Helping people deal with the problems of diabetes is what I do here, on my website, and by email. Most of this work is fulfilling, because I am often able to inspire people to improve their diabetes control.

But a part of my email correspondence is frustrating. That’s when a well-intentioned wife or husband or friend wants me to help someone who won’t help himself or herself.

I have never found that I can help anyone with diabetes indirectly. Typically, the wife or girlfriend writes on behalf of a man who doesn’t take care of his health. I don’t even try any more to offer this indirect or third-party help.

How could you or I ever possibly motivate someone that way!

Instead, I suggest to the helpful intercessor that the person with diabetes call or write me directly. More unfortunately, that’s never happened, as far as I can remember.

Certified Diabetes Educators have to deal with this frustrating problem all the time. So I consulting my favorite CDE, Karen LaVine, a couple of days ago when a friend of someone who is quite ill with diabetes wrote me.

“The harder she and other concerned people push, the tighter he’ll hang onto what he’s currently doing,” Karen told me. “Advice is like snow; the softer it falls, the longer it lingers in the mind.”

Where she works, they back off whenever even the individual with diabetes himself gives them verbal resistance. “It is immediately time to stop all forms of moving towards goals and back up to explore further the patient’s emotions and perspectives.”

They call this strategy “dropping the rope,” she says. The idea comes from training horses. When a horse in a corral is pulling back and resisting being led somewhere, you drop the rope and wait. Eventually the horse will start following you around.

For Karen, the approach that works is to allow the person with diabetes to feel safe to explore and express the pros as well as the cons of his current self management decisions. To do that she approaches him in a completely non-judgmental way, encourages him to express the emotional aspects of what he is currently choosing to do, summarizes his ambivalences from his point of view, and then helps him identify one or two SMART (Sensible, Measurable, Attainable, Realistic, Timely) goals for follow-up the during their next contact.

“That’s how we can begin to break up the logjam,” Karen says.

What Karen has to do to help people directly is hard enough. It’s even harder for a third party to intercede.

If you are facing this situation in your life, you have to understand his point of view and refrain from blurting out your concerns and advice, Karen says. This is as hard for most of us to do as it is crucial.

Karen cites a recent talk by Lawrence Fisher, professor of family and community medicine at the University of California, San Francisco, on “Advancing from Self-Care to Collaborative Family Care in Diabetes.” He calls self-care a misnomer, saying that we manage it with the help of many people in our social environment.