Bridging The Gap Part 4: Principles and Practices of Comprehensive Coaching

After outlining the shortcomings of the traditional model of coaching and calling for a clear need for change, the final article in the Bridging The Gap series provides the framework for Comprehensive Coaching ©, including the principles, practices, and attitude of a Comprehensive Coach.  The Six Principles of Comprehensive Coaching Comprehensive Coaching © applies a set of principles to the coaching process, and while they are nonlinear and cyclical, the process itself often transpires in an intuitively chronological order. These principles underlie the skillset that can be applied artfully at various phases of the client’s journey. 1. Prioritize the client’s values and identity to guide appropriate goal-setting. Foster intrinsic motivation and internal regulation to sustain the value-aligned behaviors and reduce value-misaligned behaviors. This shifts the focus from the outcome (what) to the process (why and how). It is directional since goal-setting is an essential aspect of effective coaching, but it is neither directive or dictatorial on the part of the coach[1]. The client makes the decisions and the coach guides the client to their desired destination.

“This is important to me; I know what I want to do, and why I want to do it.”

2. Bolster client self-efficacy by identifying their unique strengths and acknowledging past successes. Believe that clients harbor an innate capacity for change and a desire to flourish. Provide information with permission so clients can make informed decisions. Celebrate successes and collaborate to overcome barriers to success.

“I am positive that I can do this.”

3. Encourage client autonomy by acknowledging the individuality of the client and the client’s own expertise about themselves. Engage in active listening, skillful reflection, and evocative questioning without providing unsolicited advice or solutions. Leave the final decisions to the client after ensuring that they are fully informed of the potential costs, benefits, and outcomes.

“I am confident that I can do this on my own.”

4. Evoke psychological flexibility and adaptive behavior so that clients are equipped with the necessary skills to take value-oriented action in a range of environments. Move clients away from the need to be in control of the situation by reminding them of their innate ability to take charge of their actions, no matter what they are faced with. This approach acknowledges personal barriers by addressing individual challenges, including the internal and external, and protects a client’s self-regard by recognising the role of self-esteem, self-worth, self-compassion, self-image, and body-image.

“I am assured that I can keep doing this in the face of obstacles and challenges.”

5. Uphold a strong set of ethics by respecting a client’s autonomy and ensuring informed consent is in place at every stage of the process. A Comprehensive Coach is agnostic to the dietary intervention used and is flexible in their approach to tracking, measuring and monitoring a client’s progress. This is inline with the principle of Primum non nocere, to ‘First, do no harm’.

            ‘I know I have freedom and flexibility over the approach and direction I can take’.

Comprehensive Coaching Process in Practice  While coach interpersonal skills are strong predictors of client outcomes, concrete skills and tools facilitate the processes of Comprehensive Coaching ©[2]. Though numerous other facets can be included, the following framework presents a guideline to begin applying these skills at appropriate phases of coaching. The goal of the coach is to identify the client’s struggles, meet them where they are, and move through the model as appropriate; therefore, the order will depend on the client’s needs.

  1. Apply the Transtheoretical Model (TTM) of Change to identify the client’s stage of change and appropriate processes.

  2. Engage in Motivational Interviewing (MI) to facilitate the client’s shift from ambivalence to action.

  3. Synthesize the principles and coaching skills of Self-Determination Theory (SDT) and Acceptance and Commitment Therapy (ACT) to collaboratively develop values-aligned goals and foster intrinsic motivation.

  4. Employ ACT and Cognitive Behavioral Coaching techniques to maintain momentum and internal regulation in the face of challenges.

  5. Implement multimodal dietary approaches to encourage Intentional Eating habits that meet the client’s needs, preferences, and goals.

Transtheoretical Model of Change[3]: Integrates a number of behavior change theories and organizes the stages and processes of change temporally. Behavior change doesn’t occur in a single instance, but as a series of stages that each include overt or covert cognitive-behavioral processes, all of which can be facilitated by practitioners. These stage-matched interventions vastly improve client outcomes compared to a one-size-fits-all action-oriented approach.

Applications: Utilize the TTM to properly identify the client’s stage of change. Stage-appropriate interventions and processes are more likely to result in lasting behavior change[4]. Stages of change can be identified by paying attention to the client’s verbiage, and techniques such as motivational interviewing (on the part of the coach), counter-conditioning (on the part of the client), and stimulus control (a potentially shared endeavor) can assist in progression from a lack of readiness to long-term maintenance.

 Motivational Interviewing[5]: Motivational Interviewing accepts that ambivalence is a normal human experience and operates under the assumption that clients possess an innate capacity for change and a desire to flourish. It also emphasizes the unique aspects of evoking change talk, which predicts change, and the development of goals, which are essential to an effective coaching alliance[6][7]. Practitioner interpersonal skills and empathy may outperform other traits (ie., content knowledge) as a predictor for client outcomes in a variety of treatment settings due to the establishment of an early alliance between the coach and client[8]. Empathic listening and evocative questioning integrate a number of communication skills that help clients reach their own decisions about which changes they’ll make and how they will implement them. This practice enhances self-efficacy by encouraging autonomy and feelings of competency.

Applications: Clients often complain that they lack the appropriate ‘willpower’ to achieve their goals. Ambivalence, or the tension between want and should, is common, and intention and action are not always identical. Sustaining healthful behaviour often involves resisting actions that are alluring in the moment in order to engage in behaviours that are more valuable in the long run. Apply this client-centered, collaborative process to guide your client to their own decision using empathic listening and skillful questioning, facilitating their transition from ambivalence to action.

Self-Determination Theory[9]: A meta-theory of motivation and personality which describes ways in which the internal and external environments might support or thwart an individual’s intrinsic drive toward personal growth and development.

Applications: Specific coaching approaches such as intrinsic coaching, autonomy-supportive coaching, and cognitive evaluation therapy promote self-efficacy and intrinsic motivation, respectively, by helping clients feel more competent and autonomous in making values-aligned decisions[10]. Less emphasis is placed on highly extrinsic forms of motivation which are associated with less well-being[11]. Clients are assisted in internalizing forms of motivation and regulation based on their values, identity, and the usefulness of the task. 

Acceptance and Commitment Therapy[12]: This therapy is about taking effective action guided by our deepest values in which we are fully present and engaged. It utilises mindfulness to foster acceptance of unwanted private experiences which are out of personal control and equip the client with skills to take committed action toward living a valued life.

Applications: Teaching acceptance helps to reduce the impact and influence of painful thoughts and feelings that are a part of a normal human mind, yet often create a barrier to goal achievement. Developing one’s psychological flexibility allows the individual to defuse from psychological suffering and respond far more effectively to the problems and challenges life inevitably brings[13].

Cognitive Behavioral Coaching[14]: This collaborative, goal-directed endeavor uses multimodal learning methods to help individuals develop their capabilities and remove the psychological blocks that interfere with this process[15].

Applications: Specific subsets of CBC, such as Socrative Questioning and Rational Emotive Behavioral Coaching (REBC), challenge the rigid thinking and limiting beliefs that can lead to procrastination while eliciting reflections that may lead to new thought and behavioral patterns[16]. Research suggests that beliefs about the nature of willpower predict self-control behaviors, potentiating the ability for cognitive reframing to enhance the client’s ability to exert self-control in tempting food environments[17].

Intentional Eating:[1] A comprehensive coach can assist clients with a number of goals, be it weight gain or loss, or a weight-neutral approach, depending on the client’s experiences,  preferences, and needs. Intentional Eating is a framework that accounts for the various approaches that a coach may take, varying from the mechanical to the intuitive. The coach should have an understanding of the potential applications, intentions, strengths, and limitations of each approach, and refer to another professional if the client’s needs fall outside of their scope of practice.

The Attitude of Comprehensive Coaching Similar to the paradigm of Motivational Interviewing, Comprehensive Coaching involves a nonlinear process of interactions encompassed by an overall attitude[18]. The central tenets of positive psychology give rise to the Attitude of Comprehensive Coaching ©[19]. Positive psychology is a scientific approach to studying human thoughts, feelings, and behavior, with a focus on strengths instead of weaknesses in order to improve a client’s life. While the aim isn’t to ignore negative emotions, this area posits that positive experiences, meaningful engagement, interpersonal relationships, and achievements (together referred to as PERMA) are essential elements for clients to live a fulfilling life[20]. The familiar concept of ‘flow’ arose from positive psychology, and this sense of autonomous, joyful focused concentration can evoke intrinsic motivation to engage in tasks. It is important to consider that coaching approaches or lifestyles that inhibit any one of these areas may reduce a client’s ability to live a fulfilling life[21],[22]. Based on the cumulative theoretical foundations, research evidence, and industry expertise, we propose that a coach adopting the Comprehensive Coaching © model would embody a specific attitude while engaging in this unique process. In order to elevate the industry standard and build an effective alliance with their client, a Comprehensive Coach would approach their career with an attitude that is:

●     Conscientious: Diligent, effortful, and thorough in their work and continued education, avoiding dogmatism and relying on evidence to drive decision-making. A Comprehensive Coach is aware of the impact their behaviour has on client outcomes and is conscious of the ever evolving landscape of nutritional science. Staying up to date with the latest evidence, remaining critically self-aware of his or her circle of competence, practicing intellectual humility and being unafraid to update their views upon the weight of the current evidence are key qualities of a Comprehensive Coach.

●     Collaborative: Maintaining the coach-client alliance by building rapport and respecting the client’s expertise.

●     Empathic: Operating from a place of understanding and validation of the client’s personal experiences.

●     Evocative: Drawing forth the client’s innate capacity for change by encouraging them to consider their own internal environment of cognitions and emotions

With this underlying attitude, a Comprehensive Coach can help a client engage in value-aligned behaviours whilst truly and assuredly protecting the integrity of a client’s health. We can define health as is a dynamic, subjective, emergent state resulting from adaptive environmental and biological network interactions[23], which allows the individual to flourish. Emergence is a term borrowed from Complexity Theory; it occurs when an entity is observed to have properties its parts do not have on their own[24]. These properties or behaviors emerge only when the parts interact in a wider whole. The many domains of wellbeing - the physical, emotional, social, and intellectual - must work synergistically in order for emergent health to occur. The role of a Comprehensive Coach is to understand how a client’s unique environment can constrain their capacity to actualise health, identify their barriers using the process outlined, and operate according to the proposed principles to enhance a client’s capacity to achieve sustainable change. Concluding Remarks and Future Directions  The Comprehensive Coaching © model was developed with conscientious care and effort in order to produce an evidence-based framework for a new dynamic between coach and client. While it is rooted firmly in empirical evidence and experience, the sum of its parts as a singular framework has not yet been formally tested. We recognize the potential for limitations and growth. In the same way that human health is an emergent phenomenon, so too is the Comprehensive Coaching © model. In the same way that a Comprehensive Coach is nutritionally agnostic and careful to avoid dogmatism, the Comprehensive Coaching © model is one potential approach among many that may elicit positive client outcomes. We are hopeful that the guidance provided by the Bridging the Gap series brings about change, and humble in our presentation of this model. We are proud of our effort and investment in this series, and immensely grateful for its warm reception by the industry. [1] Grant, A. M. (2014). Autonomy support, relationship satisfaction and goal focus in the coach-coachee relationship: Which best predicts coaching success? Coaching, 7(1), 18–38. [2] Moyers, T. B., Miller, W. R., & Hendrickson, S. M. L. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73(4), 590–598. [3] Prochaska JO and DiClemente CC ( 1984 ) The Transtheoretical Approach: Towards a Systematic Eclectic Framework . Dow Jones Irwin , Homewood, IL, USA [4] Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48. [5] Rollnick, Stephen & Butler, Christopher & Kinnersley, Paul & Gregory, John & Mash, Bob. (2010). Motivational interviewing. BMJ (Clinical research ed.). 340. c1900. 10.1136/bmj.c1900.:c1900. [6] Moyers, T. B., Miller, W. R., & Hendrickson, S. M. L. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73(4), 590–598. [7] Grant, A. M. (2014). Autonomy support, relationship satisfaction and goal focus in the coach-coachee relationship: Which best predicts coaching success? Coaching, 7(1), 18–38. [8] Watson, J. C., Steckley, P. L., & McMullen, E. J. (2014). The role of empathy in promoting change. Psychotherapy Research, 24(3), 286–298. [9] Patrick, H., & Williams, G. C. (2012). Self-determination theory: Its application to health behavior and complementarity with motivational interviewing. International Journal of Behavioral Nutrition and Physical Activity, 9, 1–12. [10] Amorose, A. J., & Anderson-Butcher, D. (2007). Autonomy-supportive coaching and self-determined motivation in high school and college athletes: A test of self-determination theory. Psychology of Sport and Exercise, 8(5), 654–670. [11] Ryan, Richard & Patrick, Heather & Deci, Edward & Williams, Geoffrey. (2007). Facilitating health behavior change and its maintenance: Interventions based on Self-Determination Theory. Eur. Health Psychol.. 10. [12] Harris, R. (2009). ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger. [13] Hayes, S. C., Masuda, A., & De Mey, H. (2003). Acceptance and Commitment Therapy and the third wave of behavior therapy. Gedragstherapie (Dutch Journal of Behavior Therapy), 2, 69-96 [14] Neenan, Michael & Palmer, Stephen. (2001). Cognitive Behavioural coaching. Stress News. 13. 15-18. [15] Cognitive Behavioural Coaching in Practice: An Evidence-Based Approach. (2013). United Kingdom: Taylor & Francis. [16] Calero-Elvira A, Froján-Parga MX, Ruiz-Sancho EM, Alpañés-Freitag M. Descriptive study of the Socratic method: evidence for verbal shaping. Behav Ther. 2013;44(4):625–638. doi:10.1016/j.beth.2013.08.001 [17] Job, V., Dweck, C. S., & Walton, G. M. (2010). Ego Depletion—Is It All in Your Head? Implicit Theories About Willpower Affect Self-Regulation. Psychological Science, Vol. 21, pp. 1686–1693. [18] Miller, W. R. (William R., & Rollnick, S. (2013). Motivational interviewing : helping people change. Guilford Press. [19] Seligman ME, Csikszentmihalyi M. Positive psychology. An introduction. Am Psychol. 2000;55(1):5–14. doi:10.1037//0003-066x.55.1.5 [20] Butler, J., & Kern, M. L. (2016). The PERMA-Profiler: A brief multidimensional measure of flourishing. International Journal of Wellbeing, 6(3), 1–48. [21] Seligman, M. E. P., Steen, T. A., & Peterson, C. (2005). Positive Psychology Progress Empirical Validation of Interventions. [22]Csikszentmihalyi, M. (1990). Flow : the psychology of optimal experience. Harper & Row. [23] Sturmberg JP, Picard M, Aron DC, et al. Health and Disease-Emergent States Resulting From Adaptive Social and Biological Network Interactions. Front Med (Lausanne). 2019;6:59. Published 2019 Mar 28. doi:10.3389/fmed.2019.00059 [24] Sturmberg, Joachim & Martin, Carmel. (2013). Handbook of Systems and Complexity in Health. 10.1007/978-1-4614-4998-0_45.