Training Workbook€¦ · Personal Training Notes..... 81 . NHSG HC Workbook v09/2018 5 Training...

Health Coaching Training Workbook

Version 09/2018

Written by: Adapted from the work of:

Emily R. G. Moffat, BSc. MSc. MBPsS. Health Psychologist in Training NHS Grampian, Public Health September 2018

Kirsteen Bigland (2016) Eleanor Bull (2012) Stephan Dombrowski (2010)

NHSG HC Workbook v09/2018

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Contents

Training Outline ............................................................................................................... 5

Learning Outcomes ................................................................................................................ 5

Health Coaching Competences .............................................................................................. 6

Materials ................................................................................................................................ 7

Section 1: Listening & Communication Skills ..................................................................... 8

Non-Verbal Communication .................................................................................................. 9

Active Listening ...................................................................................................................... 9

Open Questions ............................................................................................................... 10

Affirmations ..................................................................................................................... 11

Reflections........................................................................................................................ 13

Summaries ....................................................................................................................... 14

Delivering Information ......................................................................................................... 15

General Tips for Health Coaching Sessions .......................................................................... 17

Opening the Session ........................................................................................................ 17

Guiding the Session .......................................................................................................... 18

Closing the Session ........................................................................................................... 19

Phrases to Use .................................................................................................................. 20

Phrases to Avoid .............................................................................................................. 21

ACTIVITY 1: Identifying Importance ..................................................................................... 22

ACTIVITY 2: Reflective Listening ........................................................................................... 24

ACTIVITY 3: Using OARS – Case Study (Part A) .................................................................... 26

ACTIVITY 3: Using OARS – Case Study (Part B) .................................................................... 28

ACTIVITY 4: Open Questions & Affirmations ....................................................................... 30

ACTIVITY 5: Communication Skills in Action ........................................................................ 33

Section 2: Health Coaching Programme .......................................................................... 34

Introducing Sessions ............................................................................................................ 35

Session 1........................................................................................................................... 36

Sessions 2 – 4 ................................................................................................................... 37

Client Expectations .............................................................................................................. 38

Health Behaviour Check ....................................................................................................... 40


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Establishing Baseline Behaviour (Session 1) .................................................................... 40

Establishing Post-Health Coaching Behaviour (Session 4) ............................................... 40

Choosing a Health Behaviour ............................................................................................... 42

Self-Affirmations .................................................................................................................. 44

SMART Goals and Action Planning ....................................................................................... 46

Readiness to Change ............................................................................................................ 49

Self-Monitoring .................................................................................................................... 51

Identifying Barriers .............................................................................................................. 53

Reviewing Barriers ........................................................................................................... 55

Identifying Facilitators ......................................................................................................... 56

Reviewing Facilitators ...................................................................................................... 57

Planning Self-Rewards ......................................................................................................... 59

Relapse Prevention .............................................................................................................. 60

Closing Sessions ................................................................................................................... 63

Post-Session Checklists ........................................................................................................ 66

Kolb’s Learning Cycle: ...................................................................................................... 66

Gibb’s Reflective Cycle: .................................................................................................... 67

ACTIVITY 6: Reflecting on Health Coaching Training ........................................................... 68

Section 3: Troubleshooting ............................................................................................. 69

Session 1 & General Health Coaching FAQs ........................................................................ 69

I haven’t analysed the client’s problem thoroughly ........................................................ 69

The client has different expectations to what the service offers .................................... 69

Session 2............................................................................................................................... 74

Session 3 – 4 ......................................................................................................................... 79

Personal Training Notes .................................................................................................. 81


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Training Outline

Learning Outcomes

Session 1

1. Develop understanding of health behaviours, health behaviour

change, and health behaviour change interventions.

2. Develop understanding of the Health Coaching Programme, including

goals, principles & behaviour change techniques involved.

3. Increase confidence in Health Behaviour Change competence.

4. Develop and practice effective listening and communication skills.

Session 2

1. Develop understanding of Health Coaching Sessions, including

sequence, goals, techniques and activities involved.



4. Develop and practice Health Coaching techniques – Self-Affirmations,

Decision Balance, Goal Setting, Self-Monitoring.

Session 3

1. Further understanding of Health Coaching Sessions, including

sequence, goals, techniques and activities involved.



4. Develop and practice Health Coaching techniques – Identifying

Barriers, Identifying Facilitators, Planning Self-Rewards, Relapse

Prevention.

5. Review all of the techniques involved in Health Coaching.

Mock Client Session

1. Assess competence to deliver Health Coaching Programme with a

Mock Client.

2. Assess competence to deliver Health Coaching behaviour change

techniques & skills with clients.

3. Provide feedback to Advisors on delivery of Health Coaching Session

to inform ongoing professional development & practice.


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Health Coaching Competences

1. Communication Skills

a. Using open questions, affirmations, reflections, and summarising to encourage discussion with clients.

b. Using active listening to encourage clients to talk openly and feel understood.

c. Demonstrating empathy, genuineness, and positive regard during all client interactions.

2. Client-Centred Approach

a. Expressing support and acceptance of all clients regardless of targets or progress.

b. Developing a working relationship rooted in communication and collaboration.

c. Respecting the importance of client choice regarding whether, what and how to change.

3. Delivering Information

a. Eliciting information from the client regarding what they already know and what they are interested in learning about.

b. Providing small, manageable chunks of information pertinent to health behaviour change and in line with NHS guidance.

c. Eliciting feedback from the client regarding the information and their reflections.

4. Self-Affirmations

a. Encouraging the client to consider any positive memories or experiences.

b. Increasing feelings of self-worth in order to reduce negativity or resistance to change.

5. Decision Balance

a. Explaining the purpose of weighing up both sides of a decision in order to prepare for the challenges, and work towards the benefits.

b. Supporting the client to compare the pros and cons of their current behaviour, as well as a potential behaviour change.

6. Goal Setting and Action Planning

a. Encouraging the client to set a long-term goal to aim for.

b. Explaining the difference between overall and specific goals.

c. Supporting the client to think of a specific goal for the week ahead.


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7. Measuring Confidence and Motivation

a. Understanding the importance of confidence and motivation towards the success of a goal.

b. Establishing client levels of confidence and motivation, and discussing these in more detail.

8. Self-Monitoring a. Explaining the purpose and process of self-monitoring to clients.

b. Discussing the content of self-monitoring diaries in a reflective and positive manner.

9. Barriers and Facilitators

c. Supporting the client to identify their own barrier to change, and think of their own solutions to deal with challenges.

d. Supporting the client to identify anything which could facilitate change, and make plans for how to incorporate these.

10. Self-Rewards a. Encouraging the client to identify their successes and plan positive outcomes.

11. Relapse Prevention

a. Explaining the process of long-term behaviour change.

b. Supporting the client to plan for maintaining their behaviour change through difficult of unforeseen circumstances.

c. Encouraging ongoing motivation and confidence past the end of coaching input.

12. Reflective Practice

a. Understanding the importance of reflective practice, and its potential impact on quality of care.

b. Reflecting on everyday practice with clients to inform ongoing professional development and practice.

c. Seeking regular feedback on responding to and meeting the diverse needs of clients.

Materials

Health Coaching Training Workbook (v09/2018)

Health Coaching Manual (v09/2018)

Health Coaching Toolkit (v09/2018)


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Section 1: Listening & Communication Skills

Effective communication is a vital part of any attempt to change a client’s behaviour.

Communication is the style in which the behaviour change techniques are presented, and

effective communication significantly increases the likelihood of change.

Consider it this way, if behaviour change techniques were a gift, then communication is the

wrapping paper. If the wrapping is not appealing to the client, then they will be less

interested in opening the gift, and may never even use the behaviour change techniques on

offer.

Many of the communication techniques outlined in this training are to be used flexibly

throughout the Health Coaching sessions. Below is a table of general communication tips

central to Health Coaching:

Key Listening Skills

Use non-verbal signals such as eye contact, positive body language, e.g. nodding, leaning forward, responding with facial movements etc.

Use encouraging verbal signals such as ‘uh huh’, ‘go on’, and ‘yes’ to encourage the client to continue and to build rapport.

Use silence to allow the client time to think as well as talk about their thoughts and feelings. Avoid interrupting or finishing their sentences.

Echo the last few words the client said after they have finished their sentence to encourage them to keep talking. Adopt their words to build rapport.

Be curious rather than intrusive. Try to use the phrase ‘how come’ rather than ‘why.’

Respond to what the client is saying, rather than trying to lead the conversation. Avoid telling the client what to do, disagreeing or contradicting with their suggestions. Instead, raise alternative possibilities for client to consider.

Try to see things from the client’s point of view. This doesn’t mean that you have to agree with them, but avoid assuming that your experiences are the same as the client’s.

If you don’t understand something, don’t pretend. Ask for more explanation. Ask open questions to get more information. Summarise your understanding of the client’s thoughts & feelings.


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Non-Verbal Communication

The appropriate use of non-verbal communication (NVC) is of upmost importance. Health

Coaches are aware of their own non-verbal behaviour, and use appropriate NVC including

posture, proximity to client, touch, body movements, facial expressions, eye behaviour and

vocal cues.

Helpful NVC of the Health Coach includes:

A tone of voice that matches the client’s voice.

Eye contact.

Occasional head nodding.

Varying facial expressions in response to what the client says.

Smiling at appropriate points to demonstrate warmth & understanding.

Occasional hand gesturing.

Sitting in close physical proximity to the client.

Using a moderate rate of speech.

Leaning slightly towards the client to indicate interest and concentration.

Similarly, the Health Coach needs to be aware of the non-verbal cues that the client sends

out, and act on these appropriately. However, Health Coaches are aware that non-verbal

behaviour varies with people, situations and cultures, and cannot always be easily

interpreted without verbal messages.

Active Listening

Listening is of vital importance in understanding the client and building a relationship which

will facilitate change. This is of particular importance during the early phases of the Health

Coaching process where the aim is to build a trusting, working relationship with the client,

and to accurately understand what their issues and concerns are.

Careful listening involves hearing and understanding what the client says without judging or

filtering what is said through one’s own frame of reference. When listening to clients, the

Health Coach should focus on two elements: who and what are the important elements for

the client? This helps to focus on identifying what is important to the client, invites the

client to explore the issues further, and prevents the Health Coach from jumping to a ready-

made solution based on their own personal evaluations.

Using OARS – Open Questions, Affirmations, Reflections, and Summaries – is a helpful way

to approach communication with clients.


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Open Questions

Rather than asking questions which only require a yes or no answer, try to ask open questions. For example: Instead of saying “Has this been going on for long?” ask “How long has this been going on for?” or “Tell me more about...”

Affirmations

Using positive statements to emphasise the client’s successes will help to build their motivation and self-efficacy. For example: “You’ve done really well by coming here today” or “You’re coming up with some good suggestions.”

Reflections

Repeating back a word or phrase can encourage people to go on, elaborate further on a topic, and to help the client clarify the points that they are making. For example: “Do you mean that...” or “It sounds like it’s been really difficult for you to...”

Summaries

It helps to show that you’ve listened to, and understood correctly what’s been said. Like Reflections, this can help the client to clarify points, not only for you, but for themselves. For example: “So we’ve talked about... and we’ve thought about some options for getting you more support this time. How do you feel about that?”

Open Questions

Questions are important to direct and guide a conversation. They are also important to elicit

relevant information that can be used by both the client and the Health coach to inform

decision-making in relation to behaviour change. Questions can be categorised as either

open or closed. Both types of questions are valuable, and are both aimed at achieving

different ends.

Closed questions are questions that lead to a specific answer, e.g. yes or no. These types of

questions limit the client’s response to one or two words, often without further elaboration.

Open questions are designed to still direct the client to a specific area, but allow the client

more discretion in their answer, i.e. suggesting that further elaboration on the topic is both

appropriate and welcome.


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Open questions are an invaluable information-gathering tool, and are most relevant

towards the beginning of an exploration of a problem. The advantages of open questions

are that they:

Encourage the client to tell their story in a more complete fashion.

Prevent the ‘stab-in-the-dark’ approach of closed questioning.

Allow the Health Coach time and space to listen and think, not just ask the next

question.

Set a pattern of client participation rather than practitioner domination.

Some examples of open questions that you can use with clients during Health Coaching

sessions are listed on Page 10.

Affirmations

Affirmations are positive statements and gestures that recognise the client’s personal

strengths or ability, and acknowledge behaviours that lead in the direction of positive

change, no matter how big or small. An affirmation takes very little time, but does require

that the practitioner is listening very carefully to what a client is telling them and find

opportunities to acknowledge the positive aspects of their live.

The purpose of affirmations is to:

Build rapport.

Demonstrate empathy.

Affirm exploration into the client’s world.

Affirm the client’s past decisions, abilities, and healthy behaviours.

Build a client’s motivation and self-efficacy, i.e. confidence in their own ability to

change.

Affirmations can be very brief or for very simple things, but must always be genuine,

appropriate and congruent. Health Coaches can achieve this using non-verbal

communication (e.g. appropriate silence, attentive body posture, appropriate eye contact,

relaxed facial expressions and voice tone), but also through statements of appreciated,

understanding and positive feedback. For example:

I appreciate you coming in to see me today – it isn’t always easy the first time.

You’ve taken the first step just by coming to talk to me today.

You’re coming up with some great suggestions.

You’ve given this a lot of thought.

You handled yourself really well in that situation.


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Examples of Open Questions

Initiating a Session:

What type of things would you like us to talk about?

What brought / brings you here today?

How can I help you today?

What did you first think about this behaviour?

What do you think of all this?

What would you like to do now?

Elaborating on Current Behaviour:

Tell me about the time when the behaviour began.

How did you first start drinking / smoking?

How have your friends / family / partner reacted to you coming here?

What else?

Such as?

What does ... feel like?

Elaborating on Possibility for Change:

What makes you think it might be time for a change?

What would change in your life if you stopped?

How would you like your life to be?

Tell me about a time in your life when you were successful. What did your life look like?

Setting Goals for Behaviour Change:

What would be best for you?

Tell me about your goals in life?

How would you know things were different and improved?

What would your life look like if you were successful in making these changes?

Reviewing Questions:

What’s been happening since we last met?

In what way has the last week been different for you?

What was that like?

Tell me more about that feeling.

What else can you tell me about this?

How did you feel about your behaviour change?

What’s different for you this time?


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Reflections

One of the most challenging skills is to listen reflectively to the client. This skill requires the

Health Coach to listen very carefully, observe the client’s body language and behaviour, and

reflect back using their own words and perceptions. Using this skill effectively promotes the

client’s awareness of their own thoughts and feelings, and can help a client to make more

intentional decisions and consider behaviour changes.

The purpose of using reflections is to:

Demonstrate to the client that you are listening and trying to understand their

situation.

Offer the client an opportunity to “hear” their own words, feelings and behaviours

reflected back to them.

Reflect and confirm understanding of the client’s thoughts, feelings and behaviours,

as well as their general experiences and the “in the moment” experience of the

Health Coaching session.

Reflections can include clarification, paraphrasing or rephrasing. A clarification is a question

beginning with “Do you mean that...” or “I hear you say that...” followed by a repetition of

the client’s message. Clarifications are to encourage the client to further elaborate on a

topic, to check for accuracy of what the Health Coach heard and what the client said, and to

clear up vague and confusing messages. Paraphrasing is restating in one’s own words the

content of the client’s message. It is not quite the same as clarification or summarising, as it

is intended to sharpen and be more specific than the original message, rather than just

confirm understanding. Paraphrasing helps the client to focus on the content of their own

message. Rephrasing rewords the emotional part of the client’s message to encourage the

client to express more feelings, to help the client become more aware of feelings,

acknowledge and manage them, and to increase the client’s feeling of being understood.

The following are types of reflective listening:

Simple reflection (repeat the client’s words).

Reflecting feelings (reflect what the client might be feeling), e.g. “You’re feeling

_____ because _____.”

Reflecting behaviour (state observation about the client’s behaviour), e.g. “I noticed

you just _____,” “What are you thinking?” or “What are you feeling right now?”

Amplified reflection (rephrase the client’s words - exaggerated).

Double-sided reflection (client’s words + note ambivalence – and point out

discrepancy).

Shifting focus (going back to something else or changing the direction).

Rolling with resistance (accept the client’s perception).

Reframing (invite client to examine their perception in a new way).


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Examples of Reflections

“I don’t really know what to do. I lost 2 stones last summer, but put it right back on at the end of the year. My husband doesn’t care if I am heavy. He is overweight himself. Last summer, my children didn’t even notice me losing so much weight. All they noticed was that the food tasted ‘yuck.’ When I finally went back to the old meals, like burgers and chips, everyone seemed so much happier. I know that weight is a problem. The doctor keeps telling me to lose some every bloody time, but, to be honest; I can’t be bothered as it is such an effort.”

Reflecting by Clarification

“So you are saying that you were very successful in losing weight before, but it was quite an effort. When you went back to your old habits, it all seemed much easier, especially with your family, but your weight increased again. Is that right?”

Reflecting by Paraphrasing

“Okay, so you have lost weight before, but found it easier to get back into your old habits, especially since your family didn’t seem to be too supportive of the changes you were making?

Reflecting by Rephrasing

“I can see that you are a little bit confused as to what to do. You know that you can lose weight if you want to, but you lack the confidence that your family will support you and that you can keep it up?”

Summaries

Summarising is making an explicit verbal summary to the client of the information gathered

so far, and checking that the client agrees with the summary. It is one of the most important

of all the information-gathering skills. Used periodically throughout the sessions,

summarising is the key method to ensuring accuracy. It allows the client to confirm that the

Health Coach has understood correctly what has been said, and to correct

misinterpretation. It also allows the client to further explain the problems, issues and/or

their thoughts.

During summaries, the Health Coach can selectively choose to feed back pieces of

information that are most important in relation to the client’s behaviour change, e.g.

focusing on previous successes, positive attitudes for change, or statements of confidence.

Summaries can be used in three ways – (1) to change direction in a conversation; (2) to link

different topics from the conversation; and (3) to close a meeting.


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Delivering Information

The Health Coach should avoid the provision of advice or detailed information during

sessions. Health Coaching is designed to encourage the client to make their own decisions,

and not for the Health Coach to suggest what they should be doing differently.

Some clients may ask for information in order to “intellectualise” their difficulties in

changing behaviour, and so focus the blame elsewhere. Others might have complications

which make clear advice or information challenging, e.g. medications, health conditions, or

financial circumstances. Health Coaches are not directly rained in areas of medicine,

nutrition, physiotherapy etc., so it would be unethical to provide advice based on personal

opinion or experience, rather than expert knowledge. In these situations, signposting can be

used to direct the client to an appropriate source of information, and refocus the discussion

on behaviour change.

The exception to this rule is explaining about the Health Coaching service, and the

behaviour change techniques used in it, as well as some brief details about the benefits of

changing the specific behaviour in question. In these situations, the Health Coach will be

delivering some information. This can be doing using the Elicit-Provide-Elicit (EPE) format.

Starting with what a client already knows and asking permission to fill in the gaps avoids

telling them information they don’t want to hear about, and communicates respect for their

wishes, knowledge and opinions. It also means that they are more likely to listen.

ELICIT

What do they already know? What would they like to know? Are they happy to have some more information?

PROVIDE

Deliver a tailored chunk of information.

ELICIT

What do they think of the information that you have given them? Is everything clear? Do they have any questions?


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The information should be brief and directly applicable to the individual so that it will be

listened to and taken on board. Checking the reaction afterwards make it more likely that

the information is processed and any misunderstandings are cleared up.

Some general tips for providing information in EPE format:

Use neutral language as much as possible, e.g. “Some people have found...,” “What

we know is...,” “Others have benefitted from...”

Avoid starting sentences with ‘I’ or ‘you.’

Use conditional words rather than concrete words, e.g. ‘might,’ ‘perhaps,’ ‘consider’

vs. ‘should,’ ‘must.’

Examples of EPE

ELICIT PROVIDE ELICIT

The patient’s readiness or interest in hearing the information.

Solicited information or advice in as neutral fashion as possible.

The patient’s reaction to and understanding of the information provided.

“I’m curious to know what you already know about... Would you mind telling me?”

“Research suggests...” or “Studies have shown...”

“How do you feel about that?” or “What do you make of all that?”

“I hear that you are already making some changes by... That’s great – making changes can be tricky. Would it be okay to add in some other ideas/thoughts?”

“Others have benefitted from...”

“Out of everything we have talked about, what makes the most sense for you?”

“Is it okay with you if I tell you what we know?

“What we know is...” “Where does this leave you?”


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General Tips for Health Coaching Sessions

Opening the Session

The opening minutes of a session are particularly important for making a good first

impression, beginning to establish rapport, attempting to identify any problems that the

client wants to discuss, and setting the course for the session.

The most important skills for initiating the session are:

Preparation

Put aside last task, attend to self-comfort.

Focus attention and prepare for next session.

Establishing initial rapport

Greeting client, and obtain client’s name.

Introduce self and clarify role.

Demonstrate interest and respect, attend to client’s physical comfort.

Identify the reason(s) for attending the session

The opening question: Identifying problems or issues that the client wishes to

address, e.g. ‘What would you like to discuss today?’

Listening to the client’s opening statement: listen attentively without interrupting or

directing the client’s response.

Screening: check and confirm list of problems or issues that the client wishes to

cover.

Agenda setting: negotiate agenda and format of session, taking both the client’s and

coach’s needs into account.


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Guiding the Session

Sometimes clients can become very talkative, and tend to ‘control’ the sessions with

content that is not related to changing the behaviour they have chosen to focus on. Once

clients have had some time to express their difficulties and reactions, the word ‘so...’ can be

useful to break in and redirect the conversation. Follow this up by using a paraphrase or

empathic statement, and then moving on to goal-focused questions. The use of ‘so’ signals

to the client that a topic change is coming, and gives the practitioner a chance to redirect

the conversation in a more useful direction. The Health Coach can also restate the agenda of

sessions to gently remind the client to focus on health behaviour change-relevant issues.

Care has to be taken that clients are actually talking about something completely unrelated

to behaviour, as often seemingly unrelated issues are related to issues and problems with

the target behaviour.

Summarising as previously described can also be used as an effective way of bringing the

focus back onto the topic of behaviour change (see Page 12). By summarising the relevant

pieces of information, the Health Coach can choose to ignore any irrelevant topics which

might have come up in the conversation, and guide the conversation towards identifying

behaviour change-relevant topics.

For example:

“So, I can see that you have been through a lot; [pause] ... When things start to go

better, what will be different?”

“So, how are we doing in terms of helping you make up your mind? What would you

like to achieve through changing?”

The questions we ask clients are difficult and require thought. They might often fall silent or

say “I don’t know” during the session. When that happens:

Sit back, look expectedly at the client, and use silence to allow them time to answer.

Prompt a response by saying “I am asking you some tough questions.” Use follow-up

questions such as “Suppose you knew the answer...” or “If you were to guess, what

would you say?”

Use questions that ask for the perspective of a related person, e.g. partner, family

member or friend, e.g. “What would your partner say if...”


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Closing the Session

An appropriate ending to the meeting is important to ensure a satisfactorily completed

session. This leads to improved understanding, adherence, satisfaction, and behaviour

change.

The essential elements of ending a session are:

End Summary: Summarise the session briefly and clarify future plans. This is similar

to the internal summaries of the sessions, but it draws together all relevant

information gathered throughout the session.

Contracting: Clarify with the client what the next steps of the Health Coaching

process are, including actions to be undertaken by the client and/or Health Coach,

and scheduling of future sessions.

Safety Netting: Explain possible unexpected outcomes, what to do if the plan is not

working, as well as when and how to seek help.

Final Checking: Check that the client agrees and is comfortable with the plan. Ask if

there are any corrections, questions, or other items to discuss.


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Phrases to Use

Phrase Explanation Example

“Suppose...”

This is a good word to help clients begin to imagine an alternative future to a problematic situation, without promising that their preferred future will occur. Remember, it is good practice to use pauses to allow clients the time to consider alternatives to problems.

“Suppose you were to make changes to your diet, [pause] ... What would be different?”

“Instead...”

It is quite normal for clients to not know what they want when they first meet with a Health Coach. The process of sorting this out usually begins by talking about what they do not want. Be prepared to repeatedly help clients to define what they want by building on what they find troublesome. The word “instead” is very useful here.

“What you would do instead of smoking?”

“When...”

Another suggestion is to use the word “when” instead of “if.” While “if” encourages a future focus, it also introduces more doubt. By using “when,” you are still encouraging a future focus, whilst also creating more hope that a different life could happen.

“When you change your physical activity, what differences will that make for you?”

“Different”

Clients make changes when they notice something is different in their lives. Use the word “different” frequently in your questions to help give clients ideas about what they can do to bring on further changes.

“What will you notice is different about yourself that will let you know that your change in physical activity has been successful?” “How will you know that it is really different this time?” “What difference would that make in your relationship with your partner?”


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“I wonder...”

Tentative language is a consensus-building language. It invites and allows space for the Health Coach to offer perceptions and ideas on the topic.

“I wonder what will happen when...” “Could it be that...?” “Perhaps...” “Is it possible that...?”

Phrases to Avoid

Phrase Explanation Example

“Why?

“Why?” is often head as an accusation or challenging word that implies the client made a mistake. It often encourages defensiveness on the part of the client. Asking “how come?” is less confrontational than “why?” and allows the Health Coach to explore what the client was thinking and/or feeling.

Instead of “Why did you eat all those crisps?” Try “How come you decided to abandon your goal last week?”

“Yes, but...”

We can often influence a client’s way of thinking, but we cannot win a debate or argument. If you find yourself saying these words, it is a good indicator that you are about to engage in a debate with a client and need to do something different. Get in the habit of catching yourself in time, and experiment with some other phrases.

“So what would need to be different as a result of our meeting today for you to say that our time together was worthwhile?”


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ACTIVITY 1: Identifying Importance

Identifying importance takes place by highlighting who and what are the important

elements to the client.

For example: “It’s just so difficult to eat healthily. My husband doesn’t like salad, and I don’t have enough money to buy expensive fruits.”

The who element of this statement is the husband, and the what element was the money. A response might have focused on either element.

“Can you tell me a little bit about your husband, and how he might influence what you eat?”

“How does money affect you buying healthy food?”

For the following three statements, identify the who and what elements of importance to

the client, and write a suggested response.

1. “I just don’t see when I’ve got time to exercise. I have my children to think about, and any

free time I’ve got after work, I’ll just spend it doing something with them.”

WHO:

WHAT:

RESPONSE:


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2. “I’m not sure about giving up completely, like I think I could cut down, but I do enjoy a

drink. Even just to go out for a few pints with my mate, watch the football and have a

chat. It’s the socialising that I would miss, that excuse to get out of the house for a catch

up.”

WHO:

WHAT:

RESPONSE:

3. “I know it’s about what’s best for me, for my own health. I want to be here to see my

grandchildren growing up. I need to do this for me. It’s going to be hard, but I know I can

quit smoking. I just have to think about how much healthier I’ll be.”

WHO:

WHAT:

RESPONSE:


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ACTIVITY 2: Reflective Listening

Have a go at writing down reflective response to the following sentences. Try to write a

version for each type of reflection:

Simple clarification of what they have said.

Paraphrasing into your own words.

More complex rephrasing of the feeling behind what the person is telling you.

Note that sometimes there is a choice about which feeling to reflect – which would you

choose? Why?

1. “I’m not sure I’m concerned about it, but I do wonder sometimes if I’m drinking too

much.”

2. “My father smoked for 60 years and it never hurt him.”


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3. “I don’t want my daughter to have the same kind of life that I’ve had.”

4. “It’s my body, and I’m tired of people telling me what to do with it.”


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ACTIVITY 3: Using OARS – Case Study (Part A)

Tracy has gone to her doctor because she wants to talk about her smoking habit. Below is

the conversation that takes place when she attended. First, read through the conversation

from start to finish, and then consider the three questions.

Practitioner: Hi Tracy, nice to meet you. I’m Joe. I see that you’re here today to talk about your smoking, is that right?

Tracy: Yes, I think I’d like some help to quit.

Practitioner: Hmm, yes. Quitting smoking would be a good thing. It’s really bad for your health. How much do you smoke at the moment?

Tracy: I’d say about 20 a day.

Practitioner: Have you tried to quit before?

Tracy: Yes, a couple of times, but I can’t seem to keep it up.

Practitioner: Well if you’re struggling, there are a lot of products that could help with your cravings, like nicotine patches or gum. Do you want to try one of those?

Tracy: I tried the gum already, and I didn’t like it.

Practitioner: Okay, so I think you should use the patches instead. Also, you need to decide on a quit date. Do you know when you want to quit?

Tracy: Oh... well, I suppose I could stop tomorrow...

Practitioner: Great. So starting tomorrow, no more smoking. What could also be helpful is talking to a smoking cessation service. I’ll make a referral for you.

Tracy: Okay.

Practitioner: Okay, I’ll do that and you’ll be able to make an appointment with someone there to talk about how you’re getting on. Is that everything that you wanted to talk about today?

Tracy: Yes, that’s all. Thank you.


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1. How do you think Tracy felt during this conversation?

2. What was the doctor doing during this conversation to elicit this response in Tracy?

3. What do you think the outcome would be following this conversation?


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ACTIVITY 3: Using OARS – Case Study (Part B)

Read through the conversation again and, considering OARS, write in your suggestions for

how this conversation could have been improved and what you might expect Tracy’s

response to be as a result.

Practitioner: Hi Tracy, nice to meet you. I’m Joe. I see that you’re here today to talk about your smoking, is that right?

Suggestion:

How might this affect Tracy’s response?

Practitioner: Hmm, yes. Quitting smoking would be a good thing. It’s really bad for your health. How much do you smoke at the moment?

Suggestion:


Practitioner: Have you tried to quit before?

Suggestion:



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Practitioner: Well if you’re struggling, there are a lot of products that could help with your cravings, like nicotine patches or gum. Do you want to try one of those?

Suggestion:


Practitioner: Okay, so I think you should use the patches instead. Also, you need to decide on a quit date. Do you know when you want to quit?

Suggestion:


Practitioner: Great. So starting tomorrow, no more smoking. What could also be helpful is talking to a smoking cessation service. I’ll make a referral for you.

Suggestion:


Practitioner: Okay, I’ll do that and you’ll be able to make an appointment with someone there to talk about how you’re getting on. Is that everything that you wanted to talk about today?

Suggestion:



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ACTIVITY 4: Open Questions & Affirmations

The best open questions and affirmations are short, simple, and feel natural to the client

and the conversation.

Have a go at changing the following questions into open questions, or suggesting a suitable

affirmation for each stage of the session.

Opening the Session

1. Did your nurse refer you to me?

2. Did you find your health check helpful?

3. Do you know what Health Coaching is?

Affirmation:


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Talking about Health Behaviour

1. Do you wait until coffee break for your first cigarette or is it earlier in the morning?

2. Did you eat healthily last week?

3. How long did you quit for last time you gave up smoking?

Affirmation:


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Talking about Change

1. Do you want to change right now?

2. Would your partner agree that this is a good thing to work on?

3. Are you ready to start exercising?

Affirmation:


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ACTIVITY 5: Communication Skills in Action

Discuss with group & trainer how you might react in the following tricky situations that

could put your communication skills to the test.

Draw on the skills that have been discussed during Session 1, and bring your own

experiences into the discussion.

Which communication skills would you use with a client who:

1. ... is very talkative and tends to ‘control’ the session?

2. ... says they smoke because it helps them keep their weight down?

3. ... is mostly silent or says “I don’t know” in response to questions?

4. ... is misinformed about the recommendations for healthy physical activity?

5. ... does not know what they want when they first meet the Health Coach?

6. ... goes ‘off topic,’ talking about subjects which are unrelated to health behaviour

change?


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Section 2: Health Coaching Programme

The remainder of this Workbook will review the tried and tested behaviour change

techniques (BCTs) used in Health Coaching. Using these techniques will help you guide your

clients towards better health habits, and improved quality of life.

As you read Section 2, you will find instructions to guide you through each of the steps and

techniques Health Coaching sessions, including:

Introducing Sessions.

Reviewing Client Expectations.

Conducting a Health Behaviour Check.

Using Self-Affirmations.

Setting SMART Goals and Action Planning.

Assessing Readiness to Change.

Introducing Self-Monitoring.

Identifying Barriers & Facilitators.

Planning Self-Rewards.

Planning for Relapse.

Closing Sessions.

Post-Session Checklists & Reflective Practice.

Full descriptions of the techniques you are using will be in the green boxes, and suggested

scripts for delivery will be in the purple boxes. There’s also a troubleshooting section at the

end covering some Health Coaching FAQs (see Section 3)


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Overview: Health Behaviour Change

What are Health Behaviours?

Health Behaviours are “behaviours which affect our health.”

These can be protective (i.e. have a positive effect on our health) or detrimental (i.e. have a

negative effect on our health).

When trying to understand health behaviours, we can conceptualise behaviours as either

reflective or automatic. Reflective behaviours are those where we have thought about the

option and have consciously planned how we are going to act/respond. These types of

behaviours are often affected by our values, attitudes, social norms, and our perceived

control over the behaviour. Automatic behaviours are those where we act without

conscious thought. These types of behaviours are affected by habit, or positive or negative

outcomes (whether we feel rewarded or punished as a result of the behaviour).

What is Health Behaviour Change?

Health Behaviour Change is the “motivated, decision-based & active process of abandoning

health-compromising behaviours in favour of adopting & maintaining health-enhancing

behaviours.”

The MAP Framework by Dixon & Johnson (2010) provides a helpful format for thinking

about health behaviour change, where the individual might be in this process, and the

behaviour change techniques that you can use to help the individual.

MOTIVATION ACTION PROMPTS

How important is it for you to change?

What things have you already done to change (behaviour)?

What things in your environment might make

changing (behaviour) easier?

Person is unsure whether they want to change.

Person is aware their behaviour is risking their health, but has no motivation to change.

Techniques: weighing up the pros & cons, forming an intention to change, and thinking about previous successes.

Person wants to make a change, but doesn’t know where to start (has no plan)

Person has made changes, but needs help to overcome problems in their plan.

Techniques: setting SMART goals, self-monitoring the behaviour, identifying barriers & facilitators.

Person finds that emotional, social or environmental situations make it difficult to change.

These experiences influence their behaviour.

Techniques: adapting the physical & social environment, identifying rewards, forming habits.


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Introducing Sessions

Session 1

At the first session, the Health Coach should welcome the client, introduce themselves and

engage in small talk before asking if it would be okay to explain what Health Coaching is.

This will involve briefly describing what the service will be like and the methods of working

together, and emphasising that this will be a partnership. This is very important for

establishing a functional relationship between the Health Coach and client. Remember to

use the EPE framework when delivering information!

Description: Introductions

The introduction includes a pleasant, friendly and relaxed attitude to place the client at ease. The Health Coach should show the client into the room, offer them a seat and ask if they want their coat hung up or a glass of water. Small talk is vital to put the client at east, especially for the first session. One little trick that might make the start of the session easier is to ask the client questions which they have to answer with ‘yes’. This can be achieved by stating the obvious such as “It’s a nice/miserable/very cloudy day today, isn’t it?”, “I’m going to close the door, is that okay?”, “Would you like to sit over here?” etc. This may help the client into a ‘Yes Mindset’ and the subsequent conversation might run more smoothly.

Example Script: Introductions (Session 1)

“Hello, my name is ___________. It’s lovely to meet you, thank you for coming in today.” “Do you know what Health Coaching is about? Is it okay if I tell you a little more about it? I usually meet with people that might be interested in making some changes in their everyday life. By that I mean things such as eating habits, activity levels, smoking or drinking behaviours. What we usually do is talk about whether someone really wants to change. If you decide that you would be interested in changing some aspects of your current lifestyle, we can have a look at which changes you would prefer. We can also have a more detailed look at how you could go about putting some of this into practice. The aim is to help you make any changes that you want to make and learn how to take charge of your own health. How does that sound?”


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Sessions 2 – 4

At the beginning of each session, the Health Coach should praise the client for coming back,

and use small talk to put the client at ease. This is a good opportunity to ensure that the

client is comfortable and ready to begin, introduce the agenda for the current session, and

review the achievements of the previous week.

Example Script: Introductions (e.g. Session 2)

“Hello, it’s good to see you again. Thank you very much for coming back today for the second session. Today’s session, again, will be about 45 minutes long. What we can do is talk about how’ve you got on, and also have a look over your self-monitoring diary, if you’ve brought that in. Then we’ll think about how you want to go forward from here, and what you could do next week. Today, I’d also like to talk about some of the things that make it harder for you to achieve your goals, and how to avoid these barriers. And it can also be helpful to look at some of the things that will make it easier for you to achieve your goals, and how to include these facilitators. How does that sound?”

Use this space to record your own words or phrases you might use to introduce the Health

Coaching sessions.


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Client Expectations

The Health Coach needs to know why the client has been referred, why they agreed to come

along, and what is motivating them to think about behaviour change. Explaining what will

happen in each of the sessions should help to highlight any mismatch between the service

being offered and what the client was expecting. Having an agreed plan or agenda for the

session also gives the Health Coach something to look back on if they find the conversation

is drifting ‘off topic.’

Description: Client Expectations

It is important to carefully listen to what clients expect to gain from coming to the sessions. This is to make sure that what the client assumes is going to happen is actually what Health Coaching has to offer. If clients receive something different from what they expected, they are less likely to take maximum benefit from a service. Matching client expectations with the Health Coach service is also a good way of showing clients that their viewpoints are valued and that they are being listened to. This is especially important at the beginning of building a relationship and can be achieved by using Open questions, Affirmations, Reflections and Summarising to explore the issues that are important to them to address.

Example Script: Client Expectations

“How did you come to have this meeting with me today? Is there anything in particular that you wanted to talk about?” “Is it alright if I tell you how we would be working together? Usually a session lasts around 45 minutes. We would have a chat about how your health and see if there is anything that you might want to change about how you do things now. If you think you might be interested in making some changes, then we can have a look at how you could go about doing this by using some worksheets and learning some skills. At the end of our time I hope you will go away with an idea of what it is that you could do differently. We can then meet again in about a week to see how you got on and talk about what else would help. Does that sound okay to you?” “The important thing is that I’m not here to nag you or tell you what you should do. You are the expert in your life so I’m here to support you to make any changes you want to make. We will work as a team to think about the best way forward and you can be honest with me, it will all be confidential. What do you think?”


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Below is a flowchart that you can use to help guide you in managing the client’s

expectations of the service.

If there is a mismatch between what you are offering as a Health Coach and the client’s

expectations of what they will receive, discuss this with the client and establish whether

they are still interested in continuing with Health Coaching. If they are, move on to the next

step in the Health Coaching session. If not or they are requiring support beyond your role as

a Health Coach, use this opportunity to signpost the client to a more suitable service that

can meet their health & wellbeing needs, e.g. financial support, counselling etc.


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Health Behaviour Check

Establishing Baseline Behaviour (Session 1)

Before talking about change, it is useful to establish the degree to which clients are

engaging in relevant health behaviours at the point of the first meeting. This allows the

Health Coach to gain some background information, and will also serve as a baseline for

comparison at the end of Health Coaching, to assess whether any benefit has been

delivered for the client and whether change has been achieved.

Clients can either fill this in by themselves, or for those that prefer or have literacy issues,

this can be completed by the Health Coach. Remember, it is important to attribute all

success in health coaching solely to the client whilst presenting all tasks as a joint challenge

where the health coach’s job is to support the client in their change. This is vital to

increasing the client’s sense of self control.

Establishing Post-Health Coaching Behaviour (Session 4)

Before the end of the Health Coaching experience, the client will complete the Health

Behaviour Check again. This is important to re-assess the client’s general health, and will be

used to establish whether the client has managed to achieve change, and the effect Health

Coaching has had on the chosen, as well as other, behaviours.

It is important that client’s fill in all of this check, irrespective of which behaviour they

changed over the past few weeks. Again, this check can be filled in either by the client or by

the Health Coach – depending on client preference & ability.

Description: Health Behaviour Check

The Health Behaviour Check is a quick questionnaire that asks some factual questions about the client’s performance of the four relevant health behaviours – smoking, alcohol consumptions, diet and physical activity. It is important that all clients fill in the full questionnaire irrespective of which behaviour they choose to change. The Health Coach should explain that they would like to gather some background details before coaching starts and ask permission first to ask some quick questions about the client’s health behaviours. The Health Coach can ask the questions and fill out the form as best they can, allowing the client time to discuss their answers, if they wish.


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Example Script: Health Behaviour Check (Review)

“Before we finish let’s have a closer look at some of the changes that you made to your health behaviours. Can you remember filling in this Health Behaviour Check at the beginning of session 1? This will again ask you a few questions about yourself and the things that you do that might affect your health. I have the copy that you previously completed here and once you have completed it we can compare and see if there are any changes.” If clients mostly managed to change: “Wow that’s brilliant, well done for being able to change your [insert behaviour]. This is a great accomplishment in only a few weeks and I think that you have done very well. How do you feel about this accomplishment? I think that you are on track to make permanent changes to your lifestyle that will affect your health in a very positive way. I am confident that you will be able to continue with these changes.” If clients mostly failed to change: “Not to worry. Change doesn’t happen overnight and I can see that you managed to make some positive steps towards your overall goal by [insert examples of positive change]. I am confident that you have all the relevant tools to continue and build on these successes and continue changing your lifestyle.”

Use this space to record your own words or phrases you might use to complete the Health

Behaviour Check with clients.


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Choosing a Health Behaviour

Asking the client to choose one of the four behaviours to change is an essential part of

forming an overall goal. Some clients may have already decided which behaviour they want

to change, so this section would be summarised in that situation.

If the client is not entirely sure which behaviour to tackle or hasn’t completely decided

whether to change at all, this step is important to spend a good amount of time on to make

sure that the client is happy with their decision, and chooses one specific behaviour.

Encourage them to focus on one behaviour at a time. Trying too many things at once is

often overwhelming and can lead to unsuccessful change attempts, which reduce the

client’s confidence in their ability and motivation to change. Other behaviours can be

changed once a new behaviour has become part of everyday routine.

There are two different tools you can use to help the client choose a behaviour – these are

the Health Information Cards and the Decision Balance.

When discussing the pros and cons, remember to focus on the positive side of change. You

can do this by reflecting back using the present tense instead of the conditional, i.e. “the

benefits are that you would have more energy” instead of “you would have more energy.”

Vice versa, you can use hypothetical phrasing for toning down any disadvantages of change.

Description: Health Information Cards

The Health Information Cards are four small cards with bullet points listing the health benefits of changing each specific health behaviour. These are most useful when a client is unsure which behaviour to choose, or when they are trying to decide between two. They can also be offered if a client has already decided but depending upon the conversation, the coach might decide it isn’t necessary if the client is already very confident with their decision. As with every occasion of delivering information, Elicit-Provide-Elicit must be used. The coach must remember to ask the client if they would like to discuss the benefits of changing behaviour, check what they know already and ask if it is okay to read through the points on the relevant information card.

Description: Decision Balance

Client choice is important to the client-coach relationship because the client perceives the coach to assist rather than instruct; no one likes being told what to do. When the client chooses what they want to change it makes them feel more in control because the agreed course of action is based on their own decision.


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Looking at the pros and cons of a behaviour can increase motivation towards change. Sometimes people know what they want to change but have not clearly thought through why they want to do it or what the challenges are going to be. Health Coaches should explain that listing the cons of change is the first step in preparing oneself, and listing the pros is a good reminder of why change is important to us. Encourage the client to take charge and write their own answers in their own words. If the client is still unsure, list the pros and cons of staying the same. Note that the negative side, the one we as Health Coaches want to downplay, comes first so that the discussion ends on a positive note.

Example Script: Choosing a Behaviour

“When we think about making changes, most of us don’t really look at all ‘sides’ of the change. Instead, we often try to do what we think we ‘should’ do but maybe it’s not really what we want so we end up giving up altogether. Thinking about the pros and cons of changing is one way to help us make sure we’ve really thought it through. This can help us to stick to our plan when things get difficult and remind us of all the benefits we’re working towards. Would you like to think about what the pros and cons would be for you if you changed one of the behaviours?” “Which behaviour would you like to look at first?” (Example: healthy diet). “Suppose you improve your diet, what is going to be difficult about doing that?” [listen actively but don’t reflect back the disadvantages] “So now we know that there will be challenges if you change, but what about the good things? What do you think the benefits are for you in eating healthier?” [listen actively, reflect upon and summarise the advantages] “So you will lose weight, you’ll have more energy and you’ll feel better about yourself. Is there anything else you can think of?” “Okay, that’s great. So there are a few difficult things about making changes that we’ve talked about, but there are also a lot of benefits for you in eating healthier. We’ve talked about you losing weight, feeling better about yourself and having more energy when you eat healthier food. You’ve done really well to consider the options carefully. How does this make you feel about changing? Do you think you’re ready to make a decision about next steps?” [If yes: move on. If no: continue decision balance as below] “If you’d like to think about it some more, that’s absolutely fine. You are being very thorough in this decision and thinking about it very carefully, which is fantastic. It’s so important not to rush into making decisions; you need to be happy with what you are going to do.”


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Self-Affirmations

Often when people have a lot on their mind, they can focus on all of their problems and it

becomes difficult to start thinking about how to make changes, especially in health

behaviours which tend to be of lower priority. Additionally, it is human nature to want to

feel good about ourselves, so if the topic of change comes up it can often be viewed as a

negative thing or a suggestion that the person is ‘doing something wrong’. This can lead to

resistance.

By using self-affirmations, the coach encourages the client to talk about something positive.

This can increase self-regard, improve confidence and help the client become ready to think

about health behaviour changes. These self-affirmations will be used intermittently

throughout this session and brought up again in future sessions to maintain the positive

effects.

Description: Self-Affirmations

The Self-affirmations Poster holds five thought bubbles with different questions or statements in them. In this first activity, choose one to focus on. The others will be covered later in this and future sessions. This will involve posing the question to the client and encouraging them to think of something, any small thing, that is or has been positive. It can become easy for people to focus on the negative and ignore the positive sides of their life. We then feel hopeless and cannot see how to make changes. This activity tries to break that negative cycle and open people up to thinking positively about their life, before we start trying to talk about the behaviour or changing anything. By using a poster, we can encourage the client to get up and move around, they can write a word or just talk if they want. This activity is more about the positive emotion and less about writing things down. If the coach thinks it will be useful, they can note down the questions and answers on a separate sheet for the client to take home with them at the end of the session.


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Example Script: Choosing a Behaviour

“Let’s start off with a short task with no right or wrong answers, just to get talking so that we’re both relaxed and getting to know each other a bit. How about we look at that poster over there and see if there is something on it that you think you’d like to tell me about?” If the client doesn’t choose a topic: “That’s fine, well would you mind if I asked you a question about yourself? Could you tell me something you feel that you are good at? Even if it’s just a small thing, anything at all?” [listen actively and reflect the positive aspects] “It sounds like you put a lot of effort into that. You’re good at it because you really try / you really care about it. Sometimes it’s easy to think about all of the bad things in our lives, especially when things are difficult, and we forget or we ignore all of the good things. Even something really small, even if it doesn’t matter to anyone else, can be something for you to feel good about. That’s what Health Coaching is about, making a small change that’s just for you.”

Use this space to record your own words or phrases you might use to talk about self-

affirmations with clients. Think of some of the strengths that your clients bring with them

– record them here as a reminder!


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SMART Goals and Action Planning

Once the client has chosen a behaviour to change, it is time to formulate an overall goal.

This is relevant for the behaviour change but is not necessarily a behaviour itself; this is

more like a resolution. The overall goal is the long-term target, the big change that the client

wants to achieve in six months or a year.

Next, look specifically at how this intended behaviour change can be achieved. Specific goals

detail the elements of the new behaviour that clients choose to try over the next few days.

The specific goal is the first tiny step towards that big overall goal. Specific goals should be

SMART. Each week a new SMART goal takes the client one step closer. By using SMART

goals, we can break down the big goal into small, easy behaviours that are very specific and

that we know exactly how to do. For example “losing weight” or “exercising more” are good

long-term overall goals, but for the first week a SMART goal might be to swap the lunchtime

bag of crisps for a banana on Monday to Friday.

It is not useful if goals are too abstract (e.g. I want to be healthier), too specific (e.g. I want

to clean the kitchen drawer) or irrelevant (e.g. I want a new car). If we want to break down

an abstract goal to become more specific, we have to ask ‘how’ something can be achieved

(i.e. how will you be healthier? I will eat more fruit and vegetables). If we want to make a

specific goal less narrow, we have to ask ‘why’ the client wants to set that goal (i.e. why do

you want to clean the kitchen drawer? I want to prepare to cook healthily). Note that

seemingly irrelevant goals can sometimes link to health relevant behaviours so it might be a

good idea to explore them. For example, asking someone ‘why’ they want to buy a car might

lead to the answer ‘to get out of the city more and be more active’. This information could

then be used to elicit more health relevant goals.

Description: Setting a SMART Goal

SMART stands for Specific, Measurable, Achievable, Relevant and Timed. A specific goal is the exact step that the client will take, including the location, day and time. The Health Coach can assist the client in making a goal more specific by using open questions to encourage thinking about all of the details. A measurable goal can be tracked in some way, so that we know it has been completed. Achievable means that the client must feel able to do it; there’s no point in making a big ambitious goal that they can’t stick to. Even a small goal is still the first step that they can build upon next time. If the goal is relevant, the client feels like it will lead them to achieving their overall goal. Setting a time limit means that there is a clear end point for review.


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Example Script: Setting a SMART Goal

“I’d like to talk to you about setting a SMART goal, have you heard of that before? Is it okay if I explain what it means?” “SMART stands for Specific, Measurable, Achievable, Relevant and Timed. It is a useful way to remember what a really helpful goal will include. A specific goal is clear and detailed, not something vague, like eating healthier. a clear specific goal would be ‘ I will only eat two muffins a week, one when out for tea with friends and the other on Sunday at lunch’.: If we think about what exactly you want to do, when and where you’ll do it, this will help us to get enough detail. Making a goal specific means it should be easy to measure. So, if our overall goal was to eat healthier, our specific goal could be to only eat chocolate once a week on Saturday evening when at home watching a film with your partner. This can be measured by ticking off each day that you didn’t eat chocolate, so that you can keep track of how well you are meeting your goal. It’s always better to set goals that are achievable. If you set a really hard goal straight away, it can be overwhelming and you’ll want to give up. We are aiming for small easy steps to build up slowly to the end goal. We also need to make sure that this goal is relevant. Does it feel important to you? Is it a behaviour you really want to change? Will this goal help you to reach the overall goal eventually? Making changes is easier when it feels like it really matters to you. Finally, it is a good idea to set a time limit on meeting your goal. Then you know exactly what you’re planning on which days. Normally, we would set a goal every week so this goal will focus on just the week ahead until we next meet. How does that sound to you?”

Use this space to record your own words or phrases you might use to explain setting goals

and action planning with clients.


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Description: Completing the Healthy Goals Action Worksheet (Goals)

Encourage the client to fill out the worksheet themselves. The Health Coach can do the writing if there are literacy issues. The first question on the worksheet asks what the overall goal is. Overall goals are things that the client would like to achieve in the future by changing behaviour. Having a concrete reason for change and a long term goal to aspire to can help clients to prioritise their behaviour change goal over other competing behaviours. Identifying the overall goal is therefore an important source of motivation for the client. The second question asks for the specific details of the SMART goal and action plan. Support the client to come up with their own ideas to answer the questions and use OARS to look for more details, increase or maintain motivation and keep focus on the topic at hand.

Example Script: Completing the Healthy Goals Action Worksheet (Goals)

“So we’ve talked about what behaviour you would like to change overall, and we’ve looked at the things to think about in setting a really clear goal for the next week. Are you happy to start talking about the next steps?” “The form I have here asks first for your overall goal. This is your reason for coming to Health Coaching, the long-term target that you want to reach in six months or a year, when you’ve made changes to your lifestyle and [insert behaviour e.g. exercise]. What do you think that would be?” You can ask yourself the question ‘How would I know that something has changed for the better because of my behaviour change’ or ‘What would be different if I changed my behaviour positively for a long time?’ So in the long run, your overall goal is [insert goal e.g. to lose weight, be healthier]. Good, that gives you something to aim for and writing it down here helps you to remember what you are working towards. Now for the SMART goal. What exactly do you think you could do, just this week, as the first small step towards the big goal? Let’s try to think in as much detail as we can.”


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Readiness to Change

Some people want to change but have difficulties because they don’t think that they can do

it. Other people want to change but start going about it the wrong way, trying to do things

that they have been told to instead of what they themselves think will actually help. People

with a high level of confidence in their own ability to change as well as high levels of

motivation are more likely to achieve their goals and deal with barriers that get in their way.

Therefore it is important to measure how confident and motivated a client is and how to

increase these if needed.

When discussing confidence and motivation, it can be helpful to reflect back on previous

successes, i.e. discuss times in the past when the client has changed the behaviour, even

temporarily. What did they do, how did they do it? Have they succeeded in changing other

behaviours? If you covered this earlier in the session, draw on their self-affirmations to

increase their confidence. You can also ask the client if they can think of someone they

know who has successfully managed to make behaviour changes, and to think about how

they achieved this.

Persuasion – support and encouragement – can also increase confidence, so positive

language from the Health Coach, and planning for help from friends and family is important

to consider. Give plenty of praise, and don’t put the client in a situation where they feel they

are likely to fail.

Description: Readiness Ruler

A useful tool for assessing confidence and importance is the Readiness Rulers. This is a scale numbered 1 to 10, where 1 is very low and 10 is very high. When clients indicate their place on the rulers, we can then discuss what made them choose that number and what sort of things might make them feel more confident / view the goal as more important. If a client scores less than 7 for either one, an extra step should be taken to boost this rating. If confidence is less than 7, the client does not feel that they will manage to complete the goal. This is very common, because behaviour change is not easy. But if the goal is too hard, or the client is too worried about failing, chances are that their own self-doubt will stop them from succeeding. Talk about past successes, times that the client felt something was hard but managed it anyway, in order to provide a confidence boost. If the client still doesn’t feel more confident, talk about making the goal a little bit easier. If importance is less than 7, go back to the decision balance task. Review the answers given for all of the pros and cons, remembering to summarise the change-focused aspect, and complete the second half of the activity if not done previously. If the decision remains the same, look at the SMART goal and consider if it is relevant and will actually help to change the chosen behaviour. If the client still doesn’t think the goal is important, talk about how to make the goal more relevant or consider self-monitoring for a week and reviewing at the next meeting.


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Example Script: Readiness Rulers

“So you’ve got your SMART goal, you’re ready to start making changes. What are you thinking about that? If you were to put yourself on this scale, from 1 to 10, how confident are you that you can meet this goal? And how important do you think the goal is to you? Will it help you to meet your overall goal?” [Summarise the client’s answers on the rulers and discuss in more depth using open questions; some useful examples are listed below] “What does that score mean for you?” “What made you choose that number?” “Why did you not pick a lower number / What might help you to a higher score?” [If scores are high, listen to the client explaining why they gave themselves that score, praise and move on. If scores are low, take steps as previously described using scripts below.] “It seems that you aren’t very confident about this goal. Maybe it isn’t very achievable just yet. Do you think it is something we could build up to? Can you think of a way to make the goal a little easier?” “It looks like the goal we’ve set isn’t very important to you. Will we look back at the reasons you thought of in the decision balance to make sure this is the right time to talk about this behaviour? Or maybe the SMART goal isn’t relevant enough to the overall goal? What do you think would make it more important to you?”

Use this space to record your own words or phrases you might use to explain confidence,

motivation, and using the Readiness Rulers with clients.


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Self-Monitoring

It is important that clients record their behaviour to measure their progress. This can further

motivate them when they see that they are succeeding or show them when something

keeps happening to trip them up.

People can often underestimate or overestimate how successfully they are changing their

behaviour; they might think they are achieving more than they actually are, or they might

focus on their failures and not notice the positives. Self-monitoring gives people a realistic

picture of their health behaviour. Behaviour change is usually up and down rather than

smooth progress; looking back at past records can help people keep going during any down

phases.

Examples of self-monitoring include making charts, records and diaries; we offer an example

record sheet at the end of the Health Coaching session but clients might choose to self-

monitor in a different way.

You can use the Healthy Goals Action Worksheet with the client to make a note of how they

have chosen to self-monitor their goal.

Description: Self-Monitoring (ABC Diary)

Self-monitoring is keeping a record of behaviour and it can be done before as well as during behaviour change. It can be useful when people are not ready to change, or don’t know which changes to make, since just recording the behaviour can help to show the client just what their daily habits look like and so increase the motivation to change in a desired direction. When a goal has been set, the diary is used to record behaviour related to the goal, to keep track of whether the client is succeeding or not in reaching the goal. We describe our diary as an ABC record because it has three parts: A (antecedent) records what happens immediately before the behaviour, B (behaviour) is the action itself whether completing the goal or not, and C (consequence) is what happens immediately afterwards, whether positive or negative. This can help to identify barriers that happen beforehand and lead to difficulties with changing the behaviour. It can also show the client what has helped them to make behaviour change easier and what the positive outcomes have been; this can increase motivation and help inform future action planning. The client should be encouraged to engage in self-monitoring, in a way that works best for them, and to bring the ABC diary to every meeting, even if they haven’t filled it in. The information in it can be very useful and make clients think about things they otherwise wouldn’t have noticed.


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Example Script: Self-Monitoring (ABC Diary)

“So you know what your overall goal is, you’ve decided upon a SMART goal for the week ahead, it’s an important goal and you’re feeling confident about achieving it. [OR if not setting a goal, summarise the discussion about the behaviour and explain the diary as a way of understanding more about the behaviour instead of as a record of changing it]. The last thing I’d like to ask you to do is to keep a record of how things are going over the next week. Keeping a diary is one of the best things you can do to change your behaviour. Is it okay if I explain to you how you could use this diary?” “This is a list of every time you complete the behaviour, along with what happened right before it and what happened right after. That could include things like what you were doing, where were you, who was with you, how you felt and so on. From that we can learn more about things you might not be noticing, that are making it hard for you to change, and also it can be encouraging to see the list of all the times you managed to stick to your goal. Will we go through an example to show you how the diary can be used?” “Let’s say for example, the goal is to go out for a walk on Monday, Wednesday and Friday at 12.30pm; so we fill out the diary at those times. On Monday lunchtime, the behaviour is whether or not you went for a walk. Then write what was happening before that either helped or made it more difficult, for example maybe it was raining so you didn’t go, or someone offered to go with you so you did. And then we fill out what happened afterwards. Maybe you enjoyed yourself, you felt refreshed, you were proud of completing the goal. Maybe you felt stiff and sore, it was too cold outside, you didn’t have time for lunch because you went out. Whether the information is positive or negative can tell us a lot about how you’re getting on and the reasons why you did or did not complete a goal. And the diary could be used any time; from the example, say you wrote down that you didn’t walk on Monday, but you could then write a diary section if you walked on Tuesday instead. Does that make sense?” “It would be really useful if you could give it a try and bring it back next week; even if you don’t manage to fill it in, take the form back and we can try to do it together. Keeping track of the behaviour like this will really be useful next week when we start thinking about things that are making change difficult, or extra things that will help you. Do you have any questions about using the diary?”


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Identifying Barriers

After setting a new goal clients are asked to think of potential barriers that might get in the

way of their behaviour change. Barriers might interfere with the specific goal that the client

set for themselves or with the overall behaviour change in general. The client is then asked

to think of solutions to match to each barrier.

For example, a client wants to increase the amount of physical activity they do but there is

no one else available to look after the children while the client is exercising. However, if the

type of physical activity they choose could include their children (for example, cycling

together, playing in the park, walking to the shops), it is no longer a barrier. Situations that

are likely to cause setbacks for the clients are also barriers. For example, a person trying to

give up smoking may find that when they drink alcohol, it is a high-risk situation because

they feel really tempted to smoke. The client should think of any situation where the risk of

setback would be high, and together think of some strategies for managing them. For

example, going to a place where smoking is banned, or asking friends not to smoke around

them.

Health Coaches discuss whatever problems the client brings up and works with their client

to think of possible solutions. It is very important that the client thinks of any ways of

dealing with the barrier; the Heath Coaches should only assist the client to come up with

their own solutions. Any additional difficulties, such as upcoming cold weather, that the

client may face in the next few weeks should be brought up and plans formed to cope with

these.

You can use the Healthy Goals Action Worksheet to make a note of some of the barriers

recognised by the client has recognised, and ways in which they could overcome these.

Description: Identifying Barriers

People face many barriers when they try to change their behaviour. These barriers are often the main reason why people give up trying to change. The more barriers a person faces, the more likely they are to fall back into old habits. Barriers can be divided into four categories, which can be described as BEST: Behaviour – things that we or other people do that get in the way. Emotion – feeling sad, angry or depressed. Situation – being in a situation that makes the intended change hard. Thoughts – thinking patterns that are not in line with the intended goal.


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Example Script: Identifying Barriers

“Everyone has times when it is difficult to do what they planned to do. Are there times when you find it difficult to change your [insert behaviour]?” If yes: “What sorts of things make it harder? What do you think would make it easier to deal with them? How could you avoid or overcome them?” [allow the client to fill in the barriers and solutions worksheet] Examples of barriers (give one or two examples selectively as fits best) 1. Unsupportive friends/relatives 2. A family that does not want to embrace your life change 3. Situations that make it especially difficult to perform the behaviour e.g. attending a party 4. Feeling sad or depressed and wanting to fall back into old habits 5. Not having time to prepare for the behaviour change 6. Not having the time to embrace your goals Some suggestions to overcome these barriers

1. Explain your goals and request their open support making sure that they understand that this is lifestyle change and that it would be easier with their support.

2. If your family is picky and does not want to support your lifestyle change establish

clear ground rules: “I will do ___, even if you’re not used to it.” You can also involve them in the decision process of behaviour change. For example if the overall goal is to eat healthily, ask your family to select from a variety of healthy recipes that you can share with them, and establish a weekly menu agreed amongst the family.

3. If you are invited to a party where you know there will be lots of temptations not to stick to your goal, make sure you prepare yourself for these temptations before you leave the house. Make a commitment to yourself “If this ___ is tempting me then I will do ___.”

4. If you feel sad/nervous and want to fall back into your old unhealthy habits? Then find yourself an alternative activity or a distraction. This way you will not be over indulging.

5. If you feel you don’t have the time to prepare for your behaviour change then think about the way you organise your day. Draw a clock on a blank page and divide this page into the different things you have to do in a day (e.g. sleeping, personal hygiene, the kids etc).


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Reviewing Barriers

In Sessions 2 – 4 and after having set a new goal, clients should be asked to review any of

the barriers that came in the way of goal achievement and behaviour change in the past

week.

If the barrier was dealt with using the planned solution from the previous week, the client is

praised for it. If a planned solution to one of the barriers wasn’t successful, the client is

asked to think of different ways of overcoming the barrier. Clients are asked again to think

of potential further barriers that might get in the way of their behaviour change, just like the

previous week. These barriers are again linked to solutions.

Health Coaches discuss whatever barriers the client brings up and brainstorm possible

solutions. Any additional difficulties, such as upcoming cold weather, which the client may

face in the next few weeks can be discussed and planned for.

Description: Reviewing Barriers

Reviewing barriers is as important as reviewing goals. It helps clients see if the planned solutions were helpful. Reviewing the barriers also reminds clients of the things that can get in the way of the goal and the ways s/he wants to deal with these. If any of the identified barriers, or solutions did not work out as the client would have liked these can be changed.

Example Script: Reviewing Barriers

“Remember that last week we talked about some barriers that you may run into when trying to change your behaviour. [Review the concept of what barriers can be if necessary]. We came up with a list of things that might get in the way of your change, and thought of some good ways of dealing with these. Do you still have this list with you?” [review list or use recall if forgotten]. “Did you run into any barriers last week? What sort of things were making it difficult for you to change? How did you handle that?” “Can you think of any other possible solutions for this barrier?” “Can you think of any other barriers that you might face when trying to achieve your new goal for next week?”


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Identifying Facilitators

This overlaps with the identification of solutions for potential barriers. However, facilitators

are things that make performing a behaviour easier, even in the absence of any barriers.

For example, a facilitator might be to exercise with a friend. This doesn’t mean that without

the friend the person wouldn’t exercise. It only makes performing the behaviour a little bit

easier and more enjoyable.

Remember, you can use the Healthy Goals Action Worksheet with the client to help them

make a note of the ways to make achieving their goal easier over the next week.

Description: Identifying Facilitators

People can draw on facilitators which make changing their behaviour easier. These facilitators are often the main reason why people manage to maintain their behaviour change. The more facilitators a person uses, the more likely s/he is to stick to the change and develop new habits. Facilitators can be divided into four categories, which can also be described as BEST: Behaviour – things that we or other people do that get in the way. Emotion – feeling sad, angry or depressed. Situation – being in a situation that makes the intended change hard. Thoughts – thinking patterns that are not in line with the intended goal.

Example Script: Identifying Facilitators

“So, we have set your new goal for this week and looked at how you will deal with potential barriers that you might face. It is also a good idea to look at the things that will make it easier to change. Is this okay with you? These things can be called facilitators.” “Have you heard of facilitators before? [let client have a guess if time or situation allows] Facilitators can be anything helpful for your behaviour change. This could for example be a person who encourages, prompts or supports you, a way you feel that makes change easier, a situation, or something you think. It’s helpful to think of people who are likely to be supportive and encourage you to change, and think of ways to get the most benefit from these people by, for example, spending more time with them or having a specific person to phone when you need encouragement.”


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“The community can also be a great source of support for example, self-help cooking groups. Can you think of any sources of support that you could use?” “Other examples include having access to local facilities such as a nearby supermarket (near home or work) where you can find the ingredients you need to prepare your meals; reminders or situations that can trigger you to do the behaviour; e.g. placing your goal on the refrigerator as well as a list of foods to include and avoid in your plan. It could even be as simple as having a reminder that you are doing well to keep you feeling encouraged or finding ways of putting yourself in a good mood before tackling a behaviour change task. This will help you to find behaviour change more successful and enjoyable.”

Reviewing Facilitators

As well as looking at goals and barriers, reviewing facilitators in Sessions 2 – 4 is also very

important. This review focuses on the facilitators from last week to see if these have been

helpful and to see whether changes in facilitators are necessary.

Description: Reviewing Facilitators

Reviewing what and who could help in the behaviour change process focuses attention on the positive and action oriented aspects of changing, rather than always on the things that might get in the way. Each facilitator should be reviewed to see if it was helpful in the last week and how it worked. If any of the identified facilitators or the ways to involve these did not work out as the client would have liked, these should be changed.

Example Script: Reviewing Facilitators

“Let’s also have a look at the facilitators that we identified last week. Remember that we said that facilitators are the things that make it easy for you to change your behaviour and achieve your goal.” [review the concept of facilitators if necessary] “Which facilitators did you manage to involve last week? How did you feel about those?” “Would there be any other ways of including these facilitators?” “Which other facilitators could be useful, that you might be able to use for your new goal for next week?”


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Use this space to record your own words or phrases you might use when discussing

barriers and/or facilitators with clients. Make a note of any common barriers that your

clients might share, and the things they might have done/used to overcome these.

Barriers:

Facilitators:


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Planning Self-Rewards

Following the initial behaviour changes the client has made over the previous few weeks, a

further useful concept is that of self-rewards. Clients are introduced to the idea of self-

rewards and are asked to come up with things that they would like to do when they have

managed to achieve something.

Description: Planning Self-Rewards

Acknowledging success is not only important for the client’s progress towards his or her goals, it also boosts confidence. Often we don’t acknowledge the things we have done well and tend to focus on the things we fail to do. By planning for the things we want to achieve and managing to do these, we can keep ourselves motivated and also give ourselves a lift for the accomplishments.

Example Script: Planning Self-Rewards

“Giving yourself little treats to reward yourself when you’ve made progress towards your goal can encourage you to keep going and make more progress. You don’t have to wait until you’ve achieved your overall goal to reward yourself, remember that a big goal can be broken down into smaller mini-goals. Reward yourself for any mini-goals you reach and any other small successes you have along the way. You might want to think about smaller rewards for mini-goals, and bigger rewards for achieving longer-term goals. Rewards don’t have to cost money, but you can also ‘save up’ for rewards. For example, save £1 every time you do some physical activity, then at the end of the week or the month spend the money on a reward for yourself. If you can’t think of many rewards, here are some examples. A nice relaxing bath, reading a book or magazine, inviting friends over, having ‘me’ time, listening to music, going for a walk, watching my favourite TV show, doing some gardening, asking someone to babysit so I can get away, buying a gift for myself, going to the cinema, buying myself flowers, going to a football game, booking a holiday or weekend break, buying some perfume or aftershave, renting a DVD. “ WARNING “Try not to choose rewards that are unhealthy. For example, if you are trying to eat more healthily, rewarding yourself with a bar of chocolate every time you eat 5 portions of fruit or vegetables is not a good idea.”


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Relapse Prevention

Towards the end the client will talk with the Health Coach about behaviour change being a

slow and lengthy process, and that it tends to happen in peaks and troughs.

Preparing for the troughs will prevent the client from falling back into old habits.

Description: Relapse Prevention

Behaviour change is typically not a straightforward process. After changing behaviour for a while, it often happens that old habits catch us off-guard. In these cases we need to be aware of when these small slips or lapses happen and how we can respond to avoid complete relapse (giving up completely). Relapse prevention normalises lapses and helps clients to get back on track once a lapse has happened.

Example Script: Relapse Prevention

“Along the previous sessions you have become familiar with behaviours, emotions, situations and thoughts that might restart you on old habits. The barriers you’ve identified and found solutions for and facilitators you’ve involved will be really helpful over the coming weeks to avoid a slip back to old patterns. However, this does not mean that it can’t happen. If and when a slip up, or ‘lapse’ happens, you should not judge or blame yourself. You are not a failure or bad person because of this – most people have ups and downs when changing. Do not feel that all is lost once a lapse occurs. You can learn from it and prevent it from happening again in the future. So the best thing to do if you have a lapse is to get right back on track towards your goals as soon as possible. Rather than spending time and effort on being upset (which could lead you down the path of giving up completely!), direct your activities towards regaining control. Also, if you are prepared for the possibility of a lapse you are more likely to keep it from becoming a full relapse (giving up completely). Remember that the process of change is filled with ups and downs. The downs are critical moments to focus back on success and regain control.”


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Example Script: Relapse Prevention (continued)

“Almost everyone who is in the process of maintaining changes has times when competing thoughts/cravings and old habits return. You can remind yourself of the reasons why you wanted to change, as well as all the bad things about your old behaviour you thought of when we did the decision balance. Remember that no matter how hard it sometimes feels to stick to your own plans, the gain in the long run will far outweigh any short term pleasure that might be found in past habits. To establish new habits and to stick to them takes time. Your cravings and any doubts in your own sticking power will face if you manage not to give in.” “You might find that the gains seem small in the beginning but they will accumulate bit by bit with time as a new sense of control comes from your new way of living a healthier lifestyle. Also, when the commitment to change is firm, and what we stand to gain outweighs going back to the old behaviours enormously, changes are that we will stick to our new behaviours.” “To recognise the risk situations for a potential lapse or relapse, let’s pinpoint internal and external risk factors. These can include:”

1. Negative emotional states: such as anger, frustration, anxiety, depression, boredom, caused by perceptions of certain situations (e.g. feeling bored or lonely after coming home from work) or by reactions to events (e.g. being made redundant)

2. Interpersonal conflict: situations involving conflict associated with any relationships in particular family or friends

3. Social pressure: situations in which you respond to the influence of another person or group of people who exert pressure to take part in a behaviour.

4. Positive emotional states: such as e.g. celebrations, or being exposed to unhealthy eating-related stimuli or cues.”

5.

“Breaking this down in specific units, some possible factors and warning signs for lapse/relapse might be:

Hanging around with people that you know do not support your new behaviours

Being isolated or not seeking others for support

Keeping cookies, chocolates and other sweets around the house for any reason

Going shopping when really hungry

Relationship difficulties, ongoing serious conflicts (e.g. a spouse that boycotts your efforts for healthy eating)

Setting unrealistic goals (e.g. perfectionism, being too hard on yourself)

Changes in sleeping patterns, health or energy levels

Feeling overwhelmed, confused, useless, stressed

Constant boredom or irritability, or a lack of routine and structure in life

Major life changes like a loss or a gain like winning the Euro Millions!

Ignoring lapse/relapse warning signs.”


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Example Script: Relapse Prevention (continued)

“Here are also some examples of situations that can restart unexpected cravings: Something seen on TV or in a magazine

A smell

A sound that you might associate with your past habits

A feeling or mood “ “No matter how much you have invested in changing your behaviour during the past weeks there’s always the possibility of facing unexpected behaviours, emotions, situations and thoughts that can bring you to lapse. Having a plan for how to deal with warning events / risk factors that you can identify as risk situations will help you to cope with these situations. Besides this maintaining the behaviours you decided to change will boost your confidence and help you manage barriers and involve facilitators to keep going.”

Use this space to record your own words or phrases you might use when relapse

prevention with clients. You might want to make a note of any common relapse triggers

that your clients experience.


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Closing Sessions

It is important to make sure there is an appropriate end to each of the Health Coaching

meetings. This is to ensure a satisfactorily completed session, and will lead to improved

understanding, adherence, satisfaction and behaviour change in the client.

As part of closing a session, it is important to provide an end summary (i.e. briefly

summarising the session and clarifying future plans), contract (i.e. clarify the next steps of

the Health Coaching process with the client), safety netting (i.e. explain possible unexpected

outcomes and where to seek help), as well as a final check (i.e. check the client agrees and is

comfortable with the plan).

Examples of how to close each of the Health Coaching sessions are provided below.

Example Script: Closing Session 1

“So today we’ve talked about… [summarise the session including emphasis on pros of behaviour change, restate the overall and SMART goals, reflect positively on confidence and importance and encourage use of ABC diary]. How does that sound? Is there anything else we should talk about? I think we’ve made a pretty good plan today but whatever happens this week, please do come back and talk about it. This is only the first step and there is lots more that we can think about to help you along the way to making changes. Next week we’ll go over your diary and talk about how you get on, and then we’ll think about what you’d like to do in the week ahead. We’ll also talk about things that make change difficult and how to deal with them, and things that you could plan into your goals to help you. Thanks very much for coming today, it was lovely to meet you. I look forward to seeing you next week.”


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Example Script: Closing Session 2 & 3

“Well, we’ve covered everything that I wanted to talk about today. Is there anything you wanted to add?”

So what we’ve done today is to set a new goal, we’ve thought about how you can handle the things that make it harder for you to change and also how you could plan in some things that will make change easier. How do you feel about that? “Do you have any questions? Are you happy about what we are doing?

Again, see how you get on over the week and remember that you can use your diary to record everything you do so we can see next time how you’ve been managing. When we meet next time, we’ll see if there are any other barriers and facilitators that have come up over the week, and we’ll also think about how to reward yourself for changing. I will see you again in a week on [date].”

Example Script: Closing Session 3

“What we’ve done today is to set a goal like last time and we thought again about which barriers make it harder for you to change and how you can handle these, as well as the facilitators that make it easier for you to change. We have also talked about some of the things that you could do to reward yourself when you have done well. What I suggest is that, like last week you monitor your achievements in the coming days. What is different this time is that we meet in a fortnight’s time, so in a weeks’ time you can review your goal and set a new one by yourself and then next session we’ll talk about how you got on. This will give you the chance to practice being your own Health Coach. Does that sound okay to you?

Do you have any questions? Are you happy about what we are doing? Thanks very much for coming today, I will see you again on [date].”


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Example Script: Closing the Final Session

“What we’ve done in this session today is to set a goal like last time and look at barriers and facilitators and rewards which are relevant to your goal. We’ve also thought about how to maintain behaviour over the longer-term. What you have done over the past few weeks is to have a look at your [insert behaviour]. You identified that you wanted to change something and started to plan out what you wanted to achieve through your behaviour change and how you want to achieve this. You have formulated several specific goals over the last weeks and you achieved these and refined them and build on that success to change other things that you wanted to do. You also managed to identify the barriers and facilitators for behaviour change. You managed to come up with ways of overcoming barriers which you might face and with ways of including your own facilitators. In addition to that you also managed to reward yourself for achieving your goals. You also know about the things that might make you fall back into your old habits and you know how you can get back on track should this ever happen. How have the past few weeks been for you? I would suggest that given all your expertise now, you are well-equipped to change your behaviour by yourself. However, if you would like a follow-up session at any point, please do get in touch. Is there anything else you would like to discuss before we finish? Would you mind filling out this feedback form for us to know how we’re doing? That’s really helpful, thank you.”

Use this space to record your own words or phrases you might use when closing a Health

Coaching session.


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Post-Session Checklists

After each Health Coaching session, make sure to complete the post-session checklist whilst

the topics discussed are still fresh in your mind.

Keeping an accurate record of the session allows the Health Coach to remember what the

client was aiming to do over the next week, as well as to prepare for the upcoming session.

The post-session checklist also asks the coach to consider the positive aspects of the session

as well as anything that could be improved. This encourages the coach to be self- aware and

reflect upon their own performance, professional development and training needs. Self-

reflection should be an ongoing process for Health Coaches in order to keep their skills at

optimum level and identify any need for further training or assistance.

There are many models out there that you can use to help guide your reflective practice.

The most commonly used are Kolb’s Learning Cycle, and Gibb’s Reflective Cycle.

Kolb’s Learning Cycle:

Concrete Experience

e.g. delivering a Health Coaching session

Reflective Observation

e.g. reviewing / reflecting on the session

Abstract Conceptualisation

e.g. concluding / learning from the session

Active Experimentation

e.g.planning / trying out what you have learnt from

previous sessions


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Gibb’s Reflective Cycle:

As a Health Coach, you should consider the following in relation to your Health Coaching

sessions:

What happened during the Health Coaching session?

What were you thinking about during the session? How did you feel?

What went well during the session? What didn’t go so well?

What sense can you make of the information that the client gave you?

What else could you have done? How could the session have been improved?

What would you do differently next session?

Are there any particular issues or areas that you would like to focus on with the

client?

Description

e.g. what happened?

Feelings

e.g. what were you thinking and feeling?

Evaluation

e.g. what was good or bad about the

experience?

Analysis

e.g. what sense can you make of the

situation?

Conclusion

e.g. what else could you have done?

Action Plan

e.g. if it arose again, what would you do?


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ACTIVITY 6: Reflecting on Health Coaching Training

Using either of the reflective practice models above as guidance, reflect back on the Health

Coaching training and briefly write a few sentences on:

What have you learnt across the course of the Health Coaching training? Was this

something new or building on your previous knowledge/experience?

Consider your training needs assessment, are there any areas that you feel

particularly strong on? Areas that you feel less confident in and require further

practice?

What about the training did you enjoy? What did you not enjoy?

What sense can you make of the information that has been given to you? How might

you apply this to your own Health Coaching practice?


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Section 3: Troubleshooting

Session 1 & General Health Coaching FAQs

I haven’t analysed the client’s problem thoroughly

That’s fine, Health Coaching is not about analysing clients or trying to identify a “problem”.

Particularly in Extended Health Coaching, clients might have a lot of complex issues of which

health behaviours are only one. The Health Coaching service is for the most part future

orientated and is concerned with how the person can change from this point onwards, not

why the person is or has been doing something. Past events are discussed only in relation to

positive memories or past successes for confidence building. No analysis is necessary to

establish goals. By focusing on the current behaviour and desired changes, the coach can

avoid lengthy and past orientated problem analysis.

The client has different expectations to what the service offers

It is not unusual for clients to have expectations at the beginning that do not exactly match

the service goals. The purpose and structure of Health Coaching should be carefully

explained; it may be that clients would still be interested in using a part of the service to

look at behaviour and think about it some more. Even someone who is not currently

thinking about changing their behaviour might be willing to self-monitor and think about it

again at a later date, or set a goal for finding out more information from other sources

before deciding. In some situations, the client may have completely different expectations

and not be interesting in Health Coaching; in which case, the honesty of the client should be

valued, and their wishes respected. The Health Coach should signpost the client to a

relevant service that would more appropriately address what they are looking for.

The client thinks that his/her health is unrelated to behaviour

A common barrier to working together with people to change health behaviour is that they

do not see the connection between their health and what they do. For example, people

carrying excess weight might think that it is related to their genes or to an existing health

condition and that eating or physical activity do not have an impact. If people do not see the

relevance of changing their behaviour then it makes sense that they will not change it.

The coach is responsible for helping clients become aware that behaviour does play an

important part in health. However, this should not be done by lecturing the client or

providing large amounts of factual information. The coach should instead value the client’s

perspective and offer a rationale for why the focus on behaviour might be helpful e.g. “You

are absolutely right, there are lots of different factors that influence our health like genes


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and our environment that we can’t do much about. However, we also know that the things

we do can play a part as well. The difference is that it’s hard to change our environment,

and we can’t do anything about our genes, but we can control and change the way we act.

When our genes or our environment are getting in the way, it does make it more difficult.

But changing our behaviour can still be a big help; it’s not impossible.” Focusing on the

control aspect of behaviour and giving the client a feeling of being able to do something

might be one way of increasing motivation and confidence to change.

The client talks off topic about everything but his/her behaviours

Drifting off topic is a common problem when talking about health behaviours so this

happens frequently. The coach must be able to find the balance between building a strong

working relationship, which will involve talking about topics not directly related to health

behaviour change, and managing to stay on track to deliver the service action points. A rule

of thumb should be to allow the client to talk more freely at the start of sessions, becoming

more focused on the relevant tasks in the middle and then easing off into more relaxed chat

towards the end again. There is more information about how to bring the conversation back

on topic in the introduction manual.

The client is not aware of behavioural recommendations for health

A typical problem is that people are not aware of what they should be doing because they

hear different messages from different places, or because of changing or unclear

recommendations. The coach should be aware of the standard NHS recommendations and

refer to these, with use of leaflets where appropriate, if the client asks about it but care

should be taken that sessions do not become focused on information. Client knowledge is a

poor predictor of behaviour change so information should always be used to set goals. If the

client does request information, some brief points should be delivered with questions such

as “how does this information relate to your life?”, “what do you make of that?” and “now

that you know all this, is there anything you would do differently?”

The client expects to be told what to do

When we are placed in the role of the “health professional”, it is natural that some clients

expect us to have the answers. Many people, through life experience or media messages,

have come to learn a passive approach to their care and expect to be told what is best for

them. Such clients should be encouraged to voice their own opinion and take control of

their health. A conversational style that is more leading may have to be adopted at the

beginning so that the coach can gradually shift responsibility to the client e.g. “Okay to start


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with, I’ll talk about four behaviours that can affect people’s health and we can talk about

what you think of changing one of these behaviours. Once you’ve decided, I’ll tell you what

we do next. Does that sound okay to you?” In this manner, the client is still making the

decisions but feels that the coach is controlling the session. This approach needs to be

gradually reduced, placing more emphasis on client input as the session moves forward.

The client has a lot of factual or medical questions

Health Coaching is not focused on providing information, since knowledge is a poor

predictor of change. Likewise, Health Coaches are not medically trained or provided with

detailed knowledge of nutrition, physiology or other health-relevant factors. Coaches do not

gather medical details from clients such as existing health conditions or medication use.

Therefore in situations where clients have a lot of questions, these should be considered

very carefully before giving an answer. As an NHS professional, we are bound ethically not

to provide information which may be inaccurate or unhelpful for the individual and their

own unique situation. Some brief answers may be given to simple questions, such as

providing NHS recommendations for health, if it is deemed useful to the client in setting a

goal. More complex questions should be handled by suggesting an appropriate source for an

accurate answer. Even if the coach is otherwise trained to provide this information, such as

for example Healthpoint Advisors who work in both roles, the client should be encouraged

to seek answers directly from the Healthpoint and not during coaching sessions so as not to

go off topic too often.

The client doesn’t want to talk about themselves or are finding self-affirmations difficult

Self-affirmations can be a difficult task for some people to complete; a client might feel

embarrassed or awkward speaking openly. This is part of the reason for engaging in the

task, to encourage an open and comfortable working relationship to develop. The coach

should try to reassure the client that the answers don’t have to be really personal if they

don’t feel comfortable; it could be something simple or even something about a person

close to them instead of themselves. If they still cannot think of anything, the coach can

gently lead the conversation by thinking of generic examples, such as “I think it’s something

to feel proud of, that you’re coming here today and thinking about your lifestyle” or “It

seems to me that you’re being very practical / honest with yourself by coming here today;

that’s a pretty good feature to have”. Following up with open questions such as “What do

you think?” encourages the client to put a bit of thought into their response and open up to

the coach so that a working relationship can be established.


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The client can’t think of anything positive

Even people in the worst of circumstances have something in their life past or present that

has been positive. It could be to do with a family member, a close friend, a beloved pet or

even a safe place they would go to get away from it all. The coach must be careful when

encouraging positive thoughts not to make assumptions or ask direct questions that could

lead to further negative discussions. The coach also should not lead into conversations that

are out with the focus of Health Coaching and health behaviour change. Instead, the coach

should use open questions to discuss the topics that the client themselves brings up. For

example “It sounds like you have a lot of challenges and you’re feeling pretty down about it

all. Can you tell me more about your decision to come here today? What do you think you

are already doing to keep yourself healthy? Do you think that being here today is a positive

step for you thinking about your health?” If the client persists that nothing positive comes to

mind, suggest moving on from the topic for the time being and coming back to it later. If

nothing positive comes from the whole session, it could be a task for self-monitoring that

they identify one positive thing in the week ahead.

The client becomes very negative and fixated on their problems

This is likely to happen when working with clients who are facing many difficult situations.

The client should be allowed to talk a little bit without being interrupted and the client

should provide reflections to show that they are being understanding and non-

judgemental. The client must then try to guide conversations back to the health focus of the

session. Some tips are given in the introduction manual regarding how this might be done.

Additionally, the coach might explain that it is easy to fall into a habit of thinking about the

negative things, and certainly when we’re in a difficult situation there is a lot to feel

negative about, but it can also be helpful to think of some positive things. Is there a

different health behaviour that the client feels they are performing well? That can lead on to

a discussion about change.

The client asks me personal questions about myself

This must be handled carefully because it is important to the client-coach working

relationship that the coach is friendly, open and behaving as an equal rather than a superior.

On the other hand, excessive levels of personal disclosure could be deemed unprofessional

and inappropriate. When discussing the self-affirmations, if a client asks for the coach to

provide personal examples, the coach could divert from themselves and give some generic

examples by saying “Hmm, it’s a question that takes some thought. Well, someone I know

told me once that they...” If the client persists, the coach should politely redirect the focus

of the conversation by saying something like “It’s really nice of you to be taking an interest


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in me, but we’d be better using the short time we have today to talk about you. Maybe that

would be one of your strengths; taking an interest in other people. Asking people questions

shows them that you care about what they have to say. What do you think?”

I think that the client has chosen the wrong behaviour to change

When you complete the health behaviour check at the start of the session, you might notice

that the client has a clear issue with alcohol consumption, but wants to focus on monitoring

how many salty snacks they eat. That’s not a problem. The client chooses which behaviour

they would like to change and the Health Coach accepts this choice, so long as it is one of

the four relevant behaviours. Positive change in any area is a good thing, and making

changes in one area might lead to changes in another over the longer term. Health Coaching

also has a strong focus on learning skills and techniques that can be applied to any

behaviour; the sessions serve to help the client feel more in control of what they can

change, which means that other behaviours might be tackled as a result. The Health Coach

should not make personal judgements but should assist the client in whichever behaviour

they choose.

The client can’t think of any disadvantages to making changes

Sometimes people struggle with this question in the Decision Balance because it is asking

what the negative aspects of being healthier would be. They might think, well it’s not

negative to be healthier and I really want to do it so I don’t think there are any negatives. In

this situation, clarify that this question addresses the difficult things of changing or the

things that the client will miss about their unhealthy behaviour, for example not being

around friends at work when they’re smoking or that it would take extra time to cook or

exercise. It is important to be prepared for the downside of change because this will make it

easier to deal with when it happens.

The client doesn’t want to self-monitor

Self-monitoring is a very important tool for change. It forms much of the basis for future

meetings. The coach should stress the importance of self-monitoring and try to solve any

issues that the client has with the task. It should be made clear that only the basic amount

of simple information is necessary and it would take only a moment to make a quick note of

what was going on around a specific behaviour. If the client still refuses to self-monitor then

this should be accepted. No client will be forced to do anything they don’t want to do. In the

next session, the coach will be able to use retrospective recall to remember and discuss the

previous week.


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The client has literacy issues

If clients have literacy issues then the health coach should stress that it is not important to

self-monitor with proper spelling or even with much writing at all. Options should be

discussed to solve the barrier. Perhaps they could ask a friend or partner to fill in some

sections for them. A tick or cross could be used to indicate if a behaviour was performed or

not; colours or stickers could be used to depict what was going on beforehand or the

positive or negative feelings afterwards. If the client is still concerned, encourage them to

keep track of the behaviour any way they want and the next session can discuss it using

retrospective recall.

Session 2

The client forgot all the materials

If the client forgot all the materials the Health Coach will ask about this in a non-

judgemental manner. “Don’t worry about it; was there any reason that you didn’t bring

them?”

Health Coaches will make sure that the client doesn’t feel uncomfortable about not bringing

the materials back to the session, and ensure that the client understands that s/he should

take care to bring the materials next time: “That’s not a problem, we will make do without

the materials for now. If you can, it would be useful to try and bring them next time.”

The client talks straight away about the problems encountered during the week

If the client is talkative from the beginning of the session then this is a good sign and the

Health Coach should encourage this. “It seems like you have had a very eventful week”, and

listen carefully to the issues the client come up with.

The Health Coach will assure the client that the current session focuses in more depth on

the barriers and ways of overcoming these. “It’s very good that you have identified all these

things that can make it difficult sometimes to change. Today we’re going to talk about things

that make change difficult and see what you could do to plan ways around some of these

barriers”.

I don’t believe the client

It’s hard to always believe everything that a client tells you. There could be lots of reasons

why a client might be inaccurate in what they say:


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The client might be scared to admit not having changed to the Health Coach.

The client doesn’t want to admit not having changed to themselves.

The client doesn’t remember.

Health Coaches are non-judgemental towards their clients. If the client is perceived to be

not telling the truth or exaggerating slightly it could be a sign of insecurity on behalf of the

client. In order to encourage the client to open up to the Health Coach, a trusting

relationship has to be established by showing acceptance and empathy towards the client.

The Health Coach will focus on the positives of the stories and ask the client to plan doing

further changes. “You seem to know exactly what to change, that’s great. Let’s see if you

can plan some further changes for the week ahead, shall we?”

I think the client is not recording behaviour accurately

Inaccuracies in recording the behaviour could have to do with the client not understanding

the monitoring booklet completely. Health Coaches should check that the client

understands how to monitor and also why it is important to monitor. Any barriers that

might make monitoring difficult should be discussed. Does the client struggle to find a time

for filling in the diary? Finding ways to make the monitoring part of the routine should be

established.

The Health Coach will also be attentive to clients’ literacy skills. Health Coaches will stress

that spelling is not important, but the act of recording things so that they are not forgotten.

If clients are put off by writing things down, alternative ways of monitoring should be

discussed flexibly. If clients refuse outright to monitor the Health Coach will adapt to this

wish and use the behaviour change technique verbally only.

I think that the client filled the self-monitoring diary in randomly just before the session

Does the writing in the diary look like it’s been recorded all at once? The Health Coach will

ask how the client got on filling in the diary, to see if there were any issues with filling it in

regularly. However, it should be remembered that recall of the behaviour before the session

is better preparation than no recall at all.

I think that the client is lacking crucial information

Sometimes clients lack crucial bits of information or have been misinformed. This can often

result from conflicting messages people receive, for example from the media, or friends. The

Health Coach will be sensitive to the gaps in knowledge which might hinder the behaviour


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change process. This type of information does not need to be very detailed. Typical

questions or gaps in knowledge might be “which foods are healthy?”, “which type of activity

can I do?”, “how much drinking would be too much drinking?”. Health Coaches should

inform clients of this basic knowledge, reinforcing the link between behaviour and health

wherever possible, whilst remembering that all information should be delivered in an E-P-E

format (see Manual One) and that for in-depth information, the client should be signposted

to a more appropriate source.

Sometimes clients might think that their behaviour might be largely unrelated to their

health. Often the alternative explanations are more based on a genetic perspective e.g.

obesity runs in our family. The Health Coach will attempt to close these knowledge gaps or

correct the pieces of misinformation e.g. “Is it okay with you if I tell you what other people

in a similar situation have said? Often people come to me and say that they can’t do much

about their weight as it’s a family thing. That’s correct, weight does indeed have something

to do with the family, both in terms of your genes but also in terms of things that you do

and that you learn. You can’t change your genes, so one option would be to just accept

things the way they are and do nothing. The other option that people tend to favour is to do

something about it, as they can control what they do. When it is a genetic issue, certainly

that makes things more challenging, but you can always control your behaviour so it isn’t

impossible.”

The client is feeling down and doesn’t want to change anymore

Sometimes clients might feel a little bit deflated if they were unable to reach their goals, or

if they only reach part of their goals. Sometimes this might be very demotivating so that the

client doesn’t want to change anymore. This is no problem. The Health Coach will stress that

this is a normal part of the process when trying to change things. The client should

remember the overall goal formulated in the previous session, and especially all of the

reasons why they wanted to set that goal. Are those reasons, and the overall goal they

decided upon, still important to them? If not then it might be better to set a different

overall goal (see Session 1 for details). If the client still wants to achieve the overall goal,

then the Health Coach will help in setting a more realistic SMART goal that the client can

achieve. Any ‘failure’ to achieve a goal should be attributed to the goal, not the client. In

addition, any failures should be seen as learning opportunities that give valuable

information which is crucial to change. “It’s understandable that you think you don’t want

to change anymore after you found it challenging last week. For most people, not managing

to achieve everything they want to straight away is normal and a regular part of trying to

change something. Every time you did not manage to do what you want to do, it gives you

really good information about what you could do differently next time and can help you set

better goals.”


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The client is very pessimistic about what they have achieved even when they did well

Different people have different styles to judge their own behaviour. Some clients might not

like to fully acknowledge how well they have done, are a little bit shy about their success or

do not see it as having done much. The Health Coach will praise any changes that the client

reports which were in line with the plan. The positive feedback should be in line with the

client’s communication style (e.g. not over the top for shy clients). Elaborating (“How did

you feel when you managed to achieve your goal”) can often help the client to go into some

more detail about their success.

The client can’t see any barriers that might get in the way

That’s not a problem. If the client is really confident that they are going to succeed then

barriers that might get in the way are not too important. The only way to find out is to try. If

the Health Coach would like to talk about barriers a hypothetical question could be asked to

elicit potential barriers (e.g. What do you think would be a barrier for most people?” or “if

you would ask your partner what might come in the way of your goal, what would s/he

say”).

The client can’t come up with any ways of overcoming the barriers

This would not be surprising, as clients often come to see a Health Coach because they have

issues with changing their health related behaviour. Often barriers to behaviour change

might have been encountered many times and may have been in the way of client’s

permanent change. It’s good to know which strategies have been employed previously and

which ones were successful and which ones were unsuccessful. This knowledge could be

used in this process of formulating a solution.

If a barrier seems too much of an obstacle, the Health Coach can do one of two things:

1. Suggest a way around it (“Can I tell you what people in your situation

sometimes do to overcome the barrier”)

2. Suggest a different specific goal which does not interfere with this barrier (“I

can see that this barrier is quite tricky for you, and it might actually be better

to look for something that you can do where this barrier doesn’t get in the

way as much as with your current goal. What do you think?”


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The client counteracts every solution with another barrier

If the client can’t think of any solutions the Health Coach can make two different

suggestions to the client (“What some people in your situation typically find difficult is A and

B” or “What some people in your situation do to deal with this barrier is A and B”) and ask

the client if they’d like to choose one possibility (“Does any of those apply to you

situation?”). Presenting two options at once might make the client choose one over the

other, which increases their feelings of being in control.

The client doesn’t know of any facilitators

The concept of facilitators is not always well known. People are often the greatest source of

support with behaviour change and can facilitate the process. The Health Coach will suggest

potential facilitators if the client seems interested. If nothing comes up that’s not a problem.

If clients are confident that they can achieve their goal then this can be done without

identifying any facilitators.

The client is unaware of the facilitators available to them

This is a sign for great potential for behaviour change. If the client is unaware of all the

possible sources of support, discovering what could facilitate the behaviour change is

potentially very beneficial for the client. If the client continually struggles with the sessions,

the Health Coach can ask the client to pay attention over the next week to see what might

help with the behaviour change and then come back to talk about it.

The client comes up with many new things to say at the end of the session

The Health Coach should begin drawing the session to a close at around 5 minutes before

the end and give the client room to use those 5 minutes for whatever they would like to talk

about. If the client’s discussion is lasting longer than 5 minutes, acknowledge what they are

talking about and let them know that you will make a note to pick this up with them again at

the following session. If the client has health & wellbeing needs that need addressing, but

are beyond the focus of the Health Coaching sessions, use this opportunity to signpost the

client to further, appropriate supports. If the client has nothing more to say, then it’s fine to

finish the session a little earlier.


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Session 3 – 4

The client forgot the materials (again)

The main aim of Health Coaching is to provide a one-on-one service for the client’s benefit.

Using the materials is part of this process but health coaching can be done without using

any of the materials. If clients continually forget the materials but still turn up for Health

Coaching then s/he is still getting some benefit from the service. The Health Coach will be

aware of the fact that not everyone might be interested in filling out booklets, which is not a

problem. Clients can choose themselves whether or not to use the tools offered through

Health Coaching. If, however, the client seems not to know how to use materials, or when

to use them, the health coach will assist the client to find appropriate solutions.

The client has not achieved anything (again)

If the client was perfect in achieving all of their tasks, then they wouldn’t need a Health

Coach. Not being able to do something is a sign that either the set goal was not right, or that

the client has not been able to anticipate the barriers that got in the way of the goal. The

Health Coach will listen carefully to the client’s account of the previous week and use

SMART goal setting and barrier identification as appropriate. Any small changes that the

client managed to do, including things performed in preparation for change (e.g. if the client

went shopping for healthy food, but didn’t manage to cook the healthy dinners) will be

commented on and seen as successes.

The client is still coming up with more barriers than solutions

More barriers than solutions points to the fact that the goal might be difficult. It is good if

the client manages to identify many barriers. The Health Coach will compliment the client

for being thoughtful when it comes to barriers as this is a very effective way of knowing

what is possible to change, and what might not be possible. “You seem to be very good at

identifying the things that might make change difficult which is very important. Some

people are not able to see all the barriers as clearly as you and then don’t manage to change

because these barriers get in the way. Let’s make a list of all these things and then maybe

we can talk about what you can do to deal these barriers. This way it will be easier as you

can see things more clearly.”


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The client is still not sure about what facilitators are

The concept of facilitators is not straightforward for some people. The Health Coach will

explain facilitators and assist the client to identify these. Often the self-monitoring booklets

might be a good source to prompt conversations about things that make it easier. “I can see

in your booklet that on Thursday you had a very healthy day. What was different on

Thursday compared to other days where you were perhaps not as successful?”

The client doesn’t come up with any rewards

The self-rewards sheet provides 121 examples of self-rewards from which clients can

choose. The Health Coach will make it clear to the client that not all of these are applicable

for everyone and that everyone has to find their own rewards. Self-rewarding is about

having fun and realising when one has one well. Health Coaches should communicate this to

clients.

In cases where clients don’t want to reward themselves and feel this not appropriate the

health coach could suggest saving up some money for every time the client achieves

something (e.g. went for a walk). If they don’t want to reward themselves, they might be

saving the money for their partner or children and buy them something they would like. This

would be a very good way to get social support as well!

The client hints at wanting to continue with health coaching past the 4th session

This is a great compliment for the Health Coach and the service provided. Unfortunately, the

service is designed to have a maximum impact within 4 sessions. In exceptional

circumstances the client can be seen past 4 sessions, but this is not the norm. Health

Coaches can refer to other services that can help clients continue their behaviour change.

The client seems to get nothing out of Health Coaching

If is often hard to see the immediate impact that Health Coaching can have on client’s life.

Health Coaches will certainly refrain from assuming that clients get nothing out of the

service if progress has not been smooth and perfect. Health Coaches can ask what was

helpful about Health Coaching to help the client reflect on the tools offered through the

service that seemed to be of use to them. “So what did you think was the most useful bit

about coming to see me?”


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Personal Training Notes


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