The authors’ program for dealing with the severe behavioral problems of noncompliant diabetics who consistently and deliberately refuse to follow medical advice is necessarily long-term. These patients often meet criteria for borderline personality disorder. Frequently commencing with crisis management rather than psychotherapy per se, the therapist strives for the slow dispersal of deep-rooted denial, manipulative behavior, and dependency needs. In many cases impaired family dynamics require resolution before the patient can arrive at acceptance of the illness and of practical measures for coping with it, in place of previous magical hopes for cure and resentment of physicians for not providing such cure.
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