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By Ben Benjamin, PhD

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Coaching Clients for Improved Self-Care

This is the second of several articles focusing on situations where you might be tempted to give a client advice, but can do them a greater service by taking more of a coaching approach instead. In the first article from the August 2015 issue, I briefly summarized some potential risks of giving too much advice, as well as several guidelines for effective coaching communication in a massage therapy context: get permission for having the discussion; inquire and reflect more than you advocate; remain curious; and focus on solutions, rather than problems. In this article, I'm going to apply these principles to one very common scenario: a client who's tried to improve their self-care practices but without success.

As an example, I'll talk about one particular issue that's come up many times with my own clients: doing rehabilitation exercises to recover from an injury. Even when a person knows that doing a certain exercise regularly can help them heal much more quickly, they often have a hard time getting themselves to do it. It would be easy for me to slip into an advisory mode.

senior self care - Copyright – Stock Photo / Register Mark Trap #1: Dispensing Advice

Client: "I know I should do this exercise every day, but I only manage to do it once or twice a week."

Therapist: "Why don't you set aside a specific time each day to do it?"

Client: "My schedule's different each day, so that won't really work."

Therapist: "How about going through your calendar at the start of each week and putting in one half-hour slot each day?"

Client: "I tried that, but it still didn't work."

Therapist: "Well, could you have someone remind you to do it?"

And so on.

In this exchange, the therapist makes a couple of comments that are phrased as questions (e.g., "Could you have someone remind you to do it?"), but they serve less as inquiry (finding out something new from the client) than advocacy (communicating the therapist's own point of view). There's also no reflection (paraphrasing what the client said). The therapist just comes up with suggestions, one after the other, in an attempt to solve the person's problem for them.

Sometimes, a client will accept this type of suggestion, and that's not necessarily a bad thing. There may be a simple, straightforward solution that they just haven't thought of. Other times, as in this case, it's not so simple, and the therapist doesn't know enough about the client's situation to come up with a proposal that will work for them. The more subtle risk is that the therapist's solution works, and the client agrees to it, but this type of interaction starts to become a dysfunctional pattern; the client remains dependent on the therapist to solve their problems for them, rather than learning how to manage them themselves.

Asking real questions, with genuine curiosity about the client's situation, helps to get you out of this trap. However, the type of question you ask makes a big difference. Some questions just get you deeper into the problem.

Trap #2: Probing Into Problems

Client: "I know I should do this exercise every day, but I only manage to do it once or twice a week."

Therapist: "What's getting in your way?"

Client: "I don't know. I just never seem to make it a priority."

Therapist: "Why do you think that is?"

Client: "Well, I always have a tendency to put other people's needs before my own, so I don't often make the time to take care of myself."

Therapist: "Do you have a hard time believing you deserve to recover from this injury and be healthy?"

Client: "I'm not sure. Consciously, I think I deserve it, but maybe deep down I really don't."

These types of conversations may be very compelling for both the therapist and the client, but they can easily start to verge into psychotherapy, which is well outside a massage therapist's scope of practice. Moreover, they keep the client's attention focused on what's wrong, rather than on the resources and skills they might already have to help bring about positive change. From this frame of mind, it can seem as though the only way to improve their situation is through deep, difficult changes to their personality or emotional life. Skillful coaching communication tends to be more empowering and productive for the client.

Coaching for Solutions

Client: "I know I should do this exercise every day, but I only manage to do it once or twice a week."

Therapist: "So you do the exercise sometimes, but not every day." (Reflection)

Client: "Right."

Therapist: "Many clients start out like that, and often there are ways to get into a more regular habit. Are you interested in moving in that direction?" (Asking permission.)

Client: "Absolutely. I've tried; I just haven't been able to make it happen."

Therapist: "Right. So tell me about the times when you do exercise. What's going right on those days?" (Inquiry: focus on solutions.)

Client: "It works best for me when I can exercise in the evening. I was able to do that on Friday because the kids went out to a movie with their grandparents so I had the house to myself. But that's rare. Usually, between helping the kids with their homework, getting dinner ready, and then cleaning up for the night, there's no time to fit it in. And then it's really late and I'm tired, and doing this exercise is not exactly a fun or relaxing experience. I have to force myself to do it."

Therapist: "So you don't enjoy doing the exercise." (Reflection) "Is it uncomfortable for you?" (Inquiry)

Client: "A little bit. It's not awful; it just pulls, so by the end I'm kind of sore."

Therapist: "Well, that's something we can easily fix. The exercise actually shouldn't leave you feeling sore. Let's work on either using a bit less weight or modifying the movement." (Advocacy)

Client: "Oh, good, that would help."

Therapist: "Great. Now, it sounds like the other challenging piece is finding uninterrupted time for yourself in the evening, when you're not doing housework or helping your kids. " (Reflection)

Client: "Yeah, there just never seems to be enough time."

Therapist: "So let's imagine there was something important you absolutely had to do every evening — maybe something you had to do for the kids — that would take just 10 or 15 minutes. How would you make that part of your daily routine?" (Inquiry: focus on solutions.)

Client: "Well, if I were doing it for my kids, I think it would be easier. I'm away from them all day, so in the evenings, I like to focus as much of my attention on them as I can."

Therapist: "Uh huh. So if you saw this 10-minute exercise as something that would help your kids, that might be easier?" (Reflection/Inquiry)

Client: "Yes, I think so."

Therapist: "And can you see any ways in which helping your injury to heal more quickly could be a good thing for your children?" (Advocacy/Inquiry)

Client: "I haven't been thinking of it that way, but I know you've told me that doing the exercises could shorten my treatment — so I won't need to come here every week. I could spend the time and money on my family instead."

Therapist: "That's true! So if you think of this exercise as a road to more money and more time with your family, how might you carve out 10 or 15 minutes every day to make it happen?" (Inquiry: focus on solutions.)

Client: "This could actually be an incentive for my kids to help out. I can tell them that as soon as my treatment ends, we'll all go out together and celebrate — maybe go to see a show they've been wanting to see. So they'll be motivated to let me have that time alone, and even remind me to do it if I forget."

Therapist: "That sounds like a plan!"

Though many clients experience the same basic challenge as the individual in this scenario — finding it hard to make time for exercise, or other forms of self-care — the types of support they need may differ widely from person to person. Communicating in an inquiry-based, solution-oriented way greatly increases the chances that they'll discover an approach that works for them.

In future articles, I'll discuss other types of client situations in which coaching can be far more beneficial than advice.

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