The Power of Health & Wellness Coaching: The Influence on Employee Health, Creativity & Performance

Ryan Picarella   I’m excited about the conversation we are having today and I don’t think there’s any better qualified and experienced person to discuss the topic of health coaching. So thank you for your time and the gift of your knowledge today.

Michael Arloski   It’s my pleasure Ryan. Doing these WELCOA Expert Interviews has really been a pleasure and also it’s been real rewarding because you folks have such wonderful reach out into the health and wellness field. The more we can educate people about what wellness coaching, health coaching whatever you want to call it really is, and how you can work with it effectively, the better.

RP   Awesome. I totally agree. I appreciate the kind words about WELCOA and I’ve been following your work for a long time. I’m definitely excited to learn from the many years of experience. I would love to learn a little bit about you and your journey and how you found your way into health coaching in your career.

MA   It is an interesting journey as it turns out. My background is as a counseling psychologist. I did a lot of work in university counseling centers. I was really fortunate because back in 1978, our Vice President for Student Affairs at Miami University (Ohio) went to a conference with other VPs and found out about a conference in Stevens Point, Wisconsin about wellness. He sent me and the Health Center Director and we didn’t know it at the time, but we were attending the world’s first-ever wellness conference.

I was just enthralled, because I’d always thought about prevention and always thought about outreach, not just sitting in a counseling center waiting for people to come to us when they have problems, so it fit in perfectly. We came back with all kinds of enthusiasm and ideas for how to bring wellness into university life for students and that turned out to be quite a challenge. But it was really cool and got me enthralled with the wellness movement. I started attending the National Wellness Conference almost every year and I started presenting there in 1982.

Then in the mid-90s, I was seeing that private practice was really difficult for a psychologist because of healthcare insurance not covering mental health very well and so many people not having insurance. I was working at a university counseling center and started to realize that as I was turning down opportunities to be a counseling center director. If I became a director, I wouldn’t be able to be a psychologist anymore. I’d be a university administrator arguing over budgets and things like that.

I saw that I was in a go no-where situation and that was the same time that I got turned on to coaching and life coaching. In 1996, one year after the International Coach Federation (ICF) was actually formed in ’95, I went through some training with the Coaches Training Institute (CTI) and learned about coaching itself. It wasn’t long after that before I started to realize “Wow. Wellness. Coaching. You’re talking a marriage made in heaven here”.

There’s a real need for people to have this ally to help them be successful individually or in small groups at changing lifestyle behavior. So as a psychologist, I’ve always been doing wellness: how do we actually help people change attitude, belief and behavior.

RP   Awesome. That’s a great story. What an interesting and great journey. When I first was introduced to the concept of health coaching, it was probably in early 2000’s. The traditional rhythm was, you take your health risk assessments and then you would be triaged to a coach at that point because things may have popped up on your health risk assessment. How have you seen health coaching evolve? Is that still the traditional way it works or is it is different now?

MA   The health risk assessment, the HRA’s. I actually trained people that were doing that for large companies and little one-shot deals; 15-minute interpretation appointments. When I trained somebody that did that for the first time, I said, wait a minute. Why did you even take this training? Because all you’ve got is 15 minutes. She told me after she had done this training and been back functioning in that job for a while and she said it changed the entire way she did that 15 minutes. Before it was simply educational, make him or her aware that they’re gonna die if they don’t change their ways and pat them on the back and wish them luck.

RP   Send them on their way.

MA   It really shifted her way of working with people. She actually asked questions, listened and worked with the answers. It really changed things. But what started to happen early on, like you’re saying, a lot of coaching was done in a medical compliance adherence way. People call you up and say “Hey, Ryan. How’s it going? Are you taking your medication? Do you have any questions about it?” And it was probably a nurse, so that she or he could answer the questions about the medication.

And maybe if you have other questions, she or he might refer you to a dietitian or somebody like that and that was about it. A lot of the early efforts were pretty limited in scope. I think when I started bringing real coaching, based on the ICF core competencies and theories from actual psychology and behavioral change that it started to improve the quality of the coaching that was out there.

Different companies would do internal training and people like myself and Real Balance, people like Margaret Moore at Wellcoaches^®, we started doing trainings for hundreds and then thousands of people that really placed people in corporate wellness programs, in hospital wellness programs or employee wellness programs. And it just continued to mushroom and take off.

I think the thing now is for people that are delivering coaching to realize that they’ve got to keep learning. It isn’t just that one and done type of training and they’re good to go.

That’s really a lot of my emphasis right now.

RP   What role do you think incentives play in health coaching? Are there any results without incentives?

MA   I realize that in health promotion this is really a big debate area. I remember one time at a Journal of Art and Science conference, Paul Terry conducted what was called a brain-fest. It should’ve been called a slugfest between two different sides that were arguing about incentives versus growing the culture. My first experience with incentives was at a hospital in Augusta, Georgia where I did training. They made the critical error of not explaining the program well to their employees. The coach was cast as the villain.

The wellness coach, who was perceived as making you come in for coaching and making you risk not having affordable healthcare, because it was a discount on the health insurance that was the incentive. As we all know, the prices are sky high to begin with, so you can say it’s optional, but really with the high price it’s almost imperative that you go in and get that discount. It was not introduced well. Coaches were met with anger and resentment. I’ve heard that from many coaches still today when incentive programs are used.

People would come in, but they really don’t want to be there. They feel like they’re doing work with a coach to stay that way. That would be brilliant. But they’re really not up for it and they resent being there. On the other hand, one of the people that we’ve trained and is now a trainer of ours is at Maine Health. It is a very large health program in hospitals in Maine. Their incentives were used well and actually got a lot more people through the door and got exposed to coaching.

When the coach is able to go with the person and help them see that I’m here to help you get your discount; I’m your ally and while we’re together, let’s make the very best use of your time. Now when they can pull that off, they’re probably going to see more people and hopefully more people will catch on to the value that can be in health and wellness coaching.

RP   What are your thoughts on measuring the effectiveness of coaching? I know a lot of times it takes time for someone to begin to make sustainable behavior changes and so, what type of value story do you talk about? How do you talk about it?

MA   Yeah, there’s a couple things. One is coaching if it’s being implemented say in an employee wellness program. It needs to be part of a comprehensive wellness program, as you know very well. It’s what your whole organization is about. It’s the comprehensive health and wellness programs that get the measurable effect of even very high sometimes return on investment (ROI) and value on investment (VOI). I’ve been really heartened to hear this term VOI because to me it’s getting back to what we were talking about in the wellness field.

That isn’t just cost-containment. That it’s actually improved performance, it’s improved presenteeism, it’s reduced absenteeism and it’s retaining really valued people.

It’s all kinds of things, some of them tangible and some of them intangible. So first of all, don’t hang your success on just coaching. Coaching has to be part of a bigger opportunity for people to be well. I think the second thing is that you can take a look at the group data. We can’t report well on individual accomplishment. That’s HIPAA protected. But we can look at group data and say “Okay, all those people that got coaching, did we see lifestyle improvement?”

One of the nice things about health and wellness coaching is, we can actually measure biometrics, which are about as hard a data point as you can want. Now customer satisfaction is important as well and a lot of perceived change in growth that people can indicate on surveys is also really worth measuring. I think the less tangible things are also valuable. But a nice thing is, we can say that group of people dropped their blood pressure points an average of so many units. We can get that. But I think looking at the long-term effect, is really what’s important here because behavioral change takes time.

I guess two other points that I would make about it is, one, we’re all very familiar with James Prochaska and the Transtheoretical Model (Stages of Change Model). Coaches ought to get credit for moving people along one or two stages. Even if the person doesn’t take action. Because remember, we’ve got precontemplation, contemplation, preparation, and then finally action (followed by maintenance and termination). The defeat of most programs, Prochaska would say, is we rush to the action stage. What his hard-core research has found is, that for any given behavior, only 20 percent of the people are ready to take action on that behavior. Our job is to meet the other 80 percent and get them up there and we need to get credit for that. I think that’s really important.

The other thing about measurement is, to not let the accounting department determine how to measure it. Because they don’t know about behavioral change.

RP   That’s a good point.

MA   Have them consult with a psychologist who knows about behavioral change and say “Okay, how do we measure change here? What is realistic? What kind of timelines are realistic?” Instead of an accountant who maybe has a stock portfolio and they think “Well, I’ve got to make a profit this quarter.” It does not work that way with real live human beings.

RP   Have you seen or noticed in your work how effective the different modalities might be? Whether you’re face-to-face, telephonic, email, text, or videoconference, or whatever.

MA   It’s really kind of interesting. Face-to-face encounters and appointments are kind of hard to do, especially when we start to leverage the numbers. What we have found is that telephonic coaching is actually just as effective. In fact, there has been some research saying that people feel a little more comfortable self-disclosing when they don’t have to look at their coach (when they’re on the phone).

RP   Yeah, that makes sense.

MA   Maybe I’m talking about something that’s difficult for me. If I don’t have to look at you, I can just literally be one of two people in a dark room with their eyes closed talking about it. I’m a little more free to admit something hard or that kind of thing—self-disclosure. But I think what’s really exciting is tool like Zoom or FaceTime and all of the different ways that we can connect like that. The other thing that is really happening rapidly is all of these attempts to use technology to help people succeed at change. I think what we’re going to see, to deal with the volumes, is what I call a tiered approach.

Where maybe for thousands of people, they are just getting a text message that reminds them that’s all they need. They’re pretty self-directed. They’re functioning really well. They’ve got pretty good self-efficacy. “Wow, cool”, we just helped thousands of people. On the other hand, there’s going to be another layer where they need more than that. That’s not going to get the job done. They need high-tech and they need high touch.

That’s where group coaching may be able to handle a lot of people. Especially if it’s people that share a common challenge like cancer survivors or weight loss. Then finally, the last tier that you probably aren’t going to be able to do with as many people but is going to really be the most effective is one-on-one coaching. We may have to reserve that for a smaller number, but if we’re able to, I think we can reach a lot of people that way and it will pay off in the long.

RP   One thing that you touched on that I think everybody knows, is how important the role that culture plays in just that kind of relationship and effectiveness. What is the organization’s responsibility in this? How do they really make sure that they create that solid foundation of trust make sure that the relationship does have the best chance possible to be successful for that employee?

MA   That’s a great question and a really important one. Coaching needs to be looked at as a growth opportunity. I don’t mean that in a sarcastic kind of hidden way of saying “hey, you need help”.

One of the coolest things I ever heard is that coaching is not a helping profession. It’s an assisting profession.

You don’t need help; you just need somebody to be your assistant to help you accomplish what you want to accomplish. As a coach, I’m going to look at you as being okay to begin with. If the companies use coaching to identify you as having something wrong with you, so you need to go coaching and straighten up your lifestyle. That’s not conveying the kind of message that’s going to get engagement. That’s not the kind of message that coaches are going to welcome or clients are going to welcome.

RP   That’s so important to go into the relationship that you’re not broken and I’m not here to fix you but to assist and help. I love that.

MA   Absolutely. In coaching, instead of saying what’s wrong and how can we fix it, we love to say what’s possible? What could be? How could your life be?

RP   Now that businesses are multinational, is there a cultural element to health coaching? How applicable is health coaching to other countries, or their cultures?

MA   One of the cool things about coaching is that yes, coaches need to be very aware of cultural differences and not make assumptions and not think that they know someone else’s experience.

But in the structure of coaching, the foundational principles of it, the way to be in coaching is inherently multiculturally sensitive.

Because if I have this point of view that I’m not the expert here to fix you. I’m not the guy from the majority of culture that’s going to come in and straighten you out and improve your poor conditions. If instead, I’m here to be your ally and I want to learn from you what your experience is. I’m going to come in here humbly and not make any assumptions and not have this attitude that I have a prescription for you of what you should do, ought to do, need to do.

Matter of fact, I teach coaches to take the words and throw them out of your vocabulary. Never use them.

You need to
You ought to
You should
I want you to

If we come across that way, people get it that “hey, this person coming in here respects my life and who I am and what I’ve got as strengths and recognizes them and doesn’t just see me as a person full of problems”. Even though I might be in a situation where I’ve got cultural challenges, or economic challenges galore, that’s going to make a whole different relationship. Something that has been very gratifying for me when I’ve done training in Brazil, in the Philippines, in China, in Ireland is that, people treat me really well because they know I respect them and their culture.

RP   I love that. I think as humans one lesson that I’ve certainly learned in my experiences is that, we are more similar than we are different. At the core, we all want the same thing: love, compassion, family, energy, vitality. We love to laugh, cry and so that’s well taken.

MA   I’ve been to China and am going be going to China again for the fifth time to do training. We’re actually doing a program there with a large employee assistance program to offer health and wellness coaching throughout the country. The way it’s been received by the people I’ve been training has been amazing and has really validated what you just asked earlier that, health and wellness coaching really works and is really applicable in any culture. I’ve been working with people that have gone through our foundational training, our advanced training, and even our mentor training on their path to get credentialed by the ICF. Quite a few of them are actually physicians, directors of large departments, all kinds of things like that and they just love it. They absolutely love it. It’s been such a gratifying thing.

RP   What advice would you give if I am thinking about finding the right health coach for my organization or the right organization to align with? What advice would you give to anyone that wants to begin offering this to their employees within their company?

MA   You may find that your health coach is right on board already. Maybe one of your employees that you’re already working with who is a health educator, or is a fitness trainer, or is nutritionist, dietitian, or an HR person who is really good with people. Getting them trained as a health and wellness coach can really be effective. One of the really nice things about health and wellness coaching is, it doesn’t have to be done by somebody with a graduate degree. It doesn’t have to be done by a healthcare professional. There is no evidence that a healthcare background helps someone be a better coach.

What the coach is doing is working with people on lifestyle behavioral improvement. They are not trying to provide treatment, so they don’t have to have a treatment level of knowledge about an illness to help someone improve their behavior that will improve the course of that illness. As long as someone stays within their scope of practice as a coach, and works in conjunction with treatment teams, one can be an effective coach. Your person may be right on board and just needs really good training. Or you might look for people that are external that you want to hire maybe even on a contract basis or maybe bring on board. Now, how to find as you were saying a well-qualified one.

Fortunately, we have done a lot of work to provide a way for people to ascertain who really has good adequate training and who may not. Because there’s just a plethora of training schools out there now. When I got started back in the late 90s, there wasn’t anything out there. Now it’s unbelievable. And unfortunately, there are a lot of training schools that are inadequate that are focused more on get rich quick schemes and things like that.

I was one of the founding board members of the International Consortium for Health and Wellness Coaching (now known as National Board of Health and Wellness Coaching, NBHWC).

What we did was work together to establish standards and credentials for the field.

We identified scope of practice, code of ethics, and set up a way of approving coach training programs so that they met really adequate criteria for providing education for their trainees. We initially approved 55 programs. What I would say first of all is, if the person you want to bring on board is from one of those programs, you have a lot more assurance that they are going to be well-qualified. Matter fact, I would straight up say if they aren’t from one of those NBHWC approved programs, do not touch them. It’s not worth it, because they probably have a very inadequate approach to actually helping people make change.

Now even within that 55, there are the okay, the good, and the best. You have to do your due diligence and find kind of the quality and the approach that you feel is going to be best. But it’s a huge step in the right direction to have this. One of the things that the NBHWC has done is we created a national exam for people to take to become a national board-certified health and wellness coach. About 1,800 people (2019) have done so already, and more to come. Now, do you have to have someone who’s already taken that exam and already gotten that? Not necessarily. Just if they are from an approved program, they’re on their way.

RP   Thinking about the history of health coaching and just looking ahead to the future, what do you think the future holds and how do you think that the field will continue to evolve and change in the years to come?

Well, it’s one of those “the future so bright we got to wear shade things”. It really is exciting, because the value of it is really being recognized. Where it is really growing is in three areas.

1. It’s really growing internationally. People around the world are realizing this is the answer to our dreams.
2. Another area I want to mention is lifestyle medicine. The medical world is realizing that health is largely behavioral. Sure, we have to provide the very best medical treatment, but so much of the effectiveness of that treatment depends on the behavior of the patient. Do they continue to be medically compliant, inherently? Do they take the medication that we prescribed? Are they able to change their diet and get more sleep? All the things that are prescribed in what I call the lifestyle prescription, are the able to succeed? Well, the place you get the lifestyle prescription filled is with your coach.
3. The other area is universities. They are starting to integrate actual programs like ours at Real Balance into their curriculum for public health degree’s and health and wellness degrees and things like that. The other area is primary care.

Wellness coaching has been in primary care for about 10 years already, but it’s really starting to ramp up now because we’re starting to see a couple different things. We’re starting to see organizations realize that if they’re offering health and wellness coaching, they’re going to get better outcomes and get reimbursed better. Also, if they’re providing health and wellness coaching, they look better than their competitor down the street. Lastly, what’s really kind of exciting is here is going to be when reimbursement is available and it’s probably going to differ state to state. You may still have to go through a medical provider, but there’s going to be reimbursement available for coaching for specific problems like weight loss and prediabetes.

RP   That’s awesome. That’s a huge step forward.

MA   Eventually, I think what we’re going to see is hopefully we’ll get to the point where a National Board Certified Health and Wellness Coach can get directly reimbursed and I think that’s coming. I know people that are working on it.

RP   That’s great.

MA   But the other thing about the future is, there’s always these questions that insurance companies, health management companies, just any kind of corporations has a wellness program for their employees is asking, “How do we deal with the numbers?” We have got so many people that need healthcare and need help with lifestyle change. How we deal with that? The tendency is to reach for technology like it is going to just solve all our problems. What we’re going to need is a combination, that tiered approach I was talking about. Because the technology can really help us in a lot of ways, but it can’t do it all.

One of the key things in coaching or lifestyle improvement is being aware of how often you really are on track with your wellness plan. How often am I actually walking or bike riding, or how often am I eating a really healthy meal? Now the Fitbit type of devices, that we see are so popular, absolute research shows that after six months, 50 percent of those devices are in a drawer. They are not on a wrist. The key is to make them part of the coaching. By themselves, they aren’t going to get the job done for many people. Maybe they will for some.

If I’m really a techy kind of person and I have an accountant or engineer brain and I love keeping track of data, I’m all over that. For a lot of people though, I don’t think so. If we make it part of the coaching, it can really work. But the other thing that technology is like worthless at is internal and external barriers to change. If I’ve got an attitude and belief where I can’t give myself permission to do all the self-care stuff, or other external challenges to strategize though; no device going to help me. I need to talk to a real live human being.

RP   I was just going go to say, I don’t think there’s never going to be a technology substitute for human connections.

MA   When we try, I think our whole civilization deteriorates.

RP   I think we’re seeing the beginnings of some of that with the issues of social isolation and loneliness, so I think you’re exactly right.

MA   Which is one of the biggest risks to health there is with correlated data that shows that it’s as big a risk to chronic illness as cigarette smoking.

RP   Do you have a tip or some final words of wisdom? What is the one thing we should all start doing today?

MA   The real power behind the throne at Real Balance Global Wellness Services, Inc. is actually my wife Deborah. When she read your questions and saw that one, she said, “Maybe the first thing we should do is quit saying should to ourselves. Instead, what could I do?”

I think what I would say is, my shorthand definition of wellness is living your life consciously in ways that enhance your health and well-being. To me, it’s about consciousness. It’s about mindfulness.

I just call it noticing. It’s noticing what I’m doing. Paying attention to it. I mean, it’s when we mindlessly eat something that is just out of habit instead of conscious choice.

It’s when we just spend all weekend when you have a couple days off just working around the house trying to get things fixed, instead of asking yourself, what do I really need? What’s missing? Maybe I haven’t connected with friends in months. Maybe I could spend the weekend getting together with friends and socializing. That would do me far more good than a clean house. It’s so much about noticing the effect that my actions have and it’s about reframing things positively as well. Acknowledging yourself for what you are accomplishing.

RP   Thank you so much Michael for your time, your wisdom and the gift of knowledge that you have to us. This has really a pleasure and honor to speak with you today.

MA   Well, a real welcome opportunity on my end. I’ve just been really thrilled with what you’ve been doing with WELCOA and I love how things are moving forward on all these fronts to help people realize that, this wellness approach isn’t going away. It’s better than ever.

Michael Arloski, Ph.D, PCC, CWP, NBC-HWC

CEO and Founder of Real Balance Global Wellness which has trained thousands of health & wellness coaches around the globe.

Michael is a licensed psychologist, Professional Certified Coach (ICF), Certified Wellness Practitioner, and National Board Certified Health and Wellness Coach. One of the key developers of the field of wellness coaching, his book Wellness Coaching For Lasting Lifestyle Change, is the first and most comprehensive book written on wellness and health coaching. Professionally contributing to the field of wellness since 1979, he has keynoted and presented on wellness on four continents. Michael and his wife, Deborah, live, work and play together in Fort Collins, Colorado. They are blessed with a wonderful blended, or “patchwork”, family of young adult children, and grandchildren.