We expect physicians to have answers. Implicit in the medical model of helping people is the notion that the expert knows what is best for the client. In fact, according to Manning, the medical model is defined as prescriptive: imposing an outside, external remedy for human needs and ailments.(1) The drawback with the medical model of helping people is that it doesn’t always work for the types of problems and issues that confront physician leaders.
The problems requiring help come from peoples’ crises, troubles, doubts, difficulties, frustrations, or concerns. These problems have no clear-cut solutions because the problems are complex and messy. Their origins result from living and working in the emotional turmoil of a people-driven setting and the trials and tribulations of professional life in a complicated environment.
For example, suppose a new physician leader is highly competent in their medical specialty but is achievement-driven to the point that they demand perfection in everything they do. According to people in the physician leader’s section, the leader micromanages everything and is hypercritical when judging their work. The physician leader comes to you for guidance. What do you do?
When You Don’t Have the Answer
One of the greatest myths about leadership coaching is that when people seek your help, they look for your expertise. Without question, people often view a leader as having special skills or knowledge that earns respect, and that leader is likely to be sought out for advice and counsel. This method of helping others is based on expert power: the capacity to provide others with needed information or guidance based upon one’s knowledge, skill, or experience.
Expert power works well when the problem under discussion has a “schoolbook” solution that simply requires you to provide the correct answer. Unfortunately, most useful conversations are not that simple because there are no “right” answers. When you don’t have the answer, coach.
You — not your expertise — are the most powerful tool in the coaching process. A study by the National Institute for Career Education and Counseling asked people in both the public and private sectors to share information about a helpful conversation they had (a coaching conversation) and what happened in that conversation that made it helpful.(2)
Analysis of the data gathered from 250 various types of helping conversations indicated that the predominant factor in predicting the outcome of a successful helping conversation was the behavioral characteristics of the person doing the helping — not their expertise. This conclusion is contrary to what many professionals in the medical field are taught. Much of the emphasis on knowledge, skills, and professional experience in medicine is often detrimental to understanding how interpersonal factors affect the success equation.
Interpersonal effectiveness has always been a part of successful leadership, and it is equally if not more essential to coaching. Coaching is, at its core, a collaborative relationship, a mutual dialog that helps the other person think through problem situations and accomplish personal and professional goals. The quality of this cooperative association between the coach and the “client” is termed the coaching alliance.(3)
The strength of the coaching alliance is a measure of how coaches behave toward their clients throughout the coaching process and the professional bond that’s developed. The formula for a beneficial coaching alliance is simple: be present, show interest and empathy, and be authentic.
Presence means giving your full attention to the other person while you are with them. Attention is validating. Arguably, it is the most valuable action you can offer from a helping standpoint because it is another way of letting the person know that what they are saying is important to you.
Have you ever tried to interact with someone whose attention was everywhere but on you? What signal did it send? How did you feel? Certainly not that you or what you were saying mattered. Lack of attention is considered a “turning away” response in interpersonal interactions; turning away responses spell disaster for an interpersonal encounter and for the relationship long-term.
Presence, or being entirely in the moment, focuses your mind and increases your perception of what is occurring during the coaching conversation. While it might take practice to learn to let go of the distractions that keep you from being fully present when you are helping someone, such an investment will enhance important professional and personal relationships.
Interest is an extension of presence. Synonyms for the word “interest” include attention, curiosity, concentration, attentiveness, and concern. You are not focusing on yourself; you are concentrating on the person you are helping. Focusing on their frame of reference over yours, suspending judgment, and avoiding other internal mental activities that interfere with genuine attention puts you in a better position to assist the other person. Your genuine interest and your skillful interpersonal behavior during the conversation is the catalyst that accelerates productive outcomes.
Empathy is another means of connecting with and engaging the other person. In the broadest sense, empathy refers to one person reacting to another in a way that demonstrates an understanding of that person’s perspective or feelings. Empathy is one of the most basic capacities for relating to someone; furthermore, empathy builds trust. Your understanding or even your attempt at understanding the other person’s inner world encourages rapport and mutual respect, which, in turn, engenders open communication — a hallmark of trust.
What does it mean to be authentic? It means being honest and straightforward in dealing with others: no games or hidden agendas. It means being open by appropriately sharing your thoughts and feelings, but in a way that enhances the coaching experience for the other person. It means delivering difficult but helpful feedback, and it means being willing to ask tough questions that challenge the person to think more deeply about a problem.
Summary
It is not always about what you know but who you are that matters most to the people you coach and lead. The most important part of coaching is YOU and how you manage the interaction with the person you are attempting to help.
Coaching is a collaborative relationship. Establishing and maintaining this relationship requires a great deal of self-regulation or discipline. Such discipline includes controlling your focus while the world is competing for your attention, being willing to invest yourself in understanding the other person without making judgments about what you are hearing, and being authentic instead of playing a role based on your title.
Coaching skills and techniques are beneficial, but they do not replace you as a determinate of coaching success. And by the way, the importance of YOU is true for your interactions with patients as well.
References
Manning BH. Cognitive Self-Instruction for Classroom Processes. Albany, NY: State University of New York Press; 1991.
Hirsh W, Jackson C, and Kidd J. Straight Talking: Effective Career Discussions at Work. Cambridge: NICEC; 2001.
Horvath AO and Bedi RP. The Alliance. In J. C. Norcross (ed.). Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patient Needs. New York, NY: Oxford University Press; 2002.