Case Study Rosie

Background Information

Rosie is a thirty-eight-year-old, Caucasian female who lives with her husband David, her daughter Clara, age five, daughter Amelia, age two, and her invalid mother. Rosie states, “I am so exhausted from parenting. I don’t like the type of mother I have become.” Rosie is in the sandwich generation with the responsibility of her mother, who isn’t any help with the children, and taking care of the children. Her mother has Parkinson’s disease and early signs of dementia. Rosie is an only child and, therefore, the sole caretaker of her mother. She takes her mom to doctor appointments, deals with the insurance companies, and take care of her daily needs. Rosie stated that she is irritable, cranky, ungrateful, and that she adds

to the stress level of the household.
Raising the two children is also stressful for Rosie. Her first daughter Clara started talking in full sentences when she was a year old. Rosie appreciated this because she could always communicate with Clara and knew what Clara was thinking. However, Clara also learned to negotiate with her mother which makes the relationship stressful. At this time, Rosie is concerned that Clara doesn’t help pick up the toys during clean-up time in school. Amelia, Rosie’s second daughter, is very demanding as she is entering the terrible twos. While she has a normal attachment with her mother, she is also very demanding, and often wants to be held, which is physically draining for Rosie. Amelia is still nursing which also makes Rosie tired.
Rosie reports a positive, loving relationship with her husband David. He is extremely helpful with care of the children, household duties and care of Rosie’s Mom. When he is home Rosie gets a much needed break, however, David works long hours and often travels out of town on business. Therefore, Rosie carries much of the day to day family responsibilities.
Rosie is grateful that her Mother-in-law, who lives in Ohio is very helpful. Since she lives so far away, approximately twice a year she will visit for six weeks at a time. Rosie reports that this is the only time she feels like a normal, “in-control” parent. Her mother in law helps with the cooking, shopping, house cleaning and loves being with her granddaughters. She will also help with Rosie’s mother. While her mother-in-law visits, Rosie is able to have time for herself, and she and Dave can go out together on dates. However, when she leaves, Rosie feels all the stress again and becomes anxious, on edge, and exhausted.
Rosie earned a master’s degree in psychology and logically knows how to be a good parent. However, putting it into practice at this stage of her life is difficult. She reports that she would like to be a better mother, who has patience and is in control.
Diagnosis
Generalized Anxiety Disorder 300.02
Rosie has excessive anxiety and worry occurring more days than not for at least six months about a number of issues such as taking care of her mother and children, being concerned how her daughter is behaving in school, and how her children are doing in general and what if she is being a good enough mother.

She finds it difficult to control the worry. The anxiety and worry are associated with the following symptoms. Rosie is restless and feels keyed up and on edge. She is easily fatigued. She feels irritable and has muscle tension. She often wakes up during the night and is unable to go back to sleep. The anxiety, worry, and physical symptoms cause significant distress and impair her ability to care for her mother and children. This disturbance in not attributable to the physiological effect of a substance or other medical condition and the disturbance is not better explained by another mental

disorder.

Interventions
1. Mental Health Provider (MHP) taught Rosie relaxation techniques during therapy session. During the second therapy session Rosie went through a guided meditation that focused on relaxing the body and clearing the mind to help Rosie reduce her anxiety. During the third session, MHP helped Rosie download the app Headspace that provides ten free, ten minutes meditations. These sessions teach about meditation and then guide the listener through a meditation. MHP recommended that Rosie us these meditations for the next ten days.
2.

MHP and Rosie brainstormed how Rosie can simplify her life and came up with the following solutions.

a. Rosie thinks she should go to the doctor to have her health checked. Rosie, with MHP’s help called the doctor’s office during the session and made the appointment. She explained to the receptionist that she is making the appointment because she isn’t sleeping well and has elevated anxiety.

b. Rosie would like to hire someone to clean her house every two weeks. MHP gave Rosie several referrals for a house cleaner and Rosie asked several of her friends for recommendations. Together MHP and Rosie decided on the best person to clean the house based on the quality of the referral and the price. During the session, Rosie made an appointment for this person to clean her house the next week.

c. Even though Rosie is environmentally conscience, she decided she would us paper plates and buy more prepared meals until school starts in the fall and she will have more free-time.

3. MHP listened to Rosie’s concerns and validated that she is a good mother who is currently in a difficult situation. Rosie and MHP made a list of the positive things she does as a mother. Rosie took the list home and plans to add items to the list and read it once a

day.

Treatment Plan
Problem: Rosie is anxious and impatient with her children. She feels out of control as a mother.
As evidenced by: Yelling and getting upset with children, feeling fatigued and overwhelmed, and an inability to get a good night’s sleep.
Long term goal: Rosie will reduce her anxiety and worry so she can have more patience with her children and be able to sleep through the night.
Short term objectives:
1. For the next ten days, Rosie will spend ten minutes a day meditating with the headspace app before her husband leaves for work or when he gets home at night. Rosie will also practice meditation when she wakes up during the night to help her clear her mind and go back to sleep.
2. For the next month, when Rosie feels anxious during the day, she will focus on the present moment, by slowing down her breathing and focusing on her present moment sense of smell, touch, sight, hearing, and taste.
3. For the next two months, Rosie will keep a gratitude journal. Every night before she goes to sleep, she will write down two good things about the day for which she feels gratitude.
Long term goal: Rosie will find two hours of time for herself three times a week.
Short term objectives:
1. In the next week, will make a list of three friends whom she would be comfortable watching her children and vice versa. The following week, Rosie will talk to the three friends about trading babysitting with each other. She will them made a date for she and her friend(s) to trade babysitting.
2. For the next three months, on Saturday or on an evening during the week, Rosie’s husband will watch the children while she has time to herself. Rosie will plan activities such as getting a massage, going to a movie with a friend, or hiking.
3. Once a week or every other week, Rosie will hire a babysitter she has used in the past to babysit the children while Rosie and her husband go out on a date.

Legal/ ethical concerns
Rosie once said she pushed her Clara towards the car when Clara refused to get in. Clara ended up falling down which made Rosie feel out of control and guilty. Rosie needs to get help before she becomes so out of control that it will be necessary to call Child Protective Services. Without help, she may start abusing her children.

Provisional Prognosis
I believe that Rosie’s prognosis is good because she has many strengths. She desires to be a good mother and attends therapy and parenting classes. She is also at the peak of difficulty in her child-rearing years. Next year Clara will be in Kindergarten for 8:00 am to 2:00 pm five days a week. Amelia will be attending preschool three days a week from 9:00 am to 12:00 pm. This will give Rosie nine hours a week of free-time. If she still feels overwhelmed or needs more time on a particular day, she can extend Amelia’s day at preschool by two hours. I believe that with this extra free time, and if Rosie will continue with her mindful meditation skills, and simplifying her life, she can overcome this anxiety and become the peaceful mother that she wants to be.