The Client Whose Numbers Are Getting Worse
Tom, 58, has been coaching for four months. His goal was to reduce his A1c, which was 7.4% at intake. His latest lab, shared at session 12, is 7.9%. He has lost 4 pounds, walks most days, and reports sleeping better. He is discouraged: 'I did everything you said and it got worse. What's the point?' He asks whether he should stop coaching. He also mentions that his doctor 'upped one of my pills' last week but he is not sure which one. He has not told his doctor about the walking or the sleep changes.
1. How should the coach respond to Tom's discouragement without either overpromising or dismissing the data?
Read the worked answer
The coach should not reassure Tom that the number will improve, and should not agree that coaching is pointless. The honest position is that the A1c is one measure, it moved in the wrong direction, and the behaviors Tom changed are real and worth keeping regardless of that single number.
The coach should acknowledge the disappointment directly ('that's genuinely discouraging, and I understand why you're asking') and then separate the data from the conclusion. A 0.5-point rise over four months is not explained by walking and sleeping better; it may reflect medication changes, diet, stress, illness, or measurement variation. The coach does not interpret which - that is the physician's job.
The coach should also revisit the goal itself. Was A1c the right target, or was it a proxy for something Tom cares about? If the number is the only scoreboard, a bad reading feels like failure. The coach can ask what else Tom would count as progress and whether he wants to keep the A1c goal, change it, or hold both.
2. Tom mentions a medication change he does not understand. What is the coach's move?
Read the worked answer
The coach does not explain the medication, guess which one changed, or advise on it. The coach names the gap plainly: Tom does not know what changed in his regimen, and that is worth a call to his doctor or pharmacist.
The coach can support Tom in preparing for that conversation - what he wants to ask, what he wants to report (the walking, the sleep, the weight change, the A1c result), and how he wants to raise his discouragement. That is squarely within coaching: helping the client advocate for himself.
The coach should also encourage Tom to tell his doctor about the behavior changes, since those are relevant clinical information the physician does not currently have. The coach does not contact the physician without Tom's consent, and if Tom wants the coach to share information, the coach uses a written release and shares only what Tom authorizes.
3. Tom asks whether he should stop coaching. How does the coach handle this?
Read the worked answer
The coach treats the question seriously rather than talking Tom out of it. The coach reflects it back: 'You're asking whether this is worth your time. What would make it worth it?' That question puts the decision where it belongs and surfaces what Tom actually wants.
The coach can also be honest about what coaching can and cannot do. Coaching can support behavior, adherence, and the client's own goals; it cannot guarantee a lab result. If Tom's only criterion for success is the A1c, coaching may not be able to meet that criterion, and saying so is more respectful than promising otherwise.
The coach should also check for signs that something else is going on - hopelessness, withdrawal, loss of interest - and, if present, ask directly about mood and whether Tom has someone to talk to. If Tom decides to pause, the coach supports a clean ending: summarize what Tom has built, what he wants to keep, and whether he wants to check in later. A good ending is part of good coaching.