concepts hwc
how to positive emotions effect negative emotions?
"the undoing hypothesis"
MINDFUL LISTENING *also called: *It is....
*"Active Listening" *it is listening that brings full, non judgmental awareness and integration of what is being expressed physically, verbally, and emotionally
*What empowering message does silence send? **silence can lead to______ and _____ that coaches may never have anticipated if we let it happen
*"I believe you can go deeper and figure this out yourself" **can lead to NEW INSIGHT, and DIRECTIONAL SHIFTS that coaches may never have anticipated if we let it happen
Results of facilitating the process of change (the 4th of 4 coaching mechanisms of action)
*INSIGHT (motivation/capacity) leads to ACTION (behavioral goals) (insight -> action -> insight -> action) creates a synaptic change in brain and increases the capacity to change *chaos -> order -> chaos -> order increases capacity for sustained change
with ALL precontemplators at the end of a session, a couch should _________ *If you leave the client feeling respected + understood during the interaction, they will.....
*LEAVE THE DOOR OPEN *they will remember you in a positive light and may return when change is seen as desirable and more possible
open-ended inquiry: *allows... **used to... ***important because these types of questions facilitate..
*allows client to change dialogue **used to explore client's experiences ***important bc these types of questions facilitate a wealth of information; the building blocks of the coaching experience
Purpose of decisional balance? --> - - --> --> -
-->To explore ambivalence about the value of change -how aware are they of conflict? -what is the nature and extent of their conflict? -->To explore their capacity for change -->To explore costs & benefits of changing and not changing -is one pro or con outweighing all the others?
Moore, M & Tschannen-Moran, B have recommended guidelines around scope of practice & liability that serve to uphold the code of ethics: --if you are working with paying clients., coaches should..... --as a coach or trainee, you should create and utilize...
--carry professional liability insurance to cover coaching service --informed consent and coaching contracts to facilitate transparency and accuracy of the coaching agreement (coaching contract)
How should coaches UPHOLD cultural competency code of ethics: -coach training programs should incorporate... **ongoing cultural competency training should occur where the coach is likely to work within... -coaches should use... **it is the responsibility of the coach to learn what..
-Coach training programs should incorporate education in cross-cultural issues; generally and specifically **within a cross-cultural context, multicultural society, and with indigenous people -coaches should use modalities and tools that are appropriate for use within the cultural context specific to their clients **it is the responsibility of the coach to learn what modalities, communication approaches, and tools are appropriate
MAIN COMPONENTS of ACT(3)
-MINDFULNESS -ACCEPTANCE -COMMITTED ACTION
which MI communication skills should be used in a short clinical encounter
-OARS -Roll with resistance
which coaching skills should be used in a short clinical encounter
-Scaling -exploring past efforts for future success
failure of a person or entity to meet the legal responsibility of liability leaves that person of entity open to:
-a lawsuit or any resulting damages -a court order to perform (as in a breach of contract or violation of statue)
what 3 things should informed consent include
-a statement indicating that the patient has been given an opportunity to ask questions about the program -an indication that the participant has sufficient information to give consent -a statement indicating that the participant is free to withdraw consent at any time
coaching contract: when coaches and clients agree and commit to some key principles regarding their coaching relationship *Allows both the client and coach to.... (2)
-align their goals and expectations surrounding the coaching process, relationship, and its potential benefits and outcomes -uphold the ethical guidelines of the coaching relationship
upon what theories is the coaching process based
-appreciative inquiry -transtheoretical model for behavior change -goal setting -social cognitive
challenges of personal coaching(4)
-basis is not found in science or scientific evidence -efficacy not measured or measured ineffectively -no standardization of process or technique -little oversight
How should coaches INSURE cultural competency: -before coaching commences.... -when coaches are working cross-culturally and with indigenous people, the coach should ideally be...
-before coaching commences, an open dialogue should occur between the coach and client concerning: *the coach's approach to coaching *a discussion on the appropriateness of their approach with that client -ideally be supervised by an appropriate cultural advisor
benefits of using agenda-setting chart
-can be used as a guide to expose those worries not spoken or evident -facilitates an exchange of information -establishes good rapport with patient -can facilitate cultural sensitivity
positive emotions -can increase -transform
-can increase brain resources -transform people for the better, helping them to build more resources (intellectual, physical ,social, psychological)
limitations to agenda-setting chart when used incorrectly
-can lead to premature focus -coach can rely too heavily on tool rather than the interaction with the patient
GOALS of ACT (3)
-clients experience world more directly -help clients lives be consistent with values and goals -to be with emotions and cognitions courageously and compassionately
What factors contribute to psychological inflexibility?
-cognitive fusion -lack of clarity concerning values -inaction and impulsivity -rigidity -experimental avoidance
TTM processes of change designed to encourage a client in precontemplation to discuss change from a non-threatening position and possibly move them to the contemplation stage are: - - -
-conscious raising -dramatic relief -environmental revaluation
4 coaching mechanisms of action
-cultivate a growth-promoting relationship -stimulate motivation -illuminate capacity -facilitate a process of change
expressing respect and listening to the patient throughout: -enhances.... -facilitates....
-enhances patient self efficacy and empowerment -facilitates a more meaningful commitment from the patient
patients who are empowered have (4)
-enough knowledge to make rational choice -enough control -enough resources to implement their decisions -enough experience to evaluate the effectiveness of their actions and live with the consequences of those actions
hypothetical look over the fence is a great tool for - - -
-exploring the "unknown" about change without the threat of commitment -exploring confidence and capacity for change -illuminating both motivation and confidence issues
4 basic MI principles vital to coaching
-express empathy -develop discrepancy -roll with resistance -support self efficacy
tips for success when using a BMI - -
-express respect and LISTEN to the patient throughout -take advantage of teaching moments when they arise and be careful NOT to insert your own agenda in the process
when to use offering a menu of options during EPE? -most useful after... -also useful when
-most useful after trying to evoke a plan of action from the patient first -also useful when the patient is "stuck" and not sure how to respond
reflections: Accomplished through: - -
-paraphrasing to clarify what was said; do not assume -repeating back what was said when warranted
Patient centered medicine: Works to combine...
-physical ethical values -client-centered therapeutic techniques (psychotherapeutic theories on facilitating patient's disclosure of real worries and negotiation theories on decision making)
REFRAMING: 2 steps
-reflect the positive in client's past experience and present circumstances -replace fault, counter-productive perceptions with more accurate, productive ones
5 ways you know you have your communication skills right
-the client is doing much more of the talking than you -the client is actively engaging the process -the client appears to be working had, often realizing things for the first time -you are gently facilitating the session at appropriate moments -you are listening until you no longer exist
general principles of BMI (5)
-the doctor-patient relationship is a PARTNERSHIP (more than expert-recipient rltsp) -readiness to change is a fluctuating product of an interpersonal interaction (not a patient trait) -it is the patient's task to articulate and resolve ambivalence, not the doctors -direct persuasion and argument from the doctor is not an effective method to resolve ambivalence -the counseling style is generally a quiet and eliciting one
HCP assumptions
-this patient needs to change -this patient will never change -if they do not change, i have failed
most popular theories giving influence to coaching psychology (6)
-transtheoretical model for behavior change -motivational interviewing -choice therapy -reality therapy -solution oriented psychotherapy -appreciative inquiry
tips for success when using the agenda-setting chart: -use..... to appropriately set the agenda -if the patient identifies more than 1 topic of discussion...
-use listening skills to appropriately set the agenda -more than 1 topic; use scaling to determine the one thats most important
With pre-contemplators "I CANT" clients, -use your ________ and express_________ because this shows you understand...
-use your BEING skills, and express sincere empathy for their current situation, because empathy shows that you understand how difficult change can be.
challenges (4) associated with implementing this model?
-workflow -continuity of care -team dynamics -training
The 3 basic biological needs of the self determination theory
1. COMPETENCE or mastery of environment 2. AUTONOMY or ownership of behaviors and choices and their consequences 3. RELATEDNESS or feeling that we are connected to society in general
What are the outcomes delivered by collaborative and co-creative partnership?
1. creating a plan for change that promotes: -attainment of health goals -sustainable behavior change 2. increasing self awareness and personal clarity 3. acquiring new knowledge and skills 4. increasing self efficacy
know top 10 indicators that its time to refer your client to a mental health profession
1. unable to experience pleasure, increase in hopelessness or helplessness 2. unable to focus, intrusive thoughts 3. poor sleep patterns, exhaustion 4. marked change in appetite 5. guilt, unworthiness 6. despair, hopelessness 7. hyper or excessively tired 8. irritability, anger outburst 9. impulsive, risk taking behavior 10. preoccupied with death
1st step of reframing? involves... * *
1st step: reflect the positive in client's past experience and present circumstances *see the benefits and strengths within challenge and adversity *infuse ordinary events with gratitude and meaning
The Teamlet Model of Primary care has
2 central features; 1 clinician and 2 health coaches
2nd step of reframing? involves... * * *
2nd step: replace fault, counter productive perceptions with more accurate, prodcutive ones *identify the faulty perception (all or nothing mentality, blaming, negativity) *challenge it on the basis of evidence (can anyone possibly be bad at everything?!) *replace it with a life-enhancing perception (each of us can change, regardless of your circumstance)
Definition of MI
A communication method: a directive, client centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence
3 Objectives of process of coaching techniques and skills? (& definitions)
ASSESSMENT: (clients must know where they are before they can work on where they want to be) EFFECTIVE COMMUNICATION: (skills designed to enhance collaboration and creative thinking) EXPLORATION: (discover what a client really wants and values and the resources to achieve both)
ISSUES SURROUNDING INFO EXCHANGE Conflict often arises concerning __________ - - --> creates a climate of: - -
Agenda of visit -HCP assumptions about patient -HCP beings interaction with a set agenda in mind --> creates a climate of: -mistrust by patient of HCP, = missed visits -dependence of HCP to tell patient what to do
what important information should you know regarding process of coaching?
Although the objectives of the coaching process are universal, the execution of the coaching process is not. There is not set formula, how this process evolves is individual and organic.
what type of goals will contemplation clients set? *at this stage involve... and not... **to build... identify...
BEHAVIORAL GOALS *involve reading, thinking, talking, listening, discovering and deciding, not doing a behavior. **to build self-efficacy, identify small realistic thinking, and feeling goals every week thereby empowering contemplators to be more confident in their ability to change and move forward to the next stage
What are doing skills
Communication skills -listening -inquiring and reflecting from a place of positivity
directive coaching vs nondirective coaching
DIRECTIVE: historically, coaching means to tutor someone or someone who directs/trains an individual or group to attain certain goals/objectives NONDIRECTIVE: now, tim gallaway says "coaching is the art of creating an environment through conversation and a way of being that cailitates the process by which a person can move towards desired goals in a fulfilling manner.
4 D's of appreciative inquiry
Discover Dream Design Deliver
What does EPE stand for /how is each one defined
EPE: Elicit, Provide, Elicit Elicit: find out what patient already knows by asking him or hear directly Provide: fill in the gaps/and or correct any misconceptions the patient may have Elicit: find out what this information means to the patient's life
Mindful listening is the ____________ because
HALLMARK OF GREAT COACHING because there may be no other relationship in our client's lives where they are heard in the way they are heard by the coach
Moore's definition of health and wellness coaching
Health coaching, through a well-facilitated conversation, transforms chaos to order, confusion to clarity, uncertainty to action
What are being skills
How we are with a client -presence -empathy -peace -awareness -authenticity -respect
How doing skillls help build a new brain network: Coaches encourage a clien'ts creative process by altering ________ & ________
INQUIRY & REFLECTION INQUIRY: activates prefrontal cortex REFLECTION: activates limbic system
MINDFUL LISTENING Involves...
LISTENING FOR THE MEANINGFUL WHOLE; what is said and what is not said -What is said (clients best experiences, core values, significant moments, acknowledged feelings, current challenges, future dreams) -What is unsaid ( clients demeanor, physicality, vocal tone, mood, expression, etc)
What is the bottom line on coaching ethics?
NEVER... ALWAYS..... (***Study what)
OARS in _________ stands for
OARS in MI O: open-ended acquiry A: affirmations R: reflections S: summary
_________ is most valuable to building new brain network through doing skills
POSITIVITY; changing mindset in a way that supports positive change
A health coach is someone who.... (PDIA) Possesses? Demonstrates? Is? Acts as a ?
Possesses: exceptional listening & communication skills Demonstrates: respectfulness, cultural & social sensitivity, genuineness, empathy Is: engaging and energizing Acts as a: sounding board, challenger, cheer leader, expert resource (When necessary)
Patient centered medicine: Refers to..... based on..... Reflective of....
Refers to: an approach that moved from a disease centered medical model to an overall diagnosis, based on understanding the patient from a humanistic, bio-psycho-social perspective Reflective of: the client-centered therapeutic approach
Simple Reflection: vs Perceptive Reflection:
Simple: Provide a mirror that reflects back to clients where they are, and what they are learning Perceptive: enables clients to hear what they are saying from the vantage point of another person
what TTM processes of change may help client in contemplation explore possibility of change and possibly move into preparation stage? (I MIGHT PPL)
TTM: -self reevaluation -decisional balance MI: -hypothetical look over the fence
WHY?; this is... -shows -shows -gives
This is the tie to use disclosure and reflections -shows that you empathize with and respect their feelings and needs -shows you really hear where they are with regards to behavior change -gives you the opportunity to plant a seed that may grow later
Objective of Evoking Change Talk: To evoke the patient's....... in order to....... *This change talk predicts...... which in return is correlated to....
To evoke the patients' desire, ability, reasons, and need to change in order to strengthen the patient's commitment to the behavior during a session. This change talk predicts increased commitment strength to the lifestyle change which in return is correlated to positive clinical outcomes.
Objective of EPE:
To find out what the patient already knows, fill in gaps/correct any misconceptions, and explore how this will fit into the patients life. This is a time saving strategy that both validates patient knowledge, and allows time to address barriers
what fact is crucial to keeping the door open when coaching pre-contemplators? In this, you are not... instead you are...
a coach recognizing and accepting this fact: pre-contemplators do not intend to change the behavior in this, you are not asking them to move forward on the change process at this time, instead you are focused on understanding them at a deeper level and accepting their current choices without judgement
in a short clinical encounter, what should the final elicit result in?
a commitment to a behavioral and cognitive goal the will take action on, and a commitment to the resources they engage in on those goals to enhance success
Acceptance commitment theory/ACT is a form of.... which assists....
a form of cognitive behavioral therapy which assists clients in developing psychological flexibility
what do clients build through the coaching mechanisms of action
a new brain network, and in turn the capacity for sustained change
What is the benefit to offering a menu of options to a patient during the EPE process?
a patient-centered way to provide advice or information. the patient can take ownership of their own treatments, as opposed to physician direction and telling them what to do.
wellness
balancing the 6 dimensions; spices (social, physical, intellectual, cultural, emotional, spiritual)
why is hypothetical look over the fence good fore exploring the unknown about change
because the discussion is hypothetical, there is NO PRESSURE involved so RESISTANCE MAY BE LOWER
nondirective coaching requires 1 essential ingredient
caring not only for external results, but for the person being coached
definition of self-efficacy
confidence that one can engage in the goal behavior in the face of changing, challenging, or tempting situations
perceptive reflections are often more provocative and transformational than simple reflections because it causes the client to..
connect more deeply to their emotions and their truth
decisional balance is: it fxns to: - -
conscious weighing of the pro's and con's of changing and not changing -increases awareness of compelling reasons to change -realistically explores challenges to change
negative emotions continue to
demand attention until you adress the source
POSITIVE PSYCHOLOGY is a domain that investigaes... draws on....
domain that investigates what makes people thrive and flourish draws on humanistic belief that people are whole, creative, resourceful, and resilient,, and able to gain control of their health and wellness
ex of?? "what would have to happen for you to be able to change the way you eat? what would have to be different for you to feel this change is possible?
dramatic relief **I CANT CLIENTS
ex of??? "are you sure your lack of mobility and energy is the only thing affecting you?"
environmental reevaluation **I WONT CLIENTS
what is coaching psychology founded upon
evidence-based theories and fields of study, *that increases efficacy, standardization, measurability, & credibility of health coaching
The process of coaching: Coaching employs a variety of techniques and skills grounded in....
evidence-based theories shown to facilitate lasting change
Evoking Change Talk: is an importnat strategy to...
evoke reasons for the patient to change and elct a plan of action in at least one area according to the patient's readiness to change
roll with resistance:
express empathy, then develop discrepancy
conscious raising is
finding and learning new facts, ideas, and tips that help clients see change as more possible **ICANT CLIENTS
with pre-contemplators "I CANT" clients, -focus on affirming.......... rather than.... because:
focus on affirming their strengths, rather than attempting to convince"ICANT'S" that their challenges aren't real. Because: ALL challenges are real to the client, and must be respected if the lines of communication are to remain open.
brief motivational interviewing: is an approach which provides...
general practitioner's with broader range of communication skills that are tailored to the individuals readiness to change
KNOW qualities of a masterful coach
go over them a zillion times
HOW MANY goals are there of collaborative and co-creative partnership"? HOW MANY outcomes?
goals: 6; go study what the goals are**** outcomes: 4
AMA Coaching article says
health coaching is filling in a gap; health coaches should avoid stepping on physician toes. **Read over these********
environmental reevaluation is
helping clients to look at the negative impact of unhealthy behavior of the positive impact of healthy behavior on proximal social and physical environment. allowing a coach to "plant a seed of motivation" **I WONT CLIENTS
what is social baseline theory?
humans "outsource" self-regulation and psychic resources based on perceptions and availability of social relationships
Article: Value of Positive emotions, states that you can....
indirectly cultivate positive emotions by finding positive meaning in an individual's current situation
decisional balance is not... it is ...
is NOT plan for change, it is an exploratory tools
What is crucial to keeping the door open with all clients in the CONTEMPLATION stage? *at this time, a coach sohuld not..... and instead focus on...
is a coach recognizing and accepting the fact that contemplators are not ready to set behavioral goals. *at this time a coach should not ask contemplators to move forward on the behavior at this time, instead focus on assisting contemplators to explore the idea of change at a deeper level
factors of why it is so hard to live our wellness
knowledge health care providers health care systems laziness
Definition of liability
legal responsibility for ones acts OR omissions
Silence can bring a surprise, making it __________because ______. This surprise is:
making it a core tool of coaching, because it has a way of evoking greatness from people. If we are talking, we are not listening.
what is the message that sends what current understanding about why health care providers aren't a factor of living wellness
message: "you aren't in charge, therefore you aren't responsible" current understanding: if a positive treatment outcomes are to be achieved, patient's must be a part of their treatment program
Ethical responsibilities of a coach regarding liability and client goals: When you have clients who want to achieve health goals not in line with____ do what? (3 things)
not in line with current health and clinical guidelines -relay current recommendations based on your expertise -attempt to develop a compromised goal with your patient -document all communications concerning recommendations given and choices made by client
what is informed consent? what does it ensure?
obtaining written consent from a client prior to participating in coaching is a important ethical and legal step in the coaching process *ensures client knows and understands the risks associated with different health behaviors
Patient centered medicine: Puts a strong emphasis on...
patient participation in clinical decision making, by taking into account the patient's perspective, and tuning medical care to the patient's needs and preferences
definition of mindfulness: it involves being ....
paying attention to something (client) in a particular way on purpose, in present moment, and without judgement involves being fully attuned to physical and sensory input that we experience at the very moment we do
the final elicit in BMI is important in getting patients to... *this approach may also enable patients to obtain...
process and personalize the information for themselves. *to obtain more relevant information, rather than the standard "lecture" on losing weight or smoking.
ACT works to increase_______ by fostering - -
psychological flexibility; by fostering -acceptance of unhelpful thoughts, personal scripts, mental images, and emotions
how does self determination theory influence health beahvior?
pursuit and satisfaction with goal-directed need fulfillment associated with supportive environment and agentic behavior
self reevaluation is realizing... *useful during?
realizing that behavior change is an important part of one's identity as a person *useful during exploration and self awareness process, allows coaches to help contemplators connect the dots between changes they seek and values they hold
Simple reflections do what.....
reassure clients, encourage deeper thinking, and promote open communication
What is the cornerstone of empowerment
recognizing that an individual is completely responsible for managing his or her own wellness. the patient's responsibility is non negotiable, indivisible, and inescapable.
what is self/personal disclosure
sharing personal experiences of success and failure, and the process towards both.. in an effort to assist a stuck client and improve their self-efficacy or capacity to change or to build rapport
To move forward with all pre-contemplators, the crucial coaching skill to use is
sincere empathy
"if you want someone to learn how to drive, you must put them in the drivers seat" says.. by putting them in the drivers seat, you are telling them..
telling them/showing them you are competent
reflections/reflective listening: insures... relays..
that what you are hearing and understanding matches what the client is trying to express. relays that you are "being " with the client
definition of psychological flexibility
the ability to consciously and emotionally connect to the present moment more fully, so once can change or persist in behavior that is done in the serve of valued ends (Despite screaming inner dialogue that is not supportive)
agentic behavior is the capacity to.... and is characterized by what 5 things
the capacity to exercise control over the nature and quantity of ones life -intentionality and forethought -self regulation by self reactive influence -self reflectiveness about ones capabilites -quality of functioning -meaning and purpose of ones life pursuits
why is this fact crucial? BC attempting to persuade, encourga,e or suggest that a client in pre-contemplation set behavioral goals can cause
the coach to fall into "premature focus trap"; which can trigger resistance, move responsibility or change from the client to the coach, and can destroy future coaching possibilities
definition of empowerment
the discovery and development of ones inborn capacity to be responsible for ones own life "encouraging people to participate as equal partners in decisions about the health care they receive"
definition of coaching psychology
the science of coaching based-relationships designed to optimize health and well-being
The self determination theory says...
there are 3 basic biological drives/needs that allow humans to thrive. They are unconscious, innate, and necessary to thrive
definition of emotional intelligence
to be psychologically and emotionally whole, not excluding any feeling or emotion but embracing full range of feelings and emotions
definition of personal coaching
to help clients improve their quality of life by aligning their goals and values with their work and home lives then making changes so that their lives become more fulfilling
definition of experimental avoidance
trying to suppress/block behavior or avoid situations as an evolutionary survival mechanism; can result in worsening of the psychological disorder
types and benefits of perception reflections
types: amplified reflections & double sided reflections benefits: when coaches perceptively paraphrase and reflect back what they think clients are saying, clients RESPOND MORE DEEPLY
definition of exploring past efforts for future success (coaching tool)
when a coach asks a patient/client about any situation where they were successful, even briefly, at a behavior in question "can you think of a time when you were most successful at....?" "what made it different from today/more recent attempts?"
dramatic relief is
when clients are asked to look at the experience of negative emotions (Fear, anxiety, worry) that go with unhealthy behavior **I CANT CLIENTS
why is it so hard to live our wellness
while most of us long for better physical and mental well-being, evidence suggests we're moving in the opposite direction
to be TRULY mindful, you must..... this give you...
you must separate your reactive brain from your thoughtful brain *gives you the DISTANCE to observe yourself, and manage your response