Saturday, October 5, 2019
Enhancing a Home Computer Essay Example | Topics and Well Written Essays - 500 words
Enhancing a Home Computer - Essay Example Buying a new one is quite expensive and is a waste of money if one already has a computer that is functioning well; in this case, upgrading the computer system seems to be a favorable option. A few changes here and there, and a computer system will be ready to take on any game to provide computer users with a better gaming experience (Kohler 234). Mostly, the problem experienced by gamers while gaming is the speed of the game; the games require higher amount of speed and the computer can only afford to provide a limited amount of speed. This happens because the Ram (Random Access Memory) of a particular gamer’s personal computer is lesser than the amount of space required to run a particular game. In this scenario, the gamer has to change the RAM of his/her personal computer. The RAM level should be higher than the desired amount of RAM required. Switching RAMs is quite easy and is less expensive than changing the entire personal computer. The current version of upgraded RAM on which the current high quality games are based and designed is DDR3; a 4GB RAM of DDR3 only costs around 50 pounds (Vandome 310). Just a small expense of 50 pounds, and the computer will be ready to help one play high quality games. Upgrade of RAM is not the only thing required to play high quality PC games; games now even require high quality video cards. Both RAM and video cards operate together to give a user the best experience of a particular game. The choice of video card depends on one’s pocket size; this means one’s willingness to spend money and the kind of games one wants to play (Dukish 210). If a particular game requires a gaming video card, it can not be played on a ordinary VGA card. Currently, the best available video cards for a gamer to make his PC a gaming paradise are GTX 460 and 570 (Debevec 125). The 460 one is much expensive than the
Friday, October 4, 2019
Feeding People versus Saving Nature Essay Example | Topics and Well Written Essays - 500 words
Feeding People versus Saving Nature - Essay Example For instance, humans are always looking forward to comfort which is the case why many inventions were invented from the past and at present time. On the other hand, he may be trying to emphasize that nature should not be sacrificed for the sake of achieving substantial human development because when nature falls; it would be for all humans because it is their life support system (Rolston 249). However, by simply understanding the statement of Rolston, it is clear that he admits there are times when human needs should be the first priority or sometimes the nature as top concern. After all, humans and nature coexist in which their ultimate goal is to move forward to the preservation of life. That is why Rolston acknowledges the importance of sustainable development and environmental protection. Based on the point of view of Rolston, it is clear that humans are just integral components of nature. The fact that we are sourcing all our needs from nature cannot deny the truth that we can d o nothing apart from it. In other words, we rely on nature all our needs. Now, on the issue whether we should not feed people first but save the nature instead, the argument may be based on identifying commendable values in human life. Finding which is more valuable between nature and the human life is, in fact, a very interesting topic to discuss. Â Nature cannot be more valuable than the human life and vice versa, but it is clear that human life is an integral component of nature because it sources its needs from it. Â
Thursday, October 3, 2019
Personal Position paper on Psychotherapy Essay Example for Free
Personal Position paper on Psychotherapy Essay Introduction â€Å"People are always changed by disasters, and other life events, but they need not be damaged by them.†-John D. Weaver            When we study human behavior, specifically focusing on the development of personality and crucial to how a person or individual conducts him/herself, psychology offers a variety of dimensions. The concept of personality is central to our attempt to understand ourselves and others and is part of the way in which we account for the differences that contribute to our individuality. Psychologists have been particularly concerned with shaping of the personality in relation to genetic and environmental influences. We have been fortunate that the study of human personality has been thriving and fruitful. We can choose from as many models we can to help us see ourselves better and maintain good relationships.            In the course of our study, every individual counselor – therapist eventually develops his/her own approach in the therapeutic process. The path that the practitioner takes concerning his/her choice of approach or model depends a lot on his/her own personal preferences, personality and understanding of human nature. An eclectic approach is usually the direction that anyone in this field would take; however, certain emphasis is made on some specific positions simply because these are the dominant theories which help guide him/her in focusing the essentials of the process with the client. Though the attempt is said to be eclectic then, the therapist still has this open option to change or vary some details of his/her strategy along the course of the interaction or treatment phases. Discussion            There is a need for integration not only for its theoretical applicability but also for its practical usefulness. Presuppositions or philosophical conceptualizations are the pillars of any worldview, and to successfully establish a new one requires that changes or reinforcements be made at this plane. The integrative approaches were framed at this level so as to remove mental oppositions as they arise every time in one’s thoughts. When this is not adequately laid down, no audience can align their thoughts or understanding with what the author tries to convey. This paper is an attempt to convey a personal understanding of human behavior in the context of psychotherapeutic approaches that are modified for use by the author. It appreciates the accomplishments of the various approaches such as Behavioral, Cognitive-Behavioral, Psychoanalytic, Existential, Humanistic, Family Systems, Gestalt and Client-Centered developments in the profes sion. The following reflects the views of the author in the healing process of the mind and emotions. Key Concepts of My Approach            It is therefore expected that though at this point I value the primary theories or perspectives that I am thus enumerating afterwards, this also implies that I am open to the various developments that are expectedly to occur in my practice in the future. Since this is an eclectic approach at employing strategies I have found to be beneficial personally and that of others, I wish to mention many of these in the following statements. I am persuaded further that key elements or themes are found all throughout my own version of the approach. The smaller yet finer points come only in the between. For the thrust that this paper is taking, I wish to mention then my views individually, on Behavioral, Cognitive-Behavioral, Psychoanalytic, Existential, Humanistic, Family Systems, Gestalt and Client-Centered approaches. Behavioral Therapy            This model utilizes what is termed as the learning theory posited by Skinner and Watson and the rest of the Behaviorism school. It assumes that the principles in learning i.e., conditioning (Associative and Operant) are effective means to effect change in an individual. Generally, the thrust of this theoretical perspective is focused on the symptoms that a person is experiencing. Just as many of the errors of the patterns of behavior come from learning from the environment, it is also assumed that an individual will be able to unlearn some if not all these by using the techniques as applied based on the learning principles. To a certain extent I believe that this still works: reinforcements are effective to some extent and in some or many people hence I am incorporating this stance separate or distinct from the Cognitive-Behavioral approach.  In behavior therapy therefore, thoughts, feelings and all those â€Å"malfunctioning†an d unwanted manifestations revealed in one’s activities can be unlearned and the work of a behavior therapist. The basic concepts include â€Å"extinguishing†– utilized when maladaptive patterns are then weakened and removed and in their place habits that are healthy are established (developed and strengthened) in a series or progressive approach called â€Å"successive approximations. When these (factors) are reinforced such as through rewards in intrinsic and extrinsic means, the potential of a more secure and steady change in behavior is developed and firmly established (Rubinstein et al., 20074; Corey, 2004). Although few psychologists today would regard themselves as strict behaviorists, behaviorism has been very influential in the development of psychology as a scientific discipline. There are different emphases within this discipline though. Some behaviorists contend plainly that the observation of behavior is the best or most expedient method of exploring psychological and cognitive processes. Others consider that it is in reality the only way of examining such processes, while still others argue that behavior itself is the only appropriate subject of psychology, and that familiar psychological terms such as belief only refer to behavior. Albert Bandura’s social cognitive approach grew out of this movement. Banduras method emphasizes cognitive processes over and above observable behavior, concentrating on not only the influence of the person’s upbringing for example, but also observation, imitation, and thought processes (Plotnik, 2005). Cognitive-Behavioral            In the cognitive approach alone, the therapist understands that a client or patient comes into the healing relationship and the former’s role is to change or modify the latter’s maladjusted or error-filled thinking patterns. These patterns may include wishful thinking, unrealistic expectations, constant reliving and living in the past or even beyond the present and into the future, and overgeneralizing. These habits lead to confusion, frustration and eventual constant disappointment. This therapeutic approach stresses or accentuates the rational or logical and positive worldview: a viewpoint that takes into consideration that we are problem-solvers, have options in life and not that we are always left with no choice as many people think. It also looks into the fact that because we do have options then there are many things that await someone who have had bad choices in the past, and therefore can look positively into the futu re. Cognitive-Behavioral Therapy postulated primarily by Ellis and Beck â€Å"facilitates a collaborative relationship between the patient and therapist.†With the idea that the counselor and patient together cooperate to attain a trusting relationship and agree which problems or issues need to come first in the course of the therapy. For the Cognitive Behaviorist Therapist, the immediate and presenting problem that the client is suffering and complaining from takes precedence and must be addressed and focused in the treatment. There is instantaneous relief from the symptoms, and may be encouraged or spurred on to pursue in-depth treatment and reduction of the ailments where possible. The relief from the symptoms from the primary problem or issue will inspire the client to imagine or think that change is not impossible after all. In this model, issues are dealt directly in a practical way. Coaching the patient on the step by step procedure of CBT is a basic and fundamental ingredient. Here the client is enlightened as to the patterns of his thinking and the errors of these thoughts which bore fruit in his attitudes and behavior. His/her thoughts and beliefs have connections on his/her behavior and must therefore be â€Å"reorganized.†For instance, the ways that a client looks at an issue of his/her life will direct the path of his reactivity to the issue. When corrected at this level, the behavior follows automatically (Rubinstein et al., 2007; Corey, 2004). Psychodynamic Therapy            The Psychodynamic perspective is based on the work of Sigmund Freud. He created both a theory to explain personality and mental disorders, and the form of therapy known as psychoanalysis. The psychodynamic approach assumes that all behavior and mental processes reflect constant and often unconscious struggles within the person. These usually involved conflicts between our need to satisfy basic biological instincts, for example, for food, sex or aggression, and the restrictions imposed by society. Not all of those who take a psychodynamic approach accept all of Freud’s original ideas, but most would view abnormal or problematic behavior as the result of a failure to resolve conflicts adequately. Many of the disorders or mental illnesses recognized today without a doubt have their psychodynamic explanation aside from other viewpoints like that of the behaviourist, or the cognitivists. From simple childhood developmental diseases to Schizophrenia, there is a rationale that from Freud’s camp is able to explain (Kaplan et al, 1994). Existential Therapy            The Existential approach, as put forward by Nietzsche, Kierkegaard, Sartre, Heidegger, Rollo May, and Frankl, believes that the individual’s potential may lie dormant but that it is there waiting to be ushered in time. It recognizes that man is able to achieve great heights and that these are just waiting to be tapped not only by him/herself but that also when helped by a practitioner who is persuaded of this notion. It examines such major issues as free will and the challenges of exercising this free will, the issue of mortality, loneliness and in general, the meaning of life. The Therapy is effective when the practitioner works with elderly care and death and dying issues. It focuses on the individual needs but takes into consideration the significant relationships and the meanings they bring into the person’s life. Transcending the issues and problems are primary intentions of the therapist at the same time being realistic that certain limitations do exist and may hinder the process of recovery (Rubinstein et al., 2007; Corey, 2004). Humanistic Therapy            Allport, Bugental, Buhler, Maslow Rollo May, Murphy, Murray, Fritz Perls and Rogers are those that helped usher in the Humanistic theory and consequent therapy. It holds in view the individual as possessing the options or freedom to choose, creativity, and the capability to attain a state where he/she is more aware, freer, responsible and worthy of trust. Because the human mind has immense potential, the approach assesses as well that forces from the environment bear on with the individual and depending on the interplay that occurs within the individual person, the result will either be destructive or constructive to the person. In sum, humanism takes into the perspective that essentially humans are good and not evil, and that the therapy facilitates by harnessing on the human potential through the development of interpersonal skills. This results to an enhanced quality life and the individual becomes an asset rather than a liability to th e society where he revolves in (Rubinstein et al., 2007; Corey, 2004). Family Systems Therapy            This theoretical viewpoint has been the by-product of the works of Bateson, Minuchin, Bowen, Ackerman and many others. Usually done in pairs or by a team of practitioners, family systems therapy has its roots in behavioral and psychoanalytic principles. This model understands that the family is a unit and its members or any of its members with an issue or a problem must be addressed in the context of the family as a unit. It puts its emphasis on the relationships among the family members, their patterns of communication more than their individual traits and/or symptoms. The systems theory portion of the therapy indicates that whatever is occurring or happening is not isolated but is a working part of a bigger context. In the family systems approach then, no individual person can be understood when removed from his relationships whether in the present or past, and this is specially focused on the family he belongs to (Rubinstein et al., 200 7; Corey, 2004). Gestalt Therapy            Gestalt therapy has this goal of reducing if not removing the symptoms with the rationale that the individual has personal responsibility and that the here-and-now experience is thus very important. This two-fold emphasis on the present moment as experienced by the person and that another reality is that our existence is entangled actually with other aspects and parts of the environment. It is when we understand that we are related with other things that insights to our issues are achieved and help us in finding solutions to our existence. When we are free from the obstructions of things that are â€Å"unfinished†then we reduce the obstacles and enhance the opportunities to our optimal satisfaction and fulfillment and eventual growth (Rubinstein et al., 2007; Corey, 2004). Client-Centered Therapy            Developed and known because of the works by one person – Carl Rogers – Client Centered Therapy focuses on the person who needs aid and his/her improvement depends on the client himself although with the facilitation and assistance of the therapist. The rationale for the direction of the therapy lies in the notion that humans basically possess the ability to move towards the fulfillment of his/her possibilities. According to Rogers, â€Å"Individuals have within themselves vast resources for self-understanding and for altering their self-concepts, basic attitudes, and self-directed behavior; these resources can be tapped if a definable climate of facilitative psychological attitudes can be provided†(Rogers, 1980, p 115-117 in Rubinstein et al., 2007).            This approach is very popular today and many therapists usually incorporate this model into their own eclectic method. Rogers identified three important concepts termed as conditions: these are congruence, unconditional positive regard and empathy. Many in the mental health circles have these in their day-to-day jargon. In the aforementioned conditions, a person moves toward what Rogers call â€Å"constructive direction†when these three conditions are afforded. The Role of the Therapist            I aspire to be a therapist – counselor whose practice is characterized as empowering and collaborative. By empowering, I understand the limitations of my role and as such I am constrained at the same time to impart my best knowledge and efforts to enable my client/patient to understand him/herself, and lead the treatment to the point where he/she is able to stand on his/her own without my help anymore. Further, it means that I recognize the patient or client as a person who is not only complex, he/she is also is imbued with the nature that inherently can heal, grow and mature. They contribute to the process, and their attitude towards the whole duration of the healing relationship is a crucial aspect to the attainment of their goals. The therapist then must remove by all means any barrier or obstruction to the achievement of goals especially when these come potentially from the therapist him/herself (that’s me). By collaborative, again because there are set limitations on my capacities, I recognize the availability and expertise of others in realms that I hardly know and that working with them, collaborating with them, gives my client more options, and provides him/her the best and comprehensive interventions that there is in the field. A therapy that is beneficial looks beyond my set style and preferences of diagnosis and treatment; it is progressive and seeks to enhance the initial strategies that had been established and continually expands oneself by learning and researching. Most importantly, by collaboration, my client is the most significant â€Å"collaborator†and that notion should not be missed all throughout (Rubinstein et al., 2007; Corey, 2004). .            The effectiveness of therapy in counselling is dependent substantially on two factors; namely, the patient’s cooperation, and the expertise of the therapist. Many experts in the field of Psychology have observed the significant contribution of the client to the over-all process. The individual’s perception of the therapist is extremely crucial to the ensuing treatment. Without the needed initial positive perception of the therapist on the part of the one seeking treatment, the whole process will not generate a desired momentum that would set the entire scheme in a strategic stance. Of course, the expertise of the therapist is another major factor – actually, the other half – but it’s a given to the whole package of treatment (Rubinstein et al., 2007; Corey, 2004).            Since a â€Å"working alliance†has to be established first before the actual treatment is administered, there are important or vital considerations for this â€Å"working alliance†between client and therapist to occur, and this is in prà ©cis, the intentions of this paper. What we will be considering in this paper are the challenges that new therapists face as they practice their profession. The past baggage of the client.            From any vantage point, the level of trust by client on his therapist, whether that perception is based on attractiveness, trustworthiness or as someone who knows what he may be dealing with in terms of credentials, are valid, and is the utmost concern of the helping relationship. Trust in the part of the client is necessary for the healing process. However, because the full ramifications of the issue almost always hinge on the perceptions of the client, the problems and hindrances need to be addressed or at least cited for clarity and deliberation at the outset of the relationship. As hinted above, the client may be bringing (emotional) baggage into their mutual involvement which may be due to prior engagements with other professionals in the therapeutic relations, whether positive or negative. Oftentimes, in many cases, these may be liaisons which were unsuccessful, distasteful or even traumatic for a few. The author pointed out that any form of future therapy will be affected due to these previous experiences, and it has to be dealt with right away at the outset (Horvath Luborsky, 1993, p. 4). The fitness of the therapist            By fitness, we mean sufficient, wide-ranging exposure, and right training to the kind of illness/es or disorder/s that he may be dealing. Even with years spent in the academe will not guarantee the development of skills in handling such complex and true-to-life situations or scenarios. At times, the theoretic skills acquired, instead of enabling the new therapist, may deter or hamper the process. This means to say that the therapist must possess more than head-knowledge; he should not allow his schooling to affect him to the extent that it made him conceited with no room for more learning especially when additional knowledge are available in the patient himself. He must also have the sensitivity to employ his gut-feeling to at times, direct the course of the therapy (Rubinstein et al., 2007; Corey, 2004). Therapeutic relationships are almost always exhausting, but it will be an undesirable experience for the alliance partners when just one of them becomes disinterested, hence as Luborsky pressed that â€Å"reciprocity†must be established, cultivated or maintained until the relationship is terminated, hopefully because the client is well (Horvath Luborsky, 1993, p. 4). III. The Therapeutic Process            The therapeutic process is initiated by the therapist primarily as soon as the client or others who refer or brought the patient in for the assumed long haul of the healing relationship. It would be impossible to do all approaches at one time. By eclectic and as frequently emphasized, the usage of any of the methods will be dependent on the need of the patient, and other pertinent information that help guide which of these the therapist will be using. The therapist then is enjoined to be able to diagnose well; it is at this stage that any practitioner is well aware of the risks should he/she fail to diagnose properly the needs and or issues /problems of the client. However, as he/she matures and advances in the profession, many instances occur that the mistakes made in diagnosis are oftentimes corrected while at the treatment stage, hence the traits of flexibility and humility (admitting mistakes for instance) are valued highly in this pro fession (Rogers, 1980, p 115-117 in Rubinstein et al., 2007).            Employing the Behavioral, Cognitive-Behavioral, Psychodynamic, Existential, Humanistic, Family Systems, Gestalt and Client-Centered Eclectic stance primarily involves the incorporation of distinct concepts within a single framework. The important thing is that of flexibility and resiliency on my part when to apply or implement which of the theories in the context of my client. It starts with the identification of specific problems and especially the root causes. When this is confidently achieved, the therapist is actually midway to attaining his/her goals which includes not only the relief of the symptoms that the sufferer is currently experiencing but especially the reduction of the occurrence if not altogether eliminated. The specific treatment goals are likewise essential and it helps in the remaining aspects or levels of the process. The diagnostic part by itself in most cases is considered therapeutic since many clients have experienced immediate relief; in the language of psychoanalysis, the â€Å"cathartic†effect is helpful already. In addition, another important ingredient in the process is to identify effective reinforcers which help people in crisis for instance or those in acute and chronic mental and emotional anguish to sustain their plan for change and control of their disorders. Helping the client set up a kind of self-help management program is a very effective strategy to pursue within the relationship (Rubinstein et al., 2007; Corey, 2004). ~Identifying clients in crisis            Despite breakthroughs in scientific researches and the success of many crisis interventions by established churches, there are â€Å"fly by night†operations which prey on funding of private and government groups on such types of operations. There are those who minister lacking the necessary spiritual maturity and corresponding abilities in this kind of endeavor, hence the necessity of proper credentials to minimize abuses in the profession (Buttman, p.59). Crucial to the treatment or interventions of people in crisis is the identification of clients experiencing crisis in life. â€Å"Knowledge of the three core components of crisis intervention theory (a precipitating event, client perception of the event, and the client’s usual coping methods)†is essential in this kind of work (Walsh et al, 2005). The Goal of Therapy            Trauma inducing and crisis triggering situations have spiraled its occurrence and in its primacy in the US and in many other countries in recent years. Its broad spectrum ranges from the national disaster category such as that of Hurricane Katrina or the 911 terrorist strikes in New York, Spain and England, to private instances such as a loved one’s attempt at suicide, the murder of a spouse or child, the beginning of mental illness, and the worsening situation of domestic violence (Teller et al, 2006). The acute crisis episode is a consequence of people who experience life-threatening events and feel overwhelmed with difficulty resolving the inner conflicts or anxiety that threaten their lives. They seek the help of counselors, paramedics and other health workers in crisis intervention centers to tide them over the acute episodes they are encountering. These are defining moments for people and must be adequately addressed else they lead lives with dysfunctional conduct patterns or disorders (Roberts et al, 2006).            In the integrated or eclectic approach the goal of the therapy is not just relief to the patient or client. Although an immediate relief is very helpful, this may not always be the case in most illnesses. The goal as mentioned in the preceding pages is to provide long-term reduction of the symptoms and the occurrence of the disease altogether if possible. The management then is not impossible but neither is this easy. Specifically, the counselee or patient must want to heal or believe that there is going to be curative effects in the process. It presupposes that he/she must learn to trust the therapist in his/her capabilities as well in leading or facilitating the changes or modifications. It is very much essential that (in the perspective of a cognitive-behaviorist) that the client understands ownership to the deeds and choices in thought patterns he/she made are crucial to the recurring or occurring condition that s/he experiences (Rubinstein et al., 2007; Corey, 2004).            Moreover, the identification of specific treatments or interventions according to the diagnosed issue will be accommodated and implemented based on the chosen treatment modalities fit with the therapeutic approach utilized. It may be a single modality based on a single approach (e.g., learning principles and desensitization for a patient with specific phobias) or it maybe a combination of many modalities (CBT, Rogerian, Phenomenological, or Family systems) (Rubinstein et al., 2007; Corey, 2004). The Nature of the Relationship between the Therapist and the Client            The client throughout the process is a person in need of help and support and this reality is throughout reinforced in the process until the need to terminate the relationship. The therapist is the helper, who ushers the client to discover insights into his needs and problems and until the client is able to stand on his/her own the therapist aids him/her in more ways than one. Because of usual and common abuses that either the client suffers or that the therapist at times undergoes, definite boundaries are set in place at the outset. This must be established at the initial stage and from time to time emphasized to mind either of the parties in the limits of the relationship. The therapist is guided by morality and ethics of his/her profession in the proper exercise of his/her duties and bound by law to implement this in the process and make this known as well to the client. The therapist terminates the relationship readily or refer the cli ent to another competent practitioner should the limits be reached and the relationship has become unrealistically difficult for either of the two parties. Best Practices for Techniques            Techniques or the utilization of various modalities come in a variety of forms and each when employed has the potential to meet the individual’s needs. The modality of choice at particular client/patient depends on such considerations as family support, financial constraints or financial capability, the patient’s preference, diagnosis, and age of patient (Rubinstein, et al., 2007). Employing the cathartic method, teaching the client to examine his/her thought patterns, to discern the errors of judgment and gain insight into him/herself, and to handle with patience the whole process are fundamentals in the process. When the therapist is able to shift effectively in various standpoints and enables the client to gain a better, realistic and eradicate unrealistic expectations of the self and others, they are both on the way to achieving wholeness and healing that which the client so need and aspire. This requires practice, or con stant training and endurance on the part of the therapist (Rubinstein et al., 2007; Corey, 2004). VII. Methods of Therapy            Every theoretical approach has its own assumptions. In the psychodynamic theory, the following three assumptions help guide a student of human behavior or an expert in this field determine the underlying factors that explain the overt manifestations of specific behaviors. These assumptions therefore, help guide the diagnosis of the presence or absence of mental illness. They are the same assumptions that guide the therapist in choosing what treatment that will better help heal, cure or alleviate the symptoms.            These assumptions are: â€Å"There are instinctive urges that drive personality formation.†â€Å"Personality growth is driven by conflict and resolving anxieties.†â€Å"Unresolved anxieties produce neurotic symptoms†           (Source: Kaplan et al, 1994).            The goals of treatment here include alleviating patient of the symptoms which specifically works to uncover and work through unconscious conflict. The task of psychodynamic therapy is â€Å"to make the unconscious conscious to the patient†(â€Å"Models of abnormality†, National Extension College Trust, Ltd). Employing the psychodynamic viewpoint, the therapist or social scientist believes that emotional conflicts, or neurosis, and/or disturbances in the mind are caused by unresolved conflicts which originated during childhood years. In the psychodynamic approach the treatment modality frequently used includes dreams and free association, at times hypnosis (as preferred by either the therapist or by the client). The therapist actively communicates with the client in the on-going sessions. The scenario appears that a given patient may have up to five times a week session and runs up to five years in length (Rubinstein et al., 2007).            The methods of therapy incorporate the methods of the eight models. In Behavioral Therapy – the development of behavioral skills that encourage effective actions which is done through incorporating principles in learning or classical and operant conditioning. It utilizes shaping, modeling and such concepts as behavior modification, counterconditioning and exposure, and systematic desensitization.  Behavioral or action therapies utilize insight just as much as the psychodynamic model. Just as the cognitivebehavioral model also recognizes the concept of insight as well, this is only a matter of emphasis or focus. In behavioral/cognitive-behavioral therapies the focus is on the modification or control of behavior and insight usually becomes a tangential advantage. Techniques include CBT through such strategy as cognitive restructuring and the current frequently used REBT for Rational Emotive-Behavior Therapy where irrational beliefs are eliminated by examining them in a rational manner (Corey, 2004; Davison and Neale, 2001). Whereas in insight therapies the focus or emphasis is on the patient’s ability in understanding his/her issues basing on his inner conflicts, motives and fears. Techniques then include reflection of feelings and free association; the former as employed in the clientcentered therapy and with the latter in psychodynamic therapy. Cognitive Strategies are utilized to promote functional thoughts which are likely to result in adaptive and healthy habits (Corey, 2004; Davison and Neale, 2001).            Client-centered therapy avoids the imposition of goals on the patient or client during therapy. It is the client who takes the lead in the session and of the conversation. It is the job of the therapist to create the conditions conducive to the client’s positive judgment of those experiences that are intrinsically satisfying to the client. The ‘goal’ then is to reach the point where the client desires to be a good and â€Å"civilized person.†Unconditional positive regard enhances this atmosphere however, and although the goal may be difficult to achieve, unconditional positive regard eventually, according to Rogers, encourages even the â€Å"`unbehaved†to conform or even transform (Corey, 2004; Davison and Neale, 2001). Gestalt therapy techniques on the other hand, include the I-language, The Empty Chair, Projection feelings, Attending to Nonverbal Cues, and the Use of Metaphor (Corey, 2004; Davison and Neale, 2001).            The techniques may sound a lot like pulling â€Å"this and that†from one’s tool box but in practice it is far from whimsical and impulsive. There is given time to much thought and analysis per client and an evaluation in between is mustered in order to be kept on track according to the specific goals that had been established at the outset. Here, professionalism counts and much of the efforts poured into every patient’s benefit.            In order to avoid what Corey says as a syncretistic and hodgepodge type of â€Å"eclectism†a theoretical rationale must be underpinning in the overall approach of the therapist (Corey, 2001, Article 29 in Lazarus, 1986, 1996; Lazarus, Beutler, Norcross, 1992). This means that I as the therapist must establish firmly my own worldview, which contains my value system, and communicates this at the outset to the client and intermittently in the therapeutic process.
Psychological Factors In Diabetes Mellitus Health And Social Care Essay
Psychological Factors In Diabetes Mellitus Health And Social Care Essay Health psychology is a topical development in the integration of biomedical and social sciences in health care. It addresses the role of psychological factors in the cause, progression, and outcome of health and illness (Ogden, 2007). Psychological theories can guide health education and promotion, and offer the health care practitioner a structured approach to understanding and meeting the health needs of health and social care service users (Morrison and Bennett, 2009). The appraisal of health psychology models can assist practitioners in evaluating their contribution to service users understanding of health, behaviours relating to health and the practice of health care. Appraisal and evaluation enable health care workers to apply psychological models and theories when analysing aspects of health and behaviour relevant to practice (Marks et al, 2005). Health psychology is concerned primarily with intrinsic factors, especially individual perceptions of health-related behaviour. Health behaviour, defined as behaviour related to health status, is becoming increasingly important. Public health policy has increased the emphasis on individual responsibility and choice and because of this; there is a corresponding need to improve understanding of individual motivations that affect those choices and health-related behaviours (Marks et al, 2005). The health behaviours studied by psychologists are varied, but the most commonly studied health behaviours have immediate or long-term implications for individual health, and are partially within the control of the individual (Ogden, 2007). Type 2 diabetes, formerly known as non-insulin dependent diabetes mellitus, is a serious and progressive disease. It is chronic in nature and has no known cure. It is the fourth most common cause of death in most developed countries (UK Prospective Diabetes Study Group, 1998a). Although no exact figures are available, it has been suggested that by the year 2010 there would be 3.5 million people with diabetes in the United Kingdom (UK). However, approximately 750,000 of the estimated number may be undiagnosed (Diabetes UK, 2008a). Diabetes UK campaigns to raise awareness of type 2 diabetes because if left undiagnosed, the condition can result in long-term complications such as retinopathy, nephropathy, neuropathy, and an increased risk of myocardial infarction and stroke. The total number of people with diabetes has increased by 75% over the last six years and the incidence in the UK is escalating at a faster rate than in the United States (Gonzà ¡lez et al, 2009). There is a higher incidence of type 2 diabetes in people with South Asian or African descent (Department of Health, 2007). One of the reasons for this is thought to be that these ethnic groups have increased insulin resistance. Signs of type 2 diabetes are already present in UK children of South Asian and African-Caribbean origin at ten years of age, according to research funded jointly by the British Heart Foundation and the Wellcome Trust (Whincup et al, 2010). The prevalence of type 2 diabetes increases with age to as much as one in ten in those aged 65 years. The lifetime risk of developing the condition in the UK is greater than 10% (Leese, 1991). Diabetes-related complications can have a major effect on the individual and family members, and are costly to the patient. A study undertaken by Bottomley (2001) examined the costs of living of patients with diabetes complications, including taking time off work and transport costs for hospital appointments. The study showed that the cost of treating someone with type 2 diabetes with microvascular and macrovascular complications was  £5,132 compared to  £920 for someone who does not have diabetes-related complications (Bottomley 2001). This also has implications for the National Health Service (NHS) in terms of the financial burden of managing and treating the condition and the use of resources. It has been estimated that the cost of treating diabetes nationally adds up to approximately 9% of the NHS annual budget, although most of that is used to treat associated long-term complications, such as kidney failure, blindness, amputations and organ transplantation, rather than the provision of medication (Bottomley, 2001). With regard to type 2 diabetes, psychological theories and models have a long history of informing attempts to change behaviour and improve emotional well-being. Over recent years, many clinical guidelines in the UK by the National Institute for Health and Clinical Excellence (NICE) have included recommendations for psychological interventions for long-term conditions. Evidence-based recommendations have been made not only for the treatment of associated mental health problems such as depression and anxiety (NICE, 2009; NICE, 2004) but also for physical health conditions such as obesity (NICE, 2007) and changing behaviour related to public health issues such as smoking and lack of exercise (NICE; 2007). The aim of this essay is to explore the psychological implications for a person suffering from type 2 diabetes and others involved in the experience of that illness. Type 2 diabetes, is caused as the result of reduced secretion of insulin and to peripheral resistance to the action of insulin; that is, the insulin in the body does not have its usual biological effect. It can often be controlled by diet and exercise when first diagnosed, but many patients require oral hypoglycaemic agents or insulin in order to maintain satisfactory glycaemic control and prevent the complications of diabetes (Diabetes UK, 2008a). To reduce the risk of long-term complications, both macrovascular and microvascular, people with type 2 diabetes need access to appropriate, individualised education, which informs them about the risks associated with the condition. Information relating to lifestyle changes such as healthy eating, increasing activity levels, and smoking cessation are vital (Diabetes UK, 2008a). Some people accept their diagnosis of diabetes and all that this means, and manage to adapt to their new lifestyle, but others find it difficult. Changes will need to be made to the type of food they eat, the amount they eat of particular foods and perhaps to the time at which they eat their meals. As a consequence of the required changes to lifestyle, it is not surprising that many people need some professional psychological support (Diabetes UK, 2008a). Diabetes may have an impact on peoples careers, driving, and insurance policies (life, driving, and travel). Difficulties surrounding holidays, work or travel abroad may prove insurmountable without support. People with diabetes who are also caring for others, for example children or elderly relatives, may find it very difficult to put themselves first (Diabetes UK, 2008a). Some people who have been diagnosed as having diabetes feel that they have been condemned to a life where everything has to be planned. There are, however, support networks available. For example Diabetes UK, a charity that supports people with diabetes, their families and the health professionals who care for them, has local and regional branches where people can meet and discuss problems and learn from each other how they manage their day-to-day-life (Diabetes UK, 2008a). The majority of people with type 2 diabetes are insulin resistant. Obesity exacerbates insulin resistance. As many as 80% of people with type 2 diabetes are obese at the time of diagnosis (Marks, 1996). Weight loss not only improves insulin resistance, but also lowers blood glucose, lipid levels, and blood pressure. Cardiovascular disease is often present in people with type 2 diabetes. The presence of insulin resistance accelerates atherosclerosis, leading to macrovascular complications such as myocardial infarction, stroke, and peripheral vascular disease. The mechanisms responsible for this are thought to be hyperinsulinaemia, dyslipidaemia and hypertension (Garber, 1998). However, microvascular problems such as retinopathy, nephropathy, and neuropathy still occur. The mechanism responsible is thought to be hyperglycaemia (Garber, 1998). Therefore, good blood glucose control is of crucial importance. Although the prognosis for people with type 2 diabetes mellitus is less than favourable, evidence has shown that making major lifestyle changes, such as having a healthy diet, smoking cessation, and increasing activity levels, can reduce the risk of long-term complications (UK Prospective Diabetes Study Group, 1998a). However, using the threat of long-term complications as a means of inducing lifestyle or behaviour changes has not proved to have any prolonged beneficial effect (Polonsky, 1999). Continued support and appropriate education is required to empower individuals to take charge of their condition and make appropriate and timely therapeutic decisions. The healthcare professional and the individual must decide on the most appropriate treatment regimen to provide optimum care and the best medical outcome (Marks et al, 2005). NICE published a document in 2008 entitled CG66: Type 2 diabetes which recommended that all people with diabetes should be offered structured education, pr ovided by a trained specialist team of healthcare professionals (NICE, 2008). The utilisation of theoretical health psychology models can assist these specialist team practitioner in empowering individuals with type 2 diabetes to contemplate and instigate the changes in lifestyle behaviours such as smoking, lack of exercise and unhealthy eating habits that have adverse consequences on long-term health outcomes. With regard to health psychology, as previously mentioned, health psychology is concerned primarily with intrinsic factors, especially individual perceptions of health-related behaviour. Attributing health-related behaviours to internal or external factors has been discussed in relation to the concept of a health locus of control. Individuals differ as to whether they regard events as controllable by them (an internal locus of control) or uncontrollable by them (an external locus of control) (Ogden, 2007). Accessing diabetes related health services for testing or treatment could be viewed from either perspective. The healthcare professional is perceived to be a powerful individual who can diagnose and treat diabetes (external); however, by accessing services the individual is taking responsibility for determining their own health status (internal). It is useful for the healthcare practitioner to consider that in attending diabetic health services the individual has made an initial st ep in taking control of their own health needs (Marks et al, 2005). Individuals with an internal locus of control are more likely to act in concordance with advice from a health professional than those with an external locus of control (Ogden, 2007). Knowing this can assist practitioners in their communication style with individuals who have type 2 diabetes. Identifying the specific needs of the individual, by understanding their locus of control, can help the healthcare practitioner to tailor the assessment (Marks et al, 2005). When an individual has a sense of responsibility for actions or behaviours that exposed them to a potential risk of diabetic complications, the practitioner can work on exploring the circumstances that surrounded those behaviours. The individual may already feel motivated to change these circumstances. In the case of a client who does not recognise that their own behaviour or actions were a contributory factor in posing a risk of behaviour related complications, the practitioner should focus on developing the individuals leve l of awareness to shift their locus of control from the external to the internal. For example, the individual who perceives that taking responsibility for healthy eating use is always that of their partner (Ogden, 2007). Self-management for chronic illnesses such as type 2 diabetes requires adherence to treatment regimens and behavioural change, as well as the acquisition of new coping strategies, because symptoms have a great effect on many areas of life (Glasgow, 1991; Kravitz et al, 1993). For many individuals, optimum self-management is often difficult to achieve, as indicated by poor rates of adherence to treatment, reduced quality of life, and poor psychological wellbeing, effects that are frequently reported in several chronic illnesses (Rubin and Peyrot, 1999). Self-management interventions aim to enable individuals to take control of their condition and be actively involved in management and treatment choices. In the 1980s, psychological theory was applied to develop theoretical models and their constructs have had a particular effect on the development of self-management interventions. The Health Belief Model (Becker 1974) defines two related appraisal processes undertaken by the healthcare practitioner in partnership with an individual: the threat of illness and the behavioural response to that threat. Threat appraisal involves consideration of the individuals perceived susceptibility to an illness and its anticipated severity. Behavioural response involves considering the costs and benefits of engaging in behaviours likely to reduce the threat of disease. It can be useful for the healthcare practitioner to establish the clients perception of risk and implications of their adverse health behaviours when discussing the reasons for healthy eating, increasing exercise, and smoking cessation. It is also important to discuss the likely impact of diabetes on the individuals lifestyle and behaviour (Marks et al, 2005). The Health Belief Model can be applied to evaluate the risk of lifestyle changes. The healthcare professional can initiate structured discussion with the individual to identify their educational needs, particularly around developing a realistic understanding of risk factors associated with diabetes and unhealthy eating habits, lack of exercise and smoking. It is important for the healthcare practitioner to discuss the efficacy of changes in the above in prevention of diabetic complications, while discussing other methods of behaviour modification in context (Marks et al, 2005). It is also important to establish that the individual feels confident in the practicalities of and behavioural change. Therefore, the healthcare practitioner must support the diabetic in behaviour change by giving practical health education advice on the issues of healthy eating, the benefits of exercise and the importance of giving up smoking (Marks et al, 2005). The Protection Motivation Theory (Rogers 1975, 1983) expands the Health Belief Model to include four components that predict behavioural intentions to improve health-related behaviour, or intention to modify behaviour. These include self-efficacy, responsive effectiveness, severity, and vulnerability. In social cognitive theory, behaviour is thought to be affected by expectations, with individuals confidence in their ability to perform a given behaviour (self-efficacy) particularly important (Bandura, 1992). Therefore, self-efficacy can be said to be the belief in ones ability to control personal actions (Bandura, 1992), and is comparable with the concept of internal locus of control. It is based on past experience and evokes behaviour concordant with an individuals capabilities. Self-efficacy is distinct from unrealistic optimism and does not elicit unreasonable risk-taking (Ogden, 2007). Within the context of smoking and diabetes, an example of self-efficacy might be, I am confiden t that I can take responsibility for protecting myself from increasing the risk of further complications by giving up smoking. This concept has been used in self-management interventions through the teaching of skills, such as problem solving and goal setting, to increase self-efficacy. Again, in type 2 diabetes, this could mean the acquisition of knowledge relating to healthy eating principles and putting that knowledge into practice by avoiding foods that would make the blood glucose rise quickly. The goal would be to incorporate this behaviour into daily life on a long-term basis (Marks et al, 2005). Behavioural intention can also be predicted by severity, for example: Diabetes will have serious implications for my health and lifestyle, but conversely, Good blood glucose control will decrease the risk of diabetic complications. The fourth predictor of behavioural intention is vulnerability, which in the context of diabetes may be the likelihood of cardiovascular disease or diabetic retinopathy occurring. Rogers (1983) later suggested a fifth component of fear in response to education or information as a predictor of behavioural intention. The concepts of severity, vulnerability, and fear outlined in Protection Motivation Theory relate to the concept of threat appraisal, as discussed in the context of the Health Belief Model. Self-efficacy and response effectiveness, on the other hand, relate to the individuals coping response, which is the behaviour intention. If a person has self-efficacy and perceives benefits in taking control of their actions (response effectiveness), they are likely to have the intention to modify their behaviour to reduce health risks (Ogden, 2007). Information or education that influences an individuals emotional response can be environmental (external influence, such as advice from a health professional), or interpersonal (relating directly to past experience). Information and education contribute to an individuals self-efficacy. This in turn helps develop a robust internal locus of control and will inform and/or contribute to the individuals coping response (Marks et al, 2005). The coping res ponse is considered to be adaptive (positive behavioural intention) or maladaptive (avoidance or denial). Assessment of the individuals capacity to understand and apply information and to have an adaptive response is a vital skill of the health professional. A maladaptive coping response, such as the denial of identified risk factors, has potentially serious consequences for the health of the individual (Marks et al, 2005). Successful implementation of the Protection Motivation Model can enable informed choice and empower the individual to take personal responsibility and control of behaviours influencing their health (Morrison and Bennett, 2009). Skilled questioning and the use of checking skills by the healthcare professional following information-giving are important to evaluate the benefit, if any, to the individual with diabetes (Ogden, 2007). Readiness to change is a concept derived from Prochaska and DiClementes (1983) transtheoretical model. It refers to how prepared or ready individuals are to make changes to their behaviour. Interventions guided by this theory focus on individuals motivation to change and the approach is adapted according to differences in participants motivation to change behaviour. Success is achieved only when the individual is ready to take on the actions needed to change behaviour. An individual may know that smoking and type 2 diabetes are not a good combination. However, unless the person is ready to quit smoking, no amount of discussion with a healthcare professional will change the persons decision to continue smoking. Establishing an internal motivator is a good first step to assessing an individuals readiness to change, however, an individual also needs to feel that the time is right and that they are prepared to change. Readiness to change can be assessed by asking individuals, as soon as the potential problem is identified, whether they have ever attempted to change the behaviour before. Six stages of change were identified in Prochaska and DiClementes (1983) Transtheoretical model of behaviour change: Pre-contemplation; Contemplation; Preparation; Action; Maintenance and Relapse. Most people (around 60%) will be at the pre-contemplation stage when they are identified by the healthcare practitioner and will generally react in a closed way to the idea of change (Prochaska and Goldstein, 1991). They may be rebellious to the idea, they may rationalise their current behaviour or be resigned to it, or they may be reluctant to consider the possibility of change (Prochaska and Goldstein, 1991). In this situation, it is tempting to push people into making an attempt at behaviour change using their health as a motivator or by making them feel guilty. However, this is likely to prompt the individual to either lie about their behaviour or avoid the nurse completely. During the contemplation phase, it is suggested that individuals who are starting to consider change look for information about their current and proposed behaviours, and analyse the risks involved in changing or maintaining their current behaviour. The most appropriate action is to ask the individual to form alise the analytical process by undertaking a decisional balance exercise (Health Education Authority (HEA), 1996). In this exercise the person is asked to consider the positive and negative implications of maintaining or changing their behaviour. The individual then decides whether maintaining or changing the behaviour will give them increased positive outcomes, and if they are willing to attempt the change. To be at the preparation stage, individuals need to believe that their behaviour is causing a problem, that their health or wellbeing will improve if they change the behaviour, and that they have a good chance of success (Prochaska and Goldstein, 1991). Once the healthcare practitioner establishes that the individual has an internal motivator and is ready to make an attempt at behaviour change, a supportive treatment plan is needed. Individuals who are in the process of behaviour change, or who have achieved and are maintaining the new behaviour, need help to avoid relapse (Pro chaska and Goldstein, 1991). The most effective way to do this is to ask the individual to reflect on their experiences so far. Apart from taking into account the management behavioural change for those with type 2 diabetes, it is also of vital importance that there is a consideration the emotional impact of a diabetes diagnosis and living with the condition. How patients feel when presented with the diagnosis of a chronic illness such as diabetes can have an enormous impact on their lives, and on their ability to make emotional adjustments to the disease itself (Marks et al, 2005). Research has found that that the diagnosis of a chronic illness can have a strong emotional impact on individuals, with reactions of grief, denial and depression. The emotional aspects of developing and coping with diabetes can affect overall control of the disease profoundly. Similarly, these feeling may form a barrier to effective listening and learning during the consultation process and any future self-management strategies. Therefore, it is proposed that this should be taken into consideration when developing educational prog rammes and protocols for people with diabetes (Thoolen et al, 2008). Coping and adapting to a long-term chronic illness is a major theme in health psychology (Ogden, 2007). Leventhal Nerenz (1985) propose that individuals have their own common sense beliefs about their illness. These include identity: diagnosis (diabetes) and symptoms (elevated blood sugar levels, excessive hunger and excessive thirst). Perceived cause of illness: stress, a virus, unhealthy lifestyle. Time line: acute or chronic. Consequences: physical (pain, mobility problems) and emotional (lack of social contact, anxiety). Cure and control: for example by taking medication or getting plenty of rest. With regard to adapting to an illness such as diabetes, the stress coping model of Lazarus and Folkman (1984) Transactional model of stress is the concept that is most widely utilised. The model suggests that there are key factors in adaptation to chronic illness, disease-specific coping efforts, changes in illness representation over time, interaction between psychological reality of disease and affective response, procedures for coping with the disease and interaction with context. The stress coping model (Lazarus and Folkman, 1984) emphasises the value of coping strategies to deal with a particular condition. Self-management strategies based on this model attempt to improve the individuals coping strategies. In type 2 diabetes, people are faced with the prospect of long-term complications caused by the condition. If people are aware of these possibilities and also that successful treatment is, available it makes a diagnosis of such problems less daunting. However, there are limitations to this model. It is debated that it is a frame of reference, not a theory that ignores specific features of the illness. The situation dimension poorly represented and it is not specific. The model also neglects interactions with context (e.g. social support, other life events) and offers no account of life goals on illness representation and coping (Ogden, 2007). It is of vital importance that stress is controlled and managed in an individual with type 2 diabetes. Research has shown a link between stress as a causal factor and that stress has been found to be a factor in regulation of blood glucose regulation. Sepa et al (2005) found that family stress has a significant impact on the and development of diabetes among infants. With regard to stress and metabolic control, research has found that stressful life events predict poor glucose control. In a study by Surwit et al, (2002) the management of stress was found to improve glucose control. Therefore, it is posited that the impact of stress can affect diabetes adversely and any interventions to manage stress may be a worthwhile component of diabetes education programs. An additional influence on coping and adapting to living with diabetes and the development of self-management strategies has come from clinical psychology, particularly Cognitive Behavioural Therapies (CBT). Central to these therapies is the importance of attempting to change how people think about their illness and themselves, and how their thoughts affect their behaviour. Depression is one of the most common psychological problems among individuals with diabetes, and is associated with worse treatment adherence and clinical outcomes (Gonzalez et al, 2010). A randomised controlled trial (RCT) undertaken by Lustman et al, (2008) found that the percentage of patients achieving remission of depression was greater in the CBT group than in the control group. Although the research found that there was no difference in the mean glycosylated haemoglobin levels of the groups post-treatment, follow-up mean glycosylated haemoglobin levels were significantly better in the CBT group than in the control group. Therefore, it is debated that the combination of CBT and supportive diabetes education is an effective non-pharmacologic treatment for major depression in patients with type 2 diabetes. It may also be associated with improved glycaemic control. It is important to note however, that certain limitation apply to the above study that may have an effect on the findings. The generalizability of the findings is uncertain. The study was limited to a relatively small number of patients. Similarly, the follow-up interval was limited to the 6 months immediately after treatment. Likewise, the researcher cannot exclude the possibility that CBT and diabetes education interacted in a way that potentiated antidepressant effectiveness; analogous interactions may have occurred in many clinical trials. Further studies comparing CBT and diabetes education, individually and in combination, are needed to answer such questions and to see whether successful CBT alone is sufficient to produce glycaemic improvement. Correspondingly, it is worth noting that patients in the CBT group had education almost a full year longer than controls. The difference in education was not statistically significant, but the extra educational experience may have contributed to improved outcome in the CBT group. Finally, treatment was administered by a single psychologist experienced in the use of CBT. Whether treatment would be as effective when administered by other therapists is uncertain. For any person with type 2 diabetes to engage in any self-management strategy, good mental health is necessary. However, studies have shown reduced self-worth and/or anxiety in more than 40% of people with diabetes (Anderson et al, 2001). There are several possible reasons for this. Being diagnosed with diabetes immediately poses major concerns for the individual, including what the future holds in terms of health, finance, and family relationships. Although everyone deals with diagnosis differently, for some it can cause immediate stress, including feelings of shock or guilt. Some individuals may also be ashamed and want to keep the diagnosis a secret. Others may be relieved to know what is causing the symptoms they have been experiencing. An Audit Commission (2000) report acknowledged that: people with diabetes are more likely to suffer from clinical depression than those in the general population. The report then went on to specify that therefore, diabetes services should make exp licit provision for psychological support and should monitor the psychological outcomes of care. In conclusion, to be successful in changing behaviour to negate the complications of type 2 diabetes, individuals need to decide for themselves which behaviours are undesirable, that is, which behaviours could have negative health, financial, social or psychological implications. People with diabetes also need to feel that the negative impact of risky health behaviours will be reduced or altered if they change their behaviour. It is important that individuals have confidence in their ability to make and maintain behavioural changes. It is not the health practitioners role to make this judgement or impose his or her beliefs. To support behavioural change, healthcare professionals need to feel comfortable in discussing lifestyle behaviours. They also need to assess an individuals preparedness to make a change and identify the factors that motivate them to change. The application of health psychology models, such as the Health Belief Model, the Protection Motivation Theory and the Trans theoretical model of behaviour change, to the management process can enable healthcare practitioners to assess contributory factors to health behaviours. Applying models can also help to identify motivators and barriers to health-improving and health-protecting behaviours, and identify strategies which assist the person in behavioural change. The role of the healthcare professional is to enable individuals to make an informed choice by working in partnership with them to decide when and if behaviour change is desirable. By understanding how an individual copes and adapts to living with a long-term condition such as diabetes can assist in empowering individuals to managed stress that appears to have a negative impact on blood glucose levels. Correspondingly, the use of CBT as a non-pharmacological treatment has been shown to improve depression that is often apparent in individuals with diabetes. Healthcare practioners caring for those with diabetes should be trained in the use of CBT .
Wednesday, October 2, 2019
America’s Great War: World War I and the American Experience by Robert
America’s Great War: World War I and the American Experience by Robert H. Zieger In the book, America’s Great War: World War I and the American Experience, Robert H. Zieger discusses the events between 1914 through 1920 forever defined the United States in the Twentieth Century. When conflict broke out in Europe in 1914, the President, Woodrow Wilson, along with the American people wished to remain neutral. In the beginning of the Twentieth Century United States politics was still based on the â€Å"isolationism†ideals of the previous century. The United States did not wish to be involved in European politics or world matters. The U.S. goal was to expand trade and commerce throughout the world and protect the borders of North America. The American belief at the beginning of the war was that it would be short conflict reminiscent of the fight between Germany and France in 1870(Zieger, 9). At the time both the Allies and the Central Powers, along with Americans, miscalculated the impact the involvement of American forces could have for either side. The U.S. Navy was expanded and upgraded during the presidency of Theodore Roosevelt but the Army was still a minimal force. To keep with the â€Å"true neutrality†the United States initially refused to aid either side with supplies or economic assistance. Once the battles became entrenched and a â€Å"war of attrition†began, the European nations continued to look toward the United States for aid. As American financial institutions and exporters sought guidance from Wilson’s administration they received a different answer: â€Å"short term loans and credits by American financial institutions to belligerents in connection with trade were acceptable†(Zieger, 11). Americans could not over look the potential economic boost that could be achieved by supplying the European nations with food, supplies and weapons orders being requested. Both sides accepted the United States’ aid but they also sought to cut-off each other’s supply chain. While the Allies barricaded Germany’s ports with the British Navy, Germany began attacking merchant ships using their submarines, or U-boats. While Wilson was angered by the British tactics he was even more infuriated by the German’s. This would be the ultimate end of U.S. neutrality as Wilson would sternly address Germany’s actions and not Britain’s. In 1915 a German U-boat sank a Brit... ... to be President afterwards. His unwillingness to compromise with the Senate caused the Treaty of Versailles along with the League of Nations never to be ratified by the United States. The notion of the League of Nations that won Wilson a Noble Peace Prize in 1920 was never joined his own country. After the election of 1920 America would return to its isolationism roots and watch as the nations of Europe headed down a path for another world war. As Americans watched Communism rise in Russia they questioned for the first time the patronage of their fellow Americans. Economic and social reforms that started up during the war were set to a status-quo mentality. The actions set forward from the Treaty of Versailles and stance the U.S. Congress took on the League of Nations would eventually lead the world in the worst depression ever and ultimately to a second world war in a mere twenty years. Works Cited: Zieger, Robert H. (2000). America’s Great War: World War I and the American Experience. Lanham, MD: Rowman & Littlefield Publishers Inc. Davidson, J. (Ed.). (2002). Nation of nations: A concise narrative of the American republic. (3rd ed., Vol. 2). New York: McGraw-Hill
Tuesday, October 1, 2019
Southern Racial Inequality in Faulkner’s Go Down, Moses Essay -- Faulk
Southern Racial Inequality in Faulkner’s Go Down, Moses All the stories in Go Down, Moses had a common thread: the McCaslin family. One story, however, stood out from the rest for lacking a McCaslin main character. This story was, of course, â€Å"Pantaloon in Black.†At first, I thought this story of grief was almost a beautiful love story. When Rider lost his wife and first love, he was so grief-stricken he didn’t even care to live. However, the conclusion on the story took any beauty out of this tragedy. The matter-of-fact way the deputy tells his wife the story, and the even more apathetic way that she accepts/ignores it, was Faulkner’s way of reminding us of the racial inequality in the South. Waiting until the end of the story to throw at the reader the key to the story is typical of Faulkner. We saw him waiting to shock us at the end of Sanctuary with the circumstances of Popeye’s life. He waited until near the end of Absalom, Absalom! to put together all the pieces of that puzzle. While the reader didn’t find out any shocking news at the end of â€Å"Pantaloon in Black,†we were...
Clarkson Lumber Case Essay
Clarkson Lumber Company is a classic example of a privately held company that has experienced a rapid growth in sales and has reached a point where it is facing a shortage of cash to sustain the expected growth in sales in the following years. The owner, Keith Clarkson, bought out his partner’s interest in the company in 1994 for $200,000. His partner, Henry Holtz, took a note for the $200,000 with an interest rate of 11% and was repayable in the semi-annual installments of $50,000 beginning June 30, 1995. The note was taken to give Mr. Clarkson time to arrange for the necessary financing. Mr. Clarkson seems to be running the company well, evident by the constant growth in sales year after year. However, the company is running low on cash on hand, and needs some form of financing to reach the expected sales of 5. 5 Million in 1996. Moreover, the borrowing limit set by the Suburban Bank has been reached, prompting the bank to ask Mr. Clarkson to guarantee the loan personally. Mr. Clarkson has been in communication with another bank, Northrup Bank, which might be willing to extend a line of credit of up to $750,000. Analysis There are several reasons for Mr. Clarkson’s need to rely on borrowing despite good profits. Although the profits are good, they are not good enough in our view. The Net Profit Margin has been close to 2% since 1993 (Exhibit D). The cost of goods relative to the sales is high and is keeping the profit margin low. In other words, the costs have increased at a faster rate than sales. The Cost of Goods Sold is consistently around 75% of sales. Secondly, the Return on Assets is roughly 5% in 1995 (Exhibit D). This ratio is kept low due to a high total assets figure. Total assets are also inflated due to the liabilities taken in the form of trade credits by Mr. Clarkson The company is keeping a high volume of inventory in stock as shown by its Inventory Turnover ratio average of 6%. The Average Collection Period has jumped from 38 days to 48 days since 1993 (Exhibit B). Thus, the limited amount of cash inflow is largely tied in inventory, and payments on loans. Mr. Clarkson has been unable to take full advantage of the trade discounts (2% if paid with in 10 days) during the last two years ‘due to a shortage of funds arising from his purchase of Mr. Holtz’s (his partner) interest in the business and the additional investments in working capital associated with the company’s increasing sales volume’ (Case, Pg 2). And even though Mr. Clarkson has been able to use the credit from Suburban Bank of up to $400,000 to finance the increase in sales, the ceiling has also forced the company to use cash to fund itself and pay off loans. The current and quick ratios both support this fact (see Exhibit D). Based on the pro forma sheets there is an additional $251,000 needed to attain the goal of $5. 5 million in sales. Also, since part of the agreement is to break off from Suburban National Bank, the line of credit has to cover the 399,000 covered by the loan. With about $650,000 line of credit used, the remaining $100,000 of the new loan could be used to pay off Mr. Holtz and enable Mr. Clarkson to take advantage of the trade discounts by paying his suppliers back in 10 days; thus achieving the sales target with lower cost. Recommendations We recommend Mr. Clarkson to seriously consider taking the new line of credit. The line of credit will enable the company to take advantage of the trade discounts and pay off previous debt. Lowering the costs should be a high priority and it might be worth while to consider holding less inventory (if it does not affect the service and quality clients expect). Mr. Clarkson should identify and prioritize the high profit margin products/services the company offers and focus on those. The company would also do well to try to reduce the Average Collection Period to with in 30 days. As far as Northrup Bank is concerned, we recommend that the bank extend the line of credit but makes sure that the company does not reach the ceiling again. A high proportion of the credit line would be used in the beginning but that is due to the line of credit covering the previous loan, Mr. Holtz interest and some immediate financing for inventory purchases. In the foreseeable future though, once the company sheds the loans it carried and get more streamlined, it will start increasing its cash gradually. Mr. Clarkson’s business references are excellent and the company has always paid its bills on time. Therefore, the company is not a risk and the line of credit should be approved.
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