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By Ben Benjamin, PhD

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Prescription for Empowering Your Clients: Less Advice, More Coaching

As healthcare practitioners concerned about the well-being of our clients, we all face a risk of going overboard in telling people what they ought to do. Of course, some degree of advice giving is perfectly appropriate. A client asks about treatment options, and we tell them what we'd recommend. Or we see signs of a potentially serious medical problem, and we strongly suggest that the person goes to see a physician. But it's easy for that line to get blurry.

Suppose one of your clients is considering leaving their high-powered, stressful job, and wants your opinion on whether it's a good decision. You think it's obvious that they should quit. Do you tell them that directly?

Or perhaps a client mentions they've had trouble sleeping recently. You used to sleep poorly yourself, and have experienced great results from a natural remedy recommended by an herbalist you see. Do you recommend that this person try it out, or even give them a sample from your own supply?

Advising a client isn't as straightforward as advising a friend or other peer. Your role as practitioner automatically sets up a power differential (See "Power Differential," Massage Today, February 2004). You're in a position of greater power and authority, while the client is more vulnerable – emotionally, intellectually, and physically. As a result, clients may give a great deal of weight to your opinions, even when you have no expertise on the topic you're discussing. It's not uncommon for a client to believe that their massage therapist (or acupuncturist, or other complementary health practitioner) has deep insight into them and what they need. And even if the person disagrees with what you're saying, the power differential might make it difficult for them to tell you that.

coach - Copyright – Stock Photo / Register Mark In some situations, the only ethically responsible response is to refer the individual to another practitioner. For instance, if a client looks to you for advice around a serious psychological concern or relationship breakdown, the best advice you can give is to look into getting psychotherapy.

In other circumstances, though, you may have a very useful role to play in helping a client to solve their problem. In fact, for certain clients, this type of support may make an even greater impact than the hands-on work you do. I've had that experience quite a few times in my own practice; as rewarding as it is to relieve someone's immediate pain or discomfort, empowering them to make positive, long-term changes in their lifestyle or health-related habits feels like a greater service. The question is how to discuss these issues in a truly empowering way – helping clients to help themselves – while remaining within your scope of practice. You can do this most effectively when you keep the following in mind.

Receive Permission

If the client hasn't asked you for help with an issue but you think it's important and relevant to your work with them, ask permission before initiating a discussion. For instance, with a client who complains of sleep problems, you might ask, "Is this something you're interested in thinking through with me to try to find a solution?" If they say no, let it go. If instead, the person asks you for directive advice ("Should I quit my job?"), essentially asking you to solve their problem for them, you might ask permission to redirect the discussion (e.g., "This is a big decision, and it's hard for me to know what's right for you. I'd be happy to talk the issue through with you to help you get clearer on what you really want. Would that be useful for you?").

Inquire More Than Advocate

The client possesses much more information than you do about the nature of their problem and the usefulness and feasibility of possible solutions. It's rarely helpful to lead with your own idea ("Why don't you try this herb?" or "You should talk to your doctor about having a sleep study") or to ask narrowly focused, yes/no questions ("Have you tried meditating before bed?"). Much more productive are questions that help the client tap into their own knowledge, experience, and creativity ("What would be the ideal conditions for you to get a decent amount of sleep?" "How much sleep do you need to feel really well-rested?" "What do you think needs to change for you to get that much sleep?"). Even if the client thinks up the same solution you would have proposed for them, having the idea come from them makes it much more likely that they'll feel a sense of accomplishment and ownership over the decision and actually follow through.

Reflect What You Hear

An important complement to inquiring is paraphrasing what you're hearing the client say – for example, "You're saying you get all revved up because your mind keeps racing." This gives them a chance to either agree, and possibly elaborate ("Yeah, as soon as I lie down, I start obsessing about all the work I need to do the next day"), or else provide a clarification ("Just the opposite – I think I start off being all revved up, because of all the caffeine I end up drinking, and then that's what gets my mind racing"). You may also want to empathize ("How frustrating!" "That sounds really challenging"); this, too, can help the client feel heard and understood.

Remain Curious

If you come in thinking you already know the true cause of the client's problem, or what the best solution will be, you're unlikely to be able to inquire, listen, and reflect effectively. Even if you try to suppress your point of view, it will probably leak out in one way or another, leading the client to feel pushed or pressured. A mindset of curiosity leaves both of you open to consider more creative, unexpected solutions.

Focus on Solutions, Not Problems

Be wary of digging deeper into a client's problem. Probing into a client's psyche ("Are you a very anxious person?") or personal history ("Did you grow up in a family where people worried a lot?") not only risks taking you into the territory of psychotherapy; it also keeps the person's thinking focused on what's wrong rather than what they can do about it. In contrast, solution-focused questions ("What types of thoughts and feelings at bedtime would help prepare you for a restful night?" "What helps you to feel that way?"

"How might you bring some of that into your nighttime routine?") connect the person to their emotional and intellectual resources and problem-solving capabilities.

There is a whole (large, and rapidly expanding) field dedicated to this sort of communication: coaching. In my next few articles, I'll go into detail on how you can apply a coaching approach to specific challenging situations you might encounter with your clients. Stay tuned!

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