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IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Is Coaching a Positive Psychology Intervention? Exploring the Relationships Between
Positive Psychology, Applied Positive Psychology, Coaching, and Coaching Psychology.
Abstract
Definitively identifying a particular activity as a positive psychology intervention can be
difficult. The issue is compounded by lack of clarity around where the boundaries of positive
psychology itself lie, and how it intersects with conceptually-related disciplines. A case in
point is coaching, which shares positive psychology’s interest in enhancing wellbeing and
performance across life domains. Coaching’s status with respect to positive psychology is a
matter of debate: is it a subset of positive psychology (e.g., part of its applied arm), or
alternatively a distinct field that overlaps in complex ways. This chapter considers these
issues, looking firstly at the nature of positive psychology itself (including who practises it,
and what constitutes a positive psychology intervention), and then at the relationship between
positive psychology and coaching (as a case study to shed light upon the issues). Lessons will
be drawn about how positive psychology interacts with kinship fields, and what it means to
identify something as a positive psychology intervention.
Keywords: applied positive psychology; positive psychology; coaching; coaching
psychology
In V. E. Zyl & I. Rothman (Eds.), Positive psychological interventions: Theories,
methodologies and applications within multi-cultural contexts (pp. 371-389).
London: Springer.
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
This chapter is in two main parts. Part 1 asks three central questions relating to positive
psychology (PP): (a) what is it, (b) who practices it, and (c) what constitutes a positive
psychology intervention (PPI)? In each case, the answer is far from clear – hence the need for
analyses such as the one here. Nevertheless, a rough answer will be offered, although these
are only basic heuristics, rather than fool-proof definitions, since exceptions to them can
readily be identified. The debates surrounding these questions will then be explored in part 2
though the example of coaching, a field that is closely affiliated with PP. This will be used as
a case study to shed led on the debates, and to clarify the answers tentatively arrived at.
The Nature of Positive Psychology
What Is Positive Psychology?
The status and identity of PP has always been somewhat opaque and contested. Initiated by
Martin Seligman (and colleagues) in the late 1990s, it was intended to redress a perceived
“negative bias” in mainstream psychology. Psychology as a whole was depicted as mainly
concentrating on disorder and dysfunction, with little attention paid – outside pockets of
scholarship, notably humanistic psychology (Waterman, 2013) – to more “positive” aspects
of human functioning (e.g., happiness). Hence the value of a drive to redress that imbalance,
legitimising and encouraging the exploration of these more positive phenomena. Thus, for
instance, Linley and Harrington (2007) define PP as “the scientific study of optimal
functioning, focusing on aspects of the human condition that lead to happiness, fulfilment,
and flourishing” (p.13).
So, as its name indicates, PP defined and distinguished itself by a concern with the
“positive.” In that respect, Pawelski (2016a) has offered an illuminating descriptive analysis
of the way this term functioned in the literature that helped found the field. He identifies five
main usages: (1) a positive orientation (PP’s basic direction, i.e., being complementary to the
“negative” focus of mainstream psychology); (2) a positive topography (its main areas of
study, e.g., optimism, courage); (3) a positive target population (beneficiaries of PP, mainly
non-clinical populations); (4) a positive process (approaches for achieving desired outcomes,
such as building good qualities); and (5) a positive aim (PP’s ultimate goal, namely providing
an “empirical vision for understanding and cultivating wellbeing”) (p.343).
Added to this descriptive analysis, Pawelski (2016b) also offers a normative analysis,
suggesting one inclusion criterion and five continuum criteria for identifying something as
positive. The inclusion criterion is simply preference; a phenomenon is deemed positive if its
presence is preferred to its absence. Then, the continuum criteria indicate the “degree” of
positivity, with this being a function of: (a) relative preference (the strength of the preference
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
for it over something else); (b) sustainability across time (the longer-lasting the better); (c)
sustainability across persons (the more popular the better); (d) sustainability across effects
(the more positive knock-on effects, the better); and (e) sustainability across structures (the
more scalable and transferable across organisational and cultural contexts, the better).
Relatedly, the field is often understood with reference to the overarching notion of
wellbeing. For instance, a broad and generic definition of PP is offered by Lomas, Hefferon,
and Ivtzan (2015), who position it as the “science and practice of improving wellbeing”
(p.1347). This aligns with Pawelski’s (2016a) analysis of PP’s “positive aim,” in which he
identifies PP’s “ultimate goal” as “providing an empirical vision for understanding and
cultivating wellbeing” (p.343). In such operationalisations, wellbeing is an all-encompassing
term, enfolding the various components identified above by Linley and Harrington (2007)
(e.g., optimal functioning, happiness, fulfilment, and flourishing). Indeed, wellbeing is
increasingly favoured in academia as an overarching, multidimensional term, incorporating
all the ways a person might hope to do or be well (de Chavez, Backett-Milburn, Parry, &
Platt, 2005), including physical health (Larson, 1999), social relationships (Bourdieu, 1986),
cognitive performance (Tang et al., 2007), and positive affect (Diener, 2000). For instance,
Pollard and Davidson (2001) define wellbeing as “a state of successful performance across
the life course integrating physical, cognitive and social-emotional function” (p.10).
It is worth also noting at this juncture that wellbeing can be appraised in either deficit-
based negative terms, or asset-based positive terms. With the former, wellbeing consists in
the absence of some undesirable phenomenon (e.g., a mental health disorder), whereas in the
latter it means the presence of a desirable one (e.g., purpose in life). Crucially, absence of a
deficit does not necessarily entail the presence of an asset, i.e., that people are “flourishing.”
A foundational metaphor in PP is a continuum, from a nominal minus 10, through zero and
up to plus 10 (Keyes, 2002). Ameliorating deficits such as mental disorder constitutes
bringing people up to “zero,” as fields like clinical psychology aim to do. While that is
hugely beneficial, one can still aim to move people into the positive integers, and it is that
which PP is generally regarded as focusing on. The metaphor is imperfect; for instance,
people can be simultaneously situated both in negative territory (e.g., diagnosed with mental
illness) and positive territory (e.g., excelling in certain aspects of living) (Keyes, 2002). On
the whole though, it is a useful heuristic for clarifying the basic remit and scope of PP.
While such analyses are helpful, however, they also raise questions about the nature
of the field’s “boundary.” That is, for PP to have an identity, it must be possible to say that
some things fall within its scope and others outside it. However, ascertaining where to “draw
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
the line” is tricky, and moreover contested (with contrasting visions of what the field consists
of). For instance, proponents of so-called “second wave” PP have suggested it is difficult to
categorically identify a given phenomenon as positive or negative (Lomas & Ivtzan, 2016b).
After all, such appraisals are context dependent, and moreover the question turns on whether
one is referring to positive vs negative valence (whether it feels pleasant or unpleasant) or
positive vs negative outcome (whether it is ultimately beneficial). In certain circumstances,
emotions that are negatively valenced may ultimately contribute to wellbeing (e.g., certain
forms of adaptive anxiety are linked to proactive coping; Norem, 2001). As such, although
such emotions may not usually be considered positive, they may yet be of value and interest
within PP according to some perspectives.
Relatedly, there are issues around “ownership,” i.e., the extent to which phenomena
identified as within the remit of PP “belong” to it, or rather are shared with other fields. Take
the theory of self-determination (Ryan & Deci, 2000), for instance. This is often depicted as
integral to wellbeing, and cited as a key concept within PP. However, Deci and Ryan (1980)
had been developing this theory for decades before PP emerged. Moreover, Deci and Ryan
themselves do not appear to strongly align with PP; at most they imply that PP would benefit
from fully incorporating the implications of their theory (Deci & Vansteenkiste, 2004). As
such, while PP has whole-heartedly embraced the theory (Ryan, Huta, & Deci, 2013), that is
not the same as “owning” it. It is perhaps better to say simply that it has “harnessed it”; but in
a way that other fields may do too, such as coaching (Spence & Oades, 2011). We shall
return to this point below.
Such debates remain ongoing, and will not be settled here. Nevertheless, in closing
this section, we’ll end with a broad definition of PP, one that updates that of Lomas et al.
(2015) cited above. To this, we might add the term positive, thus – as per the continuum
metaphor – defining it as “the science and practice of improving positive wellbeing.” This
helps differentiate PP from those fields that do not address wellbeing directly or primarily
(e.g., conventional education), and also those that do focus on directly improving wellbeing
but do so by alleviating negative aspects of it (such as clinical psychology). This formulation
is still not perfect: it does not demarcate PP from related fields such as coaching, as we shall
see below, nor is it immune from criticisms of the notion of the “positive” associated with
second wave PP. That said, it will serve as a basic heuristic for now, and it shall be explored
more fully in the second half of the paper (in the sections on relationship configurations and
identifying territorial claims).
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Who Practices Positive Psychology?
Related to the issue of PP’s nature is the question of who studies and practices it. Is PP a
distinct field and speciality, or rather an orientation that may be open to people from all
disciplines? In the early years of PP, the emphasis was more on the latter. As Linley and
Joseph (2004) put it, PP was a “collective identity” unifying researchers interested in “the
brighter sides of human nature” (p.4). According to this perspective, PP is more of an ethos, a
way of “leaning towards” positive topics that is open to scholars and practitioners across all
fields, from clinical psychologists (e.g., Wood & Tarrier, 2010) to neuroscientists (e.g., Urry
et al., 2004). Alignment to this mind-set and identity narrative served to unify disparate
scholars already working on topics that are now regarded as falling within the purview of PP,
such as positive emotions or psychological development.
More recently, however, there have also been efforts to delineate PP as a specific
discipline, endowing it with a distinct professional identity along the lines of specialities such
as clinical psychology (Lomas & Ivtzan, 2016a). Part of the impetus for this move comes
from the proliferation of postgraduate PP courses, whose numbers have greatly expanded in
recent years, organically leading to graduates and scholars self-identifying as “positive
psychologists (even if the label is contentious, not least since “psychologist” is a protected
title in many jurisdictions).
Two contrasting perspectives on the nature of PP are therefore emerging. The “ethos”
perspective holds that PP is open to, and conducted by, scholars across any area of
psychology (and indeed other academic and professional fields). For instance, a clinical
psychologist interested in theories and practices pertaining to flourishing could be said to be
aligned or engaged with PP, as for instance elucidated by Wood and Tarrier’s (2010) notion
of “positive clinical psychology.” Indeed, people could even embrace aspects of PP – such as
deploying a PPI – without specifically viewing themselves as being aligned with PP.
Conversely, the “discipline” perspective views PP more as a distinct speciality, an
identifiable branch of psychology, equivalent in some respects to fields like clinical
psychology – not legally or practically, one must add, but simply in the sense that a scholar or
practitioner can specialise in PP (Lomas & Ivtzan, 2016a).
Of course, these two perspectives are not mutually exclusive. It is perfectly feasible
for one scholar from a distinct branch of psychology (such as clinical psychology) to take a
keen interest in PP, and so affiliate to it from an ethos perspective, and for another scholar to
primarily view themselves as being situated within PP, and so to self-identify with it from a
discipline perspective. Thus, in closing, let’s offer another basic heuristic for the question of
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
who practises (and studies) PP, namely, anyone who aligns themselves with the broad ethos
of PP, and/or regards themselves as specialising in PP. Again, this answer is not perfect, as
exceptions can easily be found. One can imagine someone – a schoolteacher, say – who
neither aligns with the ethos of PP nor views themselves as specialising in it, but who
nevertheless is for some reason conducting a PPI (and so, for that moment at least, is
practising PP). However, it will do for now as a basic guiding rubric.
What Constitutes A Positive Psychology Intervention?
Finally, in addition to issues around the nature of PP and its practitioners, a third question
arises which is central to this chapter: what constitutes a PPI, the applied practices which are
central to the field? That is, PP has always been characterised by including a strong applied
dimension, often referred to as “applied positive psychology” (APP). Collectively, one might
refer to both PP and APP together using the acronym (A)PP. The roots of contemporary PPIs
are commonly traced back at least as far as Fordyce (1977), who designed a course aimed at
teaching participants basic “happiness principles,” together with cognitive and behavioural
techniques to facilitate them, which led to significant increases in wellbeing. Since the
inauguration of (A)PP, similar PPIs have proliferated, from gratitude exercises (Emmons &
McCullough, 2003) to strengths interventions (Peterson & Seligman, 2004). Collectively,
such interventions have proved relatively effective across a range of outcomes, issues, and
populations, although the evidence so far is not wholly conclusive. For instance, a meta-
analysis of 51 independent PPI studies found some improvement in wellbeing overall,
although the results were mixed, and where positive outcomes were observed the effect sizes
were often fairly small (Sin & Lyubomirsky, 2009).
As with (A)PP itself though, exactly what constitutes a PPI remains an open question.
Lomas, Hefferon, and Ivtzan (2014) define PPIs as “theoretically-grounded and empirically-
validated interventions, activities, and recommendations to enhance wellbeing” (p.ix).
However, even with such a generic definition, articulating the necessary and sufficient
criteria for identifying a PPI is a complex process. In that respect, Parks and Biswas-Diener,
2014) argued that there are no definitive definitions of a PPI, nor a clear set of guidelines for
classifying interventions as such. At best, they found three broad conceptualizations of PPIs
in the literature: (a) content-level definitions; (b) variable-level definitions; and (c) wellness-
oriented interventions.
Content-level definitions essentially focus on positive topics – anything a client or
practitioner deems positive in some way. The issue with such definitions is they are so broad
that they encompass any intervention in which a person does something pleasant (regardless
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
of whether this actually benefits their wellbeing). More selective inclusion criteria are offered
by variable-level definitions, which require that interventions operate by a positive
mechanism or target a positive outcome variable. Sin and Lyubomirsky’s (2009) definition of
a PPI, for instance – namely, activities “aimed at cultivating positive feelings, positive
behaviors, or positive cognitions” (p.1) – falls into this category. However, Parks and
Biswas-Diener suggest such definitions remain vague, as there is no requirement that the
intervention defines its target variable, that the target variable has an empirical basis, or that
the intervention actually changes that target variable. Finally, wellness-oriented interventions
are PPIs designed to promote wellness rather than fix dysfunction, as per the continuum
metaphor elucidated above. In that sense, a PPI is one that is targeted mainly at a non-clinical
population. However, such definitions do not really accommodate the recent development of
PPIs for clinical populations (e.g., Ruini & Fava, 2009).
Besides struggling to definitively identify exactly what constitutes a PPI, we also run
into issues around boundaries and ownership (as we saw above with respect to theories like
self-determination). Take the practice of mindfulness, for instance. This has been embraced
as a PPI, and indeed is intimately linked to the kind of positive outcomes with which PP is
invested (Ivtzan & Lomas, 2016). However, mindfulness was first harnessed in the West
within clinical settings as a treatment for chronic pain (Kabat-Zinn, 1982), and has since been
widely embraced by “deficit-focused” fields like psychiatry and clinical psychology for the
alleviation of mental health issues (Segal, Williams, & Teasdale, 2002). And of course it was
initially developed as a psychospiritual practice within Buddhism around 2,500 years ago
(Lomas, 2017). Thus, by no stretch of the imagination does mindfulness “belong” to (A)PP,
and likewise it feels hubristic to call it a PPI. Thus, as with self-determination theory, at best
mindfulness is something that has been productively harnessed by (A)PP as a PPI (together
with its concomitant theoretical perspectives).
Once again though, such debates notwithstanding, we’ll close here with a general
albeit imperfect answer to the question of what is a PPI. In that respect, we might update the
definition from Lomas et al. (2014), cited above, incorporating some of the critiques raised in
this section. In that respect, one might usefully define PPIs as “theoretically-grounded and
empirically-validated interventions, activities, and recommendations to enhance positive
wellbeing in mainly non-clinical populations.” This incorporates the expanded definition of
PP elucidated above (incorporating the term positive), plus the limiting factor of focusing
mainly on non-clinical populations. This definition aligns with more established ones, such as
Sin and Lyubomirsky’s (2009) formulation: “a psychological intervention (training, exercise,
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
therapy) primarily aimed at raising positive feelings, positive cognitions or positive behavior
as opposed to interventions aiming to reduce symptoms, problems or disorders.” The main
difference between the two is that the first formulation emphasises that PPIs are mainly – but
not exclusively – used with non-clinical populations, whereas Sin and Lyubomirsky do not
restrict it in that way. However, the Lomas definition does not exclude the use of PPIs with
such populations (hence the inclusion of the qualifier “mainly”); it is more that, as a basic
heuristic, I believe it can be useful to regard PPIs as being mostly defined by their being used
in non-clinical contexts.
So, there are considerable debates around the questions of what PP is, who practices
it, and what constitutes a PPI. We shall explore these issues in more detail in part 2, which
offers a case study of coaching, and its relation to PP. As we shall see, coaching is closely
aligned with PP, which means that their relationship sheds light upon the three questions
raised above.
Positive Psychology And Coaching
What is Coaching?
The roots of coaching stretch back at least as far as classical Greece, where elite athletes were
instructed by professional trainers (Allen, 2016). This foundational association with sporting
endeavour continues to the present, being one of the first instances of coaching being studied
academically, namely by Griffith (1926), a sports psychologist. Rather than viewing sports
coaching as simply a form of instruction (i.e., regarding the physical skill required), he saw
the coach as fulfilling a broader pedagogical and therapeutic role, whose duties included
motivating and attending to the psychological needs of athletes. This model of coaching was
subsequently embraced in other endeavours, most notably business. Inspired by the likes of
Gorby (1937), who suggested that coaching could improve productivity and profitability, the
1940s onwards saw coaches being hired to get the best out of employees. Such coaching
often initially simply took the form of informal conversations, before being followed by more
systematically-organised and model-driven forms of coaching interaction (Kampa-Kokesch
& Anderson, 2001). This focus on occupational settings dominated the theory and practice of
coaching for much of the 20th century. Then, in more recent decades, coaching has begun to
be studied and deployed across myriad settings, from health behaviours (Young et al., 2014)
to family dynamics (Allen & Huff, 2014).
As those developments were underway, the related paradigm of coaching psychology
(CP) began to be identified, and differentiated from coaching. Lawther (1951) initiated this
trend by discussing the “psychology of coaching,” and by the 1960s the term “coaching
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
psychology” had begun to appear in the literature (e.g., Gaylord, 1967). However, it was not
until the 1990s that CP as a distinct discipline, differentiated from coaching, began to really
take hold (Passmore & Theeboom, 2016). A prominent way of configuring their differences
is to present coaching as an applied activity, and CP as the science of this activity. For
instance, the International Coach Federation defines coaching a “partnering with clients in a
thought provoking and creative process that inspires them to maximize their personal and
professional potential.” CP could then be regarded as the scientific study and understanding
of this relational process. In that sense, the domains of psychology which can inform this
endeavour is very broad – from psychotherapeutic scholarship to work within occupational
psychology. Thus, one can discern a parallel here with PP and APP, in that coaching can be
regarded as equivalent to APP, and CP to PP. Collectively, both coaching and CP in this
paper will be referred to using the acronym C(P).
In understanding CP as the science of coaching, however, several key questions
emerge, namely: (a) what is the scope and remit of C(P), and (b), how do these differ from
(A)PP? First, the nature of C(P) remains a matter of some debate. For instance, Passmore and
Theeboom (2016, p.30) shed light on attempts to fashion a working definition of coaching
during a workshop at the 2002 annual conference of the counselling psychology division of
the British Psychological Society. Initially, Grant and Palmer (2002) proposed that coaching
should be defined as focusing on “enhancing performance in work and personal life domains
with normal, non-clinical populations, underpinned by models of coaching in established
therapeutic approaches.” However, critiques were made of that formulation, including in
relation to the focus on “normal, non-clinical populations,” since coaching techniques were
starting to be offered in clinical domains, and also regarding the assumption that coaching
only draws on therapeutic models. Consequently, an amended definition was proposed,
stating that coaching is concerned with “enhancing wellbeing and performance in personal
life and work domains, underpinned by models of coaching in established adult learning or
psychological approaches.” Of particular interest here is that this definition, apart from the
reference to “models of coaching,” is highly similar to definitions of PP. So too are other
definitions of coaching, such as Spence’s (2007) description of it as being “primarily
concerned with human growth and change, based on the philosophical assumption that
individuals have vast reservoirs of untapped potential within them and are naturally inclined
towards developing that potential” (p.256). Thus, even while the nature of (A)PP and (C)P
themselves remains a matter of debate, the two fields clearly share significant intersections
and overlaps.
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Intersections And Overlaps
Evidently, (A)PP has close conceptual and practical affinities with C(P), with numerous
scholars noting their convergences (e.g., Kauffman, 2006; Linley & Harrington, 2007;
Biswas-Diener, 2010; Oades & Passmore, 2014; van Zyl, Motschnig-Pitrik, & Stander,
2016). For instance, Linley and Harrington (2007) suggest that both fields: (1) are focused on
the improvement of performance and well-being (as per Pawelski’s (2016a) “positive
orientation” and “positive aim”); (2) have an interest in engendering change across life
settings, including personal life and in the workplace; (3) have a humanistic emphasis on
facilitating development, and helping people fulfil their potential (per Pawelski’s “positive
process”); (4) assume such a thing as optimal environmental conditions that can/do promote
flourishing; and (5) have an emphasis (albeit non-exclusively) on working with “normal”
(i.e., non-clinical) populations (per Pawelski’s “positive target population”).
Indeed, such are the convergences between (A)PP and C(P) that we are seeing the
emergence of hybrid paradigms such as “positive psychology coaching” (PPC)(Passmore and
Oades (2014). Passmore and Oades describe this as “coaching approaches that seek to
improve short term well-being (i.e. hedonic well-being) and sustainable well-being (i.e.
eudaimonic wellbeing) using evidence-based approaches from positive psychology and the
science of well-being and enable the person to do this in an ongoing manner after coaching
has completed” (p. 68). They propose that PPC is underpinned by four key theories or models
that are frequently associated with PP (cf. Pawelski’s (2016a) “positive topography):
strengths (Proctor, Maltby, & Linley, 2011); broaden and build (Fredrickson, 2009), self-
determination (Ryan & Deci, 2000); and wellbeing (Seligman, 2012). (However, it will be
argued below that it is not helpful to view these theories/models as “belonging” to PP, and
that CP could equally lay claim to them.) Moreover, evidence suggests that the application of
such theories can assist in facilitating effective coaching. For example, identification and use
of strengths in coaching settings can promote goal progress (Linley, Nielsen, Gillett, &
Biswas-Diener, 2010), flow (Jackson & Csikszentmihalyi, 1999) and psychological capital
(Luthans, Avolio, Avey, & Norman, 2007).
In such emergent paradigms, the interaction between (A)PP and C(P) is usually
portrayed as a mutually beneficial partnership, in which each brings different skills and
strengths to the table. In that respect then, one can ask, what are the differences between
(A)PP and C(P)? Whenever this question is posed, it is usually in terms of comparing PP
(rather than (A)PP more broadly) with coaching (rather than C(P) more broadly). In that
sense, PP tends to be viewed as bringing scientific theory and empirical rigour, and coaching
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
as bringing applied practices and competencies (Grant & Cavanagh, 2007). For instance,
Kauffman (2006) describes PP as the “science at the heart of coaching” (p.219), while
Biswas-Diener (2010) celebrates coaching as “the natural choice for being the applied arm of
positive psychology” (p.5). As such, the relationship is often discussed in terms of how PP
can further the evidence base and theoretical underpinning that coaching may be seen to lack
(Oades & Passmore, 2014). In turn, PP is often criticized for being dominated by theory that
has not (yet) been widely applied or tested in practical situations (Oades & Passmore, 2014).
In that sense, coaching is often depicted essentially as a PPI (i.e., an applied forum in which
PP can be practiced), and perhaps even the exemplar PPI (i.e., the most effective means of
delivering the insights of PP).
However, this formulation, (a) challenges the role of CP as the science of coaching,
and (b) neglects the emergent praxis of APP. That is, regarding (a), describing PP as the
“science at the heart of coaching” supplants the function of CP in this role, and yet there is
evidently a flourishing paradigm of CP. Indeed, for that conventional view to hold, it would
mean PP has exclusive access to, or ownership of, scientific theory and research, to which CP
itself cannot lay claim. However, that argument cannot be supported. It is not the case that
specific theories “belong” to PP – as argued above with self-determination theory (Ryan &
Deci, 2000). While PP has whole-heartedly embraced the theory (Ryan, Huta, & Deci, 2013),
that is not the same as “owning” it. Indeed, CP has likewise embraced the theory to its benefit
(Spence & Oades, 2011). Thus, self-determination is not owned by PP, nor by CP, but rather
is harnessed by both. Likewise, per point (b) above, PP also has its own applied dimension in
the form of APP – a point which is overlooked if coaching is presented as the “applied arm”
of PP. Of course, this then raises the question that is central to this chapter: is coaching a PPI?
As the next section elucidates, there are various ways of answering this, and more generally
of configuring the relationship between (A)PP and C(P).
Relationship Configurations
It has been argued above that both (A)PP and C(P) have theoretical/empirical dimensions
(i.e., PP and CP), and both have a realm of applied practice (i.e., APP and C). That is, a great
wealth of theories, evidence-bases, and applied practices have developed across psychology
as a whole, and other allied disciplines, and these belong neither to (A)PP nor C(P), but can
be harnessed by both. If that is the case though, how then can we appraise the intersection
between (A)PP and C(P)? It seems that this relationship can be configured in one of four
ways depending on how generously and expansively one defines the fields. First, (A)PP and
C(P) are coterminous: both APP and C are essentially forms of coaching, and PP and CP
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
draw on an equally broad range of theory and research in studying them. Second, C(P) is a
subset of (A)PP: (A)PP encompasses C(P), with APP including more forms of practice than
C, and PP including a wider range of theory and research than CP. Third, (A)PP is a subset of
C(P): C(P) encompasses (A)PP, with C including more forms of practice than APP, and CP
including a wider range of theory and research than PP. Lastly, (A)PP and C(P) are
distinctive: both (A)PP and C(P) draw on distinct, albeit potentially partially overlapping,
forms of practice (in the case of APP and C) and theory and research (with PP and CP).
Let’s consider these four possibilities in a little more detail. The first simply views
(A)PP and C(P) as fundamentally coterminous, covering the same territory, as outlined in
figure 1 below. From this stance, there is essentially nothing in C(P) that could not also be
said to pertain to (A)PP, and vice versa. That is, (A)PP and C(P) share numerous aims and
concerns, including promoting wellbeing and performance, and facilitating the fulfilment of
potential. In that respect, both PP and CP can draw on an equally wide range of theory and
research, while at the same time, APP is regarded as synonymous with coaching. In terms of
the central question of this chapter then, from this perspective, coaching is indeed a PPI, and
moreover in effect is the only PPI (since the two fields wholly overlap). In the interests of
openness, this is not my view, since my preferred configuration is the fourth one, in which
(A)PP and C(P) are overlapping but non-identical. Nevertheless, regarding (A)PP and C(P) as
coterminous is one model of their interaction, to which may appeal to some people.
Figure 1. Interaction # 1 = (A)PP & C(P) as coterminous
(A)PP & C(P)
Theoretical/empirical ex (i.e., PP & CP)
- Self-determination
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
- Goal-setting
- Work engagement
Applied ex. (i.e., PP & C)
- Career coaching
- Wellbeing counselling
- Mindfulness
The second perspective takes a more expansive view of (A)PP, and positions C(P) as its
subset, as outlined in figure 2 below. From this stance, although (A)PP and C(P) share
numerous aims and concerns (e.g., promoting wellbeing and performance), C(P) is not the
only means by which these can be achieved. Other examples include macro-level initiatives
such as the formation of public policy to promote wellbeing (Lomas, 2015). Thus, on this
view, in terms of the chapter’s central question – coaching here is again viewed as a PPI, but
not the only type of PPI (since C(P) could be regarded as a subset of the broader field of
(A)PP). Again, this is not my preferred configuration, but is a logical possibility, and one
which may hold some appeal.
Figure 2. Interaction # 2: (A)PP as encompassing C(P)
A(PP) C(P)
Theoretical/empirical ex. (PP) Theoretical/empirical ex. (CP)
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
- Socio-economic factors - Self-determination
- Religion-health connection - Goal-setting
- Cross-cultural ethnography - Work engagement
Applied ex. (APP) Applied ex. (C)
- Systemic re-organisation - Career guidance
- Policy initiatives - Wellbeing counselling
- Sport and exercise - Sporting training
Conversely, the third perspective reverses the scope of the fields in the second perspective,
taking a more expansive view of C(P), and positioning (A)PP as its subset, as outlined in
figure 3 below. For instance, whereas C(P) could be regarded as helping people improve in
all aspects of life, (A)PP could be deemed as focusing on wellbeing in particular. Thus, on
this view, (A)PP could be regarded as a subset of the broader field of C(P). As such, in terms
of the central question, coaching here is viewed as only sometimes being a PPI (e.g., when it
specifically focuses on wellbeing), with there being other forms of coaching that are not
examples of a PPI (because they are not directly concerned with wellbeing). This answer
holds for my preferred fourth configuration too, and so is a resolution that is favoured here.
However, in terms of the configuration itself, this third one is not preferred, not least because
of the example given in relation to the second configuration above, where (A)PP includes
macro-level initiatives which are broader than the scope of C(P) as traditionally conceived
(Lomas, 2015). Nevertheless, this third configuration is also a logical possibility, and one
which may resonate with some people.
Figure 3. Interaction # 3: C(P) as encompassing (A)PP
C(P) (A)PP
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Theoretical/empirical ex. (CP) Theoretical/empirical ex. (PP)
- Self-determination - Wellbeing-related self-determination
- Goal-setting - Wellbeing-related goal-setting
- Work engagement - Wellbeing-related work engagement
Applied ex. (C) Applied ex. (APP)
- Career guidance - Wellbeing-related career guidance
- Goal-setting exercises - Wellbeing-related goal-setting exercise
- Sporting training - Wellbeing related sporting training
Finally, one can configure the relationship such that (A)PP and C(P) constitute overlapping
but not coterminous fields of endeavour. Here, both (A)PP and C(P) both have
theoretical/empirical and applied dimensions in common. However, they also have aspects
which pertain to only one of them. If, for example, one defines (A)PP as the “science and
practice of improving wellbeing” (Lomas et al., 2015, p.1347), this leaves open the
possibility of identifying forms of coaching that do not directly pertain to wellbeing, but
rather just to performance. For example, a person might receive coaching to better themselves
at some discipline, such as job performance. While this activity may of course pertain to
wellbeing – such as inducing flow (Csikszentmihalyi, 1990) – it does not necessarily do so.
One might conceivably imagine a person improving while deriving no direct wellbeing
benefits – such as experiences of pleasure, or health improvements – from doing so. In that
respect, (A)PP and C(P) might constitute an overlapping Venn diagram, as shown in figure 4
below. In terms of the central question, as noted above, this fourth configuration aligns with
the answer generated by the third configuration. That is, coaching is only sometimes a PPI
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
(e.g., when it specifically focuses on wellbeing), with there being other forms of coaching
that are not examples of a PPI (because they are not directly concerned with wellbeing).
Figure 4. Interaction # 4: (A)PP & C(P) as overlapping
(A)PP PPC C(P)
Theoretical/empirical ex. (PP) Theoretical/empirical ex. (PPC) Theoretical/empirical ex. (CP)
- Socio-economic factors - Self-determination - Communication dynamics
- Religion-health connection - Goal-setting - Interpersonal influence
- Cross-cultural ethnography - Work engagement - Body language
Applied ex. (APP) Applied ex. (PPC) Applied ex. (C)
- Systemic re-organisation - Career guidance - Job performance
- Policy initiatives - Wellbeing counselling - Educational tutoring
- Sport and exercise - Mindfulness - Sporting training
Identifying Territorial Claims
Let’s stay with this fourth perspective for a moment, since it is the preferred configuration of
the author. In that respect, figure 5 below offers a flow chart for identifying whether a given
theory or practice pertains to either (A)PP, C(P), neither, or both – with both being an
integrative paradigm such as PPC (Passmore & Oades, 2014). The first question is whether
“it” – the empirical outcomes, theoretical models, or applied practices in question – directly
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
pertains to wellbeing (per Pawelski’s (2016a) ultimate “positive aim” of PP). The qualifier
“directly” is important here, albeit one that is difficult to definitively judge. After all, just
about anything could be said to “indirectly” pertain to wellbeing, inasmuch as it is hard to
conceive of something that does not affect wellbeing, however obliquely. Nevertheless, it
would be prudent to at least attempt to only focus on phenomena that directly pertain to
wellbeing, even if differentiating between direct and indirect is difficult in practice. This
differentiation also means that it is possible to identify forms of C(P) that do not overlap with
(A)PP, as alluded to in the paragraph above (e.g., forms of occupational coaching that do not
enhance the client’s wellbeing).
Figure 5. Flow chart for differentiating between fields
If it is ascertained that a given phenomenon (e.g., applied practice) does not directly pertain
to wellbeing, then this means it is not “within the scope” of (A)PP. (The phrase “within the
scope” is preferable to formulations such as “belonging to,” for reasons outlined above.) That
being the case, one can then ask whether the phenomenon involves a coaching relationship.
Of course, there may be variation in how one chooses to define such a relationship, with the
Does it directly
pertain to wellbeing?
Does it involve a
coaching relationship?
Does it involve a
coaching relationship?
Other
C(P)
(A)PP
PPC
Yes
Yes
Yes
No
No
No
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
possibility of doing so more narrowly (e.g., limiting it to situations in which participants self-
identify as coach and client), or more widely (e.g., all variations on that theme, such as
mentoring). If the phenomenon does not involve such a relationship, then it falls within the
scope of neither (A)PP, C(P), or PPC. If it does, then it may represent a case of C(P) alone
(i.e., an instance of C(P) that does not overlap with (A)PP). If the phenomenon does directly
pertain to wellbeing, then once again, one can ask whether it features a coaching relationship.
If not, then it falls within the scope of (A)PP alone (i.e., an instance of (A)PP that does not
overlap with C(P)), whereas if yes, then it represents an instance of PPC (i.e., where (A)PP
and C(P) intersect).
This flow chart may not always be easy to implement in practice. However, it does
offer an initial way of appraising the ways in which (A)PP and C(P) overlap and yet also
differ. It is hoped that this articulation will be useful to proponents of (A)PP and C(P) who
are interested in exploring their integration over the coming years. That said, practitioners
might prefer one of the other configurations elucidated above, or indeed may find themselves
drawn towards another integrative model entirely. This chapter has not intended to be
prescriptive in terms of advocating for a particular model (although I myself am drawn to the
fourth one). Rather, it is just hoped that this discussion can contribute to the fruitful dialogue
that has been unfolding between (A)PP and C(P) over recent years, thus helping to facilitate
further collaboration and integration.
Conclusion
This chapter began by exploring the nature of (A)PP (and its adherents and interventions),
charting some of the debates in that regard. Even while these issues remain unresolved, the
chapter sought to offer some basic heuristics in that regard. Thus, (A)PP was defined here as
the science and practice of improving positive wellbeing, and as something practiced/studied
by anyone who aligns themselves with the broad ethos of (A)PP, and/or regards themselves
as specialising in (A)PP. As for PPIs, these were defined as theoretically-grounded and
empirically-validated interventions, activities, and recommendations to enhance positive
wellbeing in mainly non-clinical populations. Part 2 then shed light on the intricacies of these
debates by exploring the status of C(P), and its relationship to (A)PP. In that respect, the
chapter challenged the conventional assumption that PP brings empirical science to the
partnership while coaching provides practical expertise. Rather, it was suggested that both
(A)PP and C(P) draw on a common body of theories and practice – which, as such, “belong”
to neither field – and also on theories and practices that fall within the scope of only one of
these fields. In that light, the chapter sought to address the question of whether coaching
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
constitutes a PPI. There are various ways of answering this, depending on which interactional
model one is drawn to. From my own perspective, favouring the fourth model, I would argue
that coaching – and its study in the form of CP – constitutes a PPI if it specifically focuses on
wellbeing. In such cases, the coaching practice exists within the overlapping space of the
Venn diagram labelled as PPC. Conversely, other forms of coaching (which do not focus
specifically on wellbeing) would not be deemed a PPI. It is hoped that this analysis will be
useful to scholars and practitioners in (A)PP and C(P), and will help to further the dialogue
about the identity, purpose, and future of these important disciplines.
References
Allen, K. (2016). Theory, research, and practical guidelines for family life coaching.
Netherlands: Springer.
Allen, K., & Huff, N. L. (2014). Family coaching: An emerging family science field. Family
Relations, 63(5), 569-582.
Biswas-Diener, R., & Dean, B. (2010). Positive Psychology Coaching: Putting the Science of
Happiness to Work for your Clients. New York: John Wiley & Sons.
Bourdieu, P. (1986). The forms of capital. In J. G. Richardson (Ed.), Handbook of Theory
and Research for the Sociology of Education (pp. 241-258). New York: Greenwood.
Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New York:
Harper Perennial.
de Chavez, A. C., Backett-Milburn, K., Parry, O., & Platt, S. (2005). Understanding and
researching wellbeing: Its usage in different disciplines and potential for health
research and health promotion. Health Education Journal, 64(1), 70-87. doi:
10.1177/001789690506400108
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Deci, E. L., & Ryan, R. M. (1980). Self-determination Theory: When Mind Mediates
Behavior. The Journal of Mind and Behavior, 33-43.
Deci, E. L., & Vansteenkiste, M. (2004). Self-determination theory and basic need
satisfaction: Understanding human development in positive psychology. Ricerche di
psicologia.
Diener, E. (2000). Subjective well-being: The science of happiness and a proposal for a
national index. American Psychologist, 55(1), 34-43. doi: 10.1037/0003-066X.55.1.34
Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An
experimental investigation of gratitude and subjective well-being in daily life. Journal
of Personality and Social Psychology, 84(2), 377-389.
Fordyce, M. W. (1977). Development of a program to increase personal happiness. Journal of
Counseling Psychology, 24(6), 511-521.
Fredrickson, B. (2009). Positivity: Groundbreaking Research Reveals how to Embrace the
Hidden Strength of Positive Emotions, Overcome Negativity, and Thrive. USA:
Crown Publisher.
Gaylord, E. C. (1967). Modern Coaching Psychology. Iowa: W.C. Brown Book Company.
Gorby, C. B. (1937). Everyone gets a share of the profits. Factory Management &
Maintenance, 95, 82–83.
Grant, A. M., & Cavanagh, M. J. (2007). Evidence-based coaching: Flourishing or
languishing? Australian Psychologist, 42(4), 239-254.
Grant, A. M., & Palmer, S. (2002). Coaching psychology workshop. Paper presented at the
Annual Conference of the Counselling Psychology Division of the BPS, Torquay.
Griffith, C. R. (1926). Psychology of coaching: A study of coaching methods from the point
of view of psychology. New York: Charles Scribner’s Sons.
Ivtzan, I., & Lomas, T. (Eds.). (2016). Mindfulness in Positive Psychology: The Science of
Meditation and Wellbeing. London: Routledge.
Jackson, S. A., & Csikszentmihalyi, M. (1999). Flow in sports: The keys to optimal
experiences and performances. Champaign, IL: Human Kinetics Books.
Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain
patients based on the practice of mindfulness meditation: Theoretical considerations
and preliminary results. General Hospital Psychiatry, 4(1), 33-47. doi: 10.1016/0163-
8343(82)90026-3
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Kampa-Kokesch, S., & Anderson, M. Z. (2001). Executive coaching: A comprehensive
review of the literature. Consulting Psychology Journal: Practice and Research,
53(4), 205-228. doi: 10.1037/1061-4087.53.4.205
Kauffman, C. (2006). Positive psychology: The science at the heart of coaching. In D. R.
Stober & A. M. Grant (Eds.), Evidence based coaching handbook: Putting best
practices to work for your clients (pp. 219-253). Hoboken, NJ: John Wiley and Sons.
Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in
life. Journal of Health and Social Behavior, 43(2), 207-222. doi: 10.2307/3090197
Larson, J. S. (1999). The conceptualization of health. Medical Care Research and Review,
56(2), 123-136. doi: 10.1177/107755879905600201
Lawther, J. D. (1951). Psychology of Coaching. Oxford: Prentice-Hall.
Linley, P. A., & Harrington, S. (2007). Integrating positive psychology and coaching
psychology: Shared assumptions and aspirations? In S. Palmer & A. Whybrow (Eds.),
The Handbook of Coaching Psychology (pp. 86-117). London: Routledge.
Linley, P. A., & Joseph, S. (2004). Applied positive psychology: A new perspective for
professional practice. In P. A. Linley & S. Joseph (Eds.), Positive Psychology in
Practice (pp. 3-12). Hoboken, New Jersey: John Wiley and Sons.
Linley, P. A., Nielsen, K. M., Gillett, R., & Biswas-Diener, R. (2010). Using signature
strengths in pursuit of goals: Effects on goal progress, need satisfaction, and well-
being, and implications for coaching psychologists. International Coaching
Psychology Review, 5(1), 6-15.
Lomas, T. (2017). Recontextualising mindfulness: Theravada Buddhist perspectives on the
ethical and spiritual dimensions of awareness. Psychology of Religion and
Spirituality, Vol 9(2), 209-219. doi: 10.1037/rel0000080
Lomas, T., Hefferon, K., & Ivtzan, I. (2014). Applied Positive Psychology: Integrated
Positive Practice. London: Sage.
Lomas, T., Hefferon, K., & Ivtzan, I. (2015). The LIFE model: A meta-theoretical conceptual
map for applied positive psychology. Journal of Happiness Studies, 16(5), 1347-1364.
doi: 10.1007/s10902-014-9563-y
Lomas, T., & Ivtzan, I. (2016a). Professionalising positive psychology: Developing
guidelines for training and regulation. International Journal of Wellbeing, 6(3), 96-
112. doi: 10.5502/ijw.v6i3.4
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Lomas, T., & Ivtzan, I. (2016b). Second wave positive psychology: Exploring the positive-
negative dialectics of wellbeing. Journal of Happiness Studies, 17(4), 1753-1768. doi:
10.1007/s10902-015-9668-y
Luthans, F., Avolio, B. J., Avey, J. B., & Norman, S. M. (2007). Positive psychological
capital: Measurement and relationship with performance and satisfaction. Personnel
Psychology, 60(3), 541-572.
Norem, J. K. (2001). The Positive Power of Negative Thinking. New York: Basic Books.
Oades, L., & Passmore, J. (2014). Positive psychology coaching. In J. Passmore (Ed.),
Mastery in Coaching (pp. 15–40). London: Kegan Page.
Parks, A. C., & Biswas-Diener, R. (2014). Positive interventions: Past, present and future. In
T. Kashdan & J. Ciarrochi (Eds.), Mindfulness, Acceptance, and Positive Psychology:
The Seven Foundations of Well-Being (pp. 140-165). Oakland, CA: New Harbinger.
Passmore, J., & Marianetti, O. (2007). The role of mindfulness in coaching. The Coaching
Psychologist, 3(3), 131-137.
Passmore, J., & Oades, L. (2014). Positive psychology coaching. The Coaching Psychologist,
10(2), 68-70.
Passmore, J., & Theeboom, T. (2016). Coaching psychology research: A journey of
development. In L. E. Van Zyl, M. W. Stander & A. Odendaal (Eds.), Coaching
Psychology: Meta-theoretical perspectives and applications in multicultural contexts
(pp. 27-46). Netherlands: Springer.
Pawelski, J. O. (2016a). Defining the ‘positive’ in positive psychology: Part I. A descriptive
analysis. The Journal of Positive Psychology, 11(4), 339-356. doi:
10.1080/17439760.2015.1137627
Pawelski, J. O. (2016b). Defining the ‘positive’ in positive psychology: Part II. A normative
analysis. The Journal of Positive Psychology, 11(4), 357-365. doi:
10.1080/17439760.2015.1137628
Peterson, C., & Seligman, M. E. P. (2004). Character Strengths and Virtues: A Handbook
and Classification. Washington, DC: American Psychological Association.
Pollard, E. L., & Davidson, L. (2001). Foundations of Child Wellbeing. Paris: UNESCO.
Proctor, C., Maltby, J., & Linley, P. A. (2011). Strengths use as a predictor of well-being and
health-related quality of life. Journal of Happiness Studies, 12(1), 153-169.
Ruini, C., & Fava, G. A. (2009). Well-being therapy for generalized anxiety disorder. Journal
of Clinical Psychology, 65(5), 510-519. doi: 10.1002/jclp.20592
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic
motivation, social development, and well-being. American Psychologist, 55(1), 68-78.
doi: 10.1037/0003-066X.55.1.68
Ryan, R. M., Huta, V., & Deci, E. L. (2013). Living well: A self-determination theory
perspective on eudaimonia. In A. Delle Fave (Ed.), The Exploration of Happiness (pp.
117-139). Dordrecht: Springer.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-Based Cognitive
Therapy for Depression: A New Approach to Preventing Relapse. New York:
Guilford Press.
Seligman, M. E. P. (2012). Flourish: A Visionary New Understanding of Happiness and
Well-being. New York: Simon and Schuster.
Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive
symptoms with positive psychology interventions: A practice-friendly meta-analysis.
Journal of Clinical Psychology, 65(5), 467-487. doi: 10.1002/jclp.20593
Spence, G. B. (2007). Further development of evidence-based coaching: Lessons from the
rise and fall of the human potential movement. Australian Psychologist, 42(4), 255-
265.
Spence, G. B., & Oades, L. G. (2011). Coaching with self-determination theory in mind:
Using theory to advance evidence-based coaching practice. International Journal of
Evidence-Based Coaching and Mentoring, 9(2), 37-55.
Tang, Y.-Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., . . . Posner, M. I. (2007). Short-term
meditation training improves attention and self-regulation. Proceedings of the
National Academy of Sciences, 104(43), 17152-17156. doi: 10.1073/pnas.0707678104
Urry, H. L., Nitschke, J. B., Dolski, I., Jackson, D. C., Dalton, K. M., Mueller, C. J., . . .
Davidson, R. J. (2004). Making a life worth living: Neural correlates of well-being.
Psychological Science, 15(6), 367-372. doi: 10.1111/j.0956-7976.2004.00686.x
van Zyl, L. E., Motschnig-Pitrik, R., & Stander, M. W. (2016). Exploring positive
psychology and person-centred psychology in multi-cultural coaching Coaching
Psychology: Meta-theoretical perspectives and applications in multicultural contexts
(pp. 315-355). Netherlands: Springer.
Waterman, A. S. (2013). The humanistic psychology–positive psychology divide: Contrasts
in philosophical foundations. American Psychologist, 68(3), 124-133. doi:
10.1037/a0032168
IS COACHING A POSITIVE PSYCHOLOGY INTERVENTION
Wood, A. M., & Tarrier, N. (2010). Positive Clinical Psychology: A new vision and strategy
for integrated research and practice. Clinical Psychology Review, 30(7), 819-829. doi:
http://dx.doi.org/10.1016/j.cpr.2010.06.003
Young, H., Miyamoto, S., Ward, D., Dharmar, M., Tang-Feldman, Y., & Berglund, L.
(2014). Sustained effects of a nurse coaching intervention via telehealth to improve
health behavior change in diabetes. Telemedicine and e-Health, 20(9), 828-834.
