We speak to many people looking to train as a Health Coach and those who are currently in-training who are often concerned about whether they are ‘qualified enough’ to coach clients, especially if they don’t have an existing health qualification.
The question is really, how much health and lifestyle knowledge and formal credentialling do we really need to support clients with a health concern, and stay within our scope of practice?
Given that Health and Wellness Coaching does not involve diagnosing, prescribing or advising, we don’t need clinical- or degree-level knowledge of health in order to support lifestyle behaviour change. We can leave those things to experts.
A coach specialises in behaviour change and habit formation, so our scope of practice is to help our clients to implement recognised health and wellness guidelines, and the recommendations of professionals who are qualified in specific areas.
However, coaches do need a grounding in the core health areas to have a certain level of health literacy, for the purpose of:
- Understanding and remaining within our scope of practice,
- Knowing enough to ensure our clients are setting safe and effective health goals, and
- Knowing when to refer a client to a formally qualified health professional.
As Coaches we primary work in supporting clients in the What and How
When clients work with a coach, they are generally struggling with two things: 1) what to do, and 2) how to do it.
As the conversation unfolds, most clients admit that they know what they need to do, just not how to make it happen.
The ‘how’ is the easy bit for a coach and this is where we can add the most value. It’s about helping the client to:
- get excited to tackle the area and to feel motivated and confident to start,
- identify the most relevant, effective and engaging ‘habits’ that they will most likely be able to do consistently,
- find the best day/s and time slot/s and methods to take the first steps toward developing the habit,
- navigate home, work, life and other situations that get in the way of consistency positive habits,
- manage their mindset, self-belief and problem solve along the way,
- develop self-accountability, and
- garner the right support, resources and self-accountability processes to help them get it done.
Most of the time, a coach works with a client in these areas of ‘how’.
But sometimes, your clients may lack certain skills and knowledge that are essential to them developing healthier habits. Coaches can help clients work out ‘what to do’, and educate clients in health and lifestyle areas however it is important to learn the art of educating while staying within scope of a Health Coach.
When Clients Need Help with the ‘What’… when they lack health knowledge
Clients may lack skills and/or knowledge in a variety of areas. For example, you may come across a client who:
- isn’t sure which exercises are best suited to their current level of fitness and physical health status,
- doesn’t understand the principles of healthy eating or healthy portion sizes,
- feels they are drinking too much alcohol,
- has trouble managing stress and overwhelm,
- is struggling to get a good night’s sleep.
These are just a few examples!
There are a few ways that you can work with clients who have these sorts of challenges and remain within your scope of practice.
For any of these options, it’s essential that we first find out what a client already knows (so we can see how big the gap really is), and who they are already working with (so we can identify when and whether referral is appropriate).
1. Raising Self-Awareness
A simple first step can be simply asking your clients to create a sleep diary, a food diary, a mood diary etc so they have some self-awareness of their current behaviour.
We often think we know ourselves, but the reality is often quite different, and this discovery can give some perspective and insights into what might be going wrong. Dr Gary Egger’s book, The Expert’s Guide to Fat Loss, points to this behaviour; men tend to think they are taller than they are, women think they weigh more than they do, many people think they exercise more than they do, and so on.
Sometimes, an awareness of what’s really going on can help people work out what to change without the need for special skills or knowledge in an area of health.
2. Providing Information and Options
As a second step, you can ask permission to provide information on health issues, wellbeing and wellness practices that the everyday person is unaware of, and which might help them to make more informed choices.
This is where scope of practice might feel a bit uncertain. Coaches might want to share information to their clients as a way of educating them and building their health literacy, but are concerned that this is prescribing, and working outside scope.
In most cases, this is entirely within a coach’s scope of practice because it’s simply giving information and options.
Here’s an example of how it might work in a coaching session
Let’s say you have a client who is struggling with their cholesterol levels and worried about what might be causing them to increase, given that their eating and exercise habits might already be positive.
A coach might:
- inquire about other areas including stress, sleep etc to see if there are any challenges that might link to their health challenges
- ask the client if they have consulted their doctor about this, and what they have been told
- ask the client what they know about cholesterol.
There are plenty of government guidelines and lifestyle medicine papers on managing cholesterol. You are within your rights to ask a client, “would it be helpful If I gave you some information about the factors that affect cholesterol, so you could understand it better?”
Of course, this relies on the coach accessing government guidelines and evidence-based information from credible sources.
If a client is not working with a doctor, this is also a good opportunity for referral.
Educating the Client
There are ways that a coach can educate a client and remain within scope of practice; it’s really down to the depth and specificity of the education.
Here’s how it might work in a coaching session.
Let’s say a client comes to you and is overweight, but during your initial inquiries, it’s clear she doesn’t know about portion size.
You could ask permission to share a portion size booklet from dietician Catherine Saxelby, so she can understand her current habits in that context and decide what changes she might want to make.
For example, “Lynn, I’m wondering if some information on portion size might be useful for you?” or “Would it be helpful if I shared some information on portion size with you?”
Linking to Catherine Saxelby’s website and specific resources would be helpful.
In another example, let’s say Mal shows up and is stressed and overwhelmed, and quite hard on himself.
You might ask, “Mal, I know you like to read; would it be helpful if I could point you toward some resources?”
If he agrees, you might recommend a book such as The Happiness Trap by Russ Harris, or a website related to men’s mental health, or Kristin Neff’s meditations for self-compassion. Mal gets to choose whether he pursues any or all of these resources.
Of course, you would also consider referring Mal back to his doctor for formal mental health support, which is outside your scope of practice.
Education in Coaching Programs
While a coaching program is not about educating clients (it’s about developing healthy habits), I teach that up to 30% of a coaching program could be educational, to help clients gain the skills, knowledge and motivation they need to help them make change.
If you are designing a health coaching program around a specific health condition such as diabetes or obesity or cancer, you are well within your scope of practice to link your clients to resources including books, websites and fact sheets – as long as they have been developed by the government or qualified professionals in those fields.
Those could include fact sheets on the role of sugar in inflammation and gut health; how alcohol affects the body, and so on.
In addition, stories of lived experience can be used to help people feel heard, understood and hopeful – as long as those stories are not recommending that approach or solution as the only option, or pushing clients down a specific pathway.
Summary
A coach plays two roles when working with a client: helping people work out what to do, and then, how to do it.
Most of our work resides in the category of ‘how’, but a coach can legitimately support clients to gain skills and information while remaining in scope of practice.
A coach’s job is to develop the skills of inquiry to identify the client’s existing knowledge, healthcare support and self-awareness, and then discern whether the client needs formal education and/or referral – or just to have their own answers drawn out of them!
