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A 34-year-old woman presented saying she was tired, run-down, and "stressed-out of my mind". She was working part-time as well as caring for three children aged 10, 8 and 5 years. Her husband was a shiftworker, and she felt increasingly that he expected her to "handle everything" at home so that he could sleep.

Assessment

A detailed history revealed that a major concern was the recent diagnosis of breast cancer in the patient's mother. She felt anxious about what would happen to her mother, and guilty that she had not been in more regular contact with her. Assessment of the family's domestic situation revealed that the patient had always assumed complete responsibility for all housework, shopping and budgeting, and although she resented her husband's inactivity she never discussed her anger or asked for assistance. There was no evidence that she was suffering from major depression. She did not consume alcohol or smoke.

Management

After initial discussion of her problems, the patient volunteered that she had contributed to the situation by "always doing everything", and not allowing others to help. She reflected that she tended to be critical of the children's efforts, for example in making their beds, and that she needed to revise her standards, allowing them to assume some minor responsibilities.

Discussion focused on the need to discuss her concerns with her husband, and look at ways they could renegotiate the division of domestic tasks. A major issue was to address her perception that everything at home "had to be perfect". Instead, the patient was encouraged to decide what really mattered and to set some limits at home. Promoting her need to have some time for herself (e.g., reading, meeting with friends) initially met with some resistance, but eventually she saw that these would be a useful "safety valve".

Demonstration of relaxation techniques was particularly helpful.

Other issues

Receiving information about breast cancer allowed the patient to help her mother more realistically, and put some perspective on her fear that she herself might develop the disease. Awareness of her own contribution to the problem allowed the patient to recognise her responses to stress, and to handle some things differently.