Jim: Best regards, Steve
I would ask her to list all the possible things she COULD do without any commitment to having to do them. Then have her choose one thing that would not be too hard to change and ask her what would she be willing to try to change. Ask her if ashe would promise herself to make one small change that she thinks she could change and would be willing to do. If she won't change anyhting, I would tell her that as much as you wish you could give her motivation that you cannot. You might be right about the depression. As you know, 20-25% of patients with diabetes have major depression and it often interferes with compliance. Treatment of the depresison with SSRIs leads to reductions in HgbA1cs (2 studies). Lastly, she might need some time to ventilate her disappointment, anger, and fear related to the failure of doctors to protect her family members of the ravages of the disease. That might build an alliance as long as the goal is to identofy something that she is willing to do herslef, however, small a step.
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