...what your reaction to that piece was going to be.
Heh. Did you pick up on the drug resistance/nonadherence thing, or were you just wondering in general because it was an HIV piece?
How does one work to change that sort of thing?
With this guy, who's intelligent and introspective? By working with him to dig out the assumptions and laying them on the table, where they can be examined and tested. (Typically, assumptions like "nothing I do will make any difference anyway" are not at the level of surface awareness - after all, if they were, he'd refuse the pills in the first place.)
In other situations? Once I worked with a client[1] to graph her CD4+ (T-cell count) since diagnosis, with all the ups and downs. Then we added event labels to the graph: "Okay, when you were diagnosed your count was here. Then you started meds, and it shot up to here. Here's where you started using drugs, see it going back down?... here's the real heavy binge... here's where you went into rehab, and it's been going up slowly but steadily since then." Until she saw it presented visually like that, she hadn't really grasped that her behavior made a difference. Even though we were talking about how she'd screwed up her counts, it was still inspiring for her to realize that she had control.
Sometimes you just have to start small, and walk the person through making tiny change after tiny change, in hopes that eventually they'll build up a picture of themselves as a competent person, as someone whose future isn't predetermined. But, you know, there's not always enough time. That patient I had who died recently, he eventually came around to seeing himself as a person with control over some aspects of his life - but by then it was too late. He'd run through all the drugs on the market.
[1] Details of this story have been substantially changed to protect confidentiality.
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Re: I was wondering...
Date: 2002-02-01 11:59 am (UTC)Heh. Did you pick up on the drug resistance/nonadherence thing, or were you just wondering in general because it was an HIV piece?
How does one work to change that sort of thing?
With this guy, who's intelligent and introspective? By working with him to dig out the assumptions and laying them on the table, where they can be examined and tested. (Typically, assumptions like "nothing I do will make any difference anyway" are not at the level of surface awareness - after all, if they were, he'd refuse the pills in the first place.)
In other situations? Once I worked with a client[1] to graph her CD4+ (T-cell count) since diagnosis, with all the ups and downs. Then we added event labels to the graph: "Okay, when you were diagnosed your count was here. Then you started meds, and it shot up to here. Here's where you started using drugs, see it going back down?... here's the real heavy binge... here's where you went into rehab, and it's been going up slowly but steadily since then." Until she saw it presented visually like that, she hadn't really grasped that her behavior made a difference. Even though we were talking about how she'd screwed up her counts, it was still inspiring for her to realize that she had control.
Sometimes you just have to start small, and walk the person through making tiny change after tiny change, in hopes that eventually they'll build up a picture of themselves as a competent person, as someone whose future isn't predetermined. But, you know, there's not always enough time. That patient I had who died recently, he eventually came around to seeing himself as a person with control over some aspects of his life - but by then it was too late. He'd run through all the drugs on the market.
[1] Details of this story have been substantially changed to protect confidentiality.