Episode 128 | May 1, 2025

How Client-Led Coaching Transforms Lives

What makes health coaching uniquely powerful compared to traditional healthcare approaches? This week on Health Coach Talk, Dr. Sandi takes the mic solo to explore the heart of coaching: client-led, client-centered care. She explains why letting clients lead the way is not only different from what doctors or AI health platforms offer—it’s the key to building the lasting change and self-efficacy that transforms lives.

“Coaching works not because coaches tell people what to do, but because they believe in people. When someone believes in you—truly believes you can change—you begin to believe it too. And that’s what builds self-efficacy, the true driver of lasting health transformation.”

Dr. Sandi

Drawing from decades of experience in health coaching and psychology, Dr. Sandi breaks down the philosophy behind client-centered coaching and why it is so effective. She shares why coaching is radically different from medical interventions that are expert-driven, and how it offers something even the most advanced technology cannot replicate: the human relationship that builds trust, agency, and growth. Through personal reflections and research findings, Dr. Sandi paints a compelling picture of how real transformation happens when people are given the space and support to lead their own health journeys.

For health coaches, this episode offers a reaffirming reminder of the true value they bring to the healthcare landscape. It highlights how coaches fill a critical gap that neither doctors nor AI can fill—creating safe, supportive spaces where clients can grow into the leaders of their own wellness journeys. As rates of chronic illness rise, this work has never been more essential. Ready to deepen your understanding of what makes client-centered coaching so transformative? Listen to the episode below.

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Episode Transcript

Dr. Sandi: Hello, everybody. Welcome to another episode of “Health Coach Talk.” I’m your host, Dr. Sandra Scheinbaum. And today, we are going to have a solo episode. It’s just going to be me because I want to talk about something that really defines health coaching and differentiates it from other types of interventions. And that is the power of client-led, also referred to as client-centered, and I want to really dive into exactly what that means because there is fair amount of misinterpretation.

So, what do we mean? Well, first of all, I want to say that coach-led is not where it’s at. It is client-led. This is the heart of health coaching. So, if you are working with a health coach, if you are training to become a health coach or thinking in the future you might like to be a health coach, this is what you will learn. And as a client, this is what you will experience. If you are a practitioner and you’re thinking about referring your patients to a health coach, I’m going to explain why this is so powerful and how it may differ from the approach that you are using as the medical expert.

So, this is what sets health coaching apart from traditional healthcare or even from functional medicine healthcare or integrative medicine healthcare, because that individual who’s the practitioner in most cases is still acting as the expert. They are leading the session. They are creating the diagnosis, creating the treatment plan, and they may be reviewing that with people. They are basically telling them what is recommended. But when we say client-centered or client-led, this is really putting the client in the driver’s seat. And this is why coaching builds lasting self-efficacy and leads to true transformation.

So, this is what we’re going to dig into. So, what exactly does this mean? Well, in client-centered coaching, the client sets the agenda. What does that mean? Well, the client is deciding what goals matter most to them, not the coach. They are the ones who are in charge. So, it’s not the doctor who is saying, “This is what you need to work on, or a coach telling you what you need to work on.” No. If you’re a client and you’re experiencing health coaching, you set the agenda. You decide what you want to work on.

So, a big difference is that coaches do not prescribe. Of course, they do not prescribe medication. They do not prescribe psychotherapy, treatment plans, diet plans, and they, within each session, do not prescribe what’s going to be talked about. Coaches listen. They ask open-ended questions. They reflect, and they support the client’s own vision for where they want to be and their own wisdom. A lot of coaching is the acknowledgment that, as an individual, you are in charge of your health, you know best. So, they are along for the ride as the coach, but the client is in the driver’s seat, supporting the client’s own wisdom that they can make sustainable behavior changes.

So, this is a radical shift because in the healthcare system, as we know, particularly today’s healthcare system, patients are often the passive recipients of advice or prescriptions, and coaching is so different. It works. It’s powerful because it creates a space for agency, for ownership, and deep personal growth because you only grow personally when you have a sense that you are in charge of your own destiny. So, what this means is self-efficacy. Self-efficacy, I believe, is the true game changer. So, when people ask why does health coaching work, because it helps people build self-efficacy.

So, let’s talk about what that actually means and why it matters. This is a very, very powerful psychological concept, self-efficacy. The psychologist, it was actually Albert Bandura, who defined self-efficacy, and he talks about it as a belief in one’s ability to succeed in specific situations. So, for example, if you are a client and you want to, let’s say, change your metabolic health and your type 2 diabetes, if you have a strong belief that you can do it, it might be tough but you’re going to get there, that is self-efficacy. It’s self-efficacy first. It starts with self-efficacy. It doesn’t start with somebody telling you to go on a diet plan or telling you specific foods to eat or not eat or how to move throughout the day. You may want that information, and that’s important. But the heart of coaching is helping somebody reach a state of self-efficacy.

And it grows when people take action, and they see they’re successful. And the action is based on their own goals, so they decide how, when, what way they’re going to start, and then they achieve success. And, wow, that is the basis of developing self-efficacy. They see themselves succeed. As a coach, you’re facilitating that process. You’re helping them set those realistic, achievable goals, for example.

Now there’s been a lot of research on self-efficacy and coaching. When I was doing research for my latest book, “Your Health Coach Will See You Now,” I have a whole chapter on research on the effectiveness of health coaching, and so many studies show that one of the best outcomes… So, when they ask people who have received coaching, they are filling out checklists, for example, rating scales, and it is the belief that they have developed self-efficacy. That’s what they’re reporting. They’re having a sense that they’re CEOs of their own health. They’re in charge of setting these goals, and that is what is creating this powerful behavior change.

So, there were a lot of studies. Now there were some in the American Journal of Lifestyle Medicine, Global Advances in Health and Medicine, and they consistently showed that health coaching improves self-efficacy. And especially in people managing chronic conditions, sometimes some of the most severe conditions. So, the more symptoms people had, the more it boosted their self-efficacy. That seems counterintuitive, but those are some of the findings.

So, what is self-efficacy then? We’ve talked about that. It’s a sense that, yes, you are in charge of your destiny, that you can succeed. Now this process, this building self-efficacy, this happens in a coach-free relationship. It’s not happening in a doctor’s visit. Well, let’s talk about that. First of all, it’s not structured to build self-efficacy. People get a very short amount of time with their doctor. Doctors are told based on administrative pressures, they can only talk about one concern with an individual they need to and make sure all the data is entered correctly in the electronic medical record. They are intent on refilling or giving you a new prescription, for example, describing a treatment, and that’s about it. And so you leave feeling unheard. Well, that’s not building self-efficacy. That doesn’t result in creating the sense that, “I can do it. I’m going to change. I’ve got somebody supporting me along the way, helping me set reasonable goals,” and so it’s not happening.

Well, what about in AI health coaching? Well, AI health coaching cannot replicate this power of human health coaching. There’s a lot that’s being written right now about AI health coaches. Just recently, Apple. It was all over the news. They are hard at work developing an AI health coach. It’s taking data from wearables and turning it into actionable advice. That’s what it is. It’s advice. That’s not health coaching. Coaches do not give advice. We are inundated with advice. We tune it out. It’s that process of listening, of asking these open-ended questions, knowing that you are 100% supported in setting your own agenda. That’s the power of the coaching relationship. So, doctors aren’t doing it. AI health coaches aren’t doing it.

So, as I’ve said, doctors, what do they do? They’re trained to diagnose and treat. We’ve got these short medical visits, seven minutes on average. They don’t allow time to really dive into your beliefs, your motivations, your values, your desire to change. So, health coaches are filling that gap. They offer just really being present, looking someone in the eye, having that empathy, building rapport, giving somebody space to share what might be really troubling them, what are some of the obstacles to change. So, coaches help people untangle ambivalence, ambivalence about changing. They’re nonjudgmental. When you work with a health coach, you feel like it’s okay. No matter what you talk about, they’re not going to judge you. They’re not telling you what to do. They’re not diagnosing you. They’re not giving you the sense that you’re broken, that you’re the victim of trauma, that you need to be fixed. So, you are talking about what matters most to you and how you want to live.

So, again, AI, well, it’s tracking metrics. It might suggest goals. But in real health coaching, it’s the client. It’s you as a client who is setting the goal. You as a coach are going to facilitate that process. So, this is what builds trust. Rapport come first, and then you set goals. So, AI, well, it can’t like we call hold silence. Sometimes silence in a coaching relationship is more powerful than talking, holding space for that person to have a realization, to have an aha moment. AI coaches can’t sit with somebody and hear them and really their fears, their hesitations. It’s very, very powerful when you are with someone and they say, “I hear you. Only a human person, a human being, a human health coach can create that deep transformational connection.”

So, there are some studies that have… And more than some. There are quite a few studies that show this. Here are just a few. In 2021, it was reviewed in the British Medical Journal Open found that health coaching improves physical activity, diet, weight management, and medication adherence if that’s what’s needed. And then there was a landmark study. This was published in 2024. It was a controlled trial in the American Journal of Lifestyle Medicine. It showed that adding health coaching to those on GLP-1 weight loss medication really improved long-term weight loss retention and confidence in lifestyle change. I think that’s really, really significant. If you are a health coach, you can go to providers and you can say, “Listen. You’ve got people on these medications. Maybe you’re concerned about their long-term well-being.” Well, I can help them. I can help them by building self-efficacy. They can start to implement lifestyle changes, possibly make those difficult changes in terms of doing resistance exercise so that they’re not in danger of losing muscle as they’re losing pounds. So, this process is quite valuable, not only for those who are on these medications or wanting to lose weight but just you name the condition, the chronic medical condition, and there will be a study showing the value of health coaching. There are studies on people with type 2 diabetes showing that coaching improves A1c levels and here’s that word again, self-efficacy and emotional well-being.

So, the research is really clear. I talk about that in “Your Health Coach Will See You Now.” Coaching works not because coaches tell people what to do because they believe in them. When you have someone in your corner who believes that you can do it, that’s hope, and that is so, so powerful. So, to every health coach who might be listening, you are doing work that no one else is trained to do. This is unique. It is powerful. You are walking side by side with somebody in a way that’s helping them with self-efficacy. That means building autonomy, confidence, feeling joy, and this is very, very powerful. And coaches know this because what they tell me, our graduates say over and over again, when people have this aha moment, that, yes, it’s in their power to change and they can do it, it is so powerful for the coach who’s by their side. It brings joy to them and emotional as well as physical well-being.

So, anyone who’s wondering whether client-centered coaching really matters, absolutely, it does, because when people lead their own change, they’re most likely… They own it. They’re most likely to sustain it and ultimately to thrive. They’re going to be successful with this behavior change. So, the power of coaching to sum up is so powerful because it is client-centered, client-led, and this means that people develop or build self-efficacy. And that is why they are able to make incredible changes to prevent and even reverse the chronic lifestyle conditions that are driven by lifestyle. And this is what we need to do because currently we are seeing these diseases rise in alarming rates. We have to do something. And I’ve been saying this over and over again, and I want you all to say this as well, the key is health coaching, the power of this relationship because doctors can’t do it, an AI health coach can’t do it. This is a client-centered relationship that is absolutely powerful. It’s the most powerful thing we have in healthcare. So, thank you for listening.