Mary is a 40-year-old woman with three children, ages 5, 8, and 10. She was diagnosed with rheumatoid arthritis three years ago. Until recently, she had been managing her symptoms well and has...

Mary is a 40-year-old woman with three children, ages 5, 8, and 10. She was diagnosed with rheumatoid arthritis three years ago. Until recently, she had been managing her symptoms well and has continued to work part-time at a local library, care for her children, and take online courses to work toward a degree in library science. However, after a recent exacerbation of her illness, she has lost more function and now is unable to work or drive. Mary’s arthritis causes significant morning stiffness, making it difficult for her to get going in the mornings. Since her children need to catch the school bus at 8:15AM, this is a particular problem for the family. Mary is experiencing increased difficulty with all household activities, especially meal preparation and laundry. Her mother-in-law has been assisting her in these areas on a daily basis. Although Mary appreciates the help from her mother-in-law, their relationship has always been turbulent and conflicted due to personality differences. To further complicate things, Mary’s condition has negatively impacted her intimate relations with her husband. With this and the progressive nature of her condition, Mary feels that she has become a liability to her husband (and she secretly believes her mother-in-law feels the same).
In a typical day she gets up at 7:00 AM, and takes her medicine. She does a short stretching routine then gets the kids going to get ready for school. After the kids leave for school, Mary has her own breakfast. She then rests for about 1⁄2 hour and starts doing chores around the house. She works with occasional breaks until about 11:00 AM. After that Mary goes her room to get “fixed up”, because she wants to look “presentable” when her mother-in-law comes around noon.
Mary’s mother-in-law does the grocery shopping and any of the chores that Mary cannot manage. She also cooks dinner for the family several times a week. Mary knows that she needs the help, but misses cooking and feels “less” of a wife when she cannot feed her family. Miguel, Mary’s husband works the early shift and comes home around 1:00 PM. He is tired and goes to bed until about 7 PM when the family shares a meal. He is supportive of Mary and helps when he can, but his work hours make it hard for him to contribute much in the care of the children.
The doctor told Mary that she should exercise regularly to help manage her condition. Mary does not see how this is possible. She has already quit school and work, and still cannot get through the day without outside help. Because she cannot drive, Mary’s doctor has recommended therapy services from the home health agency, and although Mary is reluctant, she agrees. Mary does not want to be seen as “handicapped” and “doesn’t need anyone else bossing her around”.


Some questions to consider:


1. Traditional medical approaches to treatment would focus on the physical management of the condition. A “client-centered” approach allows consumers to identify intervention priorities. What would be an advantage of the client-centered approach in Mary’s case?
2. Consider Mary’s many adult roles that have been interrupted by her arthritis. Mary is most distressed by the limitations in her parenting and homemaking roles. What might be some secondary effects of her inability to conform to her own performance expectations?