Identity and Adherence in a Diabetes Patient: Transformations in Psychotherapy

Abstract

The authors present a case study of a 26-year-old woman who developed diabetes in early adolescence and who attended seven CAT sessions. They used phenomenology to analyze therapy transcripts, case notes, and a reflexive journal and extract the major themes. The client's identity had been overshadowed by the development of a "diabetic identity" that the client rejected. Poor adherence was linked to the rejection. Motivation to manage her diabetes changed during the CAT sessions once her identity was confirmed as being separate from her diabetes. The client was then able to integrate diabetes into her life.Psychological and psychosocial factors are linked in complex ways, both in the personal development of adolescents with diabetes and their transition to adulthood. Understanding the impact of diabetes on identity can enhance the effectiveness of therapeutic interventions with nonadhering clients.

Transformational Experience of a Student Nurse with Diabetes: A Case Study

“…The identity change of the participant is significant because her transformative progress confirms previous research (Tilden et al, 2005), and this study also showed that an individual could shift from being "a victim of circumstances to a creator of circumstances" (Barroso, 1995 p. 44;Paterson et al, 1999, p 788).…”

“…The progress of the participant in the present study parallels the research findings of Tilden et al (2005). Self-integrity developed as frequent challenges arose that required the participant to face critical situations.…”

“…Thorne et al (2002) found that the chronic illness experience involved (a) learning: the decision to assume control, (b) fine-tuning: (i) the disease-specific context of self-care, (ii) experiencing the effects of the disease, (iii) managing the social context (iv) managing lifestyle, (v) managing treatment, (vi) managing health care, (vii) envisioning futures and (c) evaluating quality measures for self-care decision making: (i) using experts and biomarkers (ii) creating individualized standards, (iii) theorizing complexity. Tilden et al (2005) seem to see the transformation process as first, a rejection of the diabetic identity, and second, the integration of the diabetic identity. Zoffmann and Kirkevold (2005), studying the conflicting perspectives of diabetes patients and professionals in problem solving, identify 3 approaches to the situation: (a) a compliance approach that keeps the pattern unchanged, (b) a failure-anticipating approach and (c) a mutual acceptance approach that neutralizes the conflict.…”

“…Instead of impatiently trying to make generalizations from a single case, we should be impatient with the generalizations that we make and try to find an internal pattern (Tilden et al, 2005).…”

“…According to Tilden et al (2005), the case study is useful for complicated associations. Case study is the method of choice when the phenomenon under study is not really distinguishable from its context.…”