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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

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Archive for March, 2013

The theme of today’s article may not be relevant for you, but even if it’s not, I know it will be for someone you love. So I urge you to keep reading.

All of us know someone who is overweight and unhappy, with diabetes or without. Many of us will have heard this person (or ourselves) saying, “I haven’t got any motivation.” They are certain that if only they could summon up enough enthusiasm; they could make the changes they would like to their weight and health. However, in my experience the word ‘motivation’ is often a smoke screen for something else. Motivation actually comes easily when we really want something to change. In psychology, we call this “a secondary gain” — on the surface, the behaviour of overeating is unwanted, but it persists because it is serving a function. Those of you who have been part of my community for a while now will already know what this function is. Overeating works because it soothes some form of emotional upset.

So today, I have a gift for you. A short e-book that explains, simply and clearly, why you struggle, and more importantly why it’s okay to struggle. No telling off, guilt, or blame; just acceptance, hope, and action steps for change.

You can get your free e-book here: WorldWithoutObesity.com. (It’s as relevant for you even if your overeating means you can maintain a healthy weight).

I have a vision that by 2020, 20 million people will have gained a newfound control of their struggles with emotional eating and that worldwide we have a 20/20 vision of understanding the emotional context of our obesity crisis. This short guide is a part of making that vision a reality. My invitation to you is that you read it and if you find it useful, you pass it on to someone else you might know who needs it. Or, if emotional eating is not an area you struggle with, I invite you to pass it on to someone else you know who might benefit.

Get your free e-book here: WorldWithoutObesity.com

At the end of the guide, you’ll also learn about my commitment to getting even more of this important information to as many people as possible, including how to access the first part of the pilot version of my online programme, ‘Thrive’ — a video and workbook self-help programme for just £1 (approximately $1.50).

Here’s to changing the world as we know it: WorldWithoutObesity.com

 

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

  • “She says she wants to change but she always comes back and nothing is different.”
  • “Am I doing something wrong? No one seems to take any notice of my advice.”
  • “I always run out of time.”
  • “I’m stuck.”
  • “Some patients just make me feel like I’m rubbish at my job.”
  • “Why won’t he do what he needs to do to care for his health?.”

Have you ever had thoughts like these? You are not alone. Many clinicians struggle to feel they are good enough. The section that follows aims to help you think about your patients’ actions from a different perspective and introduces some strategies to help you.

Your Patient is Doing What is Right for Him or Her

You might not ‘get’ why your patient is not caring well for his or her health. People act in accordance with their feelings, beliefs, cultural norms and values, and your belief systems may be very different to your patient’s. Exploring the background to your patient’s beliefs can give both of you clarity. Behaviour that is difficult for you to understand usually stems from a person’s belief about its value, or is based in habits that might be difficult to alter. By asking questions in an open, enquiring way, you will get an insight into the beliefs that are driving the behaviours and actions.

How to Improve Your Relationship with Your Patient

Set an Agenda

Time in a consultation is short and you will both have an agenda to fulfil. It is good practice to set the frame of the space. For example:

  • “We have 15 minutes together today [point towards or indicate the clock]. I will be keeping an eye on the time for us. Let’s prioritize how we are going to spend this time, so we use it wisely. What would you most like to discuss?”
  • Make a note of the patient’s answers. If the patient starts going off at length, you could say, “Can I pause you for a moment? For now, I just want to get the main areas and then we can focus on each in turn. To recap, we’ve got [insert agenda items]. I would like to add one in too, which is [share agenda item]. We may not have time to cover them all today, in which case, I will keep a note and add them to the agenda for next time. So we can prioritize, which is the most important item to cover today?”
  • Keep track of time. When you notice you are in the final five minutes, let the patient know. “We’ve got five minutes left, so let’s make a plan to guide you between now and the next time we meet.”

Help the Patient Become Active

Invite the patient to be active within the session. You could give him or her a sheet of paper and a pen (and a surface to write on). Do be sensitive if the patient is not keen to write, or his or her literacy levels are low.

Empathy

Empathize, empathize, and empathize. Research into the efficacy of various forms of psychological therapy demonstrates the most important factor in any successful therapy intervention is the relationship. How are relationships developed? Through shared experience, being listened to, and accepted. Give permission for your patient to find things difficult.

Focus on the Issue the Patient is Concerned About

Often the patient will be most concerned about something completely unrelated to diabetes: financial worries, a sick relative, or a relationship breakdown. You do not have to be an expert in this or have a solution to it; simply acknowledging it and helping the person identify how to gain his or her own solution, or move forward, can be very helpful.

Be Curious About Successes

Be curious about any movement at all in a positive direction. Ask your patient, “What is going well with your diabetes?” (If patient replies, “nothing,” you can always let him or her know that coming to the appointment is a positive step!) “What was different on these days? What helped and what got in the way?”

Keep the Goals Very Small

Goals need to be small, in fact, the smaller the better. Success builds on success. Yes, your patient may need to lose three stone in weight. But being thoughtful about how to cut out the biscuit with the cup of tea is an important step towards an overall goal (the extra 100 or more calories, a few times a day, over a year, really adds up!). Do encourage and praise your patient, and notice times when he or she may be quick to discount success. Bring it out into the open and congratulate your patient for these with a simple, “Well done.” Be ready to encourage and praise.

Normalize

Let your patient know that he or she is not unusual. Tell your patient you have worked with lots of other people who have struggled with similar issues. Reassure your patient that his or her experience is “normal.”

Problem-Solve in the Context of Everyday Life

Behaviour change can be theory-driven, but it also needs to fit into everyday life. Think flexibly about how a goal might be implemented and the unspoken barriers that are really preventing change from being realized. Ask your patient, “What might get in the way of implementing this change?” Problem-solve with your patient. For example:

  • Does your patient forget to test his or her blood glucose? Could your patient move the kit somewhere it will be seen often, such as by the phone or on the kitchen counter?
  • Will your patient need to ask his or her partner to take on childcare responsibilities to allow some room for exercising a few times a week? When and how will your patient do this?
  • Look out for systemic issues that are obstacles to behaviour change. In the example above, is the real problem your patient does not have the skills to ask his or her partner for support? In that case, a valuable conversation could be had about how to equip the your patient with the communication skills needed to convey to his or her partner the importance of giving support.

As diabetes is woven so intricately into a person’s life, personal goals that are not obviously about a patient’s condition are still valid. They are likely also to have implications for health at some stage.

Be Comfortable with Being Silent

In “real” life, we usually have to feel comfortable with individuals before we can be comfortable with being silent with them. A healthcare appointment is not real life; of course, it is based in reality but it is not subject to the same customs as everyday interactions. Healthcare professionals can feel a pressure to fill the gaps, to provide more information, to squeeze much into a short period. Avoid this. The diabetes consultation may be the one time the patient actually thinks about their diabetes and silence can be an important part of cognitive processing. If you struggle with silence, count backwards in your head or think of the words of a song to help you. If the silence goes on for so long, you think it is because your patient doesn’t know where to start, simply reflecting this can be beneficial: “It’s difficult to know where to start,” or “It’s hard to know what to say.”

Finish with Next Steps

Many patients report struggling to recall the advice provided to them in consultations. Counter this by recapping what you have spoken about and the strategies you have suggested. Invite the patient to write these down to aid his or her memory.

  • What is my personal goal from today?
  • What will I do to achieve this goal?
  • Weekly review: How am I doing towards goal achievement?

Go Easy on Yourself: You are Not Responsible

As a healthcare professional, you will want to do the best for your patients. However, you are not their parent, and it is not your job to “solve” their health problems. They are adults and they are ultimately responsible for their health decisions. You are in a partnership, and for a partnership to work, collaboration is crucial.

I’d love to help you think more about how to foster empowering and collaborative relationships with your patients. Do get in touch to find out more at .

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

Diabetes doesn’t just affect you, it has the potential to affect your whole family. Ironically, it can be harder for those around you to manage this impact than you! Why? As humans we need to feel in control of the various aspects of our lives and while you are busy getting on with all the many and varied tasks to diabetes self-care, those alongside you are left with nothing they can actually ‘do’ — and nothing to act on —therefore, they don’t feel in control of this anxiety.

This anxiety can express itself in a variety of quite contrasting ways. The two most common are, feeling blamed or hassled by your family; or the opposite feeling, isolated and/or unsupported by those close to you.

You may feel they are observing you at every turn — checking what you are eating and how much attention you’re paying to your medication and exercise regimes. Perhaps they criticize you for being overweight, or disapprove of you for not keeping better blood glucose control, which can feel very blaming. Or maybe they seem to feel the need to ‘advise’ you at all times, which can feel more like lecturing than helpful suggestions. Or perhaps they seem to tell everyone you meet that “He/She’s diabetic, they can’t eat that,” drawing everyone’s attention to the ways in which you are ‘different’, when all you want to do is blend in like everyone else! Or maybe the opposite is true and your loved ones completely ignore your diabetes, leaving you feeling alone and isolated without their help and support.

Whatever way diabetes is affecting your close relationships, here are my top four tips from a previous blog posting, Diabetes and Relationships, to help you better manage.

Diabetes and Relationships

  1. Start TalkingFor most people for whom diabetes is causing a strain on a relationship the problem doesn’t get talked about in an open and straightforward way, rather it becomes a source of arguments or resentments. The first step in making a positive change is therefore to have a frank and honest conversation and get things out in the open. If you and your loved one regularly argue about your diabetes, this may mean you need to think about what to say beforehand so it comes across as calmly as possible. Try stating what you are unhappy with in a matter of fact way (e.g., “When you…..describe what they say or do, “it makes me feel…..insert emotion — upset, guilty, embarrassed etc”) Make clear that you don’t want to blame them, rather that you realise they love you and are trying to help, but there might be more useful ways they can do so if you think about it together.
  2. Tell Them How to Help YouBe clear about what you really want and need from your partner. For example, perhaps they are nagging at you to test your blood glucose more, when what would really be helpful would be if they praised and encouraged you with a smile and a hug when they did notice you test. Or perhaps they are berating you for your need to lose weight, when what would be really helpful would be if you could learn together how to prepare healthy meals, perhaps by researching some cookery books or going to a class together.
  3. Examine the Part You Are PlayingAre you taking responsibility for your diabetes self-care? Often those around you may see that you are ‘sticking your head in the sand’ about your diabetes care and may feel at a loss to know what to do to help. Nagging or hassling you may be the only way they know how to wake you up to the problem. Perhaps you always say, “I’m fine” when asked about your diabetes, even if it’s evident that all isn’t fine. Out of love and worry the person close to you wants to help you to change. By being honest with yourself and those around you about what you are struggling with, you can begin to take steps together to improve your diabetes health, avoiding the need for your loved one to resort to unhelpful nagging behaviour.
  4. Seek Professional HelpIf you have implemented the steps above and are still struggling, perhaps because it is difficult for one or both or you to keep calm or to see one another’s point of view when talking about diabetes, seeing a family therapist or counsellor can really help you have useful conversations. Often having a third, emotionally uninvolved person to listen and help you problem solve can really help you move forward together productively.

By following these steps above, both your relationships with those close to you and your relationship with diabetes will improve for the better.

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.