HWC Exam 1 review
what empowering message does silence send?
"I believe that you can go deeper and figure this out yourself."
article (the team let model of primary care) what are the 2 central features of the physician's visit using this model?
(1) the patient encounter involves 2 caregivers—a clinician (physician, nurse-practitioner, or physician's assistant) and a health coach—rather than only the clinician; and (2) the 15-minute visit is expanded to include previsit, visit, postvisit, and between-visit care.
(Health and wellness coaching theory) what are being skills? What are doing skills? How do "doing" skills help to build a new brain network?
-"Being" skills: presence, empathy, peace, awareness, authenticity, respect, self-determination, mindfulness, emotional intelligence, acceptance -"doing" skills: listening, inquiring, and reflecting from a place of positivity, positive psychology, motivational interviewing, cognitive and behavioral therapy -"doing" skills encourage a client's creative process by alternating inquiry and reflection, most valuable to this process is positivity (keeps limbic system activated)
What does a coaching contract allow both coach and client to do?
-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 theory -Social Cognitive Theory
(Health and wellness coaching theory) what are the 4 coaching mechanisms of action? What is the result of facilitating the process of change?
-cultivate a Growth-Promoting Relationship (Relational skills> builds a new brain work) -Stimulate motivation (twin engines of change) -Illuminate Capacity (twin engines of change) -Facilitate the process of change (Insight (motivation/capacity)> Action (Behavioral goals)>insight>action...) (Chaos>order>chaos>order) increases the capacity for sustained change
(ICF article, "Potential Perils of Personal Issues in Coaching:" ) What are the top 10 indicators that it's time to refer your client to a mental health professional? Be able to recognize examples of these indicators
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 outbursts 9. Impulsive, risk-taking behavior 10. Preoccupied with death
What are the objectives of coaching techniques and skills associated with the process of coaching? (intro to hc)
1. assessment: clients must know where they are before they can work on where they want to be 2. effective communication: skills designed to enhance collaboration and creative thinking 3. exploration: discover what a client really wants and values and the resources to achieve both
what are the outcomes delivered by a collaborative and co-creative partnership? (intro to hc)
1. creating a plan for change that promotes: attainment of a higher level of well-being, sustainable behavior change 2. increasing self-awareness and personal clarity 3. acquiring new knowledge and skills 4. increasing self-efficacy
what are the pillars of collaborative and co-creative partnership? (intro to hc)
1. honor the wisdom, resourcefulness and creativity within each client 2. encourage clients' personal accountability and responsibility to themselves and their plan 3. support, model and encourage healthy change 4. listen when clients express concerns and allow them to articulate what information they need 5. facilitate change talk
What are the 4 basic MI principles vital to coaching?
4 basic MI principles vital to coaching: Express empathy: get on the client's side of the change fence Develop discrepancy: see where they are vs. where they want to be Roll with resistance: non-confrontational "arguments" for change Support self-efficacy: ID existing levels and ways to increase Open-ended inquiry: allows the client to drive the change dialog Affirmations: Voicing statements of recognition about client strengths and resources Reflective listening: LISTEN carefully to your client and reflect back what you've heard Summaries: capture and organize client's expressions, invite patient to correct anything missed
What is the definition of motivational interviewing? Why was this method thought to be superior to other methods, even though all were equally effective?
A directive, client-centered counseling style for eliciting behavior change by helping explore and resolve ambivalence. It was most efficient.
What is positive psychology?
A domain of psychology that investigates what makes people thrive and flourish: Optimism, hope, contentment, gratitude, love Draws on the humanistic belief that people are whole (not broken and needing to be fixed), creative, resourceful, resilient, and able to gain control of their health and wellness. Positive emotions can transform people for the better, help them to build more resources
what is acceptance commitment therapy?
A form of cognitive behavioral therapy which assists clients in developing psychological flexibility
what is mindful listening? What does it require? How can you put mindful listening into action?
AKA active listening Listening that brings full, non-judgmental awareness and integration of what is being expressed physically, verbally and emotionally
what information is important to know regarding the process of coaching? (intro to hc)
Although the objectives of the coaching process are universal, the execution of it is not. there is no set or best formula. how this process evolved is individual and organic
what is scaling? why is scaling considered the most important and useful tool in coaching for all stages of change? how does scaling work? Be able to appropriately respond to a scale level given by a client and describe what might be illuminated by the client's response to your question.
Asking a patient/client to scale their feelings/attitudes/perceptions about a specific expression, issue or topic of discussion. it promotes deeper self-discovery and self-awareness, it can insure effectiveness of the coach's and patient's/client's communication in a session.
What fact is crucial to keeping the door open when coaching pre-contemplators? Why?
Crucial to "keeping the door open" is a coach recognizing and accepting this fact: pre-contemplators do not intend to change the behavior in question. 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 judgment.
what are the 4 D's of appreciative inquiry?
Discovery, Dream, Design, Deliver
(Article, "Health Coaching to Improve Patient Outcomes" ) What does E-P-E stand for and how is each of these words defined? What is the objective of the E-P-E process?
Elicit-provide-elicit Elicit:Find out what the patient already knows by asking him or her 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 objective- find out what the patient alreadyknows, fill in the gaps or correct mis-conceptions, and explore how this willfit into the patient's life
what are the differences between health experts and health coaches? (intro to hc)
Expert: authority, educator, defines agenda, solves problems Coach: partner, facilitator of change, elicits clients agenda, foster responsibility, dance with client
what are the tips for success when using BMI?
Express respect for, and LISTEN to, the patient throughout the encounter Take advantage of teaching moments when they arise while being careful NOT to insert your own agenda in the process
What should you focus on affirming with pre-contemplator "I can't" clients? Are there challenges to change real or perceived?
Focus on affirmingtheir strengths rather than attempting to convince I can't's that their challenges aren't real. ALL challenges are real to the client and must be respected if the lines of communication are to remain open
Upon what does behavior therapy focus? What are the basic principles of behavior therapy that are pertinent to coaching?
Focuses on analyzing overt behavior in terms of stimulus, response, and reinforcement Both normal and abnormal behaviors are assumed to be learned; thus, deliberate actions can positively alter both normal and abnormal behaviors The basic principles pertinent to coaching The social environment plays a key role in the development and maintenance of both normal and abnormal behaviors. the client's physical environment may need to be altered to support new or maintain acquired behaviors and prevent relapse.
what are the issues surrounding information exchange between patient/health care provider communication?
HCP assumptions about patient, HCP begins interaction with a set agenda in mind, 50% of patients leave their physicians office visit without understanding what advice their physician gave
What is Moore's definition of health and wellness coaching? (intro to hc)
Health coaching is a collaborative and co-creative partnership through which a well-facilitated conversation transforms chaos to order, confusion to clarity, uncertainty to action
What is social baseline theory? How does it affect our need for relatedness
Humans "outsource" their self-regulation, and psychic resources (how much of their psychic resources they will use on psychological and behavioral tasks, completing a task, etc.) based on the perceptions and availability of their social relationships Our brains integrate trusting, reliable relationships as a part of our own psychic resources, reducing the amount of psychic energy expended This is solely dependent upon whether or not we perceive the relationship as trusting and reliable
What do Moore, M. & Tschannen-Moran, B. (2009) recommend you do to insure you are upholding ethical guidelines?
If you are working with paying clients, coaches should carry professional liability insurance to cover coaching services, As a coach or coach trainee, you should create and utilize informed consent and coaching contracts to facilitate transparency and accuracy of the coaching agreement
What is the benefit of offering a menu of options to a patient during the E-P-E process? When should this menu be offered?
It's also a great tool when apatient is "stuck" and not sure how torespond. In presenting a menu of options, the physician allows patientsto take ownership of their own treat-ments as opposed to directing andtelling them what to do.
When ending a session with all pre-contemplators, what should a coach do?
Leave the door open
What is liability?
Legal responsibility for one's acts or omissions
How do negative emotions impact our brain? Why? How do positive emotions impact our brain? How can we facilitate positive psychology?
Negative emotions move lightning fast and stick like VELCRO, hijacking brain resources Why? Evolution created this process to alert us to danger. Why we can more easily express and focus upon the negative These emotions will continue to demand your attention until you address the source Positive emotions are fleeting and "stick" like TEFLON BUT, they increase brain resources causing our brains to light up, our thinking to be more creative, integrative, flexible and open to information
what is "the bottom line" on coaching ethics?
Never-Diagnose a patient's or client's medical status (unless you are a medical professional)-Act outside your own documented expertise-Judge a patient's social or cultural reality based on your own-Divulge a client's personal health information without their permission Always-Respect your client's privacy-Document all coaching session content-Discuss and obtain an Informed Consent and a Signed Coaching Contract before you begin
What is informed consent? What should an informed consent include?
Obtaining written consent from a client prior to participating in coaching is an important ethical and legal step in the coaching process. The consent form should be verbally explained and then signed and include the following: -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.
in MI, what does the acronym OARS stand for? Be able to discuss each communication skill
Open-ended inquiry Affirmations Reflections Summary
What is mindfulness?
Paying attention to something in a particular way, on purpose, in the present moment and without judgment
what is the purpose of the decisional balance tool? At which stage of change is this tool most useful?
Purpose of the tool: to explore ambivalence about the value of change How aware are they of conf lict?What is the nature and extent of their conflict?to explore their capacity for changeto explore the costs and benefits of changing and not changingis one pro or con outweighing all the others?
How does self-determination theory influence health behavior?
Pursuit of, and satisfaction with, goal-directed need fulfillment is associated with supportive environments and agentic behavior: (Bandura, 2001) Human agentic behavior- The capacity to exercise control over the nature and quality of one's life. Agentic behavior is characterized by intentionality and forethought, self-regulation by self-reactive influence, and self-reflectiveness about one's capabilities, quality of functioning, and the meaning and purpose of one's life pursuits The bottom line: when people are intrinsically motivated, self-regulated, curious, proactive and intentionally engage their environments and positive behaviors, they grow personally and socially . . . .They thrive!
what surprise can silence bring making it a core tool of coaching?
Requires that a coach silence the voices in their own head so they can actively pay attention to the experience of the client.
What coaching tools are useful in a short clinical encounter?
Scaling Exploring past efforts for future success
what is the self-determination theory? What are the 3 basic biological needs described in the theory? Do we need to consciously engage these needs?
Self-determination theory posits that there are 3 basic biological drives or needs which, when met, allow humans to thrive The need for competence or mastery of our environment Includes self-regulation and self-awareness. Reflects our life's purpose is being pursued The need for autonomy or ownership of our behaviors and choices and their consequences The need for relatedness or feeling that we are connected to others and to society in general We need relatedness so much, we will give up our autonomy to achieve it These drive are unconscious so when we feel they are threatened or oppressed, we react unconsciously. Rebellious teens, resistance to change
What is personal disclosure? Be able to recognize an example of an appropriate personal disclosure by a coach.
Sharing personal experiences of success, failure, and the process towards both, in an effort to assist a stuck client and improve their self-efficacy or capacity for change or to build rapport
what are reflections? What is a simple versus a perceptive reflection? What is the benefit of using a perceptive reflection?
Simple reflections provide a mirror that reflects back to clients where they are and what they are learning. a type of reflective listening that enables clients to hear what they are saying from the vantage point of another person, illicites a deeper response.
(ICF article, "Potential Perils of Personal Issues in Coaching:" ) What does it mean if a client cries during a coaching session?
Some coaches think that when their clients get "emotional" (cry) they are dysfunctional. Tears do not mean the person needs therapy - it merely means they have feelings. Feelings are healthy, if expressed in appropriate times and ways. The coach can assess the appropriateness of tearfulness, depression or moodiness. If it does not end, and continues inappropriately, the coach should bring this assessment to the attention of the client, and together pursue possible needs for outside therapy.
how do you know if you have your communications 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 hard, often realizing things for the first time You are gently facilitating the session at the appropriate moments You are listening until you no longer exist
Why is client confidentiality crucial in a coaching relationship? Be able to list 3 of the confidentiality policies included in the coach-in-training confidentiality policy.
The coaching relationship is built on a foundation of confidentiality and trust. Need to find coach-in-training confidentiality policy
What are the general principles of BMI? Why is the final elicit important?
The doctor-patient relation-ship is a partnership more than an expert-recipient relationship. Readiness to change is not a patient trait, but a fluctuating product of interpersonal inter-action. It is the patient's task, and not the doctor's, to articulate and resolve ambivalence. The doctor is directive in helping the patient respond constructively to ambivalence. 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. get-ting patients to process and per-sonalise the information for them-selves.
What processes of change are designed to encourage a client in pre-contemplation to discuss change from a non-threatening position? Be able to recognize the use of dramatic relief and environmental re-evaluation and which type of pre-contemplator each is used for.
These TTM Processes of Change are to designed to encourage pre-contemplators to discuss change from a non-threatening position and possibly move them to the contemplation stage Dramatic relief:when clients are asked to look at the experience of negative emotions (fear, anxiety, worry) that go with unhealthy behavior Environmental reevaluation:helping clients to look at the negative impact of the unhealthy behavior, or the positive impact of the healthy behavior, on their proximal social and physical environment
What processes of change are designed to assist a client in contemplation in exploring the possibility of change?
These TTM Processes of Change help contemplators explore change further and possibly move into the preparation stage:Self-reevaluation:realizing that behavior change is an important part of one's identity as a personDecisional Balance:conscious weighing of the pros and cons of changing and not changing
what are open-ended inquiries? Why are they important in coaching? Be able to change a closed statement into an open one.
These types of questions facilitate a wealth of information, the building blocks of the coaching experience, and can open your client to the posibilities of change. basically change yes or no questions to those that facilitate an answer
what are the qualities of a masterful coach? (intro to hc)
They prefer to listen rather than talk, they elicit Aha! moments through relational flow, they cannot summon an ounce of judgement, displaying an unwavering confidence in the client's ability to change
(Health and wellness coaching theory) what do clients build through the coaching mechanisms of action?
Through coaching mechanisms, clients build a new brain network and, in turn, the capacity for sustained change (Peabody et. al., 2014)
What type of goals will contemplation clients set?
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 to the next stage.
what is reframing? Be able to reframe a given statement
To change the way a client views a challenging situation -A method of shifting a client's negative perspective towards positive, life-affirming perceptions -Seek out and reflect the positive in a client's past -Replace faulty, counter-productive perceptions with more accurate, productive ones.
what is the definition of the coaching tool "exploring past efforts for future success?" What is the benefit to the client? What are the keys to using this tool successfully?
When a coach asks a patient/client about any situation where they were successful, even briefly, at a behavior in question. Look for and affirm strengths that lie within their story and reflect them back to the client Encourage patients/clients to talk about strengths and abilities rather than their failures and difficulties Affirm the patient's past hard work, especially if they've tried more than once Keep the discussion focused on things within the patient's past experiences that they can control in the present Generate the perception that change is always possible especially when patients Low self-worth and past efforts
Why is it so hard for us to "live" our wellness? What factors may or may not play a role in living our wellness? (intro to hc)
While most of us long for better physical and mental well-being, evidence suggests that we're moving in the opposite direction. We tend to ask experts but that doesn't work, lack go knowledge has no relationship between patient's knowledge about need o change and the subsequent behavior change, health care system is not currently providing long-term consistent behavior change support
in a short clinical encounter, what should the final elicit result in?
a Commitment from the patient on the resource(s) they will engage to enhance success
To move forward, what coaching skill is crucial to use with all pre-contemplators? Why?
all pre-contemplators first need sincere empathyfrom their coaches. This is the time to use disclosure and ref lections:shows that you empathize with and respect their feelings and needsShows that you really hear where they are with regards to behavior changegives you the opportunity to "plant a seed" that may grow later.
What is "evoking change talk? What is the objective of evoking change talk?
an importantstrategy to evoke reasons for the patientto change and elicit a plan of action inat least one area according to the pa-tient's readiness to change. evoke the patient's desire, abil-ity, reasons and need to change in orderto strengthen the patient's commitmentto the behavior during a session
(Ethics and Health and wellness coaching) How should coaches uphold and insure cultural competency in their coaching practice?
coach training should incorporate education in cross-cultural issues-generally and specifically, coaches should use modalities and tools that are appropriate for use within the cultural context specific to their clients, before coaching commences, an open dialogue should occur between the coach and client, when coaches are working cross-culturally and with indigenous peoples, the coach should ideally be supervised by an appropriate cultural advisor.
what is self-efficacy? How is readiness to change effected by self-efficacy?
confidence that one can engage in the goal behavior in the face of changing, challenging or tempting situations. As self-efficacy increases, people can more easily progress through the stages of change, with the greatest levels reflected in the Action and Maintenance stages.
what is the difference between directive and non-directive coaching? (emergence of coaching)
directive is someone who directs, instructs, or trains. non-directive is someone who creates an environment through conversation and a way of being, that facilitates the process by which a person can move towards desired goals. it requires 1 essential ingredient: caring not only for the external results, but for the person being coached
what is the definition of empowerment?
discovery and development of one's inborn capacity to be responsible for one's own life
what do empowered patients have? Be able to recognize an empowered patient
enough knowledge to make rational choices, enough control, enough resources to implement their decisions, enough experience to evaluate the effectiveness of their actions and like with the consequences of those actions
what is the purpose of the hypothetical look over the fence tool? Why is it good for exploring the unknown about change?
exploring the "unknown" about change without the threat of commitment. Because the discussion is hypothetical, there is no pressure involved so resistance may be lower
What does the author mean when he says, "The idea is to have confrontation as the goal rather than the style of the consultation"?
facilitate patients' self-evaluation and decision making about change rather than to confront patients with the doctor's evaluation and ideas about what they 'must do'.
On what is cognitive therapy grounded?
idea that dysfunction is due to characteristic errors in information processing
what is patient-centered medicine and what does it work to combine?
introduced by Balint and colleagues in 1970
Article, "Brief Motivational Interviewing" What is brief motivational interviewing?
isan approach which provides GPs with abroader range of communication skillsthat are tailored to the individual patient'sreadiness to change
(Communication) To be truly mindful, you must do what?
ou must separate your reactive brain from your thoughtful brain
(Coaching in the pre and contemplation stages) Be able to recognize the following transtheoretical stages of change if given an example: pre-contemplation: I won't, pre-contemplation: I can't, contemplation.
pre-contemplation The I won't's: "I don't see why I need to increase my physical activity. I feel fine the way I am. . ." The I can't's: "Everyone's telling me I should increase my physical activity, but there's no way I can. . ." contemplation The I might's: "I know being more active would probably be good for me, but it's so hard to make the time and I'm not sure how to go about exercising. Plus I'm so tired after a long day at work, but on the other hand, I think exercise would give me more energy. I'm just not sure. . ."
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 crucial to keeping the door open with all clients in the contemplation stage?
s a coach recognizing and accepting this fact: contemplators are not ready to set behavioral goals.
What is psychological flexibility?
the ability to consciously and emotionally connect to the present moment more fully so one can change, or persist in, behavior that is done in the of service of valued ends.
what is coaching psychology? upon what is coaching psychology founded? (emergence of coaching)
the science of coaching relationships designed to optimize health and wellness. founded upon evidence-based theories and fields of study: increases efficacy, standardization, measurability and credibility of health coaching. Transtheoretical model for behavior change, motivational interviewing, humanistic and positive psychology, cognitive-behavioral therapy
What is emotional intelligence?
to be psychologically and emotionally whole, not excluding any feeling or emotion, but rather, embracing your full range of feelings and emotions.
what is personal coaching? what are the challenges associated with personal coaching? (emergence of 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. basis not founded in health sciences or evidence-based research, no standardization of process, technique or training, certification of skills and abilities not required or standardized, little oversight other than ICU
article (the team let model of primary care) What are the challenges associated with implementing this model?
workflow, continuity of care, team dynamics, and training
(ICF article, "Potential Perils of Personal Issues in Coaching:" ) Essay question- Based on the information from table 1 on page 6 of the article, what is the difference between coaching and therapy? Be specific in your discussion of at least 3 of the comparisons in the table. (THIS ESSAY MUST BE COMPLETED PRIOR TO THE EXAM, PRINTED OUT, BROUGHT TO CLASS AND HANDED IN WHEN YOU HAND IN YOUR COMPLETED EXAM)
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