only Goals, objectives, and interventions… Roberta was a 69-year-old, never-m

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only Goals, objectives, and interventions… Roberta was a 69-year-old, never-married woman who sought treatment. She reported “being in a funk all the time,” having trouble sleeping, and being overwhelmed by the demands of caring for her 62-year-old brother, Jonathan, who had long been disabled by bipolar disorder. Roberta’s mother, Edna, had been Jonathan’s caregiver his whole life, but when she died one year ago after a long battle with Parkinson’s disease, his care fell primarily to Roberta and secondarily to her sister, Geraldine, who lives further away from Jonathan than Roberta and has children of her own for whom she is primary caregiver. Because Roberta has never been married and has no children, the family assumed she would take over Jonathan’s care, but this was never discussed. Roberta had been employed for many years as a clerk in a local bookstore, but she was severely injured by an uninsured driver in a car accident 13 years ago and was forced to retire early on disability. As a result, Roberta has very limited financial resources.
Roberta resides in a one-bedroom apartment and has just received notice that her rent is being increased. She lives in an expensive community and, while the rent used to be affordable, the complex changed owners five years ago and her rent, which had been stable for 20 years, has been increased incrementally every year over the past five years to the point that she now feels she cannot afford to remain there and “feels overwhelmed” by the thought of leaving her home and community of more than 25 years.
Jonathan recently moved into Roberta’s apartment and is sleeping on her couch. The move was necessitated by the need to get their mother’s home ready to sell. The home needs a significant amount of work, but their mother owned it outright, and it is in a desirable neighborhood. The proceeds will be split between the three kids, which will help, but there is concern that Johnny will lose all of the medical and disability benefits, which he is used to and on which he depends, if he suddenly inherits some money from the sale of his mother’s house.
Roberta states that, “we don’t really get along.” She sees her brother as very rigid in both his personality and expectations. Their mother “did everything for him,” according to Roberta, and she feels that he expects Roberta to do the same. Roberta states, “I know Johnny has problems, but he has never worked and never lifted a finger. It’s no wonder things never get better for him.” In the past month, Roberta and Jonathan have argued frequently about “everything,” and Roberta tearfully states, “I’m not sure how much longer I can take all this.” Jonathan is relatively healthy but is easily distracted and “doesn’t do anything for himself” according to Roberta. “He didn’t clean up after himself, cook, or do anything when he lived with mom, and now he thinks I’m just going to take over,” Roberta states through gritted teeth. Roberta reports that her brother’s care was “just sort of thrust upon me” and that there is no short-term or long-term plan for his ongoing care needs beyond sleeping on her couch until her mother’s house sells.
Roberta has several strengths and resources that have helped her through this difficult time since the loss of her mother. She is on the Board of Directors of the City Library where she lives, and she finds great pleasure in still being involved in “the world of books,” as she calls it. She has recovered significantly from her car accident of 13 years ago and is able to walk and take care of herself independently, but she now gets periodic migraine headaches, which she says, “totally derail my whole day. I have to take medication that basically knocks me out, and I have to stay in the dark for many hours until the headache passes.” She didn’t get these headaches prior to the car accident, but since then gets them as frequently as twice a week, but usually once per week on average. The headaches prevented her from getting a job, as did the long road of recovery from her other injuries, which required years of physical therapy and three surgeries. Even so, Roberta feels optimistic about her recovery from the accident and often talks about “how far I’ve come.” She says, “I can live with the migraines because they aren’t every day. I can still have a life.”
Furthermore, Roberta has lived and been involved in her community for almost three decades, so she has several close friends and many acquaintances, from the Library Board, for example, who have been a good source of support for her since her mother’s death. She used to go out to eat with friends a couple times per week, but with her increased rent she has felt the need to cut back on that. She has further limited her time with friends over the past month since her brother moved in, because “he makes me feel guilty when I leave him to go out, but he’s rude to my friends when they come over.” For example, she was a part of a regular bridge circle for which hosting rotated, but she was so embarrassed when she hosted this week, and her brother interrupted their game with this long rant about “oversexualized old ladies causing trouble” that she ended the game early and didn’t attend the next meeting. So overall, Roberta reports that her social support has been significantly reduced because of finances and her brother. Roberta says, “Lately, I feel so alone, even though Johnny is here all the time.”
Roberta stated that she thinks about dying, “mostly because I miss mom so much,” but she denies suicidal ideation or intent. However, she did emphasize that “I can’t continue to live like this—something has got to change.”

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