Analysis of Eleanor Rigby :: Douglas Coupland

Eleanor Rigby is a story about a 30-something female who lives her life with a very conscious and accepting feeling towards to her complete loneliness. She never goes out beyond her daily work experience, which she begins by counting down to her predicted date of death. This seemingly perfect mirage of a life is broken when Liz receives a phone call from the hospital saying that she best come to the E.R. As she arrives she meets a charming young man who turns out to be her son Jeremy, who she gave up after a drunken one-night-stand in the 10th grade on a school sponsored trip to rome. Soon after being reunited with her son the doctors tell her that he has m.s. and that he doesn't have much time to life. Liz takes him home and begins to care for him, marking an incredible change in her life. As Jeremy's condition declines, Liz's attitude towards life progresses, and soon she finds herself in a journey to find Jeremy's father, and to find real meaning in life. Eleanor Rigby starts out slowly and in many instances you may be tempted to put down the book, so one may be able to shut distance themselves with Liz Dunn?s seemingly incessant whining. Yet as the novel progresses it is impossible not to feel compelled by the read. Coupland incorporates dark humor that drips off of every page leaving the reader satisfied. At times its hard not to read with a smirk on ones face. Yet the reality of the story is so real and just that the reader will find their minds wandering towards thoughts of the Liz in their life, or the liz in themselves. The theme is that the prescient knowledge of death exists not to discourage but to motivate one to acknowledge the shortness of life and to exist with the greatness any individual possesses. This is supported throughout the novel by many moments coated with loneliness and sorrow. and these moments seem to permeate all of what occurs. Liz seems to live off of this feeling of intense solitude and use it as an excuse to be mediocre in life. Only when Jeremy is introduced into her life does she begin to take on roles she should have been motivated to do so earlier, and only when his imminent death becomes a pressing factor does she realize why he is not a miserable person.

Problems with The Decision to Drop the Atomic Bomb Essay -- Geopolitic

The world changed June 6, 1945 when the atomic bomb was dropped on Hiroshima and then again, Aug 9, 1945 on Nagasaki. The actions by the United States evoked a cataclysmic spiral in the morals and methods of how warfare is carried out. Officials within the United States government through both memorandums and meeting voiced their concerns with the use of nuclear technology. They worked tirelessly to persuade President Truman that the atomic bomb was a weapon of destruction far beyond the span of normal warfare. Truman and Japan were looking toward peaceful resolutions under their own separate terms, but each struggled with the definition of â€Å"unconditional surrender†. The decision to drop the bomb was faulty and skewed judgment on the part of President Truman, which cost the lives of innocent civilians in Japan. The recourse in not dropping the atomic bomb was made available to President Truman and the leaders of America; unfortunately no one can go back and disentangle what was done that day in Japan. Even after the first bomb was dropped, U.S. Army Chief Staff General Marshal met at the White House on June 18, 1945, with President Truman and brought to light three alternatives to the use of the atomic bomb; â€Å"1) destruction already route by air bombardment and sea blockade, coupled by 2) a landing on Japan indicating the firmness of our resolution, perhaps coupled with 3) the entry of threat entry of Russia into the war.† General Marshal also stated that the entrance of Russia into the war might be just the leverage needed to bring the Japanese to terms of surrender, rather than the use of the bomb. This memo displayed that President Truman had alternatives to consider, but yet decided to go against the ideas that ... ...mmanding General’s File, 24 Tab D ,Document (a). Henry Stimson, Memorandum discussed with the President, April 25, 1945, Henry Stimson Diary, Manuscripts and Archives, Henry Lewis Stimson Papers, Yale University, (New Haven, CT.), Document(b). Joint Chief of Staff, "Minutes of Meeting Held at the White House†, 18 June 1945†, RG 77, MED Records, H-B files, folder no. 76, Document 20. President Harry Truman, Truman's Potsdam Diary, Barton J. Bernstein, "Truman At Potsdam: His Secret Diary," Foreign Service Journal, July/August 1980, Document 38. Secretary of War, Henry Stimson, Diary Entry, April 25, 1945, Henry Stimson Diary, Sterling Library, Yale University, Document (d). Secretary of the Navy, James Forrestal, Diary Entry, July 24, 1945, "Japanese Peace Feelers", Naval Historical Center, Operational Archives, James Forrestal Diaries, Document 23.

Hey There Delilah Chord

INTRO D, F#m, D, F#m VERSE 1 D F#m Hey there Delilah, What’s it like in New York City? D F#m I’m a thousand miles away, But girl tonight you look so pretty, Bm G A Bm Yes you do, Time Square can’t shine as bright as you, A I swear it’s true. D F#m Hey there Delilah, Don’t you worry about the distance, D F#m I’m right there if you get lonely, Give this song another listen, Bm G A Bm Close your eyes, Listen to my voice it’s my disguise, A I’m by your side. CHORUS D Bm D Bm Oh it’s what you do to me, Oh it’s what you do to me, D Bm D Bm Oh it’s what you do to me, Oh it’s what you do to me, D What you do to me. VERSE 2 D F#m Hey there Delilah, I know times are getting hard, D F#m But just believe me girl some day, I'll pay the bills with this guitar, Bm G A Bm We'll have it good, We'll have the life we knew we would, A My word is good. D F#m Hey there Delilah, I’ve got so much left to say, D F#m If every simple song I wrote to you, Would take your breath away, Bm G A Bm I’d write it all, Even more in love with me you’d fall, A We’d have it all. CHORUS D Bm D Bm Oh it’s what you do to me, Oh it’s what you do to me, D Bm D Bm Oh it’s what you do to me, Oh it’s what you do to me, Bridge G A A thousand miles seems pretty far, But they’ve got planes and trains and cars, D Bm I’d walk to you if I had no other way G A Our friends would all make fun of us, And we'll just laugh along because, D Bm We know that none of them have felt this way, G A Delilah I can promise you, That by the time that we get through, Bm A The world will never ever be the same, And you’re to blame. VERSE 3 D F#m Hey there Delilah you be good, And don’t you miss me, D F#m Two more years and you’ll be done with school, And I'll be making history, Bm G A Bm Like I do, You’ll know it's all because of you, G A Bm We can do whatever we want to, G A Bm A Hey there Delilah here's to you, This one’s for you. FINAL CHORUS D Bm D Bm Oh it’s what you do to me, Oh it’s what you do to me, D Bm D Bm Oh it’s what you do to me, Oh it’s what you do to me, D What you do to me. Bm D Bm D Bm D Bm D D Ohhh

Key Issues in W.E.B. DuBois’ The Souls of Black Folk

The Souls of Black Folk, by W.E.B. DuBois, is a compilation of essays written by DuBois and first published in 1903. In these essays, DuBois covers many of the problems that he sees in the lives of African American people. These multitude of problems can be summed up into one issue, â€Å"the problem of the color-line† (DuBois 1994, 9).DuBois sees this â€Å"color-line† as the root of difficulties for his race reaching back to the days of the Civil War, but he claims to really see it take hold in the era that he published his book, the early twentieth century (DuBois 1994, 9). Through his collection of essays, DuBois allows the reader to see multiple events pertaining to the lives of African Americans through his eyes, and paints the history of black struggles in ways that might not have been clear to someone who had not been so close to them.DuBois chose to begin each of his essays with a â€Å"sorrow song,† a line or two of music that â€Å"welled up from blac k souls in the dark past† (DuBois 1994, 1). These bits of song give the tone for each of the essays. DuBois speaks of being â€Å"a problem† to the white world around him, but he sees major issues in his time that keep people thinking of him as â€Å"a problem† (DuBois 1994, 2). These issues are those of â€Å"work, culture, and liberty,† (DuBois 1994, 6), things that DuBois does not see coming easily to his people.At the time, they lacked the right to vote, many lacked adequate schooling, and the â€Å"emancipation† granted in the Civil War era had not led to anything resembling true freedom (DuBois 1994, 6). An example of this lack of freedom is illustrated in the chapter, â€Å"Of The Black Belt.† This particular essay gives the reader the view from a traveling buggy in early twentieth century Georgia (DuBois 1994, 53). Due to recession after the war, most of the land has been abandoned by the previously wealthy owners, and is being rented to the African Americans who are willing to work on it (DuBois 1994, 53).These African Americans live in broken down plantations houses, barely fit for inhabitation, but still must pay exorbitant rents to the people who previously lived there (DuBois 1994, 53). On top of the out of control rents, no amount of money that the African Americans pay ensures them of ever owning any home or land (DuBois 1994, 60). The work they had   done on the land over the years quite often ended up sold to a white person, not matter how much the African American had paid on it (DuBois 1994, 61).Most of them are destitute, for all the money they make from growing crops goes into the hands of their landlords (DuBois 1994, 57). For a few older people, these landlords are their former owners. DuBois does not see this as freedom in any way. In fact, in the chapter â€Å"Of the Quest for the Golden Fleece† he is critical of the Emancipation due to the fact that it turned out so many slaves on thei r own, slaves who had not thought past being freed, and eventually caused them to come back to their former owners in order to have food and a place to live (DuBois 1994, 66).Another issue that DuBois finds relevant to the problem of the â€Å"color line† is the general lack of higher educational options, or â€Å"culture,† for the African American. In â€Å"Of Mr. Booker T. Washington and Others† DuBois gives the credit for a lot of this problem to Booker T. Washington and his plan of â€Å"Negroes (surviving) through submission† (DuBois 1994, 27). Washington’s plan was threefold. In it, African Americans should give up, â€Å"at least for the present: political power, insistence on civil rights, and higher education of Negro youth† (DuBois 1994, 27).Washington believed that these things could be accomplished later, but â€Å"compromise† would further the Negro cause at the time. DuBois was very much opposed to this system, stating t hat it caused, â€Å"the disfranchisement, the legal creation of a distinct status of civil inferiority, and the steady withdrawal of aid from institutions of higher training for the Negro† (DuBois 1994, 27).   He questioned any plan that would continue holding back his race, saying that Washington was hindering by bringing up the old â€Å"attitude of adjustment and submission† (DuBois 1994, 26).Another problem point for DuBois was the lack of liberty that his people had. For example, in the chapter â€Å"On The Coming of John,† DuBois tells the tale of a young African American man who strived to get past the â€Å"veil†and make something of himself. At first he was a poor student, but he refocused after being kicked out of school and came back with a real desire to learn. This learning, however, made him aware of the many things that he was excluded from.He â€Å"noticed now the oppression that had not seemed oppression before,† was angry when people did not call him â€Å"mister,† and was offended at having to ride in the â€Å"Jim Crow† cars (DuBois 1994, 95). The story continues on with the young man facing racism at every turn. The essay ends with the young man having exerted liberty by saving a young Negro woman from an amorous white man, whom he kills, but the liberty of action came at a price. As we leave the tale, the young man is sitting calmly at the site of the crime, waiting for the lynch mob he hears from far away to come get him (DuBois 1994, 102). The message that the tale conveys is that the lack of liberty to take part in the white world in bound to lead to disenchantment and anger for those held behind the â€Å"veil† (DuBois, 1994, 95).DuBois tackles the topic of African American religion in the chapter, â€Å"Of the Faith of the Fathers.† He explains the roots of Negro religions on the plantations. They were more likely to be pagan and voodoo like, because that is what most of them were taught in their native lands (DuBois 1994, 84). It took the impressions of missionaries and plantation owners to give the religion a â€Å"veneer of Christianity,† and it took several generations for the Negroes to come to a following of authentic Christianity (DuBois 1994, 84).However, DuBois has a problem with how Christianity came to be presented to the slave population. Whereas the â€Å"voodoo† type religions had â€Å"deepened and strengthened† the slaves, Christianity was manipulated by the plantation owners to weaken them (DuBois 1994, 84-85). In DuBois’ opinion, the Negro had been so run down that he was â€Å"losing the joy of this world† and â€Å"(eagerly) seizing upon the offered conceptions of the next† (DuBois 1994, 85). The Negroes became â€Å"fatalistic,† and with that fatalism came the traits of â€Å"shiftlessness† and â€Å"hopelessness† (DuBois 1994, 85).When they became free, many turn ed their religion into an idea of â€Å"revenge† (DuBois, 1994, 85). The â€Å"Coming of the Lord† was looked for, and people pledged to die before going back to slavery (DuBois 1994, 86). There was also an idea that the slave owners would get their punishment when the Lord came, so the event was highly anticipated. At the time DuBois was writing, religion had split into two sectors for the Negro. Northern blacks held a vengeful ideal, and Southern blacks fell into â€Å"hypocritical compromise† (DuBois 1994, 87). Neither were ideal, and DuBois closed with the hope that there would be an â€Å"awakening† and â€Å"the real Negro heart† would come â€Å"out of the Valley of the Shadow of Death,† and create a new world where the things he desired for his people would not be â€Å"for White People Only† (Dubois 1994, 88).There is much more that could be said about DuBois’ essays, but the main thing that this writer believes that h e would want a person to take from his work is the idea that one group of people cannot be subjugated forever. Although some may not want to work for freedom, there are always a few that will want to learn and make a better person out of themselves. Instead of a taste of liberty angering them because they cannot do anything with it, the taste should bring them joy as they are accepted into the new world they have so longed for. DuBois never got to see a world like that, but perhaps one day his descendants, and ours, will.Reference ListDuBois, W.E.B. 1994. The souls of black folk. New York: Dover Publications.

A Dirty Job Chapter 9

9 THE DRAGON, THE BEAR, AND THE FISH In the hallway of the third floor of Charlie's building, a meeting was going on between the great powers of Asia: Mrs. Ling and Mrs. Korjev. Mrs. Ling, by holding Sophie, had the strategic advantage, while Mrs. Korjev, who was fully twice the size of Mrs. Ling, possessed the threat of massive retaliatory force. What they had in common, besides being widows and immigrants, was a deep love for little Sophie, a precarious grasp on the English language, and a passionate lack of confidence in Charlie Asher's ability to raise his daughter alone. â€Å"He is angry when he leave today. Like bear,† said Mrs. Korjev, who was possessed of an atavistic compulsion toward ursine simile. â€Å"He say no poke,† said Mrs. Ling, who limited herself to English verbs in the present tense only, as a devotion to her Chan Buddhist beliefs, or so she claimed. â€Å"Who give poke to baby?† â€Å"Pork is good for child. Make her grow strong,† said Mrs. Korjev, who then quickly added, â€Å"like bear.† â€Å"He say it turn her into shih tzu. Shih tzu is dog. What kind father think little girl turn into dog?† Mrs. Ling was especially protective of little girls, as she had grown up in a province of China where each morning a man with a cart came around to collect the bodies of baby girls who had been born during the night and hurled into the street. She was lucky that her own mother had spirited her away to the fields and refused to come home until the new daughter was accepted as part of the family. â€Å"Not shih tzu,† corrected Mrs. Korjev. â€Å"Shiksa.† â€Å"Okay, shiksa. Dog is dog,† said Mrs. Ling. â€Å"Is irresponsible.† Not once was the letter r heard in Mrs. Ling's pronunciation of irresponsible. â€Å"Is Yiddish word for not a Jew girl. Rachel is Jew, you know.† Mrs. Korjev, unlike most of the Russian immigrants left in the neighborhood, was not a Jew. Her people had come from the steppes of Russia, and she was, in fact, descended from Cossacks – not generally considered a Hebrew-friendly race. She atoned for the sins of her ancestors by being ferociously protective (not unlike a mother bear) of Rachel, and now Sophie. â€Å"The flowers need water today,† said Mrs. Korjev. At the end of the hallway was a large bay window that looked out on the building across the street and a window box full of red geraniums. On afternoons, the two great Asian powers would stand in the hallway, admire the flowers, talk of the cost of things, and complain about the increasing discomfort of their shoes. Neither dared start her own window box of geraniums, lest it appear that she had stolen the idea from across the street, and in the process set off an escalating window-box competition that could ultimately end in bloodshed. They agreed, tacitly, to admire – but not covet – the red flowers. Mrs. Korjev liked the very redness of them. She had always been angry that the Communists had co-opted that color, for otherwise it would have evoked an unbridled happiness in her. Then again, the Russian soul, conditioned by a thousand years of angst, really wasn't equipped for unbridled happiness, so it was probably for the best. Mrs. Ling was also taken with the red of the geraniums, for in her cosmology that color represented good fortune, prosperity, and long life. The very gates of the temples were painted that same color red, and so the red flowers represented one of the many paths to wu – eternity, enlightenment – essentially, the universe in a flower. She also thought that they would taste pretty good in soup. Sophie had only recently discovered color, and the red splashes against the gray shiplap was enough to put a toothless smile on her little face. So the three were staring into the joy of red flowers when the black bird hit the window, throwing a great spiderweb crack around it. But rather than fall away, the bird seemed to leak into the very crack, and spread, like black ink, across the window and in, onto the walls of the hallway. And the great powers of Asia fled to the stairway. Charlie was rubbing his left wrist where the plastic bag had been tied around it. â€Å"What, did your mother name you after a mouthwash ad?† Mr. Fresh, looking somewhat vulnerable for a man of his size, said, â€Å"Toothpaste, actually.† â€Å"Really?† â€Å"Yeah.† â€Å"Sorry, I didn't know,† Charlie said. â€Å"You could have changed it, right?† â€Å"Mr. Asher, you can resist who you are for only so long. Finally you decide to just go with fate. For me that has involved being black, being seven feet tall – yet not in the NBA – being named Minty Fresh, and being recruited as a Death Merchant.† He raised an eyebrow as if accusing Charlie. â€Å"I have learned to accept and embrace all of those things.† â€Å"I thought you were going to say gay,† Charlie said. â€Å"What? A man doesn't have to be gay to dress in mint green.† Charlie considered Mr. Fresh's mint-green suit – made from seersucker and entirely too light for the season – and felt a strange affinity for the refreshingly-named Death Merchant. Although he didn't know it, Charlie was recognizing the signs of another Beta Male. (Of course there are gay Betas: the Beta Male boyfriend is highly prized in the gay community because you can teach him how to dress yet you can remain relatively certain that he will never develop a fashion sense or be more fabulous than you.) Charlie said, â€Å"I suppose you're right, Mr. Fresh. I'm sorry if I made assumptions. My apologies.† â€Å"That's okay,† said Mr. Fresh. â€Å"But you really should go.† â€Å"No, I still don't understand, how do I know who the souls go to? I mean, after this happened, there were all kinds of soul vessels in my store I hadn't even known about. How do I know I didn't sell them to someone who already had one? What if someone has a set?† â€Å"That can't happen. At least as far as we know. Look, you'll just know. Take my word for it. When people are ready to receive the soul, they get it. Have you ever studied any of the Eastern religions?† â€Å"I live in Chinatown,† said Charlie, and although that was technically kinda-sorta true, he knew how to say exactly three things in Mandarin: Good day; light starch, please; and I am an ignorant white devil, all taught to him by Mrs. Ling. He believed the last to translate to â€Å"top of the morning to you.† â€Å"Let me rephrase that, then,† said Mr. Fresh. â€Å"Have you ever studied any of the Eastern religions?† â€Å"Oh, Eastern religions,† Charlie said, pretending he had just misinterpreted the question before. â€Å"Just Discovery Channel stuff – you know, Buddha, Shiva, Gandalf – the biggies.† â€Å"You understand the concept of karma? How unresolved lessons are re-presented to you in another life.† â€Å"Yes, of course. Duh.† Charlie rolled his eyes. â€Å"Well, think of yourself as a soul reassignment agent. We are agents of karma.† â€Å"Secret agents,† Charlie said wistfully. â€Å"Well, I hope it goes without saying,† said Mr. Fresh, â€Å"that you can't tell anyone what you are, so yes, I suppose we are secret agents of karma. We hold a soul until a person is ready to receive it.† Charlie shook his head as if trying to clear water from his ears. â€Å"So if someone walks into my store and buys a soul vessel, until then they've been going through life without a soul? That's awful.† â€Å"Really?† said Minty Fresh. â€Å"Do you know if you have a soul?† â€Å"Of course I do.† â€Å"Why do you say that?† â€Å"Because I'm me.† Charlie tapped his chest. â€Å"Here I am.† â€Å"That's just a personality,† said Minty, â€Å"and barely one. You could be an empty vessel, and you'd never know the difference. You may not have reached a point in life where you are ready to receive your soul.† â€Å"Huh?† â€Å"Your soul may be more evolved than you are right now. If a kid fails tenth grade, do you make him repeat grades K through nine?† â€Å"No, I guess not.† â€Å"No, you just make him start over at the beginning of tenth grade. Well, it's the same with souls. They only ascend. A person gets a soul when they can carry it to the next level, when they are ready to learn the next lesson.† â€Å"So if I sell one of those glowing objects to someone, they've been going through life without a soul?† â€Å"That's my theory,† said Minty Fresh. â€Å"I've read a lot on this subject over the years. Texts from every culture and religion, and this explains it better than anything else I can come up with.† â€Å"Then it's not all in the book you sent.† â€Å"That's just the practical instructions. There's no explanations. It's Dick-and-Jane simple. It says to get a calendar and put it next to your bed and the names will come to you. It doesn't tell you how you will find them, or what the object is, just that you have to find them. Get a day planner. That's what I use.† â€Å"But what about the number? When I would find a name written next to the bed, there was always a number next to it.† Mr. Fresh nodded and grinned a little sheepishly. â€Å"That's how many days you'll have to retrieve the soul vessel.† â€Å"You mean it's how long before the person dies? I don't want to know that.† â€Å"No, not how long before the person dies, how long you have to retrieve the vessel, how many days are left. I've been looking at this for a long time, and the number is never above forty-nine. I thought that might be significant, so I started looking for it in literature about death and dying. Forty-nine days just happens to be the number of days of bardo, the term used in the Tibetan Book of the Dead for the transition between life and death. Somehow, we Death Merchants are the medium for moving these souls, but we have to get there within the forty-nine days, that's my theory, anyway. Don't be surprised sometimes if the person has been dead for weeks before you get his name. You still have the number of days left in bardo to get the soul vessel.† â€Å"And if I don't make it in time?† Charlie asked. Minty Fresh shook his head dolefully. â€Å"Shades, ravens, dark shit rising from the Underworld – who knows? Thing is, you have to find it in time. And you will.† â€Å"How, if there's no address or instructions, like ‘it's under the mat.'† â€Å"Sometimes – most of the time, in fact – they come to you. Circumstances line up.† Charlie thought about the stunning redhead bringing him the silver cigarette case. â€Å"You said sometimes?† Fresh shrugged. â€Å"Sometimes you have to really search, find the person, go to their house – once I even hired a detective to help me find someone, but that started to bring the voices. You can tell if you're getting close by checking to see if people notice you.† â€Å"But I have to make a living. I have a kid – â€Å" â€Å"You'll do that, too, Charlie. The money comes as part of the job. You'll see.† Charlie did see. He had seen already: the Mainheart estate clothing – he'd make tens of thousands on it if he got it. â€Å"Now you have to go,† said Minty Fresh. He held out his hand to shake and a grin cut his face like a crescent moon in the night sky. Charlie took the tall man's hand, his own hand disappearing into the Death Merchant's grip. â€Å"I'm still sure I have questions. Can I call you?† â€Å"No,† said the mint one. â€Å"Okay, then, I'm going now,† Charlie said, not really moving. â€Å"Completely at the mercy of forces of the Underworld and stuff.† â€Å"You take care,† said Minty Fresh. â€Å"No idea what the hell I'm doing,† Charlie went on, taking tentative baby steps toward the door. â€Å"The weight of all of humanity on my shoulders.† â€Å"Yeah, make sure you stretch in the morning,† said the big man. â€Å"By the way,† Charlie said, out of rhythm with his whining, â€Å"are you gay?† â€Å"What I am,† said Minty Fresh, â€Å"is alone. Completely and entirely.† â€Å"Okay,† Charlie said. â€Å"I'm sorry.† â€Å"It's okay. I'm sorry I smacked you in the head.† Charlie nodded, grabbed his sword-cane from behind the counter, and walked out of Fresh Music into an overcast San Francisco day. Well, he wasn't exactly Death, but he wasn't Santa's helper, either. It didn't really matter that no one would believe him even if he told them. Death Merchant seemed a little dire, but he liked the idea of being a secret agent. An agent of KARMA – Karma Assessment Reassignment Murder and Ass – okay, he could work on the acronym later, but a secret agent nevertheless. Actually, although he didn't know it, Charlie was well suited to be a secret agent. Because they function below the radar, Beta Males make excellent spies. Not the â€Å"James Bond, Aston Martin with missiles, boning the beautiful Russian rocket scientist on an ermineskin bedspread† sort of spy – more the â€Å"bad comb-over, deep-cover bureaucrat fishing coffee-sodden documents out of a Dumpster† spy. His overt nonthreateningness allows him access to places and people that are closed to the Alpha Male, wearing his testosterone on his sleeve. The Beta male can, in fact, be dangerous, not so much in the â€Å"Jet Li entire body is a deadly weapon† way but more in the â€Å"drunk on the riding mower making a Luke Skywalker assault on the toolshed† sort of way. So, as Charlie headed for the streetcar stop on Market Street, he mentally tried on his new persona as a secret agent, and was feeling pretty good about it, when, as he passed a storm drain, he heard a female voice whisper harshly, â€Å"We'll get the little one. You'll see, fresh Meat. We'll have her soon.† As soon as Charlie walked into his store from the alley, Lily bolted into the back room to meet him. â€Å"That cop was here again. That guy died. Did you kill him?† To the machine-gun update she added, â€Å"Uh, sir?† Then she saluted, curtsied, then did a praying-hands Japanese bow thing. Charlie was thrown by all of it, coming as it did when he was in a panic about his daughter and had just driven across town like a madman. He was sure the gestures of respect were just some dark cover-up for a favor or a misdeed, or, as often was the case, the teenager was messing with him. So he sat down on one of the high hardwood stools near the desk and said, â€Å"Cop? Guy? ‘Splain, please. And I didn't kill anyone.† Lily took a deep breath. â€Å"That cop that was by here the other day came back. Turns out that guy you went up to see in Pacific Heights last week† – she looked at something she had written on her arm in red ink – â€Å"Michael Mainheart, killed himself. And he left a note to you. Saying that you were to take his and his wife's clothes and sell them at the market rate. And then he wrote† – and here she again referred to her ink-stained arm – â€Å"‘What about â€Å"I just want to die† did you not understand?'† Lily looked up. â€Å"That's what he said after I gave him CPR the other day,† Charlie said. â€Å"So, did you kill him? Or whatever you call it. You can tell me.† She curtsied again, which disturbed Charlie more than somewhat. He'd long ago defined his relationship with Lily as being built on a strong base of affectionate contempt, and this was throwing everything off. â€Å"No, I did not kill him. What kind of question is that?† â€Å"Did you kill the guy with the cigarette case?† â€Å"No! I never even saw that guy.† â€Å"You realize that I am your trusted minion,† Lily said, this time adding another bow. â€Å"Lily, what the hell is wrong with you?† â€Å"Nothing. There's nothing wrong at all, Mr. Asher – uh, Charles. Do you prefer Charles or Charlie?† â€Å"You're asking now? What else did the cop say?† â€Å"He wanted to talk to you. I guess they found that Mainheart guy dressed in his wife's clothing. He hadn't been home from the hospital for an hour before he sent the nurse away, got all cross-dressed up, then took a handful of painkillers.† Charlie nodded, thinking about how adamant Mainheart had been about having his wife's clothes out of the house. He was using any way he could to feel close to her, and it wasn't working. And when wearing her clothes didn't put him closer, he'd gone after her the only way he knew how, by joining her in death. Charlie understood. If it hadn't been for Sophie, he might have tried to join Rachel. â€Å"Pretty kinky, huh?† Lily said. â€Å"No!† Charlie barked. â€Å"No it's not, Lily. It's not like that at all. Don't even think that. Mr. Mainheart died of grief. It might look like something else, but that's what it was.† â€Å"Sorry,† Lily said. â€Å"You're the expert.† Charlie was staring at the floor, trying to put some sense to it all, wondering if his losing the fur coat that was Mrs. Mainheart's soul vessel meant that the couple would never be together again. Because of him. â€Å"Oh yeah,† Lily added. â€Å"Mrs. Ling called down all freaked out and yelling all Chinesey about a black bird smashing the window – â€Å" Charlie was off the stool and taking the stairs two at a time. â€Å"She's in your apartment,† Lily called after him. There was an orange slick of TV attorneys floating on the top of the fishbowl when Charlie got to his apartment. The Asian powers were standing in his kitchen, Mrs. Korjev was holding Sophie tight to her chest, and the infant was virtually swimming, trying to escape the giant marshmallowy canyon of protection between the massive Cossack fun bags. Charlie snatched his daughter as she was sinking into the cleavage for the third time and held her tight. â€Å"What happened?† he asked. There followed a barrage of Chinese and Russian mixed with the odd English word: bird, window, broken, black, and make shit on myself. â€Å"Stop!† Charlie held up a free hand. â€Å"Mrs. Ling, what happened?† Mrs. Ling had recovered from the bird hitting the window and the mad dash down the steps, but she was now showing an uncharacteristic shyness, afraid that Charlie might notice the damp spot in the pocket of her frock where the recently deceased Barnaby Jones lay orangely awaiting introduction to some wonton, green onions, a pinch of five spices, and her soup pot. â€Å"Fish is fish,† she said to herself when she squirreled that rascal away. There were, after all, five more dead attorneys in the bowl, who would miss one? â€Å"Oh, nothing,† said Mrs. Ling. â€Å"Bird break window and scare us. Not so bad now.† Charlie looked to Mrs. Korjev. â€Å"Where?† â€Å"On our floor. We are talking in hall. Speaking of what is best for Sophie, when boom, bird hits window and black ink run through window. We run here and lock door.† Both the widows had keys to Charlie's apartment. â€Å"I'll have it fixed tomorrow,† Charlie said. â€Å"But that's all. Nothing – no one came in?† â€Å"Is third floor, Charlie. No one comes in.† Charlie looked to the fishbowl. â€Å"What happened there?† Mrs. Ling's eyes went wide. â€Å"I have to go. Mah-jongg night at temple.† â€Å"We come in, lock door,† explained Mrs. Korjev. â€Å"Fish are fine. Put Sophie in car seat like always we are doing, then go look in hallway for coast to be clear. When Mrs. Ling look back, fish are dead.† â€Å"Not me! Is Russian who see dead fish,† said Mrs. Ling. â€Å"It's okay,† Charlie said. â€Å"Did you see any birds, anything dark in the apartment?† The two women shook their heads. â€Å"Only upstairs,† Mrs. Ling said. â€Å"Let's go look,† Charlie said, moving Sophie to his hip and picking up his sword-cane. He led the two women to the little elevator, did a quick assessment of Mrs. Korjev's size versus the cubic footage, and led them up the stairs. When he saw the broken bay window he felt a little weak in the knees. It wasn't so much the window, it was what was on the roof across the street. Refracted a thousand times in the spiderwebbed safety glass was the shadow of a woman that was cast on the building. He handed the baby to Mrs. Korjev, approached the window, and knocked a hole in the glass to see better. As he did, the shadow slid down the side of the building, across the sidewalk, and into the storm drain next to where a dozen tourists had just disembarked from a cable car. None of them appeared to have seen anything. It was just past one and the sun was casting shadows nearly straight down. He looked back at the two windows. â€Å"Did you see that?† â€Å"You mean break window?† Mrs. Ling said, slowly approaching the window and peering through the hole Charlie had made. â€Å"Oh no.† â€Å"What? What?† Mrs. Ling looked back at Mrs. Korjev. â€Å"You are right. Flowers need water.† Charlie looked through the hole in the window and saw that Mrs. Ling was referring to a window box full of dead, black geraniums. â€Å"Safety bars on all the windows. Tomorrow,† Charlie said. Not far away, as the crow flies, under Columbus Avenue, in a wide pipe junction where several storm sewers met, Orcus, the Ancient One, paced, bent over like a hunchback, the heavy spikes that jutted from his shoulders scraping the sides of the pipe, throwing off sparks and the smell of smoldering peat. â€Å"You're going to fuck up your spikes if you keep pacing like that,† said Babd. She was crouched in one of the smaller pipes to the side, next to her sisters, Nemain and Macha. Except for Nemain, who was beginning to show a gunmetal relief of bird feathers over her body, they were devoid of depth; flat absences of light, absolute black even in the gloom filtering down through the storm grates – shadows, silhouettes, really – the darker ancestors of the modern mud-flap girls. Shades: delicate and female and fierce. â€Å"Sit. Have a snack. What good to take the Above if you look like hell in the end?† Orcus growled and spun on the Morrigan, the three. â€Å"Too long out of the air! Too long.† From the basket on his belt he hooked a human skull on one of his claws, popped it in his mouth, and crunched down on it. The Morrigan laughed, sounding like wind through the pipes, pleased that he was enjoying their gift. They'd spent much of the day under San Francisco's graveyards digging out the skulls (Orcus liked them decoffinated) and polishing off the dirt and detritus until they shone like bone china. â€Å"We flew,† said Nemain. She took a moment to admire the blue-black feather shapes on her surface. â€Å"Above,† she added unnecessarily. â€Å"They are everywhere, like cherries waiting to be stolen.† â€Å"Not stolen,† said Orcus. â€Å"You think like a crow. They are ours for the taking.† â€Å"Oh yeah, well, where were you? I got these.† The shade held up William Creek's umbrella in one hand and the fur jacket she'd ripped away from Charlie Asher in the other. They still glowed red, but were rapidly dimming. â€Å"Because of these, I was Above. I flew.† When no one reacted, Nemain added, â€Å"Above.† â€Å"I flew, too,† said Babd timidly. â€Å"A little.† She was a tad self-conscious that she'd manifested no feather patterns or dimension. Orcus hung his great head. The Morrigan moved to his side and began stroking the long spikes that had once been wings. â€Å"We will all be Above, soon,† said Macha. â€Å"This new one doesn't know what he is doing. He will make it so we can all be Above. Look how far we've come – and we are so close now. Two Above in such a short time. This New Meat, this ignorant one, he may be all we need.† Orcus lifted his bull-like head and grinned, revealing a sawmill of teeth. â€Å"They will be like fruit for the picking.† â€Å"See,† said Nemain. â€Å"Like I said. Did you know that Above you can see really far? Miles. And the wonderful smells. I never realized how damp and musty it is down here. Is there any reason that we can't have a window?† â€Å"Shut up!† growled Orcus. â€Å"Jeez, bite my head off, why don't you.† â€Å"Don't tease,† said the bullheaded Death. He rose and led the other Deaths, the Morrigan, down the pipe toward the financial district, to the buried Gold Rush ship where they made their home.

Effects of globalisation case study- China Essay

China is the world’s seventh largest economy and the largest country in terms of population size. It has also become the 8th largest world exporter of manufactured goods and the second largest economy in the world, after the United States, on the basis of purchasing power parity. The impact of globalisation on China has been profound, having an impact in a number of different areas. Government Strategies to promote economic growth and development Between 1978 to 1994 China abandoned agricultural collectivisation, replacing it with a system of household responsibility, allowing individuals to make their own production decisions. Individuals could sell their surplus output in free markets after the state quota was met. This lead to dramatic increases in food production and incomes. Surplus income was invested into privately run town and village enterprises responsible for light manufacturing. The government also increased the authority of local officials and plant managers in industry and permitted a wide variety of small-scale enterprises in services designed to increase productivity with the ‘profit incentive’. Today, non-state economies account for 40% of China’s gross domestic product (GDP). In 1980 Special Economic Zones were established in the southern coastal provinces of China as a result of its ‘Open Door’ policy, adopted towards foreign trade and investment. These zones attracted foreign investment through incentives offered such as low tax rates, exemption from import duties, cheap labour and power, and less stringent regulations. This resulted in an increase in trade from 10% of Gross National Product (GNP) in 1978 to 36% of GNP by 1996. In 1992 tariff rates were reduced from 32% to 19%, supporting China’s drive for foreign investment. Economic growth, development and quality of life China has been experiencing a high rate of economic growth above 10% per annum. It uses foreign investment funds to finance export industries, enabling it to maintain large foreign currency reserves and receive  technology transfers from industrial countries. Higher productivity and the increased flow of money entering China as a result of globalisation have been increasing development and the quality of life, reducing the number of people below the poverty line. Although incomes in China are very low, the poverty line reflects absolute poverty based on the minimum subsistence necessary to maintain life. Higher incomes have allowed for more investment for further development in the country and living standards. The life expectancy at birth has also dramatically increased from 35 in 1950 to 72 in 2002. The Human Development Index is a number less than 1 (1 being the highest) calculated to enable the comparison of standards of living across different countries. It is based on life expectancy at birth, levels of educational attainment and gross domestic product per capita. China has a Human Development Index of .721, making it a medium developed country. Global Trade, Investment and Transnational Corporations Globalisation and trade have had a great impact on China.. Nearly 400 of the top 500 Transnational Corporations (TNC’s) have opened business or invested in China. By July 1999, China had 334000 overseas-invested enterprises with actual investment of US$288.94 billion. China ranks as the top exporter of many labour intensive products such as garments, shoes, clocks and bicycles and over the past few years many TNC’s such as ‘Streets’ ice cream have moved their operations to China to take advantage of low production costs. These low costs are due to the tens of millions of young job seekers ready to work for even less than the official minimum monthly wage of 700 yuan. Although they provide employment, workers are often forced to do long shifts often under poor conditions in order to support themselves and their families. TNC’s have affected the development of local businesses that are unable to update their technology as often as large, overseas companies. Outdated  technology means that their resources are not used as efficiently, reducing productivity and forcing wages to remain low. Unable to compete with large multinational firms and wealthy nations, small businesses have been forced to do business locally, never growing and reaching their full potential. Larger businesses that have been able to keep up with changing technology, however, have greatly benefited through increased productivity as a result of the increased level of technology brought about by globalisation. Distribution of Income and Wealth Despite average incomes rising, income and social inequality in China have grown between rural and urban populations. China’s growth and development are very dependent on the Special Economic Zones in the southern provinces which are dominated by foreign investment and technology. People living in these areas earn approximately 20000 yuan a year. In contrast, the northern provinces that rely more on agricultural production for the generation of income and employment opportunities earn an average of less than 6000 yuan per year. This is the major cause for inequality in the distribution of income. The top 20% of income earners receive 42.5% of the countries GDP. By international standards, China has entered â€Å"a zone of income distribution inequity.† Environmental Consequences Globalisation has contributed to the deterioration of the environment in China due to a loss of arable land as a result of economic development. An increased population growth in urban areas as people move to be closer to factories results in the clearing of large areas of land and a strain on resources. China, unlike many developed countries does not have extremely strict standards on the disposal of waste. Factories set up by overseas companies often create a lot of pollution and dangerous waste product not always properly disposed of in order to cut production costs. Persistent organic pollutants and the exploitation of fisheries pose major threats to the environment. High levels of energy use bear a large responsibility for man made greenhouse gasses in the atmosphere. These factors contribute to  larger problems such as global warming and ozone depletion. The integration of financial markets and trade relationships has also increased the risk of ‘contagion’. Global Financial Markets and The International Business Cycle With more large businesses moving to China, there was a large demand on funds from the financial markets. China, however, does not have a financial market competitive with overseas markets. Many Chinese financial institutions are also required to lend money, under government policy, to government businesses, which are often inefficient, depleting the supply of funds. For this reason, most of the money is generally borrowed from overseas institutions. Like all economies, China acts as a part of the International Business Cycle, moving through booms and recessions. This connection to global movements is heightened as a result of globalisation. The Asian Crisis of 1997 is an example of this. As people lost confidence in Asian economies and withdrew money from investments affecting economies through lost output, rising unemployment, higher inflation and poverty. China was not as badly affected in this crisis as other Asian countries. This was because foreign investment was in the form of assets rather than shares. This meant that investors were not able to withdraw their money quickly as they were in other Asian countries.

Cbt Case Study

CBT – Case Study Identifying Information For the purposes of the case study the client will be called Jane. Jane is a 22 year old single white British female who lives with her parents in a house outside the city. She is heterosexual and has had a boyfriend for seven years. She feels unable to discuss her issues with her boyfriend. Her parents both have mental health issues and Jane does not feel able to talk to her mother about her problems. She has an older brother she has a good relationship who lives with his girlfriend, a four hour drive away.Jane is educated to degree level, having studied Criminology and is currently working part-time for her father managing his client accounts for a business he runs from home. A typical day involves organising all receipts and creating spreadsheets for each client’s accounts. Jane states she would like to get a full time job and be normal like her friends. Jane has a small circle of friends from university who she states have al l gone onto full time employment. Jane also has a puppy she spends time looking after and taking for regular walks.Assessment Jane was referred following a health check at her GP surgery. She had been prescribed Citalopram 20mg by her GP for anxiety symptoms and panic attacks she had been having for two years. Jane has no previous contact with mental health services. Jane’s father had a diagnosis of Bi-Polar Disorder, her brother has Depression and her boyfriend has a diagnosis of Obsessive Compulsive Disorder which he is continuing treatment for. Jane’s anxiety/panic has increased over the past two years.She had read about Cognitive Behavioural Therapy on the Internet and was willing to see if it was help ease her anxiety symptoms. Jane stated that the problem started due to family issues in 2007. Her brother and father were estranged due to a financial disagreement and this resulted in Jane’s brother leaving the country with his girlfriend, causing Jane to bec ome very distressed. Also during this time she was taking her final exams at University, Jane states this was when she experienced her first panic attack.She had spent the evening before her brother left the country, drinking alcohol with friends, she remembers feeling ‘hung-over’ the next day. While travelling in the car to the airport, with her brother and his girlfriend, Jane states she started to feel unwell, she found it difficult to breathe, felt hot, trapped and felt like she was going to faint. Jane stated she felt â€Å"embarrassed† and â€Å"stupid† and had since experienced other panic attacks and increased anxiety, anticipating panic attacks in social situations.Jane had reduced where she went to, finding herself unable to go anywhere she may have to meet new people. Her last panic attack happened when Jane visited her GP for a health check and fainted during the appointment, Jane has blood phobia and she stated she had not eaten since the day before and was extremely anxious about the any medical interventions. Jane believes it was a panic attack that caused her to faint.The GP prescribed her 20mg of Citalopram, a few weeks prior to her initial assessment with the therapist. When Jane and the therapist met for the initial session Jane described herself as feeling inadequate and as if she was trapped in a cycle of panic. Although Jane felt unhappy she had no suicidal ideation and she presented no risk to others. Jane stated she had become more anxious and that she had panic attacks at least twice a week. Prior to and during therapy, Jane was assessed using various measures.These enabled the therapist to formulate a hypothesis regarding the severity of the problem, also acting as a baseline, enabling the therapist and Jane to monitor progress throughout treatment. (Wells, 1997). The measures utilised in the initial assessment were a daily panic diary, Wells (1997) and a diary of obsessive- compulsive rituals, Wells (1997) a self rating scale completed by the client Jane. Other measures used were, The Panic Rating Scale (PRS) Wells (1997), the Social Phobia Scale, Wells (1997), used by the therapist to clarify which specific disorder was the main problem for Jane.Having collated information from the initial measures, a problem list was created so the therapist and Jane could decide what to focus on first. This list was based on Jane’s account of the worst problems which were given priority over those problems which were less distressing. Problem List 1. Anxiety/Panic attacks 2. Obsessive hand washing. 3. My relationship with my family. 4. Not having a full time job. 5. My relationship with my boyfriend Having collaboratively decided on the problem list, the therapist helped Jane reframe the problems into goals.As the problem list highlighted what was wrong, changing them into goals enabled Jane to approach her problems in a more focused way (Wells, 1997), the therapist discussed goals with Jane and she decided what she wanted to get from therapy. It was important for the therapist to ensure that any goals were realistic and achievable in the timeframe and this was conveyed to Jane (Padesky & Greenberger, 1995). Jane wanted to reduce her anxiety and expressed these goals:- 1. To understand why I have panic attacks. 2. To have an anxiety free day. 3. To reduce the amount of time worrying . To reduce obsessive hand washing at home. Case Formulation Jane stated that for about a year she had been repeating certain behaviours, which she believed prevented her from having panic attacks. This involved Jane washing her hands and any surrounding objects at least twice. Jane had a fear of consuming alcohol/drugs/caffeine/artificial sweeteners, she stated she had had her first panic attack the day after drinking alcohol and had read that all these substances could increase her anxiety. Jane had not drunk alcohol for 18 months as she felt this caused her anxiety and made her nable to control the panic attacks. Jane stated she feared that if any of these substances got on her hands and then into her mouth she would have a panic attack and faint. These beliefs increased Jane’s anxiety when Jane was exposed to any environment where these substances were present. This unfortunately was most of the time, Jane stated that every time she saw any of these substances consumed or even placed near her, she became anxious and had to wash her hands and any surrounding items which she may come into contact with again.These safety behaviours maintained the cycle of panic, Jane would always continue the routines that she believed prevented a panic attack. The worst case scenario for Jane was â€Å"the panic would never stop and I will go mad, causing my boyfriend to leave me†. Jane felt this would make everyone realise what she already knew, that she was worthless. Her last panic attack happened when Jane had visited her GP; this caused Jane feelings of shame. â⠂¬Å"There’s all these people achieving, doing great things and I can’t do the most basic things†The therapist used the Cognitive Model of Panic (Clark, 1986), initially developing the three key elements of the model to help socialise Jane to the thoughts, feelings and behaviour cycle (see diagram below) Cognitive Model of Panic Bodily sensations Emotional response Thought about sensation Clark (1986) Using a panic diary and a diary of obsessive-compulsive rituals, Jane was asked to keep a record of situations during the week where she felt anxious, and this was discussed in the next session.Jane stated she had not had any panic during the week, when discussing previous panic attacks during the session, Jane became anxious and the therapist used this incident to develop the following formulation. Heart beating fast/increase in body temperature Fear/dread I feel hot, I can’t control it Clark (1986) Jane stated she felt like she was sweating, she had diffic ulty breathing; felt faint, had feelings of not being here and felt like she was going crazy.All these symptoms suggested that Jane was experiencing a panic attack and Jane met the criteria for Panic Disorder, defined in the DSM IV and states that â€Å"panic attacks be recurrent and unexpected, at least one of the attacks be followed by at least one month of persistent concern about having additional attacks, worry about the implications or consequence of the attack, or a significant change in behaviour related to the attacks† (APA, 1994). During the sessions the therapist continued to socialise Jane to the model of panic (Clark, 1986); together Jane and the therapist looked at what kept the cycle going.The therapist continued to use the model formulation, with the addition of Jane’s catastrophic interpretation of bodily symptoms, to illustrate the connection between negative thoughts, emotion, physical symptoms. Social situation I will be unable to stay here Everyone will notice I am not coping I’m going to faint Sweating/breathing fast/dizzy Clark’s (1986) Cognitive Model of Panic.Progress of Treatment The therapist hypothesised that Jane’s symptoms continued due to Jane not understanding the physiological effects of anxiety. The results were a misinterpretation of what would happen to her while being anxious, and this maintained the panic cycle. Although Jane tried to avoid any anxiety by using safety behaviours, she eventually increased the anxiety she experienced. Session 1 After the initial assessment sessions, the therapist and Jane agreed to 8 sessions, with a review after 6 sessions.Jane and the therapist discussed that there may only be a small amount of progress or change during the sessions due to the complexity of Jane’s diagnosis and agreed to focus on understanding the cycle of panic (Clark, 1986) From the information gained from the formulation process, the therapist tried psycho education. The therap ist was attempting to illicit a shift in Jane’s belief about what, how and why these symptoms were happening. The therapist discussed with Jane what she knew about anxiety and from this the therapist discovered that Jane was unsure of what anxiety was and the effects on the body.For the first few appointments the therapist knew it could be beneficial to concentrate on relaying information about anxiety, (Clark et al, 1989) focusing on Jane’s specific beliefs anxiety, the therapist wanted to try to reduce the problem by helping Jane recognise the connection between her symptoms. As Jane believed, â€Å"she was going mad†, the therapist was trying to help Jane understand the CBT model of anxiety and to alter Jane’s misunderstanding of the symptoms. The therapist and Jane discussed Jane’s belief that she would faint if she panicked, Jane had fixed beliefs about why she fainted.The therapist attempted to enable Jane to describe how her anxiety affected her during a ‘usual panic’. Instead Jane began to describe symptoms of social anxiety, this suggested to the therapist that the main problems could be a combination of /social phobia and obsessive behaviours; the following dialogue may help to illustrate this. T. When you begin to become anxious, what goes through your head? J. I need a backup plan; I need to know how to get out of there. Especially if it’s in an office, or a small room. T. What would happen if you did not get out? J. I would panic, and then pass outT. What would the reasons be for you to pass out? J. Because I was panicking. T. Have you passed out before when you have panicked? J. I have felt like it. T. So what sensations do you have when you’re panicking? J. The feeling rises up, I feel hot and I can’t see straight. I get red flashes in front of my eyes, like a warning. My vision goes hazy. I think everyone is looking at me. T. Do you think other people can see this? J. Yes. T. What do you think they see? J. That I’m struggling and I cannot cope or, I try to get out of the situation by pretending I feel ill before they notice. T.What would they notice, what would be different about you? J. I stick out like a beacon, I’m sweating, loads of sweat and my face is bright red. T. How red would your face be, as red as that â€Å"No Smoking† sign on the wall? J. Yes! I’m dripping with sweat and my eyes are really staring, feels like they stick out like in a cartoon, it’s ridiculous. T. How long before you would leave the situation? J. Sometimes the feeling goes, like I can control it. But I could not leave. There would be a stigma and then I could not go back, the anxiety would increase in that environment or somewhere similar.The therapist persisted with this example and tried to use guided discovery to help Jane get a more balanced view of the situation. (Padesky and Greenberger, 1995) T. So you would not go back? J. I would if I felt safe, like with my boyfriend or I could leave whenever I wanted to. It’s the last straw if I have to go. It makes it even harder. T. You say that sometimes it goes away. What’s different about then and times when you have to leave? J. It’s like I just know I have to leave. T. What do you think may happen if you stay with the feelings? J. That I will pass out. T. hat would that mean if you passed out? J. It would be the ultimate. It would mean that I could not cope with the situation. T. If you could not cope what would that mean? J. I can’t function, I can’t do anything. I‘m just no use. T. How much do you believe that? Can you rate it out of 100%? J. Now. About 60% if I did faint it would be about 100% T. Have you ever fainted due to the sensations you have described to me? J. No. I have fainted because I’m squeamish. I don’t like blood. Or having any kind of tests at the GP. T. So do I understand you? You have never fa inted due to the panic sensations?J. No. I’ve felt like it. T. So you’ve never passed out due to the symptoms? What do you make that? J. I don’t know, that would mean that what I believe is stupid. It’s hard to get my head around it. Session 2-3 The therapist used a social phobia/panic rating scale measures to ascertain the main problem; this was increasingly difficult as throughout each session the patient expanded on her symptoms. The therapist managed to understand that the patient avoided most social situations due to her beliefs about certain substances; this caused the obsessive hand-washing.This then had an impact on Jane’s ability to go anywhere in case she could not wash herself or objects around her. Jane also believed fainting from blood phobia had the same physical effects as panic, and she would faint if she panicked. It was complicated and the therapist attempted to draw out a formulation. I SEE A PERSON DRINKING ALCOHOL IT’S G OING TO GET ON MY HANDS AND INTO MY MOUTH I FEEL SICK, I’M GOING TO FAINT I FEEL DREAD, I FEEL ANXIOUS, SWEATING I MUST WASH MY HANDS TO STOP THE PANIC GETTING WORSE.Session 4 The formulation shows the extent of Jane’s panic and how her safety behaviours were impacting on all aspects of her life. The therapist attempted again to use information about the causes of anxiety and its effects on the body. The therapist explained what happens when you faint due to blood phobia, this was an attempt to supply Jane with counter evidence for her catastrophic interpretations of her panic. The therapist also used evidence to contrast the effects on the body when fainting and when panicking.After two sessions, the therapist continued to provide and attempted to relay the facts about the nature of anxiety/panic/fainting with the inclusion of behavioural experiments. Educational procedures are a valid part of overall cognitive restructuring strategies, incorporated with questioning e vidence for misinterpretations and behavioural experiments (Wells, 1997) The therapist asked Jane to explain to the therapist the function/effects of adrenalin, to see if Jane was beginning to understand and if there had been any shift in her beliefs about panic.The following dialogue may help to illustrate the difficulties the therapist encountered; T. Over the last few sessions, we have been discussing anxiety and the function of adrenalin. Do you understand the physical changes we have looked at? Does it make sense to you? J. Yes. Something has clicked inside my head. I feel less insane now, I understand more about what’s going on. It makes things a little bit easier, but it takes time for it to sink in. T. Do you think you could explain to me what you understand about anxiety/adrenalin? J.As I interpret it is, I like to think of it as, â€Å"I’m not anxious it’s just my adrenalin, It’s just the effects of adrenalin effecting my body† but itâ₠¬â„¢s hard to get from there, to accepting the adrenalin is not going to harm me. I know logically it’s not. But it’s still hard. T. That’s great you’re beginning to question what you have believed and are thinking there may be other explanations for your symptoms. J. Yes. But I still think it’s to do with luck. I have good or bad luck each day and that predicts whether I have a panic or not. I think I’ll be unlucky soon.Session 5-6 The therapist continued to try use behavioural experiments during the sessions to provide further evidence to try to alter Jane’s beliefs about anxiety. The therapist agreed with Jane that they would imitate all the symptoms of panic. Making the room hot, exercising to increase heart rate and body temperature, hyperventilation (ten minutes) Focusing on breathing/swallowing. This continued for most of session 5. As neither the therapist nor Jane fainted, they discussed this and Jane stated it was different in the session than when she with other people.Jane also stated she felt safe and trusted the therapist, she did not believe she could be strong enough to try the experiments alone, as it was â€Å"too scary† The therapist asked Jane to draw a picture of how she felt and put them on the diagram of a person, this then was used to compare with anxiety symptoms, while talking through them with the therapist. The therapist and Jane created a survey about fainting and Jane took this away as homework to gain further evidence. The survey included 6 different questions about fainting e. g. – What people knew about fainting/how they would feel about seeing someone faint, etc. Treatment Outcome The treatment with Jane continues. The next session will be the 6th and there will be a review of progress and any improvements. There has been no improvement in measures as noted yet. The therapist intends to use a panic rating scale (PRS) Wells, (1997) during the next session. The thera pist will continue to see Jane for two more sessions, looking at what Jane has found helpful/unhelpful. Discussion Overall the therapist found the therapy unsuccessful.Although Jane stated she found it helpful, it was difficult for the therapist to see the progress due to the many layers of complexity of Jane’s diagnosis. The therapist has grown more confident in the CBT process and understands that as a trainee, the therapist tried to incorporate all the new skills within each session. The therapist was disappointed that they were unable to guide Jane through the therapy process with a better result. The therapist would have like to have been able to fully establish an understanding of Jane’s complex symptoms earlier on in the therapy.The therapist believes that Jane’s symptoms were very complex and the therapist may have been more successful with a client with a less complicated diagnosis. The therapist would then be able to gain more information via the appro priate measures to enable the formulations in a concise manner. This has been a huge learning curve for the therapist and has encouraged them to seek out continuing CBT supervision within the therapist’s workplace. This is essential to continue the development of the therapist’s skills.The therapist feels that although this has not had the outcome that the therapist would have wanted, it has been a positive experience for Jane. There appeared to be a successful therapeutic relationship, Jane appeared comfortable and able to communicate what her problems were to the therapist from the beginning of therapy. The therapist hopes this will encourage Jane to engage with further CBT therapy in the future and the therapist over the final session hopes to be able to support Jane in creating a therapy blueprint, reviewing what Jane has found helpful.Certificate in CBT September – December 2009 CBT Case Study Panic/Social Phobia/OCD WORD COUNT 3,400 References APA (1994). Diagnostic Statistical Manual of Mental Disorders, Revised, 4th edn. Washington, DC: American Psychiatric Association Padesky, C. A & Greenberger, D. (1995). Clinicians Guide to Mind Over Mood. New York: Guilford Padesky, C. A & Greenberger, D. (1995). Mind Over Mood. New York: Guilford Wells, A (1997). Cognitive Therapy of Anxiety Disorders. Chichester, UK: Wiley