Chronic illness, diabetes and the emotional load of ongoing medical treatment
Ongoing treatment asks something of you every day, and that daily demand carries its own emotional weight. The work here treats the illness as it actually is, not as a motivation problem.
A free 15-minute call first. I usually reply within 2 working days.
You might recognise
- I do everything I am supposed to do, and I am still exhausted by it.
- I have stopped telling people how I actually feel, because the answer takes too long.
- Every appointment sits in my stomach for a week beforehand.
- I know what I should be doing. Knowing has not made it easier.
- I miss the body I had before, and I do not know where to put that.
- I have started avoiding the tests, and I am frightened of what that means.
Why it happens
Ongoing medical treatment is work. Diabetes, autoimmune conditions, cardiac and endocrine illness and many others ask for monitoring, dosing, timing, food decisions and appointments, most days, for years. The clinical term is self-management, and the volume of it is genuinely high. Fatigue after years of that is not a character flaw. It is what happens to attention and motivation when a task never finishes and the feedback is often unpleasant: a number that is too high, a symptom that returns. There is also a physiological layer. Glucose swings, inflammation, pain, disturbed sleep and some medications act directly on mood and concentration. Low mood in chronic illness is frequently a body state as well as a psychological one, and it deserves to be read that way. Then there is loss. A diagnosis often changes work, food, intimacy, travel, and the assumption that the body can be trusted without thinking about it. Grief for that is appropriate, and it rarely gets named in a fifteen-minute clinic appointment. Finally, the way illness gets talked about matters. Many people arrive having been told, in various words, that they are non-compliant. Shame is a poor engine for self-care, and it usually reduces the very behaviour it is meant to increase.
How therapy helps here
- CBT for illness self-management
- We find the exact point where a routine breaks down, rather than discussing motivation in general. That might be the evening medication, the morning measurement, or the week before an appointment. From there we run small behavioural experiments and problem-solve around the real obstacle.
- Schema Therapy for long-standing patterns
- Some people meet illness with patterns that were already there: unrelenting standards, self-punishment after a bad result, or a refusal to need anyone. Schema Therapy works with where those came from and what they are costing now, which often changes self-care more than another plan would.
- Psychophysiological techniques
- Paced breathing, muscle release and biofeedback-informed work address the body directly, which matters when arousal, pain and sleep are part of the picture. This does not treat the illness. It can reduce the load the nervous system is adding on top of it.
- Psychodynamic work with grief and identity
- Illness raises questions that techniques do not answer: who you are now, what you have lost, how much you are willing to depend on other people, and mortality. Time for these, without being sent back to coping tools, is often what was missing.
What the first sessions look like
- A first session is mostly you talking, and me asking about the illness itself: diagnosis, treatment, and what your days actually look like.
- We map where the load is heaviest. The mornings, the appointments, the meals, the nights.
- We agree on two or three things to work on, and I say plainly if I think something else would serve you better.
- By the third or fourth session you should have a sense of whether this is useful. If it is not, that is worth saying out loud.
Nobody here will call you non-compliant. You have been doing this every day for years, and that is where we start.
What this does not replace
Therapy does not replace your endocrinologist, your nurse, your medication or your dietitian, and I do not adjust doses or treatment plans. If you are in a medical crisis, or symptoms are changing quickly, that belongs with your medical team or emergency services first. Where a condition needs close multidisciplinary supervision, or where in-person care would serve you better, I will say so.
Common questions
What does a session cost, and how long is it?
An individual session is 45-50 minutes and costs €130. A group session is 90 minutes and costs €70-100. All sessions are online, in Hebrew or English.
Should I bring my medical information?
It helps, but it is not required. A list of your medications, recent results, or a letter from your clinic gives us a clearer starting point. If you would rather begin by talking, we begin by talking.
I am not depressed, I am just tired of it. Is that a reason to come?
Yes. Treatment fatigue is one of the most common reasons people come, and it does not need to reach a diagnosis to be worth working on. Naming it as fatigue rather than as failure often changes the conversation on its own.
Will you talk to my doctor?
Only with your written consent, and only when it is likely to be useful. Sometimes a short note to a treating team helps; often it is not needed. You decide, and you know what is being sent.
How long does this usually take?
Focused work on a specific difficulty often takes something like eight to sixteen sessions. Grief, identity and older patterns tend to take longer. We review it openly rather than leaving it open-ended by default.
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A free 15-minute call first. I usually reply within 2 working days.