CHAPTER 2

Core Components of Coaching

LEILA FINN, MA, NBC-HWC
Lead Instructor, Health Coach Certificate Program, Emory Continuing Education;
Certified Integrative Health Coach; ACE Certified Health Coach and Personal Trainer

IN THIS CHAPTER

Supporting Clients in the Supporting and Honoring

Behavior-change Journey Clients’ Capacity for
Change
Examining the Core Examining Barriers to Change
Competencies of Health
Coaching Exploring Facilitators of Change

Fostering the Client–Coach Summary

Relationship
Working with Unique Individuals

Cultivating a Coaching Presence

Utilizing Effective
Communication Skills
Nonverbal Communication

Verbal Communication

The Importance of Values

LEARNING OBJECTIVES:
Upon completion of this chapter, the reader will be able to:
 Outline the core coaching competencies as defined by the
International Coach Federation.

 Explain the importance of verbal and nonverbal

communication in cultivating a safe and supportive
coaching environment.

 Employ effective strategies for establishing and

maintaining a positive, productive client–coach
relationship.

 Outline barriers and facilitators of health behavior change.

ACE UNIVERSITY

If your study program includes the ACE University, visit www.

[Link]/MyACE and log in to your My ACE Account to take
full advantage of the ACE Health Coach Study Program and
online guided study experience, which includes presentations in
a variety of media to support and expand on the material in this
text to facilitate learning and best prepare you for the ACE Health
Coach Certification exam and a career as a health coach.
 Core Components of Coaching CH APTER 2

ACE Certified Health Coaches support

clients in realizing their health and wellness
goals. Health coaches do not prescribe
or give advice. Instead, they partner with
clients, helping them envision what they
truly want and collaborating on how
to achieve that health vision, exploring
what is important and valuable about the
changes clients want to make. Coaches
trust fundamentally in the wisdom and
individuality of each client and meet
clients where they are, listening rather
than directing, and apply a specific and
sophisticated set of skills to highlight what is
intrinsically motivating to the client.
Health coaching is multifaceted, blending behavioral theories, frameworks, and models
of change with practical and proven approaches that support people in translating often
big, seemingly unattainable goals into accessible, actionable steps. This includes, but is
not limited to, positive psychology, the transtheoretical model of behavior change, self-
determination theory, and motivational interviewing—topics discussed in greater depth
in Chapters 3 and 4. Health coaches approach the coaching relationship with curiosity as
well as with confidence and trust in the client, recognizing the client’s capacity for change.
This chapter explores the core components of health coaching that set the stage for
meaningful and lasting change.

Supporting Clients in the Behavior-change Journey

Health coaches support clients in making lifestyle changes to improve their health and
well-being, realizing that each person’s vision of what that means is unique. For one
person, better health might center on reducing stress. For someone else, it might mean
improving sleep, exercising regularly, or managing a health condition. While chronic
diseases, such as diabetes, cardiovascular disease, and obesity, are at epidemic levels,
many such diseases can be prevented or effectively managed with lifestyle change
(Kivela et al., 2014, Strong et al., 2005). A physician can prescribe a medication, a
registered dietitian (RD) can recommend a diet, and a physical therapist can prescribe
exercises to help a patient recover from injury or surgery. However, success is impossible
in all of these cases without consistent action on the part of the individual. Saying, “Just
do it,” does not work. Similarly, a person can decide he or she wants to exercise more, eat
more vegetables, and cook at home, but deciding and doing are two very different things.
People often know what to do, but not how to get it done. Health coaches help clients
determine how to reach their goals.

Health coaching is part of a larger shift in preventive medicine and person-centered care,
as noted in Chapter 1. It is an approach that truly listens to and takes into account the
needs and aspirations of the individual (Epstein & Street, 2011). Health coaches support
clients in making meaningful changes, with the ultimate goal that clients become self-
managers and maintain ongoing healthy lifestyle habits (Smith et al., 2013).

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To improve client self-efficacy and self-management, health coaches employ a strengths-

based approach, empowering the client to leverage his or her talents, knowledge, and
abilities to forge a path to success. This concept assumes that individuals and groups
perform best when effectively applying their strengths (Rath & Conchie, 2009; Cooperrider
& Whitney, 2005). Health coaches use affirmations to highlight a client’s skills, efforts, and
abilities, helping to reinforce the fundamental viewpoint that clients are not “broken” or in
need of “fixing.” Rather, health coaches see clients as whole and resourceful, with untapped
capacities for change.

The coach’s role is to help clients realize their goals through a collaborative process that
encourages creativity, curiosity, and experimentation, respecting the wisdom and knowledge
of clients in exploring and devising their own solutions. The coach supports each client in
unearthing his or her ”why” with regards to personal values, reasons, and motivations for
change. The coach then assists clients in finding the “how,” supporting them in creating self-
determined goals and appropriate plans of action to cultivate sustainable behavior change.

APPLY WHAT YOU KNOW

Pairing a Goal with a Plan
Susan is a 63-year-old female recently diagnosed with prediabetes. Susan’s physician has advised her to
lose weight in order to improve her health. However, what Susan needs to be successful is a defined goal
and a personalized action plan that works for her. The health coach will collaborate with Susan to define
her larger goal, which is to lose 50 pounds in the next 12 months in order to reverse her prediabetes and
reduce her risk of heart attack. Susan shares that she is committed to losing weight, as she recently
became a grandmother and wants to be around to see her grandson grow up. She feels that making
changes to her diet will be most impactful in helping her reach her weight-loss goal, as she wants to eat
healthier, more appropriately portioned foods. Together, Susan and the health coach will break down the
larger self-determined goal into manageable “bite-sized” pieces, in keeping with Susan’s desired focus on
healthful eating. These will be smaller SMART goals, which are specific, measurable, attainable, relevant,
and time-bound (see Chapter 4). To get started, Susan sets an initial SMART goal to track what she eats
for a week, during which she will write down the foods and beverages consumed throughout each day.
This is specific and attainable, as it is a particular action she feels confident she can do. It is relevant
because it will give her real data about what she is eating now to help inform what meaningful changes
she will make to support her weight-loss goal. It is also time-bound, given that she will record the meals
and snacks she eats for the duration of one week.

Having a SMART goal is important, but it needs to be paired with a plan to achieve that goal. How will
Susan keep track of what she eats, and what might get in the way? Her SMART goal includes writing
down what and when she eats, and in working with the health coach she visualizes how she will record
her food during the week. She shares that she often goes out to lunch with coworkers or business clients
and realizes she will not want to stop to write down what she eats during those meals. She decides that
with coworkers she can take a picture of her meal with her phone and when going out with business
clients she can write down the meal as soon as she is alone after lunch. Identifying obstacles and
building in flexibility makes Susan more likely to successfully achieve her SMART goal, and to take a
meaningful step toward meeting her larger health goal.

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 Core Components of Coaching CH APTER 2

Examining the Core Competencies

of Health Coaching
To support greater understanding of the skills and approaches used within today’s
coaching profession, the International Coach Federation (ICF) has developed 11
core coaching competencies, which are grouped into four clusters*:

Setting the Foundation

Î Meeting Ethical Guidelines & Professional Standards: Understanding coaching

ethics and standards and applying them appropriately in all coaching situations
Î Establishing the Coaching Agreement: Understanding what is required in the
specific coaching interaction and coming to agreement with the prospective
and new client about the coaching process and relationship

Co-Creating the Relationship

Î Establishing Trust & Intimacy with the Client: Creating a safe, supportive
environment that produces ongoing mutual respect and trust
Î Coaching Presence: Being fully conscious and creating spontaneous
relationships with clients, employing a style that is open, flexible, and confident

Communicating Effectively

Î Active Listening: Focusing completely on what the client is saying and is not
saying, understanding the meaning of what is said in the context of the client’s
desires, and supporting client self-expression
Î Powerful Questioning: Asking questions that reveal the information needed for
maximum benefit to the coaching relationship and the client
Î Direct Communication: Communicating effectively during coaching sessions,
and using language that has the greatest positive impact on the client

Facilitating Learning and Results

Î Creating Awareness: Integrating and accurately evaluating multiple sources of

information, and making interpretations that help the client to gain awareness
and thereby achieve agreed-upon results
Î Designing Actions: Creating with the client opportunities for ongoing learning,
during coaching and in work/life situations, and for taking new actions that will
most effectively lead to agreed-upon coaching results
Î Planning & Goal Setting: Developing and maintaining an effective coaching
plan with the client
Î Managing Progress & Accountability: Holding attention on what is important
for the client, and leaving responsibility with the client to take action

*Reprinted with permission from the International Coach Federation.

[Link]/core-competencies

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Fostering the Client–Coach Partnership

To ensure the safety and success of clients in their behavior-change journeys, health coaches
set the foundation for a productive client–coach partnership by adhering to the ethical
guidelines and professional standards as outlined in Chapter 1. This includes understanding
the professional scope of practice of a health coach and recognizing when it is necessary to
refer clients to other health, wellness, or exercise professionals (e.g., RDs, psychologists, or
physicians). In setting the stage for a meaningful partnership, it is also important for health
coaches to clearly define health coaching to manage expectations and establish the respective
responsibilities of the coach and client within the relationship. Such elements should be
discussed and subsequently outlined in the coaching agreement, which should also include
other important logistics, such as an agreed upon number of sessions, as well as payment and
cancellation policies (see Chapter 5).

Effective coaching requires the establishment of a trusting, authentic relationship in which

clients feel supported and respected. The coaching environment serves as a safe space where
clients can share fears, doubts, needs, and wants, and explore their personal values and
visions for the future. It is a space where clients are free from being analyzed, judged, or told
what to do. This is part of what makes health coaching so powerful. Clients feel truly listened
to and heard as an active and equal partner in the relationship. This fundamental sense of
mutual trust and respect establishes rapport in the client–coach alliance.

To facilitate a genuine connection and cultivate a meaningful relationship, the health

coach must meet each client with unwavering acceptance, also known as unconditional
positive regard. This necessitates that the health coach suspend judgement and become
aware of potential biases that could impede the development of a successful partnership.
Health coaches show empathy by demonstrating an active interest in, and effort toward
understanding, the client’s internal perspective. Given that there are many variables in an
individual’s life that influence his or her motivation and behaviors, it is important for the health
coach to attempt to see the world through the client’s eyes, metaphorically putting him- or
herself in the client’s shoes. Many clients may be struggling with various life circumstances,
dealing with difficult emotions, processing upsetting diagnoses, or living with chronic
conditions. Showing genuine compassion and empathy are essential aspects of being a
health coach. Coaching helps people find better ways to take care of themselves, to cope with
challenging events and difficult conditions, and to optimize their overall health and well-being
in order to thrive in their lives. This is facilitated by the health coach truly believing that the
client holds the answers, seeing each individual as whole, resourceful, and capable of change.

WORKING WITH UNIQUE INDIVIDUALS

Health coaches work with clients with diverse backgrounds and lived experiences, each
with his or her own unique personality, interests, skills, strengths, and values. Awareness
of personality types can be helpful in establishing and navigating the client–coach
relationship. The five-factor model presents five personality traits: openness to experience,
conscientiousness, extroversion, agreeableness, and neuroticism (abbreviated as OCEAN)
(McCrae & Costa, 2008; McCrae & John, 1992).

Î Openness to experience involves, among other traits, creativity, curiosity, and imagination.
Î Conscientiousness involves persistence, self-discipline, and consistency.

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 Core Components of Coaching CH APTER 2

Î Extroversion involves being outgoing, socially confident, and articulate.

Î Agreeableness includes being altruistic, humble, patient, and sensitive.
Î Neuroticism includes more negative traits like pessimism, jealousy, fear, and being
self-critical.
These personality traits are not absolute, but rather one way in which to describe and recognize
differences among people. It is vital to respect that each person is unique in experience,
knowledge, and personality. Some people are open to new experiences, while others feel safe
with routine. Some will talk to anyone, while others are quiet among strangers. Some are quick
to share and others are very private. For a health coach to meet the client where he or she is, it is
important to listen for these differences and adjust the approach accordingly to allow for a more
positive and productive coaching experience. It is also important for health coaches to keep in
mind that different people have different ways of learning. See page 41 for more information on
adult learning in the context of health coaching.

EXPAND YOUR KNOWLEDGE

DISC Model
The DISC model is another widely used model for understanding personality types, originally
developed in 1928 by Dr. William Marston. In this model, there are four defined personality traits or
tendencies: outgoing, people-oriented, reserved, and task-oriented (Figure 2-1).

These personality traits align with the four different personality types reflected in the DISC model:
dominant, inspiring, supportive, and cautious.
Î Dominant personality types tend to be direct, outgoing, and results-oriented; they thrive on
accomplishing tasks and making things happen.
Î Inspiring personality types tend to be people-oriented; they enjoy having fun, interacting with
others, and receiving positive feedback.
Î Supportive personality types tend to place value on relationships and helping others; it is
important to them to feel genuinely appreciated and assured.
Î Cautious personality types tend to be reserved and prefer to receive clear, accurate, and trust-
worthy information in order to inform their decisions.

OUTGOING FIGURE 2-1

DISC model of

D I
DOMINANT INSPIRING understanding
Driving Interesting personality types
Doer Interactive

TASK-ORIENTED PEOPLE-ORIENTED

CAUTIOUS
Competent
Careful
C S SUPPORTIVE
Steady
Stable

RESERVED

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In addition to understanding different personalities, health coaches must also display

cultural competence, listening to and respecting cultural differences, values, attitudes,
and beliefs. Some clients, for example, may want to meet only with a coach of the same
gender, while others may have strict boundaries about what personal information they
will share. The coach must respect and honor these differences and needs, and affirm
the value and worth of each individual client. See Chapter 17 for more information on
cultivating an inclusive coaching environment.

CULTIVATING A COACHING PRESENCE

To foster an inclusive and successful partnership, in addition to genuinely and
compassionately caring for each client, is also important for coaches to care for
themselves. Health coaching, like most other “helping” professions, can be emotionally
and physically demanding given the attention and focus placed on the needs of the
client. As such, it is imperative that health coaches employ personal self-care practices.
This enables coaches to support their own health and well-being so that they can be
fully present in the client–coach relationship and avoid burnout. Self-care practices can
be broadly defined as any activity done deliberately to enhance resilience and support
one’s physical, mental, emotional, and spiritual well-being. This can include, for example,
regularly engaging in forms of mindful movement, or taking time each day for journaling.
What is important to note is that there is no one-size-fits-all approach to self-care.
Health coaches should ensure that their self-care practices do not feel like something they
are forced to do, or that the activity lacks meaning, value, or enjoyment. Simple strategies
health coaches can employ to ensure they can meaningfully serve clients include
scheduling brief breaks between sessions to allow time to engage in mindful practices
such as deep breathing and meditation. See Chapter 7 for more information on the role of
mindfulness in health coaching.

The Science and Art of

Emotional Intelligence
Natalie Digate Muth, MD, MPH, RDN, FAAP

Emotional intelligence (EI), also known

as emotional quotient (EQ) and emotional
competence, is described as the ability to
recognize, interpret, and manage emotions in
oneself and in others. As a coach—a trusted
A coach is encouraged to spend the time and
companion to a person or a group making very
energy required to continuously improve his or her
personal and challenging behavioral changes—a
emotional competence.
high degree of emotional competence is important
for career success and client outcomes. Unlike The notion of EI was introduced in 1990,
intelligence quotient (IQ), which tends to be though the concept of “social intelligence”
somewhat predetermined, hardy, and resilient, dates back to the early 1900s (Salovey &
EI can be boosted with training and practice. Mayer, 1990). Salovey and Mayer (1990)

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 Core Components of Coaching CH APTER 2

defined EI as “the ability to monitor one’s may include correct identification of emotion
own and others’ feelings and emotions, to in a client based on subtle body language.
discriminate among them, and to use this
information to guide one’s thinking and Self-management
actions.” Daniel Goleman’s book Emotional Self-management, or self-control, is the “ability
Intelligence helped the concept gain to use emotions to facilitate thinking” (Mayer
widespread recognition in 1995 (Goleman, & Salovey, 1997). Goleman describes it as
1995). This book’s popularity and the cottage “putting one’s attention where one wants it
industry that grew from it may have come and keeping it there in the face of temptation
too soon for EI as a scientific construct, as to wander” (Goleman, 2013). A person who
a clear definition and understanding of EI scores high in this area may have a high degree
continues to be debated despite a growing of willpower and self-discipline. A high degree
body of literature on the topic spanning over of self-management also helps one to hone
25 years. While the evidence to date is not focus and attention. Goleman (2013) describes
adequate to prove a relationship between the focus, or the ability to concentrate on the task
EI of a coach and health behavior change, at hand and ignore distractions, as a powerful
the concept is included in this text to help driver of performance and goal attainment.
coaches increase awareness of, and skill in, While improving focus may initially be a self-
effective communication. In the broadest management strategy—after all, managing
sense, EI is a marker of how well a person distractions is a huge feat of willpower for
is able to navigate the “softer” side of the many—a sharp focus can also boost higher-
human experience, including emotions, level EI.
communication, and relationships.
Social Awareness
The Four Domains of Emotional
Intelligence Social awareness is described as the ability
to “understand emotions, emotional language,
EI is divided into four domains, discussed in and the signals conveyed by emotions” (Mayer
hierarchical order from the most fundamental & Salovey, 1997). A key attribute that is
to the most complex: self-awareness, strongly tied to social awareness is empathy,
self-management, social awareness, and which is broadly defined as being attuned to
relationship management. Within each the needs and feelings of others and acting in
domain, skills range from easy to complex a way that is sensitive to those needs. There
(Mayer & Salovey, 1997). are at least three types of empathy: cognitive
empathy (understanding what the client knows
Self-awareness
and understands), emotional empathy (being
Self-awareness, or the “ability to perceive attuned to understanding what the client is
emotions in oneself and others accurately,” is feeling), and empathic concern (the ability
the most foundational of the EI skills (Mayer & to sense what another person needs from
Salovey, 1997). Individuals with a high degree you) (Goleman, 2013). As a coach develops
of self-awareness are able to identify their own and strengthens skills in EI over time and
emotions and feelings, as well as the emotions with practice, he or she gains increasing
and feelings of others. The simplest task of effectiveness in communicating with empathic
self-awareness is to correctly identify one’s concern, which can be a potent facilitator of
own emotions, while a more complicated task behavioral change.

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Relationship Management with other people benefits from skill

development in EI. This is especially critical
Relationship management is defined as the
for the health coach. Health coaches can take
“ability to manage emotions so as to attain
steps to improve their own skills as well as
specific goals” (Mayer & Salovey, 1997).
The most accomplished leaders often excel those of their clients through attention and
within all areas of EI, including the highest skill practice in each of these domains. The
order, which is relationship management. process of improvement may simply begin
This domain includes a variety of skills with reading and learning more about the
and attributes, such as influence, clear concept of EI. This helps improve knowledge.
communication, conflict management, The next area of focused attention is on
collaboration, and effective team building. improving skills and abilities in identifying and
A leader becomes effective in each of these managing emotions. The various skill-building
areas due to highly developed self-awareness, activities contained within this chapter and
self-management, and social awareness. As the additional resources listed below can
Goleman describes in a now-classic Harvard help to start that process of increased ability.
Business Review article: “People tend to be Ultimately, the true learning ground is in real
very effective at managing relationships when life with every client encounter. Here, the
they can understand and control their own coach can practice EI skills, most importantly
emotions and empathize with the feelings of that of empathy. Traits are the most difficult
others” (Goleman, 1998). construct to permanently change. This is
where a coach-the-coach model is helpful to
A Construct for Improving provide feedback and direction to help change
Emotional Intelligence ingrained communication challenges.

In an effort to integrate the various teachings Additional Resources

of EI, psychologists have begun to discuss how
The Emotional Intelligence Consortium:
one might improve and build this emotional
[Link]: Includes research citations
competence. The construct of knowledge, supporting the efficacy of EI. Also contains a list of
abilities, and traits is used as a framework to assessments that measure EI, their uses, and pros and cons.
help improve EI (Mikolajczak, 2009) (see below).
UC Berkeley: The Greater Good Science Center.
Anyone whose job relies on communication [Link]

KNOWLEDGE: ABILITIES: TRAITS:

What one knows How one applies How one
about emotions. This this knowledge instinctively
includes both what a in real-life responds to
person has learned situations emotional
from others as well situations
as from personal
experience.

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Utilizing Effective Communication Skills

Health coaching is a collaborative process that requires the full engagement of both the
client and the coach. It is important to note that the coaching conversation itself is special.
Consider it sacred ground where clients have a unique opportunity and a supportive
place to explore, experiment, and discover. Here, clients can question assumptions, find
insight, and take risks. Successful coaches help their clients forge a path forward, not by
force, but by leveraging the inner wisdom of the client.

A powerful aspect of health coaching is the true curiosity and support health coaches
provide. When clients first work with a health coach, they may expect to be told what
to do. Instead, health coaching puts the client in the driver’s seat. All of the tools and
approaches that health coaches use are meant to empower clients, not direct them.
Health coaches enter the client–coach relationship trusting that the client has the
capacity and wherewithal to change. People get stuck for many reasons. Health coaching
assists clients in reassessing what is important, what has changed, and what is getting
in the way. The coach partners with the client to conceive and create a path forward,
honoring the client’s values, strengths, and vision for the future.

NONVERBAL COMMUNICATION
Active listening, which is essential to the development of rapport, requires turning off
inner chatter and truly paying attention to what the other person is saying. This requires
the focus to be on what the client is conveying: to truly hear not only the client’s actual
words, but the meaning behind them. To ensure clients feel comfortable, valued, and
understood, health coaches must be aware of their physical presence when meeting with
clients. Skilled coaches utilize body language that is open and inviting (e.g., sitting with
arms unfolded and leaning slightly forward while intently listening to the client speak),
while avoiding authoritative posturing (e.g., standing while the client sits). Eye contact,
facial expressions, and tone of voice are also important considerations, as the coach’s
demeanor should be professional yet calm, confident, and receptive. Additionally, health
coaches should be mindful to keep their attention on the client and to remain present in
the coaching experience, minimizing the potential for becoming distracted (e.g., texting,
shuffling papers, or looking at the clock). See Chapter 5 for additional considerations and
cues related to nonverbal communication in establishing the client–coach relationship.

VERBAL COMMUNICATION
In alignment with the spirit of motivational interviewing, which is further discussed in
Chapter 4, the premise of coaching is that the client is the expert and the health coach
and client will collaborate as a team. The style of communication is non-confrontational
and uses a positive approach, helping clients find what is intrinsically motivating and
subsequently empowers them to choose to change rather than stay the same. Reflections
and open-ended questions are used to explore what is important, valuable, and possible,
helping clients to shift their perspectives and explore multiple avenues of action.

Open-ended questions, which invite the client to talk in detail about a topic, encourage
more thought and discussion than closed questions, which can be answered with a
simple “yes,” “no,” or another single-word answer. These types of powerful, curious

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questions often begin with the words ”what”

or ”how.” Examples include:

Î What does being healthy look like to you?

Î How does this fit into your vision of health and
wellness?
Î What is currently motivating you?
Î What does your inner wisdom tell you?
Î How could you go about moving forward
toward this goal?
Î What is holding you back?
Î How will you go about testing your idea?
Î What would you like more of in your life?
Reflections, which are discussed in greater detail in Chapter 4, are important statements
based on what the client has said to the health coach. The use of reflections is a powerful
communication skill, as this approach enables the coach to demonstrate that he or she
has heard what the client has shared, and is also trying to perceive and understand the
meaning that the words convey. Like a highlighter, reflections can pull out the client’s most
salient points. They can highlight value, home in on conflict, and summarize possibilities.
Consider the following examples of different types of reflections a health coach may use:

Simple reflections: Repeating or rephrasing what the client has said in a brief and concise way:
Î Client: I really enjoy smoking; it helps me relax.
Î Coach: You like smoking.

Amplified reflections: Providing a direct and more exaggerated form of what the client
has stated:
Î Client: I’m here because my doctor says I need to make some changes.
Î Coach: That’s the only reason you are here.

Double-sided reflection: Exploring the client’s ambivalence by highlighting reasons he or

she has given both for and against change.
Î Client: I know exercise is important and going out for a walk after work does make me
feel better, but after a long day I’m just so tired that all I want to do is relax.
Î Coach: You enjoy relaxing at home after work, but you know if you went for a walk first
you’d feel better.

THE IMPORTANCE OF VALUES

For a change to occur and to be long-lasting, motivation must come from within. The
health-behavior change has to be the client’s idea and he or she has to be excited about
it—not because the coach is excited or provides extrinsic motivation, but because it is
something the client wants. For it to be important to the client, it has to have personal
meaning and value. This is the source of intrinsic motivation. Focusing on what is

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important to the client taps into his or her driving “why.” It helps the client begin to develop
discrepancy between current behavior and what he or she ideally wants (Miller & Rollnick,
2013). By using effective verbal communication skills such as open-ended questions and
reflections, health coaches highlight values that promote change to help clients move
forward. See Chapter 6 for practical approaches for discovering clients’ values and vision.

Supporting and Honoring Clients’ Capacity for Change

A key aspect of health coaching is the opportunity to awaken clients to their own potential
so that they talk themselves into change. Although health coaching is a partnership,
ultimately the only person who can act to make change is the client. Health coaching lends
a framework for clients to understand how they can create success, build from strength,
honor what is most important to them, and create positive goals and action steps in an
incremental way to cultivate success.

Before diving into co-creating SMART goals and action plans, however, the health coach needs
to assess where the client currently is in the change process. As noted in the previous section,
health coaches should explore value and the benefits of change with every client. However, this
is particularly important when working with clients who are ambivalent about change. Coaches
support clients in creating forward momentum, but encouraging a client to act before he or
she is ready means the plan will likely fail (Prochaska, Norcross, & DiClemente, 2007). Health
coaching is truly client-centered, meaning that the health coach honors the client’s autonomy,
which is his or her right as an individual to self-direct. This recognizes and respects that the
client is an autonomous individual capable of acting in his or her own interests.

To be successful, a client needs to be confident that he or she can achieve success. Self-
efficacy is a person’s belief in his or her own capabilities and, as further explored in Chapter
3, it plays a critical role in the behavior-change journey. A health coach should not push
a client into doing something that the client might feel is out of reach or not in alignment
with the client’s values or vision for the future. The health coach also should not presume to
know when a client is ready to act or what the best way might be to go about taking action.
Instead, health coaches facilitate self-discovery, helping their clients create awareness
of what might be possible and of what might be preventing them from moving forward.
Achieving success and building new skills and knowledge helps clients build greater
confidence and self-efficacy.

As clients determine they are ready to make a change, they often will have several ideas
about what to do and may even have several different goals in mind. The health coach
needs to be careful not to pick just one and run with it, but instead check in on each. For
example, consider a client who wants to begin an exercise routine, eat a healthier diet, and
reduce stress at work. These are all big topics. The coach should take time to explore each
and see where the client wants to go while also keeping an open mind, as the topics may
overlap. The coach should then empower the client “set the agenda” by choosing an area of
focus (see Chapter 5).

With a clear focus established by the client, health coaches support the client in
establishing self-directed SMART goals and designing actions that reflect what is important
to the client and have a high probability of success. Taking time to explore the different
paths the client can take to reach his or her goal can be a valuable exercise. This helps the client

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break big goals into “bite-sized” pieces by looking at what is possible now. The coach can help
the client define the plan when the client is ready. What will the client do this week or month?
Does there need to be a contingency plan or more flexibility? What might get in the way? What
will make the plan stronger? The action plan needs to be framed in positive terms, such as “I will
walk around the block every evening when I get home from work,” rather than “I won’t lie on the
couch and watch TV as soon as I get home from work.”

Effective planning and goal setting also takes into account possible obstacles, adding flexibility
as needed and including some form of accountability to someone else or to one’s self, which
can help anchor the plan (see Chapter 6). Remember, the coach can act as an accountability
partner, but ultimately the coach wants the client to be accountable to him- or herself. Coaches
do, however, help manage progress, supporting clients in adjusting goals and plans to create
forward momentum and success. Friends, family, or other forms of social support can provide
further structure and motivation for the client. Batch cooking on the weekend with a family
member, joining a meditation class, walking with a colleague during lunch, attending a diabetes
support group, or simply emailing or calling a “buddy” can be helpful.

EXAMINING BARRIERS TO CHANGE

Arguably one of the biggest barriers to change is motivation. If a client is not motivated
to take action, change cannot occur. Health coaches help clients identify what change is
possible and what makes that change important and intrinsically motivating to that client.
When someone seeks to change a health-related behavior (e.g., exercise regularly or go
to bed earlier), there is a discrepancy between what the person is doing and what he or
she wants. Action and value are not in alignment. Positive, realistic goals align action and
value and help clients move forward. Defining a SMART goal and developing a realistic plan
enables clients to tease out what else might get in the way. It also helps better prepare clients
for those moments when they have to make the decision to act or not act—to sit and watch
TV or go for a walk, or to go to bed or stay up late.

While there are many different real and perceived barriers to change, some commonly identified
obstacles clients may share with health coaches include time, other people, and travel.

Time
Change can feel like trying to squeeze one more thing into an already busy day. Patterns
are set and adding one more thing can seem impossible. Coaching challenges assumptions,
but it also assumes change is possible. Questions like, “When might you add some activity
into your day?” or “What else could exercise look like?” open up possibilities. The client
may view exercising at the gym as the only real option, but there are other possibilities for
increasing physical activity and engaging in regular exercise. Ultimately, what creates time
in a person’s schedule is the perception of value.

Routines are comfortable, even when they do not serve a person’s best interest. Changing
routines and habits requires thought. Essentially, the change has to be important enough that
the client is willing to push something else out of his or her routine (for example, walking instead
of watching TV, or taking 10 minutes to meditate instead of surfing the web). When a client
says he or she is too busy or too lazy, the goal is not yet a priority. Exploring what is important
about this change and the positive benefits it will provide makes prioritizing more likely.

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On the other hand, if the client sees the value but the action is too big, breaking down the
goal into something actionable is key. For example, consider a client who wants to eat less
fast food and more meals cooked from scratch. Cooking on weeknights will not fit in her
schedule, but cooking on the weekend, and then eating leftovers one or two nights during
the week, will work. Another night, the client decides she can pick up a roasted chicken and
add a salad. She realizes that she knows a cafe where she can get some healthy options to
pick up on her way home from work. “I don’t have time” is the coach’s cue to explore value
and whether there needs to be more flexibility in the action plan.

Other People
Many times, other people are perceived as obstacles in moving forward with health-
behavior change. A client might say, “I want to eat more vegetables, but no one else in the
family wants to eat the way I do.” What can the client do when other people’s interests get
in the way? Often, the key is to look at where the client does have control.
The health coach might say, “Pleasing everyone at dinner is difficult, but you want to add more
vegetables to your diet. What does food during the rest of the day look like?” The client mentioned
dinner, but that is not the only meal of the day—there may be other opportunities to add
vegetables. The client might also decide that he or she can prepare an extra vegetable for him- or
herself at dinner. Creating the context for more opportunity encourages the client to be creative.

Travel
Travel presents its own set of challenges, as health-related goals can be quickly derailed
given the change in schedule and environment. Vacation travel can pose challenges, but
they are temporary. However, work travel can make it especially difficult to stick to a plan.
Eating out, keeping irregular schedules, and staying in hotels can make it even more difficult
to meet nutrition and exercise goals.

Again, health coaches can hold space for clients to creatively strategize. Specifically, where
does the client have control? How can the plan allow for more flexibility? A client may not
have access to fresh fruits and vegetables while traveling for work, but a more flexible plan
might be to choose more vegetarian options and order extra vegetables when available to
accompany a dish.

THINK IT THROUGH
As a health coach, you will explore with clients the potential obstacles that could interfere with success.
Clients who have considered strategies to meet challenges will more likely circumvent roadblocks, rather
than be surprised and stalled by them. What open-ended questions could you use to help a client evaluate
real or perceived barriers to change?

EXPLORING FACILITATORS OF CHANGE

When helping a client design a plan, a health coach can use the confidence ruler (see Chapter
6) to explore the client’s confidence that he or she can succeed. Does the plan need more
flexibility to overcome potential barriers? Troubleshooting and problem solving are important
tools for self-management and for increasing resilience, which is the capacity to adapt and
overcome challenges as they arise. Health coaches help set the stage, but ultimately it is the
client who has to act when something gets in the way.

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Health coaches can support clients in reassessing what is possible. By empowering clients to
become aware of what they are thinking and how they feel, health coaches may enable clients
to begin to notice patterns that would otherwise get lost in their day-to-day routines. Cognitive
behavioral theory posits that how people react to events is based on their beliefs about the event.
Belief or expectation helps define the experience. What people believe is not always true. If a
person believes driving in traffic to be a stressful event, the expectation is set before the event. The
person is already anticipating that the event will be stressful. If that expectation can shift so that the
person instead thinks, “driving is a challenge, but also a nice break to be alone and listen to music,”
the experience can change. Noticing how belief and expectation affect experience (or feelings) is an
essential step toward overcoming perceived barriers and making behavioral changes (Burns, 1980;
Beck, 1976). See Chapter 4 for more information on cognitive behavioral coaching.

Knowledge, skills, and resources can also be barriers, and not all can be resolved. For example,
without health insurance a client might not be able to get the medial care he or she needs.
Transportation, neighborhood safety, financial restraints, and lack of access to fresh food are
challenges for many, but whatever the barrier there is a way to get closer to the goal. Finding
resources or information might be one powerful step forward. For example, a common barrier
to cooking meals at home is knowledge and skill. However, a health coach can support the
client in increasing his or her culinary literacy, as further discussed in Chapter 8.

Health Literacy, Health Education, and Health Coaching

Health literacy is “the degree to which individuals have the capacity to obtain, process,
and understand basic health information and services needed to make appropriate health
decisions” (Ratzan et al., 2000). Health literacy includes what clients know about health topics
from their own experiences, conversations, and personal research, as well as information they
have received from physicians, nurses, RDs, physical therapists, exercise professionals, or other
healthcare providers or educational settings. Health literacy includes knowledge of personal
and family health history, knowing how to navigate insurance and healthcare systems, and
understanding treatment options. A client may need to find out what he or she should do or
how to access care. Health coaches can help clients find out how to access help, either through
coaching, referrals, or other resources.

Health coaches can guide clients in finding relevant sources of quality information. These should
come from trusted, reputable organizations and evidence-based resources. The Centers for
Disease Control and Prevention (CDC), National Institutes of Health (NIH), American Diabetes
Association (ADA), National Academy of Medicine (NAM), and American Heart Association
(AHA) are examples of national agencies and organizations that provide valuable information
and resources. Local resources such as 2-1-1 are also helpful in providing clients with direct
access to community, health, and referral services in their immediate area. For specific areas of
lifestyle medicine, such as food and nutrition, health coaches can share the Dietary Guidelines for
Americans and MyPlate (see Chapter 8). For physical activity and exercise, health coaches can
share the Physical Activity Guidelines (see Chapter 9). Additionally, evidence-based programs
that have been scientifically evaluated for effectiveness can be great resources for health coaches
and clients alike, including the Diabetes Prevention Program, mindfulness-based stress reduction,
and the Stanford Chronic Disease Self-Management Programs. It is important for health coaches
to familiarize themselves with a variety of credible resources to match the different needs and
learning styles of their clients.

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EXPAND YOUR KNOWLEDGE

Applying Adult Learning Principles in the Context of Coaching
Adult learning recognizes that adults come with prior experiences and knowledge upon which they can build to learn new
information. It also acknowledges that people have different motivations and readiness for learning, as well as different
learning styles, such as visual, auditory, and kinesthetic. Many people rely on more than one style of learning, and how a client
approaches a goal will reflect his or her learning style (Russell, 2006; Knowles, 1973). Although health coaching is different
than health education—as addressed in Chapter 1—health coaches can support clients in the pursuit of new information that
reinforces their behavior-change efforts and promotes learning and growth (Moore, Jackson, & Tschannen-Moran, 2016). A
growing body of research suggests that adult learners benefit most when the learning is aligned with six core adult learning
principles, as outlined in Table 2-1 (Knowles, Holton, & Swanson, 2015).

TABLE 2-1
Coaching Application of the Six Principles of Adult Learning

Core Principle Coaching Objective Possible Coaching Activities

Adults need to know why Assist a client in identifying the The client completes a worksheet
they need to learn something gap between current reality and with goals and prompts to identify learning
before learning it. information that is needed to achieve gaps.
a goal.

The self-concept of adults Engage a client in the process of The client implements a learning contract.
is heavily dependent identifying a plan for closing learning
upon autonomy and self- gaps, with reliance on the client to
directedness of learning. implement the plan.

Prior experiences of the Elicit a client’s prior experiences Use the elicit-provide-elicit model to adapt the
learner provide a rich resource and knowledge before providing session to the client’s needs (see Chapter 4).
for learning. “education.”

Adults are most likely to retain Link learning to successful pursuit of Query a client’s interest in exploring a given
and act upon new information a client’s vision, goals, and/or action topic using powerful open-ended questions
when they are in a stage of plans; acknowledge when a client may before asking permission to provide information.
readiness to learn. not be ready to learn a given piece of
information.

Adults typically become ready Apply all or nearly all pieces of Role play several possible experiences as a
to learn when they experience information, education, or insight client pursues change and troubleshoot areas
a need to cope with a life shared to relevant problem-centered where increased learning is needed.
situation or perform a task. scenarios.

The motivation of adult Create and identify learning Together with the client, plan experiential-
learners is internal rather than opportunities that may serve based learning activities that serve to increase
external. to provide increased personal a client’s self-efficacy and confidence to make a
satisfaction, well-being, change. For instance, a client trying to improve
and happiness. nutrition behaviors may value a grocery store
tour or pantry makeover.
Source: Knowles, M.S., Holton, E.F., & Swanson, R.A. (2015). The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development (8th ed.).
New York: Taylor & Francis.

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ACE UNIVERSITY

If your study program includes the ACE University, visit [Link]/MyACE and log
in to your My ACE Account to take full advantage of the ACE Health Coach Study Program
and online guided study experience, which includes presentations in a variety of media
to facilitate learning and best prepare you for the ACE Health Coach Certification exam
and a career as a health coach. There, you will find an interactive learning experience that
features video lectures, ACE in Action coaching sessions, as well as knowledge checks and
quizzes to help you gauge your progress.
In the online learning activities related to Chapter 2, you will learn more about how to build
rapport and effectively use verbal and nonverbal communication strategies with clients.

SUMMARY

Health coaching is a unique blend of philosophy, behavioral

theories, and practical skills. It is rooted in the fundamental belief
that each individual has the wisdom to create better ways of
being and, given the opportunity, the wherewithal to both envision
and build a brighter, healthier future. By using a client-centered
approach, health coaches partner with clients in the change
journey, empowering them to prevent and manage chronic disease
and to enhance well-being through sustainable lifestyle change.

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