Integrating health coaching in medical practice

There is a growing demand for health coaching in medical practice. Gemma Nastasi, CAPP, CHNC, Laura Calascione-Nguyen, FMHC, NBC-HWC, and Jennifer Hanawald, NBC-HWC, during a panel discussion at the 2020 Integrative Healthcare Symposium in New York City.

Health coaches specialize in skillful conversation and strategies to actively and safely engage patients in health behavior change and can be an invaluable member of a care team. However, lack of regulation and consistent standards has led to confusion in terms of what different health coaches are qualified to do and how health coaches fit in to different models of practice.

The National Board for Health and Wellness Coaching (NBC-HWC) is a non-profit whose leaders created national standards for health coaching, including its official definition:

Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance wellbeing. In the course of their work health and wellness coaches display unconditional positive regard for their clients, and a belief in their capacity for change, and honoring that each client is an expert on his or her life while ensuring that all interactions are respectful and non-judgmental.

Hanawald said she likes to emphasize “partnership,” because health coaching is all about client agency. Rather than telling the client what to do, the coach facilitates the behavior change process.

“The client is the one in the driver’s seat,” said Hanawald. “The client is the one taking the action, there hand is on the steering wheel, and they’re hitting the gas or the brakes.”

The health coach’s role, Hanawald said, is helping them visualize where they want to go, brainstorm and identify their route and resources, and make observations, though ultimately the decisions remain with the client.

Additionally, Nastasi said the coach acts as a guide to help the client set goals and find balance. The coach may help with habit change, reframing thoughts, or adopting coping skills.

“The coach holds the space where trust is built,” Nastasi said, “and the client can feel as if they’re in charge of their outcome, that they have to put in the work, and it’s a process where they have the coach hold them accountable for any changes that they’ve decided they want to adopt.”

Coaches are also instrumental in bringing about motivation when a client struggles with achieving their goals, Nastasi said. Self-esteem, self-awareness, self-knowledge, personal responsibility, and happiness and life satisfaction are central to helping the client develop a sense of purpose and meaning in their life.

A good health coach does not position themselves as the expert, Calascione-Nguyen said. Rather, a coach uses their knowledge and training to ask powerful and informative questions so the client can self-discover and direct their own growth. In the process, the coach supports awareness and accountability, but also creates a space that is non-judgmental and unconditional.  

But how does this fit in to medical practice? Calascione-Nguyen said the coach approach can be valuable not just for coaches but for other professionals who may be flowing in and out of expert roles. However, she said she sees health coaching as a niche or specialty and believes medical professionals can benefit from developing a referral network that includes coaches. A good coach, she said, also knows when it is appropriate to refer to the client’s medical professional and support

The biggest challenge in the health coaching industry, Hanawald said, is awareness. On a basic level, there needs to be more awareness about the role coaches can play to enhance patient wellbeing. Further, meaningful change takes time and patience.

“In our results-oriented society, if we don’t have immediate success, it doesn’t mean our clients are failing,” said Hanawald. “We all, clients, medical professionals and coaches, need to have compassion, and understand that with a strong process, it is very possible to change our health habits.”