Integrated group psychotherapy for adults living with diabetes

Summary

In 2013, a weekly psychotherapy group was developed within Betsi Cadwaladr University Health Board's locality diabetes team for diabetes patients for whom self-management was very challenging. Some were reluctant to engage at all, and those discharged were repeatedly referred back to begin the cycle of usual care once again. A group was developed with supervision of the lead psychotherapist for personality disorders, and led by the dietitian as therapist in the group. Patients leave when they are ready, based on their personal outcomes. The diabetes dietitian has supervision from the lead psychotherapist in the personality disorder service. The DSN also works "on the boundary", maintaining appropriate communication whilst ensuring the safety of the patient. To date 14 patients have been active in the group and reported outcomes and acceptability are very positive and demonstrate individual clinical improvements and reductions in weight and medications.

Challenge

In 2009, as part of a new locality based diabetes team (total population 50,000), the DSN and dietitian implemented a variety of interventions to support patients to self-manage their diabetes. But by 2011, a subgroup of patients still found their diabetes management and control challenging due to co-existing emotional or relational difficulties which usual care was not addressing. This meant patients were 'held' in usual care making little improvement, or discharged where their diabetes management deteriorated, and so would be referred to re-enter the usual care over again. There were some patients also reluctant to enter usual care, or those who accessed regular contact through unplanned phone or clinic visits, were reluctant to be discharged by health professionals or their self-care (eating behaviour, glucose testing, and administration of medication/ insulin) became sabotaged. Patients who were offered referral to the local CMHT would often decline (due to stigma) or dropped out of the treatment offered, and the waiting times were around 18 months for a longer therapy which would be usual when treating emotional/relational difficulties in a psychoanalytic way. This was both unsatisfactory for the patients and difficult to time manage for the diabetes professionals.

Objectives

To provide an intervention which would be accessible to patients with the full spectrum of diabetes phenotypes, when usual care was rejected, or not successful, and whose commonality would be having emotional or relational difficulties making their diabetes self-management difficult. To develop an integrated psychotherapeutic approach to treat mental and physical health concomitantly.

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QiC Diabetes Finalist 2016
Involving the Diabetes Service User and Families/Carers
Integrated group psychotherapy for adults living with diabetes
by Betsi Cadwaladr University Health Board

Contacts

Elaine Jennings

Job title:
Clinical Lead Dietitian Specialist Diabetes Services
Place of work:
Betsi Cadwaladr University Health Board
Telephone:
01978 727159
01244 834 167
Email:
elaine.jennings@wales.nhs.uk

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