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Category: Coaching

slaoG

Posted on | Coaching
Follow the arrows to the bathroom, they said.

What’s the easiest way to solve a maze? Often it’s the same way with accomplishing your goals. Here’s a helpful drill that I use with people when they feel overwhelmed or don’t know how to start or move towards their goal. I call it the ‘Days before’ drill.

Days before

Imagine a time in the distant future when you’ve achieved your goal. Take a minute or two to really immerse yourself in what you see, hear, and feel as you enjoy that satisfaction.

Now, reflect on the day before – what small thing did you do to put the finishing touches on accomplishing your goal? Write this down for Day Before 1.

Think back to the day before that one. What 1-3 small things did you do on that day? Write this down for Day Before 2.

Keep going back, one day at a time, and think about what 1-3 small things you did to work on your goal. Continue this process all the way until you get to your current situation.

Important notes

  •  The number of ‘Days before’ doesn’t matter at all – it could be 50, it could be 500.
  •  I always tell my clients that they’ll be revising this plan at least a few times as they realize some things need to be added and some can be taken away. Therefore, it’s generally best to write it down using a computer instead of pen and paper.
  •  Some steps in the process are very large tasks – instruct your client on breaking this down into small things to fit the format. It makes these tasks much less intimidating.
  •  It’s important to tell them that the ‘Days before’ are not necessarily consecutive. Day Before 2 and Day Before 3 might actually have a week in between them in real time. This also makes them much less intimidating by removing time pressure. It also accounts for just busy days in our lives, vacations, and other normal events.
  •  I actually don’t tell my clients to follow this plan once they’ve made  it. They almost always do because it gives them a clear path to their goal, but I leave it up to them when they start. I approach it as a mental exercise and not an obligation.
  •  As they begin to follow the plan, we’ll often tweak it by adding other things as their focus and understanding shifts.

Example

I had client who had just moved into a new house and getting settled into was one of several major stressors in her life. She was an engineer so I knew she was very organized so I had her do this drill which she loved.

As we worked on her stress in other areas of her life, I would occasionally have her come back to this plan and revise it to add in other important things. Taking time for herself was a large component of her stress management plan and so I had her revise her ‘Days Before’ plan to account for days for herself. As she did that, she realized she also needed to deliberately set out time for her family and friends and she added that in as well.

This drill helped her get organized for settling into her house, but it also helped her build an awareness of her needs. She had realized that she assumed time for family and friends would just happen when it didn’t always work out that way. This allowed her to continue enjoying spontaneous moments with friends and family, but also learn when she needed to reach out and set something up.

Meaningful goals

Posted on | Coaching
This was pretty much her goal, only with a different finger.

I once received a physical therapy referral to treat the sprained joint of a lady’s middle finger. It’s the middle finger, haha, yes that’s funny – but now consider the fact that she was to come in to do physical therapy on a jammed finger. Not a broken finger, not a torn tendon, a jammed finger. Needless to say, I was very curious how our interaction would go, but it turned out her finger was healing normally (surprising no one) and she was actually coming in because she had chronic low back pain.

When I saw that referral, one of the first things I thought of was goals. They should generally always be about improving quality of life, so I figured we’d write something like, “Within 2 weeks, patient will be able to extend interphalangeal joints of 3rd digit to at least 0 degrees to be able to fully express herself while driving.”

Of course I was prepared to be flexible. If I thought that wouldn’t be attainable, we would have to go to alternative movements like teaching her to shake her fist angrily. Treatment probably would have included a lot of dynamic oscillation like using a Shake Weight or a BodyBlade.

Most have probably heard that goals should be SMART. Specific,  Measurable, Attainable, Realistic, and Time-based. This is a great way to guide writing both short- and long-term goals. If someone where trying to lose weight, this would help them set certain amounts to be lost within a set, but reasonable timeframe. However, this type of goal does tend to be a little sterile. To add depth, you should also set an overarching goal. This goal should be short, emotionally meaningful, positive, and future-oriented.

Let’s break that down. A short and emotionally meaningful goal means it cuts right to what they want. So if weight loss goals are in terms of pounds lost in __ weeks, this overarching goal would be something like, “I want to feel good about my body.” It’s not specific or measurable but it gives the reason why weight loss is important. True, you can add this to the end of your SMART goals: “Within 1 year, I will lose 40 pounds to feel good about my body.” But you can tell from comparing these two goals that by adding more, you actually take away some of the emotional meaning.

Next, a positive and future-oriented goal. Positive, here, means a goal in terms of things you want, not in terms of what you don’t want. If you ask most people their goal, they will initially tell you a negative one. “I don’t want to have pain.” “I want to stop smoking.” These seem like reasonable goals to strive for, but the issue is the focus is on the problem. The only way to tell if you don’t have pain is to pay attention to your pain all day, which would be the opposite of reducing its impact on your life. In order to form a positive goal, you need to find out what they want for their future. “If you didn’t have pain/smoke, what would you do?” Or “What would being pain-free/stopping smoking/losing weight do for you?” These questions can cut down to their motivation and help shift their focus from the problem to the future benefits.

A final note on the goal being future-oriented is that the timeframe doesn’t have to be explicitly written. When they think about this goal, a scenario of what it would look like will pop into their head. The more ‘real’ they (and you) can make it, the better. You can ask them about what completing this overarching goal would look like. Question them on all sorts of details about whatever comes to mind – when is it, who’s there, what do you feel, what do you see, what do you hear, where are you, and so on. If they can feel like they own this future, that it is theirs, then they will work very hard to claim it (and maybe even more importantly, to avoid losing it).

Anytime you review their goals, you can come back to this overarching goal and talk about what they’ve done to make it happen. Emotion is the fuel to our behaviors and this will help keep them motivated.

Chunking up using your mouth

Posted on | Coaching | Communication Techniques
When swimming in shark infested waters, always take a slower friend with you.

Note: Chunking up is a language technique, not a tutorial on shotgunning pizza (stay tuned on that).

When I was in PT school, one of my instructors always used the phrase “Let’s zoom out for a moment” to refer to when it was time to take a mental step back and look at the big picture. The natural extension of this was that our clients’ problems were like sharks. They seemed really scary when you’re in the middle of them, but if you ‘zoomed out’ and looked down from above, they weren’t so bad… For the record, this metaphor was used constantly throughout his classes and I still don’t know what they hell he wanted us to do about these sharks.

Unirregardless, zooming out, or ‘chunking up’ as some call it, is very useful to help your clients. Most of them are stuck in a loop and by changing the reference point, they can look at their problems in a different way. Often this involves putting things into a different perspective or context.

For example, if some says, “I’m so stupid”, they‘ve made a very general statement. So your job would be to put that statement in a context. You could ask, “what situation do you feel stupid in?” This removes the identity component (you feel stupid vs you are stupid) and can help narrow the problem significantly. Maybe they just feel stupid when they’re at work. This is much less than feeling stupid 100% of the time and is very context-specific.

You can chunk up anytime someone makes a very broad statement. Using terms like “always, never, every time” are often applied to problem statements. You can chunk up by asking when, specifically, they have the problem. By the time you’ve narrowed it down to specific situations, their problem will seem much smaller because you’ve ‘zoomed out’. You will also then have very specific things to work on, instead of a poorly defined problem.

The other advantage to chunking up is, it gives you what I call ‘handles’. Handles are different things that you can grab onto to help them work on their problem. If someone comes in and says, “Everything hurts”, then you’ll initially have nothing to grab onto to start. When you chunk up by asking “everything hurts?”, they’ll start defining their problem more specifically which you could then work with. The more ‘handles’ you have on their problems, the more ways you can spin it, approach it from different angles, or address specific situations.

Summary

Chunk up whenever someone states their problem in really general terms.

  •  Getting context: “What situation, specifically, do you feel __ in?”
  •  Addressing universals (always, never, every): reflect the statement back as a question with emphasis on the universal, “every time?”

Breaking bod

Posted on | Coaching | Communication Techniques | Pain
Tell me where you keep the Thera-bands and no one has to get hurt.

Last post we discussed helping people change their limiting beliefs they have about themselves in order to move past their problem. Nowhere is this more important than with pain. Things that affect our body, affect the mind. The most common belief is “I have X which causes my pain” with X being arthritis, slipped discs, bone spurs, etc. This can be simplified to the belief: “X causes pain”.

Let’s take the statement, “my pain is due to arthritis.” The fundamental belief of this statement is that arthritis (A) causes pain (B). To ‘crack’ this belief open, you can cast doubt on the cause-effect relationship by explaining counter-examples of when A happens but B doesn’t (A, not B) and when B happens and A doesn’t (B, not A).

A, not B: arthritis but no pain.

  1. This discussion can be started with general counter-examples. Research indicates that many people who have x-rays showing arthritis, don’t have pain. For example, 37% of those over 65 have x-rays showing knee arthritis but only 10% of men and 13% of women have arthritic knee pain. Then you can plant this seed of doubt: what’s different between those people with pain and those without?
  2. Now you can also get specific to your client. When you took their history, they probably already told you how their pain fluctuates throughout the day. But if all of their pain is due to arthritis, why would that happen? Since arthritis is provoked by weight bearing, it shouldn’t hurt while sitting down but many people do report aching at rest. Why does it hurt worst just after standing up but then gets better after they moved a little? If all of their pain is due to arthritis, shouldn’t it feel best after resting and only get worse with walking? If they don’t tell you these things, you can ask probing questions about when they have pain so you can later point these counter-examples out.
  3. Research is all well and good, but most people don’t think it applies to them because they’re a special case. You can, innocently, ask about other areas in their body. If one knee hurts, does the other knee hurt? Or hurt just as bad? If their back hurts in one area, do the other levels of the spine also hurt? After they answer these questions, you can point out that if one knee has arthritis, you can almost guarantee the other one has a similar amount of arthritis. So why don’t they hurt the same? And the same logic goes for different levels of the spine.
  4. All of these counter-examples serve to point out that all of their pain might not be due to arthritis alone. This leads nicely into ‘B, but not A’.

B, not A: pain but not all due to arthritis.

  1. So now your client is likely more open to believing that their pain might not all be due to arthritis. The question, then, is what is causing their pain?
  2. If you’re working with someone in pain, then I assume you’ll also do some sort of examination in order to make your own decision on what is wrong with the client. Say you do your examination and you find they have weak core muscles, tender/trigger points, muscle tightness, nerve tension, soft tissue restrictions, joint mobility restrictions, etc. These are your explanation of what else is contributing to their pain (besides arthritis). You’ll then follow-up by explaining how you will help them resolve these problems which will decrease or eliminate their pain.
  3. This is incredibly important to success because now your client understands that there are other contributors to their pain and that you can address them.

How to use this

With this covered, I’ll now go into how I believe this can best be accomplished. First, when you’re planting seeds of doubt, it’s usually best to ask pointed questions rather than just bombarding them with counter-examples. Telling them, “Well you told me your other knee doesn’t hurt as bad and since that also has arthritis, arthritis must not be the only cause of your pain” – is a great way to get them to shut down and clam up. Instead, you can ask, “does your other knee also hurt this bad? If that knee also has arthritis, what might be different? Ok, so you think arthritis is the difference?”  The last question really plants the seed when you place a doubting tone on the word arthritis, to convey to them that you might have your doubts about it. They’ll probably respond by being slightly confused at which point you can just move on to either counter-examples, or straight to your examination. Your examination will then reveal other factors that were contributing or even causing the pain which will answer your question for them.

I won’t tell you how to do your examination or what impairments to look for. However, I will say that I think every clinician should include a discussion of the nervous system. This doesn’t need to be complex, but explaining how the body’s “software” contributes to pain is extremely valuable. First, there is the threshold concept. This is usually explained using the metaphor of a cup. Your body’s pain threshold is like a cup. Different things can fill it up which is no problem. But once it is overflowing, then you have a problem. Similarly, the different impairments in a region can all add to the ‘cup’. This can include arthritis, muscle weakness, soft tissue restrictions, etc. If the cup is overflowing, then removing some of these problems (treating weakness or using manual therapy and so on) can decrease the problem. This is the equivalent of pain reduction. If you can remove enough of the problems so that the cup is no longer overflowing, well then you have no pain. Even though there might be things in the cup like arthritis, if it’s not overflowing, you don’t have a problem. This nicely opens up the possibility of partial or complete pain relief while still acknowledging that you cannot remove things like arthritis for them.

The other important piece of information is where pain is. If your right knee hurts, you assume pain is in the right knee. However, your right knee is just sending the signals up to your brain. Where you actually have pain is in the ‘right knee’ area of the brain (to be more complex, in the somatosensory cortex). This information can be extremely important because it helps explain why your interventions and treatment might work. After all, most believe that exercises, adjustments, massage, etc. can’t really ‘solve’ problems like arthritis, a torn meniscus, bone spurs, cancer-related pain, and other ‘structural’ problems. Sure, they can help, but the relief won’t last or they’ll never truly get rid of it. By explaining that your interventions not only affect their body but also their nervous system, you can ‘change the target’ so to speak from something impossible to change, to something that can be changed (how the nervous system processes pain signals).

Summary

When someone tells you their problem is something you can’t change (like arthritis), you goal is to open up the possibility that their problem is something you can change. This often starts with planting doubt that what they believe is the problem may not be the problem, or at least not the whole picture. Then, you should identify, with your examination, what the problem is and how you’ll address it.

I think, therefore I’m

Posted on | Coaching | Communication Techniques
She thought snorting crushed up Mentos and some Coke would be funny…

Most problems are rooted in a limiting belief. There are 5 components to a limiting belief: referent = [bad thing] —> problem. Let‘s take this negative statement, “I am stupid which is why no one likes me.” ‘I’ is the referent (subject of the sentence), ‘am’ is the equivalence (=), and ‘stupid’ is the [bad thing]. Next is the causation and problem. ‘Which is why’ indicates a cause-effect link between being stupid and no one liking them so it is the causation. And “no one likes me” is the problem.

When you’re helping someone break a limiting belief, you can try to ‘crack’ any of the negative components, generally being the [bad thing], the causation (—>), or the problem. To start with the example, you could come after the [bad thing] – ‘stupid’. This is what most people reflexively do by saying “you’re not stupid.” Disagreeing with their statement rarely works. Instead, it’s better to agree with it in some way. If you’re good friends, you can tease them about ‘being stupid’ until they laugh and defend themselves. Or you can agree with the positive of being ‘stupid’. This is a positive reframe and will vary based on the person you’re talking to. Someone might call themselves ‘stupid’ but really mean they blurt things out without thinking it all the way through. To them, you could say, “you’re an outspoken person who doesn’t mind being honest.” This can turn being ‘stupid’ into being ‘honest’.

Another component you can address is the causation (—>). In this example, it’s that ‘being stupid’ causes ‘no one to like you’. The easiest way to ‘crack’ causation logic is to explore counter-examples. Take this as the basic format: A —> B. Counter-examples would be any time A happens, and B doesn’t OR anytime B happens, and A doesn’t. A is ‘being stupid’ and B is ‘being unlikable’. Think of examples of A, not B: being stupid but likable. We probably all know people who aren’t the brightest but are very enjoyable to be around. You could point out some examples you know they know. Now, think of B, not A: being unlikable but smart. That’s also very easy to think of, since we all know some people who are like that.

Finally, you can address ‘the problem’. Here, it’s “no one likes me”. The most straightforward way to ‘cracking’ this is to reframe a key word in the problem, or question if it’s actually a problem. First, reframing key words. The easiest targets are any extreme words: no one, never, always, have to, must, every, etc. In this example, you can just reflect the statement back to them with a doubting tone, “no one likes you?” From there you can narrow the scope of the problem to ‘no one’ to ‘just some’. You could also reframe ‘likes’ to something else. “Maybe it’s not that people don’t like you, they just don’t know you so they don’t talk to you.” You can also reframe ‘me’. “Maybe it’s not you they don’t like, but something else.” – this could be anything else like talking at work or even they don’t like your taste in music but are fine with everything else. These reframes will be very specific to the actual situation happening. Finally, you can also question the problem. For example, if the people who don’t like you are jerks, do you really want their approval?

This approach of ‘cracking’ a limiting belief is often a big step towards finding new solutions. Limiting beliefs serve as walls that keep us locked in our problems. To break these walls down is to begin to move forward. Or laterally, or up, or down – any direction that’s outside their old rigid thinking.

Next post I’ll continue on this topic with a specific example for applying to chronic or persistent pain.

Troll the respond, Jeremy

Posted on | Coaching | Communication Techniques
“Will your partner be joining us this session?” “What do you mean, she’s right here in my arms.”

Clients often come in with problems and they almost always have the indecency to expect you to help them, just because you took their money. Your goal as a coach/clinician/hairdresser is to get them to solve their own problems – it’s much less work for you that way. So, in that interest, here are 6 ways to respond to your clients to shove them in the right direction.

Responses 1-3 tend to align with motivational interviewing – an empathetic communication style that allows the client to do most of the talking, while the clinician gently steers them towards change. Your responses are made as a statements, meaning with a downward inflection at the end, to allow your client to freely elaborate (instead of asking questions which tends to limit your clients to just answering the question and nothing more).

Responses 4-6 align more with provocative coaching – an irreverent communication style that relies on humor, trolling people, and essentially using ‘reverse psychology’ to provoke the client to change. In provocative coaching, you ramble on as the devil’s advocate and make all sorts of excuses for your client, not letting them get a word in edgewise, until they finally interrupt you to protest that your excuses don’t matter (thus taking accountability for their own actions). It is essential when using this style that you use humor that is directed at their actions and not at them as a person, as well as humor directed at yourself. So here they are.

  1. Acknowledge their thoughts of change
  2. Acknowledge the benefits of change
  3. State their interest in finding a solution
  4. Humorously encourage the problem behavior. Even suggest that they should do it more
  5. Provocatively question why they would want to change. Wouldn’t they miss the perks of their behavior?
  6. Provide excuses and justifications for why they continue to do it and why the results aren’t good

Now here are some sample statements with examples. The first one, they’re generous enough to tell you their goal and their obstacle. The second one, they just tell you the problem. Notice that responses 1-3 work by encouraging the client to elaborate on good things, while responses 4-6 work by getting them to defensively make change statements or accept responsibility.

“I want to lose weight, but it’s hard to eat healthy.”

  1. Thoughts of change: you’ve thought about tackling this problem already.
  2. Benefits of change: you already know losing weight might help you enjoy some activities more.
  3. Interest in solution: you’re interested in learning to make eating healthy easier.
  4. Encourage the problem (do that more): gaining weight is a lot more fun and the point of life is to maximize your enjoyment! [Here they might protest that it’s not all fun and point out reasons they want to change.]
  5. Question change: why would you want to lose weight when there are so many perks. You can eat whatever you want and you float a lot easier. [They might respond with why they do want to lose weight.]
  6. Make excuses: well, eating healthy is really hard and you probably are too tired at the end of the day to cook. [They might explain that they actually do have time to cook, accepting responsibility.]

“School makes me anxious.“

  1. Thoughts of change: you’re here to see what can be done.
  2. Benefits of change: learning to control your stress would probably help you with your grades and how you feel about yourself.
  3. Solution interest: you want to learn to be confident at school.
  4. Encourage the problem (do that more): that’s good – it means you’re on your toes. Teenagers will attack at a moment’s notice, so if anything, you’re not anxious enough. You really ought to keep your phone out and on selfie mode at all times so you can always see behind yourself.
  5. Question change: stress can really do wonders for getting your digestive system moving – some people say it even works too much, but there really is no such thing. Being regular is a gift, do you really want give that up?
  6. Make excuses: high school is really hard. You have no idea who you are, what you like, or what you’re doing at all which is why you’re so awkward with everyone.

There are many more types of responses for both motivational interviewing and provocative coaching, but that’s it for now!

The United Strengths