Teen Pregnancy Essay example -- Teenage Pregnancy

There is a lot of teen mothers growing up in this world wondering, what if I would have stayed in school? W hat could I have become? Would it have made my life easier if I had thought first? There is many causes for teen pregnancy. They lead to the need for the desire of love by another person. One might have a poor home life and would want something like their peers have. A teen may have a low self-esteem and simply be looking for acceptance. However, many teens that have a wonderful family and are very confidante arnt looking for the few minutes of pleasure. As several teens use the excuse that sex feels better without a condom pregnancy is likely to occur just because of that simple saying. Having a child comes with a lot of responsibility. Teens don’t think of the consequences of their actions. Children take up a lot of time, which also means, no more school. The teen should first understand that all their free time is lost, that she will have to find some way to live for herself and the child, and that any future plans are now not what she was planning. It all comes down to the education of the teen. The more they know about sex and it’s consequences at a young age the less likely they are to go out and be irresponsible about it. Teenagers that learn about different types of protection and how they work is some times one of the best ways for them to think befor they act. Every year one million teenage girls become pregnant in the United States. Teen pregnancy is a major problem in the United States. There are more teenage pregnancies in the United States than all other countries. in this day and age the rate of teenagers who become pregnant has increased. I am not one of them, but having a few fr... ...l regret your choice. The precents of teenagers getting pregnate without being married , I agree on. Teens are usualy left alone rasing their baby by their selfs. that’s why condoms and other helpful things exsicist. If having a relation ship between the opposite sex if the only cure for you problems think twice! Teens like me should be more muter. Besides wondering of into a world that carrys out to a risk in your life. Do some research, think befor you act and is that what you realy want. Just to please the opposite sex by actualy letting them in you, should have to be a second thought. You should amidiatly say no if the opposite sex isn’t married with you in anyway. Being a pregnate teen is alot of responsibility. All in all many teens please their opposite sex by the wrong way. So always researching on what you realy plan on doing is a risk in you own life.

The Life of Kate Chopin Compared to the Life of Edna Potilier Essay

The events of Kate Chopin's life strongly influence the feminist traits of Edna Pontilier, the main character in her novel The Awakening. Kate Chopin is known for her literary works that exemplify culture in New Orleans, Louisiana, and of women's struggles for freedom. Pontilier also demonstrates a woman's struggle in the 1800's and their search for a better and more independent future. The lives of Kate Chopin and Edna Pontilier are similar in their feminist views and strong urge for a free and independent life. Kate Chopin was raised under the influence of strong, independent women who told her to do what she wanted in life and not let anyone get in her way (McMahon). Her grandmother was and independent woman who worked for herself and provided a good example that woman did not need a man to make it in the world. Chopin?s mother taught her from childhood that she should always depend on herself and no one else. Also, Chopin and Pontilier were avid readers of books about everyday women gaining their freedom. Chopin read books such as Little Women, an 1876 novel about the lives of four sisters growing up during the American Civil War and Jane Eyre, an 1874 novel about a small, intelligent, and passionate orphan girl who struggles greatly on her way to freedom and independence . These books influenced her to make her novel The Awakening have a feminist viewpoint. Additionally, both women were married unprepared for the restrictions that went along with married life. They were used to being fre e and making their own decisions before marriage and were surprised at what was expected of them of society as wives. Kate Chopin defied society in many ways. She smoked cigarettes, questioned the Catholic church, loved to read and write a... ... Awakening was regarded by critics as vulgar, unwholesome, unholy and a misappropriation of Chopin?s exceptional literary talent.? ? The English Department of Bowling Green State University. After many years of criticism and questioning The Awakening was finally given the respect and recognition it deserved. Kate Chopin had many influences throughout her life that made her become the feminist writer she was when writing The Awakening. Edna Pontilier was created as a feminist because of influence of others on Chopin?s life, personal experiences and the enforcement of societal expectations placed on Chopin during this time. Both women defied society to obtain freedom and independence in a society where women were objects, not people. Without the influences in Kate Chopin?s life, Edna Pontilier my not have been the dynamic character she was during the novel.

But everyman has his price Essay

‘ But everyman has his price.’ Show the part that corruption plays in the action of A Man for All Seasons. The statement ‘everyman has his price’ suggests that all humans are capable of being corrupted. Humans then succumb to certain temptations: greed, power, deception, bribery, betrayal and self-interest. Often men fall prey to such temptations in search of material comfort at the expense of spiritual comfort. More himself comments upon these temptations in the text: â€Å"But since in fact we see that avarice, anger, envy, pride, sloth, trust and stupidity commonly profit far beyond humility, charity, fortitude, justice and thought and have to choose, to be human at all† He says that not to succumb to these, would make one a hero or at least more than a common man. More did not aim to live up to being a hero, but he stood by his moral codes and did not succumb to such temptations. Throughout the play, attempts are made to corrupt More. Such attempts to corrupt morals and religious beliefs occur mainly because of the Kings desire to remarry. Henry married his brothers widow which was disallowed by the Catholic Church-however the Pope eventually gave dispensation for the marriage of Henry and Catherine to take place. Now Henry wants a divorce, to enable him to marry Anne Boleyn and to secure an heir. This creates a dilemma and the King wants the backing of More, which we see when Henry is speaking with More â€Å"Touching this matter of my divorce, Thomas; have you thought of it since we last talked† Up until this time the Catholic Church had predominated in society and nobody had questioned its authority. Martin Luther and John Calvin were two of the primary instigators, who started a movement against the Catholic Church, because they hated the Churches ‘sale of indulgences’. For his stand Martin Luther was excommunicated from the Catholic Church in 1521. He then set up his own Church, which, in 1529 was renamed, from Lutherans to Protestants, when they protested against attempts to limit their teachings. In this respect it suited Henry’s present needs to side with the reformation, to gain his divorce and thereby making himself head of the Church of England, enabling him to become his own authority. The only reason why the King needs Mores support in his divorce is because More is honest and people recognise this honesty and integrity: â€Å"Because you are honest, what’s more you’re known to be honest† Henry attempts to use the power of kingship to persuade More to agree with him, â€Å"I have no wife†¦and those that say she is my wife are not only liars†¦but traitors† The power he has means that if someone were to oppose him, he would simply dispose of them. Henry uses the word traitor because traitors are executed. All this fails to persuade More, his moral stand is too strong. He is trying to emphasise what a good king he is by showing what he is doing is for his country. â€Å"†¦And all the Popes back to St. Peter, shall not become between me and my duty† He is, on one hand, witty, pleasant and a man of elegant appearance, but he is also self-opinionated, brutal and corrupt. As he has little success persuading More with these tactics, he tries to convince More that the original marriage was sinful: â€Å"Thomas, Thomas, does a man need a Pope to tell him when he’s sinned. It was a sin, Thomas, I admit it, I repent†¦.† He further tries to convince More by reasoning that all the sons Catherine has borne have, have died and this has been his punishment. Henrys argument insinuates that God has punished him, and therefore the Pope was wrong for allowing the union. â€Å"†¦It was no marriage; she was my brothers widow. Leviticus: thou shalt no uncover the nakedness of thy brothers’ wife† Which uses Biblical text to provide further evidence that the Pope was wrong. More was a devout Catholic and believed the Pope to be a direct descendant of Peter, Christ’s disciple and therefore the Popes authority went without question â€Å"†¦The theory is that he is also the Vicar of God, the descendant of St. Peter, our only link with God† â€Å"†¦The King in Parliament cannot bestow the supremacy of the Church because it is a spiritual supremacy.† Although More may sympathise with the kings argument we understand from what he says his devotion to the Church and Catholicism. Henry tries to challenge Mores belief saying this is a ‘tenuous link’. More clarifies his position further â€Å"†¦Why it’s a theory yes, you can’t see it, can’t touch it†¦But what matters to me is not whether its true or not but that I believe it to be true†¦Ã¢â‚¬ , thus showing he cannot disobey Rome. More will not break his principals, although in the end he leads his family into poverty. Alice and Margaret want More to agree with the King and to forget his principles. Their reason for this is for their family safety. Alice tries to convince her husband to capitulate with the King â€Å"You can fit the cap to anyone you want† and accuses him of being ‘cruel’ to the household. More asks Alice to remove his chain: â€Å"Hell’s fire-God’s blood and body no!† â€Å"†¦Is this wisdom to betray your ability, abandon practice, forget your station and your duty to your kin and behave like a printed book!† Alice is scared of loosing her position and becoming a pauper and because of this she tries to corrupt More. More is only human and Alice only wants her husband to do what she feels is best for the family and the country therefore she will not remove the chain. More, though, is acting like ‘a printed book’ and he will not accept bribes or money from the Church. Margaret knows that Sir Thomas is going to resign anyway and to show her love and respect for her father, she removes the chain although she knows it will lead to her poverty. More feels it necessary to resign because it was his way of resisting severing the connection with Rome and Chapuys encourages Mores resignation saying he could not believe that More ‘will allow himself to be associated with the recent actions of King Henry’. More too, does not want to be associated with the corrupted King. Chapuys is not really interested in Mores moral stance; his concern is for the furtherance of Spain. (Catherine is Spanish and a divorce would sever Spanish interests in England). When he mentions that Northumberland and Yorkshire are ready to resist I deduce his intentions are political and not concerned with Mores moral integrity. When Chapuys tells More: ‘Beyond that point, Sir Thomas, one is not merely ‘compromised,’ one is in truth corrupted,† he is using verbal bribery to ensure his resignation. More will not go against his principals; he does not want to stand trial for treason. He is careful not to accept any bribes. Chapuys brings a letter from Charles 1st, which More refuses to accept as it could be seen as an allegiance with Spain. More feels that if he were to take money offered by the Bishops, the King would have more evidence against him. â€Å"If the King takes that matter any further, with me or the Church, it will be very bad, if I even appear to have been in the pay of the Church† Other characters also appear to corrupt, often in their attempts to please the King. Cromwell is a very corruptive character. He shows allegiance to the King – but only for his personal satisfaction: â€Å"Sir Thomas is going to be a slippery fish, Richard; we need a net with a fine mesh† Cromwell is being corruptive in trying to discredit More. Cromwell uses metaphors â€Å"Raising the storm† and â€Å"to come out of harbour† to accuse More of causing conflict in standing by his morals. The common man also refers to social movement as ‘canals’ and â€Å"Against the current of their times.† This movement is also shown with the River Thames used as a waterway that takes the characters along. This metaphor again is used by the Boatman to show how More is getting deeper into his position and the feud is getting heavy, ‘silt’, but More is trying to keep straight: â€Å"There’s a channel there getting deeper all the time† Cromwell is trying to set More up so that he can be more acquainted with the King. He accuses More for using God to â€Å"provide a noble motive for his frivolous self conceit.† Cromwell asks Rich to help, but Norfolk defends More because he has realised that Cromwell is only trying to corrupt him and his family, therefore Norfolk wants nothing to do with this. Norfolk consequently is not corrupt, he just does not have a strong moral code to abide by. Wolsey, however, tries to persuade More to support him in getting Henry’s marriage to Catherine annulled. Again More adheres to his moral code, taking care not to criticise the King or say anything that would put him in danger: â€Å"A dispensation was given so that the King might marry Queen Catherine, for states reasons. Now we are to ask the Pope to-dispense with his dispensation, also for sate reasons?† Wolsey’s corruption is not for his personal gain. Catherine has been unable to bear Henry a son, and Wolsey feels that for the sake of the Royal succession, Henry should remarry so that he may have an heir. â€Å"The King needs a son†¦let him die without an heir and we’ll have them back again† (referring to the War of the Roses). Wolsey feels that ‘certain measures perhaps regrettable, perhaps not-there is much in the Church that needs reformation Thomas-alright, regrettable! But necessary, to get us an heir!† therefore he justifies his corruption (if you can justify corruption) because it ultimately would benefit the country. More answers this: â€Å"When statesmen forsake their own private conscience for the sake of their own public duties†¦they lead their country by short route to chaos† More does not agree with Wolsey and even these reasons are unacceptable. Of all the character in the play, More is the only one who does not succumb to corruption. It would have been the easy option for More agree and comply with the King, but the strength of his religious and personal morals meant more to him. He was respected for these attributes and did not want to loose this. He also felt that ultimately God was his judge. This play is about political dalliance rather than fast moving action, â€Å"The interval started early in the year 1530 and it’s now the middle of May 1532.Two years.† It is about corruptive persuasion that More resists and ultimately leads to his execution. This is shown at the beginning of act 2: The political dalliance of the play is instigated by More not giving in to coercion, persuasion or even temptation. Ultimately, according to his own definition, More is a hero: â€Å"If we lived in a State where virtue was profitable, common sense would make us good, and greed would make us saintly. And we’d live like animals or angels in the happy land that needs no heroes.† He lived up to his rules and the rules of his religion, however unhappy he has made those around him. ‘Everyman has his price’ except More, or was it his life that was the price he had to pay?

Pompei and Herculaneum Religious Archaeology

Being one of the most fascinating and cataclysmic events in Ancient Rome, The violent eruption of Mount Vesuvius ultimately destroyed a set of unique and culturally significant societies from Rome. With Pompeii and Herculaneum’s unique culture came their widely influenced and varied religion. Religion of which had no one following, one god or one origin. Both societies housed many cults and religions, many of which were adopted by citizens after foreign influences, significantly from the Hellenic civilizations. Pompeii was evidently a wealthy aristocratic city, as demonstrated by the abundance of valuables located along the remains of dead Pompeians. Golden coins, jewelry and lavish houses adorned with frescoes were extracted from Pompeii at the time of finding, as the volcanic debris preserved much of the city. This is not to say that Pompeii also housed many middle and lower class citizens, slaves being an integral part of the city-town. Much of these influences manifested itself in the form of temples, epigraphy and burial practices and are examples of how much and how many forms of religious impact were seen throughout the city. Seeing how these religions surfaced in Pompeii and Herculaneum can help uncover how these distinct cults and practices impacted the societies. Being one of the most prominent and distinct examples of influence in religion in both societies, the temple of Isis housed a large and devout cult all around the Roman Empire, but very much so in Pompeii and Herculaneum. Being of Egyptian origin, the god Isis was a significant part of both cities, the temple in subject adorned with mosaics of Roman and Egyptian gods, with the god Hermes carved onto the purgatorium. This demonstrates to us that the Cult of Isis did not in a way, interfere with the practices or other religions, but rather integrated into. Isis herself was represented in large of lower classmen, commoners as well as slaves and women. As such, having a large slave and tradesman population, meant that Isis was a popular cult and goddess towards the people. The courtyard itself contained a multitude of chambers and buildings, one of which led to a cistern that held water from the rive Nile. This shows us not only of their devotion to Isis, but it is also evidence of ritual and cult practice. As the Temple was kept intact so well, much of the architecture and detail in regards to the walls and columns tells that the city had strong Egyptian influence, as well as showing us how important Isis and Egyptian religious worship was to them. Such importance in that an Egyptian Temple was built in a Roman city, further enhancing the notion that Egypt had large impact onto Pompeii and Herculaneum. Plutarch stated that the Egyptians were indeed of a very pious nature, but they were not the only cult to call Pompeii its home. The cult of Dionysus, another large following in Pompeii and Herculaneum, was to honor the titular god, Dionysus. Being the god of Wine and festivities, the higher class individuals may have seen the cult as a representation of themselves, demonstrating how it catered to the aristocrats’ own lifestyle, similar to how Isis represented the poor and working class individuals. Dionysus was of Greek mythology, showing us the influence of the Greeks, but it very much resembled Bacchus, the Roman god of similar representation. Dionysus was somewhat worshipped in the Villa of the Mysteries, in which Romans would accommodate its interior. The Villa was a meeting place and a home to many patrons in Pompeii, lined with ornate and detailed frescoes, largely intact. The frescoes depict a multitude of activities and practices, such as rites of passage, leisurely activities such as dancing and instrument playing, as well as featuring Dionysus himself. This was likely some of the many practices that the cult delved in during the villa. It is also interesting to note that the exterior of the villa was closed off and although a large part of the city, it is situated in the northwest of the city, away from the general populace and larger landmarks. In addition to that, much of the rituals and events took place at night and in secrecy, specifically the rites of passage. One could assume that although the worship of either Bacchus or Dionysus was prevalent, the practices and activities that were partaken, especially at night were something to be discrete about. Such a source is useful to us as the Villa’s Dionysus worship is backed by the fact that the Villa and its practices and rituals were placed so far away from other prominent buildings and individuals. Other figures were also incorporated into housing and residences as well, one of them being the Lares. Lares were guardian figures in Roman Mythology and were widely impacted throughout Pompeii and Herculaneum. Many of our references to the Lares are shown in the form of mosaics and statues, particularly around Roman residence. Lares were seen to be protectors, which explains their use around the city. One such residence, the Villa of the Vettii, houses a particular mosaic of two Lares, assumed to be sacrificing another individual, with a snake under them, representing prosperity. Not only this, but Lare statues were placed all around the house and for many other everyday occasions, such as funerals, banquets and births. Cicerobelieved that â€Å"The mose sacred and hallowed place on earth is the home of each and every citizen†, the citizens of Pompeii rightly believing so. One could deduce that the citizens believed that the Lares were directly related to the city’s well-being and that they demanded sacrifices in order to achieve it. In addition to this, the fact that these deities were so widespread and common throughout both Herculaneum and Pompeii, in addition to much of the rest of Rome, shows its usefulness in identifying that the Lares were seen as a very significant and integral part of everyday life. Another significant religious practice in both societies was the use of tombs and burials. The ruins of Pompeii and Herculaneum are scattered with the tombs and burial sites of dead citizens, mostly of aristocratic descent around the gates and leading to the city. The graves collectively formed the Necropolis and are scattered with statues and inscriptions of different gods and followings. This shows us how diverse the religious demographic was in Pompeii and Herculaneum. Many tombs also contained valuables along with their owner’s remains. Things such as jewelry and weapons were found during excavation, detailing that these individuals had possibly believed in an afterlife with the items that they were buried with. It is also interesting to note that Hellenic and Gallic civilizations adopted this practice earlier on, possibly concluding that there could have been Northern and definite Greek influence in Pompeii. It is also a point to make that these tombs were built around the gates of Pompeii and Herculaneum, a place of high traffic. Citizens could then be speculated that they may have treated the idea of death much more positively and more conventionally than how the modern world handles it, the latter in question usually designating graveyards near places of little significance or at least, certainly not of high traffic. The Necropolis in question of its usefulness is very much a key part in understanding the belief of death, its practices in burial and the afterlife as it was and still is, the resting place of thousands of people, all of them, believing that the Necropolis was a distinguished, significant place of burial and where they wished to be encapsulated, many of them bearing and displaying their Religious affinity in either the form of epigraphy or an idol or shrine near their tomb.

Undesirable: The Tragedy of Blanche Dubois

One of the victims of this tragedy is Balance Dubos, a delicate and fragile minded outcast. Ostracizes by her hometown and abandoned by her family, she resorts to prostitution and alcoholism for consolation. In her efforts to assure herself of her own worth in her growing age, and to rescue her sister, Stella, from an abusive lifestyle, she offends the male-dominated society in which she is trapped. Despite Blanches controversial lifestyle and destructive actions, she is nonetheless a tragic heroine whose downfall resulted from poor treatment at the hands of a cruel society to which she refused to comply.Aristotle defined a tragic hero as a character of nobility with a tragic flaw that eventually leads them to their own downfall. Balance Dubos, a beautiful and sophisticated belle, once represented the vision of the south. Born into a wealthy family and happily married to a young romantic, Balance seemingly had everything desired by women of her period. However, when her young husband is revealed to be a homosexual, she is unable to cope and drives him to suicide with her disapproval. This sends Balance into a spiral of mental degeneration, rendering her unable to adjust to the changes happening in ere world, namely the fall of the south.When she goes to her sister Stella for support, she clashes with the ideals of Stellar abusive husband Stanley, ultimately leading to her mental and physical destruction through rape. Balance meets the criteria of a tragic heroine from her noble beginnings to her humble end. She was the perfect example of southern class and sophistication before the fall of the aristocracy. She lived a lofty life at her plantation, Belle Reeve, and married her first love. Her downfall began when her husband, Allan, was caught in his homosexual actions; she confronted IM and he escaped her disappointment by killing himself.The damage to her mental health resulted in the loss of her home, her self-esteem, and eventually her concept of reality, whi ch was further broken by Stanley brute invasion. While some critics argue that Balance cannot rise to the title of tragic hero due to her many character flaws, critic Kathleen Lana, in her essay A Streetcar Named Misogyny, defends Balance by reminding the readers of her humanity: In her dramatic situation, Balance is – indeed – flawed, culpable, tragically imperfect, but she is fully and flagrantly human. As a tragic Geiger she functions as a subject, to be judged by her action or inaction†¦ ere will to save herself, her sister, her home. She is being fully female, driven beyond her ability to cope with the wholly male world. At this level of the play, we may grieve as the environment destroys Balance, or we may rage as Balance backs herself into a corner with her lies and evasions. But no matter how we view Balance we see and judge Balance as Balance, a fully developed human character. Balance, as a human, has several flaws that could be considered tragic. Howeve r, the flaw that initiates the beginning of her nonfatal, Élan's suicide, is her inability to be compassionate.In his paper The Tragic Downfall of Balance Dubos, Leonard Bergman describes this flaw by stating that â€Å"Blanches most fundamental regret is not that she happened to marry a homosexual†¦ Or the discovery of Élan's homosexuality†¦ But when made aware†¦ She brought on his suicide by her expression Of disgust. † A second tragic flaw is the inability to forgive herself for denying her husband forgiveness. Bert Caraculs states in his essay Balance Dubos as Tragic Heroine, that while â€Å"Balance could hardly be expected to respond with love and understanding†¦ E never truly had an intimate, an open and trusting, relationship with him. † Caraculs goes on to say that â€Å"Balance refuses from the beginning to forgive herself for denying Allen the compassion that would have saved or perhaps changed him. † Balance could not move on from the past because she felt guilty for telling the truth, something she often praised herself for doing. At the end of the play, it seems apparent that Stanley has won; that he has conquered and triumphed over a woman who defied and insulted the wills of men.However, tragic heroes are not necessarily defined by their victories, but y their struggle against their fate. Rather than bending to the whims of men in her male dominated society, Balance instead exposed their evils, beginning with Élan's and ending with Stanley. Balance redeemed herself by admitting her own flaws to Mitch after Stanley reveals her lies. She emerged from her romanticizes fantasy land to deliver the real truth: the person she fooled the most was not him, but herself.In scene ten, Stanley believed that his personal and violent invasion of Balance would finally break her, forcing her to admit all of her wrongs and finally live in reality. While he's made out to be the actor, with nobody believing Blan ches declaration of rape, he only achieved his goal of taking all of her privately. Her mind retreated into her fantastical world of the past, allowing her to escape her reality permanently. Memories Of southern gentleman supporting their decorative belles allowed her the peace she could not find, even as she was escorted to the asylum, her new â€Å"home†, by a kindly doctor.Balance is a tragic heroine. She fits the Aristotle defined criteria, she has not only one, but two tragic flaws, and though she lost her sanity and pride by the end of the play, she does not submit to her harsh reality. Some critics argue that, in her mad hysteria, she is not befitting of the title tragic hero. However, they are simply preying on her open weakness, something that many male tragic heroes are too prideful to show. Her weakness only makes her more eligible for the title; she is exposing her flawed humanity to all who condemned her.She dares them to come clean of their own flaws, many of wh ich her society condoned. As Lana states, â€Å"She may be quite simply too noble to exist as a female in a world run by a phalanx of Stanley Kowalski. † â€Å"Balance becomes a tragic protagonist and transforms the play into an allegory; Williams uses her plight to criticize the social circumstances that have shaped her flawed persona and led her to her demise. † The social circumstances that Lauren Siegel mentions in her essay Balance Dubos: Antihero are what condemn, ostracize, and serve to flaw Balance and her fragile mind.Aside from her own tragic flaws, Blanches society is to blame for her downfall. By creating societal norms and expectations, her society placed restrictions on her actions and convinced her that what she did to survive, both mentally and financially, was morally wrong. It glorified the actions of en such as Stanley Kowalski, who measured women's worth only by their sexual attractiveness, and rejected free female sexuality. Lastly, it condemned ho mosexuals and anyone else who did not fit into society's cookie cutter conformity, namely Balance Dubos. In her hometown, Balance was known as the town nut.After the death of her relatives, paying for the plantation became her responsibility, a responsibility that weighed heavily on her damaged psyche after her husband's death. Prostitution served a dual purpose in Blanches mind; it paid the bills and allowed for meetings with â€Å"strangers† who would remind her Of her beauty. However, as knowledge of her promiscuity spread throughout the town, her name became trash and her reputation resulted in her termination from the hotel in which she worked. Though the hotel was known for its shady business, society placed her sins above others.Why? Because she was a woman who went against what was expected of her: to be married and supported by a husband, with whom she was allowed to have free intimacy. Caraculs supports this by stating, â€Å"These â€Å"strangers†, in †Å"wising up† to Blanches thinly disguised cries for help and devotion were as much to blame for her panic-driven promiscuity as she herself was. Even before the South's decline, men were the bread winners of society. However, during the reign of the aristocracy, men were expected to be gentlemen to their women, to be their financial supporters and protectors.When industrialization replaced the plantation lifestyle, a new attitude was formed. Men became cold, brutish, and domineering over every aspect of their lives, including their women. Women became objectified as property rather than respected as equals. While society praised men for owning a lot of â€Å"property, women, like Balance, were hounded for promiscuity and damned as harlots. As Lana complains, â€Å"Stanley, on the other hand, is applauded for his sexuality, for his sadistic exploitation of Stella, for his love of the ‘colored lights'. Men were permitted their adultery because of their usefulness, while women, who were viewed only as burdens, were denied their freedom. Allan and Balance needed each other to conform to society's expectations. Allen used Balance to disguise his homosexuality, and Balance used him for financial support and protection. After Balance discovered Élan's affair with another man and confronted him, she unconsciously sacrificed both her and is position in society. By embarrassing Allan, she ruined his reputation and his chances for success. His suicide left her without support or an outlet for intimacy.Caraculs uses this fact to explain Blanches acceptance of Match's courting, â€Å"she struggles at the end in his memory to achieve intimacy with Mitch which alone can restore her to grace through linking of sex with compassion. † She recognized that, though she did not love Mitch as she loved Allan, the only way to be restored in the eyes of society was to conform: to get married. However, her inability to win over Mitch after her lies are revealed mode her chances and foreshadowed that she would never be able to rejoin the society that rejected her. Society's expectations prevented both women and men from shaping their own destiny.By forcing the cult of domesticity, both Stella and Balance, the women who conformed and the women who failed to conform, suffered at the hands of men. Conformers often found themselves in unhappy or even abusive relationships and nonconformists were left to their own devises. Likewise, the men, like Allan, who could not abandon their gentle southern upbringing or hide their preference of gender, were rejected and replaced by heir more manly counterparts. Society condemned, ostracizes, and served to flaw what it did not accept. Part of what makes Blanches tragedy a tragedy is how her society treated her when she was found to be undesirable.Instead of being provided with proper help and treatment, she is hauled off to the madhouse in an embarrassing and demeaning manner. She is also denied an invest igation of her declaration of rape by Stanley, as no one believed she was in her right mind. It is this mistreatment that resulted not only in Blanches fate, but also Élan's and Stellar: mental institutionalizing, suicide, ND domestic abuse. Women were considered undesirables due to their lack of skills. However, they were never trained to be anything other than good mothers and wives in their cult of domesticity.When faced with the brutality of male dominance, women were often mistreated through physical and emotional abuse. However, because they were objectified as the property Of men, society often condoned this ruthless behavior and allowed the abuse behind closed doors. Even the women themselves thought of it as the price paid to keep the peace. Lana shows this in Stella by stating, ‘Stella knows that, t a deeply unconscious level, she must keep Stanley happy to preserve the economic and emotional security she has achieved as his woman. † Homosexuals had an equa l, if not lower, position with women in society.While they were still men, they were seen as having a closer relation to that of women. Lana shows this relation by her description of the author Williams, â€Å"Williwaw's homosexuality in a heavily masculine society rendered him naturally sympathetic toward the plight of the women†¦ With whom he identified with. † When Balance revealed Allan as a homosexual, she condemned him as less than a man by society standards. As a result, suicide became a better option than living in shame. Although he is a character with greater morality than Stanley, Élan's inability to conform to society wishes made him a reject nonetheless.Despite her protective retreat into her memories of the past, Balance still had recollection of Stanley act of violence against her. However, because of her lack of mental stability, her claim is brushed off by the doctors, her neighbors, and even Stella. Her society denied her human rights and savagely s tripped her Of her dignity in her last scene. In her madness, she believed she was making her escape with a gentlemanly lealer, but instead was greeted by two doctors intending to take her away to an asylum.After fighting them at first, she allows herself to be led away by her kindly doctor, after informing him that â€Å"she has always depended on the kindness of strangers†. These strangers, who abused her mental fragility and took advantage of her, are the same men that society praised for their masculine dominance. To conclude, Lana sums up Balance Dubbing's tragedy: â€Å"in the struggle with the dark forces of her society, Balance, with her typically female characteristics, is ultimately lost and savagely exploited.

Reflection of Aggression Essay

People usually relate the behavior of others to their internal dispositions or to their external situations. A dispositional attribution pertains to the personality of a certain person, whereas a situational attribution pertains to the environmental conditions around an event. For example, if a child was bullying another, it could be considered a dispositional attribution because the kid is just naturally a bully and he has a low self-esteem, or it could be a situational attribution because the kid that he is bullying is annoying and he deserved it. Another cause of bullying is to impress other people. It is easier to bully someone when you have a group of people behind you. Because of social facilitation, people tend to improve their performance and want to better themselves in the presence of others.For some people, they consider making someone else feel bad a way to better themselves. A person that is normally not a bully may tend to become one in a group situation. Although it ma y not be part of someone’s personality to be a bully, this may change because of deindividuation. Because the rest of the group is doing something, a certain person feels more comfortable doing it as well. A kid that may not bully anyone on his own would go along with the crowd in bullying someone because of the loss of self-awareness in a group situation. Sometimes, people can be bullied for a certain reason that is extremely unethical. This is called a prejudice or a stereotype. These two things are unjustifiable attitudes toward a group of people that in many circumstances are not at all true. For example, a person or group of people could be bullied because of their race or culture. This would be called a prejudice because it is unjustifiable to be making fun of someone because of his or her color. Oftentimes, a person is bullied because someone else needs a person to take his or her anger out on. Sometimes, a person can just be a target for someone’s anger, or a person to blame. A person may be bullied just because someone else needs a person to blame an event on. Also, a person can take out their aggression on another person when it is caused by their inability to achieve a certain goal. This is called the frustration-aggression principle. No matter what the reason, bullying or making fun of someone is not the solution to a problem. Things should be thought out and considered before drastic action is taken against a certain person, or group of people.

Cbt Case Study

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 all 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 become 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 afte r 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 difficulty 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 therapist 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 out T. 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 t o 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 fainted 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 GOING 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 evidence 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 it’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 therapist will continue to see Jane for two more sess ions, 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 appropriate 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 Cbt Case Study 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 all 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 become 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 afte r 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 difficulty 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 therapist 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 out T. 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 t o 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 fainted 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 GOING 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 evidence 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 it’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 therapist will continue to see Jane for two more sess ions, 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 appropriate 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