Trying to control biomedical risk factors and lifestyle behaviors with carrots and sticks does not make sense given the complexities of the human experience. If you want to support employees in thriving in their wellbeing and embarking upon a meaningful, sustainable change journey, create the conditions to support them and then let them be the authors of their own journey.
Supporting better thinking for employees naturally lends itself to coaching. However, not all coaching is equal. Coaching continues to increase in popularity – especially in the world of worksite wellness. The 2013 Employee Benefits Research Report from SHRM states that 48% of employers offer health and lifestyle coaching; this is an increase from 33% in 2009 and 2010. Yet despite its increased use, the results of coaching have been less than favorable. A 2012 study looked at the impact of financial incentives on completing health coaching-based behavior change programs and subsequent risk reduction. The researchers found that offering financial incentives for completing the program was associated with higher program completion rates but not with changes in health risks or improved health.1 Why is this?
Let’s start with looking at the coaching profession and how most coaching is applied in the context of traditional, “wellness or else” programs. The coaching profession is relatively young. There are no regulations over who can call themselves coaches, and the quality of training widely varies. Over the past several years, the lack of quality coaching has been a huge source of frustration for me as a consultant trying to support organizations in creating the conditions for thriving organizational and employee wellbeing. The first question I ask any coaching provider is, “What coaching certification and training do your coaches have?” The unfortunate reply usually involves describing the health-related degrees their coaches have, to which I reply, “What COACHING training and certification do they have?”
- Being an effective coach has little to do with whatever health-related degree and knowledge one has about health.
- It requires a very different skill set than being a health expert, mentor, or counselor.
- Skilled coaches elicit better thinking from people and limit their own giving of information and advice.
However, in our “quick-fix” society, people gravitate towards one- to two-day intensive training sessions to earn a coaching certification, which usually does not support the coach in first developing better thinking (a pre-requisite to being an effective coach). Consequently, the way many health coaches approach supporting change is a throwback to Motivation 3.0.
In a previous blog I discussed why Intrinsic Thinking matters and the benefits of being able to activate best thinking (I>E>S). For the purposes of this blog, I want to make a very important distinction between coaching applied in an Old Paradigm way (to try to “get” people to be intrinsically motivated, i.e., Motivation 3.0) and coaching applied in the New Paradigm way (to elicit better thinking, i.e., Motivation 4.0).
The majority of coaching provided by wellness vendors, insurance companies, and healthcare providers stems from Motivation 3.0 and is typically based in Motivational Interviewing (MI). Unfortunately, the quality control in the practice and training of MI has been non-existent.2 As a result, many wellness professionals attend a two-day MI “certification” and then call themselves coaches. However, even with quality training and application, I question whether MI actually shifts thinking for the coach or the recipient. I have had countless discussions with physicians, psychologists, health educators, and others who have had MI-based coaching training. In each case, even for those who have been training and practicing for years, it is evident the people are approaching supporting change from an S>E>I framework — trying to use MI as a tool in the toolbox to “motivate” others to change or to “get” them to be intrinsically motivated. In reality, the pause and the Intrinsic are often missing altogether; I>E>S is not activated in the thinking of the coach or the client.
Let’s look at how most health coaching (particularly coaching based in MI) addresses behavior change. The approach is “simple”: The health coach tries to assess where a person is in terms of Stages of Change and then asks fairly scripted questions that are supposed to “get” the person to move along the change continuum, closer to taking action. For example, the health coach might say something like:
- “On a scale of 1 to 10, how motivated are you right now to engage in ABC behavior?”
- “On a scale of 1 to 10, how confident are you in your ability to engage in ABC behavior?”
- “Tell me all the reasons why exercising is important to you.”
- “What benefits would you gain from losing weight?”
- “What is the downside of NOT doing XYZ health behavior?”
The problem here, of course, is that this approach stems from a mechanistic, simple cause-and-effect worldview that assumes people are predictable and can be manipulated if we just ask the right questions. If the coach just asks these questions, it should get individuals to see why that health behavior is important and then they’ll be motivated to make a change, right?! Yet we know the process is much more complex than this.
Although perhaps an improvement from Skinner’s carrots and sticks, this is clearly still an outside-in approach that puts people in a passive role. Health coaches sit in the driver’s seat — supposedly knowing what’s best for their clients and asking questions with a motive to try to get them to change specific health behaviors that the coach, their doctor or some Health Risk Assessment decided they needed to change. Furthermore, in most typical conversations like the above examples, the clients are put in a defensive role, having to explain or justify why they rated themselves a certain way. Then, the coach jumps right to strategies trying to “get” the clients to come up with ways to move them to a higher number and take action. And these typical health coaching conversations are also almost always reductionist — narrowly focused on one or two specific, isolated health behaviors.
Rarely in these conversations is there silence and pausing encouraged, and rarely are people invited to look at their greater purpose and what they want for themselves. Sustainability doesn’t come from people recalling a memory of an answer a health coach gave them; it comes from being able to tap into best thinking in moments of decision.
Activating Best Thinking via Intrinsic Coaching®
Intrinsic Coaching® builds the capability to allow the coach and client to elicit best (I>E>S) thinking. It is grounded in axiological science and is based on what neuroscience teaches us is needed to lay down new myelin — experiential learning and development that builds both awareness and skills. Participants meet via phone two hours per week for approximately six to seven months (50 hours total); they are presented with material and then engaged to put what they are learning into practice — starting with increasing awareness about their own thinking. Each week as awareness increases, participants build additional skills to learn how to temporarily disable the dominance of their Systemic thinking and create a space for Intrinsic thinking. I discussed this methodology and its benefits in more detail in a previous blog.
So how does an Intrinsic Coaching® conversation look compared to a MI conversation? For starters, the coach pays attention to his/her thinking and uses the awareness and skills to activate I>E>S in her/his own thinking FIRST and then supports the client in expanding thinking — not trying to change a behavior. There are intentional pauses and silences throughout the conversation to allow for new thinking to emerge. And the coach isn’t driving toward a specific outcome or result in the conversation; the client is truly in the driver’s seat. Here’s a brief example of how an Intrinsic Coaching® conversation might unfold:
- Coach: (first noticing own thinking and activating I>E>S) “How are you wanting to use our time together today?”
- Client: “Well this happened, and then this, etc.”
- Coach: (pausing to not act on initial S>E>I instinct to jump in and start strategizing and problem-solving) “As you hear yourself say all of that, is anything beginning to stand out to you?”
- Client: (pausing to think) “Hmm, well I guess I never realized XYZ before, but I’m not sure what to do with that?”
- Coach: (pausing and self-managing to not jump to strategizing and figuring out what to do) “Would it be helpful for you to stay right there and see if anything more begins to emerge for you in terms of what you’re wanting?”
The conversation continues with the coach not acting on his/her S>E>I instinct to jump in, instead pausing, and asking questions to support the client in eliciting expanded thinking. The result is a VERY different outcome — where the client is doing most of the work (instead of the coach) and walks away with something meaningful rather than polite agreement for some idea guided by the coach.
The bottom line is that if you want to support better thinking and create the conditions for people to be the authors of their own journey, the quality of the coaching makes a HUGE difference!
- Gingerich, S. B., Anderson, D. R., Koland, H. (2012). Impact of financial incentives on behavior change program participation and risk reduction in worksite health promotion. American Journal of Health Promotion, 27(2), 119-122.
- Miller, W. R. & Rollnick, S. (2009). Ten things that Motivational Interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129-140.