When a coach may help

An alternative to traditional therapy focuses more on the potential of the future than the problems of the past

Carol Kauffman has a question for you: If your life could look the way you’d really like it to look, what would that be?

Work it out

The practice of coaching is characterized by asking specific questions, according to Carol Kauffman of the Institute of Coaching. In the following exercise, “the idea is really giving yourself permission and then thinking about your future so it can pull you forward and help you notice opportunities to do things when they show up,’’ she said.

Imagine yourself

as a pie filled with many pieces.

Pick one of those pieces

, whether it’s work, relationships, health, where you live, your personal growth, leisure, or some other component.

If time or money were no object

, on a scale of 1 to 10 with 10 being the best, what would this part of your life look like?

If you don’t know

, close your eyes and concentrate, making yourself accessible to your dreams, as Kauffman would say.

If you said you’re at 2 1/2

, what would it take over the next six weeks to get to 3?

ELIZABETH COONEY

Depending on your answer, she’ll help you build on your strengths so you can pull yourself toward your goals, step by small step. She’ll also hold you accountable.

Although Kauffman is a psychologist, this is coaching, not therapy. Co-director of the new Institute of Coaching at Harvard-affiliated McLean Hospital, she is working to solidify the growing body of evidence-based research supporting the relatively new field that is often defined by what it is not.

“Therapy helps you overcome the challenges of the past and coaching helps you very clearly identify your vision of the future,’’ she said. “Coaching is a process of change that revolves around strengths and potential, rather than feelings of pathology and pain.’’

There are executive coaches who encourage leadership, wellness coaches who help people become more fit, and health coaches who focus on preventing disease or coping with illness. And there are life coaches who step in when people are stuck, at work or in relationships. Moving forward is the mantra, in tune with positive psychology, which Kauffman defines as “the study of what is right with us and what makes life worth living.’’

Coaching has a new research home at McLean, funded by philanthropist and coach Ruth Ann Harnisch. A pilot program at a Massachusetts General Hospital primary care practice is testing whether its health coaches can deliver improvements in blood pressure or diabetes control. But the field is still without national agreement on accreditation. Insurance companies do not cover the cost of coaching, which can range from $50 for one-on-one consultations to $500 per hour for high-end executive coaching. Kauffman’s institute will not train or certify coaches but will make grants to researchers who will build on existing studies that investigate how coaching works to help people make changes in their lives.

“People need to know this isn’t just happy talk,’’ Kauffman said. “This is great science.’’

At a time of year when change for the better tops many people’s to-do lists, coaching has intuitive appeal. Kauffman also said there’s a bottom-line case to be made: People who are flourishing in their lives, with high levels of well-being, cost the health-care system less, she said, citing research by Emory sociologist and positive psychology proponent Corey Keyes.

Susan DiGiovanni of Reading says coaching saved her life. Thunderstruck by a July recurrence of breast cancer, she turned to a wellness coach to navigate her way through a new life in which just getting out of bed to make a cup of tea was a struggle. She had superb medical care, but was emotionally, physically, spiritually, and mentally devastated by her Stage 4 diagnosis.

“I needed to find someone who could not only navigate the hospital system, but help me reach out to other opportunities, based on my own individual needs,’’ she said.

In September she met Margaret Moore, co-director with Kauffman of the Institute of Coaching and founder of Wellesley-based Wellcoaches, at a symposium on coaching and leadership in medicine. When they began working together, Moore asked DiGiovanni to write down 10 things that make her feel alive or give her purpose. Faith was her first one, so Moore suggested she start each day with 15 minutes of prayer and meditation. Family was next, followed by friends and being in nature. Going down the list, they found ways to connect with what helped her.

“We totally focused on her future and achieving her dream. I’m not talking about her cancer treatment, unless she wants to tell me about it,’’ Moore said. “We are working on how she’s building a new career, how she’s working with her teenage kids, how she’s moving into a new house.’’

DiGiovanni says the process gave her inner healing. “Most people think of wellness coaching as, ‘Jog three miles, eat a lot of salad, take your vitamins, and do a yoga class.’ It’s so much deeper.’’

At MGH Back Bay, nutrition and exercise may very well be prescribed, but not in such a top-down fashion, according to Dr. Edward Phillips, director and founder of Harvard’s Institute of Lifestyle Medicine as well as director of outpatient medical services at Spaulding Rehabilitation Hospital Network. His interest is in motivating people to exercise and he sees coaching as an effective, efficient way to deliver health messages to patients at risk for serious medical conditions.

At the primary care office, he asks patients with high blood pressure if they are ready, willing, and able to make changes that could improve their health. If they say yes, he suggests simple changes they can make right away: walking 500 extra steps, drinking two extra glasses of water a day, or brushing their teeth earlier at night and not eating afterward. In a follow-up appointment or phone call, he asks if they would like to continue with a health coach. A pilot program will track blood pressure levels to see if coaching made a difference. Next on the coaching list will be monitoring blood sugar levels for people with type 2 diabetes or at risk for it.

“We’re helping people modify health behaviors that they want to change so they can make sustainable lifestyle changes,’’ he said.

Jamie Johnson, who coached high school and college sports teams and managed a wellness center for a heath insurer before coming to MGH Back Bay, works with patients in the 12-week pilot program. She assesses their eating habits, nutrition, stress, emotional well-being, and life satisfaction as well as their physical activity.

“My clients want to change their lives and they create the agenda for how we conduct our coaching sessions,’’ she said. “It’s all about what they want to do. I help people identify their values and what their strengths are.’’

Phyllis Cohen, who from time to time has been coached by Kauffman, said she passes on lessons about identifying strengths through her own job as a career counselor. “I’m able to help them feel more positive about what they have to offer the world of work and about how they can handle their lives and job search in a different way.’’

Building on strengths is the hallmark of positive psychology, which Martin Seligman of the University of Pennsylvania says can provide the “scientific and theoretical backbone’’ to coaching, whose lack of standards concerns him.

“One need not be a licensed psychologist, or even a psychologist, to practice positive psychology or to practice coaching,’’ Seligman, often called the father of positive psychology, wrote in the journal Australian Psychologist.

Dr. Steven Berglas, a former McLean psychiatrist now an executive coach in California, worries that untrained coaches will not recognize mental illness when they see it. “With people who are in [serious psychological] trouble, I get them a shrink. Otherwise, I say I can’t help you.’’

Dr. Peter Metz, a clinical professor of psychiatry and pediatrics at University of Massachusetts Medical School, said there is room for both therapy and coaching to work together. Children and adults diagnosed with attention deficit hyperactivity disorder, for example, do well with psychiatric treatment as well as coaching on how to use their strengths to meet specific challenges. Coaching “can definitely have a psychotherapeutic benefit. It can help people feel better and do better, which is the goal of therapy.’’

Before embarking on a coaching relationship, he said, a mental health assessment may be in order. Medications or psychotherapy can complement and enhance the impact and effectiveness of the coaching.

“If you have pneumonia, you need an antibiotic. If you have depression you’ve got to get treatment,’’ Metz said. “It’s not an either/or; it’s a both/and.’’

Coaches do refer people to get the help they need, said Moore, who through the McLean Institute and Wellcoaches is working on national standards for coach training and certification. “When that kind of stuff comes up — a marriage problem, an eating disorder, anything that verges on depression — coaches will say, ‘This is beyond my scope and it looks like this would need attention for you to get where you want to go.’ ’’

Kauffman agrees. “Therapy is something very sacred and powerful. Coaching is something else. Coaching is a different process of change.’’