Solution-Focused. Wellness Coaching*

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Background
Acceptance of a multi-dimensional conceptualization of health and well ness has been gradual within the traditional medical model. The historically embraced biomedical model of illness focused exclusively on biology while ignoring psychological, environmental and social influences on health. Yet, evidence supports an increased risk for major illness and death associated ying theoretical foundations including cognitive coaching, behaviour-based positive psychology and goal-oriented coaching (Ives, 2008). Common types of coaching models include Life Coaching and Executive Coaching, which are structured approaches to help non-clinical populations set and reach goals (Green, Oades & Grant, 2006).
Several private programs focus specifically on wellness or health coach ing. For example, Wellcoaches, American Council on Exercise and the National Institute of Whole Health offer training and certifications for coaching. Addi tionally, Integrative Health .Coaching, developed at United States research institution Duke University, is a systematic and collaborative process that facilitates life experience enhancement and goal attainment related to a par ticular health concern (Caldwell et al., 2013). Despite the numerous models, there is no consensus definition of health or wellness coaching, resulting in wide variations in training, methodology and scope of practice (Smith et al., 2013). Thus, there is a need for a clearly defined model and therapeutic approach to health and wellness coaching, to provide guidelines and strate gies to facilitate lifestyle change.

Solution-Focused Brief Therapy
The Solution-Focused Wellness Coaching model provides a health and life style change approach using evidence-based counselling strategies and tech niques. Solution-Focused Brief Therapy (SFBT) is a strength-based interven tion defined by its emphasis on constructing solutions rather than focusing on problems and the assumption that clients have the resources and capac· ity to change (De jong & Berg, 2013). It originated in the early 1980's based on the work of de Shazer, Berg and colleagues at the Milwaukee Brief Family Therapy Center (BFTC) in Milwaukee, Wisconsin (De Shazer et al., 1986).
SFBT is categorized as a post-modern approach to counselling, adher·· ing to tenets of social constructivist theory (Crockett & Prosek, 2013) and emphasizing that problems and solutions are both clients' construction in a social context. SFBT utilizes a collaborative and non-hierarchical relationship with clients and recognizes that they are the experts on their goals and aspi rations. The therapist is an expert on the conversation of change that allows clients to reconnect with their resources and strengths and accomplish their self-determined goals, In addition, SFBT focuses on the present and future and believes that problems belong to the past (Lee, 2013l As described in the Treatment Manual endorsed by the Solution-Focused Brief Therapy Association , SFBT basic tenets include: focusing on the client's desired future rather than on past problems or cur-rent conflicts, it is based on solution-building rather than problem-solving, no problem happens all the time -there are exceptions, alternatives to current undesired patterns of behaviour, cognition and interaction that are within the clients' repertoire or can be co-constructed by therapists and clients as such and clients are encouraged to increase the frequency of current use ful behaviours. Additionally, SFBT differs from skill building and behaviour therapy interventions, in that the model assumes that solution behaviours already exist for clients and the conversational skills required of the therapist to invite the client to build soh;tions are different from those needed to diag nose and treat client problems. As the popularity of SFBT has grown, so has its research base. Many schol arly articles and studies have been published that examine the unique quali ties of SFBT and distinguish it from other therapeutic modalities. Among the significant differences between SFBT and other commonly used therapeutic approaches such as Cognitive Behavioural Therapy (CBT) and Motivational Interviewing (Ml), are the lack of diagnosing pathology; focusing on what is right rather than what is wrong and not assuming that what's behind the client's words is more significant than what is said (McKergow & Korman, 2009). Studies demonstrate that SFBT sessions were significantly higher in positive content, lower in negative content compared to (CBTJ (Jordan, Froerer & Bavelas, 2013) and SFBT formulations preserved a significantly higher proportion of clients' exact words and added fewer of therapist's interpreta tions than did CBT or MI .
The evidence base for Solution-Focused Brief therapy is strengthened by several outcome reviews and analyses. Reviews by Gingerich and Eisengart (2000), Gingerich and Peterson (2012) and Kim (2008) support positive ben efits of SFBT including strong evidence related to length of treatment, indicat ing that SFBT may be more cost--effective than other therapeutic approaches. Evidence supports the effectiveness of Solution-Focused Brief Therapy across a variety of populations. For example, outcome literature related to school populations demonstrates positive effects of SFBT on behavioural and aca demic problems, (Kim & Franklin, 2009), improved listening comprehension and reading fluency, perceptions of general intelligence and attitudes toward school and teachers, as well as decreased anxiety in children with reading problems (Daki & Savage, 2010).

Solution-Focused Coaching
Based on the principles of SFBT, Solution-Focused Coaching (SFC) is an adap tation of this treatment approach fo r use with non-clinical populations. Like SFBT, SFC is focused on helping people identify preferred outcomes and spe cific goals, disengaging from problem-focused thinking, identifying and utiliz ing resources and strengths, through a mutually respectful collaborative envi ronment (Grant, 2013). SFC embraces several basic beliefs that guide practice including: asking questions is more important than providing answers, focus is on the future not the past, build on client's strengths and explore solutions and "if it's not broken, don't fix it, unless it can be improved" (O'Connell et al., 2012). SFC differs from SFBT in several important ways including focusing on non-clinical goals, use of a coaching model as opposed to a psychological model and delivery by a trained coach rather than a counsellor or psychother apist (O'Connell et al., 2012).
In addition to the demonstrated effectiveness of SFBT, literature supports the use of a SFC approach. Multiple books provide rationale, guidance and techniques related to SFC (Jackson & McKergow, 2007;O'Connell et al., 2012). In addition, a number of studies demonstrate its effectiveness on a variety of outcomes. Within a coaching context Solution-Focused questioning has been found to be more effective than problem-focused questioning, with notable differences in client affect, goal approach, understanding of problems (Grant & O'Connor, 2010) and improvements in self-efficacy and action planning (Grant, 2012). Solution-Focused coaching has also demonstrated effective ness in improving workplace well-being (Grant, Curtayne & Burton, 2009) and can be effective in group interventions (Green, Oades & Grant, 2006).

SFWC framework
The proven effectiveness ofSFBT and SFC, as well as the emerging acceptance of wellness as a multi-dimensional construct, provides an ideal combination for addressing lifestyle behavioural change. The Solution-Focused Wellness Journal of Solution-Focused Brief Therapy -Vol 1, No 2, 2014 -63 Coaching model (Table 1) integrates core tenets of SFBT and SFC with a well ness framework that includes sociai, emotional, intellectuai, spiritual and physical wellness domains. By working collaboratively with clients to identify their strengths and resources, SFW Coaches can support them in identifying future-oriented goals. These self-determined goals can be focused both on specific domains of wellness and on holistic well-being.
Understanding the subjectivity of wellness as a construct, as evidenced by the multiple existing models represented in the literature, allows for flex- ibility in the client's conceptualization of their own well-being. The SFWC model provides a useful framework illustrating the multidimensional nature of wellness. However, SFWCs must be cautious not to direct the conversation, or "fit the client to the model". SFBT is built on the wants, needs, or behav iours of clients, therefore the SFWC assumes a supportive role that attempts to expand rather than limit options. (de Shazer et al., 2007). The Solution-Fo cused approach may be integrated with other techniques so long as a belief in clients' abilities to know what is best for them and to effectively plan how to get there, is maintained (Trepper, et al., 2006). Thus, SFWCs can support clients as experts in identifying and defining areas that are most pertinent to their overall wellness, while assisting in the process of distinguishing and exploring relationships between the multiple dimensions of wellness and the facilitation of wellness-related change.

Solution-Focused Wellness Coaching: Multidimensional Wellness Model
While clients may choose to focus on single or multiple aspects of well ness and "label" these domains in ways that are meaningful to them, the following are consistent to the vast majority of evidence-based wellness models (Roscoe, 2009) and provide a useful framework for addressing well ness-based change.
• Social Wellness has been described in the literature as an individu al's interactions with others, the community and environment (Hettler, 1980), the amount of support received and reciprocated and the value attached to these actions (Adams, Bezner & Steinhardt, 1997). • Emotional Wellness relates to the awareness and acceptance of feel ings (Leafgren, 1990), management or regulation of emotions (Hettler, 1980) and one's sense of self (Adams et al., 1997). • Physical Wellness can be described as maintaining bodily balance and harmony through cardiovascular fitness, flexibility, strength and healthy diet (Hettler, 1980;Renger et al., 1990), as well as taking pre ventative action to avoid illness. • Intellectual Wellness relates specifically to expanding, improving and sharing knowledge and skills through a variety of creative and stimu lating activities and resources (Leafgren, 1990;Hettler, 1980). • Spiritual Wellness focuses on the perception of meaning and purpose in life, the integration of mind and body (Adams et al., 1997) and the pursuit of a fulfilling life (Renger et al., 2000).
Using a SFWC approach, these domains of wellness can be explored with cli ents in a manner that adheres to the core tenets of SFBT. Professionals can support clients in identifying ideal states of well-being, defining and clari fying different aspects or domains of wellness that are deemed important

SFWC in practice
The SFWC can support individuals in constructing their own definitions of wellness and the value that they place on each domain. This allows for the exploration of strengths, exceptions, "ideal states," and goals related to the domains as identified by clients as current areas they would like to focus on. Through examining client strengths, the SFWC can work collaboratively with clients in identifying practices that they are currently implementing to feel physically well. Additional strategies may be identified which could build on current practices and positive, attainable goals that reflect client values can be established. By providing regular, positive feedback client strengths can be reinforced, while focusing on successes rather than ongoing problems can help to facilitate lifestyle change.
Additionally, professionals can support clients in identifying ways that domains of wellness are interrelated and examine ways that improving one area of wellness may affect not only other domains, but overall perceptions of wellness as well. By emphasizing the interrelatedness of wellness domains and developing strength-based goals, clients can create lifestyle changes that lead to improved overall health and wellness.
The SFWC model is designed for use with non-clinical populations, there fore may differ from specific goals and skills utilized in a therapeutic con text. Though there are variations in techniques within a SFBT approach, the basic tenets identified by Bavelas et al. (2012) in the Solution-Focused Ther apy Treatment Manual for Working with Individuals, illustrate the core com ponents that serve as a foundation for Solution-Focused techniques. Specific, active ingredients of SFBT include collaborative alliance, focusing on solu tions, setting attainable goals, focusing on the future, use of scaling and focus ing on exceptions to problems (Bavelas et al., 2012).

SFWC case mustration
Nico was a 20-year-old male college student who was seen for individual wellness coaching at the university wellness centre. Nico was referred to wellness coaching by his academic advisor due to concerns related to feel ing overwhelmed. After gathering background information and ruling out the need for any higher level of care, Nico and his wellness coach collaboratively agreed to explore Solution-Focused Wellness Counselling. It was determined that this approach might be beneficial to support Nico in establishing balance in his life and improve wellness.
Using a Solution-Focused Wellness Coaching approach with Nico inte-Journal of Solution-Focused Brief Therapy -Vol 1, No 2, 2014 -67 grated discussion related to his perceptions of health and wellness. Consistent with the tenets of SFBT that emphasize collaboration and a non-hierarchical relationship, the SFWC worked to gather information about Nico's strengths and experiences related to wellness. Using this approach recognized Nico as the expert and valued his conceptualization of well-being. Through this dialog, the coach was able to explore the multidimensional nature of wellness with Nico, while focusing on solutions rather than current problems. The dialog also presented opportunities to highlight exceptions, instances when Nico's strengths and resources allowed him to access a state of improved wellness. Nico: I still get to the gym on occasion, but not nearly as much as I'd like.
SFWC: Great that you still find time to exercise. It sounds like feeling phys ically well is important to you.
Nico: Yeah, I guess it makes a pretty big difference for me.

SFWC:
Are there other areas of life might be affected by your physical wellness?
Nico: Well, if I have more energy I'd probably be able to spend more time on school work, which would hopefully lead to better grades.

SFWC: What do you think might be a realistic short-term goal for improving your physical wellness? [Goal-setting]
As in many models of psychotherapy and coaching, concrete and specific goals are an important component of a Solution-Focused approach ( de Shazer et 2007). By integrating short-term, measurable, realistic goals for each domain, Nico was able to identify strategies to improve his overall well-being based on his own strengths and resources. It was essential in this case to imple ment goals on a gradual basis, as Nico's presenting concerns related to feeling overwhelmed. Thus, initial goals developed based on the preceding interac tion were focused solely on physical wellness. Subsequent weekly coaching sessions sometimes integrated goals based on other domains of wellness as identified by Nico, therefore ensuring that goals were relevant. This not only enabled Nico to develop his own goals based on his own values, but improved both domain-specific and overall wellness and improved his self-efficacy related to goal-accomplishment. Nico: I think that checking out at least one club in the next week would be realistic. l also would like to get back in touch with one particular friend that I've been meaning to call.
SFWC: Those sound like great goals. How might they change your current rating of '4' if you were to accomplish these goals?
Nico: If I was involved in a tlub? I think that alone would probably bump me up at least to a 5 or 6.
The conceptualization of wellness as a multidimensional construct created a foundation from which the SFWC was able to support Nico in exploring each domain individually, develop general wellness or domain-specific goals and work towards overall balanced wellness. This provided an opportunity for the SFWC to gather specific information about Nico's perceptions of well ness through use of Solution-Focused techniques like the miracle question and scaling questions. This was helpful in clarifying how Nico conceptualized his ideal state with regard to each domain of wellness, which could therefore inform goals in that area.

SFWC:
We've looked at goals for both physical and social weliness. How do you think these will impact your overall well-being? [Future-oriented] Nico: I'd imagine that if I can accomplish those goals l will feel a good bit better than I do now. I'll probably have more energy, be in a better mood, have more confidence.
SFWC: So physical and social wellness can affect other areas as well?
SFWC: Earlier you mentioned that you would rate your overall wellness as about a '4'. When you are able to meet these physical and social goals, how do you think it will impact your current 4 rating?
Nico: If I can do those things consistently, I'd have to think that it would get me to at least a 6 or so.
SFWC: It sounds like you had identified some areas that can definitely im prove your overall wellness. The discussion between the Solution-Focused Wellness Coach and Nico included opportunities to collaboratively explore the multidimensional nature of wellness. This was important in examining the impact each domain may have on overall wellness. Examining the construct wellness provided opportunities to clarify how Nico thinks about wellness and how specific domains influence his ability to maintain balance.
The healthcare paradigm is evolving toward a preventative, multi-dimen sional approach to wellness. Based on evidence the link between chronic illness and lifestyle factors such as inactivity, diet and stress, there is a need for professionals with specialized training who can support individ uals in developing skills and resources related to making lifestyle changes within a non-clinical context Solution-Focused Wellness Coaching uses evi dence-based techniques to support individuals in creating wellness-based changes across multiple domains. Despite multiple coaching approaches and certifications, there is a lack of consensus definition, requirements and utilization of evidence-based practices.
In contrast to the traditional Western medical model that focuses on resolving problems, the SFWC supports individuals in constructing their own conceptualizations of optimal wellness and identifying future-oriented goals and strategies based on existing strengths and resources. This strengths based approach to facilitating healthy lifestyle change is a shift from tra ditional coaching or treatment models in which the emphasis is on fixing problems. Research is needed, including studies related to individual and group SFW coaching, to establish Solution-Focused techniques as a dominant approach in health and wellness-related change and provide a foundation for integration into both physical and psychological health-related fields.
This model provides a short-term, effective approach to coaching that is applicable in a variety of health and wellness contexts including primary care, psychology and counselling, social work, occupational and physical therapies and exercise and fitness. By providing professionals with strategies and tech niques, SFWC integrates easily implemented strategies that are replicable and evidence-based with a multi-dimensional understanding of wellness. Rather than pathologising clients or focusing on problems, health professionals can utilize the SFWC model to support clients in facilitating preventative lifestyle change using a strength-based, collaborative approach.