It’s time to flourish with diabetes!: An interview with Riva Greenberg and Boudewijn Bertsch about this new world view

Over the past few months through this blog we’ve shared some thoughts, insights and innovative approaches around living well with diabetes and creating possibilities, opportunities, and a vision for the future. Through several projects we’ve been working on we became familiar with the like-minded work of Riva Greenberg and Boudewijn Bertsch and their Flourishing Approach to living well with diabetes. So, we connected and shared ideas. We thought our readers would be interested in Riva’s and Boudewijn’s Flourishing Approach, and they were gracious enough to share their time and thoughts with us.

1. Tell us about the core principles of the Flourishing Approach to living with diabetes, and how it differs from the traditional Healthy Coping approach.

Riva (and Boudewijn): I find it interesting that we call the conventional approach to diabetes management, “Healthy Coping.” That’s truly a mixed metaphor. For people with diabetes, coping does not translate positively. Their association with coping is a sense of just getting by or struggle.

The Flourishing Approach that we designed and have shared with thousands of health professionals around the world, is a paradigm shift and a new world-view, which I will explain.

Our conventional approach takes a machine-view of the body and, while most health professionals don’t realize it, causes us to see and treat people like machines. The approach grew out of acute care, however in acute care, you can repair, heal or cure someone. Here machine values make sense.

Modern medicine adopted the values of the Industrial Revolution: accuracy, precision, perfection, standards, linearity, cause and effect. These remarkably advanced medical tests and technologies. Unfortunately, they do not foster what people need to live well with a chronic illness – adaptability, growth, healing and developing resilience. Nor do they inspire the tissue of self-care – connection, confidence and commitment.

Seeing people with diabetes as machines we see defects. In contrast, the Flourishing Approach (FA) sees a person with diabetes as a biological organism. As such we see they are now in a new state, redesigned, not disabled but differently-abled. From this orientation, the Approach brings no  judgment and the direction, rather than fixing, is to promote growth and wellness as living organisms are designed for.

The Flourishing Approach also, unlike the conventional approach, sees diabetes as a complex condition and the person with it operating in a complex world. As such, you cannot apply cause and effect thinking. We cannot say, “Do this and that will happen,” there is too much complexity.

Nor can we apply accuracy and precision to blood sugar management. Telling a person with diabetes that they can “control” their blood sugar is not only untrue, it sets them up for failure. Instead, we need to nurture and equip individuals to help influence their blood sugar and respond appropriately.

The core principles in the Flourishing Approach are based on human sciences, neuroscience, biology and social sciences and according insights like we need to feel safe to function at our best. “Best practices,” culled from the masses pale against individualized “emergent practices.” The FA helps people explore their own solutions; we don’t impose standards based on averages.

As an orientation the Flourishing Approach: 1) is relationship-centered, both practitioner and person with diabetes bring their mutual strengths, expertise and ideas together, 2) explores the patient’s context 3) uses open conversations where solutions emerge 4) is positively focused, looking for what’s working and 5) aims to achieve what’s wanted, better health, not what’s to be avoided, complications.

2. The work we @AFreshPOVforYou are doing is centered around the solutions focused brief therapy approach. How does that align with the Flourishing approach?

Riva (and Boudewijn): The Flourishing Approach is based on several sciences that explain how we operate as a biological organism. Solution focused brief therapy (SFBT) is one of these theories. But it’s important to understand the FA is not just a set of tools, but a different paradigm. One can use SFBT within the conventional treatment approach. For instance, we can ask patients positively-focused questions yet still assume the mantle of the expert who has the answers.

The FA is based on Systems and Complexity theory, that we operate within systems – home, family, work, community, culture, country, and that diabetes is complex and medical sociologist Aaron Antonovsky’s ‘Sense of Coherence’ and Dr. Stephen Porges’ Polyvagal Theory.

Porges identified a third autonomic nervous system (ANS) in addition to the sympathetic and parasympathetic. He calls it the social engagement system. In this state we are most open, flexible, creative, adaptive and push forward confidently into the world. But to be in this state we must feel safe. So, I ask practitioners when I present at conferences, “What do you do to help your patients feel safe?” They have never thought of it before. The FA being relationship-centered, not patient-centered, heightens safety.

3. How can readers learn more about the Flourishing Approach?

Riva (and Boudewijn): The Approach appears in two issues of the Academy of Nutrition and Dietetics, peer-reviewed journal, “On the Cutting Edge,” The Flourishing Treatment Approach: A Strengths-based Model Informed by How People Create Health and A Flourishing Approach to Mental Health in Patients With Diabetes.

4. Would you share an impactful story/experience surrounding the Flourishing Approach.

Riva (and Boudewijn): In January 2014 we spent three weeks sharing the Approach with the medical staff of Jnana Sanjeevini Diabetes Center in Bangalore, India. One day a dietitian came up to me. She told me she’d followed our teaching and asked her patient what he was doing well and what he’d like to try next. The whole visit, she said, was light and filled with laughter and he left excited. Normally, she said, she’d try to push him to do what she thought he should, he’d leave downhearted and nothing would change.

We also have a diabetes nurse from Steno Diabetes Center in Denmark, where I’ve done a lot of training, tell me her patients are changing behaviors more easily, and she is happier in her work using the Approach.

5. What one thing would you like readers to know?

Riva (and Boudewijn): I don’t discount today’s conventional approach. It works for some. My aim is to expand health professionals’ repertoire and people with diabetes’ possibilities by using a human-, not machine-, based approach.

We’ve had numerous innovations in diabetes medicine, tools and technologies, in software and hardware. Yet no innovation in treating patients. The Flourishing Approach is an innovation in this essential aspect we all but ignore, heart-ware.

I’ve presented the Flourishing Approach at diabetes conferences around the world – the ADA and AADE annual conferences, the Charles H. Best Diabetes Center in Canada, and at conferences in Israel, Sydney and Singapore. I have also presented the Flourishing idea to device and pharma companies. This December I’ll be presenting it at the International Diabetes Federation World Congress in Busan, Korea.

If anyone is interested in a presentation on the Flourishing Approach and/or workshop, where I teach a few tools from the Approach, they can contact me at riva@diabetesbydesign.com.

Thank you Riva and Boudewijn for your encouraging solutions focused approach to flourishing with diabetes!

To learn more, here are links to Riva’s Books: Diabetes Do’s & How-To’s; 50 Diabetes Myths That Can Ruin Your Life; The ABCs of Loving Yourself With Diabetes Here’s the link to Riva’s Blog: diabetesstories.com. 

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