Steve, This has been an interesting thread to follow. More so, because we are all consumers of health care and all have these same difficulties to some degree. There is always room for improvement in both our health behaviors and our own characterological make up. Most of us are not exercising regularly/at the right intensity, eating low fat diets, doing regular breast/testicular exams, using sunscreen consistently etc. And it is certain that many or most of us will develop various forms of heart/vascular disease and/or cancer at some point in our lifespan. Patients who go to "Coping with Medical Illness" groups and the like have the same difficulties in making lifestyle change that we all face, plus lots of them are cursed with unfortunate genetics that cause more severe manifestations of disease. The really good copers don't especially need our services, the poor copers make us wonder whether we have anything worthwhile to offer them. Some guidelines that I have found really helpful are below. These are compilations of the works of other writers in this area-my apologies to the uncited authors: If you find yourself in a situation where the patient is resisting you, assume they felt pushed. Unless you and the patient have a shared understanding that you are delivering insight oriented psychotherapy, don't concern yourself with why they felt pushed. Merely use another strategy that allows them to feel less pressure. Examples of resistance are: interupting, arguing, sidetracking, minimizing, defensiveness, not answering and my personal favorite-brandishing weaponary. If you see these...do something different! Resistance is rapport gone bad. It is the health care providers problem. I agree with others that our personality impacts on motivation and health-related behaviors. Intensive psychotherapy is one way to change those coping patterns for folks with the resources to find a really good, effective therapist. But we also know that dramatic enduring shifts in personality can occur without the benefit of psychotherapy and sometimes very rapidly. For example, there are a number of people who suddenly make major changes after heart attack in their diet, exercise, relationships with others etc. In Hoyt's book Brief Therapy and Managed Care (1995) he quotes Robert Rosenbuam who points out that moutains usually evolve through the passage of time, with erosion, wind and rain molding the shape. But sometimes an avalanche can take place, forever changing the landscape of the mountain and valley. My own personal belief is that deep in our gut, we know what it might take, to change our world so radically that we would become capable of making a change that was previously impossible. Even seemingly trivial questions from our doctors about what it might take for us to move from say a 5 to a 10 on level of motivation can help us along in the existential journey. Ellen Dornelas
Thanks! Can you give more information about the Disease Management Listserve? Is it an open listserve to other health care providers?
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