My Rubix Cube and McLean (Hospital)

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I love being home on Saturdays with my family. I enjoy my morning rituals. I enjoy the hikes we tend to take along the Potomac River, the museums we visit and the dinners in Washington. I especially like my morning espresso at the coffee shop down the street from where I live and the espresso at a Georgetown place better known for its cupcakes. I like my rituals.

So, its with hesitation that I interrupt them. Doing so has a tendency to scramble the Rubix cube in my brain. Like any Rubix cube, it can be difficult to get back in order again.

As I headed off to the Harvard Medical School-McLean Hospital conference on Coaching in Leadership and Healthcare this weekend, I thought that my Rubix cube had a chance of being broken if it turned out to be a disappointment. Well, its still in tack and I am walking away from the conference with a few more techniques on how to solve my own puzzles and help others put theirs together.
My concern came from the simple fact that some of the people that I have encountered in professional coaching, both as someone who hires coaches and who works with them, lack the tools to really help my clients where they are. Many coaches do not want to work with people who have certain problems. I’ve met wellness coaches who don’t want to work with people who have serious mental health or addiction problems (I’m waiting to meet the food addict client who isn’t an addict). I have met life coaches who are really cool with working with anyone as long as they don’t have an anxiety disorder, a mood disorder, a personality disorder or any of those other things that would make them prime beneficiaries of coaching. They’re there to help, but only if your problems are easy.

There is no question, in many situations where people have serious mental health problems, the client should have a psychiatrist and/or a therapist involved in their treatment. But I firmly believe that there is a role for a good coach to help turn ideas into action, reduce failures and keep crises from turning into derailments. With the backdrop that not everyone in the profession agrees with me on this approach, I came to the conference fearing that it would be dominated by that type of thinking.

I was pleasantly surprised. But, really, I shouldn’t have been. McLean Hospital is the renowned hospital of “Girl, Interrupted” fame that is known for its respected milieu treatment programs and its ground-breaking neuroscience research. Famous former patients include singer-songwriter James Taylor, Nobel-prize winning mathematician John Nash, poet Sylvia Plath and authors and Susanna Kaysen, according to Gracefully Insane: Life and Death Inside America’s Premier Mental Hospital. David Foster Wallace was treated there, according to a recent biography, and so was Frederick Law Olmsted, who both selected the plot of land for the hospital and was a patient. Part of Plath’s memoir, The Bell Jar, includes time spent within the campus walls. I’ve referred clients to McLean for the treatment of dissociative disorders and borderline personality disorder, two areas where the hospital is considered ahead of the curve.

Most of the debates about coaching as a profession center on licensing as a means to regulate the practice and membership. It’s a debate that frustrates me because I fear that it could lead to an entire population of people who need coaching the most — those with mental health problems — to be excluded from receiving services. I also worry that the peer specialists, like the recovery coaches hired by the Fairfax-Falls Church Community Service Board and the public Loudoun County Mental Health, would be left in the dust in a liscened paradam. In essence, I fear the namby pambies will win, and coaching will turn into a profession of yoga, meditation and singing kumbaya for only the people who don’t have a condition in the Diagnostic and Statistical Manual of Mental Disorders.

It shouldn’t come as a surprise that the No. 1 psychiatric hospital in the country, which is among the top 15 recipients of National Institutes of Health grants, would confront mental illness head on and their work would be heavy on the science. Research was presented on the impact of emotional intelligence on leaderships effectiveness, coaching and healing, cross cultural coaching, coaching to create creative learning, coaching for physician leaders and a variety of technique and population specific research. Techniques like motivational interviewing, solution-focused coaching, narrative coaching, cognitive behavioral coaching and psychodynamic coaching were explored in depth. Empirical evidenced based research was littered throughout all the presentations. Discussions about utilizing techniques from mindfulness, dialectical behavioral therapy and other modalities were common. fMRI scans seemed to be in every other presentation.

Pamela Peeke, MD, a physician-coach who is a professor at the University of Maryland School of Medicine, presented on the addicted brain. She discussed the similarities between food addiction and drug addiction, discussing how consistent consumption of either can lead the brain to reduce the number of dopamine receptors to protect the mind. This, in turn, means it takes more to get the same feeling in the rewards center of the brain. That’s how one cupcake a day becomes 13, she said, adding that the research has helped coaches, therapists and psychiatrists to help clients focus on mindfulness, hypervigilance and executive function problems in order to buy time for those receptors to grow back.

Using data from research from Nora Volkow, MD, the director of the National Institute on Drug Abuse (and Leon Trotsky’s great granddaughter)  and her team, Peele laid out strong research showing the reasons why willpower — the fact that addiction impacts the regulating executive function part of the brain and the rewards center part of the brain — is such a failure in addressing any type of addiction.  

Robert Kegan, PhD., the Havard professor, discussed immunity to change, noting that the “immune system is a beautiful system, designed to protect us, but sometimes it can get us into trouble when it treats something as a threat that is not.” He compared people’s difficulty with good change to an “autoimmune reaction.” Kegan noted that the amygdala — the fear center of the brain — “gets a bad wrap” because its needed to keep us safe, but that when it goes wrong “it’s like having one foot on the gas and one foot on the break.” Kegan laid out strategies in a case study about how to help people with change.

Michael Pantalon, PhD, a Yale University assistant professor of psychiatry and director of the Center for Progressive Recovery, discussed how giving clients autonomy — acknowledging that they have a choice and empowering them to make one — has helped increase attendance among parolees for meetings with their probation officers and improved outcomes in drug treatment.

Three physicians in the session highlighted the application of this approach in medicine and mental health.

In the session, a cardiologist noted that physicians are trained to be dietetic — to tell patients what to do — and noted that she was beginning to finally see why that was not working. A family physician who is a coach highlighted how this coaching model had changed outcomes for his patients. After becoming a coach, he stopped telling clients what to do, and started casually hanging ideas out there. In one example, instead of telling a client who was trying to lose weight what to do, he mentioned that he had lost 130 pounds. The client asked about the diet and adopted all of it except the part about not eating pasta. Instead of telling the client to not eat pasta, he said ok and the client asked what would change. He replied, “You won’t lose weight.” The client ultimately decided to give it up. In addition, the director of a large psychiatric hospital described a patient who had long been on their inpatient unit who had become so entrenched that she would grab something to hurt herself whenever she was walking in the hallways. He said the staff all wear mitts to try to slow her down. The hospital director mentioned that they had told the patient she should use the tools she’s learned on the unit. Pantalon coached the director on how to essentially say, “You can use the skills you’ve learned if you want to. You can also continue to hurt yourself. It’s your choice.” I guess we’ll see how it works next year. But if Panaton’s own examples from working with addiction clients are any indication, my betting money is that empowering the patient will be successful.

A session by Ronald Schouten, MD, an associate professor of psychiatry at Harvard and the director of the law and psychiatry service at Massachusetts General, was cancelled at the last minute. It’s a shame. He was going to talk about what coaches should do when they come across those who are and who are almost psychopaths, alcoholics and depressed in their practice. Perhaps, this time, next year. I’ll be back. The other speakers included David Peterson, the director of Leadership and Coaching at Google, and Richard Ryan, PhD., a University of Rochester professor who spoke on self-determination, specifically the importance of intrinsic motivation in volitional behavior.

But the most powerful part of the conference was listening to my colleagues themselves. The issues that they are working on, struggling with, researching and tackling are impressive. The skills that they brought to the table — like the executive coaches who were as skilled in psychology and organizational development as they were in finance, and the life coaches who knew when to bring to bear insight-oriented, cognitive behavioral, dialectical behavioral and action-oriented approaches stood out.

What was most heartwarming, were the side table conversations about clients. The coaches I met showed a passion for making their lives of their clients better with a matching desire to take the most intelligent, evidence-based approaches.

I came out of the conference with dozens of new tools to help my clients, and a lot more hope for the profession. I feel like my Rubix cube isn’t just unbroken. I feel like I got another one. And that means many more tools for my clients.

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