Behavioural Change

Dr Mark Rowe www.drmarkrowe.com

Simon Matthews wellcoachesaustralia.com.au How relationships drive behavioural change

In his opening conversation with Simon Matthews, podcaster, Medical Doctor and Tedx speaker, Dr Mark Rowe almost baffles his guest with the simplicity and straightforwardness of his first question.

Rowe: So Simon, what is health coaching?

To start with, we can turn to a definition from the Health and

Wellbeing Board in the United States. Their definition is a process in which coaches partner with clients who are looking to enhance their own health and wellbeing through self-directed, lasting changes.

The self-directed part is important, and we can come back to that. The other important part is that those changes are aligned with the person’s values.

That definition goes on to mention the specific characteristics that coaches ought to display, for example, unconditional positive regard towards patients which goes back to a very old concept and the work of Carl Rogers much earlier in the 20th Century - a fundamental belief in a person’s ability to engage in a process of change and begin to make some change.

It's probably important to separate that definition from ideas like a person has everything that they need within them to be able to make the changes they want. That’s not the idea that’s embedded in this definition. A helping hand

We all need a helping hand sometimes. We all need an injection of knowledge or an injection of skill or something like that.

The idea of coaching is that it’s not practitioner directed and it’s not an advice-forward means of supporting people. We don’t immediately go in telling people what to do or what they should do. It’s listening, learning and then understanding how to collaborate with a person.

Rowe: One of the things I’ve learned as a doctor is that people don’t like being told what to do. As adults, we like to make up our own minds. Certainly, we can be inspired, and we can be influenced, encouraged and supported but making change isn’t easy.

Absolutely, and you touched on one of the central tenants of good coaching there, Mark, the point that we don’t like being told what to do. This, of course, goes all the way back to childhood. Anyone who has ever had a child or has ever been in a playground will probably be able to recall a child saying, ‘you’re not the boss of me’.

That phrase embodies the idea of autonomy. It embodies the idea that one of the things we fundamentally prize as human beings is the capacity to make a choice about what we do when In one of his recent podcasts, Ireland’s Dr Mark Rowe interviewed psychologist Simon Matthews. Simon is CEO of Wellcoaches Australia and a fellow of the Australian Society of Lifestyle Medicine. He writes and coaches on health coaching and behavioural change.

we do it, how we do it and, importantly, why we do it as well.

Rowe: Yeah, and I think that’s one of the opportunities of bringing that kind of Lifestyle Medicine approach with some positive psychology into the medical consultation. You just tune more into the person in terms of their capacity to direct their own changes with support because, if you think about it, people know often what to do. They know they should do some more exercise, maybe they know they should get more sleep, they know they should eat better, take on less and deal better with stress, but it isn’t so easy to make the changes, is it.

That’s exactly right, and that divergence you describe there, the divergence between knowing what we ought to be doing and putting it into practice, that’s the space that any coach is most effective in; to be able to support someone, to bridge that gap.

Health coaching is certainly not about getting people to do something. It’s not something to make someone do the exercise; perhaps, in the back of their minds, they have an inkling they should be doing or making someone eat a diet. It’s a process that invites someone to examine their own values, to uncover their motivations, understand more about themselves and ultimately to make a choice that best aligns with the underlying values that they have at that moment.

That, of course, means there is always a risk. There’s a risk, for example, that in working with someone who is smoking and has been told a lot of times that they ought to give up smoking - there’s a risk if we take a coaching approach that that person might come out the other side of it and say. ‘you know what, I’m balanced, I want to keep smoking. Smoking is a better fit for me with the things that matter to me in my life right now.’ Accepting the choices people make

One of the things we need to do as coaches and health practitioners is, in a sense, be okay with those choices that people may make even if they are not aligned with what we believe is best practice or what we believe is the healthy choice or the healthy option. That’s a challenge.

Rowe: It is. One of the things we see in primary care and general practice is that people can have different views about health behaviours at different moments in time. This feeds into what’s known as the wheel of change. So, if I see somebody who is a smoker, one of the interesting things is to assess where that person is at. Are they a contented smoker or are they potentially considering a change? That can change over time. One of the great things you get in general practice is repeated opportunities to influence somebody in a positive direction. And then, when that person is ready, maybe then you can move in with appropriate advice.

That perspective is so valuable – the idea that there are repeated opportunities. This is not a once-only chance to do something. In fact, the idea that our motivations may shift across time is central to the idea of behavioural change.

If that weren’t able to happen, then no one would ever make a change whatsoever; we would just stay where we are.

So, this idea of being able to approach the same person with openness and curiosity each time you see them is central to coaching. In fact, one of the illustrations given to me many years ago when I was training as a psychologist and a family therapist was the idea of a Polaroid snapshot. A Polaroid moment

When someone describes something to you or a patient or a client describes a value or a motivation, belief or a situation that they’re in, we’re best to treat that as a Polaroid of that moment and not one of those portraits that hangs up in the family home and endures for decades and decades. We’re best to think of it as just what that person is experiencing and describing at that moment in time.

Rowe: Yeah, I love the story philosopher, Heraclitus, who said, ‘no man ever steps in the same water twice’. It’s not the same water, it’s not the same person. That’s what you’ve just paraphrased there.

Exactly right.

Rowe: It’s that change is constant. Simon, in your experience, what makes health coaching interventions likely to succeed?

There are many, many ways to answer that and from many different perspectives. I’ll share with you what I think is central to coaching.

For me, coaching is fundamentally about the creation, development and maintenance of a relationship with another human being.

When we do that to the best extent that we can, when we’re focused on the creation of a genuine relationship of meaning and understanding and wanting to step into the shoes of the other person, when we do that, behavioural change is almost like a consequence. It’s almost an unavoidable result of doing that.

It’s one of the ways I’ve come to think about coaching more recently. We can get too focussed on the idea of changing behaviour or trying to change behaviour or being a motivator of change.

For me, the thing that works is the creation of a relationship in which my primary task is to set myself aside, to step into your world, step into your experience as you describe it. To listen to what you are telling me. To think, to understand what life is like as you live it.

And, from that point then, it is to engage in a discussion about possibilities that might emerge in the future – things that might be different in future.

For me, relationship is the essence of coaching.