Tier Three coaching is especially valuable with regard to life style changes (nutrition, exercise, sleep). As in the case of Tier Two, the health-base coach might help her client with stress management and the continuing use of preventative medications, Environmental safety (inside home and work place) can also be an important (and unique) source of monitoring (and questioning)  by a health-based coach – especially if her client is elderly (and living in a home that has not be retrofitted for the unique safety needs of her client).

I illustrate this Tier Three coaching strategies with an event that occurred in my own life. The health-base “coach” in this instance is a gifted and dedicated physician who found a way to spend quality time with her patients (many of whom were other physicians). She made extensive use of appreciative strategies (without ever having read anything about this approach to human interaction). She and I had focused during the previous year on my weight. I had not been very successful in losing weight and was even considering the cancellation of my annual medical appointment with my physicians given this failed attempt to lose weight.

My physician and I met and, sure enough, not any loss of weight. I was waiting for the critical review by her (and by my own super ego). Instead, my physician offered the following appreciative (and challenging) observation: “while you haven’t lost any weight, you haven’t gained any—so let’s look at what you are doing right. What are you now doing to avoid gaining weight and let’s see if more of this will help you lose weight?” I was caught! It was not a matter of simply giving up as someone who was not capable of managing their weight. I was still accountable and was not helpless. We reviewed the slight changes in my health habits and she suggested that I focus on two of these changes: (1) spending even more time in walking my dog (for exercise) and (2) continuing to cut back on my consumption of specific foods (that were not necessarily my favorite, but were what I had grown up eating—habitual behavior).

Tier Four: Second-Order Prevention

Finally, a knowledgeable health psychologist can advocate and lead a shift in public attitudes– moving people to health-oriented values, priorities and perspectives regarding their own life and the life of other people in their family, community and society. The Tier Four health-based coach, in essence, is asking the fundamental question: “why are you (we) all living on the edge of the cliff?” The option is to move away from the cliff. The health-based coach is helping her client or client system in effective advocacy regarding creation of healthy communities (moving away from the cliff).