Behavior Change Agents: How Health Coaches Help Clients Change

I want to share with you some of the behavior change techniques that I use to help my clients shift their health behaviors.

How do health coaches help people change their behavior? Check out this article from health coach Will Welch to find out. #healthylifestyle #changeagent #kresserinstitute

How Do Coaches Help People with Behavior Change?

Those of us who choose health coaching as a career and those of you who are interested in becoming health coaches share an essential characteristic: we want to help people find their best health and their best life. So what’s the best way we can do that?

Is it by giving people information or telling them what health behaviors they should start and stop? Or is it by helping them explore what matters to them, determine what changes they’re ready for, experiment with behavior changes, and connect their goals to their long-term vision of health and well-being? I’m sure you can guess which of these two approaches I use as a coach.

I’ve always found value in the proverb, “If you give a man a fish, you feed him for a day, but if you teach a man to fish, you feed him for a lifetime.” As a health coach, I don’t teach my clients or give them “the answer.” Instead, I help them learn how to build habits and set goals. I’ve found that distinction to be key to my success as a health coach.

Becoming a “Change Agent”

Health coaching is a growing field, but it’s still the Wild West—at present, anyone can call themselves a health coach, and anyone can share what they read in a book or heard on a podcast. People who want to improve their health benefit most from working with a certified health coach who has been trained to facilitate behavior change, not just regurgitate nutrition, exercise, and lifestyle information. As a coach, if you want to help people improve their health, enroll in a health coaching certification program and learn how to become a “change agent.”

Becoming a change agent takes a lot of practice to master. The ADAPT Health Coach Training Program offers world-class coaching training, and it is the only program with a curriculum that integrates Functional and ancestral health along with the art and practice of coaching. It has more hands-on training with experienced Mentor Coaches than any program available, which gives you the practice and feedback you need to help your clients in the best way possible.

My ADAPT training, as well as my experience as a health coach, has taught me several things about helping people change their behavior. Here are some tips and takeaways.

Being a Change Agent Means Building a Foundation for Change

Coaches don’t just snap their fingers and see their clients’ behavior change, nor do they tell their clients to change and expect them to comply. The stage is set for change when coaches and clients build a foundation of rapport and trust, coaches meet clients “where they are,” and clients are open to coaching.

Rapport

Client behavior change starts with establishing rapport. For me, rapport building begins from the moment I meet a client:

• Am I present?
• Am I warm and responsive?
• Do I listen to and understand what they are saying?
• Have I checked my biases, judgments, and agenda at the door?

If I can answer “yes” to all these questions in the first few minutes of a coaching session, then it’s likely that I’m laying down the foundational elements of rapport and trust with my client.

Credibility

Credibility is also crucial for building trust. As a certified health coach, I have the practical skills that an effective coach brings to the client-coach relationship and the education to understand the health problems of my clients, I know where to turn for useful resources, and I can spot and refer out “red flags” when they arise. Demonstrating these skills helps further foster trust with my clients.

Earning credible certifications also fosters trust with clients, potential employers, and the general public. The ADAPT Health Coach Training Program offers the ADAPT-Certified Functional Health Coach (A-CFHC) certification. Becoming an A-CFHC means demonstrating the knowledge, skills, and behaviors that are necessary to act safely and effectively as a Functional Health coach. Becoming a board-certified health coach through the National Board for Health & Wellness Coaching (NBHWC) also demonstrates a commitment to the profession and furthers your credibility.

The American Medical Association is also beginning to recognize the value of credentialed, credible health coaches in their creation of CPT codes for coaching services. See this press release for more information on what this decision means for health coaches.

Meeting Clients Where They Are

Have you ever heard the phrase, “when all you have is a hammer, everything looks like a nail”? Coaches can’t operate with a one-size-fits-all, hammer-and-nails approach to clients. In order to be effective, we have to meet clients where they are.

Meeting clients where they are includes being able to act as an effective coach with a large variety of clients. These are clients who are having success with behavior change and want additional support as well as clients who are very sick and just beginning to contemplate change. For clients in either circumstance or anywhere in between, coaches must establish foundational information by asking questions such as:

• What’s the big vision that the client has for their health?
• What is the client’s current health challenge?
• What’s the first step the client could take toward their goals?

The answers will be different for each client, even if the questions are similar.

Fit and Coachability

Not every coach-client partnership is a fit or successful. Assessing fit and coachability are other critical early steps that coaches can take to build a foundation for change. Does your client want to change their behavior and do the work, or do they merely want you to give them the answers? Is mental illness a concern and something that will get in the way of a client’s ability to change? Are you and the client just not a good fit? Sometimes, the answer to these questions is “yes,” and that’s okay.

When the client isn’t coachable or the fit isn’t there, the right thing to do is end the coaching engagement or work with the client on a referral to another coach or health professional. Sometimes, the best way to help someone change is not to be their coach and to connect them with the help that they need instead.

Change Agents Are Good at Facilitation and Use Education Sparingly and Wisely

The amount of health information available these days is staggering. I love a good podcast, blog article, or eBook, and these sources of information are a great supplement to my education and experience. But I don’t use this information to get my clients to change their behavior. Information can be a part of the change process, but alone, it does not get people to change.

Consider that, in 2019, there are over 50,000 health and fitness books on Amazon.com. That’s a lot of information. (1) But, at the same time, six out of 10 U.S. adults have one chronic illness, and four out of 10 have two or more. The availability of information is not translating to a healthier population. (2)

What Role Does Information Sharing Play in Behavior Change?

So what role does information play in behavior change, and when can information sharing be helpful? I find it interesting that the NBHWC says that 75 percent of each coaching session required for the National Board Certification exam “must be devoted to coaching facilitation and not education.” (3) This 75 percent requirement means not only that 25 percent of each session can include education and information sharing, but also that the NBHWC sees it as potentially part of a successful coaching session.

Information sharing can help clients with behavior change in a variety of scenarios. It can be empowering for clients to independently research their health challenges and spend time outside of coaching sessions, reading and contemplating new ideas about health and wellness. But when information can advance the exploration of a topic during a session, it may be a better fit for the coach to provide relevant information in the session rather than interrupt a fruitful discussion, have clients research the topic, and then pick up the conversation in a later session.

Information sharing may also be warranted when clients don’t understand the information that they are researching or want more resources on a topic. In these circumstances, coaches can share information on a topic in a way that clients can more easily digest or refer the client to other helpful resources on that topic. Following your clients’ lead on the topic and type of information they’re looking for, rather than sending them information that you think they should read, is the key to doing this successfully.

Sharing Information Using Elicit-Provide-Elicit

One excellent method for sharing information with clients comes from motivational interviewing, and it’s called Elicit-Provide-Elicit. (4) When coaches determine that information sharing will support clients’ behavior change, they should follow three steps:

1. Elicit: Ask clients what they already know, what they would like to know, and whether they would like more information on the topic.
2. Provide: Share information that clients want to know, be clear (no jargon), offer little bits of information and time to reflect, and acknowledge clients’ freedom to ignore the information or disagree with it.
3. Elicit: Ask for clients’ responses.

I’ve successfully used this method for sharing information with clients many times. It aligns the information that I’m sharing with my clients’ goals and interests, gives them time and space to reflect on it, and creates a dialogue around the information that furthers exploration into their behaviors, goals, and vision of health. When done successfully, this method of information sharing supports behavior change by adding clarity and awareness to clients’ understanding of their health challenges and providing them with additional paths to explore.

Change Agents Assess Readiness for Change and Match Their Coaching Techniques to Client Readiness

When I start working with clients, I am always curious about what changes they’re ready for and where they want to start the coaching process. Not every client is prepared to eliminate foods from their diet, sign up for a gym membership, or wear blue light-blocking glasses. For some clients, actual behavior change may be weeks away, they are ambivalent about it, or they are just starting to contemplate taking those first steps. Far from being “uncoachable,” these clients can make incredible progress toward their health goals if coaches know what to listen for and what questions to ask.

The Transtheoretical Model of Change

Both during my training and in my coaching practice, I’ve found that the Transtheoretical Model (TTM) of change is a useful framework for assessing clients’ readiness for change and finding the right approaches to target various levels of client “readiness.” (5) The model outlines different stages of change and suggests different techniques for coaches to help clients progress from one stage to the next.

For example, when clients are just starting to contemplate a health behavior change, I spend more time talking with them about the pros and cons of change. For clients who are beginning to take action, they already understand these pros and cons, and we spend more time discussing how to manage obstacles and potential slip-ups.

In each of these scenarios, I may work with clients who have the same goal but who are talking about that goal in different ways. One may say, “I would like to stop eating sugar, but I like ice cream too much,” whereas the other might say, “I stopped eating sugar, but I’m going to a birthday party soon, and I’m worried about being tempted by ice cream.” The goal is the same, to stop eating sugar, but these clients have different challenges. Our ability in a coach-client partnership to continue the client’s progress toward their goals depends on my listening to these differences and helping them find actions that solve their current challenges and get them to the next stage.

Listening for Ambivalence

One thing that you’ll notice in both of the examples above is that these clients aren’t overwhelmingly positive and optimistic about behavior change. Instead, they are ambivalent. Feeling two (or more) ways about something is common—for example, a client might want to change, but may also feel much more comfortable in the short term to keep eating ice cream or to give in to the social pressure at a party and eat ice cream when they planned not to. These example clients are expressing their mixed emotions around these challenges, which is a perfectly normal part of any behavior change. 

Being a change agent as a coach often comes from acknowledging this ambivalence in a coaching session and allowing clients to talk themselves into changing. One of the best things that I can do as a coach is to tell a client that I hear ambivalence from them about the change and then be silent. Clients will often then describe their mixed emotions about the change and verbally process their discomfort in a way that brings clarity to their situation and suggests possible next steps for them to take.

Change Agents Support the Change Process and Help Create the Conditions for Change

One of my coaching colleagues recently shared this useful Albert Einstein quote with me: “I never teach my pupils, I only attempt to provide the conditions in which they can learn.” Great coaches create the conditions for their clients to change behavior. These coaches:

• Encourage clients to experiment with action steps
• Help clients create targeted goals tied to a long-term vision of health
• Help clients forecast challenges
• Provide clients with accountability

Coaching as a “Messy” Process: The Role of Experimentation

I like to think of coaching sessions as a sandbox. In a sandbox, you can experiment with building sandcastles or just sit there and feel the sand between your toes. And nothing is permanent in a sandbox. You can start over with a new sandcastle if you don’t like the first one.

Similarly, clients can experiment with actions, and if those actions don’t work or clients want to try something else, then they get to start over the next week with a new action. Clients can also spend a week thinking about what a change would mean to them or why they want to change. In other words, there are no right answers or right next steps, and sometimes change is not a change in behavior, but a change in mindset.

When there are no right answers, the value in coaching comes from the experience of trying something different and the discovery of what works well and what doesn’t. For example, a client might have planned to go to the gym seven days next week, but they get busy and only go once. After that one workout, they find going to the gym easier than they thought, and then go to the gym all seven days the following week. In another scenario, they might go to the gym all seven days the first week, find that they’re too tired, and try four days of exercise the following week.

In each of these examples of behavior change, the objective “success” in that first week is different, but the client learns something about themselves and makes an adjustment the following week. Change happens in both examples, and as you can see, there are many possible paths to successful behavior change.

Setting SMART Goals to Support Behavior Change

The more targeted a goal is, and the more relevant it is to a client’s long-term health vision, the more likely the client will change their behavior and accomplish the goal. SMART goals are a great way to structure goals and make them easier for a client to complete them.

SMART goals create a framework for clients that helps them articulate and understand their goals. The acronym SMART stands for:

• Specific: Make the goal as specific as possible (e.g., “I want to lose 5 percent of my body fat” rather than “I want to lose weight”).
• Measurable: As the saying goes, you can’t manage what you don’t measure. Knowing that you’re progressing toward your goals because you have the numbers to show your progress allows you to track success.
• Attainable: Is this goal achievable and action-oriented? Set yourself up for success by selecting a goal with one specific action that you can accomplish.
• Relevant: Do you care about this goal? Is it part of your long-term health vision? If you’re trying to reverse diabetes, then running a marathon might not be as relevant as restructuring your diet.
• Time-bound: When will you complete your goal? Open-ended goals are less likely to be completed than those that have a completion date. This date helps provide accountability.

Doing the work in coaching is never easy, but SMART goals make the work more straightforward because they outline clear parameters for clients’ goals and successful completion.

To take SMART goals to the next level, coaches can help clients link these goals to clients’ long-term health vision. This linkage sets up SMART goals as defined building blocks for clients along a path to their vision.

The Role of Accountability in Behavior Change

I’ve had clients tell me that just knowing they were going to have another session made them follow through on their weekly goal. This sense of being accountable to another person can be a powerful motivator for behavior change.

Coaches can provide accountability in a variety of ways. It’s always a best practice to ask clients if and how they would like to be held accountable. Some may want to check in and update you on their progress. Others may want to spend a couple of minutes at the beginning of the next session talking about their struggles, successes, and lessons learned. As with other areas of coaching, there are no right or wrong answers, and what the client thinks will be helpful is usually the best method to use.

Coaches can also provide accountability by reminding clients of their goals and health vision. This is especially true when the client is doing things that seem at odds with what the client has said they want in previous sessions. For coaches, it can be easy to judge clients for acting in a way that appears inconsistent with their goals. However, I’ve found that merely reflecting back to them their current actions and their stated goals and asking them what they think can be a powerful way to provide awareness to clients.

For example, I could say to a client, “You mentioned that you ate ice cream every night last week. You’ve also told me that your goal is to remove sugar from your diet because it makes you feel lousy. Tell me about that.” I’m putting both things out for the client to reflect on without making them wrong. They may have cut all sugar out of their diet except ice cream and tell me they feel successful, or they may pause to think about it and tell me that they didn’t realize how hard a week they’d had and how ice cream was their comfort food. In the latter scenario, my asking the client to tell me about it may help them find their triggers for stress and identify other methods for coping besides eating ice cream.

Coaches have a wealth of tools to facilitate their clients’ behavior change. Becoming a change agent requires that all of us in the coaching profession build rapport with our clients, meet them where they are, share information wisely, and create the conditions for change. You can learn all these skills in the ADAPT Health Coach Training Program.