Academic Paper

Jo Collins ✉ (Canterbury Christ Church University, UK)

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Introduction

Informal carers/caregivers provide unpaid care and emotional support to people (spouses, parents, loved ones) with whom they have a close social relationship (Bastawrous, 2013). Informal care is distinct from paid ‘formal’ care, and from voluntary care where carers do not have a pre-existing relationship with the care recipient. In an informal caring relationship, the care recipient’s needs are the priority and carers’ wellbeing needs are often not heard or recognised (Coenen et al., 2023). Furthermore, if care recipients suffer depression and anxiety, informal carers are more likely to experience these too (Janda et al., 2017). Within informal care, cancer caring specifically is highly pressured because carers’ tasks continually change depending on the illness course and treatment cycle (Seal et al., 2015; Kim et al., 2014). Whilst not all caregivers experience cancer caring in the same way (Williams et al., 2014), Kim et al. (2014) indicate that the intensity of treatments and their changing patterns create stressors for informal cancer carers that are qualitatively different from stressors in other kinds of caring, such as challenges to carer wellbeing linked to patient behavioural change in dementia caring (Quinn et al., 2009), or changes in role in stroke caring (Woodford et al., 2018). Informal cancer caregivers are subject to significant wellbeing challenges linked to a high emotional burden (Janda et al., 2017), typically exhibiting high stress, high susceptibility to depression and/or anxiety, and low quality of life (Geng et al., 2018).

Over 1 million people are informal carers for cancer patients in the UK (MacMillan, 2011), where support is primarily through charities and is counselling-based (e.g. MacMillan, Cancer Research, Maggie’s in the UK, CancerCare in the US). There is little research on the benefits of coaching support for informal cancer carers. Research has indicated that wellbeing benefits of coaching include supporting coachees to draw on their resources (Joseph, 2014), and enabling coping (Theeboom et al., 2014). However, there are few coaching studies that are primarily designed to elicit wellbeing outcomes (Nacif, 2023). Scholarship on coaching interventions for carer coaching is also an emergent field, and only three cancer carer coaching studies have investigated wellbeing. Drawing on this research, this study comprised a coaching intervention followed by interviews with 11 informal carers of cancer patients. It fills a research gap by investigating how coaching impacts on the wellbeing of informal caregivers of cancer patients, specifically focusing on how non-directive coaching can support informal cancer carers’ wellbeing.

There are many definitions of coaching. This study focuses on wellbeing coaching, where coaching supports coachees to enhance feelings of wellness and/or take part in wellbeing activities rather than focusing on performance or goal attainment. This study follows Nacif (2023, 4), who defined wellbeing coaching as: “a change-orientated, reflective and collaborative process focused on the subjective and personal exploration of factors that can contribute to enhancing an individual’s sense of wellbeing”. Nacif’s (2023) definition fits well with the premise for coaching in this study, as it emphasizes participant agency when informal carers can lack a sense of agency (Pearlin, 1990). Nacif (2023) also foregrounds coaching as a collaborative process focused on the individual. This study’s coaching prioritized informal carers’ areas of interest (non-directive coaching), in contradistinction to many other carer coaching interventions which follow specific coaching protocols (Sepulveda et al., 2008; van Mierlo et al., 2012; Steffen and Gant, 2015; Kasari et al., 2015; Wittenberg et al., 2017; Dionne-Odom et al., 2015 and 2021; Harris et al., 2022). Consequently, this study contributes to scholarship by outlining how putting participants at the centre of coaching supports cancer carers’ wellbeing. With the informal carer central to the intervention rather than the protocol, participants felt recognized and validated, which supported their rebuilding of a sense of self. The findings also expand current understandings of negative self-talk and permission in coaching.

This study sets out to answer the following research question: does coaching support informal cancer carers’ wellbeing, and if so, how? To investigate this, the study first explores how cancer carers’ wellbeing challenges are understood in scholarship. It considers the current evidence base in wellbeing coaching to understand how coaching supports clients. It also explores current findings in carer coaching and cancer carer coaching and considers how wellbeing is conceived as directive training or education. The methodology section outlines the participants’ details, the qualitative research design and process, and the thematic analysis approach. The results, discussion and conclusion then show how carer wellbeing is impacted by coaching, connecting to under-discussed themes in the literature, including reframing negative self-talk.

Literature Review

Cancer carer wellbeing

To understand the need for a coaching intervention, it is important to chart the impacts of caregiving on carers’ wellbeing. Firstly, carers’ physical and mental wellbeing is worse than that of the general population (Spiers et al., 2019). Carers are more vulnerable to infectious diseases than the general population (Mueller et al., 2022), and are more at risk of depression and anxiety (Pinquart and Sörensen, 2003). Caregiving for cancer patients moreover involves specific challenges to wellbeing. Compared to other chronic illnesses, cancer involves multimodal treatments, leading to greater symptom variability and greater demands on carer support (Kent et al., 2016). Informal caring for cancer patients involves more daily hours than other illnesses (Kent et al., 2016), and where cancer can recur, caregivers often move in and out of caregiving (Kim et al., 2014). Anxiety and depression are much higher amongst informal cancer carers than cancer patients and other carers (Cai et al., 2021).

Wellbeing impacts of cancer caring include sleep disruption, decline in physical health, social isolation, and psychological distress (Cai et al., 2021); challenges which also emerge for stroke carers (Woodford et al., 2018) and for dementia carers (Oliveira et al., 2019). Caring has a strong psychological impact on carers. Research from Ussher and Sandoval (2008) showed that women in particular experienced over-responsibility in informal care. Over-responsibility resulted from expectations to be competent at caring and decision-making, which contributed to negative self-talk. These findings echo work by Pearlin (1990) who argued that damage to self-esteem is a secondary intra-psychic outcome of carer stress, and Bennett (2017), who described the phenomenon of ‘carer guilt’, a faulty perception of failure to do enough. Cancer carers can experience more psychological distress (including anxiety and hopelessness), and impact to their quality of life than cancer patients (Sklenarova et al., 2015). Carers are often the main source for patient emotional support and contribute to medical decision-making (Cincidda et al., 2022), yet cancer carers often feel ignored or marginalised in healthcare settings (Coenen et al., 2023) which impacts on their wellbeing (Kim and Baek, 2022). Additionally, cancer carers often feel inadequately equipped to take on this role (Bilgin and Ozdemir, 2022).

Wellbeing and coaching

Studies have shown that coaching improves wellbeing (Jones et al., 2016), reduces burnout (Solms et al., 2021), decreases stress, increases resilience (Grant et al., 2009), and supports coping with stressors (Theeboom, 2014). Coaching also aids goal-direction and self-regulation (Grant et al., 2009), although effects vary, depending on the study’s design (Theeboom, 2014). Few studies are specifically designed to enhance participant wellbeing (e.g., Theeboom et al., 2014; Barody, 2016; Hultgren, 2018; Davis, 2015; Sydenham, 2020; Nacif, 2021). According to Nacif (2023), wellbeing is often an inadvertent outcome of a study rather than a key aim. Wellbeing coaching therefore is an emergent field in coaching scholarship, but a few coaching studies have been specifically designed to investigate how coaching supports wellbeing (Barody, 2016; Hultgren, 2018; Davis, 2015; Sydenham, 2020; Nacif, 2021). Of these studies, four are workplace-based coaching studies (Barody, 2016; Hultgren, 2018; Davis, 2015; Sydenham, 2020). The workplace-based coaching studies produce findings around goal-setting and competence: Hultgren (2018) finds increased goal attainment from coaching; Davis (2015) finds increased feelings of competence; Barody (2016) finds increased role-confidence; and Sydenham (2020) finds self-concordant goal-setting. Caring however is very different from workplace conventions and coaching interventions supporting goals and performance may not translate neatly into a caring context. Goal-setting might be challenging, as carers can lack autonomy and experience a ‘loss of self’ in their caring role (Pearlin, 1990), meaning that it could be difficult to create goals for the carer when the patient is their focus. Similarly, caring can also involve negative self-judgment (Duggleby et al., 2013) and guilt (Lkhoyaali et al., 2015; Kim et al., 2016); particularly where the carer’s needs are put before the patient’s needs. Ultimately, workplace studies are dominant within the emergent field of wellbeing coaching studies. As such, coaching for cancer carers needs further research and evidence to pinpoint both how and what wellbeing outcomes can be scaffolded for these informal carers.

Carer coaching

In this study, carer coaching is defined as any intervention that seeks to support informal carers through coaching. This excludes interventions that omit the mention of coaching in their methodology, focus on coaching the patient, or that were pre-intervention studies testing coaching design. Currently, carer coaching is supported via charities (e.g. Coaching for Unpaid Carers and Carers Collective) and is not defined as a coherent field of study. Carer coaching interventions occur across a range of different caring contexts such as informal carers of children, partners, or parents with developmental disorders; eating disorders; and patients with long-term illnesses.

There are currently only six carer coaching studies that specifically investigate wellbeing (Sepulveda et al., 2008; van Mierlo et al., 2012; Kasari et al., 2015; Steffen and Gant, 2015; Chenoweth et al., 2016; Harris et al., 2022). In many of these studies, coaching is an element of a larger intervention whose aim is to train carers to improve their practice (Sepulveda et al., 2008; van Mierlo et al., 2012; Steffen and Gant, 2015; Kasari et al., 2015; Harris et al., 2022). Due to the ‘training’ nature of the studies, they feature either a protocol or workbook through which the coaching is directed. This is often because people are trained to coach to deliver the intervention. Coaching is often more orientated to training than wellbeing, with wellbeing measured as a secondary interest (except Chenoweth et al., 2016 who seek to support dementia carers through coaching to develop their wellbeing; and Harris et al., 2022 whose coaching intervention supports mothers of children with additional needs). No intervention has detailed the principles underpinning the coaching design, nor defined the coaching. Where wellbeing was investigated, diverse measures were used - varying from quantifying Carer Burden to Parental Stress, to measuring anxiety and depression. These different measures capture aspects of wellbeing but omit others, making it difficult to gain a cohesive picture of the wellbeing impacts of carer coaching interventions. There is mixed evidence as to whether carer coaching interventions impact on depression (van Mierlo et al., 2012 and Steffan and Gant, 2015 find positive effects; Sepulveda et al., 2008 find no significant effect). Other studies employ a wider definition of ‘mental health’, finding that coaching supports stress reduction (Kasari et al., 2015; Chenoweth et al., 2016; Harris et al., 2022). Overall, while carer coaching studies are directed towards achieving specific skills training aims, they show that diverse wellbeing outcomes are possible.

Cancer carer coaching

Cancer carer coaching is a subcategory of carer coaching which concentrates on coaching interventions for cancer carers. Counselling interventions are a more dominant mode in cancer carer support, with demonstrable wellbeing outcomes such as impacts on carer depression (Lappalainen et al., 2021) and on anxiety (Losada et al., 2015; Marquez-Gonzalez et al., 2020). Cancer carer coaching represents a small proportion of cancer carer interventions, with only three studies in recent years (Wittenberg et al., 2017; Dionne-Odom et al., 2015 and 2021). These studies were telephone coaching interventions that invited carers to follow pre-established problem-solving protocols to work through caregiver challenges.

Like carer coaching, the cancer coaching interventions described in the literature were directive. Dionne-Odom’s et al. (2015; 2021) interventions featured the ENABLE protocol, which alongside a toolkit and resources, followed topics across 6 sessions: 1. Carers’ stories, 2. Managing stress, 3. Completing tasks, 4. Organising Health Information, 5. Self-care, 6. Decision-making. In Wittenberg’s et al. (2017) study, a nurse delivered a coaching call to support carers’ confidence in communicating with healthcare professionals, the patient and family. This call instructed participants about the City of Hope Quality of Life model, which included the domains of Spiritual Wellbeing, Physical Wellbeing, Psychological Wellbeing, and Social Wellbeing. Wittenberg’s et al. (2017) approach to wellbeing is top-down and limited to only four dimensions. They (2017) concede that not all dimensions were covered during coaching and that psychological wellbeing needs dominated. Overall, cancer carer coaching studies show that although coaching creates wellbeing outcomes, these studies are directive rather than carer-centric.

Methodology

Design and Theoretical Underpinnings

This study follows an interpretivist paradigm that sees individuals and their society as inseparable, wherein the individual’s actions are understood in the context of their social practice – in this case, caring. Philosophically, the study sees observation as subjective (Ritchie et al., 2014) and is interested in listening to how study participants make meaning out of their caring experiences, particularly in the coaching space. The study does not seek to measure carers’ experiences of coaching, but to qualitatively investigate informal cancer carers’ experiences and sense-making of their wellbeing after participating in a coaching intervention.

The methodological approach is phenomenology, which focuses on the meanings that people attach to phenomena (Ritchie et al., 2014). The approach specifically followed psychological phenomenology (Moustakas, 1994) which emphasises how participants describe their experiences rather than privileging the researcher’s sense-making process. The aim of analysing this material was to understand key themes and generate a composite interpretation of experiences (Creswell and Poh, 2018).

Procedure

In this study the researcher recruited participants, coached them during the intervention, and analysed the data. Coaching supervision played a key part in navigating the challenges of these overlapping roles (see Collins, 2025). It was essential that the coaching sessions were coachee-led and focused. To aid transition into the research component of the study, the re-contracting and resetting of expectations occurred at interview. Ethical approval for this study was granted by the University of East London’s School of Psychology Ethics Committee. Participants were recruited through eight main cancer and carer charities (Bowel Cancer UK, Blood Cancer UK, Live Through This, Something to Look forward to.org, Action for Carers, Coaching for Unpaid Carers, The Caring Mind Blog, and Hospice UK). Those who expressed interest in undertaking the coaching intervention were invited by email to an initial consultation (the email also included exclusion criteria, eliminating potential participants with clinical depression). The initial consultation outlined the study’s objectives, explained key participant information, explored what participants hoped to gain from coaching, and examined whether coaching (rather than counselling) was the right intervention. At this point, two potential participants withdrew to seek counselling. Carers who consented to continue (n=11 – see Table 1) then participated in four free coaching sessions of a 60-minute duration, spaced at 2-4 week intervals. The coach was non-directive and session coaching topics were determined by the carers themselves. Participants were given the option to create reflections in a Qualtrics survey after the coaching sessions, to consider what they had found significant and what had changed for them. Participants could opt for the reflection to be included as study data. After the coaching intervention concluded, participants were invited to an interview (recorded on Teams) to review the impact coaching had on their wellbeing. Questions were semi-structured and sought to investigate the wellbeing impact of the coaching such as: ‘If you believe that coaching has impacted on your wellbeing, please describe what has changed?’; ‘were there any critical moments for you within the coaching process?’ ‘What three words describe the impact of coaching for you?’. Overall, 44 coaching sessions were conducted, 18 individual reflections were generated, and 11 semi-structured interviews were held.

Table 1: Participant Information

Analysis

The data analysis used Reflexive Thematic Analysis which supports coding data to the research question (Braun and Clarke, 2022). The study data (interview transcripts and post-session reflections) were coded using NVivo 12 Pro. In line with the psychological phenomenological underpinning of the study (Moustakas, 1994) and the reflexive Thematic Analysis approach, NVivo supports iterative coding cycles through transcript annotations, transcripts and theme memos. This enabled the generation of initial themes and refined constellations of meaning into core themes. Reviewing themes supported the study’s aim to explore the impact of the experience of coaching, focusing on “patterning of meaning across the dataset” (Braun and Clarke, 2022, 76). The sharing of conceptual patterns manifesting across different participants signified core insights into the topic. Initial themes were generated inductively, before reviewing and refining the themes and considering key ideas from the literature (e.g., ‘Negative self-talk’, ‘loss of self’). Whilst the literature shaped how the initial themes were reshaped, it was important to retain the participants’ voices in the articulation of the themes in the second round of coding, which involved re-reading the data and noticing where manifest themes in some data were latent in other data. A final round of coding involved visual brainstorming and defining and naming themes, to home in on coaching outcome themes and finesse theme descriptions. Participants were then invited by email to comment on the study findings. Overall, three participants commented on these draft reports.

Results

The main objective of the study was to investigate whether and how coaching has impacted on informal cancer carers’ wellbeing. The analysis generated two main themes and five distinctive subthemes (Table 2). Each theme and subtheme are defined and described below using participant quotations.

Table 2: Coaching wellbeing themes and subthemes

Coaching “validates” carers

In this theme, participants described coaching as a “safe place” (Addy, Pat), where the difficulties of the carer role could be recognised, heard, and “validated” (Han, Pat). Being witnessed without judgement was key: “[T]wo of the big things [were] that space to be able to talk about some of the unspoken stuff that’s not necessarily acceptable, but also [to think] what are you going to do about it?” (Han). Participants described how the coaching was valuable to them as a space where the “unspoken stuff” could be legitimated, through a) acknowledgement and b) processing it (as will be detailed below). This theme featured two subthemes: coaching as a “safe space”, and processing emotion.

Coaching as a “safe space”

Carers characterised coaching as an “outlet” (Addy, Flossie, Leah), a space to “unburden” (Sapo). It was a “safe” (Addy, Agy, Pat, Angela) or “neutral” (Flossie) “place” for carers to share feelings and opinions not understood by people outside their situation. It meant that carers could “be given permission […] to just say ‘I don't like this’, ‘I don’t want this’” (Addy), or have permission to focus on themselves (Mabli). It enabled carers to be “recognised in [our] own right as [having] needs rather than just the person with cancer” (Han). For Pat and Kit, who both lost their patients during the study, having someone to listen to them was vital. For both participants, being listened to enhanced wellbeing through sharing their situations: “there is some positive feeling about somebody actually giving support and asking questions” (Pat); “if you can talk it through […] when you come off it you think do you know, actually, I feel better now cause I’m actually not alone” (Kit). Having someone else ‘knowing’ the situation was also important to Sal: “it just helps to talk to someone who knows what I'm talking about”.

A defining feature of coaching as a “safe space” was what Han called “containment”. Containment ensured that what was brought to the coaching space was held within it: “you have an outlet you can learn to let whatever out you want in those moments, but you sort of learn how to close that again” (Addy). Trust and non-judgment were also crucial to creating this safe listening space as an outlet for carers. For Angela, it was important to know that “whatever your experience, it’s OK, there’s no right or wrong answer”. For Flossie, it was important that there was “someone who isn’t going to judge me”.

Processing emotion

Carers described how coaching offered an opportunity to process emotions around caring: “Even the hard things […] it’s good to be able to work through that” (Addy). For Leah, processing during coaching included positive and negative aspects: “maybe all I did is cry. […It] did have an effect, even as simple as just boosting it a bit of mental strength”. For Sapo, processing in coaching was about letting go: “I knew the pebbles were there, but nobody was helping me drop them”.

“Processing” brought the coaching close to therapy. Pat described the process as “similar to therapy”, while Sal suggested “coaching is more practical [than therapy]”. Mabli also saw a parallel with coaching resembling therapy plus “making positive steps”. For Han, coaching was a space where “the resentment or the anger or the frustration”, could emerge, but also with an impetus to action: “I can make a choice or do something differently”. Participants also pinpointed an overlap with counselling in terms of the ‘processing’ function of coaching. However, they suggested a difference in approach, with coaching rooted in action.

A key facet of processing being linked to action was that the participants recognised their agency in the process of coaching: “there’s kind of an open forum to air concerns, or views or whatever you experienced” (Kit). They saw themselves as active in the coaching process, rather than having something done to them: “it’s very much something you get to control” (Addy); “[the coachee is] very much remaining in the driving seat” (Angela). Solutions moreover came from coachees: “You [the coachee] are having to come up with all the answers” (Flossie); “[it was] me coming up with this solution” (Sal), “it came from my head” (Mabli), “my ideas” (Leah). Han suggested that the “so what?” or ‘what happens now’ aspect (differentiating coaching from counselling) drove the coachee to come up with their own solutions.

Coaching restores “sense of self”

In this theme, some participants described coaching conversations that enabled them to reconnect with themselves. Specifically, they described a shift from feeling overwhelmed by the “all-consuming” (Flossie, Pat, Addy) nature of caring, to getting their “self back” (Han). There were three subthemes describing different aspects of ‘getting back to self’: improved self-talk, prioritizing self, and reimagining self. The theme and subthemes however did not apply to Pat or Kit. Pat’s husband’s death, which happened between the coaching and the interview, left “a big hole”, because Pat’s sense of self had been so closely tied to caring: “when [a] person you care about dies […] all your reasons for being, that is all [gone]”. Similarly for Kit, who lost a parent before the interview, coaching was less about restoring a lost sense of self.

Improved self-talk

Coaching supported carers to recognise and replace negative self-talk: “[Coaching’s] definitely improved my well-being […] I don’t beat myself up anymore” (Flossie). With this recognition of negative self-talk, the possibility to ‘self’ differently emerged: “it’s allowed me, [to…] question why I was seeing [things] in a negative fashion [and…] to be able [to…] talk to myself and ask myself what needed to change” (Flossie). For Sapo, coaching enabled a shift away from “guilt” towards feeling that things were “going to be OK” when some time out from caring had occurred. For Leah, “the difficult thing is when you actively say, ‘I'm going to prioritise myself’”, this takes “little tiny steps”. This was also echoed in Angela’s comment about feeling “guilty” for focusing on issues other than caring in the coaching. Sal also navigated guilt accompanying self-care via coaching: “I’ve been going on walks and […] it’s OK to take some space and not feel like you're betraying someone.” For Han, coaching also helped “get over some of the […] guilt” associated with finding time for self-care.

Participants shifted from feeling “awful” about caring (Addy), “beating myself up” (Agy), and suggesting that compared to the patient “I don’t matter” (Han and Sapo), to recognising that their views and ambitions did matter: “I’m still allowed to want stuff” (Mabli). Mabli shifted self-talk around applying for a more senior role:

when we started talking, I was like, “I don't know why they want me to go for this manager role” […] my feelings towards that now are like night and day […] because of our coaching. (Mabli)

Coaching enabled recognition of the importance of self-kindness within the caring role: “it’s good to be able to work through that […] need to be kinder to myself” (Addy). Agy recognised that through coaching “something has shifted in self-compassion”, describing how Agy was able to reach some kind of acceptance of anger about the cancer via coaching.

Prioritising self

Positive self-talk increased the legitimacy of carers’ needs and self-care, and enabled the participants to prioritise themselves, as coaching “set[s] somebody up with the ability to say right now you can go on and you can gradually climb up that ladder of priorities for yourself” (Leah). This was a shift from previous thinking in which the patients’ needs have dominated: “the person you’re caring for is much more important than anything that you do” (Sapo). For Sapo, a key wellbeing outcome was “really taking time for myself which during the study I did”. This involved permission to take a weekend break from caring. A key dynamic in enabling the self to move up the “priority list” (Han, Leah, Angela) was the carers giving themselves permission to self-prioritise. Coaching supported “looking after yourself as well” (Sal); “made me feel like I’m still a person and I’m still allowed to […] do things for me” (Mabli); “[gave] permission to do things for me” (Han); or “the coaching […] helped me move forward by just […] giving myself permission” (Flossie).

Prioritising the self was both challenging and nuanced. For Addy, coaching enabled “reinforcement of that permission to feel however I needed to feel in whatever situation”. This prioritisation was not as definitive as ‘self’ however, it was more changeable and contingent. What Addy found through coaching was the acceptance of emotion and the conditionality of that emotion around the caring process. For Agy, who started the process wanting to prioritise “getting better at doing yoga every day”, coaching led Agy to think about the self through “self-care in a much broader sense […] in connecting with people”.

Reimagining self: identifying resources

Participants described recognising and utilising resources they already had through coaching: “I've kind of felt enabled to recognise where I started, which was most of what I need” (Addy). Participants also expressed how taking action through coaching reinforced their recognition of what they were capable of: “it’s allowed me […] to move forward” (Flossie); “coaching has really helped me because it’s made me see what the opportunities are and then go for them […] it mentally really moved me forward” (Mabli). For Han, coaching prompted a realisation that “there are bits and pieces that I can influence, or I can change”; likewise for Angela coaching represented a “locus of control […] in terms of the actions coming from you”. Mabli and Leah reimagined themselves through recognising and revisiting past habits that supported wellbeing. Mabli revealed that “coaching helped me realise how many well-being things I do […and] made me feel really good because you’re already doing these things and they are helping”. During coaching, Leah described having abandoning crocheting a cardigan because it was too onerous within the “all-consuming” nature of caring. In interview, Leah described working on it again: “if you’ve got little tiny steps, even if it’s as simple as I’m gonna sit and finish that bleeding crochet cardigan […these] little things build up to you being higher up on that ladder [of priorities]”. During the coaching, actions through ‘tiny steps’ (Leah) or ‘small steps’ (Sal) – rather than overarching goals – led to them building habits.

Flossie, Addy, Sal, Sapo and Agy reimagined themselves by recognising their strengths. Flossie reignited a capacity to “believe in myself”. Addy described how “I was enabled just to find a wee bit more strength than I had”. Sal was able to reframe attention to detail as a strength rather than a shortcoming. Sapo felt strong enough to ‘say no’. Agy described how through coaching “I’ve come to a place where I’m a bit more confident in saying […] sometimes I’ll be able to put enough back in the tank and I can keep going OK on my own, and sometimes I’ll need other people to help me.” This shows the complexity of carer resources, as for Agy, strength is also the ‘vulnerability’ to lean on others.

Discussion

The main research objective of this study was to explore whether and how coaching supported informal cancer carers’ wellbeing. Various wellbeing benefits emerged from the coaching that were shared by most participants (Pat and Kit were exceptions because the death of their patients nullified some of these wellbeing outcomes). Two key wellbeing benefits were identified. The first theme indicated that coaching was a “safe space” where carers were able to be recognised and not judged. The subthemes showed that coaching fulfilled the function of a ‘safe space’ to hold emotion (subtheme 1) and to process that emotion (subtheme 2) through activities that also supported wellbeing. The second theme showed that coaching helped participants rebuild a sense of “self” which had been lost in the all-consuming nature of cancer caring. This was supported by three processes: improving self-talk (subtheme 1), prioritising the self (subtheme 2), and reimagining the self (subtheme 3). These three subthemes show how coaching supported wellbeing through participants regaining a more positive sense of self. The findings point to the importance of coaching as a safe space for carers’ stories to be foregrounded and heard, which then laid the groundwork for them to take actions and create agency for themselves. Because the carers determined the topics, focus, and actions in the coaching, they were able to create meaningful clarity, and build a sense of self-agency, which is often lacking in caring (Pearlin, 1990). Because the carers drove their coaching, they could use it for what they really needed, as an outlet for the emotions and frustrations around caring. This discussion will now explore the implications of these findings in relation to scholarship.

Carers in the ‘driving seat’

In this study, participants found benefit in being ‘in the driving seat’. Because the intervention was not directive and not leading, they had agency in the coaching and led the conversation based on their experiences. For coaching to feel like an ‘outlet’ where carers could be listened to, and a ‘safe space’ to support their wellbeing, the participants had to feel that the coaching was for them. Carer coaching studies (Sepulveda et al., 2008; van Mierlo et al., 2012; Steffen and Gant, 2015; Kasari et al., 2015; Chenoweth et al., 2016; Wittenberg et al., 2017; Dionne-Odom et al., 2021; Harris et al., 2022) are typically top-down and feature protocols or specific coaching topics to be covered. Because many carer coaching studies are skills training interventions, they are directive. Consequently, carer coaching puts caring rather than the carer at the centre of the intervention. This study, however, puts the carer at the centre. The participants appreciated that it was a space dedicated to them, because as Angela highlights, as a carer “you are never the priority”. This study therefore adds a new dimension to outcomes in carer coaching studies, as in this intervention, coaching was able to fulfil the need for processing emotions.

Coaching as validation

The study participants shaped the coaching space for what they needed to support their wellbeing. They used coaching as an ‘outlet’ to be listened to and as a safe space to talk and “move forwards mentally”. This meant that in this intervention, emotional processing was more significant than goal-centred approaches: “I was really worried that I was taking it on a real therapy line but actually we did still [do coaching]” (Leah). The significance for carers of being recognised, heard, and validated by the coaching process (rather than goal-setting) was an outcome which has not emerged in wellbeing coaching studies (except Nacif, 2021) nor carer coaching studies. Here, coaching validated informal carers’ stories. In education theory, ‘validation’ occurs through participants sharing a story and having it heard and affirmed by others (Rendón, 2009). Similarly, coaching can provide a safe place for people’s stories to be shared and heard. It is an environment in which a story can take shape, thus supporting participant self-awareness. This is particularly important for carers whose stories were often sidelined due to their patients’ illnesses: “when X got diagnosed there was counselling available […]. I had to jump through hoops to get counselling” (Mabli); “[we need to be] recognised in [our] own right as [having] needs rather than just the person with cancer” (Han). The importance of being listened to, and the validation and development of participants’ stories reinforced the sense that coaching was a space where the carer was at the centre and empowered to direct the course of the intervention: “I realised that it was my space that […] I could use for what I wanted to” (Angela). Carers felt validated because their stories and needs steered the direction of the coaching.

Reframing negative self-talk

Another wellbeing outcome of the study was the reframing of participants’ negative self-talk and guilt for prioritising their own needs, by drawing on their resources. For carers, negative self-talk delegitimises prioritising themselves and their wellbeing (Pearlin, 1990; Bennett, 2017). Forssén et al. (2005) coined the term ‘compulsive sensitivity’ to describe the carer self-talk that prioritises the patient and blames the carer for any negative impact or rebukes them if they seek to change the situation. None of the wellbeing studies or carer coaching studies have discussed negative self-talk. Chenoweth et al. (2016) is currently the only other carer coaching study that acknowledges guilt as a potential barrier for carers prioritising their own needs. In this study, coaching became a place where some of these feelings of powerlessness were heard, and carers needs were given some space on the priority list. Therefore, addressing negative self-talk and carer guilt are key areas for carer coaching studies to address in more detail.

Permission for wellbeing

The study also shows that the carers had to go through a process of giving themselves ‘permission’ to prioritise themselves and think differently (Addy, Agy, Flossie, Mabli, Hanh, and Leah all used the word permission. Sal and Sapo talked about the process of feeling okay about prioritising themselves in interview). Nacif (2020) and Sydenham (2020) both indicate the role that permission can play in the coaching process. Sydenham (2020) specifically points to how permission might be needed to support wellbeing. This permission to ‘do’ wellbeing (in coaching) is a crucial consideration for carers, for whom “caring for [someone else] is much more important than [you]” (Sapo). Studies show that carer wellbeing is influenced by the caring role. The intimacy and empathy that carers have for their patients translates into a responsibility to support their patients’ wellbeing. This mental load also augments the decline of carers’ wellbeing (Ussher et al., 2013). Shifting the mental load of this responsibility and specifically giving carers permission to do so, is crucial to supporting carers’ wellbeing. Arguably, providing a safe space for carers to be heard is the first step towards them reframing negative self-talk and creating pathways for permission to support their own wellbeing. It is important to note here that this permission is manifested as ‘tiny steps’ forwards rather than life changing goals. For the participants, goals were contextualised within the pressures of caring: “it wouldn't have worked [...] if you'd been trying [to] be too goal-focused, I don't think I could have coped” (Addy). For coaches of carers, ‘tiny steps’ is an important terminology shift away from goal-orientation, as the latter might add to existing pressures on informal carers.

This discussion has outlined how working with carers in a dialogical, collaborative intervention (rather than a top-down approach) supports carer wellbeing outcomes. This approach supported carers to feel validated by being heard, to recognise and rework their negative self-talk and to develop unique permissions for them to pursue wellbeing. The approach meant that carers were able to steer the agenda and actions of coaching to the outcomes that were most meaningful for them.

Limitations and Future Research

A limitation of this study is the researcher’s dual role. Whilst this enabled the coach/researcher to have a holistic overview of all parts of the study, it could have negatively impacted on how data was collected at interview and introduced bias into the data analysis. Whilst the dual role of coach/researcher put the participants at ease in interview, the already-established coaching relationship might have swayed the interview outcomes towards positive feedback. Having an interviewer from outside the intervention might have revealed different and potentially less positive feedback about the coach or the coaching. Having someone other than the coach analyse the data may also have revealed different themes and emphases. Another limitation of the study is that understandably, some participants in interview struggled to remember earlier coaching sessions and articulate what they felt had happened in the coaching. Seiler (2019) has discussed how coachees are not always given tools to give adequate feedback to their coaches. This study’s reflection form could be further developed to address this. Future research could also move from gathering information about the outcomes of coaching interventions to investigating the coaching processes that support arriving at wellbeing outcomes. Considering that wellbeing challenges can vary for different carers, a valuable avenue for future research would be to explore how and whether informal carers for varied conditions (e.g., dementia/stroke patients) experience different wellbeing outcomes.

Conclusion

This study contends that non-directive coaching is a key process for underpinning wellbeing outcomes for informal carers. It asserts that non-directive coaching ensures the carer can determine the wellbeing outcomes that best benefit them, enabling them to create autonomy beyond their carer role. Listening was a key process in building a non-directive approach. Through listening and providing a safe space for sharing in coaching, carers’ stories were heard and validated, reinforcing the centrality and precedence of the carer’s self in the intervention. This was crucial because it gave carers permission to focus on themselves. The study found that coaching supported carers to move towards action through restoring a sense of self (e.g., reviving habits, creating new habits, applying for jobs, saying no). Having this safe space in which carers prioritized themselves also supported them to move away from negative self-talk.

The study explored how a four-session coaching intervention impacted on the wellbeing of 11 informal carers of cancer patients. Using data from post-intervention interviews and participants’ reflections on coaching, the study shows the value of non-directive coaching interventions. This is an original contribution to the existing literature on carer coaching. It also shows how coaching supports participants to rework negative self-talk, which is a gap in the current scholarship on wellbeing coaching. The study also adds to emergent ideas in wellbeing coaching scholarship about how coaching scaffolds permission for participants to work on their wellbeing. This research matters because globally, one in five people develop cancer, with countries featuring a high Human Development Index expected to experience 4.8 million new cases by 2050 (WHO, 2024), suggesting high rates of informal cancer care. In these countries, cancer carer support often falls to excellent but over-burdened charities (e.g., MacMillans, Maggies, Bowel Cancer UK, Blood Cancer UK in the UK), where coaching is not currently offered as a specific intervention to support cancer carers. Whilst counselling support is offered via these charities, this study demonstrates that coaching could be another complementary dimension of support to enable cancer carers to effectively access their resources and empower them whilst undertaking the challenging and “all-encompassing” work of cancer caring.

References

About the author

Dr Jo Collins is an Associate at Canterbury Christ Church University. She is also a professional coach at Research Coach, and Founder of Care for You Coaching. Her research encompasses doctoral wellbeing and coaching and wellbeing, and she has a Master’s degree in Applied Positive Psychology and Coaching Psychology.