How to Become a Health Coach (And Why Health Coaching Will Transform Healthcare) [transcript]

Written by Christopher Kelly

May 30, 2018

[0:00:00]

Christopher:    Chris Kresser, thank you so much for joining us today. We are delighted to have the opportunity to interview you live here in Berkeley. I've been a big fan of yours for a very long time. I can remember very vividly lying in bed when I should have been sleeping listening to the Healthy Skeptic podcast when Danny Roddy -- Do you remember Danny Roddy?

Chris:    I do.

Christopher:    And then Steve Wright.

Chris:    Yeah. You've been around for a while.

Christopher:    I love that stuff. Yeah, I felt like you and Ben Greenfield and Robb Wolf were three points on the same vector. It's kind of interesting to see how you've diverged over the years, but fantastic information that allowed me to recover my health. Can you start by telling us about how you used some of the things that you talk about to recover your health?

Chris:    Sure. Growing up when people ask me what I wanted to be when I grew up I never answered doctor or clinician. It wasn't part of the plan. And then I was traveling in my early 20s and spent about 18 months traveling around the world surfing. In Indonesia I got really sick with a tropical illness, vomiting, diarrhea, delirious. I can't really remember much about what happened for those few days.

    And then very long story short, I recovered from the acute phase fairly quickly but over time it became clear that it was evolving into a much more chronic problem that essentially took me about a decade to recover from it. I saw probably 30 or 40 doctors, tried everything you could possibly imagine. And then eventually it was the combination of a Paleo type nutrient dense diet, which I didn't know was called Paleo at that time. I kind of stumbled--

Christopher:    Right. It was just what works.

Chris:    I stumbled on it, certainly. And then, again, what I would call functional medicine even though I wasn't referring to it by that name, just really focusing on getting to the root of what the problem was instead of just using drugs to suppress the symptoms was what allowed me to recover my health. As I did that, people around me started to ask for help just because they had witnessed what I had gone through and what the results were and that's when I started to contemplate going back to school to formalize that informal education school of hard knocks that I had received. One thing led to another and here I am.

Christopher:    Can you tell us about how that led to the genesis of the California Center for Functional Medicine?

Chris:    Yes. So, when I graduated from school and started treating patients I was doing it on my own at first. In fact, it was just me and an office manager for the first couple of years. And very quickly my practice got full and I had to close down and wasn't even able to accept new patients for about a year and a half because the demand was so high and I couldn't serve it as just one practitioner.

    And then I was contacted by the current co-director and a great friend of mine, Sunjya Schweig, who I think you just interviewed recently. It was kind of out of the blue. I had never met him before. He said, "Do you want to meet for lunch? We share a similar kind of perspective. I'm a doctor up here in Petaluma and I'm moving down to the Bay Area and I'm wondering if you might want to collaborate."

    I'm really glad I said yes to that because we became great friends and partners and have launched the California Center for Functional Medicine a few years ago and we now have five clinicians including a nurse practitioner and health coach and we're serving thousands of patients now much more than I could have ever done just by myself and we're continuing to grow and expand.

    We're getting ready to start launching groups and group visits for existing patients. We'll probably expand that to non-patients, people who want to participate in the groups who aren't yet patients. There's no limit to the demand and the need for this kind of work. It's just really how quickly clinics like ours can scale up to meet that demand.

Christopher:    I feel like in the past you've attracted lots of complex patients but when I've read your more recent work it seems like you've got your eyes set on different horizons. Can you talk about some of the problems that you think you need to solve?

Chris:    Yeah. I mean, in my clinical practice that is still generally the type of patient I attract. I will occasionally get someone's mom or sister or aunts. That's happening more who are newer to this kind of thing. To be honest, I really enjoy those patients and working with them because it's like shooting fish in a barrel. It's like, "Oh, you're on a standard American diet and you're a few pounds overnight and you're tired?" This is going to be easy.

    It's not my typical patient but, yeah, I mean, the truth is if this is going to have the impact that we all know it can have and it needs to have in order to really stem the rising tide of chronic disease we have to get it out beyond our comfortable niche of people who are already listening to these podcasts and know what this work is.

    So, as I've progressed in my career I think my perspective has expanded where initially, of course, when I was sick my focus was on recovering my own health and then the next step was working with people one on one and helping them taking back their individual health.

[0:05:10]

    And then I realize that there was a pretty hard limit to the number of people I could see one on one in my lifetime so I started training practitioners, clinicians, with the understanding that if I train, each doctor or other clinician that I train can see thousands of patients in their lifetime. That's an exponential impact.

    And then it's become clear to me that there are never going to be enough doctors or other licensed healthcare providers to solve the chronic disease problem. And in order to really do it we actually have to create an army of people who can work with individuals and groups on diet, lifestyle and behavior change because those are the things that are going to make the biggest impact when it comes to reversing chronic disease.

    Now, we're just launching a health coach training program in June with that intention. I think we need at least conservatively 20-30 health coaches for everyone one doctor in order to be able to make a dent in this problem. It's really exciting to me to see the changes in this area. I was just at Paleo f(x) and the amount of enthusiasm and energy there was much higher than I've ever seen in all the seven years that I've been there.

    Just in the past few months I've had conversations with multinational corporations, with management consultants that work with these multinational corporations, with angel investors and venture capitalists, with people who work in municipalities or governments who are all interested in these model that we all talk about using ancestral diet and lifestyle perspective and functional medicine to make an impact for their employees or, in the case of municipalities, people who are working in that environment because they recognize, everybody recognizes that the system is broken.

    What's different now is that there is a growing awareness that this approach that we know and love is a very sensible and effective solution and there's more interest in it from the corporate market and government than I've ever seen in the entire time I've been doing this work.

Christopher:    And can you talk about some of the health challenges that you think you might be able to solve using this approach?

Chris:    I could summarize it as just saying chronic disease. I mean, that's like we now know 100 million Americans have either pre-diabetes or diabetes. Let's start there. That's in many ways one of the biggest challenges we face. That's a third of the American population. That's a completely preventable disease. It's a completely preventable lifestyle driven disease. Just reversing that could save us $250 billion a year conservatively.

    But now we know that one in six people have an autoimmune disease. Certainly autoimmune diseases have a strong genetic predisposition but we also know that predisposition has to be activated with environmental factors. That's another thing. Heart disease, still the number one killer in the US. Four of ten deaths are heart disease related. I don't think heart disease is completely preventable necessarily in a way that diabetes is but certainly we could make a huge impact on lowering rates of heart disease.

    Irritable bowel syndrome is now the second leading cause of people missing work behind the common cold. It's not life threatening in the way that heart disease or diabetes is but it's a pretty significant epidemic. That's completely related to diet and lifestyle and behavior and we can make huge progress on that even without functional medicine, with just sensible diet and lifestyle approach. Really there's not any chronic disease that I can think of that this approach can't make a significant impact on.

Christopher:    Tommy, you had some really interesting ideas about demand versus how people are going to be ready for this type of intervention. Can you ask about that?

Tommy:    Yeah, that's something that I completely agree. There's a huge need for this and many people are at multiple different levels of realizing it but how do we -- Just because there's a need doesn't necessarily mean there's a demand. So, even though pretty much the majority of people walking around outside right now need something like this, need a health coach or something, and absolutely do not need a doctor to do that, health coach would be more than enough, how do you make them want what they need even if you have, so a corporation or you have the HR department realize that maybe they could save millions of dollars because they stopped unexcused absences or illnesses?

    How do you make the employees engage with this kind of thing? How do you make people want to do this kind of thing? Because you could create a huge number of health coaches, and I know that health coaches who come out of your program are fabulous, but how do we make sure that the people are using their services?

Chris:    Yeah, it's a good question. That's going to unfold over time. I don't know if you guys saw the announcement today by Aetna's CEO, it's one of the major insurance companies in the US, came out hugely in support of integrative medicine and shared some results that they'd had within Aetna implementing wellness programs very successfully.

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    And they were voluntary initially, something like 12,000 Aetna employees have done it. They did a pilot. It was successful and they opened it up to other Aetna employees that wanted to do it and they've seen great results. They actually published, to their credit, they did a study and they published the results and the peer reviewed journal.

    The Aetna CEO basically said -- I mean, this is crazy. This is the CEO of one of the biggest insurance companies in the world. He came out and said, "Our system is broken and we have to creatively destroy it." So, this isn't like someone from the fringe thing. This is someone from like in the belly of the beast who's making this comment.

    So, I think, initially adoption to these programs within corporations and municipalities is going to be voluntary for the most part but there will be situations where it can be required. Like we did a pilot with the Berkeley Fire Department with their new recruits and basically the deal was if you're a new recruit you're doing this program because we know it's going to benefit you and it's going to reduce injuries and burnout and things like that.

    Within a corporation, it's more difficult to require and do that but I think incentives can be a big part of that solution. Like if you reach these targets, you get this incentive. There's probably a lot of debate about whether that type of extrinsic incentive is the best option for long term change but if that's what gets somebody into it, gets their foot in the door and gets them to actually experience the benefit of that kind of change then I think more focus over time can be made on shifting that motivation from being extrinsic to intrinsic which is what a well-trained health coach could do.

    I think as awareness shifts over time there is going to be more willingness because we have trained people to become passive consumers of medicine. That's basically our model. We've trained doctors to hand it out with ten-minute appointments. That's really all they have time to do. But the flipside of that is that we've trained individuals to be, like I said, passive recipients of medication and that is what passes for healthcare in this country.

    That's a narrative. That's a story. That's not something that is just inherent to being human. That narrative can be changed over time. I'm not arguing that this is going to happen overnight. There are a lot of things that needed to change but I can tell you that just within the last five years even we're in a dramatically different landscape than we are now.

    I was not being approached by venture capitalists who wanted to throw money at this stuff even three years ago. I don't know if you guys saw Parsley Health which is kind of like a functional medicine concierge type of service, just raised $10 million. There are really interesting developments happening and we have a lot of challenges and it's not going to be easy and there are a lot of deeply entrenched financial interests like pharmaceutical companies whose incentives are not aligned with what we're talking about here. We've got to struggle but I think we're equal to it.

Tommy:    Do you think that that's the same in terms of incorporating this into more traditional medicine as well? Because particularly yourself and your background, I know our mutual Rangan Chatterjee, he's creating some courses in the UK trying to teach doctors some of this lifestyle medicine stuff so they can use in their own practices.

    However, I know he's received push back because some of the people who were doing the courses, who were doing the teaching are not medically trained. They're nutritional therapists or something like that. This created some kind of -- People are less trustworthy of it for whatever reason rather than just looking at the quality of information getting out there. Do you think that we might need to do something specific in order to try and get traditional doctors to take some of this on board and where might that message comes from and does that make a difference?

Chris:    I think, first, health coaching probably will be adopted more quickly than functional medicine in my view because it's less controversial. Even the CDC, National Board of Medical Examiners, very conservative mainstream organizations have come out in favor of health coaching. It's pretty hard to argue with the basic premise of health coaching.

    Nobody disagrees that environment is the biggest driver of disease. That's pretty well-established now. And nobody disagrees with the fact that there is not enough support for those kinds of interventions. So, health coaching is kind of a no brainer. It actually could be integrated even within the existing care model. It's just a question of will. Will the insurance companies and the current system change the model so that insurance will cover that? They totally could and in many ways that's more likely to happen and there's less friction there than there is with like adopting a whole functional medicine approach.

[0:15:00]

    So, that's good news. With functional medicine, I think there are a few obstacles to adoption within the conventional model as it currently exists, one is which you mentioned. I mean, there's currently no board certification for functional medicine. So, that makes some people nervous. Like how do you know if someone is qualified in functional medicine? Just because they say they are? That's kind of how it is right now and I see the problems with that for sure.

    Of course, on the other hand, when there is a board certification, who decides what goes into that and there's problem on both sides. Another issue, and this is perhaps the biggest one, is that functional medicine doesn't really fit within our current care model of eight to 12 minute-visits. You cannot do functional medicine in eight to ten minute visits. There's no possible way.

    I struggle to feel like I have enough time even I'd spend an hour and a half of the first patient and minimum of half hour with follow-up appointments. It's very difficult to see how deeply integrated into our current system without changing that current system which is, of course, what I advocated for. And then the research question is interesting because you often hear the claim that there isn't much research to support functional medicine.

    Certainly, if you go on to PubMed and you type functional medicine you're not going to find anything because functional medicine is a paradigm. It's a way of looking at things. But if you go to PubMed and you search for SIBO and IBS or disrupted gut microbiome and IBS or gut brain access and IBS, you'll find all kinds of studies and that's functional medicine. That's showing we're looking for the underlying causes of IBS and they're all there in the scientific literature.

    And then you can even find studies on using Rifaxamin to treat SIBO and IBS improving. It's all there. You just have to know how to look for it. And it's very difficult. There's no clearing house or there's no framework for people to find that information and so they think it's not evidence based. Along the same line it's really hard to design studies on functional medicine because the whole randomized controlled trial methodology is based on drugs. It's based on studying a single intervention, a single agent and comparing that with the placebo. That's become the gold standard of medical research.

    But how do you do that with functional medicine? Because the whole idea of functional medicine is that it's individualized. You could take ten people with the same condition like ulcerative colitis and they would have ten different treatments because they're ten different people. That's very difficult to study with this RCT model that we have.

    Mark Hyman Cleveland Clinic, I think the way he's going about it is right and the only way that we're going to make progress which is just to compare functional medicine with standard care. So, you get a group of people and you give them the standard care, the drugs and stuff. And then you get another group of the same condition, match them up, and then you give them functional medicine treatment. And you see what happens. But that has been a bit of an obstacle, the research issue.

    Then the last thing, circling back to what you asked, I think we're still in the early days here and over time we will probably start to see some development of standards and best practices for functional medicine training. If you go to medical school right now, not all of the classes are taught by MDs. There are classes that are taught by registered dieticians or PhDs or whatever. I don't think that ultimately will be an obstacle. I think it's more a question of just developing some standards that we can all agree on for basic competency. I'm actually in favor of that.

Christopher:    Talk more about the health coaching program. One thing we've seen with the people that we work with is there's this common pattern where you go into the program with some very specific complaints that you're dealing with, so it's not like you're only there to learn how to be a health coach, but it's clear that many people just start our program with one on the career change. How did you start a business like this? How did you start working with people and improving their health because I want to do that? And where do I go to learn what you did? Where did you go? I've never really felt like I've had a really great place to send people so talk about what health coach would do, how you're going to train them. What does it all look like?

Chris:    Sure. So, when it became clear to me that health coaching was a really important part of the solution, I decided to go out and look at what was there because that would have been my ideal--

Christopher:    You don't want to reinvent the wheel.

Chris:    No, absolutely not. I mean, I already have a practitioner training program. I still treat patients. I've got my blog and podcast and a family and everything that I was not thinking of.

Christopher:    You're supposed to say the family first, by the way, before those other things.

Chris:    I can't wait to start another product, build a whole other training program. And there's some great fantastic programs out there that do pieces of the puzzle really well, I think, but the way I was approaching it was is there a program right now that trains people and everything that I would want the health coach that I would hire at our clinic to be trained in?

[0:19:59]

    And as it happened, we're hiring health coaches so it was very much at the front of my mind. There wasn't. So, basically, there are four things that I think a health coach needs to succeed in today's healthcare environment and then, more importantly, in the healthcare environment that we're growing into in the future. One is solid training and core coaching skills. By that, I mean, things like motivational interviewing, understanding the stages of change, positive psychology, coaching to strength. These are the skills that are well-recognized in coaching to be absolutely crucial for supporting behavior change.

    One of the misconceptions out there about health coaches is that their job is to just tell people what to eat and how to exercise better. No. We already have plenty of experts. We've got too many experts. We know that information is not enough to support behavior change. If it was, all we would need would be Google to solve chronic disease.

Christopher:    Right. Or smoking, right? It's written in the packet. Smoking kills. Just you're doing it.

Chris:    Yeah. Have you read that package? Yeah. Clearly, we need to teach people to read better. Obviously, it's not that. It's only 6% of people according to the CDC engage in the top five health behaviors which are just the most basic things. So, it's not an information problem. It's a behavior problem. And learning these core coaching skills is crucial to helping people change their behavior.

    I don't consider health coaching program that doesn't teach these core coaching skills. And by teach, I don't mean give people a book about it or show them PowerPoint slides. I mean, actually train them, give them time to practice and develop these skills over a long period of time. You cannot learn motivational interviewing in a weekend. You can't fly in and sit there because it's like how to communicate better? You don't learn that in a weekend. So, that's number one.

    And not to disparage any health coach training that is not including that, I would call that more like a nutritionist or health educator type of program. Because one of the organizations like the International Coaching Federation have defined what it means to be a coach and these core coaching skills are really at the root of that. So, that's number one.

Tommy:    Before you move on to number two, sorry to interrupt your train of thought, but on an online course particularly, how do you get people to practice and learn those skills? What techniques are you using to--

Chris:    Yeah. It's a good question. So, Zoom, which many people are familiar with now, it's a video conferencing platform, has really a cool feature called breakout sessions. So, imagine, let's say, Ken Kraybill, who's our expert on motivational interviewing, he presents a material which in the one to many format where people are just watching him on video and he says, "This is what change talk is." And he demonstrates. He asks someone, a volunteer.

    So then a volunteer who's in the room pops up with him on the video and he demonstrates it with this person and he says, "Okay, I want you to go practice." So then breaks out everybody with another partner in rooms. In your video, you're just seeing one other person and then you practice with that person. When you're done, instructor will end it, everyone goes back into the main room and then you can say, "Oh, this came up in this session. What do you do in that situation?" You get feedback from the instructor. That's how we're doing it. It's designed to replicate the classroom, more of a classroom environment.

    So, the second thing that a coach need is a very deep understanding of how to implement ancestral diet and lifestyle and behavior principles with clients. A lot of health coaching programs just do a very surface coverage of a lot of different diets like, "Here's a vegan diet, a vegetarian diet, a Paleo diet."

Christopher:    Oh, yeah. All of these things could work.

Chris:    Yeah, and I appreciate that they're trying to serve a lot of different people with a lot of different perspectives and not trying to advocate for one particular approach but I'm advocating for one particular approach because this is the approach that I think works best for the greatest number of people. Will it work for everybody? No. Will everyone be interested in it? No. Of course, a committed vegan is probably not going to be that interested in working with a coach who's trained for my program. But I'm not trying to serve everybody. I'm just trying to do what I've found works best.

    I think most of your listeners are familiar with this. I won't go into detail on it but we're training people to actually do it. Again, not to just kind of lightly cover these concepts but if someone comes in who's a mom with two kids and she's working full time and she's doing two or three cross fit workouts a week and she's eating a low carb diet and she's feeling tired and not sleeping, what do you do? That level of detail.

    And then the third thing would be basic understanding of functional medicine principles. So, health coaches are not going to be practicing functional medicine. They're not going to be ordering labs and interpreting them and prescribing treatment based on it. I feel strongly that that's not in the scope of practice of a health coach for the most part.

    But they do need to understand those basic principles because in this collaborative model of healthcare that we're moving toward where doctors are working with health coaches and collaborating together the coach needs to be on the same page and at least understand what the doctor is up to and why they're ordering those lab tests. The coach will often be the liaison between the doctor and the patient because the coach has more time to talk to them.

[0:25:22]

    The patient might ask them, "Why did the doctor order these tests? What information is it going to provide?" So, that kind of thing is very important. And then along the same lines we're training coaches specifically on how to collaborate with licensed clinicians. That's I think the huge missing piece so far. Coach will inevitably find him or herself in a position where the client needs more support than the coach can offer.

    The coach suspects they might have Hashimoto's or some other condition that they need more testing for and in an ideal situation that coach is already working in a clinic with the doctor or they have a relationship with the doctor where they can refer the client to the doctor and the doctor and the coach are working under the same theoretical and practical framework.

    So, it's not enough just to say, "Here, go see this doctor," and then the doctor is like telling them the opposite thing. I mean, that's where we're at right now and it's very confusing for clients when that happens. But if they refer to the doctor and the doctor shares the same framework, that's very powerful. We're going to be teaching how to collaborate with practitioners and also how to find other doctors to work with, how to pitch your services to the doctor as a win-win scenario.

    And then the last thing is how to build and manage your practice because if you do all the first three things right you'll be an awesome coach. But if nobody knows about you and you don't know how to run your practice then you're not going to make it as a coach. A lot of training programs that I looked at didn't really provide enough support in that area. At the end of the day that's pretty important because if someone wants to do it as a career and make a living doing it they're going to need to figure that piece out.

Tommy:    So, where do you think people are currently? So, somebody comes out and could be your course or, I mean, there are other health coaching courses in increasing number. Where do you think people need to start now in terms of building that kind of business?

Chris:    I think it really depends on what direction they want to go. I mean, you can break down the opportunities into two groups. So, one would be private practice and the other would be employment. There's definitely a growing number of employment opportunities. I was just talking to someone at Paleo f(x) who's been searching for health coaching jobs in her local community over the past few years and it's just seen a very fast growth of those types of jobs available paying anywhere from $35,000 to $55,000 or $60,000 a year for a starting position with benefits and everything that comes with working as an employee in the corporate environment.

    I think with these announcements from Aetna and Apple Computer announcing that they're going to be using more coaches and some of the conversations I'd been having with these very, very large corporations that there's going to -- I'm not worried at all about all about the amount of jobs. What keeps me up at night is how am I going to train enough coaches to fill these jobs?

    If even one of these companies that I'm in discussions with said, "Let's do it," I'd be like, "Oh my god. Okay, wait. Can you hang on a second? I've got to quickly train these 10,000 coaches that we're going to need to service your one million employees." We are still kind of early days but I think there's going to be more and more positions. I mean, 60% of companies with over 50 employees have wellness programs and most of these wellness programs employ coaches. We're going to see growing opportunities there.

    Or some people choose to go into private practice and just do their own thing. Whether they work completely on their own or whether they build a referral relationship with another doctor, which is what I recommend, I think a very good starting place is building some of those relationships because then that can be a source of referrals for you. The doctor can start referring some of his patients that he feels like would benefit from coaching to you. It's a great way to build your practice.

    I think running groups, which we're chatting about before we started recording, is really a great way to build your practice because it's a more accessible way for people to get involved. It's lower cost. It's lower commitment. They don't have to share as much about themselves necessarily. They can kind of check it out and see how it works. It's a good way for them to get an experience of you and how you work.

    I know a lot of people who've successfully built practice using groups. And then, of course, the online platform. I mean, it is 2018. One of the benefits of coaching is that a lot of it is done with video from phone. So, I met, for example, Paleo f(x) a woman who was born in Sidney, she was Australian, she started her coaching practice there and then she moved to Hong Kong, got more clients there and then moved to New York and is still coaching.

Christopher:    Seeing the same--

Chris:    Each of those moves she didn't lose those clients. I mean, that's pretty cool.

[0:30:07]

Christopher:    What I was worried about you saying was, oh, well, content marketing is how you get clients. I certainly was very disappointed with that news when I started Nourish Balance Thrive. I since heard from many other people. They really don't want to hear that. "Oh, you need to start a blog and then you need to start a podcast and then you need to do a summit and then once you've done the summit you've got enough people on your list to get a book offer and then once you've written a book you can have all your friends push it so it becomes a New York Times bestseller, then you can get some clients." Nobody wants to hear that. I mean, that's been great for you, that strategy. But clearly, that's not going to scale. So, that's not what you're suggesting here then, obviously.

Chris:    I think content marketing is so important. I don't think you have to do it at that level that you described to be successful but it is still the -- Really, I look at marketing as building relationships, basically. At least that's the way I approach it. That's what content does. When you offer free content to people that solves their problem, you're building relationship with them. You're developing trust and credibility.

    I still don't know of a better way to do that other than helping people to solve their problems and then talking to them with podcast like this where they get to know you and sharing more of your own story with emails and blog articles. I don't think that everyone needs to go down that whole trajectory that you mentioned.

    If someone is really ambitious and wants to do that -- Actually, that just kind of happened to me. I didn't set out to do that. It's not required to be successful. I know a lot of coaches and practitioners for that matter, really accomplished successful functional medicine practitioners who have full practices who don't have a book and don't have a podcast but they do have websites and they do have blogs and it helps.

Christopher:    And so you don't think these health coaches that you train are going to have a problem going to the local primary care practice here in Berkeley and then the doctor there saying, "Well, who is this person? What kind of qualification is this? Why would I employ someone like this when they're not certified by any governing body?"

Chris:    They might have a problem. That's part of the challenge that we have to deal with. At the moment there is no nationally or internationally recognized certification for health coaching although that's changing.

Tommy:    I think one recently started.

Chris:    ICHWC. So, I don't have any doubt that there will be recognized standards of credibility within the next few years. These are not unsolvable challenges. They're challenges for sure but they're things that have solutions and there's probably going to be some stops and starts and some different possibilities that arise but I don't have any doubt that we'll get there.

Christopher:    What do you say to potential health coaches that are still working on their own health problems? So, I hear that a lot from people. I'm on a call, someone's like, "You know what, you've learned so much. You will be fantastic working with people with all the things that you've learned over the last two years." And they'll say something, "Yeah, but I still have another five pounds to lose. Maybe when I've lost that final five pounds I'd be able to talk to people about what they should eat." Everybody, of course, it's the problem of constant [0:33:10] [Indiscernible], all this means something. Is that something you thought about and what do you say to health coaches that are still working on their own situation?

Chris:    I say if you're not still working on your own situation you probably shouldn't be a health coach because you're not going to be able to relate to people. Like I said in the beginning of this interview, we don't need more experts. We don't need more perfect people who know it all and who have just all the right answers. That's not, again, the problem. People are not looking for that per se. They're looking for someone who can support them in achieving their goals and even help them discover what their goals are in some cases. For people who are dealing with ambivalence and they're having trouble finding their own motivation, a health coach can help with that too.

    The other thing I would say about that is as you know, I mean, I came to this work through my own struggles with my health. And I've always been very transparent about what's going on for me and it hasn't been perfectly smooth sailing since when I recovered my health, and it's not like I've just been at 100% since then. I've gone through my own stuff which I've always shared with my list and the feedback that I've gotten all along the way is that people really appreciate that and it helps them to connect with me and relate to me and it helps them feel more trust in me that I can relate to them. A lot of my patients feel that way.

    The sooner people can let go of this idea that they have to be on some pedestal in order to do this work the better because that's a prescription for suffering. For you as a practitioner, that can be incredibly isolating and alienating and it doesn't actually serve your clients either.

Christopher:    Can you talk more about positive psychology? Whenever I hear anyone say that now it sets some alarm bells ringing because I've had the fortune to interview Gabriele Oittengen -- You're familiar with her work. And so the problem with positive thinking is that it makes people feel good in the moment but it reduces activation energy.

[0:35:13]

    And so Gabriele's work has shown that mental contrasting is helpful. It's like seeing the other side of the coin. How could this go wrong? And then the implementation intention is like, "What's the plan? When it does go wrong, what's the plan?" And so now I really worry. Whenever I hear that positive psychology, I'm like, ding, ding, ding. This is that thing where it's like a religion and you get into trouble for being negative about anything. I'm not talking about cynicism where you're negative about everything. It's balanced.

Chris:    I think it's a common confusion. Positive psychology is not positive thinking. Those are two very different things. Positive psychology is a pretty mature and robust science at this point. There's lots of research that supports it. One of the key differences is just focusing more on the present than the past, not believing necessarily that you need to dig through your past traumas and things that happen to you when you're a kid and fix all of those traumas in order to make progress in the future.

    It also involves focusing on learning how to identify your strengths and harness them to reach your goals rather than trying to fix what's broken. This is the field of character strengths, understanding character strengths and learning to work with character strengths. So, for example, if you know that you have certain strengths and you've been able to apply those in another area of your life like relationships and you recognize that you have those strengths but then how you bring those to bear in this other part of your life like health where you're struggling more? And that's a different mentality than saying, "Gosh, I'm really just lazy and I'm not able to find this motivation so I have to fix that laziness."

    In positive psychology, it's not about denial of negative emotions. It doesn't mean that we don't address things like anxiety and depression. It's not the same as positive thinking or affirmation. It's really learning how to focus more on what's working well and leverage that than to fix what's not working.

Christopher:    There was some other words on the landing page for a webinar that I read recently that kind of made me scratch my head a little bit. It said, "Tap your natural gift for communication and listening." I wonder whether anyone has a natural gift for communication and listening. I have a three-month old baby and the only thing that I can figure out he was born being able to do are suckle and cry maybe.

    Certainly when I started NBT six years ago I did not have an ability to communicate. It was hilarious. People would endorse me on LinkedIn for public communication and public speaking and I'd be like, "What are you talking about? I'm a back office programmer. A successful day is avoiding as much eye contact as possible." And now here I am doing a podcast with however many people listening to it and I'm working with people one on one.

    Clearly, recovering my health changed my biology in the way that I thought but I did not have a natural ability to communicate. That was something that I worked on very hard. I would argue that all things are like that. I think this general pathology is well described in Mindset by Carol Dweck which is a fantastic book. So, what do you think? Do you think people are going to have to practice to become good at communicating?

Chris:    Communication is a big part of our program. We have John Kinyon who is a phenomenal person I've known for many years and teacher of nonviolent communication, empathic communication. We also have Forest Fein who's teaching mindfulness based communication. We have Ken Kraybill that I mentioned who's teaching motivational interviewing which is really another form of communication.

    I would say learning to communicate with your clients is one of the most important skills you're going to learn in this program and that all coaches need to learn. People who are drawn to coaching often do have more of a gift or an interest in communication than the general population. That's was that was aimed. You probably weren't the target audience to reach out.

Tommy:    Chris likes to use himself as an example when he should not be the example.

Christopher:    Everyone keeps saying to me. Forget about what you think.

Chris:    I mean, these are broad generalizations, of course, but generally women are more drawn to communication or have a different approach, maybe a softer approach to communication than men. They're more receptive to it. The coaching demographic definitely skews more female. It's probably 60% to 80% female depending on what you look at.

    I'm sitting here talking to two guys but that's how it is just demographically. Do you have to be an absolutely excellent communicator to succeed as a coach? Probably not. But I've always been kind of blown away by the fact that none of us, well I shouldn't speak for everyone but I certainly wasn't taught anything about communication at any level in school.

[0:40:02]

    Elementary school, high school, college, graduate school, never. One of the things that we do -- I mean, other than breathing and eating, what do we do all day every day no matter what career we're in unless we're like an ascetic monk living in a cave in India? We communicate all day every day. If there's one thing that we can do to improve our life and our effectiveness at our work and our relationships it's to be better communicators. I believe strongly in the importance of that and that's the program reflects it.

Christopher:    Yeah. I found that paying attention to failure is the most important thing. I remember the first time I listened to my podcast. It's one of the hardest things I've ever done. You cringe hearing the sound of your own voice. But it was important because I realize where I was going wrong and that allowed me to improve. I'm hoping that the health coaching program, you're going to give people the space to fail safely so that when they get out into the wild they've already made those basics schoolboy errors and they'll be more accomplished practitioners.

Chris:    That's a great point. I mean, that was one of the main things that was missing for most of the programs that I saw, was the opportunity for practice. So, the way our program is structured, the first six months is the pre-practicum. That's when a lot of the skill acquisition and development happens. And then the second six months is the practicum. It's basically six months dedicated to practice which means constant failure.

    But you're failing with supervision of a mentor coach who's trained and experienced coach so you can say, "Hey--" Because we have -- You do 25 practice sessions with your clients during the practicum so that you have a session and you say, "Wow, that really bombed." But you take it back to your mentor coach and you say, "This is what happened. What would you have done differently in that situation?" And as a good mentor coach, they'll probably turn that around and say, "I don't know. What would you have done differently?"

    That's actually baked into the program. We say this program is intensive. It requires about eight to ten hours a week as a time commitment. It's not like a dabble kind of program. That includes the practice. I've seen some programs that say it's two, three hours a week but that's just like reading about motivational interviewing or reading about empathic communication. It doesn't include any time -- Or mindfulness or whatever. It doesn't actually include the time that you need to spend practicing those things to learn them.

    Coaching is like learning an instrument. You could read book about the piano. You'll acquire some knowledge about the keys and the music and you could even learn a lot a great of pianists and stuff and you at a cocktail party could sound like you really know what you're talking about when it comes to the piano. But then when you sit down and try to play the piano just from having read a book it's going to be a disaster. Learning to be a health coach is like learning an instrument or sport. There's some level of information you need to acquire. But beyond that, it's mostly practice.

Christopher:    Are there any other logistics that people considering doing the training should know about? Start dates?

Chris:    It starts like the second week of June and it's all online, ultimately would love to have some in person events. We've talked about how communicating in person is fantastic.

Christopher:    Starting a business is very isolated.

Chris:    I'm a big believer in that but we wanted to reach as many people as we could with this and we have people in the UK and Australia and all over the world who are passionate and want to do this. And with the technology that we talked about before like Zoom and the breakout sessions that seem to me that we could mitigate most of the disadvantages of not having the in person meetings and reach a lot more people.

Christopher:    Well, let's hope that it becomes so popular that they'll be enough people doing it to have in person meet-ups. You could plan a little get together in your town because there's seven other people in your town that's also doing it. That'd be great.

Chris:    I would hope so too. I mean, we are planning a Kresser Institute Conference at some point. I mentioned that to healthcare practitioners. We've got several thousand people in the community now.

Christopher:    Where should people go to find out more about this online?

Chris:    Kresserinstitute.com is the best place to go. If you go to kresser.co/coach, that will take you right to where you get more information about the coaching program.

Christopher:    That's great. I will, of course, link to those things in the show notes for this episode. Is there anything else you'd want people to know about?

Chris:    I don't think so. Just we need you. If you are contemplating moving in this direction whether you join our program or any other, as I said before, what keeps me up at night is not that coaches aren't going to have jobs but that we're not going to have enough coaches to serve the growing need. For me, just being able to wake up in the morning and know that I'm going to spend my day helping people and making a difference in their life and continually learning, which I'm super passionate about, I couldn't imagine not having that. It's what gets me jumping out of bed in the morning and my hope is for as many people as possible to have that feeling when they wake up in the morning.

Christopher:    We enjoy that too. I realize only with hindsight that it was an important part of recovering my health. I had this super cushy job working at a hedge fund where I didn't have to do any work, had a fantastic salary, PPO insurance, was essentially a professional athlete in terms of the number of hours I was able to put in. I must be bonkers giving up this job.

[0:45:11]

    And then I did to start a health coaching business. And then you realize only with hindsight how much improved your health is by doing meaningful work. I feel like there's probably a lot of people listening to this podcast where that's one of the last remaining pieces of the puzzle, is you need to quit your crap job and find some meaningful work.

Chris:    Yeah. The flipside of that is you can put up with a lot of crap if you have meaningful work.

Christopher:    It was really difficult. I will never forget the look on my wife's face. We had a six-month old baby, getting home, "Oh, guess what, honey, I quit my job. We're going to start a health coaching business." She's like, "Yes, great."

Chris:    Yeah, right. Props to you for doing that. That was really impressive at that time in your life.

Christopher:    But, I mean, we've just brought before in the podcast as well, is that I'm sure if you're listening to this you're a smart person and you have options. The worst that could happen is you go get another job. I mean, that's what I was thinking as a computer programmer living in Silicon Valley. How bad could this be? How long would it take you to get a job? It is the greasy used car salesman pitch. Just give it 30 days and see how you like it. You can always go get another job.

Chris:    Yeah. Well, I mean, health coaching is, obviously, not for everybody but the people who are interested know who they are. I meet them all the time and I see it in their eyes and they know they want to do it. I get it. It's a big shift to make that leap. I'm not sure what it is that makes someone ready to do what you did.

Christopher:    I don't know.

Chris:    The good news is it's not going anywhere. So, if you're not ready to do it now health coaching is still going to be around in one year, five years, whatever. That's it. Just my plug for following your heart and your passion.

Christopher:    That's wonderful. Thank you so much for your time, Chris. We've been both a huge fan of your work so it's a great privilege to finally get to interview you.

Chris:    Thank you both. Pleasure to meet you. I'm glad you can make it in person. It was nice to do this in the flesh.

Tommy:    Absolutely. Thank you.

Christopher:    Yeah. Thank you.

Chris:    I appreciate that.

[0:47:02]    End of Audio

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