Education: Program Accreditation and the Practice Skills Guidelines

In August, the International Consortium for Health and Wellness Coaching (ICHWC), released the long awaited guidelines for full program approval for health and wellness programs.  Since the Certificate Program in Narrative Health Coaching is approved as a transitional program by the ICHWC, a glimpse at the new guidelines held few surprises.  Programs will need to be 75 hours in length, including 15 hours of Lifestyle Medicine and 60 hours of core coaching curriculum.  Of the 60 hours, a minimum of 40 must be delivered synchronously, in real time, either in person or online. Each student attending an approved program is required to be observed and given feedback by a qualified mentor coach three times – totaling 1 hour of observation and 1 hour of direct feedback.  I’m pleased that the Certificate Program in Narrative Health Coaching is already designed to meet these criteria.  The application for program approval will be completed and submitted by Teleosis in the coming weeks.

One document stands out as worthy of further discussion: the Practical Skills Guidelines (PSG), which covers the skills necessary to be a health and wellness coach as defined by the ICHWC.  While the PSG are not organized into groups, I’ve taken the time to organize the skills into three areas – co-creating the relationship, communicating effectively, and facilitating learning and results.

Co-creating the relationship requires relationship skills often overlooked in clinical medicine.  Establishing trust and rapport, demonstrating empathy, ensuring the client’s agenda drives the coaching relationship, and inviting the client to determine the focus of the conversation are not the real emphases of clinical medicine.  Just how the clinical encounter will shift to a more relationship-centered process is directly determined by the skills with which the clinician is able to show up for the client. Bringing his or her full presence to the clinical interaction, investing in mindfulness skills, learning how to prepare for a client session, and holding the space when strong emotions emerge are all key skills for becoming a more effective clinician.

Communicating effectively is not new in clinical medicine. Physician Dr. Timothy Gilligan, MD, Director of Coaching at the Cleveland Clinic, has run thousands of practitioners through his communications program at the clinic.  His basic assumption that clinicians benefit significantly by engaging in skill development for improving communications has proven to be true. Actively listening is more than simply tuning into the client’s wishes.  With active listening, clinicians listen for what is said and what is not said, reading between the lines.  Asking open-ended questions allows both client and coach to dig deeper into the client’s experience.  Gaining awareness of the interior motivations that inform our health behaviors offers a powerful tool for facilitating growth and healing.  Learning how to mirror clients, how to focus the conversation while allowing the client to maintain tempo and the discovery process, matures over time.  These skills can be named, studied, practiced and mastered.

Facilitating learning and results is the third area of the Practical Skills Guidelines.  To begin, exploring the client’s vision of optimal health and well-being is a novel and powerful tool at the heart of health coaching, as are exploring and articulating the client’s values, and sense of meaning and purpose.  Unlike clinical problem solving, health coaches explore broader perspectives meant to inspire interest in change and new possibilities.

One of the aspects of health coaching that has a big impact on my clinical process is establishing long-term and short-term goals.  We create together a healing topic that articulates the long-term goals for the client.  We create learning objectives that become the short-term goals, and the practices I assign serve these objectives. Issues such as motivation, resistance and accountability are all wrapped in the client’s preferences for self-monitoring. In my experience, clients have a considerable learning curve when it comes to self-observation.  Rather than paying attention to symptoms, the learning objectives facilitate clients’ learning to pay attention to their behaviors and their experience in new ways that facilitate learning.  The process of self-discovery is key to clinical health coaching. Actions that foster learning and insight help keep clients engaged in the healing process.

Ongoing coaching conversations help the client anticipate and navigate challenges.  Rather than the coach-practitioner acting as an expert in the field, health coaches serve the role of positive resource, gently supporting positive growth and change. Facilitating learning and results brings coaching front and center in the clinical encounter.  Clients quickly shift from symptom reports to descriptions of the process they are engaged in while working towards their health goals.  In my own practice, clients look forward to the sessions in which they share their experience and anticipate new learning in the next learning cycle. I see clients more frequently when I coach.  Clients look forward to the sessions.

The new Practical Skills Guidelines serve as the basis for professional competency.  As more and more integrative practitioners understand the power of these skills, health coaching will continue to be integrated into clinical care.  Some younger clinicians will be exposed to these skills earlier in their training. For many of us who have been working with clients for decades, identifying, seeking, applying and assessing these new skills will serve as an effective tool for improving clinical care.  Over the coming months, I will be returning to the Practice Skills Guidelines as a way of opening the door to the benefits that health coaching skills offer the integrative physician.