How to Find the Right Therapist When You Have Diabetes
By Alexandra Frost
Finding a mental health specialist who understands the challenges of managing diabetes can be difficult. Here’s what to consider in your search for a therapist who is right for you.
Amanda Gilchrist’s 6-year-old daughter Emmie was diagnosed with type 1 diabetes (T1D) two years ago. And for that same amount of time, she has been trying to match her up with a skilled mental health care provider, without success.
“We sought out therapy for Emmie after her diagnosis and could not find any available provider, with or without diabetes knowledge,” she said. “We tried contacting numerous places, including endo offices with mental health providers.”
Gilchrist and her husband, who live in Massachusetts, also sought help for themselves “to better manage the stress of [parenting a child with] a chronic condition.” It took them 18 months to find someone to work with, and it isn’t someone who has specialized knowledge of diabetes.
Finding a mental health specialist is challenging, and even more difficult if you are seeking someone knowledgeable about chronic conditions like diabetes. The Association of American Medical Colleges reported that more than 150 million people live in federally designated mental health professional shortage areas, and projects a shortage of up to 30,000 mental health providers in the next few years.
The association noted that mental health conditions peaked during the pandemic, with 40% of adults reporting depression and anxiety symptoms compared with 11% in the “before” times. Although those numbers have decreased some, a third of Americans still reported symptoms as of June 2022.
For people with diabetes, the numbers are even more concerning. Mental Health America (MHA) reported that rates of depression are twice as high for those with diabetes; people with type 1 diabetes are also twice as likely to have an eating disorder. As many as half of all people with diabetes reported that they experienced “diabetes distress” at some point, which shares some traits of depression and anxiety, and is linked to diabetes-related issues.
Dr. Ann Goebel-Fabbri, a health psychologist in Brookline, Massachusetts, who focuses on diabetes, says that the proper standard of care is for a diabetes team to take a multidisciplinary approach to care, including access to a medical doctor, a dietitian, a nurse, and a therapist.
“But very few practices have access to that,” she said. This is evident as MHA also reported that almost half of mental health conditions go undetected among people with diabetes. So, not only is finding a reputable provider a struggle, as Gilchrist found, but finding one with specific knowledge of the additional difficulties and complications of a diabetes health journey can seem daunting.
A tool to find diabetes-educated providers
The American Diabetes Association (ADA) sought to ease the challenge of finding a mental health provider with diabetes training by offering the Mental Health Professional Referral Directory. Providers in the directory are licensed mental health professionals, are members of the ADA, have completed ADA’s Diabetes Education 101 for the Behavioral Health Provider course, and have “demonstrated competence treating the mental health needs of people with diabetes.”
“This ensures that no matter how many years of diabetes experience they may have, all mental health professionals in the directory have the appropriate knowledge and tools to support their patients,” said Katharyn Vartanian, senior manager of professional education and engagement for the ADA. “We also require all professionals in the directory to maintain an ADA membership so they stay updated on the latest diabetes information. Our hope is [that people with diabetes searching for a therapist] become established with a licensed behavioral health provider who has diabetes education to help support them on their diabetes journey.”
Goebel-Fabbri points out that this isn’t the only way to find a provider, and that not every provider with diabetes training or experience is listed in the directory, as some might not be members of the ADA. However, it’s a starting point for those who might have diabetes-related issues they’d like to discuss with a qualified mental health professional.
Vartanian advises people with diabetes to start with a search within their area, then determine the type of professional they want; then determine if they offer telemedicine and what their special interests are in diabetes.
“For example, if the patient was a 16-year-old female with type 2 diabetes, the directory can help narrow down professionals that would be the best fit for that patient,” Vartanian said. “The directory will provide information on what types of languages the provider speaks, if they offer telehealth, and a background on how long they’ve been supporting patients with diabetes.”
The importance of diabetes education for mental health providers
Choosing someone already familiar with diabetes might take a load off an already distressed patient. “There’s so much undue burden just living with diabetes and managing it hour to hour, that expecting the patient to teach the provider about their disease feels very unfair to me,” Goebel-Fabbri said.
She pointed to an example from a coworker (without diabetes experience) whose patient referred to being “high” repeatedly; on the basis of this conversation, the mental health provider incorrectly concluded that she either meant “drugs” or “mania.” This eventually led to a misdiagnosis of bipolar disorder. Obviously, the coworker meant high blood glucose numbers.
Goebel-Fabbri also noted a lack of education and understanding surrounding diabetes-related mental health conditions, including eating disorders. For some, removing calories by intentionally running their glucose too high results in “diabulimia.” Leadership at eating disorder treatment centers maintain that they don’t have the staffing to oversee a person’s glucose levels and insulin administration.
What to ask a mental health provider to find the right fit
Even if a provider has diabetes knowledge, finding a good therapist can be a little like dating — it takes some time and energy to find the right person. Goebel-Fabbri explained that there are specific questions you can ask to help determine their knowledge and comfort level with your condition.
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How much do they know about diabetes?
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Do they have other patients in their practice with diabetes or have they in the past?
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Would they be willing to talk to your endocrinologist or nurse practitioner to better understand your condition?
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For someone who isn’t familiar with diabetes, ask if they’d be willing to learn about it to educate themselves.
Goebel-Fabbri added that you don’t always have to have a therapist with diabetes experience, especially if the reasons you are seeking a therapist don’t have anything to do with diabetes. However, if you are looking to establish a long-term relationship with a therapist, it can be helpful in case additional issues come up later that would require that knowledge.
“Find somebody who you like, who you feel you fit well with, and make sure that person is willing to learn from your medical provider what your treatment plan is, what it entails, and maybe learn more about [diabetes],” she said. “That’s sort of a test — are they willing to do this?”
In addition to the ADA tool, if you searching for mental health providers with or without chronic condition training, you can visit Psychology Today’s therapist directory. If you are in an immediate mental health crisis, call 988, (Suicide and Crisis Lifeline), or go to the nearest emergency room.
