Imustbeasgoodastheothermusiciansperformingpublicly.• I’mafailureifIdon’tsticktothedietplanwedesigned.• There’snotmuchIcandoaboutthestressorsIexperienceinmylife.

ThereisaperspectivesworksheetintheHandoutsectionthatmaybeusefulforcoachestousewithVeteransinhelpingthemidentifyhowtheirperspectiveinfluencestheirchangeprocess.

WORKINGWITHNEGATIVESELF-TALK

We,ashumans,allhaveself-talkandmay,ormaynot,beawareofit.Self-talkisthemessagewesaytoourselvesaboutourselves.Veteransarenotalwaysawareofthesenegativemessagestheysaytothemselves.Likeperspectives,negativeself-talkmaybelimitingandinterferewithsuccessfulaction.Itmaybehelpfulforcoachestobringthisnegativeself-talktotheVeterans’awarenessandhelpthemassesswhattheygainfromit,orhowithindersthem.Someexamplesofnegativeself-talkare:



• “I’mnotsmartenough.”• “I’mtoolazy.”• “IalwaysfailwhenItryto...”• “I’mtoooldtostartthis.”• “Idon’tdeservethis...”• “Idon’thaveenough...”

Coacheswillseethatworkingwithnegativeself-talkisalmostidenticaltoworkingwithperspectives.Thesamestrategies,stylesandquestionsapply.Theintenthereistoshowthesimilaritiesandallowcoachestochoosewhichlanguageworksbestforthem.ThesameistrueofWorkingwiththeInnerCritic.

WORKINGWITHTHEINNERCRITIC

Likenegativeself-talk,innercriticworkinvolvesassistingtheVeteraninidentifyinghowtheircriticalthoughtsaboutthemselvesmayservetheminsomewaysbutnotinothers.Effectivecoachinginvolvesidentifyingthesecriticalmessages,assistingtheVeteraninidentifyinghowtheinnercriticdoesordoesnotservethem,andhelpsthemmakechoicesaboutwhichmessagestheywanttogivetheinnercritic,including:

• Payingattentiontotheinnercritic.• Makingpeacewithorbefriendingtheinnercritic.• Ignoringtheinnercritic.Orchoosingnottobelievetheinnercritic.• Givingtheinnercriticlesspower.• Namingtheinnercritic.• Playingwiththeinnercritic.• Askingtheinnercritictoleave.

Anotherwaytoignoretheinnercriticistofocusonpositivemessages.Thiscanbedoneby:

• FocusingontheVeterans’mission/purposeandvalues.• Brainstormingotherperspectiveswiththem.• HaveVeteransidentifyamessagetheymightgiveafriendstrugglingwithaninner

critic.• Elicitingwhatbringsjoy,peace,and“aliveness”.• Recognizingtheirprogressandencouragingactionsteps.• EncouragingVeteranstoparticipateinwhatnourishesthem.

WORKINGWITHCOMPETINGORCONFLICTINGVALUES

Whatmaybeperceivedasabarrierinsomecasesisanothervaluethatiscompetingforthetime,attention,andenergyoftheVeteran.HelpingtheVeteranidentifytheirown



competingvaluesmaymakeiteasiertothinkaboutstrategiesorplansforconsciouslyselectingwhatvaluetheywanttohonorinthemoment.

ItmaybeimportantforthecoachtorecognizethatvalueconflictsarenotnecessarilyperceivedassuchbytheVeteran.Acoachmighthearwordslike,“Ireallyvaluemyhealth,butI’mjustlazyandwanttohangoutonthecouch.Lyingonthecouchandbeinglazyisnotavalueofmine.”ItmaytakesomereframingofthesituationfortheVeterantorealizetheydogetsomethingoutof“beinglazyandlayingonthecouch”eventhoughtheydon’tviewitasavalue.Ithassomeimportanceinthatparticularmomentthatservestheminsomecapacity.Assistingtheminunderstandingwhattheygetfromthatbehavior,withoutjudgingthemselves,istheartfulchallengeforthecoaches.

ELICIT-PROVIDE-ELICIT

Whencoachesbelieveitmaybevaluabletoprovidesomeinformationorpotentialresourcesforthepartner,theinformation/resourcesmaybemoreeasilyheardwhenusingthefollowingstrategy:

• ElicitwhethertheVeteranisinterestedinlearningsomethingyouthinkmightbehelpfulorrelevant.IftheVeterandeclines,stop.Providinginformationnowisapttomakechangelesslikely.

• IftheVeteranisinterested,providetheinformationorconcernyouhave.Rememberingtokeepitbrief.Thisisnotthecoach’sopportunitytoofferupeverythingtheyknoworoverloadtheVeteranwithtoomuchinformation.

• ElicittheVeteran’sinterpretationofthatinformation,howshethinksitappliestoher,whatsenseshemakesoutofit.EmphasizethattheVeteranistheonetodecidewhattodowiththeinformation.

BRAINSTORMING

Anotherstrategyforworkingwithbarriers/challengesisbrainstorming.Inbrainstorming,coachesaskpartnersiftheywouldliketobrainstormsomeideas(elicitpermission).

• Explainthebrainstormingprocess–abriefexchangeofideas,notmeanttobeponderedordiscussed,but“thrownagainstthewalllikespaghetti”.Itismeaningfulforthecoachtoemphasizethat“anythinggoes”–anyideaisworthofferingup,nomatterhowbig,small,oroutlandish.Theideaistogeneratethinkingwithoutjudgment.

• ThecoachandVeterantaketurnsofferingideaswithnojudgment.FirsttheVeteran,thenthecoach,andsoonuntilanagreeduponnumberofideasareonthetable.

• AttheendofthisexchangethecoachaskstheVeteranwhich,ifany,ideassound



doableforthem.Insummary,therearemanywaystoviewbarriersthatmaybehelpfulforboththeVeteransandcoaches.Theimportanttaskforcoachesistolistenforwords,thoughts,andexpressionsthatmaybelimitingthecoachingpartnerinsomeway.HavetheVeteransidentifyhowthatperspectiveisbothservingthemandnotservingthem.Havethemexploretheirattachmenttothatparticularperspectiveandassistthemin“tryingon”anotherperspectivetoseewhatmightbepossiblefromthatnewperspective.

STAGETHREE,PHASE4–ESTABLISHACCOUNTABILITY

EstablishingAccountabilityStrategy.Mostpeoplefindthatbycommittingtoanotherpersontoreportwhattheyaccomplishedordidnotaccomplishfortheweek(oranyothergiventimeperiod)canbeverymotivatinginachievingthedesiredactionstep.Manywillindicatetheirdesiretobeaccountabletothecoachattheirnextmeeting.Othersmaywanttosolicitthehelpofaspouseorfriendtoholdthemaccountable.Sometimes,aVeteranmaywanttobeaccountabletothemselvesbywritingdownorjournalinghowtheydideachdayinachievingtheiractionstep.

NomatterwhatmethodtheVeteransuse,itisanotherimportantpartoftheprocess.ThisisanotherplacewherethisphaseshouldbeofferedasanopportunityandnotjustassumedthattheVeteransarewillingorwantingtoestablishaccountability.

Questionsthecoachesmaywanttoconsideratthisphaseinclude:

• Ifyoufinditusefultoholdyourselfaccountabletosomeone,I’mofferingmyservices.Ifyouwantmetobethepersontowhomyouholdyourselfaccountable,howcanIdoitinthewaythatismostsupportiveofyou?

• Aretherewaysthatyouwanttobeaccountabletoyourself?Ifso,whatmightbesomeofthoseways?

• Isthereanyoneelsewhocouldbethe“right”persontocommittoholdingyouresponsible?

STAGETHREE,PHASE5–PROVIDEAFFIRMATIONS

ThisisnotphaseofStage3,perse,butthroughoutthecoachingsession—andespeciallyafterthepartnerhasinitiatedaction—thecoachwillwanttolookforopportunitiestoprovideaffirmations.Thefollowingarestrategiesforprovidingaffirmations.

Thereareseveralstylesofaffirmationswithwhichcoacheswillwanttobefamiliar:



• Judgment:“Youhavedonearemarkablejobinstoppingyourcuttingbackonyoursugarintake.”

• Impact:“Iappreciatehowhonestyouarebeingintalkingaboutthesethings.”(AdescriptionofapositiveexperienceinresponsetowhattheVeteranisdoingorhasdone.)

• Observation:“Youweresuccessfulinstoppingthefighting.”(FocusontheVeteranandfactsthatemphasizethepositive.)

Therearealsosomecautionsinutilizingaffirmations.Thefollowingquestionsmayhelpcoachestothinkaboutthesecautions:

• Isyouraffirmationcomingfromadeficitworldview,whereyousoundlikeyoubelieveyourVeteranlacksknowledge,skills,orattitudes?

• IfyousaytheVeteran’sbehavioris“good,”thenadifferentbehaviororchoicewouldhavebeenlabeled“bad”?

• or• IsyouraffirmationcomingfromaviewoftheVeteranascompetent?• IdentifyingvaluesorcharacteristicsoftheVeteranthattheVeteranmightusetofeel

seen,unique,worthy?

STAGEFOUR

STAGEFOUR,PHASE1–ASSESSTHEACTIONTAKEN(ORNOTTAKEN)

AssessingActionTakenStrategy.OncetheVeteranhascommittedtotakinganActionstep(s),thecoachingentersanotherstage.TheVeteranwillhavedoneoneofthesethreepossibilities:

• Fullycompletedorexceededtheproposedactiontobetaken.• Partiallycompletedtheproposedactiontobetaken.• Didnottakeanyactionthatwasproposedandcommittedto.

Inallcases,thereispotentialforlessonslearnedwhichinturnresultsinsustaining,modifying,oreliminatingtheplanandreturningtoanearlierstage.

STAGEFOUR,PHASE2–LESSONSLEARNED

AssessingLessonsLearnedStrategy.Inassessingtheactiontaken,ornot,thefirststepistoexplorewiththeVeteranwhattheylearnedfromtheexperience.

TheVeteranmayhaveencounteredadditionalbarriers,bothinternalandexternal,thattheydidnotanticipate.ItmaybeusefultoexplorewiththeVeteranwhattheyplantodo



(PlanB)whentheyencounterthisbarrieragain.Thesamestrategiesandstyles,describedunderBarrierspreviously,areapplicableinthesesituationsaswell.

Identifyingstrengthsandsuccessesisaveryimportantpartofthelearningprocess.Evenifthesuccesswaspartial,itwasstillasuccessandshouldberecognizedassuchforthelessonsthesuccessesengender.Bemindfulof:

• WhatdidtheVeterandointhesesituationsthatcontributedtothesuccesses?• WhatbarriersdidtheVeteranneedtoovercomeandhowdidtheydoit?• Whatstrengthsdidtheydiscovertheyhadwithinthemselvestoachievethe

success?• Whatdidtheylearnaboutthesestrengthsthattheycanapplytofuturesituations?

Inallcases,theVeteranshouldbeacknowledgedandaffirmedfornotonlywhatwasaccomplished,butalsoforthelessonslearned.

STAGEFOUR,PHASE3–RE-PLAN

Re-PlanningStrategies.Inthisphase,coachesandVeteransdeterminewhatmodificationsoradditionsshouldbemadetotheactionstepstomovetowardthegoal.IftheVeterandeterminedtheyweresatisfiedwiththeirsuccess,theymaywanttocontinuewiththesameactionplan.Or,theymayfeelreadytoaddadditionalactionsteps.Inthesecases,establishingadditionalactionstepsshouldfollowthesameproceduresasidentifiedinStage3,Phase2,ActionPlanning.

IncaseswheretheVeteransdidnotfeeltheywereassuccessfultheymaywanttore-assesstheactionstepstoseeifmodificationsshouldbemadethatwouldengenderfuturesuccess.Perhapstheyweretooambitiousintheiroriginalactionplanning,orperhapstheyencounteredmorebarriersthantheyanticipated.CoachingsessionsinStage4arefocusedonlessons-learnedandmakingadjustmentsifnecessary.

STAGEFOUR,PHASE4–TAKEFURTHERACTION

FurtherPlanningStrategies.Inothercases,TheVeteranmaydeterminethattheywanttoreaddressotherpartsoftheirplanincludingthegoal,ortheareaoffocus.Theymayhaverealized,throughattemptingtheaction,thattheywerenotreadytotakeonthisareaoffocus,orthatthegoalseemedtooloftyandnotobtainable.Inthesecases,theVeteranshouldbeaffirmedforthelessonslearnedandtheirwillingnesstotakeonthechallengeinitially.Theyshouldnotbe“shamed”formodifyingthegoalorfocus.Thesewereallveryimportantlessonsthatcouldonlybelearnedbyattemptingtheplannedaction.AssumingtheVeteraniswilling;coachesmaywanttosupporttheVeteraninrevisitingearlierstagesofthecoachingprocessandreassessingvalues,areaoffocusandgoals.



TheprocessdescribedhereinStage4continuesuntiltheVeteranandcoachagreetoendthecoachingsessions.ThismayoccurwhentheVeteranfeelstheyhaveexperiencedenoughsuccesstocontinueontheirown,ortheydeterminethatwhatevertheyhavelearnedorgainedisenoughatthispoint.

Insomecases,thecoachingendsbecausethecoachingisnotworkingfortheVeteranandprogresshasstopped.Inthesecases,thecoachshouldassisttheVeteranindeterminingwhatotherservicesmaybehelpfultothemorassistthemindeterminingwhentheymightwanttotrycoachingagainandunderwhatcircumstances.

CoachesshouldassistVeteransinframingtheterminationofthecoachingsessionsnotasterminationperse,butasastepintheprocessofmovingtowardwhatmatterstothemandrealizingtheirMAP.Itisallpartofthejourney.

WHENUTILIZINGTHEFULLCOACHINGPROCESSISNOTFEASIBLEORPOSSIBLE

Therearemanytimeswhenutilizingthefullcoachingprocess,asrepresentedinthischapter,isnotfeasible,norpossible.Frequently,participantsintheWholeHealthCoachTrainingarenotintendingtodocoachingexclusivelybutareinterestedinaddingthecoachingskillstowhattheycurrentlydointheirVHAcapacities.Tothatend,trainingtimewillbedevotedtoutilizingcoachingskillsincarryingoutpartsofthecoachingprocessthataremostrelevantgivenlimitedtimeframes.ThefollowingPowerPointslidesofferaglimpseintohowelementsofthecoachingprocessmaybeutilizedinlimitedtimeframes.

• IfaVHAemployeehadanopportunityintheircurrentjobtoaskonequestion,itmaybeonelikethis:

• Iftherewasanopportunitytoexplorefurther,scalingquestionsmightbeutilized:



• Finally,ifthereistimetoask3questions,thequestionsmaybesimilartothefollowing:



CHAPTER5:ENHANCINGYOURWHOLEHEALTHCOACHINGSKILLS

Thereareseveralwaystothinkaboutenhancingyourhealthcoachingskills.Onewaytoenhanceyourhealthcoachingskillsistopracticewithpeers.Createcommonsituationswhereyouwouldliketouseyourhealthcoachingskillsand,withthegroup,brainstormpossibleresponses.

Perhapsitwouldbehelpfultoapplysomeratingscaleforhealthcoachingskillsdemonstrated.

Anotheristoseekoutamentororpeerwhoiswillingtoobserveyouandprovideyoufeedback.Somewaysthepeerormentormighthelpyouare:

1. Listento5-10minutesoftheinteractionanddescribewhichofthehelpingstyles(directing,following,orguiding)mightfit.

2. Thehelpermightusemorethanonehelpingstyleduringtheinteractionandyoumightbeabletoconsiderwhyaparticularstylewasusedforsomeparticularcontent.

3. Forthoseinstanceswhereadirectinghelpingstylewasused,itcanbeusefultoconsiderwhatwouldhavetobemodifiedsothatitwouldbemorelikeaguidinghelpingstyle.

4. Listento5-10minutesoftheinteractionandcountthenumberofopenandclosedquestions.

5. Acoachingstyleofteninvolvesmoreopenthanclosedquestions.6. Oneguidelineistohaveatleastasmanyopenquestionsasclosed,and

evenbetteristohavetwiceasmanyopenasclosedquestions.7. Onewaytopracticeistoconsidereachclosedquestionandgeneratea

correspondingopenquestionthatmighthavebeenusedinitsplace.8. Listento5-10minutesoftheinteractionandcountthenumberofsimple

andcomplexreflections.9. Acoachingstyleofteninvolvesmorereflectionsthanquestions.10. Oneguidelineistohaveatleastasmanyreflectionsasquestionsandeven

betteristohavetwiceasmanyreflectionsasquestions.11. Morecomplexreflectionsthansimplereflectionsarealsoconsidered

valuable.12. Onewaytopracticeistoconsidereachquestionandgeneratea

correspondingreflectionthatmighthavebeenusedinitsplace.13. Similarly,considereachsimplereflectionandperhapsgenerateacomplex

reflectionthatcouldhavebeenusedatthatpointintheinteraction.



14. Listento10ormoreminutesoftheinteractionandcountthenumberofaffirmations.

15. Acoachingstyleofteninvolvesaffirmations.16. Listenformomentswhenyoucouldhavehighlightedwhatthepartnerwas

doingasadmirableorinspiredyou.

UTLIZINGAPEERSUPPORTGROUP

Ifyouwanttouseapeersupportgrouporapeerinterestgroup,youmightconsidertheseguidelines.YoumightconsiderincludingtheHealthBehaviorCoordinator(HBC)orothercolleagueswhohavereceivedthehealthcoachtraining.

1. Scheduleregularmeetingsforthesolepurposeofworkingtogethertostrengthenhealthcoachingskills.

2. Don’tletadministrativedetailsorotheragendafillthetime.

3. Anhourmeetingtwiceamonthwouldbeonepossibility.

4. Inearlymeetings,itmaybehelpfultodiscussspecificreadingsthattheparticipantshavedonebetweenmeetings,ortheirexperienceofaCommunityofPracticeCall.Ajournalclubof20minutesorsomightbeadded.

5. Ratherthansimplylisteningtoeachotherpracticecoaching,makeuseofsomestructuredcodingtools.Someexamplesare:

6. Countingquestionsandreflections.

7. Codingdepthofreflections(simplevs.complex).

8. Countingpartnerchangetalkandnotingwhatprecededit.

9. Trackingpartnerreadinessforchangeduringthesession,andkeymomentsofshift.

10. Thepersonwhodidtheinterviewmightcommentfirstonitsstrengthsandareasforimprovement.

11. Thegroupmayalsowatch“expert”tapes,codinganddiscussingtheskillsbeingdemonstratedinthem.AsktheOPCCiftheseareavailableforyouruse.

12. ThegroupmayalsowatchexamplesfromYouTubewhich,althoughoftendescribedasexamplesofcoaching,providemoreofastimulusforhowonemightimprovetheuseofcoachingskillsthanademonstrationofgoodcoachingskills.

13. The group may focus on practicing and strengthening specific components ofcoachingskills.



SUGGESTIONSFORCREATINGAHEALTHCOACHINGENHANCEMENTPROGRAM

Generallyspeaking,itisnotenoughtosimplyattendahealthcoachingtraininginordertobeaneffectivehealthcoach.Likewise,itisseldomsufficientforanorganizationtosimplyprovideacoachingtraininginordertosustainahealthcoachingprogram.Inorderfortheinitiallylearnedskillstobeenhancedanddeveloped,anongoingsupportsystem,includingeffectivefeedbackandmentoring,needstobeestablished.And,thehealthcoachmustcontinuetopracticeandreceivefeedbackabouttheskillslearnedintheinitialtraining.Ideally,eachsitewillhavealeaderoradministratortoarrangemeetingsandcoordinateongoingactivitiesthatsupportskillenhancementandprogramdevelopment.Meetingonaregularbasistosupporteachotherinenhancinganddevelopingskillsiscritical.Evenifthesitedoesnothaveanexperiencedmentorortrainer,thereismuchthatcanbedonethroughpeersupport.Oneadvantageofnothavingaleadmentororsupervisoristhatthecoacheslearntomorefullyrealizetheirownpotentialtosupporteachotherinmakingimprovements,withlessrelianceonthe“experts.”

Ifyouare“onyourown”asahealthcoach,thereareideaslistedhereinthesecondsectionthatyoucanusetoenhanceyourskillsaswell.

ESTABLISHINGAHEALTHCOACHINGSUPPORTNETWORKATYOURLOCALSITE

Thereareseveralimportantfactorsthatleadtoasuccessfulcoachingprogram.Evidencehasshownthatnomatterhoweffectivetheinitialtrainingexperience,thelearningwillnotbesustainedwithoutotherfactorsbeingconsidered.Infact,itcouldbearguedthattheinitialtrainingexperienceisnotthemostimportantfactor;thereareseveralotherissuestoaddressthatmaybeofequalormoreimportance.Thetablethatimmediatelyfollowsallowsforanassessmentofsomeofthemostimportantfactorsinsettingupahealthcoachingprogram.

Asasummaryoftheassessment,theprimaryfactorstoconsiderare:

• Weretherightpeopleselectedforthetrainingtobehealthcoaches?• Wasthetrainingadequateandgearedtotheleveloftheparticipants?• DoestheHealthCoachingProgramhaveleadershipsupportatalllevels?• DoPerformanceMeasuresadequatelysupporttheworkofHealthCoaches?• Isthereanongoingsupportsysteminplacetoencouragethefurtherenhancement

ofcoachingskills?• Areindividualcoachesprovidedspecificfeedbackandskillenhancementplans?• Isthereanongoingevaluationprocessinplacetoassistindeterminingthe

effectivenessoftheprogram?• DoestheProgramhaveconsultantstheycanutilizetoassistinestablishingtheir

Program?



WHOLEHEALTHCOACHINGTRAININGIMPLEMENTATIONASSESSMENT

Program/CourseAssessed___________________________ ByWhom____________________________

ForWhom_____________________________________________ Date__________________________________QuestionsforConsideration Ratingor

NumberComments

ExtentofProgram NumberofProgramstobeEstablishedbyWhen?

NumberofVeteranstobeServedbyCoaching?

Other OutcomesDesired Vision,Mission,andStrategicInitiativeshavebeenestablished

12345

Milestoneshavebeenestablished 12345 DesiredOutcomeshavebeenclarified 12345 ValuesofProgramhavebeenPrioritized(reduceddependenceonservices,VeteranSatisfaction,cost-benefit,improvedbiomarkers,goalachievement)

12345

Other ProgramAlignswithNBHWCProjectedAccreditationStandards

Numberofpre-Servicetraininghoursmeetprojectedstandard

12345

Numberofdocumentedpracticehourshasbeenestablished

12345

Numberofmentoredhourshasbeenestablished

12345

Mentors,trainers,andsupervisorsmeetprojectedNBHWCcriteria

12345

Contentofpre-servicetrainingmeetsnationalstandard

12345

Knowledgetesthasbeendeveloped 12345 Performancetesthasbeendeveloped 12345 SelectioncriteriahasbeenestablishedthatmeetsNBHWCrequirements

12345

OngoingCEUswillbeavailableforhealthcoaches

12345

ScreeningWHCApplicants AneffectiveWHCapplicantscreeningtoolandprocessisinplace

12345

Other Pre-ServiceTraining



QuestionsforConsideration RatingorNumber

Comments

Trainingflexibletomeetdifferentproviderneeds 12345

ExperientialActivitiesareadequate 12345 LearningModalitiesarevaried 12345 Affectivementoringisavailable 12345 Evaluationplanisinplace 12345 Other CoachingandConsultation(Mentoring) Adequatementoringisavailablepostpre-servicetraining

12345

Mentoringexpectationsareclearandguidelinesareestablished

12345

Mentoringongoingtrainingisavailable 12345 Other ProviderEvaluation Mechanismsareinplacetoprovideongoingfeedbackandevaluationtocoaches

12345

Coacheshaveadequatenumberofobservationsinordertoreceiveongoingfeedbackandevaluation

12345

Evaluationrecordsarekeptaspartoftheemployee’srecord

12345

Opennesstofeedbackistrainedandevaluatedonaregularbasis.Remedialproceduresareclearlydelineatedforimprovement

12345

Other AdministrativeSupport Coacheshaveclearlydelineatedlinesofsupervision 12345

Leadershipisfullyawareof,andsupportiveof,coachingProgramatthelocation

12345

Coaches’performancestandardsareconsistentwithcoachingexpectations

12345

Coachesaregivenadequatetimeandresourcestocoach

12345

CoachingpositionshavebeencreatedaspartoftheVHAemploymentprocesses

12345

Coachesarefullyawareofproceduresforsupportandreferrals

12345

ProgramhasanadequateamountofFTEequivalenciestomeetCoachingInitiatives

12345

CentralOfficesaresupportiveoftheVHACoachingProgram

12345

VISNandCenterDirectorissupportiveofCoachingProgram

12345



GeneralComments:

QuestionsforConsideration RatingorNumber

Comments

Mid-levelManagementandSupervisorsaresupportiveofCoachingProgram

12345

Other ProgramEvaluation AnongoingProgramevaluationprocessandtoolhasbeenclearlydevelopedandisinplace

12345

OngoingResearchandevaluationarepartoftheProgram

12345

Other ContinuumofServices Thereisacontinuumofservicesclearlyestablished 12345

ThecontinuumofservicesisadequatefortheVHAneeds

12345

Cliniciansareawareof,andclearlyinformedof,thecoachingservicesavailable

12345

Veteransareawareof,andclearlyinformedof,thecoachingservicesavailable

12345

Other StaffCoachingandWellness Avarietyofcoachingforstaffwellnessisavailable 12345

Supportisavailableforstafftotakeadvantageofwellnesscoaching

12345

Other MarketingofServices Veteransareadequatelyinformedofcoachingservices

12345

ClinicalStaffisfullyinformedofcoachingservices

12345

Other



CHAPTERSIX:GROUPCOACHING

TothispointintheManual,thefocushasbeenonindividualcoaching.However,groupcoachingisapotentiallypowerfulmodalitytowhichthecoachingstyles,processesandstrategiescanbeapplied.Groupcoachingoffersavarietyofopportunitiesandchallengescomparedtoindividualcoaching.Inthischapter,weexaminesomeoftheseopportunitiesandchallengesandprovideseveralframeworks,aswellastechniques,forhowgroupcoachingmightbeconducted.Aswiththeindividualcoachingchapters,we

willprovideasetofpotential“maps”forgroupcoaching.However,theactualgroupjourneymaynotunfoldaccordingtoanyparticularmaporframework.Thesesuggestedframeworksareonlyastartingpointforcoachestobeginconceptualizinghowtheymaywanttoinitiateandconductgroupcoaching.

OPPORTUNITIESWITHGROUPCOACHING

Groupcoachingprovidesopportunities,oradvantages,forcoaches,Veterans,andorganizations.Someoftheseadvantages/opportunitiesare:

VETERANS’ADVANTAGES/OPPORTUNITIES

• Learnfromeachother.Veteransareabletohearfromothersabouttheirchangeprocessesandthinkabouthowtoapplywhattheyheartotheirownlearningandchangeprocess.

• Supporteachother.Asgroupmembersdevelopcamaraderie,theyareabletooffersupporttooneanother,bothduringthegroupmeetingsaswellasoutsidethegroupsetting.Veteranshaveasharedsenseofmissionandaregenerallyverysupportiveofoneanother–thiscanbeharnessedtotheirbenefitingroupcoaching.

• Reducedcost.Veteransmightrealizeareducedcostforgroupsessionsincomparisontoindividualsessions.

• Learnwithothersinsimilarsituation.NotonlydoVeteranslearnaboutthechangeprocessbylisteningtoothergroupmembers,buttheyalsomaylearninformation,especiallyiftheyareworkingonasimilarissue(i.e.,diabetes,heartdisease).

COACHES’ADVANTAGES/OPPORTUNITIES

• Workwithseveralindividualsatonetime.CoachesareabletoworkwithseveralVeteransatonetime;thishastheadditionaladvantageofaccomplishingmoreVeterancoachinginagiven timeframe.

Ifyouwanttogoquickly,goalone.Ifyouwanttogofar,go

together.

– Africanproverb



• Allowsforcoachingbyexample.Veteransobservethecoachcoachingothergroupmembersand,inmanycases,beabletoapplywhattheyareobservingtotheirown situations.

• Severalsourcesforlearning.GroupVeteranswillnotonlylearnfromthecoachbutwilllearninformationaswellaschangeprocessesfromothergroupmembers.

ORGANIZATIONALADVANTAGES/OPPORTUNITIES

• Abilitytogetmemberscoachedinashorterperiodoftime.Largeorganizations,whowanttoimpactoverallhealthoftheorganization,willbeabletogetthe

• target audience trained/coached in a shorter expanse of time compared to individual coaching.

• Reducedcosts.Groupcoachingmightbelessexpensivetoanorganizationthanindividualcoaching.

• Supportforteameffort.Byworkingingroups,asopposedtoindividualcoaching,membersoftheorganizationwillmorelikelydevelopsupportforeachotheranddevelopa“teameffort”approachwithintheorganization.Thiswillespeciallybethecaseiftheorganizationhaschosentotargetspecifichealthbehaviors.

Groupcoachingalsopresentssomeuniquechallengesthatmaynotbeencounteredasfrequentlyinindividualcoaching.Thesechallengesinclude:

• Balancingequaltimeforgroupmembers.Inmanygroups,someVeteranswilltendtotalkmorethanothers.Attimes,itcanbeachallengeforthecoachtogiveallmembersequalopportunitiestospeak.Respectfulgroupmanagementiskeyinthese

• situations. • Notallgroupmemberswillbesupportiveofeachother.Notallgroupmembers

may“like”eachotherorwanttosupporteachother.Theremaybeconflictsamonggroupmembersthatmustbeaddressedinorderforthegrouptofunctioninaneffectivemanner.

• Groupmaytakeonanegativedynamic.Groupscantakeonmanydynamics,impactingtheeffectivenessofthegroup.Ifsomegroupmembersbecomeunhappywiththeirexperienceitcouldimpactthegroupdynamicsinanegativeway.

• Groupmembersmaybeindifferentplacesinchangeprocess.Morethanlikelygroupmemberswillbeindifferentplacesinthechangeprocess.Whilesomewill stillbedecidingonafocus,othersmaybereadytotakeaction.Thismay



providesomelearningopportunities,butalsomayprovidechallengesforthecoach.

• Groupmembersmaynotalwaysbepresentforeachsession.Withindividualcoaching,ifaVeteranisunabletomakethesession,itcanfrequentlyberescheduled.Withgroups,itwouldbemuchmoredifficulttorescheduleforthesakeofoneortwogroupmembers.Ifgroupmembersareunabletoattenditwillhaveanimpactongroupdynamicsandthenon-attendingmemberswillbeatadisadvantageinnotexperiencingtheeventsofthesessiontheymissed.

• Maintainingawarenessofbothgroupandindividualdynamics.Asinanygroupprocessthereisanartandchallengetostayingawareofbothgroupdynamicsandindividualmember’sprocesses.Ifcoachesfocustoomuchonindividual

• member’s processes, they may “lose” other group members. If the focus is on group dynamics, members may think that not enough time is being devoted to their individual needs.

• Membersmaybeworkingondifferenthealthissues.NotonlywillVeteransbeindifferent places in the change process, but they may also be working ondifferenthealth

• issues. This may be a challenge if members are not able to extrapolate from another member’s content area and apply it to their own.

• Confidentialitymaybeanissue.Coacheswillnotbeabletocontrolwhatothergroupmembersdowithdisclosuresinthegroup.Althoughconfidentiallyshouldbeaddressed,itdoesnotassurethatallgroupmemberswilladheretotheconfidentialityagreements.

SETTINGUPAGROUP–SOMECONSIDERATIONS

Thereareamultitudeofdecisionscoacheswillneedtomakebeforesettingupgroupcoachingsessions.Asthegroupcontinuesitsprocess,additionaldecisionsmayneedtobemadealongtheway.Thesedecisionpointswillbeoutlinedbelowalongwithideasforconsideration.

GroupSize.Therearemanyfactorstoconsiderwhendetermininghowlargeacoachinggroupshouldbe.Thesefactorsinclude:

• Availability.HowmanyVeteransareavailableatanygiventime?Iftoomuchtimeelapseswhileagroupiswaitingtoform,Veteranswhosignedupinitiallymaybecometiredofwaitingtoget started.

• Amountofindividualtime.Tosomeextent,coachesneedtodecideaheadoftime howmuchapproximatetimetheywanttoprovideforeachgroup



member.This willhaveimpactonthenumberofgroupmembers.Ifagroupbecomestoounwieldyintermsofnumbers,individualmayfeel“lost”inthegroup.Ifagroup istoosmall,groupmembersmaynotbenefitasmuchfromlearningfromothers.Tosomeextent,thiswillbedeterminedbythevaluesofthecoaches,andhoweffectivetheybelievetheycanbeinlargerorsmallergroups.

• Costeffectiveness.IftheVHAisconductinggroupcoaching,theymayhaveacertainnumbertheywanttogetcoachedeachtime,giventheunitcost.

OpenorClosedGroup.Inaclosedgroup,allmembersbeginandendatthesametime.Nonewmembersareallowedtojointheclosedgroup.Inanopengroup,sessionsareongoingwithmembersleavingorjoiningatdifferenttimesandfordifferentlengthsoftime.Theadvantageofaclosedgroupistheintimacyandtrustthatgetsestablishedamonggroupmembers.Also,allmembersareawareofwhathasbeensharedhistoricallywitheachmember.Therewillnotbememberscomingandgoing.Anopengrouphassomeadvantagesaswell.Veteransdonothavetowaittojoinandhavefreedomtoenter/leavethegroupaccordingtotheirownwants/needs.

Veteranscancomeandgoaftertheybelievetheyhaveachievedwhattheywanttoachieve.Withnewmemberscomingintoagroup,thegroupdynamicschange;newideasandnewdynamicscanbestimulatingtothegroupprocess.

TelephonicorIn-PersonSessions.Thecoachwillneedtodecidethenumberofsessionsthegroupwillmeetinpersonandthenumberoftelephonicsessionswillbeheld.Grouptelephonicsessionscanpresentnewchallengesbeyondthoseofindividualtelephonicsessions.Itmaybedifficulttoassessgroupmembers’processwithmorethanonepersononthephone.Itrequiresalotmore“checkingin”toseewheregroupmembersare.Groupdynamicsmaybemoredifficulttoassesswithoutthenon-verbalcues.Theadvantagesoftelephonicsessionsarethesameasfortelephonicindividualsessions.Theyrequirelesstraveltime,aneedforspace,andallowforgreaterflexibilityintermsofhavingtobeinacertainlocation.

Ifcoachesusetelephonicsessions,theymaywanttoaddressthefollowing:

• Apersonalcommitmentnottomulti-taskwhengroupmembersareonthephone.

• Groupmembersmayneedtoidentifythemselveswhentheybegintospeak.• Groupmemberscommittolisteningwhenothersarespeaking.• Toreduceoreliminatebackgroundnoisewhenparticipatinginthetelephonic

group.



SingleThemed.Agroupcouldbefocusedonasinglehealthconcernsuchasdiabetesorheartdisease.Asingularlyfocusedgrouphasseveraladvantages:

• Groupmembersmayfeelagreaterbondwhendealingwithsimilarissues.• Groupmemberswillmorethanlikelyfeelasiftheyarewithotherswho

understandwhattheyaregoing through.• Groupmemberswilllearninformationfromeachotherthatpertainstotheir

issue.• Coachescanbemorefocusedonwhatinformationtopresent.• Chancesaregreatertheywillcontinuetosupporteachotherafterthegroup

sessionsareover.LengthofGroupProcess.Thecoach(ortheorganization)needstodecidehowmanysessionsthegroupwillbeandoverwhatperiodoftime.Thismaybeeasiertonegotiatewithanindividual.Inthecaseofagroup,thecoachmayhavetodeclarethelengthofthegroup.Itmaybedifficulttodeterminealengthiflefttoa“democratic”process.

• Lengthoftimeandhowmanysessionswillalsobeinfluencedbythepurposeofthegroup.Somegroupscouldbeopen-endedintermsoflength,especiallyifgroupmemberswantedtoworkonseveralissuesorserialissues(i.e.,oneright

• afteranother).Agroupthathasaspecificissuewithaspecificoutcomecanmoreeasilylimitthenumberofsessionsanddurationofthegroup.

• Timebetweensessionswillalsohavetobedetermined.Coacheswanttogivegroupmembersenoughtimetoprocessand/ortryoutnewactions.However,toomuchtimebetweensessionscouldbedetrimental,especiallyforthosewhoarestrugglingwithexecutingnewactions.Manycoacheswouldfindthatformostgroups,anythinglessthanoneweekbetweensessionsistooshortandanythingover2weekswouldbetoolong.

EducationalComponent.Again,dependingonthepurposeofthegroup,itmaybeadvantageoustohaveaneducationalcomponent.Ifthegrouphasasingularhealthissuetheyaredealingwith,guestspeakerswithexpertiseinthathealthissuemaybebeneficial.Ifthecoachisknowledgeableinthehealtharea,theymaywanttoprovidesomeeducationoreducationalresources.Also,thegroupmemberscouldbetaskedtofindoutinformationonvariousaspectsofthehealthissue.Aswithindividualhealthcoaching,coachesmustbecarefultoavoidgivingmedicaladvice.Likewise,ifthematerialcomesfromgroupmembers,itshouldnotbeconstruedasthesameasexpertmedicaladvice.Coachesshouldsuggesttogroupmembersthatanyinformationtheymayreceiveinthegroupshouldbecheckedoutwiththeirmedicalproviders.



AmountandTypeofGroupStructure.Somegroupscouldoperatewithverylittlestructureandbesuccessful.Coachescouldbeginsessionswithveryopen-endedquestions,suchas“Whathaveyoulearnedsincelastsession?”andessentiallygofromthere.Theycouldusewhateverarisesinthesessiontomakesalientpoints.Or,coachescouldbeverystructured,planningthequestionsandformatthatwillbeusedforeachsessionandstrictlyfollowingthosequestionsandformat.Theformatandstructurewillbedeterminedbytheoutcomeintentofthegroup.Forinstance,agroupthathasbeenstructuredaroundweightlossmayrequiregreaterstructurethanagroupwhoseintentistoimproveeachmember’soverallhealth.

CoacheswillalsohavetodetermineiftheyaregoingtotakethegroupthroughtheWholeHealthCoachingProcessasagroup,orifeachmemberwillbecoacheddependingonwheretheyareintheprocess.Forinstance,coachescouldstartoutagroupbyhavingeverygroupmembertalkabouttheirvisioninthefirstsession.Thegroupdoesnotmoveontovaluesuntileveryonehashadachancetodefinetheirhealthvision.Likewise,thegroupdoesnotmoveontoGoalSettingandPlanninguntileverygroupmemberhaschosenafocus.Clearly,agroupsetupthiswaywillhaveuniquechallenges.Mainly,groupmemberswillbereadytomoveatdifferenttimesandtheywillhavetowaitontheirfellowgroupmembers.

Bycontrast,agroupcouldbesetupsothateverygroupmembermovesthroughthecoachingprocessattheirownpace.Groupmemberswhoarenotnecessarilyinthesamestagecouldstilllearnfromlisteningtoothergroupmembersatthatstage.Coachesneedtobeadeptatrememberingandaddressingeachindividualwheretheywereintheprocess.Theywouldalsohavetobeskilledatpointingoutthelessonsthatcouldbelearnedfromgroupmemberswhoareindifferentstagesintheprocess.

Itmaybehelpfultothinkofsessionshaving3phases:

1) Beginningofacoachingsession-Thebeginningofthecoachingsessionstartswith

someformofcheck-in,whichisusuallyanopen-endedquestionaddressedtoeveryone.Potentialopeningquestionsare:a) “Whatdidyousucceedwiththisweek?”b) “Whatoneworddescribesyourweek?”c) “Whatthemewouldyouusetodescribeyourweek?”

Somecoachesmightwanttobeginwithamindfulawarenessactivitytoassistgroupmembersinbecomingpresent.

2) Bodyofacoachingsession-Thebodyofthecoachingsessionoftenincludesprocessing



themembers’experiencessincethelastsession.Morespecifically,theprogresstowardgoalsandovercomingchallengeswillusuallytakethebulkofthetime.Questionsmaybe:a) “Whatsuccessesdidyouexperiencethisweek?”b) “Whatwasachallengeforyouthisweek?”c) “Wheredidyouexperienceexcitement?”

3) Endofacoachingsession-Letmembersknowyouhaveanallottedamountoftime

left.Aswiththecheck-in,itisimportanttohearfromeveryoneduringcheck-out.Questionsmightinclude:a) “Whatareyoutakingawayfromthisgroupthisweek?”b) “Whatnewbehaviorwillyoudothisweek?”c) “Whatwouldyoulikeus/metoholdyouaccountabletoduringournext

session?”

MissedSessions.Coacheswillneedtoaddress,aheadoftime,howmissedsessionswillbehandled.Willtheabsentmemberneedtomakeupthesessionsomehow?Willtheyhavetolistentoatapeofthesession?Willtheyneedtobebroughtuptodateonwhattheymissed?

BlendingGroupandIndividualInterventions.Onechallengeforcoachinggroupsisbalancingtheamountoftimespentonanyoneindividualandgivingtimetotheoverallgroupprocess.Onewaytobalancethisprocessistostaymindfuloftheamountoftimeyouasacoacharedevotingtothefollowing:

• Coachingindividualgroupmembersandbringingtherelevanceforwardtoallgroupmembers.

• Coachingthewholegroup,askingquestionsforthewholegrouptoconsider,andlisteningforcommonthemesaswellasdifferences.Useresponsestoweaveinteachablemomentsforthewholegroup.

• Groupmemberscoachingeachothercanhavearealimpactforthegroup.Thecoachmayhavetoinvitegroupmemberstocoachbyaskingquestionssuchas“Ifyouwerethecoach,whatwouldyousay,orwhatwouldyouasktheVeteranrightnow?”Thistakesthefocusoffthecoachastheonlyonewhoisabletocoachandallowsformoregroupinteractionsasopposedtoeveryinteractiongoingthroughthecoach.Itmightbeimportanttoremindgroupmembersthatthisisnotanopportunitytoofferadvice,asagreeduponinthegroupdesign/groundrules.



DEALINGWITHDIFFICULTGROUPBEHAVIORORGROUPPROCESSES

Groupscanpresentuniquechallengesthatwillnotlikelybeencounteredinindividualcoaching.Managingthesedifficultiesmayrequireadditionalpracticeandexperiencetobeaneffectivegroupcoach.Someofthesedifficultgroupsituationsmightbe:

Situation:Memberswhomonopolizeorramble

Intervention:“Irespectyourviewpointandamgratefulforyourwillingnesstoshare.Ialsowanttohearfromotherpeopleinthegrouponthistopic.”

Sometimes,groupmembersarenotawareofhowmuchtheyinteractcomparedtoothers.Twowaystoaddressthisare1)Askthewholegrouptobeawareofhowmuchtheyasgroupmembersareinteractingcomparedtoothersor2)Addressitdirectlywiththegroupmember,perhapsonabreakorafterthegroupsession.

Situation:Memberswhotendtocomplainincessantly

Intervention:“Ihearthatthisisupsettingforyou.I’dliketogiveyouanotherminutetoexpressyourviewandthenI’dliketohearfromothers.”

Situation:Memberswhogivefrequentadvicetoothers

Intervention:(Assumingnotgivingadvicehasbeensetupasagroundrule)“Ihearwhatyouareofferingnowasadvice.Howcouldyouchangeyourapproach,andaskaquestionthatwouldallowthepersontoexplorewhatyouareoffering?”

Situation:Sidebarconversations.

Intervention(Assumingthishasbeensetupasagroundrule)Eyecontactwith thesidebarmembers.Ageneralreminderaboutthegroundrulesandsidebarconversations,“Wedidspeakaboutsidebarconversationsinthegroundrules–itishelpfultorememberthem”.Usingproximity(standingnearby)tobringattentiontothespeakers,andthenperhapsaskingparticipantstochangeseatstoseparatethem.Finally,simplyaskingthemtorefrainfromsidebarconversationsforthesakeofthelargergroup.

Someofthesedifficultsituationscanbeavoidedoratleastaddressedbysettingupgroundrulesinthebeginningsession.Memberscouldthenberemindedofthegroundrulesthroughoutthesessions.

SETTINGUPTHEINITIALGROUPSESSION

Thereareseveraltaskscoacheswillwanttobemindfulofastheybeginthefirstsessionofgroupcoaching.Someofthesearesimilartoindividualcoachingfirsttasksbutmaytakeon



adifferentflavorwhendoingtheminagroupsetting.Thesetasksarepartofdesigningthegroupcoachingalliance:

• Introduceyourselfandyourintentorgoalforthegroup.Youmaywanttoconsiderintroducingyourselfwhenothergroupmembersintroducethemselves,providingthesameinformationtheyprovide.Thiswillcontributetoadifferentgroupdynamicthanifyouintroduceyourselfdifferently,oratanothertimeintheprocess.

• Createguidelinesorgroundrulesforthegroup.Itemssuchasconfidentiality,bottomlining,notgivingadvice,howmemberswillcommunicatewithoneanother,andattendanceareallissuesthatcouldbeaddressedduringthistime.Coachesmaywanttoprovidesomeofthegroundrules,whileothersmaybegeneratedfromthegroup.Generally,memberswilltakemoreresponsibilityandownershipforcarryingoutorenforcinggroup-generatedgroundrules.

• Emphasizethatthegroupwillbeinteractive,focusedondialogueandnotbesimplytheforumforthecoach.

• Providethegroupinformationonthestructureofthegroupandhowyouenvisionthegroupprocesstakingplace.

• Besuretoallowadequatetimeforeachgroupmembertobeheardinthefirstsession.

• Providesomerelatively“safe”open-endedquestionsthatallgroupmemberscanrespondto.

ENDINGTHEGROUPEXPERIENCE–THELASTSESSION

Thereareseveralpointscoacheswillwanttokeepinmindwhenendingthegroupexperience.Theseare:

• Areviewofwheregroupmembershavecomefromovertime,andwhatchangestheyhavemade,isusuallyveryusefulandmotivating.

• Havingmembersstatewhattheyhavelearnedthatcanbeappliedtootherareasoftheirlivescanbehelpfulinhavingthemidentifychangestrategies.

• Sharinglastthoughts,theymaywanttoexchangewithothermembersofthegroup.• Havinggroupmembersnotonlyidentifywhattheyhavelearned,butalsothink

aboutwhatotherareaoftheirlifetheymaywanttoworknext.• Feedbackforthecoachintermsofwhathasbeenhelpfulaboutthegroup,aswellas

howthegroupcouldbeimproved.• Exchangeofcontactinformationifappropriate.



CHAPTER7:PRE-SESSION,FIRSTSESSION,ANDLASTSESSIONCONSIDERATIONS

Thischapteraddressessomeuniqueconsiderationsthatcoacheswillwanttoconsiderinbeginningandendingcoaching.

PRE-SESSION

CoachesmaywanttothinkofprovidingVeteransapacketofinformationthatincludesthefollowingbeforethecoachingsessionsstart:

Abriefdescriptionofwhatcoachingis.Veteransmaynotbefamiliarwithwhathealthcoachingis.Abriefbrochureonwhathealthcoachingis,andwhathealthcoachingisnot,mayprovidetheVeteranwithinformationaboutwhattheymaybeencountering.IfVeteransarereferredbyotherhealthcareprovidersortheirPACT,itwouldbeusefultobegivenabrochureorhandoutatthetimeofthereferralalongwithanopportunityfortheVeteranstoaskquestions.

AdescriptionofwhattheVeteran’sresponsibilitiesis,andwhattheCoach’sresponsibilitiesare,intheCoachingsessions.ThismayhelptoclarifywhatcoachingisfortheVeterans.Afewoftheseideasare:

• TheVeteranwillberesponsiblefortheagendaandwhattheywanttoworkon.• ThecoachingwillbeconductedinthecontextofwhatmatterstotheVeteran.• Coacheswillmakeeveryefforttoprovideasafeandsupportiveenvironmentand

willhonortheinterestsoftheVeterantoaddress(ornotaddress)whatevertheVeteranbringsup.

• Coachingisnotonlyaboutlearningandgaininginsight,butabouttakingactionaswell.

• TheVeteranwillbeexpectedtodothework;thecoachistheretoguidetheprocessandsupportthem.

Anyinventoriesorassessmentsthatthecoacheswouldliketohaveavailableforthefirstsession.Forinstance,somecoachesmaywanttheVeteranstocompletethePHIbeforecomingtothefirstsession.Ifthatisthecase,theyshouldprovidethePHIseveralweeksinadvancewithspecificinstructionsinfillingitoutalongwithsomeguidanceabouthowitwillbeused.

Anylogisticsaboutthecoachingsessions.Directionsonwheretogo,howtogetthere,thelengthofsessions,howmanysessions,expectationsforbeingontime,areallpartofthelogisticsthatshouldbeprovidedtotheVeteran.



FIRSTSESSION

Thefirstsessioncanbeveryimportantindevelopingtrustandsettingthetoneforfuturecoachingsessions.Likeanyhelpingprofession,effortsshouldbemadetojoinwiththeVeteran,usingcommoncourtesieswhengreetingandmeetinganotherpersonforthefirsttime.AskingtheVeteranwhattheyneedtobemorecomfortablewouldbeanexample.Alsoaskingaboutwhatinformationtheywouldliketoknowaboutthecoachingsessionsmaybeimportant.

Providinga“healing”spacethatispeaceful,uncluttered,quiet,andnotpronetodistractionsorinterruptionswillbeimportantinpromotingafavorable“firstimpression”.CoachesshouldmakeeveryefforttobefullypresentfortheVeterans,perhapspreparingfortheencounterbypracticingsomemindfulawarenesspriortothesession.

TheVeteransmayhavequestionsaboutconfidentialityandwhoelse(otherproviders)willhaveaccesstoanyinformationtheymayshareintheirsessions.CoachesshouldbehonestwiththeVeteransandsharewhattheirroleisinrelationtoanyotheroftheVeteran’shealthcareproviders.

LASTSESSION

Endingthecoachingrelationshipcanassistinleavingafavorableimpression(andperhapsreferrals)fortheVeterans.Moreimportantly,askingtheappropriatequestionscanassistinpreparingtheVeteranforthefuturewithoutthesupportofcoaching.QuestionsfoundpreviouslyundertheGroupCoachingLastSessionsectionarealsoappropriateforindividualcoaching,thosequestionsare:

• AreviewofwheretheVeteranhascomefromovertime,andwhatchangestheyhavemade,isusuallyveryusefulandmotivating.

• HavingVeteransstatewhattheyhavelearnedthatcanbeappliedtootherareasoftheirlivescanbehelpfulinhavingthemidentifychangestrategies.

• Sharinganylastthoughts,theymaywanttoexchangewiththecoach.• HavingtheVeterannotonlyidentifywhattheyhavelearned,butalsothinkabout

whatotherareaoftheirlifetheymaywanttoworknext.• Feedbackforthecoachintermsofwhathasbeenhelpfulaboutthecoaching,aswell

ashowthecoachingcouldbeenhanced.• Sinceregoodbyes.



SESSIONIIICONTENT



CHAPTER8:MINDFULAWARENESSANDCOACHINGPRESENCE

MindfulAwarenessandCoachingPresencearefoundationaltocoaching,andthetermsareoftenusedinterchangeably.Presenceisanessentialqualityandskillofaneffectivecoach.ItisaNBHWCcorecompetency.

“Coachiscalm,present,andemotionallyavailable”(NBHWCContentOutline1.1.1)

“Engage[s] in self-awareness practices, including emotional self-regulation”

(NBHWCContentOutline4.1.3)

Beingpresenttakespractice.Similartomusclememory,presencerequiresintention,awareness,andrepetition.

HOWMINDFULAWARENESSSUPPORTSTHECOACHINGPROCESS

Mindfulawarenessservesthecoachingprocessby:

• Enablingthecoachtotrackthesenseofconnection,energy,andfeelingsforbothselfandclient.

• Providingthecoachwithvaluableinformationtoguidethesessionmosteffectivelyinserviceoftheclient.

• Aidingthecoachinnoticingthoughts,judgments,andopinions. Thereisanemergingbodyofresearchtodocumenttheimpactofmindfulawarenessonsupportiveandtherapeuticpresence.Researchhasshownthatpatientoutcomesimproveevenwhenpatientsorclientshavenoideathattheirpractitionerwaspracticingmindfulawareness.Theclientalsodoesnotneedtoknowanythingaboutmindfulawarenesstoexperiencethisbenefit.Itsimplycomesfromthepractitioner’spresence.Oneexampleofaresearcharticledescribingthedetailsofthiscanbefoundatthislink:

https://www.attach.org/wp-content/uploads/2015/05/Therapeutic-Presence-and-Polyvagal-Theory-2014.pdf

MINDFULAWARENESSPRACTICES:FORMALVERSUSINFORMAL

Adistinctionismadebetweenformalandinformalpracticesofmindfulawareness.Bothtypesarepracticedwithintentionandbotharegenerallyseenascomplementingoneanother.Additionally,bothtypesofpracticesupportone’swell-beingandenhancecoachingeffectiveness.



Formalmindfulawarenesspracticeisthemeditationpracticeofremainingstill,usuallyinaseatedposition,oftenwitheyesclosed,whilenoticinginternalandexternalsensations.Suchpracticescanbeself-guidedorledbyanotherperson.Examplesincludeawarenessofbreathorsound,bodyscan,mindfulwalking,andmindfuleating.

Informalmindfulawarenesspracticemeansconsciouslybringingyourfullattentiontosomethingyouarealreadydoing,likewashingdishesorpettingthecat.Theideaistobringyourfullattentiontotheunfoldingexperience,andwhenthemindwanders,bringyourattentionback.

WHATMINDFULAWARENESSIS–ANDWHATITISNOT

Mindfulawarenesshasseveraldistinguishingfeatures.Theseinclude:

• Beingawareinthemoment,withcompassiontowardselfandothers.• Noticingexternalstimuli(sights,sounds).• Bringingattentiontointernalsensations(breath,body)andourresponsestothem.• Bringingattentiontoourmentalphenomena.• Listeningtothepersonal,innerwisdomofourowninterconnectedself-care

circles.

Meanwhile,thereareseveralotherusefulpracticesthatmayincorporatesomeoftheabovefeaturesbutarenotconsideredmindfulawareness.Someexamplesare:

• GuidedImageryandVisualization.• ProgressiveMuscleRelaxationandotherrelaxationpractices.

Otherpracticesaremoreformalapplicationsofmindfulawareness.Theseformalpracticesgobeyondsimplynoticingyourpresentmomentexperience,sowedistinguishthesefrommindfulawareness.

• YogaandTaiChi.• Meditation.• Mindfulness-basedStressReduction(MBSR).

Notethattheterms“mindfulawareness”and“Mindfulness”areoftenusedinterchangeablyineverydaylanguage.TheOfficeofPatient-CenteredCareandCulturalTransformation(OPCC&CT)drawsadistinctionwhichisdiscussedinfurtherdetailattheendofthischapter.



STEPSFORGUIDINGAMINDFULMOMENT

Asacoach,itisappropriatetoguideVeteransinamindfulmomentatthebeginningofacoachingsession,sobothcoachandVeteranbecomepresentandgrounded.ThisshortpracticetrainstheVeterantobecomeawareofwhatthebodyandmindaredoing;thisskillmayalsohelptheVeteranlistendeeplytowhatreallymattersduringacoachingsession.Thefollowingaregeneralstepsthatcanbeusedtoguideamindfulmoment.

• Beginbyaskingpermission.• Encouragefindingacomfortableposition.• Inviteclosedeyes,loweredgaze,orsoftvisionfocus.• Bringattentiontothebreath(noticeinhalation,chest/bellyriseandfall,exhalation).• Whenattentionwanders,noticewithoutjudgementwhereitwent.• Gentlybringattentionbacktothebreath.• Allowpauses-thispermitspeopletopractice.• Bringpracticetoaclose.• Checkin(“Whatdidyounotice?”)

MINDFULAWARENESSVS.MINDFULNESS–VHARESOURCES

TheOfficeofPatient-CenteredCareandCulturalTransformation(OPCC&CT)makesadistinctionbetweenmindfulawarenessandMindfulness.MindfulawarenessisinthecenteroftheCircleofHealthandisaboutnoticing,beingfullypresent,andpayingattentiononpurpose.

MindfulnessfacilitationandinstructionrequiresspecializedtrainingandisbeyondthescopeofWholeHealthCoachtraining.ForcoacheswhoareinterestedinfacilitatingMindfulness,thereareresourcesinternalandexternaltotheVAthatwouldbehelpfultoexplore.Inparticular,trainingintrauma-sensitiveMindfulnessisespeciallyimportant,sothatpractitionerscanbehelpfulwithoutcausingharmtotheVeteranswithwhomtheywork.

Forthoseinterestedinlearningmore,thebestplacetobeginisbypursuingtrainingthroughareputableprogramandbeginningtopracticeyourself.Ifthepracticeresonateswithyou,youmaywanttopracticeinformalmindfulawarenesswithVeterans,payingconsciousattentiontotheunfoldingexperienceofyourinteraction.However,intheroleofcoach,andwithoutpropertraining,itisnotappropriatetoteachMindfulnesstoVeterans.Instead,allowyourcoachingpresencetogiveVeteransthesharedexperienceofmindfulawareness.



MINDFULAWARENESSSCRIPTS

AsstatedpreviouslyintheMindfulAwarenesssectionofChapter2,MindfulAwarenessisnoticing,awareness,andattention.Mindfulawarenessisnotguidedimagery,relaxation,normeditation.Beforebeginningamindfulawarenessmoment,offersetupcommentsincludingaskingpermissiontoofferamindfulmoment.

INCLUDESET-UPCOMMENTS

• “I’dliketoofferamindfulawarenessmoment.Wouldthatbeokwithyou?”• “Thismaynotbeforeveryone”• “Closeyoureyesifyoulike,orleavethemopen”• “Disregardmyvoiceatanytime”• “Stopanytimeyouareexperiencinganydiscomfort”• “Rememberthisisabout‘payingattentiononpurposeandnotnecessarilyabout

relaxation.”

AWARENESSOFBREATHSCRIPT

• Settleinandfeelthesupportofthechairorfloor.• Allowyoureyestocloseorsetasoftgazearoundtheroom.• Remembertomaintainattitudesofnon-striving,non-judging,andpayingattention.• Thisisatimetoletgoofbusinessorlife’sconcerns.• Nowpayattentiontoyourbreathwhereveryouexperienceit.Don’ttrytochangeit,

justpayattentiontoit.Feelthebreathascompletelyaspossible,theinhaling,pausing,andexhalingofthebreath.Itmaybeeasiertofocusonyourbellyduringtheexperienceofbreathing.

• Whenyounoticethatyourattentionissomewhereelse,congratulateyourselfandgentlyreturntothebreath.Youwillprobablyneedtodothismanytimes.

• Noticethesoundofyourbreath,thewarmthofyourexhales,andthecoolnessofyourinhales.

• Ifyounoticeoutside(orinside)distractions,simplynoticethem,andthenpatientlyreturnyourfocusbacktoyourbreathing.

• Noticethelengthanddepthofeachbreath.• Practicethiswayaslongasyouwish.• Allowyourselftorestandlookmoredeeplyasyousettleintothis.• (Aftertimeisup)Whenready,youmayendyourmindfulawarenesssessionby

simplyopeningyoureyes.

PRACTICEOFMUSCLEAWARENESSSCRIPT

First,findacomfortableposition,withyourbackfeelingsupportedbythechairandyourfeetsupportedbytheground.Sometimeswesaysittingwithafirmbackandanopenheart.Takeadeepbreath;letitoutslowly.Whatwe’llbedoingisalternatelytensingandrelaxing



specificgroupsofmuscles.Aftertension,amusclewillbemorerelaxedthanpriortothetensing.

Concentrateonthefeelofthemuscles,specificallythecontrastbetweentensionandrelaxation.Intime,youwillrecognizetensioninanyspecificmuscleandbeabletoreducethattension.

FocusontensingonlythespecificmusclegroupIcalloutateachstep.Trynottoholdyourbreath,grityourteeth,orsquint.Breatheslowlyandevenlyandthinkonlyaboutthetension-relaxationcontrast.(Notetofacilitator:Eachtensingisfor6seconds;eachrelaxingisfor6seconds.Notethateachstepisreallytwosteps—onecycleoftension-relaxationforeachsetofopposingmuscles.)Aswithothermindfulawarenesspractices,youmaynoticeyourmindwanders.Ifitdoes,justgentlybringitbacktothesensationsinyourbody.Youmaycloseyoureyesorsetasoftgazearoundtheroom.

(Optionalinstruction:Iwillcountslowlytosixwhileyoutenseandrelaxeachmusclegroup.)

1. Hands.Tenseyourhands,makingafist(6secs).Nowrelaxyourhands,fingers

relaxedinyourlap(6secs).

2. Bicepsandtriceps.First,makeamuscle—shakingyourhandstomakesureyouarenottensingthemintoafist(6secs).Nowrelax,droppingyourarmstothechair(6secs).Nowtenseyourtriceps,tryingtopushyourstraightenedarmstowardstheback(6secs).Nowdropthemandrelax(6secs).

3. Shoulders.Pullyourshouldersback(6secs)andthenrelaxthemtoneutral(6secs).Pushtheshouldersforwardasifhunching(6secs).Andthenrelaxthemtoneutral(6secs).

4. Neck(lateral).Withtheshouldersstraightandrelaxed,turnyourheadslowlytotheright,asfarasyoucan(6secs);nowrelaxtothefront(6secs).Turnyourheadtotheleft(6secs);andrelaxtothefront(6secs).

5. Neck(forward).Digyourchinintoyourchest(6secs);nowrelax,bringingtheheadforwardtoneutral(6secs).(Tiltingtheheadbackisnotrecommended).

6. Mouth.Openyourmouthasfaraspossibleandhold(6secs);nowrelaxthemouth(6secs).Bringyourlipstogetherandpursedastightlyaspossible;hold(6secs);nowrelax(6secs).

7. Eyes.Openyoureyesaswideaspossibleandhold(6secs);nowrelax(6secs).Closeyoureyestightly,holdingasquint(6secs);nowrelax(6secs).

8. Back.Withshouldersrestingonthebackofthechair,pushyourbodyforwardso



thatyourbackisarched(6secs);nowrelax(6sec).

9. Butt.Tensethebutttightlyandraisepelvisslightlyoffchair(6sec);nowrelax(6secs).

10. Thighs.Raiseyourstraightenedlegsabout6”offthefloororthefootrest–trynottotensethestomachasyoudothisandhold(6secs).Nowrelax(6secs).

11. Stomach.Pullinthestomachasfaraspossibleandhold(6secs);relaxcompletely(6secs).Pushoutthestomachortenseitasifyouweregettingreadyforapunchinthegut(6secs);nowrelax(6secs).

12. Calvesandfeet.Pointthetoes(withoutraisingthelegs)andhold(6secs);relax(6secs).Pointthefeetupward,asifyouwerepullingyourtoestoyourshinsandhold(6secs).Nowrelax(6secs).

13. Toes.Withlegsrelaxed,digyourtoesintothefloor(6secs);relax(6secs). Thatconcludesourbodyscanwithmusclerelaxationexercise.Takeacoupleofdeepbreaths,openyoureyesiftheyareclosed,andlet’scontinuebydiscussingtheexperience.

MINDFULEATINGSCRIPT

FacilitatorInstructions:Thisexercisecanbedonewithoneorseveralfooditems.Itmaybeadvantageoustohaveseveralsmallfooditemsavailable,sotheparticipantcanmindfullynoticethechoiceofanitemtheychose.Youwillhavetoplanaheadtomakesuretohavefooditem(s)available.

1. Startbyfindingacomfortablesittingposition.

2. Takethreeslow,deepbreathsandnoticehowyoufeelphysically.

3. (ifapplicable)Payattentiontothechoiceoftheitemyouchose.Onwhatbasisdidyouchoosethisitem?

4. Placethefooditeminyourhand.Don’teatitquiteyet.Noticehowyouwouldnormallyputtheiteminyourmouthwithouttakingthetimetofullyappreciateit.Nowpretendthisisthefirsttimeyou’veeverseenthefooditem.

5. First,feeltheweightofthefooditeminyourhand.Isitheavierthanyouimagined?

6. Now,takealookatthefooditem.Seeitasifforthefirsttime.Whatdoyounoticethatyoumayhavenotnoticedbefore?

7. Imaginewheretheitemcamefrom.Wasitproducedlocallyorbroughtoverfromaverydifferentplace?Thinkabouthowmanypeoplewereinvolvedinbringingthisitemtoyoutoday.

8. Slowlybringtheitemclosetoyournose.Doesithaveasmell?Doesthatsmell



remindyouofaneventfromthepast?

9. Continuetonoticeanypositiveandnegativethoughtsyouhaveabouttheitem.Noticewhatyoumightbeexpectingittotastelikeatthispoint.Isyourmouthstartingtomakesalivainanticipationofeatingthefooditem?

10. Eversoslowly,placetheiteminyourmouth,withoutbitingintoit.Useyourtonguetopushtheitemagainsttheroofofyourtongueandthenagainstthebackofyourteeth.

11. Keepthefooditeminyourmouthforatleast10moresecondswithoutchewingandnoticehowittastes.

12. Now,youarefinallyreadytoeatthisitem.Softlybiteintotheitemandcontinuechewingitasmanytimesasyoucan.Trytochewtheitematleast15timesbeforeswallowingit.

13. Onceyouhaveswallowedtheitem,takeamomenttositquietlyandnoticehowyoufeel.Didthisprocessmakeeatingtheitemmoresatisfying?

Youcanrepeatthesestepswithotherfoods.Youcanalsopracticeaquickerversionofthiswithmealsjustbypayingmoreattentiontowhatyouareeatingandlettingallofyoursensesexperienceafoodbeforeyouswallowit.

LOVINGKINDNESSMEDITATIONSCRIPT

We’regoingtobeginwithanewMindfulAwarenesspracticecalledLoving-Kindness.Findacomfortablepositionwithyourbackrestingagainstyourchairandyourfeetsupportedbythefloor.Thispracticecanbeintenseforpeople.Ifyoudecideyoudon’tlikethispracticeatanypoint,justtreatmyvoice-asIguidethepractice-asyouwouldanynoisethatmightdistractyou.Youdon’thavetofightmyvoiceandyoudon’thavetofollowiteither.Justturnyourattentiontoyourbreath.

Allowyoureyestocloseorsetasoftgazearoundtheroom.

Now,takefiveabdominalbreaths,breathinginandoutatyourownpace.Remember,youdon’thavetochangeyourbreathingpattern,justtakedeep,fullbreathsinyourowntime.

Thenwe’llstartthefourphrases.Thereareseveraldifferentwaystodothispractice.Youwillrepeatthephrasesquietlytoyourself.Bringingyourselfintofocus,offerthefollowingphrases:

• MayIbehappy.(pause)• MayIbehealthy.(pause)



• MayIbesafe.(pause)• MayIbepeaceful.(pause)

(Repeatthesephrasesonemoretime.)

Now,directingyourattentiontosomeonewhomyoulike—maybeafriend,familymemberorapet,offerthesephrasestothem:

• Mayyoubehappy.(pause)• Mayyoubehealthy.(pause)• Mayyoubesafe.(pause)• Mayyoubepeaceful.(pause)(Repeatthesephrasesonemoretime.)

Nowdirectingloving-kindnesstowardssomeoneorsomethingthatmaybecausingyounegativeemotions.Picturingthatpersonandbringingintofocus,andofferingthefollowingphrases:


Nowofferingthistothoseintheroomandbringingthegroupintofocus.Andofferingthefollowingphrases:

• Mayyoubehappy.(pause)• Mayyoubehealthy.(pause)• Mayyoubesafe.(pause)• Mayyoubepeaceful.(pause)(Repeatthesephrasesonemoretime.)(Optional,dependingontime.)

Nowofferingthistoeveryoneinourworld:


Finally,onceagaincomingbacktoyourself:

• MayIbehappy.(pause)



• MayIbehealthy.(pause)• MayIbesafe.(pause)• MayIbepeaceful.(pause)(Repeatthesephrasesonemoretime.)

Nowfinishingwithfivemoredeepabdominalbreaths.Andopeningyoureyeswhenyou’refinished.

MINDFULWALKINGINSTRUCTIONS

LetParticipantsknowthattodayyouaregoingtointroduce‘Mindfulwalking’.Thisactivityisaboutfocusingattentionontheactualexperienceofwalking—noticinghowyourfeettouchthesurfaceonwhichyouarewalking.

Tobegin,haveparticipantspracticewalkingintheroomforaminuteorsojusttogetthesenseofwhatit’sliketopayattentiontotheirfeetcontactingthefloor.

Givethem5minutestowalkeitherinthebuildingoroutsideifpossible.Havethemwalkinsilence,nottalkingtoothers.

Havethemnoticethefollowing:

• Whatit’slikejusttowalk,continuingtonoticetheirfeetcontactingthesurfaceonwhichtheyarewalking.

• Noticetheirspeedofwalking.• Whatelsetheymaynoticewhentheirmindorattentiongoessomewhereelse:

sights,sounds,orothersensations-thingstheymayneverhavenoticedbefore.• Practicebringingtheirattentionbacktotheirwalkingwhentheirattentionhasgone

elsewhere.Letthemknowthetimewhenyouwantthembackintheroom.

BODYSCANMINDFULAWARENESSPRACTICESCRIPT

Thisisatimetotallysetasideforyou,andtobewithyourself.Atimeforrenewal,rest,andhealing.Atimetonourishyourhealthandwellbeing.Rememberthatmindfulawarenessisaboutbeingwiththingsastheyare,momenttomoment,astheyunfoldinthepresent.Letgoofideasaboutpersonaldevelopment.Letgoofyourtendencyforwantingthingstobedifferentfromhowtheyareandallowthemtobeastheyare.Giveyourselfthespacetobeasyouare.Youdon’tevenneedtotrytorelax.Relaxationmayhappenoritmaynot.Relaxationisn’ttheaimofthebodyscan.Ifanything,theaimistobeawareofyourexperience,whateveritmaybe.



1. Loosenanytightclothing,especiallyaroundyourwaistorneck.Youmaycloseyoureyesorsetasoftgazearoundtheroom.Youmayliketoremoveyourshoes.(Pause)

2. Beginbyfeelingtheweightofyourbodyinthechair.

3. Noticethepointsofcontactbetweenthatandyourbody.Eachtimeyoubreatheout,allowyourselftosinkalittledeeperintothemat,bed,orchair.(Pause)

4. Becomeawareofthesensationsofyourbreath.

5. Youmayfeelthebreathgoinginandoutofyournostrils,orpassingthroughthebackofyourthroat,orfeelthechestorbellyrisingandfalling.Beawareofyourbreathwhereveritfeelsmostpredominantandcomfortableforyou.(Pause)

6. Whenyou’reready,moveyourawarenessdowntheleftleg,pastthekneeandankleandrightdownintothebigtoeofyourleftfoot.

7. Noticethesensationsinyourbigtoewithasenseofcuriosity.Isitwarmorcold?Nowexpandyourawarenesstoyourlittletoe,thenallthetoesin-between.Whatdotheyfeellike?Ifyoucan’tfeelanysensation,that’sokay.(Pause)

8. Expandyourawarenesstothesoleofyourfoot.

9. Focusontheballandheelofthefoot.Theweightoftheheel.Thesidesandupperpartofthefoot.Theankle.Then,whenyou’reready,letgooftheleftfoot.(Pause)

10. Repeatthisprocessofgentle,kind,andcuriousacceptingawarenesswiththelowerpartoftheleftleg,theknee,andtheupperpartoftheleftleg.(Pause)

11. Noticehowyourleftlegmaynowfeeldifferenttoyourrightleg.(Pause)

12. Gentlyshiftyourawarenessaroundanddowntherightleg,tothetoesinyourrightfoot.(Pause)

13. Becomeawareofyourpelvis,hips,buttocksandallthedelicateorgansaroundhere.(Pause)

14. Moveuptothelowertorso,thebelly,andlowerback.(Pause)

15. Bringyourattentiontoyourchestandupperback.

16. Feelyourribcagerisingandfallingasyoubreatheinandout.Bemindfulofyourheartbeatingifyoucan.(Pause)

17. Gotobotharmstogether,beginningwiththefingertipsandmovinguptotheshoulders.(Pause)

18. Focusonyourneck.

19. Thenmoveyourmindfulattentiontoyourjaw,noticingifit’sclenched.Feelyourlips,insideyourmouth,yourcheeks,yournose,youreyelidsandeyes,yourtemples,



yourforeheadandcheckingifit’sfrowning,youreyes,thebackofyourhead,andfinallythetopofyourhead.Takeyourtimetobewitheachpartofyourheadinamindfulway.(Pause)

20. Nowletgoofallefforttopracticemindfulness. Getasenseofyourwholebody.Feelyourselfascomplete,justasyouare.Rememberthissenseofbeingisalwaysavailabletoyouwhenyouneedit.Restinthisstillness.

Pauseandtheninviteyourcoachingpartnerorgrouptoreturntheirfocustothepresentmoment.



CHAPTER9:ADVANCEDCOACHINGSKILLS

CoachesattendingtheWHCTrainingareexpectedtohaveasoundandfoundationalgraspofthecoachingqualities,skills,andstrategiesspecifictotheProcessModelstages.TheSession3curriculumfocuses,largely,onsomemore“advanced”coachingskillsandprocesses.Thischapterwillintroducethoseadvancedcoachingskills.Theabilitytolearn,understand,andutilizetheseskillswillenhancethecoaches’currentpracticewithVeterans;andincreasetheirknowledgeinanticipationofsuccessonthenationalexam.

METAPHOR

Metaphorisanotheradvancedcoachingskillor“tool”inthecoach’stoolkit.Manypeopleusemetaphorintheirdailyconversationsasawaytoexpresstheirthoughtsandfeelingswithavisualanalogy.Incoaching,metaphorscanbeofferedbythecoachtodeepentheconversation,furtherexplore,andencourageforwardmovement.ThecoachmayalsoheartheVeteranuseametaphor,anditcanbeeffectiveforthecoachtoreflectthisback.

WHYAMETAPHOR?

Ametaphorisafigureofspeechthatdirectlyreferstoonethingbymentioninganother,suchas“stuckbetweenarockandahardplace”or“I’montopoftheworld.”Anotherwaytothinkaboutmetaphorisavisualanalogy;metaphorconveysapicturethatcapturestheessenceofwhatisbeingsaid.Utilizingmetaphorisusefulbecauseitcreatesimagesinthemindthattapintoaclient’screativity,unlockingideasandpotential.

Researchhasshownthatusingmetaphorstodescribeathought,feeling,orcircumstancedoesmorethansimplyhelpingusunderstand.Metaphorsactivatepartsofthebrainassociatedwithtouch,feeling,andmovement,thusmakingametaphoricalstatementmorepowerfulthanitsliteralcounterpart.Theuseofmetaphor,therefore,mayofferthecoachdeeperinsightintotheVeteran’suniqueperceptionoftheirsituation,maycreateenlightenmentfortheVeteran,anditmayshifttheVeteran’sperspectiveinhowtheyseethemselvesortheirsituation.

USINGMETAPHORINTHECOACHINGROLE

MetaphorisapowerfultoolforboththecoachandtheVeteran.Toeffectivelyusemetaphorinthecoachingrole,itisimportanttolistentotheVeteran’suniquelanguageinordertoofferanappropriateandusefulmetaphor.DoingsohelpsbuildrapportwiththeVeteranandletsthemknowtheyareheard.MetaphorsthatincorporatetheVeteran’sownlanguagecanalsohelpdeepentheconversation,solidifyanidea,andincreasetheVeteran’smotivation.



IfaVeteranexpressesathought,feeling,orcircumstanceusingametaphor,useit!Reflectitback,worktoweaveinthemetaphorthroughoutthecoachingsession,andseeifittakestheconversationdeeper.Asacoach,ifyouofferametaphorforwhattheVeteranhassaid,playwithit.Recognizethatthemetaphormaynotlandorlast.IftheVeteranshowsnoenergyinfollowingthepathofmetaphor,letitgo.

EXAMPLESOFCOMMONMETAPHORS

ThefollowinglistofmetaphorsaretakenfromGavin,J.,&Mcbrearty,M.(2019).Lifestylewellnesscoaching.Champaign,IL:HumanKinetics(p.188)

Ifeelbluetoday.Ifeelontopoftheworld.Ifeelflighty.Ifeelinsideout.Ifeelblownaway.

She’scuteasabutton.Shehasaheartofgold.She’sawitch.She’samoneymagnet.She’sanangel.She’sadevil.

Life’sabeach.Life’sabowlofcherries.Life’sarollercoaster.Life’sjustadream.Life’sahardroadtotravel.Life’sagift.

He’scoldasice.He’sarock(asnake,apig,aknightinshiningarmor,adiamondintherough).

Timeismoney.Astitchintimesavesnine.Don’tcryoverspilledmilk.Makehaywhilethesunshines.Abirdinthehandisbetterthantwointhebush.Apennysavedisapennyearned.

INTERRUPT&REDIRECT

HealthcoachingrequiresafinebalancebetweenallowingtheVeteranfullautonomyinasessionwhilealsomaintainingthesessionstructure.Oneofthecoach’sresponsibilitiesistoholdthefocusandstructureofasessionfortheVeteran.TheskillofInterruptandredirectisanadvancedcoachingskillusedtoensurethefocusofacoachingsessionismaintained.

Culturally,weareoftentaughtnottointerrupt.Incoaching,however,interruptingisausefulskillwhenintentionallyandgentlyemployed.Beforefurtherexploringtheskillofinterruptandredirect,itisimportanttodifferentiatebetweenunconsciousinterruptingandconsciousinterrupting.



CONSCIOUS&UNCONSCIOUSINTERRUPTING

Unconsciousinterruptingoftenhappensinconversationswithoutpeopleevenrealizingtheyareinterrupting.Itisoftenaresultofnottrulylistening,andnotwaitingtoheartheendofastoryorathought.Unconsciousinterruptinginvolvesthetendencytointerjectone’sownopinionmidsentenceornoteffectivelypausing.

Consciousinterruptingisanintentionalredirection;itisdonewiththeintentiontoserveabiggerprocessorreason.Incoaching,consciousinterruptingisutilizedwhenthecoachunderstandsthereisaneedandpurposetoredirecttheVeterantobestservetheirsession.Consciousinterruptingmaybeusedto:

• Focus. • Redirect. • Exploredeeper.

THEPURPOSEOFINTERRUPT&REDIRECTASASKILL

Whenusedappropriatelyandwithintention,interruptandredirectgivesthecoachanothertooltoensureeachcoachingsessionmeetstheneedoftheVeteran.Interruptandredirectcanbeusedinavarietyofinstances,someofwhichinclude:

• Toredirectbacktothecoachingconversation. • Tokeepthecoachingprocessontrack. • TohelptheVeteranstayfocusedonwhatismostimportant. • Topauseandofferappropriateaffirmationoracknowledgment.

Itisimportanttonotethatinterruptandredirectisnotusedasanopportunitytoinsertthecoach’sopinion.Rather,thecoachgentlyinterruptstheVeteranandguidestheconversationbacktothecoachingfocuswithaquestion,reflection,oracknowledgment.

THESKILL

Beinginterruptedoftenleaveaspeakerfeelingembarrassedorself-conscious,sometimestothepointofshuttingdowntheirabilityordesiretocontinuespeaking.Therefore,itisimportantforthecoachtobeawareofhowtointerruptwithagentle,intentional,andrespectfulapproach.

Thecoachistheexpertoftheprocessandstructureofeachsession.TheskillofinterruptandredirectisdirectivebutcanbeusedinawaythatstillallowstheVeteranautonomywithinthesession.First,askingpermissiontointerruptatthebeginofacoachingsessioncanreducemanyofthenegativefeelingsaVeteranmightexperiencewhenbeing



interrupted.Second,interruptingwiththeintentionofgainingtractionandmaintainingforwardmovementaroundtheVeteran’schosenfocussupportsVeterangoalsandautonomy.

WHENTOINTERRUPT&REDIRECT

DecidingwhentointerruptandredirectrequiresanunderstandingoftheVeteran’sfocus,personalself-awareness,andknowledgeofsessionstructure.Belowaresomeexamplesofsituationswhereinterruptandredirectmaybeusefulandhowitmaysoundduringacoachingsession:

• TheVeteranhassaidalotandthecoachrecognizesaneedtobottomlineorsummarize

o “You’vesaidalot–howcanyoubestsaythatinonesentence?”• TheVeteran’sstoryisaboutfixing,blaming,orfocusingonsomeoneelse

o “Ihearyoufeel bythisperson/situation.Whenyouthinkaboutthis,whatdoyounoticethatyouhavecontrolover?”

• TheVeteranhassharedsomethingimportantthatneedstobeexploredmoredeeply(struggle,valuesconflict,oversights,etc.)

• “I’mgoingtopauseyouforamomenttodivedeeperintowhatyoujustsaid.”• TheVeteranhasgoneoffonatangentunrelatedtothefocusofthesession• “MayIpauseyouforamoment?Saymoreabouthowthisstoryrelatestowhatyou

wantedtodiscusstoday.” Beforeinterrupting,alwayspauseandconsidertheintention.

HOWTOINTERRUPT&REDIRECT

Aspreviouslydiscussed,beinginterruptedcanoftenleavethespeakerembarrassedorself-conscious.Therefore,itisimportanttoestablishguidelinesforinterruptingearlyinthecoachingprocess.InthefirstcoachingsessionwithaVeteran,clearlyexplainoneofthecoach’sresponsibilitiesistomaintainsessionstructureandfocus;explicitlystatethatinterruptingmaybeoneofthewaysacoachkeepsthesessionfocused.LettheVeteranknowwhyinterruptingisimportantanduseopen-endedquestionsandreflectionstoexplorehowtheVeteranfeelsaboutbeinginterrupted.Finally,asktheVeteran“Whatisthebestwayformetopauseandinterruptyouduringoursession?”Honortheirrequestiftheneedforinterruptandredirectarisesinsubsequentsessions,alwaysredirectingwithintentionandrespect.

USEFULEXAMPLES

InterruptandredirectlookandsoundsdifferentineverysessionandwitheveryVeteran.Belowaremoreusefulexamplesofwaystogentlyinterrupt(I)andredirect(R)aVeteran.



Noticetheprocessofinterruptingisalwaysfollowedwitharedirectionbacktothecoachingconversation.ConsiderrephrasingthesebasedonhowVeteranssharetheywouldliketobeinterrupted.

• “Let’spauseforamoment(I)andnotice(R)…” • “Ihearthisstoryisimportanttoyou(I).Whatdidyoulearn(R)?” • “Youhavealottosay(I)–whatisthemostimportantthingyouwantmeknow

aboutthis(R)?” • “MayIpauseyouforamoment(I)?Iwanttohearwhatismostimportanttoyouin

thisstory(R).” • “Letmepauseyouforamoment(I).Youhavealreadyhadsuccessinthisarea(R).” • “Yousaidyouareinspiredby…(I).Theseareimportantvaluesforyou.Let’sgo

backtohowthesesupportyourhealth(R).”

DECISIONALBALANCE

Veteransworkwithacoachbecausethey’reinterestedinmakingchanges.Decisionalbalanceisatoolthatinvolvesexploring,withnonjudgmentandcuriosity,theprosandconsofmakingachange.

DecisionalbalanceisatooloftenutilizedwhenaVeteranisinContemplation(accordingtotheTranstheoreticalModel/StagesofChange)orexperiencingambivalencearoundaspecificbehaviorchange.Thecoach’sroleistoexploretheprosandconsofchangingandnotchanging,whilemaintaininganattitudeofnonjudgmentandcuriosity.

COACH’SNONJUDGMENT

Maintaininganattitudeofnonjudgmentisakeycoachingqualitythatisespeciallyimportantwhenusingthetoolofdecisionalbalance.NonjudgmentisimportanttofosterasenseofpsychologicalsafetyfortheVeterantoexploreandprocesshonestly.Thecoach’sroleisnottodirecttheVeterantochangeorencourageonesideofchangeovertheother.Instead,thecoachallowstheVeterantofreelyexploreallaspectsofchangingandnotchanging.

CoachingskillsthatsupportanonjudgmentalenvironmentincludeallowingtheVeteranfullautonomy,offeringdouble-sidedreflections,andreflectingchangetalk.Double-sidedreflectionsofferbackbothsidesofthedecisiontheVeteranisconsidering;using“and”insteadof“but”oftenhelpsthereflectionsoundnonjudgmental.Remembertoendthedouble-sidedreflectiononthesideofchange,sincethisisthelastthingtheVeteranhears.ChangetalkisdefinedastheVeteran’sownstatementsthatdescribereasonsformakingchange.WheneveryouheartheVeteransharingreasonsforchange,reflectthechangetalk.



COACH’SCURIOSITY

Inadditiontomaintaininganattitudeofnonjudgment,approachingthedecisionalbalancewithgenuinecuriositywillencouragetheVeterantoexploretheprosandconsofchangingandnotchanging.Askingopen-endedquestionsthathonortheVeteran’sambivalencewillallowtheVeterantoprocessthechangeindependentlyandbuildself-efficacy.Remembertoexplorebothchangingandnotchanging,askingquestionssuchas:

• Whatarethebenefitsofnotchanging? • What’sthedownsidetomakingthischange? • Whatisleadingyoutowanttochange? • Ifyoudochange,whatmightbepossibleinyourlife?

Becreativeandcuriouswiththeopen-endedquestionsyouasktoaddresschangingandnotchanging.

EXPLORINGPROSANDCONS

Auniqueaspectofdecisionalbalanceistakingtimetohonortheadvantagesanddisadvantagesofnotchanging.Often,thisisnotacknowledgedbyhealthprofessionals,butitisamajorobstacleforVeteranstryingtoimplementabehaviorchange,especiallywheninContemplation.ManycoachesfinditusefultoexploretheprosandconsbyhavingtheVeteranlistthemina2x2chart,suchastheonefoundbelow

Noticethatspaceisgiventotheadvantagesanddisadvantagesofbothchangingandnotchanging.IfthematrixisconfusingortoooverwhelmingforaVeteran,simplystartwithalistorpros/cons,oradiscussionaroundtheadvantagesanddisadvantagesofchange.Thekeytodecisionalbalanceisexploringbothsideswithcuriosityandnonjudgment.

Often,completingalistorachartoffersdeeperinsightforboththecoachandtheVeteranthatmaybeusedforongoingexplorationandcoaching.Exploretheadvantagesanddisadvantageswithopen-endedquestionsthatencouragetheVeterantosharemoreabout



theemotion,motivation,andreasonsforchangingornotchanging.Decisionalbalanceisnotaone-timetool;itisanongoingstrategyforprocessingthathonorsthechallengeandambivalencethatmaysurroundbehaviorchange.Theinitialexerciseoftenservesasatemplateforexplorationandinsightthroughouttheentirecoachingrelationship.

PERSPECTIVES

Aperspectiveisaview,outlook,orlensthroughwhichpeopleseethemselves,asituation,ortheirworld.Itisimportanttorecognizethateveryonehasperspectivesabouteverythingtheydoandexperience.Individualsmayormaynotbeconsciousofalltheirperspectives,but,ultimately,perspectivesinform,create,andinfluenceourbeliefsystems.Perspectivesinfluencehowpeopleinteractwithothers,howtheyinteractwiththemselves,andhowtheyinteractwiththeirworld.

Withregardstocoaching,itisimportanttolistenforthelanguageofperspectives,understandhowperspectivesimpactbeliefsystems,andeffectivelyutilizethecoachingtoolofexploringperspectives.

THELANGUAGEOFPERSPECTIVES

Perspectivescanbebothpositiveandnegative;theyaresimplyalensthroughwhichpeopleviewtheworld.Incoaching,itisimportanttolistenforthelanguageofperspectives.Positiveperspectivescanbeempoweringandmotivating,pushingtheVeterantoreachtheirfullestpotential.Negativeperspectives,ontheotherhand,cancreateinternalbarriers,hinderingtheVeteranfromimplementingchange,tryingnewthings,andreachingtheiroptimalhealthvision.

ListenforsomecommonphrasesthatindicateaVeteranissharingtheirperspective:

• “Ithink…” • “Ibelieve…” • “Inmyopinion…” • “Frommypointofview…” • “I’mjust…”

• “ThewayIseeit…” • “I’mtoo…” • “Ican’t…” • “Iwon’t…”

AmplifypositiveperspectivesandbewillingtoexplorehowthisperspectivemaymotivateorsupporttheVeteranintheirbehaviorchange.ReflectnegativeperspectivesandusethisasanopportunitytoassisttheVeteraninexploringhowaperspectiveisaffectingtheirbeliefsystem,theiractions,andtheirself-talk.Thecoach’sroleisnottochangeaVeteran’sperspective,buttoexploreaVeteran’sperspectiveandinvitethemtoconsiderlookingattheirperspectiveindifferentways.



PERSPECTIVESANDBELIEFSYSTEMS

Perspectivesoftencreateandinformbeliefsystems.Aspreviouslystated,positiveperspectivescanmotivateandempoweraVeteran,pushingthemtomoveforward.NegativeperspectivescanfuellimitingbeliefsandleaveaVeteranfeelingstuckorboxedin,becomingabarriertoforwardmovementincoaching.

ListenempatheticallyandnonjudgmentallyasVeteransshareperspectivesandlimitingbeliefs.Aperspectivemayhaveoncefeltsafe,confined,orcomfortable,but,overtime,theperspectivenolongerfits.Exploringanddevelopinganewperspectivetakestime,growth,andawillingnesstostretch.Similartochange,takingonanewperspectivecanbeadauntinganduncomfortabletask,sobewillingtoaffirmtheVeteran’sefforts,strengths,andwillingnesstostretchthemselves.

EXPLORINGPERSPECTIVES

Exploringperspectivesisacoachingtooltobeusedwhenneeded.Belowareexamplesofscenarioswhenexploringperspectivesmaybeuseful:

• Exploringandovercomingfeelingsofbeingstuck. • Exploringandmovingoutofresistance. • Exploringalimitingbelief. • Exploringnewopportunities. • Exploringanewattitudeorapproach.

Exploringperspectivescanbedeepanddifficultworkthatrequiresuncoveringtheemotions,thoughts,andbeliefsbehindabehavior.Asacoach,recognizethebehaviorastheconsequenceofthedeeperemotions,thoughts,andbeliefsaVeteranholds.Emotionsinfluencebehavior,thoughtsempowerordisempoweractionthroughinnerdialogue,andbeliefsaredeeplyingrainedideasinone’ssubconsciousandunconscious.ThetoolofexploringperspectivesgivestheVeterananopportunitytouncovertheemotions,thoughts,andbeliefsbehindabehavior,withtheopportunitytotryonanewperspective

POWERFULQUESTIONS

PerspectivescanservetomoveaVeteranforward,andtheycanlimitaVeteran,keepingthemstuck.Onethoughtful,meaningfulquestionhasthepowertoshiftperspective.Possibilitiesexistfromeveryperspective.ShiftingalimitedperspectiveorbeliefopenstheVeteranuptonewpossibilities,filledwithpositivityandpossibility.

Asacoach,yourjobisnotto“change”theVeteran’sperspective,buttosimplyofferanopportunitytoexploredifferentwaystolookatasituation.WhenaVeteransharesalimiting



belieforfeelsstuck,thefollowingquestionsmaybeusefultoencouragethemtoconsideradifferentperspective:

• Howmightsomeoneelseseeit?(the‘other’perspective) • Whatmightyoutellsomeoneelse? • Howmightyourolder/wiserselfseeit? • Whatmightyouryoungerself(orachild)saytoyou? • Whatmightbeacompletelyoppositebelief? • Whatwouldbepossibleifyouheldtheoppositebelief? • Whatbeliefwouldopenuppossibilities?

GentlyexplorethenewperspectiveandgivetheVeterantimeandspacetorespond.ReflectanyshiftinperspectiveandrecognizetheVeteranstillmaynotbereadytoadoptanewperspectiveorturnanewperspectiveintoaction.TheexplorationallowstheVeterantoattempttoviewthesituationdifferently.Remember,alotofworkandprocessinghappensbetweencoachingsessions.

EXPLORINGMULTIPLEPERSPECTIVES

FormanyVeterans,adiagramortoolisusefulinexploringdifferentperspectives.WhenaVeteranhasanareaoffocusoragoalinwhichtheyarelimitedinmovingforward,considerinvitingthemtoparticipateinawrittenexercisesurroundingthefocusorgoal.ThediagrambelowisanexampleofavisualtoolthatallowsaVeterantoexploremanydifferentperspectivesaroundaspecificfocusorgoal:



WiththeVeteran,firstinvitethemtoidentifytheareainwhichtheyfeelstuckandthebelieforperspectivetheybelieveisholdingthemback.Checkinoninternalbarriers,limitingbeliefs,thoughts,andemotions.Explorethebehavior,consequences,andpossibilitieswhenoperatingfromthatperspective.

Whenthatperspectiveisexhausted,invitetheVeterantochooseanotherperspectivefromthelistbelow,oroneoftheirownchoosing:

• Oppositebelief. • Friend. • Olderself. • Youngerself. • Trustedmentor. • Successfulself. • Whatwouldyoutellafriendinthissituation? • Other?

InvitetheVeterantoconsiderthethoughts,feelings,andemotionswiththisnewperspective.Explorethebehavior,consequences,andpossibilitieswhenoperatingfromthesecondperspective.

IftheVeterandesires,completetheexerciseoneortwomoretimeswithdifferentperspectives.OncetheVeteranhasexploredmultipleperspectives,explorewhattheynoticed,whatstoodout,andwhattheyaretakingawayfromtheexercise.Remindthemthisisatooltheycanutilizeindependentlywithanylimitingperspectiveorareainwhichtheyfeelstuck.

Exploringperspectivescanopenaworldofpossibilities.Thelanguageofshiftedperspectivesinvolvespositiveself-talkandpositivereframing.Asacoach,whenaVeteranshiftsfrom“Ican’t…”to“Ican…,”“Iwon’t…”to“Iwill…,”or“I’mtoo…”to“Iam…,”reflectitback,amplifytheshift,andacknowledgetheeffortittakestoadoptanewperspective.



CHAPTER10:COACHINGSTRUCTURE

Healthandwellnesscoachingsessionsaretypicallytime-limitedinterventions,designedtosupportbehaviorchangeoverthecourseofseveralmonths.Akeyresponsibilityofacoachistomaintaintheoverarchingstructureofthehealthcoachingprocess,aswellasthestructureofeachindividualcoachingsession.TheNationalBoardforHealth&WellnessCoaching(NBHWC)suggeststhecoachingprocessbeorganizedintoaparticularsequence,witheachcomponenthavingkeyelementscriticaltothebehaviorchangeprocess:

• Coachpreparation. • Initialsession. • Routineongoingsessions. • Closingsession.

Inthischapter,thesessionsandkeyelementsaredescribedindetail.Althoughthelengthofeachsessionmayvaryaccordingtotimeconstraints,coach’sstyle,andVeterancomplexity,itisimportanttoaddressallthecomponents.ThiswillrequireflexibilityandadaptabilityforbothyouandtheVeteran,asyoudeterminethecomponentsforagivensessionandarriveatnaturalstoppingpoints.Pickupatthestoppingpointatthenextsessionsonocomponentsaremissed.

Notethatcoaching“structure”willdeviatefromthecoaching“stages”(Stages1-4)thatareoriginallytaughtintheWholeHealthCoachingmodel.WhiletheWholeHealthCoachingstagesarehelpfultogroupthemesandpartsofthecoachingconversation,theydonotcorrespondtocoachingsessionorvisits.Assuch,thecoachingstructuredescribedbelowdoesnotdirectlycorrelatewithStages1-4;however,youwillrecognizecomponentsfromStages1-4interweavedthroughout.

PREPARATION

Personalpreparationisessentialpriortoanycoachingsession.Notonlyisthecoachresponsibleforpaperworkandlogistics,butalsoensuringthatafocused,mindful,andsafeatmosphereismaintainedforthedurationofacoachingsession.Priortoanycoachingsession,itisrecommendedthecoachsetaside5to10minutestocompletethefollowing:

• ReceiveandreviewallVeteranmaterials(referrals,PHI,previoussessionnotes,etc.). • Secureadistraction-free,confidentialspace. • Confirmtimeanddurationofcoachingsession. • Personalpreparationtoensurecoachispresentandfocused(mindfulawareness

practice).



INITIALSESSION

Theinitialcoachingsessionhasseveralkeycomponentsthataretypicallyaddressedtosetthegroundworkforongoingcoachingsessions:

• Explanationofthecoachingrelationship. • Coachingagreement. • ReviewofPersonalHealthInventory(PHI). • AssessVeteran’scurrentstate(CircleofHealth). • Identifyanareaoffocus. • Nextsteps.

Initialsessionsrangeindurationfrom60-90minutes.ItisimportanttonotethatexploringtheVeteran’svalues,vision,mission,andcurrentstatearefoundationaltotheentirecoachingprocess.Ifa90-minuteblockisnotfeasibleforthecoachandtheVeteran,thecomponentsoftheinitialsessionmaybeaddressedovermultiplemeetings.Considerthetimeavailableandtheconversationathandwhendeterminingwheretodividethecomponentsofaninitialsession,ifnecessary.Besuretocoverallcomponentsoftheinitialsessionbeforeaddressinganycomponentsofanongoingcoachingsession.

INTRODUCTION

Atthebeginningofthecoachingprocess,brieflyintroduceyourselfandallowtheVeterananopportunitytointroducethemselves.Usecurious,open-endedquestionsandreflectionstoexplorewhatmotivatedtheVeterantoparticipateincoaching.TheinitialsessionisanimportanttimetolistenandconsideriftheVeteranisanappropriatecandidateforcoaching.Veteransdisplayingsignsofmentalillnessorsubstanceabusewhoarenotalsoworkingdirectlywithamentalhealthprofessionalmaynotbeappropriateforcoaching.

RememberthatthecoachingrelationshipwillbenewtomanyVeterans.Therefore,itisimportanttotaketimetoexplainthecoachingrelationship,thecoachingprocess,andreviewcoachandVeteranresponsibilities(seesectionbelow).Usingopen-endedquestionsandreflections,explorewhattheVeteranhasheardaboutcoaching.Askpermissiontosharehowhealthcoachingisdifferentfromotherhealthcarerelationships:

• CoachingisVeteran-centered(i.e.,Veteransaretheexpertsintheirownlife). • Coachingisnottherapy. • Coachescannotprescribeordiagnose. • Veteransareactiveparticipantsinthecoachingprocess(expectedto“do”mostof

thework). • CoachingisacollaborativepartnershipbetweenthecoachandtheVeteran.

Afterintroducingthecoachingrelationship,itmaybehelpfultopauseandelicitanyquestionsorconcernsfromtheVeteran.Onceallcomponentsoftheintroductionhavebeen



addressed,pausetotakeamomentandexplaintheagendafortheremainderoftheinitialsession.

VALUES,VISION,ANDSTRENGTHS

AkeycomponentoftheinitialsessionisunderstandingwhatmakestheVeteran“tick,”ortheirvalues,vision,andstrengths.Usingopen-endedquestionsandreflections,explorethefirstthreequestionsoftheVeteran’sPersonalHealthInventory(PHI).Considerasking:

• Whatmattersmosttoyouinyourlife? • Whataresomeofthestrengthsthatarehelpingyoubesuccessful? • Wheredoyouseeyourselfinthreetofiveyears?

Inaddition,encouragetheVeterantosharewhattheyseeastheirmission,aspiration,andpurpose(MAP)inlife.ExploretheirMAP,howitconnectstotheirvalues,vision,andstrengths.OffermultiplereflectionsandacknowledgmentsoftheVeteran’svaluesandstrengths,rememberingtopausetoallowtheVeterantimeandspacetoexpandordeepentheconversation.

AVeteran’svalues,vision,strengths,andMAParekeymotivatorsforbehaviorchange.Ensureadequatetimeisspentexploringeachofthesecomponents.Asacoach,youwillregularlyrevisittheVeteran’svalues,vision,andstrengthsinongoingcoachingsessionstoincreasetheVeteran’smotivationforchange.NotonlywillaVeteran’svalues,vision,andstrengthsbeimportantforthecoachtoknow,buttheyareimportantforaVeterantorecognizeandverbalize,increasingmotivation,buildingcompetence,andimprovingself-efficacy.

ASSESSCURRENTSTATE

TheCircleofHealthisaself-careassessmenttoolthatallowstheVeterantoexplorewheretheyareandwheretheywanttobeindifferentareasofself-care.WhilesomeVeteransmaywanttodiscussallareasontheCircleofHealth,itisnotalwaysnecessarytodoso.Instead,startbyaskingtheVeterantoidentifyareasinwhichtheygavethemselvesahighernumber,andexplore.Followingthisdiscussion,asktheVeterantoidentifyareasinwhichtheygavethemselvesalowernumber.ForeachareaontheCircleofHealththeVeteranwantstodiscuss,ataminimum,ask:

• Whatnumberdidyourateyourself? • Whatdoesthatnumbermeantoyou? • Wherewouldyouliketoseeyourself? • Whatwouldyourlifelooklikeifyouwereata ?



Aseachsectionisexplored,listenforgapsbetweenwheretheVeteranisandwheretheVeteranwantstobe.Considerexploringdeeperusingpowerfulquestionsinadditiontothequestionsabove(“Whatelse?”).EncouragetheVeterantoconsidertheimpactofmakingachangeinaspecificarea,whatmakesthatareaimportant,andwhatelsewillbepossibleintheirlifewhentheydomakeachange.AllowtheconversationaroundtheCircleofHealthtobeanexploration,notaproblem-solvingsession.Useopen-endedquestionsandreflectionstofullyexploretheVeteran’svisionoftheiroptimalhealth.OncetheCircleofHealthhasbeenfullyexplored,theVeteranhasaclearerpictureofwheretheyareandwheretheywanttobe.

FOCUSANDNEXTSTEPS

AfterexploringtheCircleofHealth,invitetheVeterantoidentifyoneortwoareastheywouldliketofocusoninthenextthreetosixmonths.Usingascalingquestion,assessimportancearoundthisareaoffocus.Iftimeallows,exploreimportanceusingscaling(0-10)andrelatethefocusareabacktotheVeteran’svalues,usingareflection.

Toclosetheinitialsession,brieflyaddressthefollowing:

• Giveanoverviewofthenextsession(settingalong-termgoal) • Setanactionbeforenextvisit(“Beforeournextsession,whatisonethingyou’dliketo

tryinyourareaoffocus?”) • AsktheVeteranforkeytakeaways/learnings • Confirmthetimeforthenextvisit

EventhoughtheVeterandoesnotyethavealong-termgoal,besuretoinvitetheVeterantocommittosometypeofactionbeforethenextvisit.Thecoachingprocessisaboutconsistentforwardmovement,soitisimportanttheVeteranhassomethingtoworkoninbetweeneachcoachingsession.Nexttime,theVeteranwillhavetheopportunitytosharewhattheylearnedwhenattemptingthisaction.ThisisthestandardwaytobegineachRoutineOngoingSession.

ROUTINE-ONGOINGSESSIONS

OngoingcoachingsessionsfollowaspecificstructurethatallowtheVeterantoassesstheirpreviousactionstep,identifyanareaaroundwhichtheywouldlikecoaching,andsetanewactionstep.Mostcoachingsessionswillfollowthestructureoutlinedbelowforongoingcoachingsessions:

• Reviewpreviousactionsteps. • Sessionfocus–wherewouldyouliketogofromhere? • Setnewormodifypreviousactionstep. • Veterantakeaways.



ASSESSACTION

AfterbrieflycheckinginontheVeteran’scurrentstateandofferinganoverviewoftheupcomingsession,assesstheVeteran’spreviousactionstep.Usingopen-endedquestionsandreflections,explore:

• Whatwentwellwiththeactionstep? • Whatdidnotgoaccordingtoplan? • Whatdidyoulearn?

IntentionallyaskaboutVeteransuccessesfirst,ashumannatureistosharewhateverdidnotgorightfirst.ReflectandaffirmtheVeteran’ssuccess,effort,orawareness,eveniftheactionstepwaspartiallycompletedornotcompletedatall.AstheVeteransharesobstaclesorsetbacks,itcanbehelpfultoacknowledgethedifficultyandthenreframeitasalearningopportunity.BesuretoasktheVeteranwhattheylearnedfromtheexperienceandreflecttheirlearnings.

Amplifyanynewinsightsorperspectiveshiftsinthereflection.

SETALONG-TERMGOAL(FOLLOWINGINITIALSESSION)

Animportantpartofthecoachingprocessoccursinthesessionthatfollowstheinitialsession:settingalong-termgoal.InvitetheVeterantosetalong-termgoalintheirarea(s)offocus.Sincetheareaoffocuswaschosenintheinitialsession,check-infirstwiththeVeterantoseeifithaschangedorwillstaythesame.AsktheVeteranwhattimeframetheywanttosetalong-termgoal,typically3-6months.Thelong-termgoalshouldbeabehavioralgoalinSMARTformat(SeeChapteronOutcomevsBehavioralGoals)

Itisimportanttorealizethisstepoccursonlyinthesessionthatfollowstheinitialsession.Duringfutureongoingsessions,itisappropriatetoaskhowtheVeteransfeelstheyareprogressingtowardtheirlong-termgoal.

FOCUS

Inmostroutineongoingsessions,thesessionfocusisanopportunityfortheVeterantodiscusswheretheywouldliketogonext(intoday’ssession).ThesessionfocusshouldbeelicitedfromtheVeteranwithanopen-endedquestion,suchas:

• Wherewouldyouliketogofromhere? • Whatwouldyouliketofocusontoday? • Whatismostimportantforyoutoreceivecoachingaroundtoday?

OncetheVeteranhasidentifiedtheareaoffocus,useanopen-endedquestiontoelicitwhatisimportantaboutthisareaandhowitrelatestotheiroverallhealthandwell-being.



Duringthefocus,usethecoachingskillsofpowerfulquestions,reflections,acknowledgments,andotherskillstoexplorehowmakingachangeinthisareawillimpacttheVeteran’slife.ExplorehowtheareaoffocusconnectstotheVeteran’svision,MAP,andvalues.IftheVeteranisstuckorneedsfurtherinformation,offerbrainstormingorprovideinformationwithElicit-Provide-Elicit.Thefocusshouldconstitutemuchofthecoachingsessionandmayleadtoaneworrevisedactionstep.

NEXTSTEPSANDCLOSING

Afterthesessionfocus,assesstheVeteran’sreadinesstosetanactionstep.Actionstepsinongoingsessionsmaybenew(relatedtothesessionfocus)ortheymaybecontinuationormodificationsofpreviousactionsteps.Foranynewormodifiedactionstep,ensuretheactionstepisbehavioralandinSMARTformat.UseguidingquestionstohelptheVeterancreateanactionstepthatisSMART:

• Howoftenwillyou…? • Whendoyouplanto…? • Whattimewillyou…? • Whatdoyouseeyourselfdoinginthenextweek? • Howwillyoutrackyouractionstep? • Whoorwhatwillhelpholdyouaccountable?

Veteransaremorelikelytobesuccessfulinimplementingactionstepsiftheplaniswelldeveloped.Useopen-endedquestionstoexploreprevioussuccessesandhowtheVeteranmayapplypersonalstrengthstoimplementthisactionstep.Fullyexploreinterpersonal,environmental,andexternalsupports.EnsuretheVeteranhasaccesstotheresourcesnecessarytoimplementtheiractionstep.Inaddition,useopen-endedquestionstoasktheVeteranwhatbarriersorobstaclesmightgetintheway;allowtheVeterantoidentifythebarriersthatmaycomeupintheirownlife.HelptheVeteransetaspecificcontingencyplanforeachbarriertheyidentify.Whenaddressingsupportsandbarriers,ask“Whatelse?”untiltheVeteranhasnothingelsetoshare.

OncetheVeteranhasaclearplan,useascalingquestion(0-10)toassesshowconfidenttheyaretheywillcompletetheiractionstep.IfaVeteranhasaconfidencelessthana7,askthemwhatwouldincreasetheirconfidencetoa7.

ToensuretheVeteranhasaclearunderstandingofnextsteps,itishelpfultoask,“Inyourownwords,whatisyournextstepbeforewemeetagain?”Finally,asktheVeteranwhattheyaretakingawayfromthesession.



CLOSINGSESSION

Theclosingsessionisanopportunitytoreflectonthecoachingprocess,celebratetheVeteran’ssuccesses,andestablishamaintenanceplan.Atthebeginningofthecoachingrelationship,thecoachandVeterantypicallyagreetoacertainnumberofsessionsormonthsofcoaching.Duringongoingsessions,itishelpfultoperiodicallyremindtheVeteranhowmanysessionstheyhavepriortotheclosingsessionsotheycanbegintomentallyprepare.

ASSESSGOALS

Likeongoingcoachingsessions,theclosingsessionstillbeginswithareviewofthepreviousweeks’actionsteps(successes,obstacles,learnings).Ratherthanshiftingtothesessionfocus,timeisspentreviewingtheVeteran’sprogresstowardtheirlong-termgoal(s).

Usingopen-endedquestionsandreflections,invitetheVeterantosharewhatprogresstheyhavemadetowardstheirlong-termgoal.Asyoureflect,fillinanygapsandaffirmtheirprogress.

ReflectonchallengesthatarosethroughoutthecoachingprocessandwhattheVeterandidinresponse.

Someofthequestionsbelowmaybeusefulwhenreviewinglong-termgoals:

• Whatprogressdoyoufeelyouhavemadetowardsyourlong-termgoal? • Whatdoyouconsideryourbiggestsuccessinrelationtothisgoal? • Whatwasmostchallenginginworkingtowardsthisgoal? • Howdidyoudealwiththischallenge?

RecognizethatnotallVeteranswillfullymeettheirlong-termgoals.ItisimportanttonormalizethisfortheVeteranaswell.Affirmanysuccessorprogressinanyarea.HighlightandreflectVeteranlearnings,efforts,andstrengthsdisplayedastheyworkedtowardstheirlong-termgoal.

REFLECT,TAKE-AWAYS

AkeycomponentoftheclosingsessionisofferingtheVeterananopportunitytoreflectonthecoachingprocess.Useopen-endedquestionsandreflectionstoexploreVeteranlearnings,newperspectives,andkeytakeawaysfromthecoachingprocess.SolicitfeedbackfromtheVeteranonthesupportyouofferedasacoach.



SomeofthequestionsbelowmaybeusefulastheVeteranreflectsonthecoachingexperience:

• Whatdidyoulearnfromthecoachingprocess? • Whatisyourkeytakeaway? • Howhasyourperspectivearound…changed? • Whatnewinsights/perspectiveshaveyougained? • Asyourcoach,whatdidIdothatbestsupportedyou? • WhatcouldIhavedonedifferentlytosupportyouasyourcoach?

ListenandreflectnonjudgmentallyastheVeteranshares.Thecoachingprocessisallaboutlearningandgatheringnewinsight,sospendsometimewiththeVeteranastheyreflect.

MAINTENANCEPLAN

Atthispoint,theVeteranispreparingtomaintaintheirprogressandinitiatenextstepsindependently.Thecoachingprocessisdesignedtobuildself-efficacyandempowerVeteranstoimplementbehaviorchangeontheirown,butitisimportanttodiscussamaintenanceplanduringtheclosingsession.Keycomponentstoaddressinamaintenanceplaninclude:

• Supportsneededtomaintainprogress. • Accountability. • Potentialchallengestomaintainingprogress. • Contingencyplans.

Inaddition,theVeteranmaybeconsideringimplementingnewchangesinotherareas.InvitetheVeterantosharewhattheyseeastheirnextstepsfortheirhealthandwellness.Useopen-endedquestionsandreflectionstoexplorewhatsupports,resources,andstrengthstheyhaveastheymoveforward.ItisalsoimportanttoaddresswhatmightsignaltheVeterantheyneedtoreturntocoaching.

Someofthequestionsbelowmaybehelpfulwhenestablishingamaintenanceplanintheclosingsession:

• Whatsupportswillhelpyoumaintainyourprogress? • Whatmightgetinthewayoftheprogressyouhavemade? • Howdoyouplantodealwiththischallenge? • Whatareyournextstepsforyourhealthandwellness? • Whatsupports,resources,and/orstrengthswillhelpyoutakethenextstep? • Howwillyouknowyoumightneedtoreturntocoachingforsupport?



Oncethecomponentsofaclosingsessionhavebeenaddressed,bepreparedtosaygoodbyetothisformoftherelationshipwithaVeteran.AdheretotheguidelinesofyourVHAfacilityanddeterminewhattypeofcontactisappropriatetohavewiththeVeteran.ThismayrangefromtheVeteranusingtheMyHealthyVetSecureMessaging,periodiccheck-insordrop-ins.

COACHANDVETERANRESPONSIBILITIES/EXPECTATIONS

Thecoachingrelationshiptypicallyinvolvesawrittenagreementoutliningmutuallyagreedupontermsfortherelationship,including:

• Lengthofthecoachingrelationship. • Frequencyofsessions. • Adescriptionofthecoachingprocess. • Coachresponsibilities. • Veteranresponsibilities.

Belowisabriefdescriptionofthecoachingrelationshipandresponsibilitiesthatmaybeincorporatedintoaformalhealthcoachingagreement.BothcoachandVeteranshouldhaveaccesstoasignedcopyofthecoachingagreement.

THECOACHINGRELATIONSHIP

Thehealthcoachingrelationshipempowerstheclienttomakechangesthataremotivatingandpersonallymeaningful.AkeytenantofthecoachingrelationshipisthebeliefthattheVeteranistheexpertintheirownlife.CoachingisaboutthepartnershipbetweentheVeteranandthecoach.Thecoach’sroleisNOTthatofanexpertwhodiagnoses,advises,educates,ortellstheVeteranwhattodo.Coachingisnotcounselingortherapy.TheVeteranisanactiveparticipantinthecoachingprocessandisexpectedtodomostofthe‘work’ofcoaching.Thecoach’sexpertiseisintheprocessofsustainablechange,guidingtheVeterantoself-discoverstrategiesthattheVeterancansustainovertime.

VETERANRESPONSIBILITIES

• IwillbeontimeforsessionswithaclearagendaofwhatIwanttofocuson. • Iwillbeauthenticandhonest,especiallyaboutanythingthatdoesnotfeelrightto

me. • Iunderstandthatcoachingisacomprehensiveprocessthatinvolvesallareasofmy

life,andIchoosetodiscloseonlywhatfeelssafeandcomfortable. • Iwillkeepanopenmindtoexplorenewperspectivesandtrynewthings. • Iwillnotexpectthecoachtoprovidesolutionsorsolvemyproblems. • IwillprovideadequatenoticeifIamnotabletoattendacoachingsession. • Imayendthecoachingrelationshipatanytime.IfIchoosetoendthecoaching.



relationship,Iwillgivethecoachadvancenoticeforafinalsessiontosummarizewhatwaslearned.

COACHRESPONSIBILITIES

• Iwillbefullypresentduringcoachingsessions. • Iwillhonorandsupportwhatismostimportanttotheclient. • Iwillberespectful,honest,anddirectinconversation,includingconversations

aboutanythingIfeelmaybeaffectingthecoachingrelationship. • Duringsessions,Iwillcheck-inregularlyonwhattheclientisexperiencing. • Whilekeepingtrackofoutcomes,Iwillfocusoninvitingtheclienttoexplorewhat

theyarelearningaboutthemselvesduringthechangeprocess. • Iwillmakereferralsasnecessary(forthesakeofclientandcoach). • Iwillprotecttheclient’sconfidentialityandPersonalHealthInformation(PHI)in

accordancewithstandardsofdutytoreport.



CHAPTER11:OUTCOMEVS.BEHAVIORALGOALS

Goal-settingtheoryidentifiestwodifferenttypesofgoals:

• Outcomegoals–focusedonadesiredresult,oroutcome. • Behavioralgoals–focusedonaspecificactionorbehavioroverwhichyouhave

control. Veteransoftencometocoachingwiththedesiretosetanoutcomegoal;forexample,“Iwanttolose15pounds”or“Iwanttoquitsmoking.”Whilethiscanfeelmotivatingatfirst,focusingonanoutcomeincreasesthelikelihoodaVeteranwillexperiencefeelingsoffrustrationsorfailureiftheyarenotsuccessful.Ultimately,theoutcomeisoutoftheVeteran’sdirectcontrol.WhattheVeterancancontrol,however,aretheactionsorbehaviorsthatleadtothatoutcome.Therefore,incoaching,itisoftenbettertosetbehavioralgoals.

SettingabehavioralgoalinvolvesfocusingspecificallyonstepsandactionsoverwhichtheVeteranshasdirectcontrol.Achievingabehavioralgoalimprovesself-efficacy,developsskills,andenhancesconfidencearoundspecificbehaviorsthattheVeterancanapplytomultiplesareasoftheirlife.ObstaclesthatarisearoundabehavioralgoalareovercomebytappingintotheVeteran’sstrengthsandsupports,againimprovingself-efficacyandempoweringtheVeterantoovercomefuturebarriers.

Toeffectivelysetabehavioralgoal,encouragetheVeterantodiscusswhatstepsorbehaviorsarenecessarytoachievethedesiredoutcome.Forexample,ifaVeteranhopestolose15poundsinthreemonths,askthemwhattheyhopetobedoinginthreemonthsthatwillleadtotheirdesiredoutcome.Perhapstheywanttobeworkingout4timesaweekoreatingthreeservingsoffruitsandvegetableseachday,orwalkingfor25minutesfivetimesaweek,orcookingfourdinnersathomeeachweek.Eachoftheseisanexampleofabehavioralgoal.Itmayormaynotleadtothedesiredoutcomebutworkingtowardthatgoalwillproduceresultsinthedesireddirection,whilebuildingtheVeteran’sconfidencethattheycan,infact,implementchange.

ConsidersomeofthequestionsbelowtohelpguidetheVeterantowardabehavioralgoal:

• Whatcanyoudothatwillhelpyou ? • Whataresomeofthebehaviorsyouhopetoincorporateinyourlife? • Whatwillyoubeabletodowhenyouaccomplish thatyoucannotdo

now?• Whatstepsdoyouseeyourselftakingtoachievethisgoal?



• Howwillyourlifelookdifferentin3-6monthsthanitdoesnowwhenyouaccomplish______________?

Examples:

OutcomeGoal“WhatresultdoIwanttoachieve?”

BehavioralGoal“WhatwillIdotogetthatresult?”

Iwilllose15poundsin3months. In3months,Iwillexercise4timesaweekfor45minutes.

In6months,Iwillsleep7hours5nightsaweek.

In6months,Iwillmeditatefor30minutesbeforebed5nightsaweek.

In3months,Iwillhavelessanxiety. In3months,Iwillparticipateinyogatwiceaweek.

In4months,Iwillbeabletoruna5K. In4months,Iwillrunfor40minutes3timesaweek.

Whensettingbehavioralgoals,itisimportanttofollowSMARTcriteria:

• Specific • Measurable • Actionable • Realistic • Time-bound

Beginbyestablishingalong-termbehavioralSMARTgoal,andthensettingsmaller,incrementalstepseachsessionthatledtheVeterantowardthelong-termgoal.Afteralong-termbehavioralgoalisset,asktheVeteranwhatisoneactionthatwillgetthemclosertothatgoal.Oraskwhatthefirststepistheywouldneedtotake.Forexample,ifalong-termbehavioralgoalistoeatthreeservingsofvegetableseveryday,anactionstepforthenextweekmightbetoeattwoservingsofvegetablesonTuesdayandThursday.Long-termbehavioralSMARTgoalsareeasiertobreakdownintoactionsteps,increasingthelikelihoodofgoalattainmentandlifestylebehaviorchange.



CHAPTER12:COACHINGTHEORIES

Behaviorchangeisacomplexprocessthatinvolvesmorethanadecisiontochange.Thecomponentsofbehaviorchangerangefromintrinsicmotivationtoneurologicalchangesthatoccurasanewhabitisformed.Thefieldofhealthandwellnesscoachingemergedfromstudiesinmotivation,behavioralneuroscience,andhealthpsychology.Healthcoachesarebehaviorchangeexpertswhounderstandscientifictheoriesthatunderlysustainablebehaviorchange.

Asahealthcoach,itisimportanttobefamiliarwithandutilizebasicbehaviorchangetheories.Inthischapter,youwillfindabriefoverviewofthefollowingtheories:

• TranstheoreticalModel(StagesofChange). • Travis-IllnessWellnessContinuum. • Self-DeterminationTheory. • SocialCognitiveTheory(includingSocialLearningTheoryandSelf-EfficacyTheory). • GrowthMindset.

TRANSTHEORETICALMODEL:SIXSTAGESOFCHANGE

Changeisnotalinearprocess,butoftenacyclicalone.TheTranstheoreticalModelofBehaviorChangeidentifiessixstagesofchangepeoplecyclethroughwhenimplementingbehaviorchange.RecognizingthestageofchangeaVeteranisinwithregardstoaspecificbehaviorchangewillhelpyourecognizethecoachingskillsthatwillbestsupporttheVeteraninimplementingchange.

Abriefdescriptionofeachstageofchangeisoutlinedbelow.AVeteranmaystartatanystageandmayshiftinoroutofonestageduringtheprocessofchange.Itisimportanttonote,Veteransmayalsobeindifferentstageswithregardstodifferentactions.

PRECONTEMPLATION

AVeteraninprecontemplationisnotreadytochangeandhasnointentionofchanginginthenext6months.Asacoach,youmaynoticeaVeteraninprecontemplationwithdrawingorbeingdefensivewhenchangeisaddressed.Youmayalsoheartalkoffailure,lackofawareness,orevenrationalizationofagivenbehavior.

WhencoachingaVeteraninprecontemplation,itisimportanttoholdthespace,listennon-judgmentally,buildrapport,anddemonstrateatrustingrelationship.UtilizingthePHIasaninitialexplorationmayormaynothelptheVeteranidentifyanunhealthybehavior;



allowthistobeacceptableand,instead,inviteinputanddiscussionaroundtheexperienceofcompletingthePHI.

CONTEMPLATION

AVeteranincontemplationseesreasonsbothforchangingandfornotchanging.Contemplationisthefirstsignwherechangeistrulybeingconsidered.Asacoach,youwilloftenheartheVeteranofferingreasonsfornotchanging,orfrequent“Yeah,but…”inresponsetoaspecificbehaviorchange.

WhencoachingaVeteranincontemplation,itisimportanttoholdthedecisionalbalanceandelicitchangetalk.Listenforboththereasonstochangeandnottochangeandreflectbothback.EncouragetheVeterantoverbalizetheprosandconsofchanging.UsevisioningquestionsthatencouragetheVeterantoconsidertheshortandlong-termconsequencesofnotchangingandofimplementingachange.Thecoachmayalsoimproveself-efficacybyaskingtheVeterantoidentifystrengthsandsupportsthatmaytipthebalanceinthedirectionofchange.

PREPARATION

AVeteraninpreparationhasmadethedecisiontoimplementchangeandisbeginningtoprepareforchange.Asacoach,youwillheartheVeterandiscussingthechange,supports,resources,andstrategies.Coachesmayalsohearexcitementaroundchangeorworryandfearoffailure.

WhencoachingaVeteraninpreparation,offerasupportiveenvironmentwheretheVeterancanopenlydiscussboththeirsupportsandtheirpotentialobstacles.EncouragetheVeterantocreatearealisticplanwithSMARTgoalsandcontingencyplans.Themorespecifictheplan,themorelikelytheVeteranwillbetoputtheplanintoaction.

ACTION

AVeteranintheactionstagehasimplementedchangewithinthepastmonthandisworkingondevelopingaplantosustainthechange.Asacoach,youwillheartheVeteranexpressingsuccessaroundimplementingactionsteps.

WhencoachingaVeteranintheactionstage,itisimportanttocontinuetoassesssuccesses,obstacles,andlearningsforeachactionstepinthechangeprocess.WorkwiththeVeterantomodifyactionsteps,ifneeded,creatingcontingencyplansasnewobstaclesarise.SupporttheVeteran’sself-efficacyandconfidencebyregularlyreflectingbackstrengthsandvaluesandlinkingthechangetotheVeteran’soverallhealthvision.



MAINTENANCE

AVeteraninmaintenancehassustainedabehaviorchangeformorethansixmonths.WhencoachingaVeteraninmaintenance,itisimportanttoacknowledgetheeffort,strengths,andsuccessuptothispoint.EncouragetheVeterantoexpandtheirsupportnetworkstoincludeotherswhomaintainasimilarhabit.DiscusspotentialchallengesandthepossibilityofrelapsewiththeVeteran;helpthemidentifystrengths,tools,andcontingencyplanstocopewithfuturechallenges.

TERMINATION/ADOPTION(RELAPSE&RECYCLE)

Onceabehaviorhasbeenmaintainedformorethansixmonths,thecoachhelpstheVeterandeterminebetweenterminationandcontinuedmaintenance.WhencoachingaVeteranatthisstage,youmaysupporttheVeteranastheyworktoimplementnewbehaviors,summarizethebehaviorchangeprocess,andcelebratetheVeteran’saccomplishments.Ultimately,thecoachsupportstheVeterantomovetowardsindependenceinthebehaviorchangeprocess.

Evenafternewbehaviorshavebeenmaintained,thecoachrecognizesthatrelapseisatypicalpartofthechangeprocess.NormalizethisbyremindingtheVeterantheyhavebeenherebefore,sowhatdidtheylearnwhentheywereatthisstage?WhileitcanbedemoralizingfortheVeteran,thecoachremainscuriousandsupportive.AskwhattheVeteranlearnedpreviouslythatcanberecycled.Changeisnotalinearprocess,butoftenacyclicalone.

TRAVISILLNESS-WELLNESSCONTINUUM

TheTravisIllness-WellnessContinuumpresentswellnessindegreesofillnessandwellnessratherthanstatesof“illness”andstatesof“wellness.”Inaddition,theIllness-WellnessContinuumdemonstratestherelationshipofthetreatmentparadigmtothewellnessparadigm.



Thetreatmentparadigm(medication,surgery,therapy,etc.)maybeusedtobringanindividualfromtheillnesssideofthecontinuumuptothe“neutral”point.Similarly,thewellnessparadigmmaybeimplementedatanypointonthecontinuum,helpingindividualsmoveasfartowardswellnessaspossible.

High-levelwellnessisnotdefinedbytheabsenceofillness.Instead,wellnessisdefinedbythechoicesonemakes.Researchhasalsoshownitmatterslesswhereoneisonthecontinuumandmoreinwhichdirectionheorsheisfacing.Asacoach,youcansupportaVeteraninimplementingactionsthatsupporthigh-levelwellness,includingself-care,positiveself-talk,creativity,improvingsurroundings,physicalmovement,activespirituality,positiverelationships,andpsychologicalself-care.UtilizingthePHIandtheCircleofHealthcanhelptheVeteranidentifywherechangeismostneeded.

SELF-DETERMINATIONTHEORY

Self-DeterminationTheoryexploreswhethermotivationisextrinsicorintrinsic,anditidentifieskeyfactorsthatsupportthedevelopmentofintrinsicmotivation.Ingeneral,changeiseithermotivatedextrinsically(byoutsidefactorssuchasmoneyorpraise)orintrinsically(byinternalfactorssuchassatisfactionandfun).Thehigherone’sintrinsicmotivationforchange,themorelikelyitisthebehaviorchangewillbesuccessful.

Self-DeterminationTheorynamesthreeuniversalneedsforpsychologicalhealthandwell-beingthatincreaseintrinsicmotivation:autonomy(notfeelingpersuadedorcontrolled),competence(confidence)andrelatedness(connectednesstoothers).Asacoach,itisimportanttofosterautonomy,competence,andrelatednessineverycoachingsession.

SOCIALCOGNITIVETHEORY

SocialCognitiveTheoryexplorestheimportanceofobservation,imitation,andmodelingonone’sperceivedself-efficacy.ManyVeteransarehesitanttoattemptchangebecausetheydonotbelievetheyarecapableofcreatingandsustaininganewhabit.Inotherwords,theirself-efficacymaynotbehighenoughtobeginthebehaviorchangeprocess.Asacoach,youcanworkwiththeVeterantoimprovetheirself-efficacybyutilizingsociallearningtheoryandself-efficacytheory.

SOCIALLEARNINGTHEORY

Sociallearningtheoryemphasizestheimportanceofobservationandrolemodelsasmotivators.Veteran’swithalowself-efficacymayfirstbenefitfromconsideringrolemodelsorotherswhohaveimplementedasimilarbehaviorchange;seeingthepossibility



ofchangeinothersmayencouragetheVeterantotakethatfirststeptowardschange.AschangeisimplementedandtheVeteranbeginstoexperiencesuccess,theirself-efficacywilllikelyincrease.ThemotivationforchangewillshiftfromtherolemodeltotheVeteran.

SELF-EFFICACYTHEORY

Self-efficacyreferstoone’sconfidenceintheirabilitytoachieveagoaloroutcome.Thelowerone’sself-efficacy,thelesslikelyactionwillbeattempted.Self-efficacyoftenincreaseswithsuccess,sothecoachsupportsSMARTactionstepswhileencouragingtheVeterantoconsidersupports,motivators,andpotentialchallenges.Asthisiscompletedoverandoveragain,theVeteranwillbegintotakeownershipoftheprocess.Overtime,theylearntheyhavetheabilitytonavigatetheupsanddownsofbehaviorchangeontheirown.

GROWTHMINDSET

Growthmindsetisthebeliefthatabilitiesarenotfixedbutcanbecontinuouslyimprovedwithexperimentationandpersistentefforts.Researchhasshownanindividual’sbeliefabouttheirowncapabilitieshasasignificantimpactonmotivation,effort,andresilience.Individualswhobelievetheirabilitiesareincontinuousdevelopmentaremorelikelytotakeonchallengesandchange.

CoachescanhelpaVeterandevelopagrowthmindset.Approachingbehaviorchangeasanexperimentwillsetthestageforchangeasanopportunitytolearnratherthansomethingatwhichtobeperfect.Whenassessingactionstaken,coachesshouldcuriouslyaskaboutsetbacks,listeningforstrengths,efforts,andsmallsuccesses;reflectthesemomentsbackandaffirmanyeffort,forethought,attemptorstrengthyouhear.RegularlydiscussinglearningsfromattemptedactionwillimprovetheVeteran’sresiliencyandcontinuetosupportagrowthmindset.



CHAPTER13:THETRANSTHEORETICALMODEL–COACHINGAROUNDSTAGESOFCHANGE

TheTranstheoreticalModeldescribesbehaviorchangeasacyclicalprocesswithsixdifferentofstagesofchange:

• Precontemplation • Contemplation • Preparation • Action • Maintenance • Termination/Adoption(Relapse/Recycle)

AVeteranmaycometocoachingatanystageinthechangeprocessandmaymoveinandoutofdifferentstagesthroughoutcoaching.Asacoach,itishelpfultorecognizethestageofchangeaVeteranisinandutilizedifferentcoachingskillsaccordingly.Inthischapter,youwillbeintroducedtoeachstageofchange,howtorecognizeeachstage,andusefulcoachingskillsandstrategiesforeachstage.

PRECONTEMPLATION

AVeteraninprecontemplationisnotreadytochangeanddoesnotintendtochangeinthenext6months.

WHATTHEVETERANMIGHTSAY

Asacoach,youmaynoticeaVeteraninprecontemplationwithdrawingorbeingdefensivewhenchangeisaddressed.Youmayalsoheartalkoffailure,lackofawareness,orevenrationalizationofagivenbehavior.AVeteranmayfrequentlysay“Ican’t”or“Iwon’t”inresponsetoaspecificbehaviorchange.

AVeteraninprecontemplationmayhavemultipleresponsestochange.Somemaybeclearlyresistanttochangeandseenoimmediateneedforchange.Somemaywanttomakeachange,butdonotintendtomakeachangeinthenextsixmonths.Somemaybetoldtheyshouldorneedtomakeachange,butdonotintendtomakeachangeinthenextsixmonths.ThecoachshouldrecognizethataVeteranwhodoesnotintendtochangeinthenextsixmonthsisinprecontemplation.

THECOACH’SROLE

Asacoach,listenmindfullywithempathyandnonjudgment.ReflectwhattheVeteransharesandhonortheVeteran’sthoughtsandfeelingsaroundchange.Whenreflecting,



amplifyanyvaluesconflictsyouhear(“Soyourgrandchildrenyoulovesomucharenowonyourcasetostopsmoking”).Reflectthelackofreadinesstochange,andseedchange(“Youaren’treadytochangeyourdietyet”).Usingopen-endedquestionsandnonjudgmentalreflections,explorethereasonstheVeterandoesnotwanttochange.IftheVeteran’sstateisnotanimmediatehealthrisk,allowtheVeterantoexplorefreelyduringthestateofprecontemplation.

RecognizethatsomeVeteransmaybeinprecontemplationbecauseoflowself-efficacy.Usingopen-endedquestionsandreflections,exploretheprosofchange,theVeteran’sstrengths,andtheVeteran’ssupports.Acknowledgeanythought,effort,orpastsuccesstheVeteransharesinthisarea.

OtherVeteransmaybeinprecontemplationbecausetheyaremisinformedabouttherisksoftheircurrentbehavior.Usingopen-endedquestionsandreflections,exploretheircurrentknowledge.

IfaVeteranismisinformed,useElicit-Provide-Elicittoshareinformation.PersonalizetheinformationbasedontheVeteran’sspecificrisk.

USEFULQUESTIONS

ExploringprecontemplationisaboutunderstandingboththereservationsandthemotivationsoftheVeteran.BelowaresomepotentialquestionsthatmaybeusefulwhencoachingaVeteraninprecontemplation:

• Howwillyouknowthatit’stimetochange? • Whatwouldhavetohappenforthistobeaproblem? • Whatexperiencedoyouhavewithtryingtochangeinthepast? • Whatarethebenefitsofchanging? • Whatwillyourlifelooklikein5yearsifyoudon’t ? • Howdoesyourbehaviorimpactothers?

CONTEMPLATION

AVeteranincontemplationseesreasonsbothforchangingandfornotchanging.Contemplationisthefirststagewherechangeistrulybeingconsidered.


Asacoach,youwilloftenheartheVeteranexpressingambivalenceordoubtaroundtheirabilityordesiretochange.TheVeteranmayofferreasonsfornotchanging,orfrequentlysay,“Yeah,but…”inresponsetoaspecificbehaviorchange.AVeteranwhoexpressesa



desiretochangebutstrugglestocommitorfollowthroughonanactionisusuallyincontemplation.

THECOACH’SROLE

WhencoachingaVeteranincontemplation,itisimportanttoholdthedecisionalbalance(seechapteronDecisionalBalance)andelicitchangetalk.HonortheVeteran’sambivalenceandcompetingagendas;listenforboththereasonstochangeandnottochangeandreflectbothback.ElicitmotivationbyallowingtheVeteranspacetoprocesstheprosandconsofbothchangingandnotchanging.

Intentionalopen-endedquestionsarealsousefulwhencoachingaVeteranincontemplation.AskvisioningquestionsthatencouragetheVeterantoconsidertheshortandlong-termconsequencesofnotchangingandofimplementingachange.EncouragetheVeterantosharewhatmakesthechangeworththeeffort.Thecoachmayalsoimproveself-efficacybyaskingtheVeterantoidentifystrengthsandsupportsthatmaytipthebalanceinthedirectionofchange.

USEFULQUESTIONS

Usingdecisionalbalance,coachingaVeteranincontemplationismosteffectivewhenspaceisgivenfortheVeterantoexplorebothreasonsforandreasonsfornotchanging.BelowaresomepotentialquestionsthatmaybeusefulwhencoachingaVeteranincontemplation:

• Defaultself:Ifyoudonothingdifferent,whatwillyourlifelooklikein5years? • Optimalself:Ifyoudomakethischange,whatwillyourlifelooklikein5years? • Evokereasonsfornotchanging:Whatareyourreasonsfornotchanging?Whatare

theconsequencesofchanging? • Evokereasonsforchanging:Whatismotivatingyoutoconsiderthischange?What

arethebenefitsofchanging? • Whatmakesthischangeworththeeffort? • Howdoesmakingthischangehonoryourvalues? • Howwouldyourlifebebetterif…? • Whatwillhelpyoumakethischange?

PREPARATION

AVeteraninpreparationhasmadethedecisiontoimplementchangeandisbeginningtoprepareforchangewithinthenextmonth.




Asacoach,youwillheartheVeterandiscussingthechange,supports,resources,andstrategies.TheVeteranmaysay“Iplanto…”or“Iamgoingto…”.Coachesmayalsohearexcitementaroundchangeorworryandfearoffailure.

THECOACH’SROLE

WhencoachingaVeteraninpreparation,shiftthefocusfromelicitingmotivationtobuildingbehavioralskills.OfferasupportiveenvironmentwheretheVeterancanopenlydiscussboththeirsupportsandtheirpotentialobstacles.WorkwiththeVeterantocreatearealisticplanwithSMARTgoalsandcontingencyplansthatfitstheirlifestyle.Themorespecifictheplan,themorelikelytheVeteranwillbetoputtheplanintoaction.AssesstheVeteran’sconfidencearoundimplementingtheplanusingascalingquestion(0-10).IfaVeteranexpressesconfidencelessthan7,useopen-endedquestionstoexplorewhatwouldimprovetheirconfidence.

USEFULQUESTIONS

CoachingaVeteraninpreparationisfocusedongarneringsupportsandskillsthattheVeteranmayusetosuccessfullyimplementabehaviorchange.BelowaresomepotentialquestionsthatmaybeusefulwhencoachingaVeteraninpreparation:

• Howwillyoumakethischange? • Whatisthefirststepyouarewillingtotake? • Whenwillyoudothis? • Whatsupportsdoyouneedtotakethefirststep? • Whatmightgetintheway? • Whatisyourbackupplan?

ACTION

AVeteranintheactionstagehasimplementedchangewithinthepastmonthandisworkingondevelopingaplantosustainthechange.


Asacoach,youwillheartheVeteransharingsuccessandobstaclesaroundimplementingbehaviorchange.TheVeteranmightsay“Iamdoing…”,“Iattempted…”,or“Thisweek,Itried…”.AVeteranintheactionstageisactivelyworkingtoimplementabehaviorchange.

THECOACH’SROLE

WhencoachingaVeteraninAction,itisimportanttoassesssuccesses,obstacles,andlearningsforeachactionstepinthechangeprocess.Supportsmallsuccesses,acknowledge



effort,andreframeobstaclesaslearningopportunities.Normalizeobstaclesandsetbacksaspartoftheongoinglearningprocessinvolvedinanybehaviorchange.

Whenmodifyingorcreatinganewactionstep,ensureeachactionstepisintheSMARTformatandclearlyalignswiththeVeteran’slong-termgoaloroverallhealthvision.Assesssupports,accountability,obstacles,contingencyplans,andconfidenceforeachactionstep.EnsuretheVeteranhasaclearplaninplaceaftereachsession.SupporttheVeteran’sself-efficacyandconfidencebyregularlyreflectingbackstrengthsandvaluesandlinkingthechangetotheVeteran’soverallhealthvision.

USEFULQUESTIONS

• Whatwentwellwithimplementingthechange? • Whatobstaclesdidyouencounter? • Whatdidyoulearnwhentryingthisaction? • Whatsmallstepwouldyouliketotakenext? • Whatsupportsdoyouneed? • Whatmightgetintheway? • Whatwillyoudoif ?Whatisyourcontingencyplan? • Howconfidentareyouonascaleof1to10youwillcompleteyournextstep?

MAINTENANCE

AVeteraninmaintenancehassustainedabehaviorchangeformorethansixmonths.


Asacoach,youwillseeorheartheVeterandescribingabehaviortheyhavesustainedforatleastsixmonths.

THECOACH’SROLE

WhencoachingaVeteraninmaintenance,itisimportanttoacknowledgetheeffort,strengths,andsuccessuptothispoint.Useopen-endedquestionsandreflectionstoexplorehowthebehaviorchangelinkswiththeVeteran’svalues.ReflectthebigpictureofchangeandcelebratetheVeteran’ssuccess.

EncouragetheVeterantoexpandtheirsupportnetworkstoincludeotherswhomaintainasimilarhabit.DiscusspotentialchallengesandthepossibilityofrelapsewiththeVeteran;helpthemidentifystrengths,tools,andcontingencyplanstocopewithfuturechallenges.



USEFULQUESTIONS

AVeteraninmaintenanceneedstonotonlycelebratetheirsuccess,butalsodevelopaplantomaintaintheirprogressandconfrontfutureobstacles.BelowaresomepotentialquestionsthatmaybeusefulwhencoachingaVeteraninmaintenance:

• Whatishelpingyoutochange? • Whatwillhelpyousustainyourchange? • Whatwouldputyourchangeatrisk? • Ifyoufindyourselffacedwith[thisrisk],howdoyouplantoconfrontit?

TERMINATION/ADOPTION(RELAPSE/RECYCLE)

Onceabehaviorhasbeenmaintainedformorethansixmonths,thecoachhelpstheVeterandeterminebetweenterminationandcontinuedmaintenance.


Asacoach,youmayhearaVeteranexpressingadesiretoexploreanewbehaviorchangeortoconcludecoachingsessions.AVeteranmightsay“I’mreadyto…”,takingownershipoftheirbehaviorchangeprocess.

THECOACH’SROLE

Atthisstage,aVeteranhassuccessfullymaintainedabehaviorformorethansixmonthsandisreadyforoneoftwopaths:terminationoradoption.TerminationwilllikelyleadtotheconclusionofcoachingwithaVeteran.AdoptionallowstheVeterananopportunitytocontinuecoachingandworktoimplementnewbehaviors.

IfaVeteranchoosestoendthecoachingrelationship,itisimportanttosummarizethebehaviorchangeprocess,celebratetheVeteran’saccomplishments,andexploretheVeteran’slearnings.

Anotherimportantpieceofendingthecoachingrelationshipisplanningforthefuture.Asacoach,itisimportanttoensuretheVeteranunderstandsthatrelapseisatypicalpartofthechangeprocess.NormalizethisandencouragetheVeterantoconsiderwhatstrengths,supports,andlearningstheynowhavethattheycanrecycleinthefuture.BrainstormfutureobstaclesandbackupplanswiththeVeteransotheyarepreparedtomaintainthebehaviorindependently.

EnsuretheVeteranconsiderssignsthatindicatetheyneedfuturecoachingorsupportinthebehaviorchangeprocess.



IfaVeteranchoosestocontinuecoaching,itislikelyyouwillsupporttheVeteranastheyworktoimplementnewbehaviors.Aswithtermination,summarizethebehaviorchangeprocess,celebratetheVeteran’saccomplishments,andexploretheVeteran’slearnings.Remaincuriousandsupportiveaboutanyrelapsethathappenswiththesuccessfulbehaviorchange.ExplorewhatstepstheVeteranwantstotakenextfortheirhealthandwellness.Usecuriousopen-endedquestionsandnonjudgmentalreflectionstoassesswhatstageofchangetheVeteranisinwithregardstothenewchange.AskwhattheVeteranhaslearnedpreviouslythatcanbeadoptedandrecycledastheybegintoimplementanewbehavior.Ultimately,thecoachsupportstheVeterantomovetowardsindependenceinthebehaviorchangeprocess.

USEFULQUESTIONS

Inthefinalstageofthebehaviorchangeprocess,thecoachencouragestheVeterantoexplorelearnings,strengths,supports,andsuccessesthatemergedduringbehaviorchange.BelowaresomepotentialquestionsthatmaybeusefulwhencoachingaVeteraninthetermination/adoption(recycle/relapse)stage:

• Whatareyoutakingawayfromthechangeprocess? • Whatmostsupportedyouinthechangeprocess? • Whatstrengthsdidyouusetoovercomeobstacles? • Whatobstaclesdoyouforeseeinthefuture? • Howdoyouplantoaddressrelapse? • Whatdidyoulearnthatcanberecycledforfuturechange? • Whatareyournextstepsforyourhealthandwellness? • Howwillyouknowyouneedcoachingorsupportinthefuture?



CHAPTER14:THEETHICSOFCOACHING

HealthCoachingisarelativelynewandevolvingfield.Trainingprogramsarerecognizinganimportantnichetheycanfillinaddressingtheneedsofthisnewendeavor.Academicprogramshavebegun.However,thisevolvinginterestandeducationalresponseshavearisenpriortoclearnationalguidelinesforpractice,trainingandethicsbeingestablished.AlthoughthereisaCodeofEthicsdevelopedbytheNationalBoardforHealthandWellnessCoaching(NBHWC)forcoachingingeneral,thereisnotacodeofethicsforHealthCoachesperse.Therearenostateregulationsnormonitoringofhealthcoaches;therefore,self-regulatoryethicsareveryimportant.Asthisfieldprogresses,ethicalstandardswillundoubtedlyproliferate.Untilthen,ethicalstandardsareaworkinprogress.

HealthcoachesworkingwithintheVHAsettingshouldfamiliarizethemselveswithVHAethicalguidelinesforallclinicians.

CoachesshouldbeawarethattheNBHWChasbeenrecognizedasaprimaryorganizationforsettingnationalstandardsforcoachingingeneral.InadditiontoaCodeofEthics,theyhavedeveloped:

• DefinitionofCoaching. • CoreCompetencies/Standards. • ProfessionalCoachCredentialing,includingongoingCEUrequirements. • OversightforEthicalConductReview. • OngoingSelf-RegulatoryOversight

Thepurposeofthischapteristooutlinebroadareasofethicalconcerns;thedetailsinhowtoaddresstheseconcernswillneedtobeimplementedbyindividualcoaches.Usingmature,professionaljudgment,andkeepingtheVeteran’sbestinterestattheforefrontwhenaddressingtheseconcernswillgoalongwayinfosteringanethicalcoachingpractice.

FACTORSCONTRIBUTINGTOCHOOSINGETHICALACTION

Beforeoutliningspecificareasofconcerns,itisusefultorecognizethattherearefactorsthatwillcontributetohowindividualcoacheswillrespondinethicalsituations.Someofthesefactorsareoutlinedanddetailedbelow.

INDIVIDUAL’SPERSONALCHARACTER

Coachesbringahistoryofpersonaldevelopmenttothecoachingsituation.Theattributesthatfollowhavebeendevelopedovertime,butcoachesmustconsciouslycontinueto



practicebehaviorconsistentwiththeseattributesinthecoachingsetting.Thesepersonalattributesare:

• PrudenceorPracticalWisdom.Carefullythinkingthroughthepotentialramificationsofanybehaviorandavoidingtheappearanceofimproprietyisacharacterskill/traitdevelopedfromyearsofexperience.Prudenceorpracticalwisdomalsoincludesthinkingthroughthelong-termconsequencesofanygivenbehavior.

• Integrity.Coachesactingoutofintegrity,beinghonest,andpromotingthebestinterestofVeteransarelesslikelytoencounterethicalissues.Coacheswithintegritydonotnecessarily“need”acodetoguidetheirethicalbehavior.Itcomesoutofasenseofintegrity.Infact,coacheswhopracticeintegrityandhavemoralreasoningskillsmayactuallypracticebehaviorthatgoesbeyondanywrittencodeofethics.

• Trustworthiness.Trustworthinesshasbeendiscussedingreaterdetailpreviouslyinthis chapter. Coaches who have worked to demonstrate trustworthiness in theirrelationshipswithVeteransarelesslikelytoencounterethicalissues.

• Respectfulness.Respectfulnessinvolvesbeingawareof,aswellashonoringtheVeteran’sbeliefsandvalues.PracticingRespectfulnesswillcertainlyreducetheincidentsofethicalconflicts.

• Compassion.UnderstandingandcaringabouttheVeteran’sfeelingsandlifeexperienceswilllimitanypotentialbehaviorsthatresultincompromisedethics.

MORALREASONING

Coacheswhocanreasonfromamoralperspectiveandtakeintoaccount“whatisinthebestinterestforthegreatergood”andnotjustinthecoaches’bestinterest,willhaveabasisformakingdecisionsthatwillresultinfewercompromisedethicalsituations.

PROFESSIONALETHICALIDENTITY

Professionsthemselvesdevelopbothwrittenandunwrittencodesofethicsovertime.Thesecodesaredevelopedbyboththeleadersandconstituentsoftheprofession.Howmuchethicsareemphasized,bothintermsoftrainingandcodeenforcement,begintodefinetheethicalcultureoftheprofession.Underlyingeachprofessionarephilosophicalprinciplesthatmayormaynotbeevidenttomembersoftheprofession.Theseunderlyingphilosophicalprinciplescanhaveanimpactontheprofession’sspokenandunspokencodeofethics.



ETHICALTRAINING

Eventhoughethicalreasoninganddecisionmakingareheavilyinfluencedbycoaches’personalcharacter,ethicalchoicescanbeenhancedbytraining.Mostprofessionsprovidecoursesortraininginethicaldevelopment.IntheWHCtraining,weprovideopportunitiestoreasonandthinkwithcolleaguesregardingcoachingsituationsinwhichethicaldecisionsneedtobemade.Althoughtheremaynotbeonegiven,specificcourseofactionincomplexethicalsituations,coachesareprovidedanopportunitytothinkthroughpotentialethicalsituationsbeforetheyactuallyoccur.

COMPETENCE

Ifcoacheshavemasteredthecompetenciesofcoaching,therewillbefarfewerviolationsofprofessionalethics.Imbeddedinthecompetenciesofcoachingareattributesthathelptoavoidcompromisedethicalchoices.Thefollowingcompetencieslistedbelowareonlyafewexamplesofcompetenciesthatfostersoundethicaljudgment:

• PromotingtheVeteran’sagendaandbestinterest.CoacheswhokeeptheVeteran’sagendaandbestinterestinmindwillfindthemselvesinfewercompromisedethicalsituations.TheywillbereasoningfromwhatisinthebestinterestoftheVeteranratherthanfromwhatisinthebestinterestofme,thecoach.

• Co-creatingacoachingpartnership.IfcoachesaretrulyinterestedinpartneringwiththeVeteraninordertoassistinpromotingtheiroptimalhealth,theywillfindthemselvesactinginthepartner’sbestinterestinpotentialethicalsituations.

Inaddition,ascertificationbecomesarealityinthefieldofhealthcoaching,theprofessionitselfwillhaveaninfluenceinself-monitoring,andthosewhoarenotcompetentwillnotbecertifiedtopractice.Thisprofessionalinfluence,inadditiontopersonalcompetency,willimpactthenumberofethicalsituationsthatmayariseinthefield.

Inconcludingthissection,itisimportanttonotethatethicalscenariosarenotalwaysblackandwhite.Thereareseveralquestionsthatmaybehelpfulforcoachestoaskthemselvesinethicalsituations.Considerthesequestionswhenreviewingthe“10EthicalScenarios”intheHandoutsection(coveredduringin-persontraining).Answerstothesequestionswillbeinfluencedanddeterminedbythefactorsidentifiedabove.Thesequestionsare:

• Whataremyowninternalvalueconflicts? • Whobenefitsfromwhichcourseofaction? • Whatcorevalues(bothpersonalandprofessional)arebeingcompromised? • Whatcorevalues(bothpersonalandprofessional)arebeingstrengthened? • HowdoesmyVeteranwinorlose,dependingonthecourseofaction?



• Withwhomwoulditbenefitmetoconsulttoexaminetheconflictsinvolved? Thefollowingquestionsmaybeusefulinnurturingethicalsensitivity:

• Whatisyour“gut”responsetothissituation? • Whatisthefocusofyourattention? • Whoelseisinvolvedinthissituation? • Whatmakesyouthink“Thisdoesnotfeelright”? • Whataretheissuesrelatedtocultureand/ordiversity? • Howdoesmyroleascoach(andprivilege)impactmysensitivityandchoices?

AREASOFCOACHINGREQUIRINGETHICALCONSIDERATION

Therearemanyscenariosincoachingwhereethicaldecisionswillneedtobemade.Thesescenariosaregroupedandoutlinedasfollows.

CONFIDENTIALITYVS.DUTYTOREPORT

Aswithallhealth-relatedprofessions,coachesshouldbecarefultoprotectVeteranconfidentiality.Insomesettingsandstates,theremaybe“dutytoreport”issues,especiallyifthecoachdeterminesthattheVeteranmaydopotentialharmtothemselvesorothers.Coachesshouldbecomefamiliarwiththedutytoreportproceduresintheirworkenvironments.Ifcoachesdeterminethatit’sinthebestinterestoftheVeterantoshareinformationwithanotherprofessional,coachesshouldfirstobtainVeteran’spermissionafterdiscussingthereasonsfortheircourseofactionwiththeVeteran.CoachesshouldhaveplacestokeepnotesandVeteraninformation,preferablysecuredwithlockandkeythatisnotavailabletoothers.

Itshouldbeclearlystatedthatsuicidalideationconstitutesalegaldutytoreportandisnotconsideredanethicaldilemma.

VETERAN-COACHRELATIONSHIP

Thereareseveralpotentialconcernstobeawareofunderthistopic.Theseinclude:

• Setclear,appropriate,andculturallysensitiveboundariesregardingphysicalcontact.

• AvoidanysexualmisconductwithVeterans. • ProvideclearandaccuratecommunicationaboutwhattheVeteranmightexpect

fromcoaching.Avoidover-promising. • AvoidexploitationofVeteranformonetaryorpersonalgain. • DiscussterminatingthecoachingrelationshipwhencoachesorVeteransdetermine

thatVeteranscouldbebetterservedbyanothercoachorprofessional. • Establishclearcommunicationbeforecoachingbeginsregardingthenumberand



lengthofsessions,finances,andthenatureofthecoachingrelationshipandconfidentiality.

• HonorandsupporttheVeteran’srighttoterminatethecoachingrelationship. • Avoidprovidinganyinformationthatcouldbeconstruedasmedicaladviceor

directingaVeteraninamedicaldirectionthatrunscountertotheirwishesandvalues.

• ConsiderterminatingthecoachingrelationshipwhenVeterans’andcoaches’valuesconflictsarecurrentlyorwillpotentiallyimpedetheeffectivenessofcoaching.

• KeepclearrecordsofsessionsandVeteran/coachagreements.Thiswillhelpinclearingupanymisunderstandingalongthecourseofcoaching.

• WhensolicitinginformationfromtheVeteran,onlysolicittheinformationthatisusefultothecoachingprocess.Havingadditionalinformationnotonlyhaspotentialethicalimplicationsbutcreatesmorepotentialliabilityforcoaches.

DUALORMULTIPLEROLES

Insomecases,thecoachmayfindthemselvesindualormultipleroleswithaVeteran.Forinstance,ifaVeteranisarelative,orVeteranandcoachworkforthesameinstitution,theremaybereasonstohavetheVeteranseekanothercoach.IftheVeteranisaneighborortheVeteranandcoachbelongtosameorganizationssuchasplacesofworship,theremaybeethicalconsiderationsbeforeenteringintoacoachingrelationship.

Also,ifthecoachhasanotherprofession,suchasbeingapsychologist,thecoachwillhavetobeclarifywiththeVeteranwhatroletheyarefulfillingwiththeVeteranandnotattempttoblendthetwo.IfthecoachandVeterandecidetochangethenatureoftheirprofessionalrelationship,itshouldbeexplicit,andtheVeteranshouldnotfeelpressuredtoassumethenewrole.Ifyouserveinanotherhealthcareprofession,beclearastowhichprofessionalguidelinesprevailinethicalsituations.

USEOFASSESSMENTS

Eventhoughassessments,suchasHealthRiskAssessmentsorPersonalHealthInventory,canbeveryusefulinincreasingself-awarenessandfurtheraction,theymustbehandledethically.

Coachesshouldknowthelimitationsofassessments,aswellastheirlimitsinexpertisetointerprettheresultsofassessments.Insomecases,coachesmaywanttoobtaintheservicesofanexperttoadministerandinterprettheassessment.ThisshouldonlybedonewiththeconsentoftheVeteran.Coachesshouldestablishclearboundariesintheuseofinformationtheyreceivefromanyassessment.Culturalsensitivityandconfidentialityarealsoimportantconsiderationsintheuseofassessments.



LIMITSOFCOACHINGAGREEMENT

Inacoachingagreement,coachesshouldbecarefultoarticulatewhattheyareofferingandnotofferingtheVeteran.Thisshouldbeawrittenagreement,signedbyboththecoachandVeteran.Coachesshouldbecarefulnottoover-promisewhattheVeteranwillreceivefromcoaching.

IfcoachesdeterminethattheVeteranhasissuesthatarebeyondthescopeofthecoaches’expertise,theyshoulddiscussotherprofessionalassistancewiththeVeteran.“Whenindoubt,referout”istheguidingprincipletokeepinmind.

PROFESSIONALEXPECTATIONS

Althoughcoachesmayhaveconflictingvalueswithothercoachesorcoachingorganizations,itisexpectedthatcoacheswillnotdenigrateotherpersonsororganizationswithwhomtheirvalues/beliefsand/orofferingsmaydiffer.Coachesmaywantto“defend”whattheyhavetoofferversusanotherhealth-relatedprofessional;however,theyshouldacknowledgedifferenceswithoutplacingavalue(especiallyanegativevalue)ontheother’sservices.

CoachesshouldfamiliarizethemselveswiththeCodeofConductestablishedbytheNBHWC.Asthisfieldemerges,statesmaytakevaryingpositionsandenactlawsgoverningcoachingpractices.Itisimportantthatcoachesfamiliarizethemselveswithanystatelawthatmaypertaintothecoachingprofession.Thesearesubjecttochangeandcoachesshouldfindsourcestokeepthemselvesabreastofnewand/orchanginglaws.

COMMONETHICALBLINDSPOTS

Asahealthandwellnesscoach,maintainingastandardofethicsthatbestservestheVeteranisoftheutmostimportance.Bemindfulofbothyourpersonalandprofessionalcodeofethics,aswellassomecommonethicalblindspots:

• Sellingproductsand/orservices • Recordprotection • HIPAAviolation(sharingpatientinformation,PHI) • Relationships(dating,acquaintancesoffamily/friends) • Confidentialityboundaries(obligationtoVeteranvs.healthcaresystem) • Dualroles • Dutytoreport(safetyvs.knowledgeofunethicalbehavior)



Otherethicalscenariosareaddressedduringthein-persontrainingandarereferencedinthehandoutssectionofthemanual.Remembertotrustyourinstinctand,whenindoubt,referout.

APPROACHINGETHICS:KEYPOINTS

Insummary,whenfacinganethicaldilemma,remembersomeofthekeypointsbelow:

• Useyourintuition. • Watchfor“redflags”,bemindfulofyourgutfeeling,andpayattention. • Rememberthescopeofpracticeforcoachingandanyotherlicensureorcertification

youhold. • Consultwithcolleaguesandreferasappropriate. • Seekandreceivementoring. • Seekconsultationorsupervisionasneeded. • Knowyoursupportingstructureandyourchainofcommunication. • Whenindoubt,referout.

SOURCESFORINFORMATIONINTHISCHAPTER

LawandEthicsinCoaching:HowtoSolveandAvoidDifficultProblemsinYourPractice,PatrickWilliamsandSharonAnderson,JohnWileyandSons,Hoboken,NewJersey,2006

TheNBHWCCodeofEthicsandScopeofPractice,NationalBoardforHealth&WellnessCoaching,website:www.nbhwc.org(*BothprovidedasHandoutsinthisParticipantManual.)



CHAPTER15:GROUPCOACHINGCONTINUED

Groupcoachingisaguidedgroupprocessledbyaprofessionalcoach.Theintentionofthegroupformatistomaximizetheindividualparticipants’combinedenergy,experience,andwisdomtoachieveindividualgoals(definitionadaptedfromGingerCockerham,MCC,GroupCoaching:AComprehensiveBlueprint;iUniverse,2011).

ESSENTIALELEMENTSOFGROUPCOACHING

Thespecificdetailsofgroupcoachingcanvaryacrossdifferentsituations,buttherearecertaincharacteristicsthatremainconsistentacrossgroups.Allcoachinggroupssharethefollowingqualities:

• Thecoachusesfoundationalcoachingskills. • Thecoachusesgroupcoachingskills. • Thegroupprocessfollowstheestablishedcoachingstructureandprocessmodel. • Participantschoosetojointhegroup. • Participantssetpersonalgoalsandcheckinregularlyforaccountability. • Groupsaretypicallycomprisedof6-12participants.

GROUPDESIGNCONSIDERATIONS

Whencreatingagroup,therearemanyfacetstoconsider.MostofthesearecoveredindetailaboveintheParts1and2Contentsection.

• Coachinggroupsaretypicallymadeupof6-12members.Theidealsizeforanygroupwilltakeintoconsiderationhowtobestoptimizeachievementofgroupgoals,anyuniqueparticipantcharacteristics,andthetimeframeallottedforthegroup.

• Closedgroupsarethoseinwhichallmembersstartthegroupatthesametime.Thistypeofgroupworksmosteasilyforgroupcoachingsinceitisimportantforeveryonetobecommitted,andaccountablefromoneweektothenext.Consistencyandcontinuityareimportantformomentuminreachinggoals.

• Opengroupsarethoseinwhichmemberscanjoinatanytime.Inanopengroup,theleaderwillneedtohaveaprocessfororientingnewmemberswhojoinlater,andformanagingthedepartureofgroupmemberswhofeeltheyhavemettheirgoal(oranyotherreason).Itisimportantthatindividualsdonotdropinandoutintermittently.Groupcoachingshouldnotbesporadicasinother“open”groupssuchasAAorWeightWatchers.



RECRUITMENTANDSELECTIONCRITERIA

Indesigningagroup,itcanbeimportanttoclarifytheprocessforidentifyingandrecruitingpotentialgroupmembers.Insomecases,theymaybereferredbyaVAproviderorprogram.Word-of-mouthcanbeanotherpowerfulrecruitmenttool,ascanoutreachwithintheVAandtovariousexternalVeteranServiceOrganizations.

Itisoftendesirabletohaveparametersforinclusionorexclusioninthecoachinggroup.Ifso,thesecriteriashouldbespecific,determinedpriortorecruitmentandpublicizedasneeded.

GROUPFORMATCONSIDERATIONS

Whenstartingagroup,itmightbeautomatictothinkofanin-persongroupformatbutthinkingoutsidetheboxatotherformatsisoftentimesveryhelpful.OneexampleofthismightbeTele-healthwhichistypicallyconductedusingacamerawithparticipantsjoiningfromadistance,possiblydialinginfromhome.Avariationofthiswouldbeifthecoachleadsfromadistancewhilethegroupistogetherinoneroom.Therearemanypossiblevariationsintermsofformatandcoaches/groupleadersshouldbeopentoexploringallformats.

Timingandschedulingareotherformattingconsiderations.Thesemightincludedeterminingtheideallengthofeachsession,howmanysessions,willthegroupbeopen-ended,howmuchtimetoallowbetweensessionsandfinallythebesttimeofdaytomeet.Someofthesemightbedeterminedbythecoachandothersmightbedependentonmeetingtheneedsofthemajority.

Anotherconsiderationforgroupformatsiswhetheritwillbesinglethemedoramixedfocus.Anexampleofasinglethemedgroupwouldbeonethatfocusesonalifestyleissuelikeweightmanagementorachronicconditionlikediabetes.AmixedfocusgroupmightbeonethatworkswiththeCircleofHealthaddressingdifferentareaseachsession.Regardlessoftheareaoffocus,allgroupsshouldbeconductedfollowingthesetprocessmodel.

Insomegroups,informationmaybesharedrelevanttoatheme.Wheneveraneducationalcomponentisintroduced,itshouldbeofferedusingthecoachingskillsetofelicit-provide-elicit.

STEPSTOCONSIDERBEFOREBEGINNINGTHEGROUP

Therearestepsthecoachcantakebeforebeginningagrouptocreatethefoundationforasuccessfulgroupexperience.



• PreparationandPresence-Prepareyourmaterialsandpracticewhateverhelpsyoutocomeintothepresentmoment,leavingbehindthepastandthefuturetobefullywithyourgroup.

• Systemization-Determinewhowillbeyoursupport:supervisor,mentor,referral,supportsystem,chainofcommand.Knowwhatthereportingprocessentailsintheeventareferralisrequired.

• Practice-“Practicemakesperfect”-themoreyoupracticegroupcoachingskillsandbecomefamiliarwiththecontentyouwanttodeliver,themoreconfidentyoubecome.

• CreatingaSafeSpace-Whilenocoachcanguaranteesafetytogroupmembers,effortsshouldbemadetosetuptheconditionstosupportasenseofsafetyandpredictabilityforthemembers.Manygroupcoacheshaveapartner–a“co-facilitator”.Thiscannotonlyprovidesafetyinnumbers,butitcanalsoenableonecoachtocontinuethesessionastheotherfocusesonamemberwhomightneedpersonalattention.

GROUPCOACHINGSTRUCTURE

Whenyouarefacilitatingaclosedgrouptherewillbeaninitialsession,ongoingsessions,andalastsession.Allparticipantstypicallystartandendtogetherunlesstheydropoutofthegroup.Eachgroupcoachingsessionconsistsofthreephases:beginning,body,andend.

• Initialgroupcoachingsessionstructure-ConsiderationsforsettingupandconductinganinitialgroupsessionaredescribedintheWHCFoundationsManual.Thebasicstepsareasfollows:

• Introductions-Choosehowtointroduceyourselfbasedonthedynamicyouwanttocreateinthegroup.Youmightintroduceyourselfatthesametimetheparticipantsdoorintroduceyourselfatthebeginningofthegroupbeforetheparticipantsdo.OneexampleishowitisdoneintheWHCcourse:name,role,funthing,etc.

• Intention/goalforthegroup-Settingtheintentionofthegroup,upfront,cancreateclarity,anopeningbookend,andsetsomegroupmembersateasearoundwhytheyaregathered.OnegroupmightbeintendedtoworkitswaythroughthePHI,whileanotherfocusesonweightloss,diabetescare,etc.Thisisoftentakencareofingroupadvertisementmaterialsorrecruitment.

• Describethegroupcoachingprocess-NotallVeteranswillbefamiliarwiththegroupcoachingprocessorstructure.Takingtime,intheinitialsession,toexplaintheprocess,format,andstructureofgroupcoachingcancreateclarityandeasewiththeunknown.



GROUPGUIDELINES

Groupguidelines,oragreements,areanimportantpieceofanycoachinggroup.Consistencyandclarityindesigningtheguidelinesforyourgroupwillenableyoutospeaktothemiftheneedarisesduringagroupcoachingsession.Thecoachcaneitherelicitguidelinesfromthegrouporofferapre-determinedlistofguidelines.Ifthelatter,groupmembersshouldbeofferedanopportunitytorespondandaddormodifyasappropriate.Oncegroupguidelineshavebeenestablished,solicit/discusswiththegroupwhattodoiftheguidelinesarenotfollowed.

Commongroupguidelineareastoaddress:

• Confidentiality.Onequestiontoaskmightbe“whatdoyouneedtofeelsafeinthisgroup”?

• Howmemberswillrespectfullycommunicatewitheachother. o Bottom-lining.o Refrainingfromgivingadvice.o Refrainingfromcrosstalk.o Beingauthentic.

• Attendance o Beingontime.o Followingproceduresformake-upsand/ormissedinformation.

Thesearesomeexamplesofguidelinesforcommunicating.Otherguidelinesincluderespectforothers,balancingtime,andstayingontopic.

BEGINNINGTHEGROUP–INITIALSESSION

Coachinginagroupsettingmeansusingnotonlyfoundationalcoachingskills,butalsogroupcoaching“meta-skills”describedingroupmanagementskillsslide.Willparticipantsworkthroughthestagestogetherorprogressattheirownrate?

Itisimportanttoask“safe”open-endedquestionsinthegroupcoachingsession–thesearequestionsgroupmembersgenerallyfeelcomfortableanswering.Youmightelicitsomepossibilitiesfromthegroup,movingtoyourownideaswhennoneareoffered.Belowisalistofpossibleopen-endedquestionsthatcreateease,conveygenuineinterestandcuriosity,andfeelsafe.

• Whatbringsyoutothisgroup? • Whatdoyouhopetogetoutofthisgroup? • Whatwouldmakethisgroupagreatexperienceforyou? • Howcanyoumakethisgroupexperienceenjoyableforyourself,orothers?



• Howcanyouuseyourtimeinthisgroupmosteffectively?

MOVINGTHROUGHTHEGROUPSESSION

Onceintroductionshavebeencompleted,guidelinesdiscussed,andthegrouphasbeenmadecomfortablewithgenerallycuriousandsafequestions,itistimetomoveintothe“body”ofthegroupcoachingsession.Thebodyofthegroupsessionmightlooklikethis:

• Askinganopen-endedquestionthatinvitesgroupmemberstospeaktotheirareaof“focus”andhowitisconnectedtotheirvisionandvalues(Stage1-2).

• EncouragingeachgroupmembertocreateanActionStepthatmovesthemclosertotheirareaoffocusandultimatelytheirlong-termgoalforahealthierself.(Stage3).

• ItmightbehelpfultoincludesomeeducationalcontentontheStagesofChangeand/orSMARTGoals.

CLOSINGTHEINITIALGROUPSESSION

Bringingthegroupcoachingsessiontoanendisthefinalpieceinthecoach’sresponsibilitiesinholdingthegroup.Theabilitytocreatea“bookend”forthesessionbringsaclearandvisibleendtothegroup’stimetogether.Justasthecoachstartedthefirstsessionwithopen-ended,safe,questionstopromptcommunicationandflow;itisthesameinendingtheconversation.

• Askeachgroupmembertosummarize–inonesentence–whattheiractionstepwillbefortheupcomingweek.

• Inquirewhatgroupmembersare“takingaway”fromtheday’ssession.

ROUTINE-ONGOINGGROUPSESSIONSTRUCTURE

Routine–ongoinggroupsessionsarethesessionsthatoccurbetweentheinitialgroupcoachingsessionandthefinalsession.Thenumberofongoinggroupsessionsisoftendecidedpriortothegroup’sconvening.Oftenthesitemakesthedecisioninthenumberofsessionsaspecificgroupwillmeet,sendingthisinformationoutinadvertisementmaterialsandrecruitmentpostings.

Theongoingsessionsarethe“meat”ofthegroupcoachingexperience.Thisiswheremuchofthegroupcoachingworkgetsdone.Theon-going,consistentmeetingofgroupmembersistheformationofthegroup’srelationship,bond,andevenidentity.

Ongoinggroupcoachingsessionsfollowthesamebasicstructureateachmeeting:



OPENINGAROUTINEGROUPCOACHINGSESSION

Remindthegroupofpreviouslyagreeduponguidelines.Inviteeverymembertocheckinaccordingtoarequestedformat–usuallyanopen-endedquestion.Forexample:

• “Whatoneworddescribestheprogressyoumadewithyouractionstepinthepastweek?”

• “Whatthemewouldyouusetodescribehowyouractionstepwentthispastweek?”

BODYOFAROUTINEGROUPCOACHINGSESSION

Thecoachusesopen-endedquestionstoguidethediscussion,withafocuson1)processinggroupmembers’experiencessincethelastsessionand2)askinggroupmembersabouttheirprogresstowardgoalsandovercomingchallenges:

• “Whatsuccessesdidyouexperiencethisweek?”• “Whatwasachallengeforyouthisweek?”AND“Whatwasyourworkaround?”• “Whatdidyoulearnaboutyourselfthisweek?”

CLOSINGTHEROUTINEGROUPCOACHINGSESSION

Asthegroupcoachingsessionnearsitsend,thecoachshouldletthemembersknowtheallottedamountoftimeleft.Manygroupmembersfindthisannouncementhelpful;somefindtransparencyabouttheprocesscomforting.Thisisthebeginningofthebookend.

• “Whatareyoutakingawayfromyourtimeinthegroupthisweek?”• “Whatnewbehaviorwillyoutakeonthisweek?”• “Whatwouldyouliketobeheldaccountableforduringournextsession?”• “Whatareyoumostexcitedaboutfortheupcomingweek?

FINALROUTINEGROUPCOACHINGSESSION

Thefinalgroupcoachingsessionisthelasttimethisspecificgroupwillgather.Itistheendtotheirgroupcoachingexperiencetogether.Pointstoaddressinthefinalsessionaremeanttobringthegroupcoachingexperiencearoundfullcircle.

THEFINALSESSION

Reviewingtheprogressthatgroupmembershavemadesincethebeginningofthegroupisanappropriate–andmeaningful–wayto“begintheend”.Manymembersinthegroupwillhavemadenotable,meaningful,andsignificantbehavioralchanges.Somewillhavemadechangesandperhapsstumbled,redirected,orcompletelyquiet.Othergroupmembersmightnothavemadetheprogresstheyexpected.Allofthesememberswillneedan



opportunitytoputtheirvoiceintothegroup.Thecoach–usingacceptance,empathy,acknowledgment,willmeeteachmemberwheretheyaretobringtheirtimetoaclose.

BODYOFTHEFINALSESSION

Elicitwhatthegroupmembershavelearned(especiallywhatmightbeappliedinother,future,situations).Offertheopportunityforparticipantstoexpressfuturegoalsandpossibilitiesandtoidentifypotentialsupportandresources.

CLOSINGTHEFINALSESSION

The closing group coaching session often includes soliciting feedback about the group experience – both positive and enhancements – as well as a chance to share “last thoughts”. Group members may exchange contact information to stay in touch – this is an appropriate action so long as group members agree.



CHAPTER16:EXAMINATIONPREPARATION

Untilrecently,therewerenonationalstandardsforhealthandwellnesscoaching.Anyonecouldcallthemselvesahealthcoach,regardlessoftrainingorexperience.Beginningin2010,expertsinthefieldofhealthandwellnesscoaching–leadersinscience-basededucation,practicalskillstraining,andresearchincoaching–volunteeredtheirtimeandeffortstodevelopacomprehensivenationalstandard.Afterworkingtogetherformanyyears,thisgroupofdedicatedvolunteerleaderspartneredwiththeNationalBoardofMedicalExaminers(NBME)toofferthefirstnationalcredentialingexam.In2017,thefirstnationalexamwasadministeredtocoachesacrossthecountry.

WHYPURSUECERTIFICATION?

Pursuingcertificationcanbeapersonaland/orprofessionalchoice.Currently,theVAdoesnotrequireWHCoachestobenationallycertified,thoughsomesitesmaycreatetheirownPositionDescriptions(PD)andmakethisapartoflocalsiterequirementsinthefuture.ManyVAHealthCareSystemsandMedicalCentersareintheprocessofhiringdedicatedWHCoachestotheirfacultyofhealthcareprofessionals.Thisiscurrentlyasite-by-sitedecision;yetpossiblesystemwiderequirementscouldbeonthehorizon.Nationalcertificationwillcertainlybepartofthatconversation.

Pursuingnationalcertificationoffersopportunities,bothpersonallyandprofessionally,toVHAWHCtrainedcoaches.ProfessionalstandardsandnationalcertificationwillempowerandequipcoachestomoveforwardinprovidingVeteranswithcoachingthatmeetsnationallyrecognizedrequirementsandcompetencies.

CERTIFICATIONWITHINTHEVHA

AlthoughtherearecurrentlynorequirementsofnationalcertificationforcoachesworkingintheVHA,thereisexpandingenergyandinteresttocoordinatetheeffortsoftheOPCC&CT,VHAVISNleadership,andthehundredsofVHApersonnelwhohavesuccessfullycompletedtheWholeHealthCoachtraining.OpportunitiestoworkwithinPACTteams,specialtyclinics,andmanyotherareasoftheVHAareopeningfornewhealthcoaches.Anenormousamountofworkhasbeendedicated,inthepast5years,togrowingtheWHCoachingprogramsothatparticipantswhosuccessfullycompletethetrainingarebetterpreparedtositforthenationalexam.

TheOfficeofPatientCenteredCareandCulturalTransformation(OPCC&CT)iscommittedtotheWHCoachingprogram,itstrainedcoaches,andtheprofessionalstandardprovidedbynationalcertification.Theirefforts,support,andresourcesarestronglyinplacetoassist



trainedhealthcoachesintheirindividualpursuitofnationalcertification.TheOPCC&CTisdedicatedtomodelinghowcoachescanbeintegratedintotheVHA–workingaspioneersinthetransformationofthehealthcaresystem.

InJanuary2020,thefirstWeek3WholeHealthCoaching:CertificationTrainingwasheld.InFY21theWeek3Certificationtrainingwascombinedwiththe2-weekFoundationsTrainingtocreateonecomprehensive3-WeekWHCTraining.Coachescompletingthe3-weekWHCTrainingbenefitbylearningandpracticingbothfoundationalandadvancedcoachingskills,strategies,andcompetencies.

Thiscomprehensive3-WeekWHCTrainingbringswithitanincreasedlevelofexpectation–asynchronousinstruction,additionaltelephoniccoachingsessions,advancedcoachingskills,anddedicatedgroup-coachingexperience.Theseadditionalhoursoftraining,alongwithastrongself-studyregimen,allowWHCCoachestomovetowardstheirgoalofsittingforthenationalcertificationexam.

CPTCODES

CoachingintheVHAisaconstantlygrowingandchangingprocess.Thereisincreasingsupportandimplementationofstandardsbeingcreatedtoaddopportunity,standardization,andregulationtothisnewprofessionalrole.OnJuly1,2019,theAmericanMedicalAssociation(AMA)announcedtheapprovalofthreedistinct“CategoryIII”CPTCodesfor“HealthandWellnessCoaching.”TheseCPTCodeswentintoeffectJanuary2020.

TheabilitytoapplyCPTCodestocoachingsessionswithVeteranswillhaveawideimpactonhealthcoachesacrosstheVHA.CoacheswhohavesuccessfullyreceivedtheirNationalCertificationwiththeNBHWCarequalifiedtoapplycodestotheirVeterancoachinginteractions–givingthemtheabilitytoaddreimbursementtopatientvisits.Anadditional,informationaldocumentregardingCPTCodescanbefoundintheHandoutsectionoftheParticipantManual.

EXAMPREP

Preparingforthenationalexamisessential.ThelearningandtrainingreceivedintheWHCTrainingisalignedwithNBHWCstandardsandcompetencies.TheintensiveandcomprehensivetrainingprovidesWHCcoachesintheVAwiththefundamentalcoachingqualities,skills,andstrategiestheyneedtocoachVeteransaroundtheVAsystem.

AsintensiveandcomprehensiveastheWHCtrainingis,itisnotsufficienttofullyprepareparticipantsforthenationalexam.Preparationfortheexamrequiresamulti-facetedapproach:WHCtraining,dedicatedself-study,andplentyofactualcoachingexperience.



Thischapterwillbrieflycovertheareasimportanttosuccessfullyprepareforthenationalexam.

RESOURCES

TheNBHWCwebsite(https://nbhwc.org)isthemostimportantresourceinthepursuitofnationalcertification.TheWHCtrainingfacultyconsiderthissitetheprimaryresourceinpreparationfortheexam.Allquestionsregardingthenationalexam,examrequirements,contentoutline,referencematerial,andanexhaustiveamountofhealthcoachingresourcesareavailable.

TheNBHWCalsoprovidesopportunitiesforcoachestostaycurrentandtakeadvantageofmanyhealthcoachingresources,throughsocialmedia,emailupdates,andQ&Awebinars.

Additionalhealthcoachingresourcesarereferencedduringthein-personWHCTraining,andadedicatedLinks&ResourcessectionisincludedintheWHCParticipantManual.

SELF-STUDY

Probablythemostimportantstrategytoprepareforthenationalexaminvolvesself-study.AlthoughtheWHCTrainingprovidesthefoundationalcoachingqualities,skills,andstrategiestocreateskilledandcompetenthealthcoaches,itisnotintendedto“prepare”coachesfortheexam.Thecombinationoftraining,self-study,andcoachingpracticearethefoundationsforexampreparation.

AnadditionalWHCExamPrepGuidehasbeencreatedtoaddtotheever-increasinglistofnationalexamresources.ThisguideisanexpansiveandcomprehensivereviewofallVHAWHCcoursematerialsandadditionalNBHWCContentOutlinetopics.SeparateOPCC&CTLandingPages,createdforWHCandAsynchronousLearning,bothincludelinksandreferencetotheExamPrepGuide.UtilizingtheNBHWCwebsiteforresourcereferencesiscrucial.ThesitecontainsanHWCCertifyingExaminationContentOutlinethatcanbedownloadedandusedasastudytool.ThisContentOutlineoffersanextensivelistofresources;takeadvantageofyourexistingknowledgetofocusonareaswhereyoucoulduseadditionallearningandsupport.OtherareastoreviewincludeNBHWCCodeofEthics,ScopeofPractice,andknowledgeofHealthandWellnessbiomarkers.Thematerialisthoroughandcomprehensive,sospendingeffortsinoneareaatatimemaybehelpful.

TheVHASharePointsitealsooffersawealthofhealthcoachinginformation,resources,andtoolsusefulforself-study.WHCTrainingmaterials(ParticipantManual,PowerPointSlides,andcoachingdemonstrationvideos)areavailabletoallVHAcoaches.Anadditional“SampleNBHWCExamStudyGuide”isofferedasanoptionalstudytool.Itisimportantto



rememberthatthisisa“sample”studyguide,whileitprovidesasenseofwhatisrequiredtopreparefortheexam,cannotberelieduponastheonlysourceofstudymaterial.

The3-WeekWHCTrainingincludesadditionalindependentlearningintheformofasynchronousonlinemodules.ThisasynchronousinstructionisrequiredtomeetNBHWCtrainingstandardsandbetterpreparestudentsforthenationalexamcontent,particularlyaroundHealth&Wellnessmaterial:chronicdiseasebiomarkers,healthbehaviors,andriskfactors.Participantsshouldconsiderthislearningintegraltotheirdevelopmentasqualifiedcoaches;breezingthroughtothefinishlinesimplyto“meettherequirement”shouldbesecondarytotheactuallearning.YourlearningwillsupportthequalityofcoachingprovidedtoVeteransANDincreasetheprobabilityofsuccessinbeingpreparedfortheexam.

Belowisalistofhelpfultipsforcontinuedself-studysuccess:

• Takeyourtimepreparing–don’trushtotaketheexam. • Createstudygroupswithfellowcoaches. • ExplorewhetheryoursitewillpurchasesomeoftheNBHWCreferencedcoaching

books. • Findanonline“examprep”course. • ListentoCommunityofPractice(COP)callsonSharePointregardingthenational

exam(call#31,32,33,34,and35). • UsetheExamGuideOverviewonSharePointasaresource(linkincludedin

References). • Receiveadditionalmentoring.

SELF-CAREDURINGPREPARATION

Ascoaches,youareawareoftheimportanceofbeingpresentandsupportingothers’self-care.Itisimportant,andvital,thatyoupracticethesesameskillsforyourselfduringyourtimeofpreparationfortheexam.Explorewhatreallymatterstoyouaboutthisopportunity.Understandtheimportanceofthisendeavorforyourselfasacoach;thiswillenableyoutostayfocusedasyoustudy,practice,andprepare.

Allowingampletimeforstudy,research,practice,andevenmorepractice,willmeanpacingyourselfandcreatingastudyschedulethatmaintainsbalanceinyourlife.Applyingwhatweknowaboutself-careforothers–toourselves–isanewskill.Creatingastudyschedulethatfeelsrightforyouwilladdtothatbalanceandpreparedness.Organization,timemanagement,andcommitmentwillbethebackbonetoyoursuccessfulstudyroutine.



Creatingacentralizedlocation(physicalorelectronic)foryourstudymaterialsandresourceswillkeepyouorganizedandhelpinyoursuccess.

SELF-CAREBEFORETHEEXAM

You’vestudied,you’vepracticed,you’veprepared.Youhaveputinthelong,dedicatedhours.Preparingyourselfonthedayoftheexamisjustasimportantandhelpful.Thenationalexamhasarrived,andyouwanttobeatyourbest.Utilizewhatyouknowaboutrestandrecharge–andsleephygiene–tobeawakeandalert.Gettingagoodnight’ssleep,theweekleadingtotheexamwillincreaseyourabilitytofocusonexamday.

Propernutritionandhydrationarealsowaystoprepareyourself,body,andmind,forthetimeyouwillspendtakingtheexam.Foodsheavyinsugarorfat,orprocessedfoods,cancreateasluggishnessinyourmindandbody.Eatingwell,includingfreshfruitsandvegetables,willsupplyyouwiththeenergyrichnutrientsyouneedtomaintainyourstaminathroughthehour’slongexam.Contactingtheexamproctoringsitetoinquireaboutbringinghealthysnacksandwatermaybeonemoresuccessfulself-careapproach.

Onefinalself-caretoolyoumaychooseinvolvesvisualization.Visualizeyourselfsuccessfullyapproachingtheexam,takingtheexam,andcompletingtheexam.Thiscancreateameaningfulandpowerfulvisiontoholdcloseasyouprepare.Thistypeofvisualizationcanbedoneleadinguptotheexam,justbeforetheexam,andevenduring.Addinginmomentsofawarenessofbreathingmaybeanothermindfulawarenesspracticeyouutilize,bothpreparingforandtakingtheexam.Progressivemusclerelaxation,stretching,orbodyscanarealsohelpfulformanytesttakers.Practicewhatyouknowworksforyou–whateverbringsyouease,clarity,focus,andcalm.



RESOURCES&REFERENCES

WHOLEHEALTHWEBSITE

PublicWebsite(Internet):https://www.va.gov/wholehealth/

SharePoint(Intranet):https://dvagov.sharepoint.com/sites/VHAOPCC/Education/SitePages/Home.aspx

ExamGuideOverview(onSharePoint):https://dvagov.sharepoint.com/sites/VHAOPCC/Education/SitePages/WH-Coaching-National-Exam-Guide.aspxTheVAOfficeofPatientCenteredCareandCulturalTransformation(OPCC&CT)workswithVAleadershipandhealthcareproviderstotransformVA’shealthsystemfromthetraditionalmedicalmodel,whichfocusesontreatingspecificissues,toapersonalized,proactive,patient-drivenmodelthatpromoteswholehealthforVeteransandtheirfamilies.

• Personalizedcaremeansputtingyourneedsfirstandpartneringwithyoutocreateacustomizedhealthplanbasedonyourgoals,personalhistory,andlifestyle.

• Proactivecaremeansyourcareteamwillactivelyworkwithyoutofindpreventive,ratherthanreactive,optionsthatstrengthenyourindividual,innatecapacityforhealthandhealing—forexample,usingmind-bodyapproachesandnutritionalchangespriortosurgeryorchemotherapy.

• Patient-drivencareputsyouattheheadofyourpersonalhealthcareteam,soclinicianscangiveyoutheskills,resources,andsupporttodriveyourowncare.

TheVAisbuildingaproactiveandpersonalizedhealthcaresystemthathonorsVeterans’serviceandempowersthemtoachievetheirgreatestlevelofhealthandwell-being.AstheVAtransformsthedeliveryofcare,auniquecommunityforVeteransthatembracestheirdistinctiveneedsisbeingforged

ThepatientcenteredcaretransformationisgrowingandrobustinmanyVAfacilitiesacrossthecountry.ThroughLiveWholeHealth,OPCC&CTandVAareprovidingtheresourcestogiveVeterans,healthcareproviders,andstaffthefreedomtocreateacultureinwhichthistransformationcanflourish.Now,VeteransandprovidershavetheopportunitytoworktogethertodefinethefutureofWholeHealthcareatVA.



COMMUNITYOFPRACTICECALLS

WholeHealthCoachingCommunityofPracticecall

• WholeHealthcoachingeducationandskill-development,subjectmatterexperts,bestpractices.

• Monthlycallon4thThursdayat2:00ET. • VANTS:1-800-767-1750,AccessCode43351• AdobeConnectlink:http://va-eerc-ees.adobeconnect.com/whcoachcop/

WholeHealth:ContinuetheConversationCommunityofPracticecall

• WholeHealthlearningandskill-development,subjectmatterexperts,bestpractices. • Monthlycallon1stThursdayat2:00ET. • VANTS:1-800-767-1750,AccessCode43351• AdobeConnectlink:http://va-eerc-ees.adobeconnect.com/wh_cop/

OTHERVARESOURCES

TherearemanyvaluableresourceswithintheVAsystemwhichmayprovideadditionaltrainingopportunitiestosupplementtheskillsandconceptslearnedintheWholeHealthCoachingprogram.Theseareasamplingonlyofwhatisavailable.Forspecificopportunitiesatyourlocation,pleasecontactyourimmediatesupervisor,HealthEducationCoordinator,HealthPromotions/DiseasePreventionProgramManager,HealthBehaviorCoordinator,WholeHealthCoordinator,orPatientCenteredCareCoordinatorforcoursesyouareeligibleandabletoattend.

• MotivationalInterviewing(NCP)• TEACH(NCP)• CREW(NCOD)• ClinicianCoaching(NCP)• TelephoneLifestyleCoaching(NCP)

MaketheConnectionstoriesfromVeterans,Servicemembers,andNationalGuard:https://maketheconnection.net/

TheseSharePointsitescontainmanyresourcesthatsupportWholeHealth:

VHANationalCenterforHealthPromotionandDiseasePrevention:http://vaww.infoshare.va.gov/sites/prevention/default.aspx



VHANationalCenterforOrganizationDevelopmenthttp://vaww.va.gov/NCOD/CREW.asp

TelephoneLifestyleCoachinghttps://dvagov.sharepoint.com/sites/VHAPrevention/TLC/default.aspx

SUGGESTEDWEBSITES

(ThesewebsitesareprovidedsolelyforadditionalinformationandarenotendorsementsbyeitherTechWerksortheVHA/OPCC&CT)

• InternationalCoachingFederation-http://www.coachfederation.org/• NationalBoardforHealth&WellnessCoaching–http://www.nbhwc.org• Health&WellnessCoachCertifyingExamination/ContentOutlinewithResources-

https://www.nbme.org/pdf/hwc/HWCCE_content_outline.pdf

SUGGESTEDREADINGMATERIALS

(ThesematerialsareprovidedsolelyforadditionalinformationandarenotendorsementsbyeitherTechWerksortheVHA/OPCC&CT)

• Britton,J.J.(2010).EffectiveGroupCoaching:TriedandTestedToolsandResourcesforOptimumCoachingResults.Hoboken,NJ:JohnWiley&Sons.

• Dossey,B.M.,Luck,S.,&Schaub,B.G.(2014).NurseCoaching:IntegrativeApproachesforHealthandWellbeing.NY.

• Dossey,B.M.,&Hess,D.(2013).ProfessionalNurseCoaching:AdvancesinNationalandGlobalHealthcareTransformation.GlobalAdvancesinHealthandMedicine,2(4),10-16.doi:10.7453/gahmj.2013.044GlobalAdvancesinHealthandMedicine—May2013Vol2No3 http://www.gahmj.com/toc/gahmj/2/3

• Miller,W.R.,&Rollnick,S.(2012).MotivationalInterviewing,ThirdEdition:HelpingPeopleChange.NewYork,NY:GuilfordPress.

• Rollnick,S.,Mason,P.,&Butler,C.C.(2010).HealthBehaviorChangeE-Book.St.Louis,MO:ElsevierHealthSciences.

• Rollnick,S.,Miller,W.R.,&Butler,C.C.(2012).MotivationalInterviewinginHealthCare:HelpingPatientsChangeBehavior.NewYork,NY:GuilfordPress.

• Whitworth,L.,Kimsey-House,H.,Kimsey-House,K.,&Sandahl,P.(2007).Co-ActiveCoaching:NewSkillsforCoachingPeopleTowardSuccessinWorkandLife.London,UnitedKingdom:NicholasBrealeyPublishing.

Whole Health Coaching Participant Manual.Feb19.2021

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