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Doctor and patient

A New Code of Ethics For Health And Wellness Coaches: Healthy Boundaries, Part One

The old New England expression that “good fences make good neighbors” applies to the world of professions as well as it does to rows of piled rocks in the old fields and forests of places like Vermont and Maine. The concept of professional boundaries seems to expand the more you look into it. In this and a following post we will look at role definition, ethics and scope of practice, boundary crossings and violations, self-disclosure, and other issues from the unique perspective of the health and wellness coach.

Since its inception just over twenty years ago the ICF (International Coaching Federation) has developed a Code of Ethics which it revises on a regular basis. The ICF also maintains an Ethics Community of Practice where you can bring ethics questions and learn from presentations.

Law & Ethics in Coaching: How To Solve And Avoid Difficult Problems In Your Practice (2006) by Patrick Williams and Sharon K. Anderson houses considerably valuable information from the chief authors and other contributors.

With the development and growth of the field of health and wellness coaching, the question of ethics and scope of practice emerged with the realization that such coaches often face unique situations, sometimes interacting with the medical world, that require a fresh look. While the ICF Code of Ethics is to be embraced by all coaches, the need for something more became evident.

As an Executive Team member of The National Consortium for Credentialing Health and Wellness Coaches, I was honored to chair a committee last summer of extraordinary coaches who are part of our NCCHWC Council of Advisors.

Through our efforts “in August 2016, the NCCHWC created the Code of Ethics and Health & Wellness Coach Scope of Practice to serve as a reference for health & wellness coaches and faculty. The NCCHWC expects all credentialed health and wellness coaches (coaches, coach faculty and mentors, and students) to adhere to the elements and Principles and ethical conduct: to be competent and integrate NCCHWC Health and Wellness Coach Competencies effectively in their work.”

Please download the NCCHWC Code of Ethics and Health & Wellness Coach Scope of Practice here: NCCHWC Code of Ethics; NCCHWC Health & Wellness Coach Scope of Practice. You can also find copies of both documents in the Wellness Resources section of the Real Balance website.

Codes of ethics such as these serve as the primary guides to help form professional boundaries that we can adhere to. In Section Three of the NCCHWC Code of Ethics we find most of the references to boundaries. The most obvious boundary here is #23 – to avoid any sexual or romantic relationship with current clients, sponsor(s), students, mentees or supervisees. But, we also see in other items in this section, that much of the issue of boundaries also refers to creating clear agreements with our clients about the nature of coaching, how it works, confidentiality, financial agreements, etc. The client-centered nature of coaching is emphasized along with complete transparency, spelling out the rights, roles and responsibilities for all involved.

The issue of boundaries is more directly addressed in item #22. Hold responsibility for being aware of and setting clear, appropriate and culturally sensitive boundaries that govern interactions, physical or otherwise, I may have with my clients or sponsor(s). Here we are looking at how we create a safe environment for our client where they feel respected, comfortable and safe. While most individuals are at least somewhat sensitive to this in most social interactions, the coach must be especially sensitive about it because of the trusting nature of the coaching relationship. While not on the same level as clinical relationships, coaching clients must feel free to express themselves at a trusting level. The health and wellness coaching client who is attempting to gain insight about how they hold themselves back from being successful at weight loss, for example, needs to feel that they can reveal information about relevant feelings and experiences without feeling vulnerable. This shows up mostly in two areas, the appropriateness of touch, and self-disclosure.

While not inherently wrong, behaviors such as giving/receiving a hug from/with a client after a triumphant moment in coaching, may be misconstrued in its intention. For one client it may, according to some authors, “engender healthier relationships”, while for another it may feel like a boundary crossing, which other authors would argue, might “pave the way to a boundary violation.”  Coaches learn early on in their training to ask permission. Seeking permission first and respecting our client’s wishes can avoid such boundary crossings/violations. We avoid the pitfalls of assumptions and honor our client’s personal and cultural boundaries in this way.

Self-disclosure also has different boundaries in different cultures and with different individuals. We looked closely at this topic in a previous blog post “Self-Disclosure in Coaching – When Sharing Helps and Hinders“. We can remember from that post that coaches who do not self-disclose at all are not trusted, while those who disclose “too much” are thought to be incompetent. Our own self-disclosure, should never put undue pressure on our client to also self-disclose. Differences in culture, social class, family upbringing, etc. all can set very different boundaries around the issue of appropriate self-disclosure.

Originally published on Real Balance blog. Reprinted with permission.


Dr. Michael Arloski is the CEO and Founder of Real Balance Global Wellness Services, Inc. (www.realbalance.com). Real Balance has trained thousands of wellness coaches worldwide. Dr. Arloski is a board member of The National Wellness Institute, and a founding member of the executive team of The National Consortium For Credentialing Health and Wellness Coaches. He is author of the leading book in the field of wellness coaching: Wellness Coaching For Lasting Lifestyle Change, 2nd Ed.

finger-touch

Success in Life & Business… It’s a Matter of Touch

I am sure you would agree that effective communication plays a significant role in relationships with clients, customers, patients, partners, family members, colleagues, friends, etc. But what about when those individuals are away from you? Do you fill that void effectively and systematically or do you leave it to chance?

Maximizing success in life and in business is dependent upon a complete relationship. To optimize your success you must see your time away from others just as important as the time you spend with them.

Let me explain. Your spheres of relationships are continually changing from both your perspective and from the perspective of others. As a result of these shifting viewpoints, the strengths or weaknesses of these bonds fluctuate and unless you systematically inject yourself into the relationship, you leave success and happiness to chance.

So how do you step-up and make sure you are not rolling the dice when it comes to your success? Simply put, by implementing real, honest, and effective “touches” you can maintain your presence the way that you want it to be. These “touches” are small, short, targeted, and balanced communications that fill the relationship gap that will maintain and even grow trust, loyalty and commitment. Found in various forms, these individualized gems can be phone calls, text messages, video calls, written letters, cards, etc. And the frequency? This depends on each situation but I recommend 14 to 21 days as the sweet spot to offer the best balance.

Remember, to maximize your success, “touch” everyone regularly in a way that will positively inject your influence and not allow chance to control of the outcome.

Reprinted with permission from Dr. Steve Feyrer-Melk.


Steve Feyrer-Melk, MEd, PhD, is a powerful, passionate, and trusted authority in Lifestyle Medicine who is bringing an innovative, refreshing, and successful approach to proactive health care. Dr. Steve co-founded the Optimal Heart Attack & Stroke Prevention Center where he crafts and hones real-world programs for immediate impact. Dr. Steve also serves as the Chief Science Officer of Nudge, LLC, a lifestyle medical technology company.

pearl-z1

Member Spotlight: Functional and Integrative Medicine Physician Pearl Zimmerman, MD, MPH

Dr. Zimmerman specializes in patients with multiple medical problems that haven’t found help through Conventional Medicine. She uses the Functional Medicine Systems approach to address genetic variations and nutritional deficiencies, balance the immune system, hormones, and brain neurotransmitters, plus diagnose undetected Infectious Diseases, GI health, and Cardiovascular/Metabolic issues, instead of just treating symptoms.

Home care

From Couch to Coach: The Benefits of Health Coaching for Improving Physical Activity in Parkinson’s Disease Patients

The benefits of health coaching for managing chronic diseases has been growing in popularity for the past decade and contrary to popular belief, a health coach is not someone who is just providing guidance on weight loss. The concept of activation is a crucial component to managing healthy behaviors and for those diagnosed with Parkinson’s Disease (PD) or other neurological conditions, the ability to adhere to exercise programs can be a challenge.

According to Terry Ellis, assistant professor at Sargent College and Director of the Center for Neurorehabilitation, a virtual coach was effective in helping individuals diagnosed with PD adhere to a daily walking regimen. After one month of coaching, Ellis’ study demonstrated a 100 percent retention rate among participants due to the ability of the coach to build social and emotional relationships.

For those living with neurological conditions, both the availability and accessibility to exercise programs for this population can be a limiting factor. For those with advanced symptoms, driving themselves to an exercise class is not possible and can place an added strain on their caregiver to coordinate such processes. A health coach can be just what is needed to link the patient to the outside world by which they feel connected socially and emotionally. This can provide enough motivation for them to engage in the necessary level of exercise the can significantly reduce symptoms related to PD or other neurological conditions.

Health coaching for this population should focus primarily on:

  • Managing the severity and variability of symptoms through a day, week or month and counsel the patient on how to stay on track with healthy behaviors
  • Ensuring adequate social and emotional support and possibly connecting them to community resources such as respite programs, support groups, or educational classes
  • Connecting them to experts that can help them remain physically active while avoiding injury or falls
  • Support the needs of the caregiver through the progression of the disease and guide additional services that may be required should symptoms worsen
  • Health coaches are not expected to be experts in the disease itself, but rather an outlet for the patient to express their needs and ensure the highest quality of life possible.

 

Resources

Ellis, T. (2013). Feasibility of a virtual exercise coach to promote walking in community dwelling persons with Parkinson Disease. American Journal of Physical Medicine and Rehabilitation. Vol. 92, Issue 6, pp. 472-485. Doi: 10.1097/PHM.0b013e31828cd466.

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The Benefits of Health Coaching For Sustaining Patient Activation in Patients with Heart Disease

Heart disease, also referred to as Cardiovascular Disease (CVD) or Coronary Artery Disease (CAD), is the leading cause of death for both men and women and responsible for approximately 610,000 deaths annually. Someone has a heart attack every 43 seconds in the United States and of those, 1 in 4 will die. Although the rate of mortality (death) has declined over the past few decades as a result of improved medical therapies, a staggering 30% of heart attacks annually are in people that have already had a previous heart event and face increased risk of dying.

Fibromyalgia signs

Four Tips for Proactively Managing Your Chronic Pain with your Healthcare Provider

If you suffer from chronic pain or fibromyalgia, it’s time to get proactive when it comes to your health. When I was dealing with my chronic back and neck pain and fibromyalgia that occurred from a car accident in 2006 I took everything my doctors said as gospel, but after years of listening and following their instructions, my pain was still not improving. That is until I started to take things in to my own hands.