Parents have asked me how they can help their teenagers when they notice their behaviours have changed. They are either short tempered or slower to react, plus parents notice their children may not be eating properly. My advice to these parents is to use motivational interviewing techniques, such as open ended questions and not to judge or exhibit value judgments. This can be very difficult to do when parents are concerned about their children’s health and well-being.
Motivational interviewing for teenagers with diabetes is a therapeutic tool which can encourage and support behaviour change. It incorporates cognitive-behavioral therapy techniques and the stages of change model. Cognitive-behaivoural therapy highlights how thoughts and emotions towards a problem, such as taking glucose levels, can result in behavior such as not testing glucose levels. The challenge is then how to develop a trusting relationship with your son or daughter so that alternative behaviours can be looked at and eventually implemented. By changing the behaviours, parents can help their teenager with diabetes change his/her thoughts and emotions towards testing in a non-threatening, empathic and empowering fashion.
The main key with this type of work is to understand that change takes time. Change can occur immediately when initially discussing a plan of change, such as testing more at particular times during the day, morning and at night. Then, a few days later, the testing stops. This behaviour is natural. It is very hard for a person to change and adapt immediately. Sometimes the change occurs, so one step forward to change and then two steps back. Consistent change can take a long time to occur. Sometimes up to seven times of ‘one step forward to two steps back’ behaviour is required before effective permanent change. Patience and empathy towards the teenager are very important tools to remember.
Motivational interviewing uses 5 key principles:
1. Express empathy by listening to what your teenager is feeling about managing his/her diabetes. Diabetes management is not easy when he/she is involved in normal activities. ie. getting their marks high enough to go to university or college, working part time as they go to school, socializing and trying to be normal like their friends
2. As their parent, your teenager will argue with you and resist changing the behaviour. This will occur when the child feels safe to do so. Allow this to occur. Talk about the pros and cons of not taking care of themselves. Discussion is good. This helps the teenager to learn how to problem-solve.
3. Avoid arguing with the teenager or you will lose the opportunity to help.
4. Resolve the teenager's ambivalence through discussion. Discuss how they feel when they have a low or experience a high sugar level and ask if this is something the teenager wants to change. Also at this point empathize about how difficult their life is.
5. Support self-efficacy by emphasizing autonomy. Allow your teenager to make mistakes. This is the hardest part of being a parent, because you want them to feel better and be healthy.
Other tools to implement are 4 communication skills:
1. Open-ended questions ie: “I have noticed that you seem to be grumpier lately. What do you think is happening?” (hopefully they will start to talk about their diabetes management) “Tell me how you are managing your diabetes. What are the good things and the not-so-good things about it?”
2. Affirmations: Emphasize a strength, and notice and appreciate a positive action. These need to be genuine, very honest, and to express positive regard and caring
3. Reflections: Good opening phrases are: "it sounds like you…."
4. Summaries: summarize what has been discussed in a casual way. This takes practice.
Developing a safe, open communicative relationship with your teenager is very important when helping your child change so that his/or her diabetes management can improve. It can be a very difficult role for a parent to play due to the severity of diabetic complications. If this can be done though, eventual success should follow.
The evidence shows that motivational interviewing works. Teenagers with diabetes can be helped to achieve healthier lifestyles and better outcomes when given a trusting and safe environment to explore his/her thoughts and feelings about managing diabetes.