Living with Diabetes

Shifting from Drama to Empowerment

Drama in Healthcare Conversations

More and more, doctors and other healthcare professionals are finding that reacting to the problem of diabetes as a way to motivate patients to take responsibility for their health care decisions is an ineffective pathway to sustainable behavior change. Many healthcare professionals ask, “Why can’t patients just take the good information we give them and take charge of their health?” Subsequently many patients feel and act like victims of their health “problems.”  This triggers healthcare providers to rescue the patient and then, ironically, become the object of persecution by the patient when he/she is unable to attain maintainable results.

This is the drama that many health professionals find themselves enmeshed within.  Patients and health care providers alike are stuck in conversations that often result in despair, blame and disempowerment.

Over forty years ago, psychologist Dr. Stephen Karpman explained why many people react to life’s problems with so much drama and disempowerment.  He observed that people, when under pressure, behave either like a Victim, Rescuer or Persecutor (or all three).  Dr. Karpman named this set of relationship roles and dynamics the Drama Triangle. It is exactly these roles that many patients exhibit when relating to their diabetes.

Healthcare Conversations that Transform Drama into Patient Empowerment

There is a desperate need to create new conversations that transcend the drama and increase the likelihood of patient empowerment.

Over the last few decades, counselors and therapists have widely come to understand that these roles create a toxic brew of ineffective relationships, which is why I have come to call Karpman’s model the Dreaded Drama Triangle (DDT) ™.  Up until now, when the triangle was used, patients were often told, “Now that you know about the drama roles, don’t engage in them anymore.  Nothing good comes from being a victim, looking for someone or something to rescue you, or acting like a persecutor by blaming others.”  But what is the alternative?  How does a patient and/or a health care provider escape the Drama Triangle?

“There has got to be an alternative!”  That is what I said to myself after learning about the Karpman Drama Triangle. As I pondered the question of an alternative, a powerful new triangle of relationships began to take shape, with three new roles: Creator, Challenger, and Coach.  These more resourceful and empowering roles provide an “antidote” to the DDT roles. I eventually named the new triangle TED* (*The Empowerment Dynamic)™.

Riding the Diabetes Roller Coaster

Some years after this insight, I was diagnosed with type 2 diabetes. As an executive coach, leadership development professional and someone who specializes in behavior change, one could expect that I would be equipped to respond to the shock of the news.  However, like so many others, I unwittingly fell firmly into relating to my disease through the DDT. Diabetes was the Persecutor and I was its Victim.  I turned to my doctor hoping that the medical profession would be my Rescuer.

I have been lucky in that I have been able to manage my diabetes fairly well.  But one day, after a periodic trip to my doctor, I learned that my blood sugar numbers had increased again. While I understand that diabetes is a progressive disease and my numbers will change overtime, it also dawned on me that I was riding the “diabetes drama roller coaster!”

The ride goes like this: for a time I would take focused action, which included oral medication, diet and exercise, and the numbers would come down.  Feeling good about the success, I would relax from healthy food choices and slack off on exercising.  Of course, in relaxing my focus on doing all that I need to in managing my diabetes, the numbers would again increase!”

While this roller coaster is all too typical, it was not the way I wanted to live with diabetes in the long run.  I had been living with diabetes from what I call a Victim Orientation, in which I focused on the disease as a problem that aroused my anxiety, which would cause me to react by trying to do what I was told by my healthcare professionals, only to ride another round of the roller coaster.

This is how the roller coaster looks and unfolds:

The Victim Orientation and Roller Coaster Results

Once I realized I was on the roller coaster, like I did years before, I told myself again that there had to be an alternative.  It was time to step up and practice what I teach.  Rather than reacting to the diabetes as a problem, I decided to shift my relationship to it by adopting a Creator Orientation, in which the focus is on what one passionately wants to create.

Focusing on Optimal Health

The TED* way of thinking helped me to shift my focus from what I don’t want (diabetes) to what I do want (optimum health).  This shift in thinking allowed me to embrace the fact that I could become Creator of my own health and develop an empowered approach to living with diabetes. I now see diabetes as a Challenger that has come into my life to teach me about health. I am learning to eat differently, exercise regularly and take the Baby Steps necessary to live with purpose, resourcefulness and a sense of wellbeing.   I no longer look for the perfect path to “fix” my diabetes.

This has created a different conversation with my doctor and healthcare team.  Rather than relying on them to be a Rescuer, I am taking greater responsibility for creating health in my life and look to them to act as a Coach in helping me make informed choices and taking Baby Step actions as I live into my vision.

Diabetes educators and other healthcare professionals can help facilitate a similar shift for their patients.  It begins by treating patients as Creators who are responsible for their health and diabetes management and who are capable of optimal health, rather than treating them as Victims of their disease.  This evolves as a practitioner by primarily acting as a Coach, rather than a Rescuer.

TED* (*The Empowerment Dynamic) provides a positive approach to life’s challenges. It provides an effective escape from the drama that health care professionals often experience with their patients and can generate new and empowering conversations.

David Emerald is a coach, leadership educator, consultant and speaker. His first book, The Power of TED* (*The Empowerment Dynamic) was published in 2005.   His second book, co-authored with Dr. Scott Conard MD, is TED* for Diabetes: A Story of Health Empowerment was published in 2012.  He is a frequent guest presenter and facilitator on leadership topics and creating sustainable behavior change.  David is a person living with type 2 diabetes.  He can be contacted through his website ( or at and 206-780-0994.
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