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J Rat-Emo Cognitive-Behav Ther (2008) 26:38–52

DOI 10.1007/s10942-007-0069-y

ORIGINAL ARTICLE

How Cognitive Behavioural, Rational Emotive


Behavioural or Multimodal Coaching could Prevent
Mental Health Problems, Enhance Performance
and Reduce Work Related Stress

Stephen Palmer Æ Kristina Gyllensten

Published online: 4 March 2008


Ó Springer Science+Business Media, LLC 2008

Abstract This case study describes the therapeutic work with a client suffering
from depression. A cognitive approach was used and a brief summary of the
problem and the therapy is outlined. The client had suffered from procrastination for
a long time and this was one of the key areas to be addressed in therapy. This case is
presented to highlight that cognitive behavioural, rational emotive behavioural or
multimodal coaching may be able to prevent mental health problems. It is possible
that the client’s problem with procrastination could have been tackled in psycho-
logically based coaching at an earlier stage. Psychological coaching could have
provided the client with tools to deal with the procrastination and increase her self-
awareness. This could have prevented the development of the depression or helped
the client to intervene at an earlier stage.

Keywords Cognitive behavioural coaching 


Rational emotive behavioural coaching  Multimodal coaching 
Cognitive coaching  Cognitive therapy  Work related stress 
Psychological coaching

Introduction

Work Related Stress

Research has consistently identified stress as an important factor causing ill health
(Cooper et al. 2001). Stress can cause psychological and physiological ill health
and may lead to depression, heart disease, and lower levels of job satisfaction,

S. Palmer (&)  K. Gyllensten


Coaching Psychology Unit, Department of Psychology, City University, Northampton Square,
London EC1V 0HB, UK
e-mail: dr.palmer@btinternet.com

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Reduce Work Related Stress 39

self-esteem, and motivation (Health and Safety Executive 2003). The survey ‘Self-
reported work-related illness in 2003/2004,’ commissioned by the Health and Safety
Executive (HSE), based in UK, indicated that half a million people in UK believed
that they were suffering from stress, anxiety or depression that was related to their
work. It was further estimated that 12.8 million days were lost due to work-related
stress, anxiety or depression (Jones et al. 2004).
There are many different definitions of stress. The American National Institute
for Occupational Safety and Health (NIOSH 1999) defines work stress as ‘the
harmful physical and emotional responses that occur when the requirements of the
job do not match the capabilities, resources or needs of the worker.’ According to
the HSE (2001) stress is defined as ‘the adverse reaction people have to excessive
pressures or other types of demand placed on them.’ Within cognitive definitions of
stress there is more focus on the perceptions of the individual. Palmer et al. (2003a)
propose the following definition ‘stress occurs when the perceived pressure exceeds
your perceived ability to cope.’

Cognitive Therapy

Cognitive therapy, developed by Aaron T. Beck, proposes that dysfunctional


thinking is prevalent in psychological disturbance. Dysfunctional thinking influ-
ences the client’s mood and behaviour (Beck 1995). Beliefs can be divided into
three levels (Curwen et al. 2000; Greenberger and Padesky 1995; Beck 1995, 2005).
Automatic thoughts are surface level cognitions and are the actual words or images
that pass through a person’s mind. Assumptions are intermediate level beliefs and
consist of attitudes, rules and assumptions. Core beliefs are the deepest level of
beliefs and these beliefs are rigid, global and overgeneralised. Cognitive therapy
aims to evaluate and modify unhelpful thinking and behaviour (Beck 1995).

Coaching

Coaching is gaining attention (Kampa-Kokesch and Anderson 2001) and the actual
practice of life/personal and executive coaching has greatly increased during the last
decade (Palmer and Whybrow 2005; Passmore 2003). There are many views of the
difference between coaching and counselling (for a discussion see Bachkirova and
Cox 2004). Grant (2001a) suggests that clinical psychotherapy is mainly concerned
with treating psychopathology whereas coaching is concerned with improving
performance or life-experience. According to Grant (2001a) the client group
attending coaching has generally a low psychopathology and high functionality,
whereas the client group attending therapy has generally a high psychopathology
and low functionality. However, Bachkirova and Cox (2004) argue that this
distinction is not necessarily clear cut. Others assert that there are Duty of Care
issues that need to be addressed as many coaches may have insufficient training to
recognise and refer on clients with mental health issues (Spence et al. 2006). It is
worth noting that although qualitative studies may have found that coaching may

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40 S. Palmer, K. Gyllensten

reduce work related stress, quantitative studies have had less statistically significant
results (e.g., Gyllensten and Palmer 2006).

The Adaptation of Psychotherapeutic Approaches to Coaching

The adaptation of psychotherapeutic approaches to the field of coaching has


continued over the past decade (Peltier 2001). Two UK surveys of coaching
psychologists found that the most popular adapted psychotherapeutic approach was
from cognitive therapy to cognitive coaching, with facilitation coaching being the
most used approach (see Whybrow and Palmer 2006). Figures 1 and 2 highlight the
findings of the most recent survey undertaken in 2004 (n = 109) (Whybrow and
Palmer 2006).

Fig. 1 Approaches used by coaching psychologists (Ó Whybrow and Palmer, 2006; reprinted with
permission)

Fig. 2 More approaches used by coaching psychologists (Ó Whybrow and Palmer, 2006; reprinted with
permission)

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Reduce Work Related Stress 41

Other approaches used by coaching psychologists not shown in Figs. 1 and 2


include Gestalt, Existential, Psychosynthesis, Hypnosis and Motivational Inter-
viewing. Similar to the field of counselling and psychotherapy in the 1980s,
currently with coaching psychologists the eclectic approach is more popular than the
integrative approach, whereas now, the reverse in true in psychotherapy. This paper
will be focusing on three psychological coaching approaches from the cognitive
behavioural and eclectic traditions, the popular Cognitive Coaching and the less
well used Rational Emotive Behaviour Coaching and Multimodal Coaching.

Cognitive Behavioural Coaching

Coaching based on cognitive behavioural theory and practice (CBC) has been
described by Neenan and Palmer (2001a) and Neenan and Dryden (2002). CBC
does not aim to provide coaches with definite answers to problems but uses guided
discovery to help individuals to find their own answers or solutions. This form of
coaching is time-limited and goal-directed and aims to help coaches to develop
action plans for change as well as increase self-awareness (Neenan and Palmer
2001b). CBC is suitable both for life and workplace coaching and can be used for a
variety of issues including, procrastination, enhancing performance, problem
solving, assertiveness and dealing with criticism. It has also been adapted to the
field of health coaching (see Palmer et al. 2003b). Researchers have attempted to
evaluate the suitability of cognitive behavioural coaching to the field of executive
coaching (see Ducharme 2004). So far the research into cognitive and cognitive
behavioural coaching has been promising (e.g., see Grant 2001b). In UK cognitive
coaching or cognitive behavioural coaching is closely based on the adaptation of
cognitive and cognitive behavioural therapy to coaching. It is worth noting that the
approach is not identical to the Cognitive Coachingsm as practiced in the United
States (see Costa and Garmston 1994) which has been extensively applied to the
teaching profession in some schools (see Foster 1989; Edwards and Newton 1994).
To avoid the confusion with Cognitive Coachingsm, in UK the pioneers of cognitive
coaching (e.g., Neenan and Palmer 2001a) have preferred to use the term cognitive
behavioural coaching instead.

Rational Emotive Behavioural Coaching

Rational emotive behavioural coaching (REBC) (see Neenan and Palmer 2001b;
Anderson 2002; Kodish 2002) has been developed from rational emotive behaviour
therapy (REBT) (see Ellis 1994) and adapted for executive and life coaching to
enhance performance and reduce stress. It has been applied to both telephone and
Internet coaching (Palmer 2004).
Similar to REBT, REBC focuses on disputing and modifying four key types of
irrational beliefs which are:
(a) Demands which are rigid, absolutist, dogmatic and illogical, e.g., ‘I must
perform well.’ And three major derivatives which follow on from the demand:

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42 S. Palmer, K. Gyllensten

(b) Awfulising—Events are defined as worse than bad, e.g., ‘This outcome is
really awful.’
(c) Low-frustration tolerance (LFT) in which the person believes that he or she
cannot tolerate discomfort or frustration, e.g., ‘I can’t stand it!’
(d) Depreciation of self, others or life which incorporates global negative ratings,
e.g., ‘I’m useless.’
In coaching, the modification of these four major ‘irrational’ or unhelpful types of
belief lead to enhanced performance and reduced stress.

Multimodal Coaching

The Multimodal approach has been used for life, stress, health, performance and
executive coaching (Richard 1999; Palmer et al. 2003a, b) and was developed from
Multimodal Therapy (Lazarus 1997). The approach asserts that people are
‘essentially biological organisms (neurophysiological/biochemical entities) who
behave (act and react), emote (experience affective responses), sense (respond to
olfactory, tactile, gustatory, visual and auditory stimuli), imagine (conjure up sights,
sounds and other events in the mind’s eye), think (hold beliefs, opinions, attitudes
and values) and interact with one another (tolerate, enjoy or suffer in various
interpersonal relationships)’ (Palmer 2006, p. 376). These dimensions of personality
are known by the acronym, BASIC I.D, derived from the first letters of each
modality, namely Behaviour, Affect, Sensations, Images, Cognitions, Interpersonal
and Drugs/biology (Palmer 2006, pp. 322–323).
In multimodal coaching, the BASIC I.D. modalities are assessed and a coaching
programme developed addressing the key concerns arising from each modality.

Case Study

This article will briefly describe a case that one of the authors (KG) worked with in
her job as a psychologist at a cognitive therapy centre in Sweden. The client1 was a
50-year-old female who was married, had two children, and was working as a civil
engineer. When the client presented for therapy she had received the diagnosis of
depression. In the first session the client explained that she suffered from low mood,
lack of energy, extreme difficulty in completing work tasks, and had thoughts
relating to hopelessness and failure. The client talked very slowly and reported that
she found it difficult to concentrate and had a score of 22 on Beck’s Depression
Inventory (moderate depression).

The Problem

The client explained that she wanted help with procrastination. She had struggled
with this problem since being a student. Her procrastinating behaviour had been
1
All names and identifying information have been changed to ensure client confidentiality.

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getting worse and the client found it more and more difficult to complete projects
within the agreed work deadlines. During the last year the client had been unable to
complete a long-term work project she had been responsible for and had therefore
been asked to leave her job. It is important to note that the latter is uncommon in
Sweden. The first therapy session was a couple of weeks after the client had learnt
that she had to leave her job. The client reported that she had started feeling low
*3 months prior to the first session and that she had become very distressed about
her procrastinating behaviour.
The client described how in the past she had thrived on the adrenaline kick of
completing tasks in the last minute but she no longer experienced a ‘positive kick,’
rather what she called ‘negative stress.’ Together the client and the therapist did an
assessment of the problem. At the beginning of the long-term project, the client did
a plan of what needed to be done and in what order. The client did not have any
problems following the plan at the beginning of the project. However, what
transpired in the assessment was that at every stage of the project the client left what
she considered to be the boring, uninspiring bits and continued with the exciting
tasks such as looking for new research and information. Often the client became
involved in parts of the project relating to her specialist competency, and spent more
time and work on these tasks than was necessary. The last stage involved writing a
report that summarised all the information and findings, and finalising the ‘boring
bits.’ At this stage, the client found it difficult to complete the work and continued
leaving it to later. When the client switched on the computer to start work, a
negative automatic thought (NAT) occurred which triggered anxiety. This anxiety
was then reduced by avoiding the task (see Fig. 3 for a visual representation of the
analysis of procrastination). After some discussion, it also became clear that the
client had a rigid rule that she had to perform perfectly otherwise she was
inadequate; this rule triggered the NATs which were associated with anxiety
avoidance behaviour.

Fig. 3 Analysis of Situation: Switches computer on to write final report and


procrastination
complete the boring bits that have been left

NAT: ‘This is boring’

‘What if I don’t do it good enough?’

Feeling: Anxiety

Behaviour: Switches computer off

Feeling: Temporary reduction of anxiety, but low mood

was maintained

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44 S. Palmer, K. Gyllensten

Cognitive Conceptualisation

A cognitive conceptualisation is completed in order to aid the therapist’s


understanding of the client’s problems. The therapist begins to complete the
conceptualisation from the assessment stage and continues to refine it during the
therapy. The formulation is shared with the client at strategic points in the therapy
(Beck 1995) to help develop insight into the relationship between the beliefs,
behaviours and emotions associated with the presenting problem(s).
The conceptualisation was based on a diagram presented by Beck (1995). The
diagram illustrates the relationship between deeper-level beliefs and automatic
thoughts. It is important to note that the conceptualisation was not final at the time
of writing this article as the therapy was still ongoing. Nevertheless, starting from
the top to the bottom in the client’s cognitive conceptualisation (see Fig. 4) the first
box lists the relevant childhood data. Nothing was noted in this box. The early
origins of the client’s beliefs had not yet been discussed in the therapy. The core
belief the client appeared to hold was ‘I am inadequate’ and a related assumption
was ‘If I do not do a perfect job then I am inadequate.’ The compensatory strategy
that protected the client from anxiety in the short-term was to avoid working on
projects or specific parts of projects for as long as possible. According to Beck
(1995), compensatory strategies are normal behaviours, but many psychologically
distressed clients overuse these strategies rather than using other more functional
strategies. The NATs presented in the diagram were three NATs discussed in the
therapy.
As stated above it was not yet clear when and how the client developed the core
belief ‘I am inadequate.’ However, this belief and the related assumption, ‘If I do
not do a perfect job then I am inadequate’ appeared to have been influencing the
client for a long time. For example, the client reported that in the past she often had
the NAT ‘this is not good enough’ while writing reports. She had also been working
according to the rule that the reports had to be perfect. The NAT ‘this is not good
enough’ occurred despite the fact that the client generally got good feedback on her
reports. Moreover, when the client read old reports she realised that her work was
adequate and was at a high standard even though she thought it was ‘inadequate’ at
the time of writing. Thus, it appeared that the core belief ‘I am inadequate’ and the
rule ‘I have to do a perfect job’ had been influencing the client’s thinking and had
stopped her from realistically evaluating parts of her work performance. The core
belief was not relevant to all work performance issues and the client reported that
she was highly knowledgeable and up-to-date within her area of expertise.

Summary of the Therapy

The main problem the client wished to focus on was her procrastinating behaviour.
The client had no desire to focus on any other aspects of the depression and was
taking action outside of therapy to improve her mood such as exercise and spending
time doing enjoyable tasks or activities. The short-term goal was related to
completing job applications and the longer-term goal was related to completing

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Relevant Childhood Data


No relevant information noted

Core Belief
I am inadequate

Intermediate Beliefs: Conditional Assumptions/Attitudes/ Rules


I should perform well
I can’t stand doing boring tasks
If I do not do a perfect job I am inadequate

Compensatory Strategies
Avoiding working on projects/parts of projects until
the last minute as they may not be good enough

Situation 1 Situation 2 Situation 3


Sitting in front of Writing a job In therapy - talking
computer in order to application form about homework task
write a report that was completed

Automatic Thought Automatic Thought Automatic Thought


This is not good This should have a I should have been
enough higher standard able to do so much
more

Meaning of The AT Meaning of The AT Meaning of The AT


I am inadequate I am inadequate I am inadequate
– this is hopeless

Emotion/ Physiology Emotion/ Physiology Emotion/ Physiology


Anxiety heavy Anxiety tired Sad tired

Behaviour Behaviour Behaviour


Avoids writing Stops writing the (No behaviour noted)
the report application and looks
for other ads

Fig. 4 Cognitive Conceptualisation demonstrating the link between the automatic thoughts, intermediate
and core beliefs, and the compensatory procrastinating strategies

longer work projects. The therapy involved planning and carrying out practical steps
towards the goals while learning to identify and challenge NATs. Discussion about
the negative and distorted thinking in depression was important as the client had
NATs about the actual depression such as ‘Get a grip,’ ‘I should not be feeling like
this’ that de-motivated her and caused additional frustration. After three sessions,
the therapy also focused on the client’s perfectionism and fear of failure. The client
reported that being aware of the process leading to procrastinating behaviour and
subsequently learning to identify and challenge thoughts sometimes helped her to

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46 S. Palmer, K. Gyllensten

complete tasks and tolerate the associated anxiety. A discussion of the ending of the
therapy is not included as the therapy was still ongoing when this article was
submitted.

Difficulties in Therapy

The pace and progress of the therapy were slow and the client appeared to be
uncomfortable being in therapy. The distorted thinking associated with the
depression and the difficulty in accepting the situation triggered additional
frustration for the client. Other symptoms of the depression also had an adverse
impact on the client such as early morning waking. A deep breathing exercise was
recommended and the client reported that it was sometimes effective in helping her
to sleep better.

Psychological Coaching—An Alternative?

It is important to recognise that there are many factors that can trigger depression.
Nevertheless, task-blocking procrastination was an important contributory factor to
the client’s suffering and was the problem the client wanted to resolve. This
problem was difficult to focus on in isolation as the other symptoms of the
depression also caused distress and negatively influenced the client’s abilities and
coping skills. Coaching whilst still at work could have helped the client to deal with
her procrastination. It is our contention that psychological coaching such as
Cognitive Behavioural or Rational Emotive Behavioural or Multimodal Coaching
can be preventative and help clients tackle issues relating to reduced performance
such as procrastination at an earlier stage before it leads to negative or serious
outcomes at college, work or other areas of life. Whereas counselling and
psychotherapy are tertiary interventions, psychological coaching could be consid-
ered as primary or secondary interventions depending upon what particular issue is
targeted.
The more popular and traditional behaviourally based frameworks of coaching
such as the GROW framework (i.e., Goals, Reality, Options, Will or Wrap-up; see
Whitmore 1992) are less likely to have been effective in dealing with procrasti-
nation unless they addressed the performance interfering thoughts (PITs),
intermediate and core beliefs.

Cognitive Behavioural Coaching

CBC may have helped the client to tackle her procrastination by helping her to
improve her problem solving skills and by identifying and changing unhelpful
thoughts. Neenan and Dryden (2002) present a problem solving framework for
coaching, based on a model outlined by B. Wasik (1984, unpublished data). This
model consists of seven steps: Problem identification, goal selection, generation of

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alternatives, consideration of consequences, decision making, implementation and


evaluation. According to Neenan and Dryden (2002), it is also useful to identify
self- and task-defeating beliefs as a part of the problem solving process. The coach
could have helped the client to identify and work with PITs and performance
enhancing thoughts (PETs) (Neenan and Palmer 2001a, b). Deeper beliefs relating
to the client’s perfectionism could also have been discussed and modified in the
coaching. The coach may have been able to support the client through a long-term
project. Collaboratively, the client and coach could have worked through difficult
issues arising during the project.
In recent years, alternative cognitive-behavioural models have been developed.
Edgerton and Palmer (2005) describe the psycho-educational SPACE framework
that can be used within cognitive behavioural coaching, therapy and stress
management. It helps clients to understand the links between five key dimensions,
aids assessment and interventions. The client’s emotion triggering situation is
developed in three stages with graphical illustrations of ACE, PACE and finally
SPACE:
ACE:
A—Action,
C—Cognition,
E—Emotion.
PACE:
P—Physiology,
A—Action,
C—Cognition,
E—Emotion.
SPACE:
S—Social context,
P—Physiology,
A—Action,
C—Cognition,
E—Emotion.
The completed SPACE diagram for a stressed teacher witnessing a theft from a
student’s bag is illustrated in Fig. 5 (Edgerton and Palmer 2005). The possible
interventions are discussed for each dimension with the client. In coaching, the
Social Context of the SPACE framework becomes an important area for discussion
as the interpersonal aspect is often key for both life and executive coaching.
As with other cognitive behavioural approaches, self-help material and books can
be used to aid coaching. Some modern self-coaching cognitive behavioural books
include mobile phone text messaging to reinforce what the clients are reading in the
book (see Palmer and Wilding 2006). However, there is a caveat for use of self-help
books as an adjunct to cognitive or cognitive behavioural coaching. It is important
that the popular bibliotherapy material often associated with cognitive therapy (e.g.,
Greenberger and Padasky 1995) is generally avoided in coaching otherwise the
client may feel that the coach has judged them as having a ‘mental health’
condition. Books that have adapted the cognitive model to the field of coaching are

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48 S. Palmer, K. Gyllensten

Fig. 5 Completed SPACE diagram for a stressed teacher witnessing a theft from a student’s bag
(Ó Edgerton and Palmer 2005, reprinted with permission)

preferable such as Neenan and Dryden (2002). If the client does have a mental
health condition that needs addressing then the coach (even if qualified as a
therapist) should seriously consider referring the client to a qualified therapeutic
practitioner to avoid boundary issues and the possible complaint of enticement into
long-term therapy from a short-term coaching contract.

Rational Emotive Behavioural Coaching

In REBC, the anxiety would have been assessed as the goal-blocking emotion and
the coaching programme would have focused on challenging and modifying the
associated irrational beliefs. The coaching assessment could be summarised as
follows:
A: Activating event—Performance-related task or project.
B: Beliefs—I should do a perfect job (Demand),
—If I do not do a perfect job I am inadequate (Self-depreciation),
—I can’t stand doing boring tasks (LFT).
C: Consequences—Performance Anxiety,
Procrastination.
A variety of emotive, cognitive, imaginal and behavioural techniques would have
been used to help the client to change the performance anxiety to performance

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Reduce Work Related Stress 49

concern, self-depreciation to self-acceptance, and LFT to high-frustration tolerance


and thereby eliminating the procrastinating behaviour. The ABC assessment
framework can be finished with the following Disputation and Effective new
approach sections:
D: Disputation and restructuring unhelpful beliefs—It’s strongly preferable to do
a good job but realistically I don’t have to,
—I can learn to accept myself if I do not do a perfect job,
—Although I don’t like doing boring tasks, I’m living proof that I can stand
doing them.
E: Effective new approach—Stay focused on immediate task to achieve goals.
Start the ‘boring bits’ earlier and on completion reward self with a large latte
coffee and favourite cake once a ‘boring bit’ has been finished.
In REBC, the interventions focus on the present and future and often REBC
practitioners will focus on the last part of the framework as below (Palmer 2002) so
that clients can learn to become their own self-coach:
F: Focus remains on personal or work goals and learning process may enhance
future performance and reduce stress—Focus remains on work goals,
—Future focus: Learns not to rigidly demand a ‘perfect’ performance from
self.
There are many books based on REBT that are also suitable as bibliotherapy in
coaching settings (e.g., Ellis 1999; Ellis and Powers 2000; Dryden and Gordon
1991).

Multimodal Coaching

Multimodal therapists take Paul’s (1967, p. 111) mandate very seriously: ‘What
treatment, by whom, is most effective for this individual with that specific problem
and under which set of circumstances?’ In addition, relationships of choice are also
considered. How is this applied to coaching? In multimodal coaching the coach
would have considered whether or not he or she was the best person to help the
client, and if not a judicious referral to a more suitable colleague may have been
necessary. The choice of techniques would depend upon what the client is most
likely to believe would work, noting the input from the coach. The coach may also
adapt his or her interpersonal style to the one that would maximise the coaching
outcome(s) for the client. This has been called acting as an authentic chameleon by
Lazarus (1993) and coaches adapt themselves to the expectations of different clients
and situations.
In multimodal coaching, the development of a modality profile which forms both
the assessment and coaching programme in a client-friendly, easy to understand
format is seen as important to help the client stay focused on the solutions. Figure 6
is the hypothesised Modality Profile for the Case Study described in the earlier
section.

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50 S. Palmer, K. Gyllensten

Modality Problem Proposed coaching


programme
Behaviour Procrastination: leaves Use time management
completion to the 11th techniques; challenge
hour. unhelpful beliefs about
Avoids starting ‘boring being a failure
bits’
Affect/Emotional Feels increased anxiety Use feeling identification
when starting important to ascertain helpful
projects (concern) versus
unhelpful (anxiety)
emotions
Sensory Feels tense when Use relaxation
about to start ‘boring techniques.
bits’ of project(s)
Imagery Can see herself not Use coping imagery
finishing her project
Cognitive/thoughts/ideas I should do a perfect Challenge and modify
job (Demand) belief

If I do not do a perfect Self-acceptance training


job I am inadequate Read self-help material
(Self-depreciation) and books

I can’t stand doing Challenge and modify


boring jobs (LFT) belief

Complete Enhancing
Performance Forms
Interpersonal Does not ask for Role play with coach to
supervision from practice asking
manager when faced manager/supervisor for
with a difficult or boring guidance
piece of work
Drugs/ biological None reported Check nutrition and
exercise

Fig. 6 Hypothesised Modality Profile focusing on procrastination

The programme is negotiated with the client during the first or second sessions of
coaching. However, the Modality Profile is a flexible template which can be
modified and updated during the course of coaching.
Multimodal self-coaching literature or books may be used as an adjunct to
coaching (e.g., Palmer et al. 2003a, b; Lazarus and Fay 1975; Lazarus 1977, 1984,
1985; Lazarus et al. 1993).

Conclusion

This article has described the therapeutic work with a client suffering from
depression and anxiety. A key focus of the therapy was on her procrastinating
behaviour and it was suggested that this problem may have been better dealt with by
coaching at an earlier stage. Psychological coaching could have increased the
client’s self-awareness and given the client tools to deal with the procrastination. In
a best case scenario, it is possible that coaching could have helped to prevent the
subsequent depression. It is possible that the client would have become depressed
regardless of any coaching. However, the client did not appear to be comfortable
attending therapy and it is likely that coaching at an earlier stage would have suited
her better. Indeed, Bachkirova and Cox (2004) highlight that coaching can help

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individuals who might not seek therapy. On the basis of this case study it is
proposed that coaching may serve a function in the prevention of mental health
problems.

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