Question: Vignette Analysis II:

Vignette Three (3-4 page response) Erik a 40-year-old, man of European descent, is a husband and father of three children, ages two, five, and eleven. Erik was diagnosed with brain cancer four months ago, and his wife, Judy, reports that his illness not only impacts the couple's sexual relations, but also the level of intimacy they once shared.

Prior to Erik's diagnosis, the family was very active. Both Judy and Erik enjoy literature, and would often discuss books of interest. They both love the outdoors, and would often take part with their children in many outdoor activities such as bike riding, hiking, and kayaking. Once Erik was diagnosed, those activities came to a halt.

Erik reports that the level of intimacy he once felt with Judy has changed because he feels isolated and alone; different from other people. He doesn't feel that Judy truly understands his perception of his illness or what he is going through emotionally or physically.

Due to Erik's treatment regimen, Judy reports that she and Erik are often unable to predict how he will feel at any given time during the day. In addition, she states that caring for Erik and tending to the needs of their three children exhausts her and leaves her with little time to care for her own needs. She feels disconnected from Erik, as they often have little time to talk about anything other than his and the children's care.Does intimacy become more important after a diagnosis such as Erik's? Why or why not? What psychosocial effects of Erik's cancer might impact his sexual relationship with Judy?

What physical influences on intimacy might exist for Erik and Judy? What key elements of the Interpersonal Process Model of Intimacy might you use to foster the development of intimacy between this couple?

How would you use the principles of the Relationship Intimacy Model to guide your interventions with this family? Based on Judy and Erik's description of their relationship prior to Erik's diagnosis, what are the chances of their relationship improving? Vignette Four (3-4 page response)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.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?

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?

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?

Reference: Larsen, P.D., Whitney, F.W. (2016). Chronic Illness: Impact and Intervention. (9th edition). Burlington, MA Jones & Bartlett Learning. ISBN: 978-1284049008