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Diabetes, like all chronic illnesses, impacts all aspects of a person's life, perhaps even more so in childhood. Using a developmental, social-cognitive approach, Dr. Alan M. Delamater works closely with children and their parents to help children learn to live with and manage their own diabetes.
In this session, Dr. Delamater meets with an 8th-grade girl and her mother, helping them first set goals for managing diabetes and then providing them with psychoeducational information for reaching those goals.
The therapeutic approach is informed by social cognitive learning theory as well as a developmental family-systems model. Effective therapy begins with comprehensive assessment, identification of patient strengths as well as problem areas, and consideration of developmental issues and family relationships that help in understanding the nature of the patient's presenting problems. This process leads to a case formulation, which when communicated with the patient, leads directly to specification of goals and the therapy approaches to be used.
A variety of psychoeducational and behavioral intervention approaches then may be utilized to progress toward the patient's goals, including self-monitoring, goal setting, behavioral contracting, positive reinforcement, problem solving, communication skills training, and cognitive restructuring. When working with children and adolescents as patients, many of these interventions are family based.
A typical client would be an adolescent with Type 1 diabetes who does not adhere well to his or her medical regimen, has poor control of blood glucose, inappropriate health beliefs, and frequent conflicts with his or her parents about his or her diabetes management. In many cases, parents and adolescents have different goals for diabetes care. In such a case, the adolescent usually has primary responsibilities for diabetes self-care, with parents assuming their adolescent is capable of self-care autonomy.
In the course of therapy, the appropriateness of diabetes health beliefs are addressed, diabetes care goals and responsibilities are negotiated, and supportive parental involvement and communication is achieved, as is the adolescent's need for autonomy.
This approach can be used in typical cases but may not be appropriate when there are complications such as parental psychopathology, severe family conflict, or the presence of psychiatric disorders, such as depression or eating disorders in the adolescent. These cases will also require direct interventions for these other problems.
About the Therapist
Alan M. Delamater, PhD, ABPP, received his doctorate from the University of Georgia in 1981. He is currently professor of pediatrics and director of clinical psychology at the Mailman Center for Child Development and the Department of Pediatrics at the University of Miami School of Medicine, where he has been since 1991. Prior to that, he was on the psychology faculty at Washington University (1981–1987) and Wayne State University (1997–1991).
As a researcher, he has consistently received grant funding from the National Institutes of Health and other agencies and has published widely in the field of pediatric psychology. Although most of his research has focused on psychosocial and behavioral aspects of diabetes in children and adolescents, he has also published in a number of other areas, such as asthma, cystic fibrosis, and cardiovascular disease. He has served frequently as a grant reviewer for the National Institutes of Health and is on the editorial boards of several professional journals.
As a teacher, he has chaired over 30 dissertations, master's theses, and honor's theses. He is active as a clinician, and is board certified in clinical health psychology.
Anderson, B. J., & Rubin, R. R. (Eds.) (2002). Practical psychology for diabetes clinicians (2nd ed.). Alexandria, VA: American Diabetes Association.
Delamater, A. M., Alvarez-Salvat, R., & McCullough, J. (2003). Evidenced-based interventions for children and adolescents with type 1 diabetes. In L. Vandecreek & T. L. Jackson (Eds.), Innovations in clinical practice: Focus on children & adolescents (pp. 51–62). Sarasota, FL: Professional Resource Press.
Delamater, A., Jacobson, A., Anderson, B., Cox, D., Fisher, L., Lustman, P., et al. (2001). Psychosocial therapies in diabetes. Diabetes Care, 24, 1286–1292.