A holistic assessment should be a very comprehensive picture of your client’s whole life and when done properly, it gives the coach all the information needed to begin working with a client.
Holistic Client Assessments
Assessments for clients are constant and cyclic, re-visited throughout the coaching process to gauge effectiveness, evaluate client change, improvement or to identify client lapses as early as possible, and to identify the need for further reassessment or rearrangement of strategies used (this is more extreme and less likely to be the norm). Therefore competency in holistic assessment is crucial to successful client planning and optimizing positive client outcomes.
The Value of Doing Accurate Assessments
Assessments used by Certified Holistic Life Coaches are valuable tools in the coach’s toolbox and offer a variety of benefits to the coaching partnership. When coaches are integrated into healthcare or health behavioral and biometric data through assessments is vital for program out comes measurement. Health risk appraisals are now widely validated and used as tools by health plans and employers to measure health and lifestyle status as well as change readiness and to identify “red flags” with respect to mental health status or medical care gaps.
Coaches use a variety of assessments of life or wellness domains to evaluate holistic living. More recently, assessments of character strengths or traits have come forward, providing an interesting possibility in directions taken by coaches in the sessions they do with clients.
Coaches may decide to get training on the use of specialized assessments in other areas including emotional intelligence or personality type; these lie outside the realm of this course and would be more inclusive within a coaching psychology course, for example.
Physical Health Risks
IMPORTANT: After completing the Physical Assessment included in your Appendix, it is vital that you stay aware of any “red flags” such as health risks, injuries, or other health concerns that might require a physician release before engaging in regular exercise. If exercise will be a part of the coaching program, a physician release form can be provided to the client to give to his/her physician.
Other issues, such as depression, may be import- ant to discuss. Such issues may limit the efficacy of a coaching program or may justify a referral. Clients may already be working with other professionals and may view coaching as complementary part of their forward progress. In any case, it is important to discuss the circumstances of any client health risk.
If clients share in their assessment or in a coaching session a serious or even life-threatening mental health or physical health issue, advise them that the situation is outside your scope of skills and credentials and encourage/assist them to seek professional help as soon as possible.
Mental Health Risks
It is also important to consider whether clients have significant emotional or mental health risks that would impair their ability to move forward in a coaching relationship. Remember that coaching is distinct from counseling or therapy. While traditionally a psychologist or therapist works to understand how the past is affecting and influencing the present to help clients heal emotional wounds, resolve problems, or process undigested life issues, a coach works in the present, helping the client define goals and create a new future.
Spirituality
More than 80 percent of Americans perceive religion as important. Issues of belief can affect the health care encounter, and patients may wish to discuss spirituality with their physician. Many physicians report barriers to broaching the subject of spirituality, including lack of time and experience, difficulty identifying patients who want to discuss spirituality, and the belief that addressing spiritual concerns is not a physician’s responsibility. Spiritual assessment tools such as the FICA, the HOPE questions, and the Open Invite provide efficient means of eliciting patients’ thoughts on this topic. The spiritual assessment allows physicians to support patients by stressing empathetic listening, documenting spiritual preferences for future visits, incorporating the precepts of patients’ faith traditions into treatment plans, and encouraging patients to use the resources of their spiritual traditions and communities for overall wellness. Conducting the spiritual assessment also may help strengthen the physician-patient relationship and offer physicians opportunities for personal renewal, resiliency, and growth.
Scope of Spiritual Beliefs
The perceived importance of spirituality by patients and physicians is borne out by secular opinion polls, medical literature, hospital regulations, and clinical practice guidelines. Gallup polls indicate that 91 percent of U.S. adults believe in God or a universal spirit, and that 81 percent consider religion important. Research studies demonstrate that up to 94 percent of hospitalized patients believe spiritual health is as important as physical health; 40 percent of patients being treated for a condition use faith to cope with illness and 25 percent of patients use prayer for healing each year.
Conducting the Spiritual Assessment
Before conducting a spiritual assessment, coaches should consider their personal faith traditions, beliefs and practices, positive and negative experiences, attitudes on faith, healing, and comfort as well as having the ability to appreciate another’s spirituality – or share their own. Some coaches may not consider themselves religious, but may still obviously be spiritual. Others might simply not wish to discuss spirituality. Coaches vary in their skill level of ease or capability when discussing spiritual concerns. Rather than a coercive responsibility, conducting a spiritual assessment and offering spiritual supportive coach actions are preferable. This gives your client another way to understand and support their experience of health.
Several tools exist to help physicians conduct a spiritual history. The FICA Spiritual History Tool uses an acronym to guide health professionals through a series of questions designed to elicit patient spirituality and its potential effect on health care. Starting with queries about faith and belief, it proceeds to ask about their importance to the patient, the patient’s community of faith, and how the patient wishes the physician to address spirituality in his or her care.
The spiritual assessment also allows patients to identify spiritual beliefs, practices, and resources that may positively impact their health. Helpful questions include, “Do you have spiritual practices, such as praying, meditating, listening to music, or reading sacred text, that you find helpful or comforting?” and “Are you part of a faith community? If so, does it have resources such as a home visitation program, a food pantry, or health screening?” Physicians can reinforce positive coping behaviors and, with the patient’s permission, offer to contact the patient’s spiritual community to mobilize community faith resources as appropriate.
Finally, there may be some instances in which physician and patient faith traditions coincide. In these cases, if the patient requests, the physician may consider offering faith-specific support. This may include patient-or physician-led prayer. Given the variety of spiritual practices followed in multicultural societies, it is best not to assume that a physician’s spirituality mirrors that of his or her patients. Prayer should not be a goal of a spiritual assessment, and physicians should not attempt to get patients to agree with them on specific faith issues.
Potential Benefits in the Phyician-Patient Relationship
Assessing and integrating patient spirituality into the health care encounter can build trust and rapport, broadening the physician-patient relationship and increasing its effectiveness. Practical outcomes may include improved adherence to physician-recommended lifestyle changes or compliance with therapeutic recommendations. Additionally, the assessment may help patients recognize spiritual or emotional challenges that are affecting their physical and mental health. Addressing spiritual issues may let them tap into an effective source of healing or coping.
When to Refer Clients
Coaches do not diagnose mental health risks but they should know what to look for in case there is a need to provide a referrals to another health professional, be it a psychologist, therapist, or appropriate physician for consultation. The following indicators are examples to watch for:
Depression: Clients who are not eating or sleeping
In a normal pattern, such as not sleeping or sleeping all of the time, have lost their appetite, or are binge eating, may be showing signs of clinical depression and may need to be referred their physicians. Eating disorders: Clients who have lost a great deal of weight without surgery and/or medication, and continue to do so when advised it will be harmful to their health (anorexia), exercise beyond their normal physical capacity, or continue to gain and/or loss 20-30 pounds without stabilizing their weight may be showing signs of an eating disorder and may need to be referred their physicians. Substance abuse: Clients who display unusual behaviors, such as acting out or violent outbursts, that are uncharacteristic of their usual behaviors may be showing signs of substance abuse, including steroid use, and may need to be referred to their physicians. Anxiety disorders: Clients who suffer from panic attacks, claustrophobic behavior, or shortness of breath may be showing signs of anxiety disorder and may need to be referred to their physicians.
Honor Your Intuitions
If you have a sense that a client should seek further medical attention, or needs resources beyond your expertise, respectfully yet candidly express your concern. If the client then chooses not to engage with additional resources, it is recommended that you terminate the coaching relationship until the client has received the appropriate assistance.
Using Other Health Practitioners and Providers; Working Synergistically
It is valuable to build relationships with highly-respected therapists and therapist groups in your area. Situations may arise where you work with professionals in your network with your client concurrently. You can – and should – then refer clients to professionals who you know and respect. This may also lead to cross-referrals and a lot of targeted business-building. If you don’t have the ability to make such a referral directly, always recommend that clients see their primary
care physicians for a referral (be sure to document the date and time that you make such recommendations in case it comes up later). If you seek advice about a client that you believe has a mental health problem, be sure to follow the Health Insurance Portability and Accountability Act (HIPAA) rules (privacy of personal health information), taking full precautions not to share the client’s name or any revealing personal information.
Discussing the Holistic Assessment With The Client
The first coaching session with a client is an opportunity for the coach to establish trust and rapport, confirming your sense of things based on any assessments that may have been completed ahead of time. We are also going to be determining the readiness/energy level of the client for holistic change. As we know that we should never assume that assessments completed ahead of the first session will reveal the whole story. We do not really even know yet how our client will respond to the first session, much less anything 12 weeks down the road; the pre-assessment will not give us a reflection of how the client will be feeling when the first coaching conversation finally takes place. It’s natural for both of you to be in a mixed state of “selves” during this time.
Also, mistakes or the misinterpretation of questions can sometimes occur when filling out forms. Confirming items that might be significant in working towards a client’s vision, or checking out items that don’t seem to add up based on other comments in a coaching conversation, is wise.
That’s why it’s so important for coaches to practice mindfulness and to be in the moment with clients, rather than trying to “fix” clients – or being fixated on the results of an assessment. Assessments are helpful as guides; they become contraindicated or more harmful when they include an agenda that is not of our client’s own wishes. This is what triggers client’s to become reluctant, ambivalent or resistant.
First, Work to Establish Trust and Rapport
We all to establish trust and rapport with clients at every coaching session; it is especially true at the initial parts of the first coaching session. Coach and client may be unknown to each other, apart from pre-assessment materials exchanged ahead of time. At this time of your co-active relationship, it is essential for coaches to put clients at ease and to bring them into their confidence through:
- Holding them in positive regard
- Expressing empathy
- Slowing down
- Listening with full attention
- Allowing them to formulate and find their own answers
- Honestly sharing observations
- Under promising and over delivering
- Being humble in sharing information and advice
- Honoring confidentiality
Try to get a sense of how your client views their experience and learning from doing your assessments – were they open and willing, or were they guarded or reluctant? Always encourage your client to share any feelings, issues, or questions they may have related to the assessment(s) you perform; remember, we always explain why we are doing an assessment prior to getting into the nuts and bolts of it. Pay attention to the emotional state of your client, and listen to your intuition as to their underlying needs so that you can be the most present for them (coaching presence) and be able to offer an empathy reflection in reply if appropriate. Be sure the client feels heard and respected, on an emotional level, before moving on.
“What’s working in a positive or ideal state for you right now?” is a simple, but loaded question. If you are not sure as to why, refer to the reading on appreciating our client’s strengths and mining for positive attributes from our client. In this way it really becomes the operative question. Regardless of how our client may have rated and prioritized things at the time of the assessment(s), coaches work with clients in the moment you are both in. Things may have shifted between then and now, for any number of reasons (including what the client learns from taking the assessment(s) before you meet physically.
Be open and flexible – it is your job to stay open and receptive to the energy being presented by your client at any given time; some coaches find benefits to mirroring this energy. This is the time when you learn your client’s issues – we don’t arrive at this meeting with our own agenda or goals apart from providing structured support for our clients goals, once they have been determined. The aim is to honor a flow state while co-construct facets of your clients real life experiences as well as their vision. We do not play expert, teacher/advisor or therapist.
Discover Client Successes, Strengths, Frameworks, and Wishes
The best way to discuss an assessment is to use the information gleaned from the assessment to make powerful, client-specific, strength-based inquiries in a way that will assist clients to know themselves and to move forward in the direction of their desired future. By asking clients open-ended questions about their successes, strengths, frameworks, and wishes, you will not only learn more about their priorities and what they want to focus on at this time, you will also elevate their readiness and energy for change. Clients are used to taking assessments which reveal flaws that need to be repaired; it is refreshing when assessments are used to reveal strengths that need to be reinforced. That is the work and shift of masterful coaching. It is all about paying attention to and building on the energy clients show up with for coaching. When their energy is low (whether physically, mentally, emotionally, or spiritually), appreciative empathy can bring new energy. When their energy is high, appreciative inquiry can assist them to get or stay inspired. Either way, discovering client successes, strengths, frameworks, and wishes that are grounded in reality as revealed by the assessment(s) and by what they have to say now, in the moment, will enable clients to develop a vision and to design appropriate actions.
Discover Preferred Client Learning Modes and Styles
People learn best in different ways. More than 80 learning-style models have been developed and another book would be needed to do them justice. The Myers Briggs and DISC assessments, to mention only two of the more popular (see below), reveal learning styles and are among the models to consider. While there is considerable criticism of the validity of learning style models and assessments by psychologists and psychometricians, there is no dispute that we can observe individual preferences in learning styles. Take weight loss, for example. Some prefer to learn from books, some want a close personal mentor such as a personal trainer, some enjoy online self-help programs or online social networks, some value a local live group discussion or class format, some seek out competitions, while others do best when they go away for an intensive learning week with experts.
If there is not equal respect between you and your client, it’s not possible for your client to connect or feel comfortable with you in ways that may be necessary to support and promote their holistic learning and growth.
When we discuss holistic assessment with our clients, it’s important to notice the language and approaches they use for indications of their preferred learning modes and styles as well. We can then better come alongside clients in the process of enabling them to more rapidly and successfully acquire new knowledge and skills – provided they are congruent with their goals.
Learning modes and styles that are used widely include the following:
Learning Modes
Aural learners: Clients who learn best by listening would rather listen to someone speak than read information or see illustrations. They prefer to take in information by ear. Self-help audios or podcasts may be ideal.
Visual learners: Clients who learn best by seeing illustrations would rather look at drawings, video clips/webinars, or other visual media. They may not absorb or remember information given without a visual component.
Print learners: Clients who learn best by reading prefer to see the written word. Articles, books, and websites are good resources. Print learners are often note-takers.
Verbal learners: Clients who are articulate, and like to talk, learn best by speaking. It is helpful to have these clients repeat key information and instructions. This helps them internalize and remember, especially if they are not note-takers.
Interactive learners: Clients who learn best by exchanging ideas do best in live groups or with a trainer/educator, including a coach. These clients want to talk and stay actively involved in the process. Suggest that these clients discuss your coaching sessions with other trusted people to reinforce the positive effects.
Kinesthetic learners: Clients who learn best kinesthetically prefer to use movement and psycho-motor skills. They would enjoy, for example, performing exercises with you watching in person or via web camera. They need to feel their legs bending at 90 degrees during a squat. They also benefit from role-playing situations, such as how to “just say no” to offers of second helpings of cake.
Tactile learners: Clients who learn best tactically prefer to do hands-on activities. They like to handle objects or sort things out physically. This person is the type to feel the weight of a dumbbell when talking about the appropriate weight to use for an exercise. They enjoy being creative with hands-on activities, such as drawing or cooking; this is also the type of client that might use a pedometer and post results screenshots to their social media pages; this is how this client learns, by touching something and/or gauging progress.
Learning Styles
Note-taker: Note-takers learn best when they write or type information, goals, and instructions, rather than having it done for them or given to them. Writing the information themselves helps them think it through, absorb it better, and remember it better. It gives them a more active role.
Detail-oriented: These clients may use any of the above modes for learning, but what sets them apart is the amount of detail they require. They want to understand “why” as well as “what” and “how.” They are often intelligent, highly educated, and in a detail oriented profession.
Holistic: These clients don’t want detail and will be bored by it. They want a sense of the whole – how it all fits together. They are often visual or kinesthetic learners.
Affective: These clients are people-oriented and focused on emotions and involvement with others. They respond to exploring their own attitudes and those of others as a means to learning. Rather than starting with a concept, start with an example that involves emotions or other people and then work on the concept. These clients often put others ahead of themselves and need to be encouraged to nurture themselves.
Observer: These clients like to watch and listen, and may take a while before interacting easily with you. Don’t be discouraged if they seem passive. Ask, “Do you learn best just taking things in?” Take small steps drawing them out so they may become independent learners with time.
Self-directed: These clients will take the ball and run with it. They like to be in charge of their decisions and actions, and will sometimes take over the coaching session. They want options and information before being questioned about the direction they want to take. They like doing their own research, so point them in the right direction and let them go. Frequently ask them what they learned. By telling you, they’ll reinforce it in their own minds and behavior.
Thinker: These clients rely on reason and logic. They like to analyze and evaluate concepts and ideas. They are intelligent, independent, and like to challenge ideas they don’t think have merit. They want coaches who match their intellectual level.
IMPORTANT: Feel confident in asking clients directly about their preferred learning modes and styles. A direct question, such as, “What do you know about how you learn best?” can generate a treasure-trove of growth-promoting value. Although some clients won’t have any idea, others will be able to tell you specifically what works for them. Be responsive to what you learn and go with what works when it comes to promoting client learning and growth.
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