The Science of Well Coaching® Psychology Coupled with Physical Therapy

The Science of Well Coaching® Psychology (Affiliate of Harvard Medical School) Coupled with Physical Therapy 

• Biomechanics 

• Psychology 

By Dr. Kim Byrd-Rider, PT 

BRSGS uses the Well Coaching ® system to improve Physical Therapy outcomes. Pain has a psychological component. It is irrelevant whether the pain caused the psychological disruption or the psychological disruption created the pain. The psychological disruption could be as simple and debilitating as sleeplessness. Regardless of the presentation, both are present when the patient/client comes to physical therapy and both physical and mental issues need to be addressed for holistic wellness. Now, for the first time, with this standardized simple protocol a physical therapist can do both. 

BRSGS requires a 30 minute pre-treatment period at each treatment where patients/clients develop their goal vision for that day and listen to a focusing meditation or silence. During the exercise treatment they explore the protocol questions together with the PT, as the patient designs his/her own life. 

What is Well Coaching ®?   Why do we need it in Physical Therapy? 

• Elaborate upon the expert vs. coach approach as they relate to how Physical Therapists (PT) treat and motivate patients/clients toward their health goals.  

            The expert approach is traditionally established as a standard authoritarian or educator approach. The expert defines agendas, feels responsible for client’s health, solves problems, focuses on what’s wrong, has the answers, interrupts if off topic, works harder than client and wrestles with the client (Moore, Jackson, & Tschannen-Moran, 2015). This is contrary to the partner mentality of the coaching approach of facilitator of change, elicits client’s agenda, client is responsible for health, fosters possibilities, focuses on what’s right, co-discovers the answers, learns from client’s story, client works as hard as coach and “dances” with client (Moore, Jackson, & Tschannen-Moran, 2015). 

            Evident by these list, to switch mentalities from expert to coach requires a switch in mental focus to non-judgement, humility, patience, letting go of righteousness and curiosity. In psychology these cumulative qualities are actually a trait. The Big Five personality traits are well known: extroversion, aggregable, conscientious, neuroticism and openness (Jongman-Sereno, 2017). A sixth trait exists in the HEXACO personality trait model though: honesty/humility.  

The characteristics of the honesty/humility trait at the high end of the spectrum are integrity, sincerity, honesty, generosity, faithfulness, humbleness, fairness and modesty (Jongman-Sereno, 2017) which vividly describe the characteristics needed for a coaching model. The characteristics at the low end of the honesty/humility trait spectrum are sly, deceitful, manipulative, greedy, arrogant, hypocritical and selfish (Jongman-Sereno, 2017) which could be characteristics of the expert model. The honesty/humility trait appears to be a prominent trait needed in the coaching model. 


          Curiosity is considered a trait or a state, not a virtue, and is also a component of the flow state (Agarwal & Karahanna, 2000). Curious people move toward complex, uncertain and/or novel activities (Tomkins 1963; Turner & Silvia, 2006). The curiosity trait is associated with the willingness to choose activities that develop skills, increase potential, stretch abilities and it promotes self-growth-oriented behaviors (Tomkins 1963; Turner & Silvia, 2006). The curiosity trait intrinsically (as opposed to extrinsically) motivates exploration of the self and world (Tomkins 1963; Turner & Silvia, 2006). It seems the difference between the expert model and the coaching model is that the coaching model requires high honesty/humility and high curiosity trait cultivation from the coach while the expert model does not.  

• In what way does “coach as designer” differ from that of expert, teacher, educator, etc.? How might this approach allow a patient/client to become a designer in their own life and in their journey towards self-determination? 

An expert, teacher or educator stance means the coach comes to the client with predetermined visions and goals for the client and assigns them to the client. Conversely, the coach as designer works like an architect using analysis and imagination to reach solutions. Open-ended questions, mindful listening and empathy from the coach is required. The tools of a coach as designer are empathy, optimism, collaboration and experimentalism, instead.  

            In the coach as designer model, goal visions need to be built on current success, be stretched past the status quo, be what a person truly wants (opposed to not want), feel as if it was already true and involve many stakeholders (Cooperrider, & Whitney, 2005). Goal visions need to a have important value to the client and exploit his/her strengths. Past success and a what is working now focus helps with motivation to commit. Goals toward the vision need to be SMART (specific, measurable, action-based, time-bound). SMART goals should be set for an intermediate time-line, first (three months). Then short-term SMART goals aimed at moving toward the top three intermediate goals, afterward (today-next week).  

Short-term weekly experimental oriented goals are set slightly beyond the client’s skills and present experiences. The client drives the brainstorming goal setting processes and is guided by the coach to clarify the topic or to clarity what is being generated. Judgement is deferred. Bold and even wild ideas are encouraged. They are built on what others say, visual, specific, high in quantity and fast. The goal honing process of the coach is to put the client in the driver’s seat and together order and weed through them according to achievability and desirability. 

Measuring goals and goal monitoring is good for goal achievement but written assessment tools support client autonomy better (Halverson, 2010). Discussions between the coach and the client need to conclude what should be measured and how. Clients are more likely to take action when clear evidence supports them (Halverson, 2010). 

            This procedure allows the client to be the creator of his/her own life, supporting the human need for autonomy and developing his/her life purpose (Ryan, & Deci, 2017). The coach is merely a guide asking appropriate questions, not the architect. The client becomes the architect of his/her life. The process has a different effect on the coach than the effect on the client. The coach practicing and strengthening the trait of honesty/humility. Both participants are growing in the direction of the authentic-self (Horney, 1950). To obtain both aspects of the authentic-self (life-purpose and honest/humility) one would need to be both a coach and a client. The coach needs to also be participating in a coaching program as the client.  

• Discuss the concept of optimistic reappraisal in Well Coaching ® and how it can lead to greater self-compassion. 

            A study by Gordon and colleagues (2016) found that optimism and the ability to control ones emotions led to less negative interpretations of an event even when the participants were already angry. The study shows that these skills give people the ability to build inner resources changing their interpretations of events. Optimistic reappraisal builds a client’s inner resource and has nothing to do with emotional suppression (Moore, Jackson, & Tschannen-Moran, 2015). It involves and leads to improved self-esteem, self-compassion, self-determination, nonviolent communication and empathy (Moore, Jackson, & Tschannen-Moran, 2015). Negative reactions to our environment happen automatically but humans are capable of reappraising the situation into more favorable and less stressful conditions. Firstly, we have to distinguish between the event and our interpretation of the event. We must become aware of our unconscious interpretations. We must recognize that we are filtering the event through our own beliefs and values. We must recognize that there are alternative and more positive filters to use for each event, then we must apply them. The goal of the coach is to support a client’s inner resource to make ongoing conscious reappraisals (Moore, Jackson, & Tschannen-Moran, 2015). 

• In what ways can a Well Coach ® (PT) help a patient/client develop greater mindfulness and self-compassion? 

Being a role model of mindfulness, self-compassion and coming from a place of empathy can help clients develop greater mindfulness and self-compassion (Moore, Jackson, & Tschannen-Moran, 2015). This means the coach needs to practice the strategies and grow themselves. The coach can learn nonviolent ways of speaking. Using Marshall Rosenberg’s method called NVC (non-violent communication) uses empathetic connections (Moore, Jackson, & Tschannen-Moran, 2015). This, in turn helps feelings and needs become acknowledged leading the client to deeper awareness. It also creates a safer and more connected feeling with the coach and the client experiences compassion (Moore, Jackson, & Tschannen-Moran, 2015). Compassion is also important in dealing with others, according to Kristen Neff and colleague (2017). It involves the coach opening his/her awareness to the pain of others and for their suffering to emerge (Neff, & Germer, 2017). An understanding of the common human bond of fragility and imperfection is necessary for compassion to surface (Neff, & Germer, 2017). Finally, be kind to oneself as if you were talking to a good friend (Neff, & Germer, 2017). The coach must not only treat the client in this way but must be a role model and treat himself/herself this way. It is easy to outline here but this task takes a lifetime of diligent work to achieve. Both the coach and the client must continually practice. 

• The five stages of change and motivation to change understood by the Well Coach ® (PT) – precontemplation, contemplation, preparation, action, maintenance. 

Precontemplation (not thinking about it), contemplation (thinking about it), preparation (preparing for action), action and maintenance (keeping it going) are the five stages of motivation according to Moore and colleagues (2015). Words that parallel these stages are precontemplation “I won’t or I can’t”, contemplation “I may”, preparation “I will”, action “I am” and maintenance “I still am”. One event can trigger all five, usually in a progression but sometimes regressing before progressing to the next stage. Well Coaching ® can help clients move through the stages smoothly. 

• Discuss the impact of increasing patient/client awareness and focus on the pros of change. 

Decisional balance is an effective way to objectively increase awareness of ones opinion of a subject (Norcross, 2019). According to a 2008 study, when clients weigh the pros and cons of changing out of a precontemplation or contemplation state, it is more effective than the other change processes studied (Prochaska, 2008). Inevitably, when people are stuck in these two stages the cons significantly outweigh the pros. As people move through the stages of change into preparation, action and maintenance, the pros rise and the cons lower (Prochaska, 2008). The article also says that focusing on decreasing the cons often lowers them but they return over time, like doctor persuasion. The pros must be greater than the cons prior to taking action to get the best outcome. The focus in coaching needs to be on increasing the pros (Prochaska, 2008). 

• Describe as a sustainable, healthy mind?  

I believe my mind would be healthy if I could control my temper when talking to the 1-800 number people (self-regulation), if I could be aware of what is going on around me and appreciate it (self-awareness), if I could eat a meal and get fascinated by the tastes (self-awareness), if I would take the time to connect with the people around me (self-transcendence) and additional related situations. It would be sustainable if the learning process were free, I could do it without help and nothing special was needed. I would prefer if it did not require too much effort or pain! 

Luckily there appears to be a solution. A sustainable healthy mind is defined in Vago and Silberswieg’s 2012 article on mindfulness. In this study, they examine additional neurobiological mindful intervention study findings. They conclude that meditation/mindfulness practice (Buddhist and Jon Kabat-Zomm’s 25 y/o Mindfulness-Based Stress Reduction-MBSR) helps people develop self-awareness (meta-awareness), self-regulation (ability to effectively modulate one’s behavior) and self-transcendence (transcend self-focused needs and increase prosocial characteristics). With the absence of these, a person experiences self-processing biases which lead to suffering (Vago, & Silbersweig, 2012).  

By focusing and learning to intentionally shift one’s attention between objects, meditation performs a critical process for effectively managing or altering one’s responses and impulses (Vago, & Silbersweig, 2012). The brain learns how to volitionally control attention. Concentration forms of meditation increase the efficiency of the attention processing system. The activities that improve with meditation include alerting, orienting and engaging to an object; sustaining that attentional focus; executive monitoring and detecting distraction; and disengaging from the source of distraction to re-engage with the original object (Vago, & Silbersweig, 2012). 

Meditation practices strengthen evaluative, expressive and experiential aspects of our emotions’ neural circuitry systems producing the ability to shift focus of the attention at will to modulate ongoing emotional activity (Gross, 1998; Northoff, 2005; Carver & Scheier, 2011; Koole, et al., 2011). 

Meditation has been shown to improve brain processes used in social interactions. Major facets of prosocial behavior include empathy for others and perspective taking. Mindfulness/meditation allows a person to disengage from the contents of his/her personal mind and move toward experiencing an other’s sensory or emotional state (Decety, & Chaminade, 2003; Singer, & Lamm, 2009). Although one’s personality can be biologically biased, prosocial behavior and empathic responses are plastic and can change throughout a lifetime with social-cognitive work (Singer, & Lamm, 2009; de Greck, & et al., 2012; Fan, & et al., 2011). 

The outcome of meditation/mindfulness is building stronger and more experiences in the first-person present perspective without reflection or evaluation. This perspective is considered a higher order of consciousness by psychologists due to its inner and outer volitional awareness abilities including the motivational, social and affective feelings associated with the experience (Vago, & Silbersweig, 2012). The study examines the neurobiological brain areas to support these statements by mapping and documenting them in top-down and bottom-up neuro-processes (Vago, & Silbersweig, 2012). Meditation/Mindful Practice is sustainable because meditation/mindful practice can be continued throughout a life-time. Most if not all psychological interventions are based on accomplishing these constructs that meditation addresses. Meditation is a simple, free and independent solution. 

Benefits to Clients:  

Self-Efficacy + Beneficence + Life Purpose + Love + Positivity + Character + Strengthens = Phychological Capital 

• Explore how coaching develops a client’s psychological capital. 

            Psychological capital can be best defined by the HERO acronym: hope, efficacy, resilience and optimism (Kim, Perrewé, Kim, & Kim, 2017). Luthans, & Youssef-Morgan, 2017). These four share a sense of control, goal pursuit and intentionality. They also all have a theme of “positive appraisal of circumstances and probability for success based on motivated effort and perseverance” (Luthans, & et all, 2007, p. 550). The four work together. For example, one will have optimism toward a goal, hope for the end result, resilience to persevere to the goal and the self-efficacy to do the work to get there. All four can be developed and strengthened or left dormant over a lifetime. Studies have shown that these HERO attributes are contagious to others when exhibited (Luthans, & Youssef-Morgan, 2017).  

• Activities to cultivate hope include: goals and pathways designs and scenario/obstacle planning.  

• Activities to improve efficacy include: experiencing success, modeling relevant others, persuasion (education), positive feedback and arousal.  

• Activities to improve resilience include: identifying and building assets/avoiding risks and learning how to affect the influence process.  

• Activities to improve optimism include: interpretation changes, attribute events positively, glass is “half full” outlook and developing positive expectancy. 

HERO are not the only contributors to psychological capital. Other attributes such as creativity, flow, mindfulness, gratitude, forgiveness, emotional intelligence, spirituality, authenticity and courage have profound research-based evidence as psychological capital influencers (Luthans, & Youssef-Morgan, 2017). 

• Describe four ways to develop self-efficacy. 

There are four principles to developing self-efficacy: engaging, focusing, evoking and planning (Moore, Jackson, & Tschannen-Moran, 2015). 

Engagement between the coach and the client requires a calm, safe, judgment-free relational space where people can comfortably share. No fears of judgment, ridicule or pressure can exist or people won’t authentically share their feelings, needs, thoughts and wants. The coach needs to roll with any resistance caused by feelings of prodding, pushing or insisting. People resist other’s trying to change them. They must change themselves. 

Focusing involves the development of the pros and cons of a situation (decisional balance) to explore where one is on the ready-to-change spectrum (precontemplation, contemplation, preparation, action, maintenance). Reflecting back without exaggeration, interpretation or distortion on these lists is valuable. 

Evoking involves establishing the reason for changing. The “why” or one’s purpose is important here. Using readiness, confidence or willingness scales are useful here. 

Planning must be done to develop self-efficacy. Talking about it is not enough, collaborative planning needs to be in place (Moore, Jackson, & Tschannen-Moran, 2015). Appreciating and stimulating a client to discover what they can do is important on an appropriate scale. Exploring stories of their best experiences, strengths, core values, heartfelt wishes is helpful to dream and design plans that work (Moore, Jackson, & Tschannen-Moran, 2015). 

• How might a (PT) Well Coach®  use beneficence to empower a patient/client’s wellbeing? 

            According to Martela and Ryan (2016) beneficence satisfies the needs from the well-established Self-Determination Theory: autonomy, competence and relatedness needs. These researchers found that beneficence is also a stand-alone need and should be researched as such in the future. In coaching, autonomy, competence and relatedness are considered and purportedly met during coaching sessions. Based on this research beneficence may need to be addressed as well. This could be addressed by coaches in two ways. 

            Firstly, coaches could take the direct approach and add a specific questioning process on this topic. Questions like, “Have you ever considered giving in any area of your life?”, “To whom?” and “What would that look like?”. Allow the client to explore this area and possibly set goals around it, due to its importance in well-being (Martela, & Ryan, 2016). 

            Secondly, if the coach ever hears the client mention anything that sounds like an area of a benevolent act, then the coach would make every attempt to explore this area in depth. The coach would then take the client into goal setting around this need. Many times, people passingly mention wanting to do a benevolent act but it goes unnoticed and unexplored. Hence, it dies. Due to the emphasized importance of beneficence on well-being (Martela, & Ryan, 2016), it is the coaches responsibility to make sure the client explores this area of his/her life. 

• What is your definition of well-being? Life Purpose? 

            According to Ryff and colleagues (2016), purposeful life engagement is the key to longevity, reduced risk for various disease outcomes, reduced physiological dysregulation and gene expression for better inflammatory responses. They explain that even a simple intervention like keeping a daily diary of positive happenings (Well-Being Therapy) works. Ardiet and Ferrari (2018) found a positive correlation between wisdom/religiosity and subjective well-being. They too explain improved well-being as being a result of greater mastery and purpose in life. 

            Finding purpose in life appears to be important to us all. My definition of well-being would be to persevere forward with my purpose. This endeavor is not easy, simple nor stress free but according to the research it appears to be worthwhile to myself in the long term. A measurement would be to set short-term and long-term goals then measure if they get accomplished. Also, allowing those goals to change somewhat as circumstances and new experiences happen, without giving up on them for an easier life. An easier life would look very much like the American dream. Retirement, relaxation and hedonism is the dream. Even though these things promise to bring one closer to well-being, the research says the opposite. It is the pursuit of purpose. 

• What is love not? What is love? Describe how Fredrickson’s definition of love is used in Well Coaching ®. 

Love is not just the connection to your soulmate (Fredrickson, 2014). It is not just the lightning strike. There are two types of love: compassionate love and celebratory love (Fredrickson, 2014). Compassionate love includes taking micro-moments to not only connect and love those closest to us but to reach out to any human and offer them love improves our well-being (Fredrickson, 2014). Celebratory love is gratitude’s generous cousin. Celebrating the things in other people that are clearly going well is love. How we deal with someone’s success is a litmus test of the quality of the relationship. Love can be just a simple genuine smile; being open and being vulnerable. Every interaction with another person is an opportunity for love and to give and receive health (Fredrickson, 2014). Love is a choice and it can happen throughout our day with many people. 

            Fredrickson’s (2014) definition of love is used in coaching when an empathetic and compassionate coach offers a compassionate love connection with a client.         It’s not a romantic love but an authentic compassion. The client becomes vulnerable and the coach becomes a safe place for that vulnerability. This is a transference of love between two people. 

• Explore three ways that Well Coaching ® generates positivity. 

Resources range from intellectual, social, psychological to physical resources (Fredrickson, 2001). Positivity plays a role in flourishing and flourishing is a goal of coaching (Fredrickson, 2013). Positive emotions contribute to the broaden-and-build theory which is believed to broaden people’s momentary thought-action repertoires. Then, that builds their enduring personal resources (Fredrickson, 2001). Coaching starts with an area in a person’s life that they want to change or elicits negative feelings. Through the coaching process, the persons sets goals about relieving those negative emotions. As the person walks out those goals, positive emotions are generated. Secondly, the coach offers empathy and compassion which usually generates positive emotions. The presence of someone who is curious, interested and supportive lends itself to positive emotions. This is another reason why judgement and criticism need to be left out of a coaching session. They may generate negative feelings. This type of coaching interaction can be interpreted as love which is definitely the experience of a positive emotion. Thirdly, when people realize there is a self-generated solution to their problems this alone may encourage more positive emotions towards their life. Knowing that there is a way out of their problems creates a more optimistic outlook. Ultimately the broaden-and-build theory supports the ability to experience the positive emotions in coaching may be a fundamental human strength central to flourishing (Fredrickson, 2001). 

• How might you further cultivate your strengths as the authors suggest through “enhanced awareness, accessibility, and effort”? 

            A person’s strengths can be cultivated if the person is aware of the strength, has accessibility to it and puts in the effort to change (Biswas-Diener, & et al., 2011). This concept opens an opportunity to apply the concept to coaching (Goodman, Disabato, & Kashdan, 2019). Results can be as profound as enhanced therapeutic bonding, patient/client mastery experiences, decreased symptoms, increased intrinsic motivation, mobilizing social support, building upon past success, more engaged at work and higher performance at work (Biswas-Diener, & et al., 2011).There are also risks associated to the strengths that need to be recognized by the patient/client (Biswas-Diener, & et al., 2011). At BRSGS, we have an assessment tool and test for patient/client psychological strengths at the PT initial evaluation so he/she can leverage them throughout the coaching. 

My Testimonial, Kim Byrd-Rider 

• Describe an “aha” moment you experienced during the Well Coaching ® exercise and describe one action you plan to take with this new awareness. 

According to the Harvard Extension School President and Fellows (2017) we have a built-in emotional immunity system that is trying to protect us from shame and disappointment. Kagen and Lahey (2009) have developed a protocol to override the immunity system: 

• Claim an improvement Goal 

• Establish behaviors that work against that goal 

• Figure out the hidden competing commitments 

• Honestly lay out any big assumptions  

I took this protocol and what I learned was that people can go really deep exploring their needs and goals on a piece of paper and with another person who is not a certified therapist. I think the amazing part was about starting with a superficial goal about going somewhere. After unraveling behaviors that work against that goal, I discovered deep seated beliefs that were not only hindering that goal but was at the bottom of why some of my other goals were not getting achieved. As I moved on to hidden competing commitments and big assumptions, I realized that I did not want to attach to anyone for fear of losing them. That is a very life affecting revelation from a four-question protocol. 

It was not just the four questions, it was also the fellow student partner assigned to me. As I told her what was on my sheet, she just asked curious questions that made me go deeper. I had my realization when she said, “Do you have dogs?” I said no, I don’t have animals because I would get attached to them and they are pretty much guaranteed to die before I do. I don’t want to go through losing them. She said, “That’s why I asked you.” That is when I saw that this one big assumption is ruling my life choices. 

Now that I am aware of what I am doing, I am going to ask myself, “Are you trying to sabotage an opportunity to connect?”, “Are you going to destroy an opportunity to avoid connecting with someone?”, or “Are you making this choice because you don’t want to move toward other people?”  When I make decisions, I must always evaluate if I am running away because it is such a foundational value to save myself from attaching.  

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