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Let's Help People With Diabetes Feel Seen And Heard!
Learn why feeling seen and heard is essential in diabetes care!
Johnny raises his hand energetically, trying to catch the educator's eye, while Susie slides deeper into her chair. Chris interrupts the conversation, restating his point. What do these situations have in common? You are right if you guessed, it relates to being seen and heard! What is the feeling of being seen and heard? Why is it essential in diabetes care? How does it connect to you, the diabetes professional?
The Inclusive Diabetes Pyramid was created by Megrette Fletcher, M.Ed., RDN, CDCES, to unpack how stigma presents in diabetes care. The image shows the five inclusion levels: Belonging, Ease, Seen and Heard, Nonjudgment, and Whole Self-care.
If you are curious about the first two levels, read Belonging and Ease: Reducing Barriers to Diabetes Care.
What Seen and Heard Feels Like
Understanding your experience of feeling seen and heard differs from your client's experience. Pausing and reflecting on how your experience is the same and different is helpful. Remember a time when you felt truly seen and heard. When did this happen? Was it this week, this month, or many years ago? Get even more curious and picture where it happened. Were you in a doctor's office, with a trusted friend, or meeting with a teacher, partner, or parent? How did the experience feel in your body? Right now, touch that part of your body where you feel a sense of being seen and heard. See where you placed your hand. Is it on your head, throat, chest, or stomach? What were the conditions that helped you feel seen and heard? Consider how easy or hard it was for you, now or in general, to feel seen and heard. Was the felt sense of being seen and heard assumed?
Feeling seen and heard isn't always the case for your clients with diabetes. Diabetes is complicated, and managing diabetes is a stressful experience, resulting in Diabetes Distress. DiabetesDistress.org states, "Many people experience significant diabetes distress - about 40% of adults with either type 1 or type 2 diabetes report significant distress at any point in time, and over 50% report significant distress during any 12 months."
The prevalence of diabetes distress can explain why overwhelmed clients are more likely to offload feelings in a session. This break in composure can strengthen or fracture a counseling relationship. The relationship grows if received with compassion and the needed space and grace for trust to emerge. The counseling relationship is weakened if a person feels judged for being overwhelmed or feeling like they don't belong. Without a trusted relationship, author Brené Brown, Ph.D., explains these emotional breaks result in a "vulnerability hangover," which accurately describes the shame, guilt, and a feeling of being 'othered.' Clients overwhelmed by diabetes may not have the capacity to revisit these essential conversations, which adds to feeling like they don't belong. It creates a cycle depicted in the following image.
Nonjudgemental Counseling Ideas
Motivational interviewing, MI is a nonjudgmental counseling approach founded on Partnership, Acceptance, Compassion, and Evoking, which can be easily remembered by the acronym PACE.
Using reflections can highlight the client's unspoken desire to be seen and heard. In MI, this is pulling for the wish, explains Stephen Andrews, LCSW and owner of Health Education Training Institute, HETI.org. Stephen encourages professionals to "Meet your clients at their dreams." For example, you might tell Johnny, "You want to share the changes you have already made in your diet." To Susie, you might reflect, "Your experience dieting has been harmful, and you know that focusing on weight loss isn't effective for you." Reflecting to Chris, "You need more information before making changes."
Reflecting on the unspoken wish to be seen and heard is a great way to model acceptance and compassion. "You are tired and working very hard to manage your blood sugar. [Client responds.] Coming to this session took courage. [Client responds]"
Helping clients experience a sense of belonging, ease, feeling seen, and not being judged is powerful. These felt senses build trust and confidence and increase engagement.
As you have seen, the opposite of belonging is othering. Like a series of dominos, the sense of being othered makes any situation harder, robbing the client of ease. It can cause clients to remain silent because being seen and heard isn't safe.
In medical care, there is a familiar desire to sort or group people. Placing anyone with diabetes into a group, for example, "Compliant vs. Noncompliant," "Thin vs. Obese," "Male/Female," and "Motivated vs. Not motivated." "In control vs. Out of control." It includes and excludes the client to some degree, resulting in the feeling of being othered.
Understanding the limits of a binary approach to sorting is confusing because the medical community has created systems to manage the millions of people with elevated blood sugar. It is easy to forget that clients are grouped to help you or the institution, not them. Privileged clients may self-sort to get better care because they understand helping you is beneficial. The article, You Have A Superpower And Don’t Even Know It, is an excellent place to consider the pros and cons of sorting. A follow-up article, Sorting's Secret, explains the power of discernment to help you move out of binary thinking.
Sorting enables you to follow specific clinical care but also reinforces the sense that some clients belong and others don't. If you (and your organization) need additional training in inclusive care to understand how systems meant to benefit clients unintentionally oppress them, Inclusive Diabetes Care is here to help. The IDC is a Professional Education Company that provides CPE for Dietitians, Diet Technicians, Health and Fitness professionals, Community Health Workers, Social Workers, Case Managers, and Health Coaches. Fostering a sense of belonging: Countering diabetes stigma, distress, and burnout
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