I have worked with several people that have diabetes. One individual went into a diabetic coma during a therapy session in my second year of graduate school. I called parametics and my client left the outpatient clinic by ambulance.
I was fortunate to have a supervisor, Karen, at the time that was diabetic herself. She spoke openly about what the illness is like, which was immensely helpful to me.
Almost 20 years later, two things stand out in particular about what Karen taught me. The first is how to ask people about how well they are taking care of their diabetes. The second is an understanding about why so many people with diabetes experience depression.
There is an art to how psychologists ask their clients questions. How a psychologist asks questions can either improve communication and strengthen the relationship, or it can shut down communication all together.
With respect to asking about blood sugar monitoring, for example, asking “Do you monitor your blood sugar levels?” will invariably receive a “Yes.”
However, asking the question, “How many times a week do you not monitor your blood sugar levels?” will typically receive an answer like “Seven.”
Why the difference in responses? The first question doesn’t leave any room for the client to be non-compliant with their medical treatment, while the second question expects the client to be non-compliant right from the start.
I ask questions about blood sugar monitoring during my first session with every diabetic client. I ask how many times a day they don’t measure their blood sugar levels. I listen to the answer and remain non-judgemental about how my clients are caring for themselves and their illness.
There’s a difference between accepting how someone is caring for themselves, and working to help them understand what is happening so that they can improve their self-care.
Karen taught me that people don’t want to do something as aversive as monitor their blood sugar levels because doing so is a reminder, three times a day, about how they are going to die. Every diabetic is aware of the dangers of diabetic comas. They know that diabetes can lead to secondary complications that include heart disease, kidney disease, blindness, and neuropathy in their feet and hands.
Every diabetic also knows that achieving their target blood sugar level three times a day is impossible. Rather than feeling successful, they get to see, when they test their blood sugar levels three times a day, that they have missed the mark again. Karen told me that she didn’t measure her own blood sugar levels three times a day for this reason. She said she didn’t want to be reminded at breakfast, lunch and dinner every day that she has this illness.
It makes sense, as we explore this idea further, that diabetes, combined with predictable difficulty maintaining target blood sugar levels, leads to depression. If you ask psychologists whether diabetes and depression go together in their practices, they all say, “Yes.”
So what’s the answer? How can a psychologist help a client with diabetes to better cope and more effectively address their depression? A first step is to listen to the client talk about their diabetes while remaining non-judgemental. One client recently told me, “I don’t want to admit I have a problem… I don’t want to be reminded about it… I don’t want to be diabetic.”
The psychologist’s initial role, as therapy begins, is to listen closely to their diabetic clients as they talk about what’s going on for them with respect to their health, the fears they have about today and about the future, and how these fears are affecting them.
Dr. Patricia Turner, PhD, Registered Psychologist, Calgary, Alberta
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