Narratives of Integrative Health Coaching

Background Of Integrative Health Coaching

Integrative health coaches (IHCs), such as the ones trained at Duke University Integrative Medicine where Jennifer receives her training, focus on an eclectic approach to healing. The Wheel of Health from Duke Integrative Medicine (2010) encourages patients to reflect on multiple dimensions of health including movement, exercise and rest; nutrition; personal and professional development, physical environment; relationships and communication; spirituality; mind-body connection; and mindful awareness (p. 5). This makes health become a comprehensive plan that focuses on the person, not just the disease.

Health coaching and conversations about the responses to both written and numerical subjective questions can help patients illuminate the health stories they tell themselves. Health coaching can also build a bridge between helping patients decode complex medical terms and comprehending their treatment plan. Brown (2007) describes the feelings many patients have and shares, “it doesn’t matter if it’s physical pain or emotional pain. When we can’t find the right words to explain our painful experiences to others, we often feel alone and scared” (p. 155). When patients feel that their medical practitioners and health coaches earn the right to hear their stories, the sharing of narratives can become healing conversations. Health coaches are not psychologists; if a patient wants to share a painful story about the past, the health coach will make a referral to a psychologist. Instead, health coaches help patients maintain forward momentum for achieving their goals by providing encouragement, suggestions for completing a prescribed treatment plan, translation of potentially confusing medical terms, and a supportive person to listen.

Steele (2009) encourages medical teams “to develop the tools and systems needed for effective and consistent patient education and expectation setting” (p. 99). Such tools, according to Jones, Brady, and Gaunt (2009), include “a diary showing type of surgery and progress” (p. 100) and “homework sheets that contain exercises and assignments for patients outside scheduled PT sessions” (p. 100). Health coaching provides patient education for patients. Health coaches also serve as another member of the support team for both patients and clinicians. As Helldorfer and Moss (2007) explain, “one important component in the way many medical facilities measure success is by the degree of patient satisfaction. How patients feel about the care they are receiving starts with first impressions. Taking the time to look a patient in the eye, say hello, and ask them how they feel is an ongoing challenge when we are busy” (p. 275). Health coaches follow up with patients about how they are feeling and provide a continual assessment for clinicians of how important each patient feels about the treatment plan and his or her confidence in achieving it. If the treatment plan a clinician provides is not important to a patient, the patient will be less likely to want to accomplish it. It therefore becomes the job of the health coach to determine what the patient values and how the patient can align the treatment plan with his or her values to achieve improved healing gains. If the patient is not confident he or she can accomplish the treatment plan, the patient will also be less likely to comply with it. Once patients become non-compliant it is not possible for them to get satisfactory results. It therefore becomes the job of the health coach to provide a vision of past success for the patient to build momentum in order to achieve future success.

Since health coaching is a new field in medicine, there is not a large amount of previous studies to share. Simmons and Wolever (2011) report, “broadly defined, health coaching is a method of working with patients that utilizes thoughtful inquiry, accountability, goal clarification, goal setting, identification of obstacles, use of support systems, and connection to intrinsic motivation, vision, and values to improve health through positive behavior change” (p. 1). Simmons and Wolever summarize the existing research and elaborate,