There’s a new methodology on the psychology block, and it’s called coaching, writes Dr Jocelyn Lowinger.
Just pick your need and there’ll likely be a coach who claims they can meet it. Whatever it is – wellness at work, relationship management, career planning – coaches are out there spruiking their wares. And insurers and government agencies have jumped on the bandwagon.
A particular favourite at the moment is telephone coaching. From smoking cessation, to physical activity and weight management, to diabetes support, people can simply pick up the phone and be coached through their issues. Easy!
And while there’s growing evidence for the benefits of well-conducted coaching, it’s an unregulated industry and anybody can claim they are a coach without restriction. Hyperbole and over-promising abound.
So what is the evidence for coaching? How good is it as a tool for helping people better self-manage chronic conditions? And how might coaching help doctors?
Drawing from elements of consulting, mentoring, and therapy, coaching has emerged as a unique discipline. It is designed to assist people create positive and purposeful change, achieve personal and professional goals, maximise potential, as well as enhance subjective and psychological wellbeing (1).
But coaching is not therapy – or consulting, or mentoring – for that matter. While coaching draws heavily from psychology and has an impact on wellbeing, it is not designed to directly address psychological problems or mental-health issues. That does not mean that people with mental-health issues, such as depression or anxiety, cannot engage in or benefit from coaching, but it does mean that coaching is not the right method to directly address those issues.
The term evidence-based coaching was first used in 2003, as practitioners worked to establish coaching, in particular coaching psychology, as a discipline derived from methodologically rigorous and relevant research. Coaching psychology was keen to be differentiated from non-scientific popular approaches, such as pop psychology (a la Tony Robbins), “new age” and “self-help” genres.
Coaches who use an evidence-based approach are trained in coaching psychology and base their practice on empirically tested frameworks, theories and techniques. This builds confidence in the effectiveness of their methods in helping clients achieve their desired outcomes (2). One example of a theoretically based coaching approach is cognitive behaviour coaching. This is currently the most frequently assessed, theoretically based coaching methodology. Ten of 18 studies included in a recent meta-analysis assessed the efficacy of coaching involving cognitive behaviour coaching (combined with or without a solution-focussed approach) (3).
Derived from cognitive behaviour therapy, this type of coaching is said to bring about change through identification and correction of maladaptive thoughts, emotions and behaviours to develop more evidence-based and adaptive thinking. But remember, coaching is not therapy. So where CBT focuses on addressing clinical problems and developing coping mechanisms, cognitive behaviour coaching focuses on the promotion of wellbeing and purposeful change. It does this through facilitation of greater self-insight into thoughts, feelings and behaviours and removing psychological blocks to attaining goals and change (4). A seemingly subtle, but important, difference.
The collection and interpretation of evidence assumes agreed standards of practice and outcomes. However, coaching is unregulated, so agreed standards are few. This means it is not clear how generalisable evidence is across various contexts. Further, coaching operates in an environment of complexity, uncertainty and instability, with no guaranteed linear relationship between cause and effect, making evidence-based coaching difficult to apply (5).
Currently, the volume of high-quality coaching-specific research is limited, of variable quality, evolving, and reveals only a small slice of the whole truth about coaching (6). Evidence cannot speak to all elements of importance and not everything can be measured (7). Even the most rigorously conducted and replicated studies designed to remove bias and random error cannot fully describe the true effect of an intervention (8). This is as true for medical science as it is for coaching.
The National Health and Medical Research Council has long recognised this challenge. Not every research question is a randomised controlled “nail” so we need to learn which “hammer” (or indeed other tool in the box) to best “hit” the research question with. Matching the methodology to the research question is the key. Research on coaching highlights this need, and effective, replicable methods based on an evolving theoretical framework are still being developed.
Theories and techniques used in evidence-based coaching are grounded in psychological theories of human behaviour and motivation. These theories include:
- Control theory – how people self-regulate
- Goal theory – how people set and attain goals
- Self-determination theory – how meeting basic psychological needs (autonomy, competence and connectedness) enhances motivation and goal attainment
- Change theories – how to help people design and implement change (and understand what gets in the way)
- Adult development theory – how people develop “perspective taking” and “meaning making”
- Systems and complexity theories – how groups, teams, and organisations operate
Many techniques have been adapted from clinical psychology and used to promote purposeful and positive change. These include:
- Acceptance and commitment coaching
- Cognitive behaviour coaching
- Person-centred (humanistic) coaching
- Positive psychology and strengths based approaches
- Psychoanalytically informed coaching
- Solution-focussed coaching
Doctors and coaching
Coaching can be provided in a range of domains, including business, career, executive, health and wellness, leadership, life, relationship, and workplace. Doctors might choose to undergo coaching as a professional development, personal and career-support tool.
A key area in this respect is burnout prevention (9). A 2013 South Australian study showed a cognitive behaviour coaching intervention reduced distress levels of rural GPs and improved retention (10). And a 2016 study showed group coaching supported junior doctors in their transition from medical school in a number of areas, including professional identity development, career planning and managing a healthy work/life-balance (11).
Coaching can also be anticipated to assist doctors with a range of important career aspects including:
- Development of leadership, supervision, mentorship or teaching skills
- Career planning for selecting a specialty or planning a working life outside clinical practice
- Support through study and training programs.
Choosing a coach
Done well, by appropriately trained and experienced practitioners, coaching is an effective evidence-based behaviour-change methodology. Numerous large corporations and public-sector agencies were quick to recognise the benefits for their staff, and have been effectively using coaching for some time. Health professionals are now beginning to appreciate the gains for themselves. But finding the right coach with high level skills can take a bit of searching.
Coaches come from a range of professional backgrounds and training. These include: professionals with, often extensive, on-the-job experience rather than formal qualifications, those who’ve paired their professional background with coaching courses of various lengths and rigour, and some who have complemented their professional background with a postgraduate qualification. The University of Sydney has recognised the need for rigour in this field and offers a well-regarded Masters in Coaching Psychology through their psychology department. The requirement for psychological training in coaching is not compulsory, but recent Australian and Israeli research suggests coaches who have an academic background in psychology are more effective (12).
Opinions differ regarding whether coaches should have a background in the relevant professional discipline or industry. For doctors, there are potentially some advantages for a coach to have healthcare knowledge and experience. These include a deep understanding of the sector and the challenges doctors face. However, sometimes having a person outside the health sector can provide fresh, and needed, insights.
There are a number of accrediting organisations through international bodies including the International Coach Federation, the Association for Coaching, and the European Mentoring and Coaching Council. Accreditation primarily assesses a coach against pre-determined standards (13). Accreditation is different to certification, which is less reliable and is often self-applied (14).
Not all coaches practice the same way. It’s important that a coach can explain the methodology they propose to use, how long coaching will take, and how coaching will be evaluated. As one writer notes: “If a coach can’t tell you what methodology he uses – what he does and what outcomes to expect – show him the door.” (14)
Experience and reputation
There are complex rules about how doctors are able to advertise their clinical services. In general, this means not using testimonials to promote their practice. How this applies to doctors who provide professional coaching services is unclear. However, a recommendation from a trusted colleague about their experience working with a professional coach can be invaluable. A satisfied customer may be one of the best ways to tell how good a coach is. Ask for references and see if you can talk to some of the people they have coached before.
So much of the work doctors do is focused on our patients’ needs. And that’s how it should be. But if our needs – both as professionals and humans with lives beyond our work – are not acknowledged and met, we are of little use to our patients. “Physician, heal thyself”. Coaching has a lot to offer in this regard.
Dr Jocelyn Lowinger is Director, Think Feel ACT: Coaching & Writing and Consumer Committee Member of the Black Dog Institute NHMRC Centre for Research Excellence in Suicide Prevention
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