‘Coaching has great potential in the world of mental health’
It is not uncommon in The Psychologist to hear of ongoing frustrations on the route to becoming a clinical psychologist. But can the passion that pulls people to the profession take them down interesting alternative paths?
I had become interested in the ways in which lifestyle impacts our physical and mental wellbeing, and in how we prevent rather than treat mental ill health. I was realising that simply working within existing mental health systems may not offer me the autonomy I desired, to challenge the status quo and move away from medical approaches. I wanted to further my education, but wasn’t sure exactly what shape this might take. I decided to Google ‘Masters wellbeing’ and see what came up. I discovered an MSc in Public Health at my local university.
In all honesty, I didn’t even know what public health was. But as I read, it became clear that the discipline was very much in line with my own values around promotion of wellbeing and prevention of illness. The course would teach me the principles of public health and offer the flexibility for me to explore my interest in mental health to my heart’s content. It was perfect.
I embarked on the course part-time, just as my work within local mental health services was drawing to a close. I had become deeply disheartened by the over-medicalisation I witnessed, and had stopped working in a clinical setting some months earlier, unable to bear the dissonance between my own values and the systems I was obliged to help maintain. I was working in a temporary post helping to coordinate a pilot project between the NHS Trust and local police department to provide better support for victims of crime with mental health problems. It was an interesting and worthwhile project, but the pilot was about to end and no further funding was available to continue my post. Besides this, I was looking for progression, for more challenging work that went beyond mostly administrative duties. In short, I needed a job, and it had to be interesting, challenging and in line with my values.
Having developed such a passion for healthy lifestyles, and having now spent several years working on my own lifestyle and reaping the benefits, I craved work that would enable me to support people to live more healthily. A happy coincidence occurred around this time – we had a class on my MSc course delivered by someone from our local public health team, and he talked of how they had just commissioned a brand-new service that would seek to combat the problem of NHS overspending on chronic illness, by supporting people to make healthy changes around the four biggest known influences on physical health problems: weight management, physical activity, smoking and alcohol. The service would be a single point of contact for support in these areas, and one of its unique offerings would be one-to-one support via telephone-based wellness coaching.
You can imagine my delight at the possibility of working in such a role. I piped up to ask how I might go about acquiring a Wellness Coach post, and was put in touch with the person who was handling recruitment. Speaking to this person over the phone we agreed I might be a good match for the job, and arranged a face-to-face interview. I got the job and started on the day the service launched.
Enabling and empowering
‘Wellness coaching’ can be defined as the application of life-coaching principles to health and wellbeing. The coach uses skilful communication to support the coachee to make life changes through working towards their personal goals. It is grounded in the principle that the coachee has the knowledge and capacity required to make the desired changes, and that the coach’s job is not to come up with solution but to support the client to find their own way and tap into their existing strengths and abilities. Thus, it is an enabling and empowering mode of support.
Much of the skill of coaching lies in the use of open questions and motivational interviewing techniques: these allow the conversation to be opened up and facilitate the client to explore their situation and problem solve around the obstacles to change. They also help to highlight the discrepancies between the client’s current and desired states, thus enhancing their motivation to change. The coach must express empathy and maintain a sense of non-judgement throughout, in order for the coaching to be truly empowering for the coachee. It is very much a collaborative process, which should be free of power differences between coach and client. Ultimately, if done well, this means that coaching can really support long-term change as the coachee attributes success to themselves and not to an external source.
Skills such as motivational interviewing take some practice to understand and master, and it was an enjoyable challenge for me to learn the art of coaching. Although I had no previous coaching experience, I had studied a health psychology module during my undergraduate studies and recognised much of the theory behind wellness coaching from this. This stood me in good stead, and I had a satisfying sense of things coming together, as I couldn’t have predicted at the time I was studying how relevant this knowledge would become in my career.
One thing I particularly like about coaching is that one doesn’t need to be an expert in whatever they are coaching somebody on; rather, it is the expert use of coaching skills that makes it successful and, indeed, applicable to a vast range of issues. Within the realm of health, coaching has been shown to be of value in overcoming addiction, better managing long-term health problems, and making healthy lifestyle changes such as losing weight or giving up smoking.
In studies of coaching for chronic conditions, the range of outcomes seen in coachees has included psychological benefits such as improved mood, social functioning and quality of life. This suggests that there is an inextricable link between coaching and mental health, even when coaching has the sole aim of supporting someone’s physical health. Almost invariably, people’s health behaviours are rooted in some form of psychological or emotional difficulty.
This got me thinking: what is the potential for coaching directed specifically at supporting somebody with their mental health? A quick web search highlighted fiercely opposing opinions, with some people strongly advocating mental health coaching and others marking it as an inappropriate or even dangerous form of mental health support. Oddly, I found that proponents on either side had failed to back up their claims with evidence. I followed this up with a preliminary search of the literature, and found that there seemed to be very little research on the direct application of coaching for mental health difficulties (rather, there was more of a focus on the general impact of coaching on psychological wellbeing for a ‘healthy’ population). I was interested in exploring this more robustly, and so, the focus for my MSc dissertation project was born.
Focus on what you value most
In a scoping review I conducted with colleagues, recently published in the Journal of Public Mental Health, we found that only a small number of studies had been completed into coaching with the intended purpose of supporting someone with their mental health difficulties. For the most part outcomes have been positive (and where this is not the case no negative outcomes have been reported). The benefits reported range from symptom reduction to improved self-management to the development of life skills necessary for achieving career-related goals. Coaching appears to bring about benefits beyond those provided by other forms of mental health treatment, offering a viable alternative or adjunct to these, which is pertinent given the current demand for efficient and empowering approaches to mental health support (see the Mental Health Taskforce’s 2016 report The Five Year Forward View for Mental Health). With the launch of the British Psychological Society’s Division of Clinical Psychology-funded ‘Power Threat Meaning Framework’ earlier this year, it seems like an ideal moment to be exploring and embracing human-centric forms of support, with lifestyle coaching offering one such mechanism.
Of course, the evidence-base will need to become much bigger before we can draw any robust conclusions from it. But the message so far seems to be that coaching has great potential in the world of mental health, to be harnessed and further explored. I am very keen to conduct further research in this area, which is getting me thinking about my next career steps.
I have recently changed jobs and started working as a Project Support Officer in my local NHS Clinical Commissioning Group (CCG). I had enjoyed many aspects of my previous role, but was looking for a change and something that might offer further development opportunities. Prior to this, I was still working in the health improvement service, but had moved on to delivering training to other organisations. I felt I took well to the role of trainer. As a child I was convinced I was going to be a teacher, and adding this to my passion for research puts thoughts of a career in academia in mind. I’ve published in journals on the basis of my Masters research, and presented at my university’s Postgraduate Research Conference last year. A PhD could well be the next big career step for me.
I feel that my movement away from fixation on the clinical psychology route, and the adoption of a more dynamic approach, has put me in really a good place. I still get to use psychology all the time, and have also discovered a new discipline in public health, which I really love and complements psychology very well. I’m excited to see what the future brings, and hope my experience might provide a little inspiration to others struggling to find their way as a psychologist: focus on what you value most and you may be pleasantly surprised by the opportunities that present themselves.
I would be very interested to hear from others with an interest in mental health coaching to discuss possible research questions and opportunities for collaboration: reach out on Twitter).
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