As we wrote in the Institute of Coaching report – Leading with Humanity - the pandemic era has awakened our humanity as leaders. More of us are tuning into the ultimate purpose of organizations - to serve humans - our aspirations, needs, values, strengths – the sum of everything that influences human well-being. Everything leaders and organizations do have the ultimate, higher intention of making human lives better. We are moving away, albeit slowly, from bureaucracies where humans serve institutions and moving toward “humanocracies” where institutions serve humans and humanity. How work drives human well-being is right in front of our eyes now – connection, trust, relationships, purpose, engagement, collaboration, productivity, and creativity – these are drivers of BOTH human well-being AND great performance at work. Our eyes confirm the work of researchers. Leading well, aka being led well, has been shown to generate psychological and physical well-being – improving engagement and reducing stress and burnout. The research shows that the reverse is true too – life well-being enables our best performance at work. What’s a map then for leaders to foster human well-being, in ways that also enable great work? In my co-authored Harvard Health book, Organize Your Emotions, Optimize Your Life, we explored nine universal personality elements that code for our individual needs, values, interests, and strengths. Each of us has our own formula for well-being based on our unique personality mix. These personality elements also manifest in 8 types of corporate cultures, as explored in an HBR article on corporate culture. We’ve since mapped the nine elements to a variety of personality models, including: Jung's cognitive functions, the basis of the Myers-Briggs assessment Enneagram model of personality drives Let’s consider how these core elements of well-being offer leaders a whole, human-centered model for leading well. Autonomy (Jung’s introverted feeler, Enneagram Reformer) A primary human need is autonomy (self-determination theory) – to live our lives in alignment with our core values, interests, needs, and strengths. High levels of autonomy are needed to lead well – to model personal responsibility, stand up for what is good and right, to be authentic, and to be courageous and values-driven. Empowering others to do the same promotes their autonomy and well-being. Relational (Jung’s extraverted feeler, Enneagram Helper) Another primary need is relationships where we attune to and serve others’ needs, strengths, and values, and receive the same in return. Social intelligence and compassion have been shown to be vital in leadership and teamwork. They generate well-being in followers as we/they feel connected, seen, heard, appreciated, respected, and supported, especially in tough situations. Confidence (Self-Determination Theory, Enneagram Challenger) Confidence is both task-specific and broad. It’s a big driver of well-being – one of the three core psychological needs unpacked in Self-Determination Theory. We dearly want to be competent, using our strengths to master work and life’s challenges. Leaders continually help people learn, grow, and expand their competence and confidence, which spills over to engagement - using our skills and knowledge well at work. Continual growing and learning is a hallmark of a human-centered leader - for self and others. Regulator (Jung’s introverted sensor, Enneagram Loyalist) We all need a sense of stability, balance, safety, and security, built upon a work (and life) environment that is carefully constructed to have integrity and to be stable. Good leaders know how to balance and stabilize themselves (e.g. good emotion regulation, good fitness, and health). They encourage everyone to be physically and psychologically fit and healthy, and to steer around reactivity and burnout. They also create a psychologically safe culture and a sound organizational structure (e.g. people, processes, finances). Adventurer (Jung’s extraverted sensor, Enneagram Enthusiast) Once adults (like children) feel stable, they are ready to explore, take risks, learn new things, create new adventures, find the lessons in adversity, enjoy life’s pleasures, and change what’s ripe for reinvention. Leaders model the adventurous spirit, agile and enthusiastic, shaking up the status quo, and keeping up or, even better, getting ahead of external change. Thinker (Jung’s introverted thinker, Enneagram Investigator) People want to understand how things work, what causes what, to solve complex problems, and to make and implement great decisions. Leaders model critical, objective thinking and analysis, finding the truth camouflaged in the noise and messiness of human minds and activity. Leaders’ thinking processes are on display in their communications, helping others think and understand clearly their analysis and best steps forward. Standard Setter (Jung’s extraverted thinker, Enneagram Achiever) Humans need to strive toward a purpose and goals, to have a reason to bounce out of bed and make ourselves and our world a little better every day. Leaders model the purposeful goal-directed process – defining what excellence looks like, designing goals and being accountable to get there, getting things done, and tracking and reporting continual progress. Creative (Jung’s extraverted intuitive, Enneagram Individualist) While most of us aren’t songwriters or artists, we all want to be creative and develop new opportunities, new ways of doing things, and new or improved products and services. Co-creative collaboration is particularly nourishing – when we come together and invent things none of us could do alone. Leaders help themselves and others be more creative, igniting and inspiring others to go nonlinear, to outgrow today’s ways of thinking, feeling, and doing. Strategist (Jung’s introverted intuitive, Enneagram Peacemaker) The ability to step back and zoom out to see the whole picture, create harmony, make meaning of complex situations, find the wisdom in the moment, synthesize all of the data into a strategy – this is the higher purpose of leadership. Leaders are in their roles because they handle more complexity, spot gaps, see further ahead, and find and convey meaning, wisdom, gratitude, and good strategy. As a human-centered checklist on the well-being of the people and organization you lead, consider how well you are supporting these nine personality elements individually and collectively - autonomy, relationships, competence, regulation and stability, adventure and change, critical thinking and decisions, ambition and direction-setting, creativity, and strategic thinking. While our personality structures vary widely in the sorting of our mental processes, drives, and strengths, we share all of the underlying elements. This is our common humanity, which makes for a good starting point in mapping human well-being to leadership. Onward and upward, Coach Meg www.coachmeg.com www.wellcoaches.com www.instituteofcoaching.org www.nbhwc.org Resources: Institute of Coaching report: Leading with Humanity - the future of leadership and coaching McKinsey & Company - Cultivating compassionate leadership during COVID-19 Humanocracy - Creating organizations as great as the people in them Research Handbook on Work & Well-being Organize Your Emotions, Optimize Your Life, Harvard Health book published by William Morrow The Leader's Guide to Corporate Culture, Harvard Business Review Carl Jung's Psychological Types Enneagram personality types Self-determination theory Social intelligence Compassion matters in leadership Josh Bersin - The secret to well-being at work is leadership

Wellcoaches created the animated movie “How Coaching Works” to explain health and well-being coaching when it was in its infancy. Now with almost 2 million views, the video remains a helpful illustration of the beauty of the coach/client relationship. This blog series aims to share the psychological underpinnings of the cartoon. The first blog provides insight into the approaches used by the coach which are based on the principles and processes of coaching psychology. This blog series aims to share the psychological underpinnings of the cartoon. The first blog provides insight into the approaches used by the coach which are based on the principles and processes of coaching psychology. Scene One: MEET In this scene you find the coach in the office with a client. You may expect that it’s the coach’s role to tell my client what to do. Instead, the coach asks them to create a picture of their vision, symbolized by the mountains off in the distance. The client is eager to move toward that vision, and has even started doing some of the thinking necessary to get there, but feels overwhelmed by the things that stand between reality and the dream. The knotted path represents the many possible paths toward the vision. It’s up to the client, with the coach’s support, to figure out which path is the best one. The coach and client first agree on how they are going to work together. They shake hands, symbolizing the important boundary-setting conversation and agreement that starts a coaching relationship. For this relationship to be growth-promoting, the coach radiates warmth, empathy, confidence, zest, humor, and courage. Scene Two: VISION In the next scene, the coach encourages the client to get very clear about what it is that they want, and why. The coach elicits motivation by getting the client to explore why change is important now. They explore what it is exactly that the client wants to create – noting that all of life is invented – and that together they will experiment with how to get from Point A to Point B. Did you know that it’s all invented? According to the Constructionist Principle, we construct our reality - what we perceive, what we believe, what things mean, and what we value. In other words, it’s all made up! And, it’s from this frame of reference that the best coaches work with their clients. They playfully support the client in making up the rules to the client’s “game of life” and in experimenting with the ways to play it. An inspiration for coaches comes from the work of Ben and Rosamund Zander in their book The Art of Possibility. Check it out and learn to say “How fascinating!” about all of life’s knots in the road. Scene Three: THE PLAN Notice that when the client works on their plan, the coach digs into the toolbox and hands over a tool – a BIG pencil. The client is uncertain that they can handle the pencil, but the coach’s certainty is greater than the client’s doubt. From the domain of Hope Psychology, we know clients have the willpower, and now just need to develop the waypower. And, waypower isn’t best developed by having someone tell you what to do, or doing it for you; it’s best developed by experimenting with the change oneself. The client gets specific with what they want to have happen –the specific changes that will take place in their life to get to the mountains in the vision. The more specific, the better. The box that the client draws represents the importance of focus and clarity in setting one’s goals. They are exploring the question of what the client is going to take responsibility for creating, and doing, to reach the beckoning goal. Scene Four: THE JOURNEY As the coach presents the next tool, a trampoline, the client is beginning to feel more confident in their ability to take that first leap. The trampoline represents the power of setting goals that are appealing, specific, and measurable, and of thinking through all that it will take to be successful, including the ever-important supporting relationships. The coach invites the client to recall other times when they have been successful in achieving other life or work goals, as well as their strengths and talents. It’s an opportunity to learn from past successes and to apply one’s strengths, rather than focusing on what’s hard. More building blocks are constructed – the stepping stones to reaching success. The vision of the client’s best self becomes clearer and closer. But as the client continues to experiment, they fall off of the ladder – missing a challenging step. This, of course, happens in real life – we lapse and fall back into our old habits. The coach brings a safety net, a non-judgmental space in which they can explore what happened and what they learned from it. How fascinating! This leads to his insight and decision to create smaller steps, drawn onto the ladder. How important it is to move to action at the right time, with the right goal in mind. There is little benefit to clients of working on goals that are beyond their capability. When clients set goals that are well matched to their readiness to move forward, with enough stretch to be engaging but not too much to produce anxiety, they become aligned with their “best self.” The client rises above the challenge, achieves the plan, and jumps up, having grown into the image of their best self. They are excited as they experience what it feels like to be there – and that will propel more successes going forward. Scene Four: SUCCESS The Coach and Client end with a celebration – the client has found the best path, outgrown perceived roadblocks, and become the vision of their best self. Together the heartily acknowledge the accomplishment. The final scene is a cliff hanger, so to speak. Its message of “To Be Continued” speaks to the fact that change is a journey, a process to revisit continually. We know that as the client continues down the road toward the vision, there will be another knot, or a ditch, or a seemingly impenetrable object. Yet, through the coaching partnership that cultivates hope and the acknowledgement of strengths and abilities, the client will continue on the path and further develop their best self.

“In this century, human knowledge is extremely expanded and developed. But this is mainly knowledge of the external world. In the field of what we may call "inner science", dealing with the inner things, there are many things, I think, that you do not know. You spend a large amount of the best human brain-power looking outside - too much. and it seems you do not spend adequate effort to look within, to think inwardly. . . . Perhaps now that the Western sciences have reached down into the atom and out into the cosmos finally to realize the extreme vulnerability of all life and value, it is becoming credible, even obvious, that the Inner Science is of supreme importance. Certainly, physics designed the bombs, biology, the germ warfare, chemistry the nerve gas, and so on, but it will be the unhealthy emotions of individuals that will trigger these horrors. These emotions can only be controlled, reshaped, and rechanneled, by technologies developed from successful Inner Science.” ~ The Dalai Lama, speaking at Harvard in 1984 ( courtesy of www.wisdomatwork.com)

One of the enduringly fascinating questions in coaching is why it actually works. To consider this question, a valuable body of research is that of common factors theory. Believe it or not, we’ve been talking about why therapy and coaching work for over 80 years. The common factors research suggests that elements such as client resources, strengths, supports and practitioner attitudes – warmth, empathy, compassion and many others account for about 70% of the beneficial changes a client experiences. These ideas area discussed widely in what remains one of the best books on the subject – The Heart and Soul of Change. Still, the question remains – why do these elements make such a difference? In coach training, we teach the 3 core skills – “doing skills”, if you will, or “micro-skills” – deep listening, open inquiry and reflection. These are embedded in the words of Epictetus, the Greek Stoic philosopher, who lived from about 50 CE to 135 CE. He was born into slavery in what is now Turkey, living many of those enslaved years in Rome, before gaining his freedom as an adult. He moved to Greece and established a school of philosophy. Among many other profound reflections on the nature of being human, Epictetus observed this: “We have two ears and one mouth - we should therefore use them in that proportion.” Applied to coaching, such a view centralises the skill of listening, as the most important of the three core skills. Listening demonstrates a deep commitment to being present for another person. It also provides the foundation on which the other two core skills – open inquiry and reflection – are built. Without listening, any inquiries would be “unanchored”, and reflections would be impossible. Open inquiry embodies the attitude of curiosity in coaching. Curiosity is key to remaining “non-judgmental”. Curious open inquiry communicates to the client a desire to know and learn about them. It is “co-created” by client and coach, in that a client’s response to one inquiry then has a shaping response on the following inquiry. At its best, curious open inquiry conveys to a person that their story, however it emerges, has value. Reflection is the skill which “closes the loop” of communication – it tells the sender of a message that it has been received and understood as intended. This approach is already used in many industries all over the world including aviation, marine, rescue, first response and more. The importance of understanding a message as intended is embedded in those industries. Yet in interpersonal communication, we sometimes make the assumption that because something has been said, it has been understood. Reflection helps the speaker to be confident that they have conveyed the message they wish to convey. When these three skills – deep listening, open inquiry, reflection - are used together, they do the work of establishing channels of communication. But they do much more than this – they provide a “meta-communication” to the client which builds a bridge between two unalike beings and forges a bond which says: I am with you I want to learn about you I see you I hear you I understand you

Ellen Albertson is launching her newest book this month entitled: "Rock Your Midlife: 7 Steps to Transform Yourself and Make Your Next Chapter Your Best Chapter.” Albertson, a Wellcoaches professional coach training graduate, has been working with women in midlife her whole career. Today, at nearly 60, her aim is to revolutionize aging and live well to at least 100. She calls this period in life, a second adulthood, a rich time to take everything we’ve learned and ask, “what do I want to create?” One of her aspirations is that “when our daughters get to be midlife there’s no crisis left.” Anybody can pick up this book and get something from it, she said, adding it is based on reams of science and research much like Wellcoaches curriculum. A major section of the book is focused on “destination vibration.” What that means in practical application is to become the person you want to be, today. And you start by thinking about a time in your life that you were really happy. For Albertson, she visualizes herself dancing. She recreates the energy and joy she feels while dancing. Albertson’s career has morphed and transformed as much as she has over the years. Moving from a dietician and personal trainer into coaching and practicing self-compassion. “I would not be who I am without Margaret Moore. Wellcoaches changed my trajectory.” She recalls Wellcoaches Professional Coach Training having a distinct impact on her work. Through the training, she has even more tools in her toolbox. The work of Bob Kegan, Barbara Frederickson, Martin Seligman, all this work that was introduced in Wellcoaches training also shows up in her book. “It was so worth it and it was so much fun. It’s going to have a profound impact on your coaching skills. No hesitation one of the absolute best training I have ever done. If not THE best,” Albertson said. “PCT transformed my life. Getting all of this coaching and a profound opportunity for enlightening yourself." She said Margaret Moore guided her toward Fielding Graduate University where she earned her Ph.D. and learned about self-compassion. Albertson shared that while earlier in life she had a negative body image and experienced depression, she has now through the integration of Kristin Neff’s work on Self-compassion (who also was on her dissertation committee) created a better relationship with herself. She feels more empowered. The seven steps in her book are all part of her personal experience too. She has moved through them and said she is now called to make the world a better place.

Good morning! “I’m so tired and overloaded,” he exclaims. "How come?" I ask. "I don’t know why I keep saying yes to things,” he replies. "I’ve agreed to two new projects, to changing my plans, to a couple of truly messy meetings, and to a new committee role. It’s too much!” Indeed, we have an epidemic of ‘yes.’ In theory, saying ‘no’ should be straightforward. But every day I talk to leaders that say ‘yes’ when they really want to say ‘no.’ We realized that ‘no’ is bad when mom and dad fussed at us for saying “I don’t want to go to bed/brush my teeth/ share with my sister.” We’ve been cajoled, bribed, or downright forced to say ‘yes’ instead of ‘no.’ So we learned to say ‘yes’ in order to please people, avoid conflict, not be criticized, get kudos and praise, prove our worth, demonstrate our commitments, and even show our love. Oy! Turns out that saying ‘no’ is an act of maturity and personal power, and leadership skill of its own. Of course, there are times when saying ‘yes’ is the exact right answer; times to agree, accede, compromise, and even capitulate. And even if you’re asked to do something that’ll cost you (family time, energy, money, falling behind on your duties), it can still be a ‘yes' if you’re staying true to your values, and the cost is worth it. But if your ‘yes’ is an automatic reflex that has no boundaries, then you pay with your health, get burnt out, frustrated, disengaged, and even resentful. A default and automatic ‘yes’ isn’t a choice, it’s a habit. Your ability to say ‘no’ is correlated with making choices. Choices are correlated with having agency. Agency is correlated with personal power and saying ‘yes’ when you mean ‘no’ leaks away your power. As a “healing” process, I invite you to be a conscious being at choice, and experiment with intentional ‘no.’ Turns out that when you feel your power and choose to say ‘no,’ you can then say ‘yes’ with genuine commitment and sincerity. Next time someone invites you to a meeting, asks for a favor, or wants you to take on a project, in your mind, say ‘no.’ Don’t answer aloud yet. Listen to your heart and your gut, and notice what they are saying. Does saying ‘no’ make you more relaxed or more tense? Why say ‘yes?’ Is it to soothe or appease, to get approval or people please? Or is ‘yes’ your genuine choice? Mentally start with ‘no’ and then make a choice, but don’t just agree on autopilot. Then if you want to say 'no' out loud, here are a few starters that you can adapt to your personal style. “I can’t do this now, but I’d love to revisit this next week” “I want to do a great job, and given everything on my plate, I can’t take this on and do a job I’m proud of. What do you think I should deprioritize?” “I can’t do this, but Brenden over in Marketing might be interested.” "I’m going to say no for now, but if conditions change, I promise I’ll get back to you.” “I can’t do what you’re asking for, but I can do this instead.” And, "No, I'm not going to do that." As you bring on the ‘no,’ some folks will feel (and some will tell you) that you’re being selfish and “not a team player.” Not true. You’re becoming a conscious being at choice. I promise that with practice, saying ‘no’ makes you more effective, less overwhelmed, and more powerful.

Effects of the COVID-19 pandemic reinforced intuitive relationships between suffering from infirmity and mental/physical health. Of course, the emergence of the novel coronavirus has taken a negative toll on population health and well-being. However, the inverse of that relationship is not as intuitive but may also be true. We expect healthy people to get less sick, but do they have any specific protection against coronavirus? Do wellness, wellness habits, and psychological well-being have any impact on the rate and severity of infection from the virus? It may be surprising to learn these questions are being empirically studied. An enormous repository of published pandemic-related research is growing rapidly, and many COVID studies address issues surrounding wellness (i.e., status and habits). Wellness habits, particularly related to exercise and diet, are well-studied. This blog focuses on these questions while describing findings from related research. The accompanying Reading List contains the relevant citations, and most all are freely available open access via a Google search. Wellness Habits: Exercise and COVID While well studied, there is only one randomized controlled trial of the effects of exercise on COVID. Researchers asked 30 COVID patients with mild or moderate symptoms to exercise while recuperating in Turkish hospitals. They assigned half of the patients to 40 minutes of moderate-intensity aerobic exercise (treadmill or bike) and half to a control group. After just two weeks, they concluded the exercise group improved COVID-related symptomology and immune profile (leukocytes, lymphocytes, IgA) better than non-exercising patients. It is encouraging to see exercise being investigated as a treatment, and, this behavioral change has a positive impact on patients’ progression at such a critical time in their convalescence. Another study of COVID patients (n=145) examined the effects of prior habitual physical activity on COVID symptoms (fever, cough, sore throat, loss of taste, etc). Physical activity was self-reported using a questionnaire asking about the type and duration of regular weekly activities. This study found participation in prior moderate physical activity was the only independent predictor of COVID symptomology with greater habitual activity lessening the number of symptoms experienced during COVID. This suggests an active lifestyle might lessen suffering after COVID infection. Another impressive and much larger study, also done retrospectively, examined prior exercise habits in nearly 50,000 COVID patients tracked by Kaiser-Permanente electronic health records. Inactive patients (those who consistently did not exercise over the prior two years) had more than twice the likelihood of hospitalization from COVID infection than those who were previously meeting physical activity guidelines (>150 min of physical activity weekly). They were also more than twice as likely to die from complications of the infection. Patients who previously engaged in some physical activity were better off than those who did no activity, but these light exercisers had poorer outcomes than those who met published activity guidelines. The Kaiser-Permanente study is a landmark paper showing an active lifestyle can improve outcomes during a pandemic. These effects of exercise habits on COVID-19 are not completely unexpected because similar results have been seen in American studies with other types of upper respiratory tract infection. A decrease in the rate and severity of infection is commonly seen in those who regularly perform moderate-intensity exercise. There are sound immunologic reasons to expect a beneficial exercise effect on COVID-19. These immune system mechanisms are nicely addressed by Codella et al. (see Reading List) and include effects on immunoglobulins (e.g., IL-6), T-cells, and natural killer cells. Regular exercise also initiates mechanisms to reduce chronic inflammation, and this can be potentially beneficial to COVID patients who may suffer from fluid accumulation in the lungs. Wellness Habits: Nutrition and COVID Like exercise, nutrition can also play a role in immune system function and resistance to infection. Glutathione, vitamins A, D, and C are all known immune influencers. As described in a recent review (see Scudiero et al. in Reading List), each of these nutrients was studied in COVID patients. All were shown to have a potential beneficial impact on the course of recovery when kept in proper balance. The merits of Vitamin D effects on COVID progression have been argued in the popular press; the limited data we have suggests it may be helpful, especially in cases of Vitamin D deficiency. The immune system connections to good nutrition have been further elucidated by others (see Calder et al. in Reading List). On a macro-dietary level, adherence to the Mediterranean diet was shown to lessen COVID infection rate and related mortality. As opposed to the traditional Western diet, the Mediterranean diet is rich in fresh fruit and vegetables, whole grain, nuts, fish, and olive oil. While very encouraging to see a drop in COVID cases associated with this diet, the study did not go so far as to clearly describe the extent of reduction in infection rate. The authors discussed the limitations of their ecological study design but ultimately concluded that any diet-reducing inflammation might reduce the risk for severe COVID. A similar argument of benefit has been postulated for the Keto diet (see Gangitano in Reading List). However, this proposal currently has a smaller evidence base and is more speculative than the case made for the beneficial effects of the Mediterranean diet on COVID. Another study, using data from the World Health Organization, globally evaluated 23 dietary attributes across 188 countries. They found diet can greatly impact COVID recovery and death rates and emphasized the negative role of sugar consumption in this effect. The authors simply stated, “Good nutrition is important before, during, and after an infection.” They concluded unbalanced diets are a health threat across the world and urged policymakers to make societal modifications for healthier dietary choice accessibility. A Harvard study presented large-scale evidence for nutrition-based COVID protection. Examining over 500,000 participants, in a cell-phone based project, they reported a high-quality diet (plant-based: fruits and veggies) was associated with a lower risk of COVID infection and lower risk of disease severity. In other words, a diet much like the aforementioned Mediterranean diet provides a protective effect against COVID. It was valuable to learn this dietary effect was prominent in persons living in disadvantaged conditions. In summary, diet like exercise, can impact the COVID pandemic experience. Wellness Status and COVID Wellness status (e.g., BMI, stress level, fitness) appears to have a strong relationship with COVID-19 infection and infection outcomes. Obesity is possibly the most studied characteristic, and it is clear that obesity leads to a greater rate of infection and a poorer prognosis once infected. A meta-analysis using 41 studies and over 200,000 subjects (more than 100,000 infected) concluded obese subjects have more positive COVID test findings and greater incidence of hospitalization, intensive care, ventilator use, and mortality. Specifically, visceral fat is the culprit and researchers have speculated it may be responsible for the “cytokine storm” reported in severely deteriorating COVID cases. One theoretical paper postulated this potentially fatal and exaggerated immunological response is related to chronic psychological stress (see Lamontange et al. in Reading List). These authors speculated patients with a history of chronic stress ought to seek strategies of stress reduction that can be implemented during a period of social isolation. Other wellness-related indicators that predict COVID outcomes are fitness, age, and disease status. Those with greater cardiorespiratory fitness had a lower rate of dying after COVID infection than a less fit cohort. Moreover, performance on maximal exercise testing was shown to be inversely related to the likelihood of COVID hospitalization. The message is clear, increasing fitness level through habitual exercise leads to protective effects during a pandemic! Male gender, older age, diabetes, and chronic illness are risk factors each associated with poorer COVID outcomes. A study of over 3,700 COVID patients in New York determined male gender and having more than two comorbidities (e.g., heart failure, dementia) increased odds for hospitalization and death. A meta-analysis reiterated the negative impact of male gender and diabetes and added hypertension, smoking history, and fatigue to the list of risk factors for severe COVID. Those with these risk factors should be especially careful and should seek the most effective rehabilitative measures should they become infected with COVID. It seems clear that wellness status is a critical factor in COVID prognosis and poor initial health greatly worsens outcomes expected after a COVID diagnosis. We can conclude that healthy behavioral habits, such as regular exercise and a plant-based diet, appear to be protective against becoming infected or suffering greatly if infected by the coronavirus. Being physically fit, maintaining normal body composition, and avoiding unhealthy stress are also important to maintaining health during a pandemic. Health care professionals, especially health and wellness coaches, can take this information and use it to help those trying to safely make it through these difficult times. From a broader perspective, healthy behavior habits can now be encouraged to attenuate the effects of future COVID variants or unforeseen pandemics that might be down the road. Add this benefit to the ever-growing list of advantages attributed to living a healthy lifestyle. READING LIST Wellness Habits: Exercise and COVID Mohamed AA, Alawna M. The effect of aerobic exercise on immune biomarkers and symptoms severity and progression in patients with COVID-19: A randomized control trial. J Bodyw Mov Ther. 2021;28:425-432. doi:10.1016/j.jbmt.2021.07.012 Zeigler Z, Lawrence J, Jamison A, Salzano P. Physical Activity Behaviors and COVID-19 Symptoms. OBM Integrative and Complementary Medicine 2021; 6(3): 11; doi: 10.21926/obm.icm.2103027. Sallis R, Young DR, Tartof SY, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. British Journal of Sports Medicine 2021;55:1099-1105. https://bjsm.bmj.com/content/55/19/1099 Codella R, Chirico A, Lucidi F, Ferrulli A, La Torre A, Luzi L. The immune-modulatory effects of exercise should be favorably harnessed against COVID-19. J Endocrinol Invest. 2021;44(5):1119-1122. doi:10.1007/s40618-020-01403-5 Wellness Habits: Nutrition and COVID Scudiero O, Lombardo B, Brancaccio et al. . Exercise, Immune System, Nutrition, Respiratory and Cardiovascular Diseases during COVID-19: A Complex Combination. Int J Environ Res Public Health. 2021 Jan 21;18(3):904. doi: 10.3390/ijerph18030904. PMID: 33494244; PMCID: PMC7908487. DeLuccia R, Clegg D, Sukumar D. The implications of vitamin D deficiency on COVID-19 for at-risk populations. Nutr Rev. 2021 Jan 9;79(2):227-234. doi: 10.1093/nutrit/nuaa092. PMID: 32974671; PMCID: PMC7543577. (Calder Nutrim). Greene MW, Roberts AP, Frugé AD. Negative Association Between Mediterranean Diet Adherence and COVID-19 Cases and Related Deaths in Spain and 23 OECD Countries: An Ecological Study. Front Nutr. 2021 Mar 5;8:591964. doi: 10.3389/fnut.2021.591964. PMID: 33748170; PMCID: PMC7973012. Gangitano E, Tozzi R, Gandini O, et al. Ketogenic Diet as a Preventive and Supportive Care for COVID-19 Patients. Nutrients. 2021 Mar 20;13(3):1004. doi: 10.3390/nu13031004. PMID: 33804603; PMCID: PMC8003632. Kamyari N, Soltanian AR, Mahjub H, Moghimbeigi A. Diet, Nutrition, Obesity, and Their Implications for COVID-19 Mortality: Development of a Marginalized Two-Part Model for Semicontinuous Data. JMIR Public Health Surveill. 2021 Jan 26;7(1):e22717. doi: 10.2196/22717. PMID: 33439850; PMCID: PMC7842860. Merino J, Joshi AD, Nguyen LH, et al. Diet quality and risk and severity of COVID-19: a prospective cohort study. Gut. 2021 Nov;70(11):2096-2104. doi: 10.1136/gutjnl-2021-325353. Epub 2021 Sep 6. PMID: 34489306; PMCID: PMC8500931. Wellness Status and COVID Yang J, Hu J, Zhu C. Obesity aggravates COVID-19: A systematic review and meta-analysis. J Med Virol. 2021 Jan;93(1):257-261. doi: 10.1002/jmv.26237. Epub 2020 Oct 5. PMID: 32603481; PMCID: PMC7361606. Sattar N, McInnes IB, McMurray JJV. Obesity Is a Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms. Circulation. 2020 Jul 7;142(1):4-6. doi: 10.1161/CIRCULATIONAHA.120.047659. Epub 2020 Apr 22. PMID: 32320270. Favre G, Legueult K, Pradier C et al. Visceral fat is associated to the severity of COVID-19. Metabolism. 2021 Feb;115:154440. doi: 10.1016/j.metabol.2020.154440. Epub 2020 Nov 25. PMID: 33246009; PMCID: PMC7685947. Lamontagne, S. J., Pizzagalli, D. A., & Olmstead, M. C. (2021). Does inflammation link stress to poor COVID-19 outcome? Stress and Health, 37( 3), 401– 414. https://doi.org/10.1002/smi.3017 Rahman A, Sathi NJ. Risk factors of the severity of COVID-19: A meta-analysis. Int J Clin Pract. 2021 Jul;75(7):e13916. doi: 10.1111/ijcp.13916. Epub 2020 Dec 20. PMID: 33372407.

“Hey Eric,” Brianna launches in, “I’ve been meditating regularly for more than six months, been trying to get into this for years.” She’s pleased with her accomplishment, I can tell. And she adds, “One of the themes that keep coming up as I meditate is Doing versus Being.” “Oh, that’s super cool,” I say, “I’ve been thinking about this for a while, too.” “Yeah,” she adds, “It took this crazy pandemic to get me going with a meditation practice.” “I totally get it, Bree. I know you’re among a crowd of leaders that have taken up meditation to deal with the anxiety, stress, and burnout that this unprecedented pandemic has brought on.” Then I ask, “What are you thinking about Doing Vs. Being?” “Well,” she answers, “I guess what I really want to do is stop all this crazy Doing and learn to just Be.” “Crap,” I blurt, “I don’t know how to do that!” “No way Eric! You’ve been at this for decades,” her surprise is mixed with disappointment. “Seriously,” I add, “the word versus is a dead-end for me. Versus means ‘as opposed to or in contrast to’.” “But that’s exactly what I want.” Brianna presses, “I want to stop the stress of Doing and enjoy the peace of Being.” “From my experience, Bree, when we jam ‘versus’ between Being and Doing, we get trapped in a binary distinction, a false binary.” I think for a moment and add, “Versus implies that one is opposed to the other. To me, that’s not helpful. Personally, I’ve stopped trying to oppose Doing with Being. What I’m focused on is how to bring more Being quality to my Doing.” I’m 35 years into my meditation practice, and I don’t see credible evidence that you can just BE. To be alive is to DO. Even meditating is doing something. Thinking is doing something. Loving is doing something. Relaxing is doing something. You can't not do something. Being is NOT opposed to Doing. Being is the way you do what you do. The problem isn’t Doing, it’s Compulsive Doing – pushing ourselves with shoulds and have-tos and oughts, fixating on the future, constantly fixing our flaws, being impatient with our moods, rejecting our feelings, and measuring every aspect of our activity and progress. It’s too simplistic to conceive that the always-on crazy-busy of Compulsive Doing will be permanently replaced with relaxing, not stressing out about task lists, and not fixating on goals and objectives. I mean, that’s a vacation, right? For sure, take a vacation; there’s no prize for racking up the most unused PTO. But that’s not the same as Being. Being isn’t the same as ‘not doing.’ BEING is the way that you direct your attention, your awareness; Being is a type of PRESENCE. Compulsive Doing is a constant humdrum of attention to the present, past, and future; it’s a blend of activity + anxiety + scarcity. Activity is either physical or mental. Anxiety is fixating on the future (especially possible negative future). And scarcity is believing that you're inadequate, “not enough” - time, money, power, opportunity, value, or love. Being isn’t opposed to Doing, it’s a form of Doing. Being is attending to the present moment. In the present moment, there's activity, there are sensations, and there are thoughts and feelings. But in this present moment, you don't weave your thoughts into stories, you don't convert feelings into identity, and you don't endlessly reflect on everything that can go wrong. In the present moment, you make unfiltered, direct contact with experience and phenomena. This is how you peel away anxiety and scarcity. Immerse yourself in the direct experience of your task at hand and, voila, you are Being (even as you’re doing). So, what are a few practical steps to subdue Compulsive Doing and experience more Being? Here are four tips. Pause. Yup, this is foundational. In Compulsive Doing mode your attention flits over and over from present to past, to future. Use a timer or an app to set up a sequence of daily pauses, just moments long, to break the cycle. And what to do in that pause? Notice if you’re on Compulsive Doing Autopilot. Breathe deeply a few times. Notice your body and the myriad sensations in your body. Be fascinated by the sounds around you. In other words, be mindful; shift to intimate contact with current reality. The more you do this, the more you entrain yourself into Being. Align with values. If you haven’t already, make time to identify and articulate your values (adventure, boldness, compassion, curiosity, fun, influence, etc.). Your Being mode switches on when you live deliberately, and values are your guides for deliberate, intentional living. Living into your values reduces the triggers of have-tos and oughts, and creates more alignment and meaning. If you haven’t done this, ask me for a values clarification exercise. Work your strengths. Compulsive Doing is implicitly focused on your inadequacy. This sets off a perpetual drive to self-improvement, self-criticism, and a relentless self-beating to work harder, fix yourself, and monitor your progress. Truth is that you’re really good at a few things, and you can’t be a master of all things. Identify your strengths and honor them, then your efforts will be more harmonious and less odious. Make friends with your past. Regret is a super expensive mental activity – it drains energy by replaying the past, and it keeps you upset and ashamed. I’d be a fool to glibly tell you to “let bygones be bygones,” it’s not always easy to “just let go.” Do, however, engage in whatever inner work you have to do to resolve your regrets, shame, and guilt. Dwelling on the past holds your attention captive. It also compels you to keep planning and preparing to make sure you don’t repeat your shameful screw-up. Go to the past to learn from it and extract the wisdom. Then bring your powerful attention to the present. Since NOT DOING is off the table, I deeply encourage you to uplevel your BEING skills. This isn’t just good for you, it’s good for your loved ones, your teams, and the entire human ecosystem. In the spirit of leading and learning. Eric

Note: This article was published by the Institute of Coaching on July 26, 2021. Join Institute of Coaching using the Wellcoaches Sponsor discount. Introduction We quoted Christina Maslach here as she is respected by many as a scientific leader in burnout, and a beloved presenter at a recent IOC conference. While thriving is an optimal state for everyone, it is a state which is hard to achieve, especially for physicians who are dealing with the epidemic of burnout, well-established before they had to navigate the peaks and the long tail of the pandemic. Suzanne Koven, a physician at Massachusetts General Hospital, began a 2016 article in the New England Journal of Medicine, titled, The Doctor’s Dilemma: “Then I sit at my workstation to document and bill for our encounter, perched at the edge of my seat, on the verge of despair. This IOC research dose explores an article by Alyssa McGonagle and team entitled Coaching for Primary Care Physician Well-Being: A Randomized Trial and Follow-Up Analysis, which describes a well-designed research study of a coaching intervention for physician burnout. This research project is an IOC success story, supported by an IOC Harnisch grant, presented in an IOC webinar, and published in a highly respected journal of the American Psychological Association. Physician burnout The authors note that “burnout, which often manifests in the face of ongoing work stress, is characterized by emotional exhaustion, depersonalization or cynicism, and reduced perceptions of personal efficacy and accomplishment.” Physicians experience significantly greater burnout symptoms than the general U.S. population: they reported levels of emotional exhaustion and/or depersonalization of 45%, 54%, and 44% in 2011, 2014, and 2017, respectively. Literature on physician burnout highlights several contributing factors, including lack of control over workload, poor teamwork, a chaotic work environment, and a requirement to chart on electronic systems at home after hours. Physicians are often also finding that their values don’t align with their leaders. Physician burnout is linked to higher rates of medical errors and diminished patient satisfaction. It’s associated with substance use issues, marital discord, and can contribute to suicidal ideation. Physician specialties reporting the highest burnout rates were those on the front lines of care, including primary care (family medicine and internal medicine) and emergency medicine. Primary care physicians (PCPs) are integral to population health in the U.S. and their well-being impacts all of us; by 2018 the US had a shortfall of approximately 14,000 PCPs which is expected to rise to a shortage of almost 50,000 PCPs by 2030. (Association of American Medical Colleges, 2020) Existing interventions The issue of PCP burnout is not only pressing but also multifaceted; successful interventions are required at various levels—targeting organizational level issues such as work culture and environment, leadership, workflows, and structure, and team dynamics, as well as individual issues related to, for instance, coping, stress management, and communication. Interventions for physician burnout are typically group trainings on topics such as communication and stress management. The researchers cited a 2017 study that identified 20 interventions that were able to produce small or medium level decreases in burnout scores. Twelve of these were individual interventions and included training in mindfulness, communication, stress management, self-care, and coping; however, none studied coaching. Along with other reviews of physician burnout interventions, this review comes to the conclusion that there are methodological limitations in the literature, such as a lack of control groups and post-intervention follow-up assessments to evaluate the sustainability of results. Coaching as a potential Intervention The research team describes coaching as a: “one-on-one intervention between a coach and individual coachee that is systematic, collaborative, future-focused, and goal-focused, and is meant to help coachees attain valued professional or personal development outcomes… The one-on-one nature of coaching allows it to be contextualized to an individual’s role and workplace, the challenges they experience, and the meaning they derive from work…We propose that coaching should be helpful for PCPs in terms of accessing personal resources and handling work-related stressors, which should help promote well-being and decrease vulnerability toward and experiences of burnout.” The study intervention The researchers’ hypothesis was that "a positive psychology coaching intervention will promote positive emotional states in PCPs, which will improve their levels of personal resources and well-being. We selected personal and work-related outcomes of coaching that align with our theoretical framework and are indicators of well-being across different PCPs, despite variation in individual PCP’s goals: psychological capital, sense of compassion, job self-efficacy, job satisfaction, work engagement, job stress, burnout, and turnover intentions.”  They describe the potential of coaching to shift these indicators: Psychological capital includes the interrelated dimensions of efficacy, hope, optimism, and resilience. Coachee goal setting and striving as well as reframing negative situations improve positive emotions and psychological capital. Sense of compassion is important in patient care, and compassion fatigue is one expression of burnout. Coaching can help build self-compassion through reflection, and also improve compassion for others. Job self-efficacy represents one’s positive beliefs in one’s abilities to perform well at work. Coaching helps coachees improve confidence by reframing challenging situations and seeing new possibilities. Job satisfaction can be improved in coaching by expanding opportunities for job aspects that bring joy. Meaning, and enthusiasm. Work engagement can be enhanced in coaching by job crafting to align with personal strengths, using strengths to overcome challenges, and increasing opportunities for a state of flow. Job stress and burnout can be reduced in coaching by increasing psychological capital with new strategies and possibilities to better manage overload. Turnover intentions to leave an organization are reduced when stress and burnout decrease and job satisfaction and engagement improve. The study The research team recruited 5 coaches with master’s or doctoral degrees and prior experience in coaching health care professionals. The 59 study subjects were recruited from four medical practices in the Boston area. They were early and midcareer PCPs and more than 70% of them were women. Potential coachees were screened for serious levels of psychological distress that would need mental health support, a study exclusion criterion. The PCPs were randomized using a coin flip to start coaching immediately (29) or waitlisted as a control group with a 6-month delay of the start of coaching (30). The PCPs completed online surveys pre-coaching, immediately post-coaching, and at 3 months and 6 months after coaching. The PCPs received six coaching sessions over a 3-month period. Before starting, each participant completed the Maslach Burnout Inventory and Workplace PERMA Profiler. The first coaching session was a one-hour in-person session that reviewed PERMA results, assessed strengths, and set client-centered goals. The five following sessions were 30-minute phone sessions and concluded with agreement on homework for the next session. Validated tools were available and their use was customized to each coachee: Values in Action Inventory Character Strengths Assessment, Using Strengths in New Ways, Best Self, Mindfulness Reflections, Reframing, Social Flow, and Gratitude Reflections. Each tool included standardized instructions used by all coaches. In the post-coaching survey, coaching framework fidelity (not training or mentoring) was assessed with six questions: Who set the coaching meeting agenda for the majority of your coaching sessions? Who did most of the talking during the coaching sessions? Did your coach tell you how to behave or what to do? Did your coach check-in to see whether the session met the goals you had for the session? Did you have a “homework assignment” to do between sessions? Did your coach review your homework at the subsequent session? Results from this study The coaching intervention significantly reduced burnout, job stress, turnover intentions, improved psychological capital, job satisfaction/engagement, and job self-efficacy by the end of the coaching intervention. The reduction in burnout is similar to an earlier randomized controlled study of a coaching intervention that we summarized in an IOC research dose. The earlier study didn’t find improvements in job engagement or satisfaction as did the featured study. The current study also assessed psychological capital, previously shown to correlate with lower burnout levels in leaders, which wasn’t assessed in the earlier study. In fact, this study is one of the first coaching studies to evaluate psychological capital. The researchers conclude that coaching is an effective intervention for reducing PCP burnout, improving work engagement, and psychological capital. Takeaways for coaches Share the positive effects of coaching on primary care physician burnout in your network, including health care professionals you know. Learn about the characteristics of burnout so that you are better able to recognize burnout for yourself and your clients. Burnout may be a significant clinical issue; be aware of and plan for clinical referrals. Investigate the validated tools used in this study: Workplace PERMA Profiler, Values in Action Inventory Character Strengths Assessment, Using Strengths in New Ways, Best Self, Reframing, Social Flow, and Gratitude Reflections

I first came across the phrase “non-judgmental” long before I even began training as a psychologist, nearly 30 years ago. I didn't like the phrase then, and I like it less now. Why? Well, mainly because it is an instruction to not do something. In my experience, being instructed what not to do is never a good way to learn. Recall your very first days of driving a car - if the instructions to you had been “don't accelerate too quickly”, “don't brake too hard”, “don't go over the lane markings”, imagine how difficult it would have been to learn what you could actually do to drive a car safely (and how anxious you would’ve felt!). The origins of “non-judgmental” are in the humanistic psychotherapy of Carl Rogers. Generations of coaches, counsellors, psychologists and psychiatrists have been taught this mantra. Curiously, the idea does not help us avoid all forms of judgment. If I ask you to define “non-judgmental”, you may tell me that it requires not saying or thinking particular things about clients. But judgment and evaluation can also seem “positive” – when a client comes to a session having completed a particular goal they were working towards and the coach responds with “Wow! That’s awesome – I’m so proud of you!”, it sounds encouraging. But it is, in fact, highly judgmental and evaluative. In this case, we are determining what constitutes good work on the part of the client. You may be of the view that cheerleading like this is not that bad; however – there is an opportunity cost - and in this case the lost opportunity is affirmation. Affirmation can be thought of as a combination of empathy and summary reflection. It seeks to hold a mirror to the client so that they can see for themselves the ways in which their own values, strengths and resources have been used by them. At its best, affirmation can fuel the process of “verbal persuasion” - one of the four means by which Bandura’s social cognitive theory argues that we develop self-efficacy. The shadow side of cheerleading is that it becomes a subtle external cue or reward; and over time, this may lead to a deepening cycle of the client being motivated by the desire for external praise rather than the internal fulfillment of self-efficacy. Cheerleading is a judgment. Affirmation is a reflected observation. The idea that we should avoid judgment does not imply that we should not use our knowledge, experience and wisdom (wisdom = deeply integrated understanding as a result of applied knowledge). Sometimes ethical considerations demand that we bring our knowledge to the fore - for example if the client were at risk of engaging in an activity which may be harmful to their health. At other times, the gentle request by us to share knowledge or wisdom can support the client to clarify confusion or uncertainty and make a useful choice for themselves, with just a little guidance from us. So, to return to the original question - if we are to avoid judgment, then what should we do? The opposite action to judgment is, in fact, curiosity. Curiosity represents a deep desire to understand as fully as we possibly can, the experience of another. To do this, we seek to make sense of their experience not through our own filters and experience. We figuratively cross the room, stand next to the client, turn and orientate ourselves in the same way as the client. Then we call to mind and engage with their values, beliefs, strengths, fears, hopes and dreams and seek to understand their experience through that lens. Curiosity should not be conflated with the action of seeking information from our clients because it satisfies some internalised interest of our own. If my client has travelled on foot across South America and I’ve always wanted to do this, extended exploration of this experience is not likely curiosity; rather, it represents the satisfaction of a non-client-centered urge to know something. At its heart, curiosity is profoundly empathetic. It asks that we adopt a “naive” or “alien” mindset - setting aside our own assumptions in order to understand what is in front of us. In this context, curiosity is not an action – we are not called on to “have” curiosity about a particular aspect of our client’s experience. Instead, we are called on to adopt curiosity as a way of being, a way of engaging with the world around us. When I was training as a family therapist 30 years ago, we were taught to imagine that we had arrived from another planet and therefore had no understanding at all of local customs, practises and ways of being. Every single action that we observed would be new and we would therefore need to adopt a curious mindset in order to be able to learn about what we were encountering. The mechanism by which curiosity averts judgment is very straightforward - judgment arises from passing an experience through our own filters - beliefs, values, past experiences and expectations. When we decide to put these filters aside and look through “fresh” lenses with a continuous desire to understand what is before us, we can no longer form judgments. Rather, we remain open to learning “what is”. The primacy of the relationship between coach and client cannot be overstated. This relationship always sits at the heart of change for the good. In order to honour this relationship, as coaches we must be warm, engaging, affirming and hopeful. And above all, we must be curious.

One element of the many skills developed as part of a coaching approach is the use of motivational interviewing (Miller and Rollnick 2012). MI first emerged as a means of supporting people to manage significant and enduring addictions; however, its efficacy generally in supporting behavioural change is well documented. It is a collaborative and conversational engagement with the client that does not give primacy to expert knowledge. Rather, this knowledge is offered “just in time” and only when absolutely necessary to support behavioural change. One of the very useful features of motivational interviewing is the conceptualization of ambivalence. Coming from two Latin words, ambivalence literally represents the idea of “both options having strength” to the person. In practice, ambivalence is often seen as a problem to be overcome in the client and this can lead very quickly to the health care provider engaging in an ultimately unhelpful tug of war - trying to “pull” the client towards a particular behavioural change, while the client “pulls” equally strongly, to argue for the value they see in not changing. But ambivalence ought not be seen in this problematic way. Rather, it can be viewed as an opportunity to celebrate purpose and drive. Why? The person experiencing ambivalence is feeling driven towards two (or more) quite different outcomes. If ambivalence can be conceptualised in this way, it ceases to be a “problem to be solved” and can be looked upon as an energy or impetus within the client to be worked with – much better to have a desire for multiple possible outcomes, than no desire for any. We all experience ambivalence, and we experience it frequently throughout life. If you’ve ever scanned a cafe menu and felt an urge for two different breakfast options, or experienced the pleasurable dilemma of being invited to two social events occurring simultaneously, or felt thrilled and terrified at the same time as your roller coaster car crests the top of the rise, you’ve had an experience of ambivalence. How can coaches work effectively with ambivalence, to support client autonomy, and to create the conditions most favourable to health behaviour change in a client? Firstly, employ the fundamental tools of engaging communication and connection – deep listening, reflection of what is being said and not said, and open inquiry to understand more. While there are many types of reflection in interpersonal communication, two approaches that particularly support working with ambivalence are the “empathy” and “double-sided” reflections (Moore, Tschannen-Moran, and Jackson 2016). An empathy reflection seeks to reflect the full experience of the person, not only their words: Client: I really wanted to get to 30 minutes of continuous walking this week, but I just couldn’t. Coach: You’re feeling disappointed that you didn’t reach the goal you set for yourself. A double-sided reflection seeks to capture all aspects of a person’s feelings about change (not only those related to the benefits of change): Client: I know that moving more could help, but I’m just so afraid of ending up in the sort of pain I was in last year. Coach: You’re keen to experience the benefits of more movement, and wary of unintended setbacks too. Learn the signs that indicate ambivalence. It frequently shows up in consultations as a combination of “change talk” and “sustain talk” (Miller and Rollnick 2012) or as the client beginning to redirect or correct your efforts to influence their choice. Change talk embodies the client expressing desires, abilities, reasons or needs to make a change. Sustain talk, on the other hand, represents views expressed by the client which seek to justify or legitimise not changing. As a practise point, it's important to avoid what Miller and Rollnick refer to as “the righting reflex” - the tendency of the practitioner to respond to sustain talk with change talk. This leads to a polarising interaction in which the practitioner more and more strongly occupies the “change talk” space and the client strongly occupies the “sustain talk” space. If this continues, the client will likely become irritated or agitated with the coach and feel unheard and misunderstood. In practice, the polarising interaction could look like this: Coach: If you were to begin to gently increase the amount of exercise that you do, what do you think might be the benefits? Client: Well… I'm not sure. Last time I tried that, the pain in my knees was unbearable. Coach: A short term increase in pain is to be expected here, but it's important that you understand that your condition won't improve if you don't start moving more. Client: But I just couldn’t stand any more pain than I have already… If you think you recognise ambivalence, then don’t just do something – sit there. Resist the urge, if present, to convince the client through force, facts or fear about the imperative of change. Instead, take time to listen and to understand the value that the client sees in continuing along their current path. This can be done by using the decisional balance tool (Miller and Rose 2015). The decisional balance tool provides a means for dispassionately exploring the client’s perceived benefits and disadvantages of modifying their behaviour, and also continuing as they are; however, it is best approached in a particular order, beginning with the perceived advantages of not changing. This “meets the client” at the strongest point of their ambivalence. It also demonstrates a desire to understand the reasons for this and avoids the perception on the part of the client, that the Coach may be pushing for change. From here, move to inquiring of the client the disadvantages they perceive in modifying or changing their behaviour. Once this has been explored and reflected, inquiry about the disadvantages of not changing may be explored and finally conclude with a discussion about the perceived advantages of modifying behaviour. When undertaken in this way, the client has walked systematically through all areas of their perceptions and concerns and if appropriate, the discussion can continue, focused on what the client might do to begin the process of change. A decisional balance process may look like this: Coach: What are the benefits you see for yourself in not making any changes to your exercise and activity habits? Client: Well for one thing I won’t get the pain – it’s a killer when that happens. I really can’t stand it. Coach: Mm-hmm– what about the disadvantages you see in increasing the amount of exercise that you do? Client: Apart from the pain, I guess I'd have to re-organise some things in my day to make time for it. And I'm really not sure if I'd be doing the right thing – it's a long time since I exercised. And I don’t know what’s going to be helpful and what may not be. Coach: OK…you’re uncertain about the steps to take and whether they’re the right ones…tell me about the risks you see in not making any changes? Client: All the things you and I have spoken about already – my mobility will continue to decline; the pain I get probably won't ever really go away completely. And in a few years’ time I may find that I’m even less able to do things I want to do. And as I say that now, I worry about that because I really want to travel after I retire. Coach: Right – you need mobility for your vision for the future – so what are the benefits to you of making a change to your patterns of exercise? Client: I do know that exercise will help – and I do really want to be able to move around more freely and without pain. My wife and I have been talking for years about walking the Camino de Santiago when we retire… Lastly, remember the central role that autonomy plays in human behaviour. Autonomy is a primary psychological need of all sentient creatures (Deci and Ryan 1985; Deci and Ryan 2010). If you want to see it in action, observe your dog next time you try and encourage him or her to move away from a scent that's exciting and interesting. The drive to preserve autonomy may also be particularly strong in those who have experienced some trauma. Nothing guarantees that any particular client will engage in behavioural change; however, the honouring of autonomy maximises the likelihood that the client will engage in a behaviour that has meaning and value to them and which they will be able to sustain in the long term. So we should not be afraid of ambivalence – instead, quietly celebrate the energy and interest your client has in exploring and experiencing so many dimensions of life. By always honouring autonomy, and systematically reviewing all dimensions of a possible change, we can help build a solid foundation on which lasting change – driven by deeply held values – can be cultivated. Resources: Deci, Edward L, and Richard M Ryan. 2010. "Self‐determination." The Corsini encyclopedia of psychology:1-2. Deci, EL, and RM Ryan. 1985. "Intrinsic motivation and self-determination in human behavior: Springer Science & Business Media." Miller, William R, and Stephen Rollnick. 2012. Motivational interviewing: Helping people change: Guilford press.

Dr. Angelika Maria Koch shares a powerful story about how her career and life path ultimately came out of a “primal experience” as a young mother when her son was sick many years ago. During this experience while living in England, she shares she wasn’t getting the guidance she needed from the doctor, so she then consulted a homeopath and the remedy didn’t work and she was facing the weekend with a sick child. After discussing taking him to the emergency room, her husband suggested she get quiet, go inside herself, and then encouraged, I know you’ll know what to do. She said this was not a typical conversation they would have and it was out of character but she went along with the idea. She said she was surprised but she was able to get in touch with her inner voice. She recalled thinking, this is an intense situation and I need it (the remedy) in a higher potency. She went back to the pharmacy, got the remedy in a higher dose, and within 24 hours her son was doing well. A week later, she enrolled in a 4-year homeopathic training. Fast-forward many years later, Koch is now living in the United States and has consistently continued her education. She is a doctor of Natural Medicine with her own practice Medica Nova, has a master’s in herbalism, and has accumulated 18 years as an adjunct professor at the University of New Mexico. She teaches courses in Integrated Health Coaching & Integrative Medicine. Koch continues to share her personal story to illustrate how important it is for people to tune into themselves. For her students at the University of New Mexico, a health coaching course is part of the Bachelor of Science and Liberal Arts Degree. She said they start out in the course, because it’s a requirement but, “down the road, they realize this is fantastic.” She says they learn life skills and how they can apply these skills with clients but with themselves first. “They realize this is really interesting,” and she says usually halfway through the semester, she gets calls asking if there is a way to learn more about coaching. For Koch, she has one answer, “Wellcoaches, that is what you have to go for.” “Wellcoaches has such a kaleidoscope of resources. Although it’s based on health and wellness it’s really a universal and unique school which provides a diversity of life skills; from positive psychology to the meditative part to truly hands-on coaching skills.” Koch became a certified coach because, as she says, “for myself as a person, I like to learn.” When working with a client or a patient, she says it’s about “asking them to take charge of their life, guiding them to that place of self-efficacy, self-empowerment…get in touch with that natural impulse to be well.” It’s about taking charge of their life and the health issue is the trigger to catalyze that decision. “It’s not just about how to quit smoking or change the glycemic index. That’s just the entrance.” “Coaching skills provide the client with a sense of wholeness, coming back to oneself. They learn how to meet the obstacles in life and have the skills to overcome them, transform them. This doesn’t mean they are perfect. But they will not forget anymore that experience of self-empowerment. No money can touch that,” she said. “That is the core essence of my practice going within and listening to the truth within. The voice within.”