Agreed, I like the paper bag. If the disorder diagnosis is of no value, think how much less valuable the spectrum notion is. Examining the original statement of problem, there are some obvious ways to go. "She stated that she was here to get motivation to exercise and improve her diet, since she was not exercising at all, and continued to eat lots of high fat foods. The group tried to suggest various strategies that worked for them, but she quickly rejected them all." "I then tried the "stick", since the "carrot" clearly was unappetizing to her, and let her know that if she continued with her blood sugars at this level - due to her weight, diet, and lack of exercise - then she was looking toward painful neuropathies, a series of amputations, blindness, renal dialysis, heart disease, etc. She said that she knew all that, since her mother was on dialysis and died of diabetes related factors, and her uncle who lived with them had his left leg amputated and was blind due to diabetes." I would apologise at that point, along the lines of: "Silly me, of course you do". "I asked her if she was resigned to having diabetes, and felt there was nothing she could do about it, to which she replied: "No. I know that if I exercise and eat right that I can contol it. I just don't have the motivation. That's why I came here." So now, time to ask a range of questions like "What do you think undermines your present motivation"; "Lets go over in detail what happens when you try to do stuff....(seek to identify where things go wrong, what runs through her mind, that kind of stuff). Also helpful to consider contextual factors (e.g. unhelpful partner/family, setting conditions, reinforcers, lack of alternative behaviours, general beliefs). BTW, the book I mentioned in a previous post is Rollnick, S., Mason, P. and Butler, C., "Health Behaviour Change: a guide for practitioners" pub Churchill Livingstone, 1999 (July). it is very good, and very relevant here. Strangely enough, the closest the index gets to "Personality Disorder" is an entry on "Personal choice and control, reducing resistance". Now that's what I call a good book.....
My guess would be this is because she had tried them, and they hadn't worked for her. A more detailed discussion of what would happen if she tried these would be very helpful. Telling her that many people have difficulties in this way, and that the trick is to look for the obstacles to doing stuff ("motivation") is the task would not go amiss.
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