May 2012 Issue

Counseling Tips for Anxious Couples — Diabetes Education Calms Fears and Helps Patients Better Manage the Disease
By Carol Patton
Today’s Dietitian
Vol. 14 No. 5 P. 50

Several years ago, my husband and I attended a diabetes education course sponsored by his healthcare plan. One gentleman in the class, who was in his 50s, had been recently diagnosed with type 2 diabetes. I was concerned about him, not so much because of his illness, but because of his wife’s anxieties about his care.

Throughout the month-long course, she discussed activities that she no longer allowed him to do and the foods she refused to let him eat. To her husband’s dismay, she volunteered him to have his feet examined in front of the entire class.

By the end of the course, the already-thin gentleman appeared to have lost weight. His face was gaunt, and his wife’s list of dos and don’ts continued to grow.

This woman’s anxiety about caring for her husband with diabetes isn’t uncommon. Typically, spouses overreact to a new diabetes diagnosis out of love and fear that their husband or wife will lose a leg, their eyesight, or their life. They hear the horror stories, based on inaccurate information, about family and friends who have diabetes complications, and they fear the worst will happen to their loved one.

Dietitians and CDEs who aren’t trained to manage such situations may lose control of the conversation during counseling sessions with couples. However, if RDs and CDEs take the reins early on and educate patients and their spouses about the disease, they can prevent them from making unnecessary behavioral and lifestyle changes, quell their fears, and help patients better manage the disease.

Fear Factor
More wives than husbands tend to overreact to a new diabetes diagnosis, mainly because women typically are the ones who buy the groceries and prepare family meals, explains Alison Massey, RD, CDE, a clinical dietitian at Mercy Medical Center in Baltimore.

She recalls one patient whose wife seemed overly anxious. Each time Massey asked the husband a question, she’d answer. “Or if her husband answered, she’d point out discrepancies, whether it was regarding his food intake at home or what he really had been doing since his recent diagnosis,” Massey says. “She was trying to highlight every little thing she thought was important, but she ended up coming across slightly demeaning to her spouse.”

Massey believes the lack of knowledge about the disease was behind the wife’s behavior, causing her to fear for her husband’s future health. She may have been listening to family gossip or other misinformation. For example, family members may have blamed diabetes for Uncle John’s foot amputation instead of recognizing what really happened. Uncle John developed a foot infection but ignored it so his foot had to be amputated to prevent the infection from spreading to other areas of his body, Massey explains. So diabetes education is key not only for individuals but also for couples who are dealing with the disease together.

Damage Control
The following strategies will help RDs and CDEs educate couples, reduce their anxiety, and encourage them to lead healthier lives:

Use reflective listening. Listen to the husband and wife and then rephrase their statements to demonstrate you understand their concerns about the disease, Massey says. For example, if the spouse is focused on the husband eating potato chips before bedtime, you can say, “You sound like you’re concerned about your spouse’s food choices. We’ll talk about that and develop some small goals and work from there.”

By rephrasing your patients’ statements, Massey says, “You’re acknowledging their concerns and redirecting the session. Acknowledging them is important, but you don’t want them taking control of the session, so you need to manage the dynamics.”

Explain the ground rules. Politely tell the spouse you need to direct your questions to your patient and that he or she must wait until all questions are answered before jumping into the discussion.

Excuse the spouse from the room. If the spouse interrupts, say, “If it’s OK with you, I’m going to talk with your spouse to get some information, and then we’ll bring you back into the room,” Massey says.

When spouses try to control the counseling session, Dawn Sherr, RD, CDE, a practice manager at the American Association of Diabetes Educators, suggests using this statement: “This was an important session for you to attend, but the next one isn’t essential, so maybe your husband can come by himself. I need to focus one on one with him on just this one aspect of his illness.”

Divide and conquer. Some overbearing partners can disrupt diabetes education classes. On these rare occasions, ask the partners to sit in chairs against the wall of the conference room or on the outskirts of the conference table and focus your attention on the patients. Tell partners to ask all questions pertaining to specific circumstances after class or during individual sessions with their dietitian, says Gretchen Perea, MS, RD, CDE, of the Nutrition Wellness Center at Saddleback Memorial Medical Center in Laguna Hills, California.

Describe everyone’s role. Periodically, Massey uses a sports analogy when counseling couples, explaining that they’re both players on the same team. “I’ll say [to the spouse without diabetes], ‘Your spouse is the quarterback of the diabetes team. It’s [his or] her responsibility to execute the plays. Your [spouse’s] doctor is the coach. Your role is to support the quarterback. Your spouse and I are going to set some small goals, and we’ll determine how you can best support [him or] her at home.’”

Invite partner participation. Encourage partners to attend diabetes classes together, Sherr suggests. Not all partners do, she says, adding that they miss out on vital information, causing them to continue believing misperceptions and holding on to fears.

Refocus partners’ demands. Sherr says sometimes partners make impractical, definitive statements, such as, “You’re never going to eat this again” or “You’re going to eat broccoli.” Instead of confronting these types of remarks, ask patients what their favorite meals are and then offer suggestions on how they can prepare those meals with healthier ingredients.

Assign specific tasks. Among the biggest mistakes CDEs can make is leaving spouses on the sidelines, Sherr says. Suggest spouses help manage or administer medication, count carbs, calculate insulin dosages, plan meals, record daily blood sugar readings, and exercise with their loved one.

Discuss symptoms. Patients can forget to take their insulin and become cranky, Sherr says. Spouses often will pick up on this mood change before patients do. So discuss warning signs with patients and their spouses to help them feel more in control, less fearful, and capable of avoiding emergency situations.

Provide extreme examples. Because patients and their spouses have different levels of nutrition knowledge, you may need to provide dramatic examples when discussing dietary limitations. In most diabetes education classes, Perea says people are confused about why they must use olive oil sparingly. “I say, ‘You can eat 1,300 calories worth of Oreo cookies and lose weight, but that wouldn’t be healthful. Or you can eat 4,000 calories per day of healthful foods such as baked chicken, brown rice, and vegetables and gain weight. If you need to lose weight, you need to pay attention to calories, and olive oil is high in calories.”

Send them to school. Suggest patients and their spouses attend one diabetes education class before any private sessions. Perea believes these classes “quiet everybody down” since many of their fears and misconceptions typically disappear within the first hour of instruction. This enables dietitians to concentrate on personal matters specific to each patient during private sessions rather than correcting overprotective spouses.

Perea says there are patients in her diabetes classes who elbow their spouses when the spouses were wrong about something and the patients were right—they can eat that piece of bread. “Spouses get that deer-in-the-headlights look,” she says. “That’s when I see them sit back in their chairs going ‘ahhh’ because nobody explained it [to them].”

All these strategies highlight one important point: the need for education. By helping spouses better understand diabetes and nutrition, they’ll no longer walk around in fear but will be able to support their loved one in an informed and helpful manner.

— Carol Patton is a freelance journalist in Las Vegas who covers health-related topics for various publications.