Hello. I'm Dr. Karen Lawson from the Earl E Bakken Center for Spirituality and Healing. I'm the Director of the Integrative Health and Well-being Coaching program, and an integrative physician with 30 years of experience in the field. I'm here to talk to you today about integrative health coaching, and how it impacts those who live with, and those who practice taking care of people with chronic pain. The part 1 first presentation that we're going to do today is, what is it? Let me tell you what health coaching is, so we can help you understand how it might help you. The things that I'm hoping to cover in the next 10 minutes or so are to really explore this concept of what I call the missing provider. It helps you understand where the idea of health coaching came from, although we'll do a little bit of a definition of health and wellness coaching. I'd like to give you an understanding of the four, what we call core pillars of holistic health coaching, which is the basis for the program that we teach and practice here at University of Minnesota. As I mentioned, I was a practicing physician. I worked in primary care for a number of years, and then in the emergency room for 10 years. In my experience with that, I noticed a lot of frustration on the part of both myself and on my patients on the fact that we would have the same conversation over and over again; you need to quit smoking, you need to exercise more, you need to eat better, yet they would come back every 2-6 months and nothing had really changed, and they felt disappointed and guilty. I didn't see any outcomes that were positive. We were in a mutually frustrating place. It was one of the reasons why I started making a move into holistic and integrative health care, because I felt that there had to be a different way for us to really approach how we deal with health and healing in general. I started exploring other systems of health care. In the late '90s, I started launching new clinical endeavors, where I brought together teams of integrative practitioners, chiropractors, acupuncturists, massage therapists, physical therapists, nutritionists, trying to do a different kind of integrative primary care practice. It was fascinating to me that I had a bit of the same experience, and that people still came in to see an expert, to have an expert tell them what to do or to do something to them, yet they would leave and they wouldn't really successfully implement any new ways of living in their own lives. It felt like we needed a different kind of provider. We needed a provider that could be there in the trenches with the client, that could be side-by-side, that could talk to them frequently, even more than once a week, if needed, that really understood how to help people make change and to help that change be sustainable. We called that person the Integrative Health Coach. That was in 1999, and really led to helping to develop a new profession, and to certainly change the direction of my professional practice. We started looking at how could this person, this health coach, address the issue that you see talked about everywhere these days, which is lifestyle modification? It's hard making behavior changes, whether it's your diet, sleep, exercise, substance use, drugs, alcohol, whatever it is, it's hard to make those kinds of changes. We don't really have systems around us to support those. It's also very difficult to make some of the underlying core belief changes, which are the things that sometimes keep our behaviors, that we don't want, grounded so that they can't change. How do we make changes in how we think about things? How do we decrease our stress? How do we increase our mindfulness? How do we find an equanimity in our spirit so that we can actually behave differently by choice? When you look at what's the reason behind all of this lack of success and difficulties with making lifestyle changes, it really is very simple. It's hard, our providers aren't trained, and we have lack of support in order to do the things that we need to do. The Health Coach was brought on board to help with these very things. We've been in the process of developing and supporting nationally this new profession. It emerged, not de novo or from nothing, but it came out of a background. First, it came out of this milieu from the '70s and '80s, where we were seeing the development of employee well-being. The wellness field was really happening. In the '70s and '80s, we know corporations started putting in gyms and started talking about preventative health programs as part of their health insurance. There was this need to decrease the cost of illness by improving employee well-being. Wellness was really starting to get a foothold. Again, it was predominantly talking about those behaviors that we see with exercise, diet, perhaps sleep. Then there was the movement of the complimentary, holistic and integrated healthcare. How do we start thinking about our health in different ways? How is it done in different cultures, in different locations, and bringing those ideas into the American health care scene. All of this was really coming together in the '90s. The traditional or the conventional health care system was starting to realize that they had to recognize the importance of relationship-centered care, and activating the patient. Having the patient really feel empowered to make choices for themselves. All this was simultaneously happening with the advent of HMOs, with the crisis of our really diminishing healthcare outcomes and our skyrocketing healthcare cost. We have been shown to be the lowest on the mark internationally for the overall health of the American public, somewhere down around number 31 of developed countries, yet we have the highest per capita healthcare cost of any place in the world. That's not a recipe for continuity and for sustainability when it comes to taking care of health. Then we have what was happening in the understanding of human behavior. We had, had humanistic psychology that had come out of the '50s and the '60s, behavioral change theory that had come out of the work of Skinner. Then life coaching, which had started in the '90s, that was really about helping people make changes and sometimes professions, sometimes just how they manage their daily life, but it hadn't yet been linked to their health or their well-being. Then obviously, we had this need because we're seeing more and more chronic disease including chronic pain and people were not getting better. We feel that health coaches could be that missing provider. I wanted to share this quote from the literature. This is from Dr. Ruth Wolever who at this time was the lead researcher in health coaching and she was at Duke University and published this in diabetes education in 2010. But I was really impressed by her summary when she said that drawing upon the roots of psychology, health management, and personal development, the coaching profession acknowledges that the client is ultimately responsible for his or her choices. That's why we're doing this program. For those of you who have pain, you can start learning how can you be responsible for the choices that you make moment-to-moment and day-by-day that impact your experience of your pain? A coach helps the client access the motivation needed to initiate and maintain change and offers a variety of perspectives and recognizing that numerous factors contribute to achieving goals. Really is looking at that greater scope of a person's life and way of managing their day-to-day experience. This professional health coaching then evolved. It came from work not just at University of Minnesota, but programs that were popping up in several places around the country. Around the 2002-2003 area, and it has led to a national consortium that has now become an international consortium that is guiding the credentialing and the setting the standards in the field. All of the leaders in the United States have worked together to put this consortium together and we'd been in place now since 2010. Our working definition of professional health coaching, I think is very relevant for you to hear. Health and wellness coaches partner with clients, so that's the first thing. For most people when they go see their physician, they don't necessarily feel that they're in a partnership, power relationship. In coaching, you are a partner with your coach. The client and the coach are an even footing. Therefore clients who are seeking self-directed, lasting changes that are aligned with their values. This is all about finding what's important to you, the client, you the consumer, and not having the physician dictate this is what you should do, but you deciding what's really important to me and then how am I going to get there? It's about not just fixing a disease or temporizing the pain, but it's about enhancing the overall well-being. It's a much broader lens. In the course of their work, health and wellness coaches display unconditional positive regard. What's most important about that is that it has to be a safe and non-judgmental place. If you feel like you started an exercise program and it didn't go very well and you were committed to four days a week, but you came in to see your doc and you really had only gone once a week, then the coach would commend you for the once a week and just help you decide how do you want to entrench that practice more and then expand it, but it wouldn't make you feel a failure because you hadn't done the four times a week. It's very important for us as individuals that we feel reinforced in order to feel confident that we can make changes and move forward. If we're feeling guilty or defensive or disappointed in ourselves, that's not a recipe for sustainable change. Coaches have a belief in the capacity of their client to make change and to heal. Sometimes they have to hold that belief even when the client or us as individuals can't hold that belief for ourselves, it's a very important role for the coach. Ultimately, the coach honors that the client is the expert on his or her life and their experience. The client really has their own answers, they're not there to get their answers from the coach. What do we do? Well, the coaches help you improve health and wellness behaviors by helping you identify your values and your beliefs, and what are the emotions that are connected to those behaviors, good, bad, or otherwise. They help bridge the gap between the lifestyle prescriptions. When the doctor says, "You need to go exercise three times a week", what does that mean? How does that look? Why do you want to do it? How do you want to do it? What resources do you need? It helps to identify and overcome the barriers to achieving the goals. A coach helps build relationship and partnership. Coaching is always built upon relationship. It's very unusual to have just a one-time interchange between a coach and a client. It could happen in an unusual circumstance, but it certainly is not the recipe for optimal coaching and it really is about creating that safe space. Finally, but by no means least important, a coach needs to be modeling their own engagement and self-care health and well-being activities. We often say in our training program to our students that a coach can never take a client further than they go themselves. The coach really has to be engaged in their own personal evolution along their own well-being. Lastly, I just wanted to put this up to help you differentiate this idea that health coaching is not education or counseling. In a medical model, we do counseling where we more or less tell people what to do. Health coaching uses a learning or development model that's about cultivating the learning from the inside of a person. In a conventional healthcare model, it's about diagnosing the illness in a pathology paradigm. It gets labeled with a diagnostic code and it's about fixing or treating the disease. In health coaching, it's about achieving the best possible experience regardless of what the diagnosis is. Healthcare focuses on fixing a problem, health coaching focuses on optimal performance. Healthcare focuses on an expert providing information, health coaching focuses on a non-judgmental partner that explores your own health priorities. Counseling and healthcare may do a lot of why questions and sometimes we'll have a past focus. Why did you get to this place? Why did you make that decision? What do you think happened that led you to establish this behavior? Health coaching is very focused in the now and the future. Where are you right now and where do you want to go? There are times when you definitely need therapy or counseling to work instead of coaching or prior to coaching or even simultaneous with coaching, but coaching does not focus on the past issues of how we got to where we are. Then lastly, in healthcare conventionally we really focus on restoring a previous level of functioning, wherein health coaching we want to help you focus on how do we move to a more optimal behavior? This is the model that we use at University of Minnesota. This model does not define coaching, but it's the foundation that underlies what coaching is sat upon. It is made up of the ideas of mindful presence. When a person, both the coach and the client, really have to be cognitively, emotionally, and physically present in their space in order to interact with each other. They have to both be committed to a practice of self-awareness and sometimes that takes a lot of practice. We often turn off our experience of our pain or uncomfortable emotions because we don't want to deal with them and we have to elevate self-awareness that we know what our experience is so that we can start connecting that experience to the choices that we make. Then it's about a safe and sacred space. As I mentioned earlier, the non-judgmentalness and that feeling like I can make mistakes here and it's okay. Fourthly, authentic communication is the process that coaches use and that consists of four parts. Deep listening, really hearing not just what said, but also what's not said. What's in-between the words, what's in the body language, what's in the emotion. Curious inquiry, which means a question to help the client pursue their own exploration, not just for the coach of the health professional to get an answer that they have to enter into an electronic medical record. Then perceptive reflections. Often our greatest wisdom comes out of our own mouth and talking about our own lives. However, we may not hear it. It's important for a coach to be able to meaningfully reflect to a client when they speak. Did you hear what you said or these are the words I've heard you say over and over again so that we can start as a client hearing our own language? Then lastly and very important, silence. Sometimes we just need to be in a space with each other where we can have our own deep experience and silence allows time for it to unfold at a speed that's comfortable for us. That's the model that we'll use and refer to as we move ahead. In conclusion, just wanted to share this summary idea that having a coach is particularly powerful when a client has decided to fully commit to making significant changes in one or more areas of his or her life. Therefore, health coaching may be most effective when the client is activated or motivated as a healthcare client or consumer themselves. It's not effective to send to someone else for coaching. It's effective when we decide as individuals, I want to be coached because I want to make a change. I hope that was helpful and informative to you and I look forward to talking to you in part 2.
