‘Co-active coaching’ could help HIV patients
Co-active coaching’ could help HIV patients
New type of counseling involves goal-setting
A counseling technique that takes an action-oriented approach to helping people make major life changes, much used by business executives and other professionals in recent years, now appears to offer some value to HIV patients. Co-active coaching could be a solution to mild depression and inertia for some HIV-infected patients who have difficulty making decisions about how to spend a lifetime living with the disease.
"I think it has tremendous potential for people with HIV," says Miriam Garfinkel, MA, LMFT, a psychotherapist who provides organizational consultation and training in independent practice in San Francisco. "Business coaching and executive coaching have gotten trendy, but co-active coaching is more about looking at one’s values in life, one’s sense of balance, and addressing all aspects of life," Garfinkel says. "It’s really very holistic in that it looks at what makes any of us happy in our lives as a whole."
Garfinkel has worked with HIV-infected people for many years, but has more recently integrated co-active coaching theory into her sessions. The change occurred as a result of the advent of protease inhibitors and antiretroviral combinations that have made HIV infection more of a chronic disease. Suddenly, people with HIV have had to consider the possibility of living years longer than they thought they would, and their decisions about how to spend their time naturally have begun to change, she says.
The stakes grew even higher when these same people found they could no longer take their antiretroviral regimens for granted as the virus became resistant to drugs, again making a long-term prognosis uncertain, Garfinkel adds.
While some HIV patients find traditional psychotherapy helpful, others want a more action-oriented approach. "They’re stuck and don’t know what else to do with their lives," Garfinkel explains. "So they want an approach that helps them clarify their values, look at their lives to see where it’s balanced and unbalanced, and have someone look with them, like a personal trainer for your life."
Co-active coaching is not so much a type of therapy as it is a professional relationship in which one person (the coach) assists another person in making major life decisions and setting and meeting goals that would lead to desired changes.
"The coach functions by asking powerful and illuminating questions to excite curiosity in the client and to encourage the client to identify and do what would bring the most fulfillment and success, however the client defines that," explains Eileen Blumenthal, JD, EdM, principal of Rocket Science Coaching and Consulting in San Francisco. Blumenthal provides co-active coaching services to HIV-infected people and others.
"I’ve worked with a lot of people who have HIV, and there are several very valuable and rich possibilities with treatment involving communication, setting limits, re-defining their lives, purpose, and passion," Blumenthal says. "It’s a very powerful relationship."
Blumenthal gives the example of a client of hers, an HIV-positive man with a high-powered job who was very successful in his career at the time he began to experience symptoms of AIDS. The man became very ill and at one point was given only six months to live. However, thanks to new medications, he recovered and regained his energy and health. "So his death sentence became a life sentence," Blumenthal says. "His doctor advised him that his prognosis was very favorable, and the man realized he had his future back, but he didn’t have a clue about what to do."
With Blumenthal’s coaching help, the man learned how to be optimistic about the future. Some of the questions he answered with her guidance included:
- What are your personal values?
- What will bring you satisfaction and fulfillment?
- What are you committed to?
- What would really make life worth living given a second chance?
- What do you want your future to be like?
While the man could have answered these questions on his own or with the support of family or friends, Blumenthal as his coach added an additional layer to the relationship: She held him accountable for his actions. "I asked him probing questions and challenged him, and then I championed him and held his feet to the fire," Blumenthal explains. "I counted on him to do what he said he would do."
The coaching sessions were action-oriented and did not focus on therapeutic issues. After six months of co-active coaching, the man applied for and was offered a job in a new field. "It was very different from the work he had done before, but it made his heart sing," Blumenthal says. "And, he had a perspective on work that he hadn’t had before."
The man now understood that if one’s life could be thought of as a pie, then work is only one slice. Other pieces include such aspects of life as spirituality, community, fitness and recreation, and personal relationships. "I think he was very pleased with the results of the coaching in terms of securing that job and because he was happy with this regained sense of hopefulness and control," Blumenthal says.
Co-active coaches do not necessarily have to have degrees in social work, psychology, or psychotherapy. While nurses and people with therapy training could easily provide co-active coaching, other professionals with training in the technique could do so as well, Garfinkel says. "It’s not standardized or regulated at this point," Garfinkel says. "The coach could be anyone who will listen to clients and understand the idea of working with the client’s agenda as opposed to their own." Coaching is essentially client-centered counseling that uses visualization and other tools to help clients clarify their values and establish goals.
Garfinkel notes that co-active coaching may not be the answer for clients who have other mental health issues, such as clinical depression, because the goal-setting and achieving process could be yet another way for the client to fail and feel worse about him- or herself.
Typically, coaches will initially meet in person with clients and then continue to monitor clients’ progress toward goals through telephone calls, e-mail messages, and/or face-to-face meetings. Since the meetings are not for therapeutic purposes, they could take place in many different settings, and Blumenthal has sometimes met with clients in cafes or even on the beach. "My preference is to meet in person, at the most for four times a month and about one-half hour at a time," Blumenthal says. "I co-design the sessions with the client." Clients may take notes during the sessions and write down ideas and assignments.
One of the first tasks is for the coach to help the client clarify his or her values in life, such as whether the client places value on community involvement or personal relationship, work or family, etc. The coach will help the client rank various aspects of life according to their importance, including such items as intimacy, autonomy, free time, and living environment. "We help them look at how they live their lives according to those values, so now they can have a sense of whether they are living according to what they think is important," Garfinkel says.
Coaches assist clients in visualizing themselves in 20 years’ time, according to how they might look, where they would live, what their sensibility is, and what they’ll be doing with their time. Clients might be asked to imagine what kind of advice the person they are 20 years in the future would give to the person they are today.
Coaching focuses on goals
Co-active coaching is very outcome and future-oriented and less focused on history, Blumenthal notes. Coaches spend a great deal of time helping clients develop concrete and meaningful goals. These goals might involve a career change, a desire to enter into a more intimate relationship with a loved one, a move to a new city, success in sticking to an antiretroviral drug regimen, involvement with a church or community group, or success with a physical, artistic, spiritual, or personal task.
One of Garfinkel’s clients was a 40-something lawyer who had avoided HIV infection during its epidemic early years and then became infected much later. "He hadn’t thought it would happen to him," Garfinkel says. "As much as he had lived through years of many people dying and getting ill, he had a lot of reactions about his own infection that he didn’t think he would have."
As his coach, Garfinkel validated his reactions, helped him deal with his grief about his future, and then worked with him to re-evaluate his life and goals. The man suddenly was uncertain about continuing to be a lawyer, so they spent a lot of time talking about his goals and values and what made him happiest in his life. Because the man had some emotional issues regarding his HIV status, he felt it was important to connect with other HIV-positive people, so they set up a goal of having him join a support group.
Although the client first procrastinated about making the calls, Garfinkel gently nudged him toward his stated goal, and eventually he enrolled in a support program for people who are newly diagnosed. "It was really great, and he came back talking about all of the helpful questions they asked him, and then he ended up going to support groups," Garfinkel recalls. "He ended up realizing this was the first thing he needed to do, and he didn’t really need to change his career right now or move or anything like that."
Probably the single most important thing a coach does is to encourage, remind, push, and even goad a client to take the steps necessary to achieve a desired outcome. This element of co-active coaching differs from traditional therapy. For example, one of Blumenthal’s clients is a business professional who wants to become a professional photographer. One of his assignments is to take at least five photographs a week that he will e-mail to Blumenthal on a deadline.
"It happens consistently that the e-mail arrives 30 minutes before our session, and it’s clear to me that a large part of his motivation in taking those pictures is to keep his word," Blumenthal says. "As he’s trying to develop some discipline and habit, he’s accountable to me."
Occasionally, as a client is pursuing a particular goal, the client may have an insight about some other goal that he or she would rather achieve, so the client and coach can adjust the goals accordingly, Blumenthal adds. "Pursuit of the goal often is as illuminating and satisfying as making the goal, and sometimes clients fail because coaching is not any guarantee or insurance that they will succeed," she says.
In addition to providing clients with accountability, coaches help them keep a bigger picture in mind. For example, an HIV-infected woman may decide that one goal is to take medications on time each day, but her vision for this goal may encompass improving her health and achieving the best viral suppression she can. "You say you’ll take these pills, and you do, but why are you doing this, and how does this fit in with the bigger picture of maintaining your health and vitality?" Blumenthal explains.
Co-active coaching could be another service offered by an AIDS service organization or a health clinic that treats HIV patients, Garfinkel says. An ideal situation would be to establish a co-active coaching clinic within a broader mental health program of a multiservice clinic, she explains. This way, clients would have the option of co-active coaching in addition to all of the health care services they might need.
"People living with HIV are very complicated, so what presents as a coaching issue could be more of a mental health issue, and this would need to be addressed," Garfinkel says. "I’d like to see co-active coaching as an option for care for people with the potential for referral as appropriate."
[Editor’s note: For more information about various forms of coaching-type counseling, there are two organizations that hold conferences, provide training, and have web sites:
Coach U. Contact information: Sandy Vilas, president, P.O. Box 25117, Colorado Springs, CO 80936-5117. Telephone: (800) 482-6224 or (941) 387-8440. Fax: (800) 329-5655. Web site: www.coachu.com.
The International Coach Federation. Contact information: 1444 I St. NW, Suite 700, Washington, DC 20005. Telephone: (888) 423-3131 or (202) 712-9039. Fax: (202) 216-9646. Web site: www.coachfederation.com. The federation will hold its 6th Annual International Coach Federation Conference Aug. 15-18 in Chicago.]
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