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Original Question

Jose and Maria, are a 48-year-old Hispanic American couple, married for 28 years. The couple has 3 grown children, all in college or living on their own. Maria has been struggling with MS for the past 10 years. Research shows that women with MS live with the unpredictable course of their disease and doubts about their worthiness, attractiveness, and identity. The male partners of these women with MS perceived little impact on the women’s sexuality, likely because the women went to great lengths to maintain their customary roles and to buffer their male partners from the full impact of the disease. Recently Jose, was diagnosed with Stage I testicular cancer. His doctor informed him that he needs surgery and chemo treatments. Jose tells you that he feels “unreal and in another world” and “at the mercy of the cancer and the treatments.” The ultimate question he cannot get out of his head is: “Am I going to die?” Jose loves his wife and children, and with their first grandchild (a boy) on the way, he wonders if he will ever get to see him. Since the diagnosis, Maria tells you that Jose is distant, has no interest in intimacy. She knows it is his cancer diagnosis, but can’t help but think that her own chronic illness is part of the problem. A. The phenomenon of powerlessness is dynamic and complex in chronic illness. Feelings of powerlessness can recede and advance throughout the course of the chronic illness as individuals negotiate between control and loss and the changing landscape of their daily realities. Powerlessness can extend beyond medical and treatment issues to feelings of insecurity and threats to social and personal identity. What do you think that Jose has experienced over the course of his illness? His family? His friends? How about Maria? B. Chronic illness is described as a dialectic between the individual and his/her world. Clients shift between the perspectives of wellness in the foreground and illness in the background. What are Jose and Maria’s experiences and actions as you examine the principles of the Shifting Perspectives Model? How can you apply the principles of the Self-Determination Theory to Jose and Maria’s situation? C. Outcomes associated with powerlessness in clients with chronic conditions can be measured from three perspectives: self, relationships with others, and client behaviors. What specific outcomes do you think that Jose and Maria would want? Their family? Their friends? Their healthcare providers?

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