Coaching for Mental Health: Ethical Dilemma or Ethical Development?

Recommendations from a Mental Health Report: 2000

Following recommendations are extracted from “Understanding Mental Illness. Recent advances in understanding mental illness and psychotic experiences. A report by The British Psychological Society Division of Clinical Psychology. June 2000”.

The majority of the recommendations are so akin to the principles used by the life coaching discipline that it seemed an obvious opportunity to show them together.

Section 15 (in its entirety) : “Implications of this report for mental health services”.

  • “A ‘one size fits all’ approach that sees all psychotic experiences as arising from one cause, and the only answer as lying in one particular type of treatment, cannot be justified from the evidence. Services therefore, need to adopt an individual and holistic approach”. The nature of coaching demands total adherence to the individual’s needs in the fullest context of their lives using their internal and external environments.
  • “The nature and causes of mental health problems are complex and incompletely understood. Services must therefore respect each individuals understanding of their own experiences. Service users should be acknowledged as experts on their own experiences”. Clients set the agenda at all times in the coaching process and are respected as being the professional in their own life (though often they need initial support to realize this).
  • “Staff attitudes are particularly important. The effectiveness of any treatment depends on a good trusting and collaborative relationship between the service user and the clinician”. “(Having decided on a course of action the person may well then require…assistance that will enable them to carry through their chosen course and help them to review their decisions from time to time in the light of the events. But that is not compliance, rather collaborative alliance)” (page.63) In coaching the ‘designed alliance’ is a relationship that is designed to meet the exclusive needs of the client. The regular review of timed goals and assessment of progress is a major component within this design.
  • “The use of coercive powers can undermine collaboration between service users and clinicians. Such powers should not be further extended”. Coaching respects the rights of each individual, and encourages free will and self-determination. The coach always requests permission of the coachee before offering information and advice. Coachees are reminded at all times that they are in control of the relationship. Progress depends on realistic goal setting and coaches have an obligation to make these achievable and recommend any additional appropriate support.
  • “Service should be based on the recognition that recovery is possible and that recovery means different things to different people. Psychological therapies should be readily accessible to people who have psychotic experiences. Help with housing, income, work and maintaining social roles can often be as important as ’treatment’ or ’therapy’”. Coaching believes that everyone has the innate abilities to reach their maximum potential and supports and challenges them to decide what their needs are. It advocates that their whole life be addressed in their existing and desired context.
  • “People who have personal experiences of mental health problems become experts as a result of their experience. Their help may be particularly valuable in supporting others, helping to improve existing services and develop new ones and in training staff”. Coaching already teaches the model of whole person support as recommended in this report. Coaches use their own experiences to support their coachees if requested and appropriate. With an average of 1 in 4 adults experiencing some form of mental health problem during their lives, there is an already existing pool of experts, who with life coaching skills can provide an enhanced support.
  • “Training is needed nationally to educate all mental health staff about the information contained in this report. It should also be part of the basic training of all the mental health professionals”. This report advocates the teaching of life skills and strategies for the patients and teaching principles and values to the staff. Life coaching has both those agendas at its very heart. Training all staff in life coaching could be economically and therapeutically cost effective.
  • “A large-scale campaign of public education is needed to break the vicious circle of social exclusion and mental health problems. Prejudice and discrimination against people with mental health problems should become as unacceptable as racism and sexism”. Though it is a worthy aspiration, the lack of awareness that alienates those perceived as socially different and unpredictable, is culturally entrenched and perhaps it would be easier to try new definitions. Life coaching is already marketed as a strategy for life management and increasingly used by people for all areas of their lives. The use of life coaching strategies and recommendation of life coaches could prevent an initial diagnosis of mental ill health. Use of these strategies even after a mental health diagnosis could reassure the patient that they are not on the path to social exclusion and no longer able to contribute in the real world or a normal human.

 

Ideally I would like to see personal and group coaching available on prescription as part of a package of primary and preventative mental health care. Offering coaching would give a new perspective on emotional fragility. Coaching is promoted heavily in the media and is largely seen as a management opportunity not a mental health strategy, therefore the prognosis will already appear more positive. The use of coaching at this stage could also be an effective diagnostic procedure without negative side effects – helping to identify the real needs and eliminating those individuals who need more therapeutic interventions. (Report: Doctors surgery intervention: Ashenden etc 1997 Family Practice 14 160-175).

My proposal, that coaching be offered at the Doctors surgery, would take very little modification of the existing model, just a willingness by the coach to accept that emotional vulnerability can be a normal temporary reaction to life’s excessive stresses.

The initiatives taking place through the NSF, though encouraging, still leave a large number of existing ‘clients’ with their dependencies on specialists, social services, benefits systems and medication. A modified form of coaching – a combination of coaching and therapy – could help. I have recently discovered NLP and realize many of the techniques I use come from that discipline. It offers a positive, practical partnership as recognised in ‘The NLP Coach’ by Ian McDermott and Wendy Jago.

Coaching could offer a continuity and commitment that is missing in mental care provision due to insufficient resources and staff and which has resulted in a lack of trust for many within the mental health system, both clients and staff. Continuity is available in the private sector but at a cost and unsurprisingly poverty is a contributing factor to mental ill health. The voluntary sector picks up where all else ceases, but it is a fire fighting measure, dependent on dwindling numbers of volunteers and erratic funding. For working with people already in the mental health system the existing coaching model would need some modification.

It is important in this potential field of coaching that the coach has credibility or personal experience of mental health problems. With 1 in 4 of the population experiencing mental health problems there cannot be a lack of personal ‘professional’ experience with coaching expertise. For authenticity the coachee needs to feel that their coach identifies with some of their experience and be reassured that there really is hope.

The opportunity to experience positive dynamic people can be therapeutic in itself. “Being with positive people makes me feel better” Coachee. The coaching relationship provides positive role models, (coaches are expected to continue their own personal development), with the energy and motivation to challenge their existing negative mindset and to create an atmosphere of determination until it becomes automatic. Emotional people are highly suggestible and Helen Graham writes “there is a growing recognition within orthodox medicine of the need to inspire rather than dispirit patients and of the therapeutic importance of positive emotions, attitudes and hopes” Picture of Health. 1995 (p.187) also ‘Making it Happen report’ 1999 (p.169)

A new book “Life Coaching: A Cognitive-Behavioural Approach”. Neenan and Dryden 2001 aims to offer a problem-solving outlook to therapists.

“Lifecoaches are a new breed of counsellor, motivator and consultant all rolled into one. Developed in America in the last decade, the idea emerged because everything in life got complicated — from work to relationships. Lifecoaches claim they can help you live the life you want” “Lifecoaches are not miracle makers or therapists. They are individuals trained to hone in on ways that help you express your personal needs, and then aid and encourage you to find solutions for them”. Dolly Dhingra. The Guardian October 8 2001. (Page 12 Office Hours).

The external environment needs the same attention as the internal one as the human sense of identity and self-worth is bound up with domestic, social and work roles. Benefits to the emotionally vulnerable come from “a regular routine, social contact, externally generated goals, opportunities to use skills, and social status”. The inhibiting role of ‘patient’ can prevent access to these benefits. “Individuals may develop greater self esteem and greater acceptance by others if they have a more socially acceptable role in addition to that of ‘mental patient’”. Mental Health Report p.55. Coaching with its focus on developing life-enhancing roles, influenced by its origins in management, encourages the coachee to explore new directions in order to fulfil these roles and make an active contribution.


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