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What Is Health Coaching? The 4 Pillars That Define It

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by Kelli Saginak, EdD, A-CFHC, NBC-HWC

As the prevalence of chronic disease continues to rise and patients struggle to implement their practitioner’s recommendations and change their habits and lifestyle, the need for certified health coaches increases.


In his passionate quest to reverse chronic disease, Chris Kresser advocates that health coaches fill a critical gap in today’s healthcare model. With 75 percent of deaths in the United States resulting from chronic diseases, the need for health coaches has never been greater. (1) Likewise, as healthcare systems grapple with increasing chronic diseases and costs, practitioner time spent with patients decreases, after which patients are expected to know what to do and how to implement their practitioner’s recommendations.

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Why Health Coaching Is so Important

According to the Centers for Disease Control and Prevention, only 6.3 percent of Americans follow these top five healthy behaviors: (2)

  1. Not smoking
  2. Exercising regularly
  3. Drinking moderately or abstaining from alcohol
  4. Maintaining a healthy body weight
  5. Getting enough sleep

Common reasons for not following through include not knowing how or being driven by negative emotions and external pressures. (3) Under pressure to make changes, patients resort to using willpower to “white-knuckle” change, which rarely produces positive outcomes and is definitely not sustainable. Clearly, more handouts and advice are not the answers. (4) “Just tell me what to do and how to do it” approaches will not solve today’s chronic disease epidemic. However, health coaching, according to Chris Kresser, is “uniquely positioned to tackle the chronic disease epidemic” by helping clients implement practitioner recommendations and sustain long-term change.

Health coaching is all about helping clients achieve their health and wellness goals. Check out this article from health coach Kelli Saginak to learn more about what health coaching is and the foundation it’s built on. #iamachangeagent #wellness

What Is Health Coaching?

Health coaching is distinct in its influence on patient outcomes through its unconventional client-centered, growth-fostering, thought-provoking partnership with clients that assists them with achieving their highest level of health and well-being. Clients take full responsibility for:

  • Designing their personal vision of wellness
  • Crafting the goals to achieve it
  • Taking consistent action toward their goals
  • Monitoring their progress along the way

Health coaching skillfully facilitates clients’ engagement and investment in their capacity to change (5), implement their practitioner’s recommendations, and move beyond mere symptom management toward optimal health and wellness, which is something that is sadly missing in today’s healthcare model. In this light, “health coaching has the power to turn the tide of the chronic disease epidemic—and change the world.” Uniquely positioned at the center of health coaching’s transformative process are the four pillars of health coaching, which enable health coaches to empower positive patient outcomes.

What Are the Four Pillars of Health Coaching?

Envisioned and developed by Karen Lawson and her colleagues, the four pillars of health coaching support health coaches in their facilitative role as collaborative change agents with clients. (6)

Depicted as the “philosophic ‘heart’ of health coaching,” Lawson regards the four pillars as foundational to “personal and cultural transformation” and “aligned with the highest vision of mind-body-spirit well-being for us all.” (7) Brought to life through masterful and powerful health coaching, if integrated throughout healthcare, the four pillars are capable of “transforming the current medical culture” and lead the way to reversing the chronic disease epidemic and changing the world. (8) The four pillars are:

  1. Mindful presence
  2. Authentic communication
  3. Self-awareness
  4. Safe and sacred space

1. Mindful Presence

Mindful presence is the process of bringing intentional focused, nonjudgmental awareness into the present moment across multiple levels. As described by Jon Kabat-Zinn, creator of Mindfulness-Based Stress Reduction, mindfulness (the core of mindful presence) is paying attention, on purpose, to the present moment with curiosity and non-judgment. (9) Mindful presence incorporates essential “being skills” characteristic of masterful coaching, such as:

  • Empathy
  • Warmth
  • Acceptance
  • Courage
  • Zest
  • Partnership
  • Fun

Mindful presence embodies the skills of mindful listening, which is “the skill most recognized for enhancing the quality of the coaching relationship and perhaps the most important.” (10)

2. Authentic Communication

Integrated into a coherent whole, authentic communication pulls together notable communication approaches and strategies such as “motivational interviewing, appreciative inquiry, and nonviolent communication.” (11) Within the practice of authentic communication resides:

  • Deep listening
  • Curious inquiry
  • Perceptive reflections
  • Silence

Deep Listening

Inspired by the motto of artful health coaching, “Listen until I don’t exist,” (12) deep listening is hearing below the surface of what clients are communicating beneath and between their words, body language, nonverbal behaviors, and emotions. (13) Nourished by kindness, compassion, and curiosity, deep listening cultivates stronger, closer, successful relationships with ourselves and others. (14) It’s our path across the divide, or as developmental theorist Ruthellen Josselson describes, our only means of bridging the separateness that exists within the “space between us.” (15)

Deep listening invites clients to explore themselves deeper, ask deeper questions about their lives and futures, and the beliefs, choices, and habits that have brought them to where they are today, and could potentially move them forward. (16) As echoed by John J. Prendergast, spiritual teacher and author of In Touch: How to Tune In to the Inner Guidance of Your Body and Trust Yourself, deep listening transports us beyond “superficial mental realization” towards clearer self-awareness, understanding, and attunement. (17)

Curious Inquiry

Likened to the feeling of fascination, curious inquiry invites child-like wonder into the health coaching relationship as a means of investigating and exploring deeper. Curious inquiry invites open-hearted, fresh, limitless, unbounded, and unknowing exploration, without goals, expectations, or judgment; however, the process is not always comfortable or easy. As well-known theorist of group process, organizational culture, and leadership Ed Schein reminds us, curious inquiry can provoke uncomfortable emotions such as “dependency and vulnerability,” and even fear as clients explore those deeper, hidden places within themselves. (18) However, as uncomfortable, even painful as connecting with our deeper emotions can feel, through the curious exploration of what lies beneath the surface of ourselves, we gain priceless insight that can empower us to take action and transform our lives. In the words of Brené Brown:

“… we need to cultivate the courage to be uncomfortable and to teach the people around us how to accept discomfort as a part of growth.”

In short, it’s normal and okay to experience uncomfortable, difficult emotions in our process of learning, growth, and change.

Perceptive Reflections

Through thoughtful mirroring of what is heard or perceived by the coach, perceptive reflections allow clients to see and hear themselves, perhaps for the first time. Given full autonomy, clients have an ongoing invitation to confirm, clarify, and expand upon that which the coach perceives and reflects. As one of the core coaching skills alongside mindful listening, perceptive reflections symbolize deep listening. (19) Skillfully and purposely offered, perceptive reflections aim at intentionally moving clients from the comfort of their “cerebral thinking mind” into the often ignored or avoided emotional center of their brain. Key for client self-awareness and successful behavior change, perceptive reflections facilitate dramatic relief or emotional responses (e.g., fear, inspiration, guilt, and hope) that often accompany clients through the early stages of change. (20)

Silence

An essential and often forgotten ingredient in authentic human communication is the mindful practice of silence. Masterful health coaches are comfortable with silence and intentionally integrate silence into their conversations with clients. Clearly aware that if they are speaking, they are not listening, skilled health coaches use precision with choosing to speak so that their words flow with client-focused intention. In a similar light, the more that clients experience the stillness of silence, hear themselves through perceptive reflections, listen deeply to their inner voice, and connect with their emotions, possibilities for change emerge and grow. What once seemed impossible suddenly seems within reach.

3. Self-Awareness

Simply stated, self-awareness is being consciously tuned into our physical, mental, and emotional self in the present moment. Daniel Goleman, author of the best-selling book, Emotional Intelligence, refers to self-awareness as, “the ability to monitor our inner world.” (21) Within the context of coaching, self-awareness is an inner knowing of where we are in the coaching relationship and how to return to the present moment in those rare, yet human, moments when we drift.

The practice of self-awareness is a lifelong commitment to expanding consciousness. Described by Daniel J. Siegel, best-selling author of Aware, and clinical professor of psychiatry at the UCLA School of Medicine, and executive director of the Mindsight Institute, expanding consciousness is a practice of “strengthening the experience of knowing and our capacity to be aware.” (22) Masterful coaches are keenly and intuitively aware of their thoughts, feelings, and internal reactions and able to respond to clients with clear conscious awareness. Their dedicated practice of evolving their self-awareness is instrumental to helping clients step into their own expanded self-awareness (i.e., “I’m the one standing in my own way.”) and channel their discoveries into sustainable health and wellness practices (i.e., “I can do anything I put my mind to.”).

4. Safe and Sacred Space

Essential for change is a safe and sacred space, the open, trusting, connected, respectful, safe, non-judgmental holding environment where clients can explore and discover possibilities freely, openly, and honestly. (23) Co-created collaboratively by the client and coach, the safe and sacred space is where clients learn to trust themselves, which according to Becky Gorman, PA, Center for Spirituality and Healing, University of Minnesota, is the “ultimate goal of coaching.” (24) The trust cultivated within the coaching relationship translates into clients’ deeper trust in themselves and what they are capable of achieving. Within the safety of the coaching relationship and environment, clients feel supported to venture into experimenting or “trying out” possibilities, perhaps for the very first time. (25) The whisper of, “I’d really love to complete a 5K, even if I walk it,” suddenly feels possible.

How the ADAPT Health Coach Training Program Incorporates the Four Pillars of Health Coaching

The four pillars of health coaching and more come to life in the ADAPT Health Coach Training Program, a robust online training course that prepares health coaches to serve as behavioral change experts. Through a carefully orchestrated curriculum and practical, applied experiences, students hone the art and practice of effective, national competency-based coaching grounded in:

Students of the ADAPT Health Coach Training Program study Functional Health (including Functional Medicine principles and nutrition and lifestyle from the ancestral perspective) and how to apply Functional Health knowledge to their work with clients and patients. In preparation for building a career as a health coach, the program includes professional and business development (including business setup, operations, and marketing). Through practical, applied coaching experience while beginning to build their business or apply for positions, ADAPT students graduate with much more than knowledge in Functional Health, ancestral lifestyle, and how to coach; they graduate actively coaching actual clients and putting their awareness, knowledge, and skills into action. To find out more about the ADAPT Health Coach Training Program, click here.

A signature component of the ADAPT Health Coach Training Program is the ADAPT model of health coaching. With the purpose of providing clients and patients with the support they need to build new habits and change their lives, the ADAPT model of health coaching provides health coaches with a framework from which to support and facilitate clients’ process of change. That integrates National Board for Health & Wellness Coaching competencies with the four pillars of health coaching. Throughout the year-long training program, students learn to apply the ADAPT Model of Health Coaching in their coaching sessions while applying the foundational principles to their own lives with the support and supervision of nationally certified mentor coaches.

Holding Mindful Presence

Learning the art and practice of mindful presence is integrated throughout the ADAPT Health Coach Training Program. Students are asked to develop their own mindfulness practices with the intention of evolving essential “being skills” that include mindful listening. Mindfulness meditation is taught and led by expert faculty alongside reflective journaling that invites students to explore themselves more deeply, which translates to modeling and facilitating mindful presence with their clients.

Learning the Art of Authentic Communication

Authentic communication is threaded through the Art and Practice of Coaching component of the ADAPT Health Coach Training Program. Throughout the year-long program, students practice coaching “being” and “doing” skills weekly, and through ongoing feedback and supervision evolve their ability to model authentic communication and use it fluidly in their coaching sessions. It becomes part of who they are and how they show up in their relationships and connections with others.

Building Self-Awareness

Cultivating self-awareness is embedded throughout the ADAPT Health Coach Training Program curriculum and clinical experiences. Each week’s curriculum content and live and practice sessions offer students a variety of opportunities from which to know themselves deeper and discover priceless awareness and insight. Through weekly homework, practice coaching sessions, mentor coaching, and feedback, students peel back the layers of who they think they are and uncover, alongside ongoing support, more of their “true” selves as masterful coaches, passionate professionals, and compassionate people.

Understanding Safe and Sacred Space

The highly applied and interactive training program models the essence of the safe and sacred space. From enrollment calls, advising and support services, and learning alongside expert faculty, nationally certified mentor coaches, and licensed nutritionists, the program environment embraces and models the four pillars. Online interactive live sessions provide students with safe and supported laboratory space where they can:

  • Experiment with and practice coaching skills
  • Receive immediate feedback
  • Gain confidence and competence
  • Learn to trust themselves
  • Serve as an example of what is possible for their clients

As emphasized by Lawson, “We must promote health coaching’s practice and its principles as both an example and a force for change within a system of healthcare that is struggling to create greater accessibility, effectiveness, and sustainability.” (26) Collectively, the ADAPT model of health coaching, supported by the four pillars, and Functional Health principles and perspectives combine to create a strong, powerful, competency-based foundation from which to train and develop highly effective health coaches. Those coaches are capable of serving as a force for change in partnership with their clients and within healthcare systems. Masterfully skilled and fully prepared to collaborate with practitioners, nutritionists, allied health and other professionals, and clients, health coaches fill the gap in today’s Functional Medicine healthcare model; they are the change agents needed to reinvent healthcare and reverse the epidemic of chronic disease.