Dr. Gabrielle Fundaro, CISSN, CHC and Shannon Beer, LLB, MNU-Certified Nutritionist
The attitude of the Comprehensive Coaching © approach is evocative, accepting, and conscientious, and the process undertaken is iterative and emergent. These values and characteristics have been applied to the conceptualization of the Comprehensive Coaching © (CC) framework, which has allowed us to improve the model based on feedback from our colleagues with greater expertise in the areas of health and sport psychology. While the initial CC framework served as a visual representation of the theories and skills included in the process of coaching, its organization was unclear and lacked practical applicability. Skills and theories were not differentiated, and some theories may have been oversimplified and over-emphasized. While the coach-client alliance was emphasized throughout the articles and intimated in the attitude of CC, the process of engaging and building rapport wasn’t explicit in the framework. The new framework is simplified, clarified, and fully integrated to differentiate the theories, skills, attitudes, outcomes, and processes within and between the coach and client. We are grateful for all of the insight and guidance, and hopeful that the new framework will better express our ideas and intentions.
Changes to the Foundations
Former Foundations of Comprehensive Coaching
The original Foundations of Comprehensive Coaching graphic depicted both theories and interventions side-by-side, with an emphasis on the philosophies of positive psychology underpinning the interventions and theories included in the framework. While these are all still included as aspects of the Comprehensive Coaching framework, it was necessary to differentiate between the skills or interventions used and the theories that informed these interventions.
Theoretical Frameworks
The Transtheoretical Model (TTM) and Self-Determination Theory (SDT) are conceptual explanations for how and why people progress through stages of change, which can inform our practices in facilitating their journey [1], [2]. Positive Psychology is a way of studying the human experience that emphasizes individual strengths and potential, supporting the coach’s unconditional positive regard for their client--a key attitudinal aspect for effective Motivational Interviewing practice [3].
Interventions
Acceptance and Commitment Therapy (ACT) involves skills and practices that clients and coaches can apply to promote values-oriented, intentional actions when faced with challenges along the change journey. Cognitive Behavioral Coaching (CBC) is also a skills-based approach to helping clients challenge cognitive distortions that may be impeding their progress [4],[5]. Motivational Interviewing (MI) is its own set of attitudes (the spirit), processes and skills which work synergistically with ACT and CBC to provide a non-judgmental space for clients to explore their ambivalence and the possibility of change [6].
The Foundations changed in both structure and the unintentional hierarchy of positive psychology over other aspects of the framework. While the TTM serves as a useful academic construct to help coaches identify a client’s potential ambivalence or readiness for change, the reality of change is much less discrete and specific [7]. Previously, inclusion of SDT focused primarily on strengthening intrinsic motivation--engaging in a behavior for the sake of enjoyment--but this was a reductionist view of the utility of other internal forms of motivation, and the reality of external motivation as a strong force for initiating (not maintaining) a behavior [8]. While SDT was removed from the framework structure, it is implied in the client’s internal processes with a greater emphasis on values-identification and overall internal motivation to power the initiation and maintenance of desired behaviors. The new framework also reflects empirical evidence suggesting that client autonomy and competence may be more influential than relatedness to increase motivation [9]. The philosophy of positive psychology is implied in both the spirit of MI and the attitude of CC, so explicit inclusion isn’t required. It is also important to note that positive psychology may be oversimplified in its representation on social media, sometimes to the point of toxic positivity. Toxic positivity stigmatizes difficult emotions and compulsively promotes positivity and happiness, invalidating or minimizing authentic emotional experiences [10]. In order to avoid promoting a potentially diluted and harmful version of positive psychology, we chose to remove it from the structural framework, but the emphasis on client strengths and capacity for change remains an integral aspect of MI practice. The skills of CBC, ACT, and MI are delivered to facilitate cognitive, emotional, and behavioral change while enhancing competence and respecting the autonomy of the client.
Changes to the Process
Former Process of Comprehensive Coaching
The initial Process replicated many of the shortcomings present in the representation of the Foundations, with the addition of a cyclical visualization that inaccurately implied a specific order while conflating the skills and theories. It depicted the interventions a coach might use, but failed to illustrate the dynamic between the coach and client. The Process and Foundations have now been integrated in such a way that the skills of MI, ACT, and CBC are applied throughout the process, interactions between coach and client are explicit, and internal processes and attitudes are illustrated.
The Attitude and Spirits Combined
Former Attitude of Comprehensive Coaching
With the exception of explicit positive psychology inclusion, the Attitude has remained unchanged. The new framework includes both the CC Attitude and Spirit of MI depicted as foundational to the delivery of the skills of MI, ACT, and CBC. The characteristics include conscientiousness, collaboration, compassion, empathy, evocation, and acceptance. The skills are always delivered with the attitudinal aspects to maintain rapport between the coach and client [11].
New Additions To The Framework
The reformulated framework emphasises the coming together of coach and client to form a collaborative partnership, combining the coach’s expertise in nutrition, exercise and behaviour change with the client’s own experience, preferences and ambitions. Additionally, we have expanded our Principles, Standards, and Skillset to explain in greater depth our intentions for practicing as a coach embodying this framework in the facilitation of Flourishing Health.
Principles
Prioritize the client’s values and identity to guide appropriate goal-setting.
Bolster client self-efficacy by identifying their unique strengths and acknowledging past successes.
Encourage client autonomy by acknowledging the individuality of client and the client’s own expertise about themselves.
Evoke psychological flexibility and adaptive behavior so that clients are equipped with the necessary skills to take value-oriented action in a range of environments.
Uphold a strong set of ethics by respecting a client’s autonomy and ensuring informed consent is in place at every stage of the process.
Standards
The use of evidence-based practice: integration of research evidence, personal experience/expertise, and the client’s values, preferences and circumstances
The avoidance of dogmatic attachments to specific styles; nutritionally agnostic and impartial to the approach taken to implement, monitor and track the client’s choice of approach
Employment of the framework of Intentional Eating: the client’s informed, reasoned decision to adopt a way of eating that lies at the intersection of their preferences, needs, and goals
The ability to assist with intentional weight-focused and weight-neutral goals in manners that prioritize client well-being and, when applicable, longevity in their sport
Upholding a strong set of ethics and embodying the attitude when interacting with clients and colleagues
Case Conceptualization
The new process begins with case formulation, where the coach seeks to understand the nature of the clients’ concerns, how and why the problems developed, and the type of intervention that may be helpful. We were inspired by the Five Ps of the therapeutic approach to case formulation, which considers the presenting problem, predisposing factors, precipitating factors, perpetuating factors and protective factors that are relevant to the change at hand [12]. We introduced the Five F’s of Comprehensive Coaching, to promote a clear and systematic approach to understanding our clients’ unique experience and obstacles. This comprehensive insight enables us to meet the client where they are at, draw on their personal strengths, and explore different avenues for change.
Latest Iteration of the Framework
Here we present to you the latest iteration of our framework, designed to schematically represent the coaching alliance and the movement towards Flourishing Health.
We appreciate all feedback and recommendations to improve the framework and its application. We encourage coaches and clients to communicate, collaborate and continue to bridge the gaps within the industry! If you would like to connect with others, consider membership in our Comprehensive Coaching Facebook Community, and stay tuned for upcoming webinars!
References
[1] Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48. https://doi.org/10.4278/0890-1171-12.1.38
[2] Ryan, Richard & Patrick, Heather & Deci, Edward & Williams, Geoffrey. (2007). Facilitating health behavior change and its maintenance: Interventions based on Self-Determination Theory. Eur. Health Psychol.. 10.
[3] Seligman ME, Csikszentmihalyi M. Positive psychology. An introduction. Am Psychol. 2000;55(1):5–14. doi:10.1037//0003-066x.55.1.5
[4] Harris, R. (2009). ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
[5] Cognitive Behavioural Coaching in Practice: An Evidence Based Approach. (2013). United Kingdom: Taylor & Francis.
[6] Miller, W. R. (William R., & Rollnick, S. (2013). Motivational interviewing : helping people change. Guilford Press.
[7] Michie, S., Ashford, S.,Sniehotta, F.F., Dombrowski, S.U., Bishop, A., French, D.P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology & Health, 26(11), pp.1479–1498.
[8] Rodgers WM, Hall CR, Duncan LR, Pearson E, Milne MI. Becoming a regular exerciser: Examining change in behavioural regulations among exercise initiates. Psychol Sport Exerc. 2010;11(5):378-386. doi:https://doi.org/10.1016/j.psychsport.2010.04.007
[9] Ntoumanis N, Ng JYY, Prestwich A, et al. A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health [published online ahead of print, 2020 Feb 3]. Health Psychol Rev. 2020;1-31. doi:10.1080/17437199.2020.1718529
[10] Gross, J.J., & Levenson, R.W. (1997) Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, 107(1), 95-103.
[11] Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behav Cogn Psychother. 2009;37(2):129-140. doi:10.1017/S1352465809005128
[12] Macneil, C. A., Hasty, M. K., Conus, P., & Berk, M. (2012). Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice. BMC Medicine, 10(111), 1–3. https://doi.org/10.1186/1741-7015-10-111