Diagnosis of a chronic condition such as Type 1 Diabetes (t1d) can cause a grief response - Much like the grief response after the loss of a loved one.

Some of the emotional states people may experience, in no particular order, can include denial, anger, fear, sadness, shock and yearning. There are many theories that inform grief and loss therapy. In earlier years, Kubler and Ross 5 stages of grief was a popular and well- known approach that stated: To “resolve” or “get over” our loss we need to go through 5 stages: denial, anger, bargaining, depression and acceptance. However, more contemporary approaches view grief as a more fluid process that involves moving between tasks of grieving such as feeling the pain of the loss and tasks of creating new life after the loss such as adopting new roles or new behaviours.

When applied to the diagnosis of a chronic condition, such as t1d, people will remember vivid details about the exact time of diagnosis such as…” I felt so sick” or “My doctor said go straight to emergency” or “My mum just started crying”. In counselling it helps to go through all the details of events at the time of diagnosis and then explore how life was before diagnosis and how life has changed now. It also helps to explore the client’s emotional process as time goes on. If a client is newly diagnosed they may not yet have accepted that they have t1d and be searching for answers and promises of a cure. They may have little motivation to participate in important daily tasks such as checking blood sugar levels, counting carbohydrate they eat or measuring units of insulin they must give. Counselling can help clients to work through each emotional state at their own pace, so they are able to tolerate the emotional distress and hopefully limit harmful coping behaviours such as alcohol misuse or disordered eating.

The added importance for t1d diagnosis is that although someone may be experiencing painful grief that is causing them to feel fatigued and helpless, there is now very important health implications for their behaviour. If someone is struggling to complete daily tasks now required of them, poor health and feeling unwell can compound their grief process. Some other factors that can influence how someone experiences their loss are:

• culture
• pre-existing emotional distress
• being a man or a woman
• family of origin response
• social support
• coping styles
• philosophical beliefs
• con-current crisis

Parents of children who have been diagnosed with t1d experience a grieving process of their own that often involves guilt (that this is somehow their fault). Counselling can help parents to cope with diagnosis and adapt to new life with a child who lives with t1d. When treating either a person who has been diagnosed with t1d, their parents or support people, it is important for a counsellor to demonstrate a willingness to explore whatever painful thoughts, feelings and images are distressing the client. As is encouraging the client to find good social and medical support and identify grounding factors such as a family pet, exercise, music, friends, work or study.

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