J Health Behav Med Hist 2025-18
Coaching in Context: Structure as the Foundation of the Interactional Space
Robert C. van de Graaf, MD, director
MEDTCC Institute for Health, Behaviour, Medicine and its History, The Netherlands.
A beginning coach walks into her first session. She is eager, full of questions, and ready to inspire. Yet as the conversation unfolds, it meanders without a clear beginning or end. Time slips away, the session overruns, and the client leaves unsure what has been achieved—or what to expect next time. The coach, too, feels the lack of impact. What was missing was not energy or goodwill, but structure.
When people think of coaching, they often picture meaningful dialogue, powerful questions, or practical tools for behaviour change. These are behaviour change techniques (BCTs): the visible interventions that directly shape what clients do. But BCTs do not operate in a vacuum. They require a holding space—a framework that shapes, supports, and directs the process. This holding space is created through interaction techniques.
The Interactional Context of Coaching
Interaction techniques do not directly change behaviour. Instead, they shape the interactional context—the relational and structural space within which behavioural change can take root. In the literature, these techniques are sometimes referred to as modes of delivery or common factors. In an earlier publication (Dijkstra et al., 2025), we called them intervention techniques, but here the term interaction techniques is more precise.
They are called techniques because each serves a distinct purpose, has identifiable characteristics, and operates within clear boundaries. Crucially, they are skills that can be learned, practised, and mastered, just like behaviour change techniques (BCTs).
Interaction techniques can be grouped into four essential clusters:
- Design of the Trajectory → the structural dimension: how sessions and processes are designed, monitored, and adjusted.
- Optimizing the Relationship → the relational dimension: building trust, safety, and alliance between coach and client.
- Strengthening Motivation → the motivational dimension: fostering the client’s willingness to engage in coaching.
- Supporting the Ability to Be Coached → the cognitive and energetic dimension: ensuring the client has the presence, focus, and energy to benefit.
These clusters do not compete with BCTs; they make BCTs work. Without structure, relationship, motivation, and ability, even the most sophisticated behavioural techniques are likely to fall flat. In fact, when interaction techniques are applied poorly—or neglected altogether—the coaching conversation may never truly take shape.
Imagine a coach who dives straight into setting action goals (a BCT) without first clarifying the session agenda or establishing trust. The client nods politely but feels uneasy and unfocused. Halfway through the session, time runs out, and both leave with a vague sense of unfinished business. The problem isn’t the goal-setting technique itself; it’s the absence of a solid interactional context to hold it.
The Structural Dimension: Designing the Trajectory
This paper focuses on the first cluster of interaction techniques: Design of the Trajectory. Structure is far more than administrative background work. It consists of a series of concrete techniques that together form the scaffolding of effective coaching. Good structure gives coaching its shape, direction, and rhythm—before, during, and between sessions.
1. Before the coaching starts
Structural techniques applied in the preparatory phase lay the foundation for a safe and focused process. They include the intake assessment, where goals, context, and expectations are explored, and clear agreements about frequency, duration, location, and practical arrangements. Decisions are also made regarding communication channels, financial agreements, the use of materials and media, and reporting and confidentiality. Finally, referral criteria are established for situations in which coaching is not appropriate or sufficient.
These preparatory techniques create a shared framework that clarifies what coaching involves and where its boundaries lie.
2. At the session level
Once coaching begins, structure becomes visible through techniques such as agenda-setting, time management, and framing the session. Together, coach and client define what will be discussed, agree on priorities, and monitor progress within the available time. These simple but powerful techniques prevent sessions from drifting, ensure that key topics are addressed, and help both parties keep track of their work together.
3. Along the way
Effective coaching trajectories require continuous assessment—a recurring evaluation of progress, satisfaction, and readiness for change. This technique allows the coach to make thoughtful adjustments to the coaching plan or to an individual session, always within the agreed boundaries. Evaluation moments can be brief check-ins at the end of each session, structured mid-term reviews, or more informal reflections. Regular feedback loops strengthen alignment and shared ownership of the process.
4. In the moment
Finally, structure also operates within the conversation itself. Coaching dialogues are often dynamic and unpredictable. The coach must continuously decide which interactional and behavioural techniques to use, and when. This real-time structuring—sometimes called process steering—involves guiding the flow of the conversation, maintaining focus, pacing interventions, and making deliberate choices about when to deepen, redirect, or close a topic. Continuous assessment plays a cross-cutting role here, informing decisions at every level of the trajectory.
Consider a coach who begins each trajectory with a thorough intake and clear agreements. Each session starts with a jointly defined agenda and ends with a brief check-in. Midway, coach and client review progress and adjust the plan. During sessions, the coach actively steers the process, ensuring focus and flow. This structured approach creates clarity, builds trust, and allows behavioural techniques to land effectively.