Issue in my community (I live in Mecklenburg County which is in Case Study

Issue in my community (I live in Mecklenburg County which is in Charlotte, NC) - Case Study Example Unemployment occurs when people who are willing and able to work cannot find jobs appropriate to their level of expertise. This issue is highly prevalent in this community. In January 2012, the unemployment rate was 9.8%, which was less than the previous month but is still greater than the state-wide average which was 9.5%. As a result of this issue of unemployment, the citizens of Mecklenburg are forced to seek help even for basic survival. They need help even for basic necessities like food, housing, clothing etc. The unemployment rate rose from 9% in April to 9.6%in May2012 (Charlotte Business Journal, Web). This increase can has serious implications for the community as a whole. People who are unemployed look for other ways to earn income due to which the crime rate might also increase. It is really important to find the causes of this increase in unemployment in order to solve the issue completely. One of the major reasons of high unemployment is the lack of educational opportun ities for the citizens of Mecklenburg County. The leaders of the country should introduce reforms so that equal educational opportunities are given to all the citizens. Quality education is extremely important for the future of a country as the children who are educated today will be the leaders of the country tomorrow. ... Due to unemployment and illiteracy, people get involved in illegal activities and as a result, the crime rate of the country also rises. As a result of these criminal records, people find it even harder to get jobs as employers do background checks to ensure the credibility of the employee or applicant. This further increases the unemployment and affects the entire country as a whole. The people of Mecklenburg County also suffer because of lower employment opportunities available in their market. The government needs to attract foreign businesses to set up in this country which will create more employment opportunities and will benefit the citizens. This will also increase the career choices available for the youth of this country. As a result of these greater employment opportunities, the unemployed citizens will be able to will be able to support their families and the overall unemployment rates of the country would also fall. Unemployment has other disadvantages as well which affe ct the citizens as well as the entire nation as a whole. One of these is the unemployment benefits that these people would receive from the government. As a result of this, the working population would have to pay more for the rising cost of these benefits and more burdens would be placed on them. Another disadvantage is that the government might reduce its public spending such as on schools, healthcare etc. In the long run, this would result in fewer jobs and a higher unemployment rate. In economic terms, unemployed labor of Mecklenburg County is a waste of its resources as total output falls and the tax revenue also falls. The tax revenue paid for

Counseling Models Essay Example for Free

Counseling Models Essay Most counseling models make use of the core conditions; empathy, unconditional positive regard and congruence. A. Psychoanalytic Model Sigmund Freud’s psychoanalytic system is a model of personality development and approach to psychotherapy. Psychoanalytic: The original so called talking therapy involves analyzing the root causes of behavior and feelings by exploring the unconscious mind and the conscious minds relation to it. Many theories and therapies have evolved from the original Freudian psychoanalysis which utilizes free-association, dreams, and transference, as well other strategies to help the client know the function of their own minds. Traditional analysts have their clients lie on a couch as the therapist takes notes and interprets the clients thoughts, etc. Many theories and therapies have evolved from the original psychoanalysis, including Hypnotherapy, object-relations, Progoffs Intensive Journal Therapy, Jungian, and many others. One thing they all have in common is that they deal with unconscious motivation. Usually the duration of therapy is lengthy; however, many modern therapists use psychoanalytic techniques for short term therapies. Psychoanalytic counseling or Freudian psychology prompts patients to imagine lying on a couch and divulging personal information. This type of counseling relies on patients history and an analysis of their thoughts, behavior and feelings. NYU Medical Schools Psychoanalytic Institute holds that psychoanalysis is based on observations of patient behavior and recognition of symptoms and explores how unconscious factors play a role in relationships and behavior patterns. Psychoanalysts provide help to clients through the diagnosis of disorders and the utilization of talk therapy. Clients work through issues with the assistance of a trained counselor. Psychodynamic (psychoanalytic): Sees childhood as cause of present problems and focuses on exploring past in some depth. Explores transference – displaced feelings from early childhood experienced in adult situations. Uses ‘free association’. Long term. Psychoanalytic therapy is the model where clients lay down with no eye contact or relationship with the therapist. (Less common these days) Counseling Implications Some counselors find combined psychosexual and psychosocial perspective a helpful conceptual framework for understanding developmental issues as they appear in therapy. The key needs and developmental tasks, along with the challenges inherent at each stage of life, provide a model for understanding some of the core conflicts clients explore in their therapy sessions. The Therapeutic Process Therapeutic Goals Ultimate Goal: To increase adaptive functioning which involves the reduction of symptoms and the resolution of conflicts. The two goals of Freudian Psychoanalytic Therapy are as follows, (1) to make the unconscious conscious and (2) to strengthen the ego so that behavior is based more on reality and less on instinctual cravings or irrational guilt. Successful analysis is believed to result in significant modification of the individual’s personality and character structure. Therapeutic methods are used to bring out the unconscious material. Then childhood experiences are reconstructed, discussed, interpreted and analyzed. It is clear that the process is not limited to solving problems and learning new behaviors. There is also deeper probing into the past to develop the level of self understanding that is assumed to be necessary for a change in character. Therapist’s Function and Role In classical psychoanalysis, analysts typically assume an anonymous stance, which is sometimes called the â€Å"blank screen approach†. They engage in very little self disclosure and maintain a sense of neutrality to foster a transference relationship in which their clients will make projections onto them. Central functions of analysis is to help clients acquire the freedom to love, work and play. Other functions include assisting clients in achieving self awareness, honesty and more effective personal relationships; in dealing with anxiety in a realistic way; and in gaining control over impulsive and irrational behavior. Roles Establish a working relationship with the client and then do a great deal of listening and interpreting. Empathic attunement to the client facilitates the analysts apprehension and appreciation of the of the client’s intra psychic world. Particular attention is given to the client’s resistances. The analyst listens, learns and decides when to make appropriate interpretations. A major function of interpretation is to accelerate the process of uncovering unconscious material. The analyst listens for gaps and inconsistencies in the client’s story, infers the meaning of reported dreams and free associations, and remains sensitive to clues concerning the client’s feelings towards the analyst. Client’s Experience in the Therapy Clients interested in traditional (or classical) psychoanalysis must be willing to commit themselves to an intensive and long term therapy process. After some face-to-face sessions with the analyst, clients lie on a couch and engage in free association. *Free association allows the client to say whatever comes to mind without self-censorship. This is known as the ‘fundamental rule’. Clients report their feelings, experiences, associations, memories and fantasies. Lying on the couch encourages deep, uncensored reflections and reduces the stimuli that might interfere with getting in touch with internal conflicts and productions. It reduces clients’ ability to read their analyst’s face for reactions and hence, fosters the projections characteristics of transference. At the same time, the analyst is freed from having to carefully monitor facial cues. Therapeutic Techniques and Procedures The therapy is geared more to limited objectives than to restructuring one’s personality The therapist is less likely to use the couch There are fewer sessions each week There is more frequent use of supportive interventions such as reassurance, expressions of empathy and support and suggestions There is more emphasis on the here-and-how relationship between therapist and client There is more latitude for therapist self-disclosure without ‘polluting the transference’ Less emphasis is give n to the therapist’s neutrality There is focus on mutual transference and counter transference enactments The focus is more on pressing practical concerns than on working with fantasy material Six (6) Basic Techniques of Psychoanalytic Therapy (1) Maintaining of the Analytic Framework This refers to a whole range of procedural and stylistic factors such as the analyst’s relative anonymity, maintaining neutrality and objectivity, the regularity and consistency of meeting starting and ending the sessions on time, clarity on fees, and basic boundary issues such as the avoidance of advice giving or imposition of the therapist’s values. (2) Free Association It is the central technique in psychoanalytic therapy. In free association, clients are encouraged to say whatever comes to mind, regardless of how painful, silly, trivial, illogical, irrelevant it may seem. (3) Interpretation The analyst points out, explains and teaches the client the meanings of behaviors that are manifested in dreams, free association, resistances and the therapeutic relationship itself. (4) Dream Analysis This is an important procedure for uncovering unconscious material and giving the client insight into some areas of unresolved problems. During sleep, defenses are lowered and repressed feelings surface. Freud sees dreams as the â€Å"royal road to the unconscious†. 2 Levels of Dream Content Latent Content Manifest Content (5) Analysis and Interpretation of Resistance This is anything that works against the progress of therapy and prevents the  client from producing previously unconscious material. Resistance helps the client to see that cancelling appointments, fleeing from therapy prematurely are ways of defending against anxiety. (6) Analysis and Interpretation of Transference The client reacts to the therapist as he did to an earlier significant other. This allows the client to experience feelings that would otherwise be inaccessible. Its analysis allows the client to achieve insight into the influence of the past. *Counter transference – is the reaction of the therapist toward the client that may interfere with objectivity. Limitations of Classical Analysis This approach may not be appropriate for all cultures or socioeconomic groups Deterministic focus does not emphasize current maladaptive behaviors Minimizes role of the environment Requires subjective interpretation Relies heavily on client fantasy Lengthy treatment may not be practical or affordable for many clients B. Client-centered Model Person-centered therapy (PCT) is also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy. PCT is a form of talk-psychotherapy developed by psychologist Carl Rogers in the 1940s and 1950s. The ultimate goal of PCT is to provide clients with an opportunity to develop a sense of self wherein they can realize how their attitudes, feelings and behavior are being negatively affected and make an effort to find their true positive potential. The aim is directed towards achieving a greater degree of independence and integration. Two primary goals of person-centered therapy are increased self-esteem and greater openness to experience. Some of the related changes that this form of therapy seeks to foster in clients include closer agreement between the clients idealized and actual selves; better self-understanding; lower levels of defensiveness, guilt, and  insecurity; more positive and comfortable relationships with others; and an increased capacity to experience and express feelings at the moment they occur. Rogers wanted to assist the clients in their growth process so clients can better cope with problems as they identify them. In this technique, therapists create a comfortable, non-judgmental environment by demonstrating congruence (genuineness), empathy, and unconditional positive regard toward their clients while using a non-directive approach. This aids clients in finding their own solutions to their problems. It places much of the responsibility for the treatment process on the client, with the therapist taking a nondirective role. Basic Characteristics In the Person Centered approach the focus is on helping the client discover more appropriate behavior by developing self-awareness ways to fully encounter reality. Through this encounter the client gains insight of themselves the world. Core Conditions Rogers (1957; 1959) stated that there are six necessary and sufficient conditions required for therapeutic change: 1. Therapist-Client Psychological Contact: a relationship between client and therapist must exist, and it must be a relationship in which each persons perception of the other is important. 2. Client in-congruence: that in-congruence exists between the clients experience and awareness. 3. Therapist Congruence or Genuineness: the therapist is congruent within the therapeutic relationship. The therapist is deeply involved him or herself they are not acting and they can draw on their own experiences (self-disclosure) to facilitate the relationship. 4. Therapist Unconditional Positive Regard (UPR): the therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted by others. 5. Therapist Empathic understanding: the therapist experiences an empathic understanding of the clients internal frame of reference. Accurate empathy on the part of the therapist helps the client believe the therapists unconditional love for them. 6. Client Perception: that the client perceives, to at least a minimal degree, the therapists UPR and empathic understanding. Processes Rogers asserted that the most important factor in successful therapy is the relational climate created by the therapist’s attitude to their client. He specified three interrelated core conditions: 1. Congruence The willingness to transparently relate to clients without hiding behind a professional or personal facade. genuineness or realness  The helper does not deny his or her own feelings: the opposite of hiding behind a professional mask. â€Å"I find that I am closest to my inner, intuitive self,when I am somehow in touch with the unknown in me, when perhaps I am in a slightly altered state of consciousness†¦Then simply my presence is releasing and helpful.† (Rogers) 2. Unconditional Positive Regard The therapist offers an acceptance and prizing for their client for who he or she is without conveying disapproving feelings, actions or characteristics and demonstrating a willingness to attentively listen without interruption, judgment or giving advice. Unconditional positive regard acceptance and caring, but not Approval of all behavior Related Terms: Acceptance of the other’s reality with kindness Non-possessive caring Prizing Non-judgmental attitude 3. Empathy The therapist communicates their desire to understand and appreciate their client’s perspective. Accurate empathic understanding – an ability to deeply grasp the client’s subjective world Helper attitudes are more important than knowledge Empathy is a consistent, unflagging appreciation of the experience of the other. It is active attention to the feelings of the client It involves warmth and genuineness The Therapist Rogers believed that a therapist who embodies these three critical attitudes will help liberate their client to more confidently express their true feelings without fear of judgment. To achieve this, the client-centered therapist carefully avoids directly challenging their clients way of communicating themselves in the session in order to enable a deeper exploration of the issues most intimate to them and free from external referencing. Rogers was not prescriptive in telling his clients what to do, but believed that the answers to the patients questions were within the patient and not the therapist. Accordingly the therapists role was to create a facilitative, empathic environment wherein the patient could discover for him or herself the answers. Therapists are used as instruments of change but are not to direct the change in client Therapist helps develop an environment in which the client can grow Through attitudes of genuine caring, respect, and understanding the client is able to let their defenses down become more self aware Therapist reflects client’s view of the world (Phenomenological approach) The Therapist must be: Congruent  able to approach client with unconditional positive regard  demonstrate accurate understanding and empathy Focuses on the quality of the therapeutic relationship Serves as a model of a human being struggling toward greater realness is genuine integrated, and authentic, without a false front Can openly express feelings attitudes that are present in the relationship with the client Therapeutic Process Main focus is on the person not on the persons problems This allows the client to reconnect with him/her.  Client is assisted in therapy so that they can deal with current problems as well as problems that develop in the future Focuses on helping a person  become aware of their true self develop congruency Client’s Experience Through therapy client is able to let down his/her defenses become more true to him/her selves They gain perception into themselves, which allows them to better understand accept others Application: Therapeutic Techniques and Procedures One of the major contributions of Rogers in the counseling field is the notion that the quality of the therapeutic relationship, as opposed administering techniques, is the primary agent of growth in the client. The therapist’s ability to establish a strong connection with the clients is the critical factor determining successful counseling outcomes. The person-centered philosophy is based on the assumption that clients have the resourcefulness for positive movement without the counselor assuming an active, directive or problem-solving role. What is essential for clients’ progress is the therapist’s presence, being completely attentive to, and immersed in the client as well as in the client’s expressed concerns. In a study conducted in the 1990s, it was revealed that the effectiveness of person-centered therapy with a wide range of client problems including anxiety disorders, alcoholism, psychosomatic problems, agoraphobia, interpersonal difficulties, depr ession, cancer and personality disorders. Moreover, an effective therapy is based on the client-therapist relationship in combination with the inner and external resources of the client. Learning to listen with acceptance to oneself is a valuable life skill that enables individuals to be their own therapists. The basic concepts are straight forward and easy to comprehend, and they encourage locating power in the person rather than fostering an authoritarian structure in which control and power are denied to the person. The person-centered approach is especially applicable in crisis intervention such as an unwanted pregnancy, an illness, a disastrous event, or the loss of a loved one. When people are in crisis, one of the first steps is to give them an opportunity to fully express themselves. Communicating a deep sense of understanding should always precede other more problem-solving interventions. C. Rational Emotive Model Albert Ellis founded rational therapy in the mid-1950s and was one of the first therapists to emphasize the influential role of cognition in behavior. In 1960s, he changed the name to Rational Emotive Behavior Therapy (REBT), because of his contention that the model had always stressed the reciprocal interactions among cognition, emotion and behavior. Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is a comprehensive, active-directive, philosophically and empirically based psychotherapy which focuses on resolving emotional and behavioral problems and disturbances and enabling people to lead happier and more fulfilling lives. REBT is based on the assumption that we are not disturbed solely by out early or later environments but we have strong inclinations to disturb ourselves consciously and unconsciously. We do this largely by taking our goals and values, which we mainly learn from our families and culture, and changing them into absolute â€Å"shoulds†, â€Å"oughts† and â€Å"musts†. REBT therapists employ active/directive techniques such as teaching, suggestion, persuasion, and homework assignments and they challenge clients to substitute a rational belief system for an irrational one. It emphasizes the therapist’s ability and willingness to challenge, confront, and convince the members to practice activities that will lead to constructive changes in thinking and behaving. The approach stresses action – doing something about the insights one gains in the therapy. ORIGINS OF EMOTIONAL DISTURBANCE A central concept of REBT is the role that absolutist â€Å"shoulds,† â€Å"oughts,† and â€Å"musts† play when people become and remain emotionally disturbed. We forcefully, rigidly, and emotionally subscribe to many grandiose â€Å"musts† that result in our needlessly disturbing ourselves. According to Ellis (2001a, 2001b), feelings of anxiety, depression, hurt, shame, rage, and guilt are largely initiated and perpetuated by a belief system based on irrational ideas that were uncritically embraced, often during early childhood. In addition to taking on dysfunctional beliefs from others, Ellis stresses that we also invent â€Å"musts† on our own. Ellis (1994, 1997; Ellis Dryden, 2007; Ellis Harper, 1997) contends that most of our dysfunctional beliefs can be reduced to three main forms of â€Å"musturbation†: 1. â€Å"I absolutely must do well and be approved of by signiï ¬ cant others. I must win  their approval or else I am an inadequate, worthless person.† 2. â€Å"You must under all conditions and at all times treat me considerately, kindly, lovingly, and fairly. If you don’t, you are no damned good and are a rotten person.† 3. â€Å"Conditions under which I live absolutely must be comfortable so that I can get what I want without too much effort. If not, it is awful; I can’t stand it and life is no good.† Rational emotive behavior therapy is grounded on existential principles in many respects. Although parents and society play a signiï ¬ cant role in contributing to our emotional disturbance, we do not need to be victims of this indoctrination that takes place in our early years. We may not have had the resources during childhood to challenge parental and societal messages. As psychological adults now, however, we can become aware of how adhering to negative and destructive beliefs actually hampers our efforts to live fully , and we are also in a position to modify these beliefs. THE A-B-C THEORY The A-B-C theory of personality and emotional disturbance is central to REBT theory and practice. The A-B-C theory maintains that when we have an emotional reaction at point C (the emotional Consequence), after some Activating event that occurred at point A, it is not the event itself (A) that causes the emotional state (C), although it may contribute to it. It is the Belief system (B), or the beliefs that we have about the event, that mainly creates C. For example, if you feel depressed (C) over not getting a promotion at work (A), it is not the fact that you weren’t promoted that causes your depression; it is your belief (B) about the event. By believing that you absolutely should have been promoted and that not receiving it means that you are a failure, you â€Å"construct† the emotional consequence of feeling depressed. Thus, we are largely responsible for creating our own emotional disturbances through the beliefs we associate with the events of our lives Ellis (2011) maintains that we have the capacity to signiï ¬ cantly change our cognitions, emotions, and behaviors. We can best accomplish this goal by avoiding preoccupying ourselves with the activating events at A and by acknowledging the futility of dwelling endlessly on the emotional consequences at C. We can choose to examine, challenge, modify, and uproot B—the irrational beliefs we hold about the activating events at A. GOALS OF A REBT GROUP The basic goal of REBT is to help clients replace rigid demands with ï ¬â€šexible preferences. According to Ellis (2001b; 2011), two of the main goals of REBT are to assist clients in the process of achieving unconditional self-acceptance (USA) and unconditional other acceptance (UOA), and to see how these are interrelated. To the degree that group members are able to accept themselves, they are able to accept others. The process of REBT involves a collaborative effort on the part of both the group leader and the members in choosing realistic and self enhancing outcome goals. The therapist’s task is to help group participants to differentiate between realistic and unrealistic goals and self-defeating and self-enhancing goals (Dryden, 2007). Further goals are to teach members how to change their dysfunctional emotions and behaviors into healthy ones and to cope with almost any unfortunate event that may arise in their lives (Ellis, 2001b). REBT aims at providing group members with tools for experiencing healthy emotions (such as sadness and concern) about negative activating events rather than unhealthy emotions (such as depression and anxiety) about these events so that they can live richer and more satisfying lives. To accomplish this basic objective, group members learn practical ways to identify their underlying irrational beliefs, to critically evaluate such beliefs, and to replace them with rational beliefs. Basically, group members are taught that they are largely responsible for their own emotional reactions; that they can minimize their emotional disturbances by paying attention to their self-verbalizations and by changing their irrational beliefs; and that if they acquire a new and more realistic philosophy, they can cope effectively with most of the unfortunate events in their lives. Although the therapeutic goals of REBT are essentially the same for both individual and group therapy, the two differ in some of the speciï ¬ c methods and techniques employed, as you will see in the discussion that follows. CONFRONTING IRRATIONAL BELIEFS REBT group leaders begin by teaching group members the A-B-C theory. When they have come to see how their irrational beliefs are contributing to their emotional and behavioral disturbances, they are ready to Dispute (D) these beliefs. D represents the application of scientiï ¬ c principles to challenge  self-defeating philosophies and to dispose of unrealistic and unveriï ¬ able hypotheses. Cognitive restructuring, a central technique of cognitive therapy, teaches people how to make themselves less disturbed (Ellis, 2003). One of the most effective methods of helping people reduce their emotional disturbances is to show them how to actively and forcefully dispute these irrational beliefs until they surrender them. This process of disputation involves three other Ds: (1) Detecting irrational beliefs and seeing that they are illogical and unrealistic, (2) Debating these irrational beliefs and showing oneself how they are unsupported by evidence, and (3) discriminating between irrational thinking and rational thinking (Ellis, 1994, 1996). After D comes E, or the Effect of disputing—the relinquishing of self destructive ideologies, the acquisition of effective new beliefs, and a greater acceptance of oneself, of others, and of the inevitable frustrations of everyday life. This new philosophy of life has, of course, a practical side—a concrete E, if you wish. In the previous example, E would translate into a rational statement such as this: â€Å"I’d like to have gotten the job, but there is no reason I have to get what I want. It is unfortunate that I did not get the job, but it is not terrible.† According to REBT theory, the ultimate desired result is that the person experiences a healthy negative emotion, in this case, disappointment and sadness, rather than depression.Group members learn to separate their rational (or functional) beliefs from their irrational (or dysfunctional) beliefs and to understand the origins of their emotional disturbances as well as those of other members. Participants are taught the many ways in which they can (1) free themselves of their irrational life philosophy so that they can function more effectively as an individual and as a relational being and (2) learn more appropriate ways of responding so that they won’t needlessly feel disturbed about the realities of living. The group members help and support one another in these learning endeavors. The Therapeutic Process GOALS OF A REBT GROUP The basic goal of REBT is to help clients replace rigid demands with ï ¬â€šexible preferences. According to Ellis (2001b; 2011), two of the main goals of REBT are to assist clients in the process of achieving unconditional self-acceptance (USA) and unconditional other acceptance (UOA), and to see  how these are interrelated. To the degree that group members are able to accept themselves, they are able to accept others. The process of REBT involves a collaborative effort on the part of both the group leader and the members in choosing realistic and self enhancing outcome goals. The therapist’s task is to help group participants to differentiate between realistic and unrealistic goals and self-defeating and self-enhancing goals (Dryden, 2007). Further goals are to teach members how to change their dysfunctional emotions and behaviors into healthy ones and to cope with almost any unfortunate event that may arise in their lives (Ellis, 2001b). REBT aims at providing group membe rs with tools for experiencing healthy emotions (such as sadness and concern) about negative activating events rather than unhealthy emotions (such as depression and anxiety) about these events so that they can live richer and more satisfying lives. To accomplish this basic objective, group members learn practical ways to identify their underlying irrational beliefs, to critically evaluate such beliefs, and to replace them with rational beliefs. Basically, group members are taught that they are largely responsible for their own emotional reactions; that they can minimize their emotional disturbances by paying attention to their self-verbalizations and by changing their irrational beliefs; and that if they acquire a new and more realistic philosophy, they can cope effectively with most of the unfortunate events in their lives. Although the therapeutic goals of REBT are essentially the same for both individual and group therapy, the two differ in some of the speciï ¬ c methods and techniques employed, as you will see in the discussion that follows. Role and Functions of the Counselor The therapeutic activities of an REBT group are carried out with a central purpose: to help participants internalize a rational philosophy of life, just as they internalized a set of dogmatic and extreme beliefs derived from their sociocultural environment and from their own invention. In working toward this ultimate aim, the group leader has several speciï ¬ c functions and tasks. The ï ¬ rst task is to show group members how they have largely created their own emotional and behavioral disturbances. The leader helps group members to identify and challenge the irrational beliefs they originally unquestioningly accepted, demonstrates how they are continuing to  indoctrinate themselves with these beliefs, and teaches them how to modify their thinking by developing rational alternative beliefs. It is the group leader’s task to teach members how to stop the vicious circle of the self-blaming and other-blaming process. REBT assumes that people’s irrational beliefs are so deeply ingrained that they will not change easily. Thus, to bring about a signiï ¬ cant cognitive change, leaders employ a variety of active cognitive and emotive techniques (Ellis, 1996, 2001b; Ellis Dryden, 2007). REBT group practitioners favor interventions such as questioning, confronting, negotiating homework assignments, and helping members experiment with new ways of thinking, feeling, and doing. REBT group leaders are active in teaching the theoretical model, proposing methods of coping, and teaching members strategies for testing hypotheses and solutions. REBT group leaders assume the role of a psychological educator, and they tend to avoid relating too closely to their members and thus avoid having them increase their dependency tendencies. They provide unconditional acceptance rather than warmth and approval (Dryden, 2009b). However, REBT group practitioners demonstrate respect for the members of their groups and also tend to be collaborative, encouraging, supportive, and mentoring. REBT practitioners employ a directive role in encouraging members to commit themselves to practicing in everyday situations what they are learning in the group sessions. They view what goes on during the group as important, but they realize that the hard work between sessions and after therapy is terminated is even more crucial. The group context provides members with tools they can use to become self-reliant and to accept themselves unconditionally as they encounter new problems in daily living. Application: Therapeutic Techniques and Procedures Ellis originally developed REBT to try to make psychotherapy shorter and more efï ¬ cient than most other systems of therapy; hence, it is intrinsically a brief therapy. As applied to groups, REBT mainly employs interventions that teach group members how to tackle practical problems of living in a brief and efï ¬ cient way (Ellis, 2001b). From the origin of the approach, REBT has utilized a wide range of cognitive, emotive, and behavioral methods with most clients. Like other cognitive behavioral therapies, REBT blends techniques to change clients’ patterns of thinking, feeling, and acting. It  is an integrative therapy, selectively adapting various methods that are also used in existential, humanistic, phenomenologically oriented therapeutic approaches, but the emphasis is on the cognitive and behavioral dimensions (Ellis, 2001b). REBT focuses on speciï ¬  c techniques for changing a client’s self-defeating thoughts in concrete situations. In addition to modifying beliefs, this approach helps group members see how their beliefs inï ¬â€šuence what they feel and what they do; thus, there is also a concern for changing feelings and behaviors that ï ¬â€šow from rigid and extreme beliefs. This model aims to minimize symptoms by bringing about a profound change in philosophy. REBT practitioners are ï ¬â€šexible and creative in their use of methods and tailor their techniques to the unique needs of group members (Dryden, 2007) References A. Internet-Based http://www.allaboutcounseling.com/counseling_approaches.htm http://www.ehow.com/list_7162754_psychological-counseling-techniques.html#ixzz2cmnFA0bd http://www.ukessays.com/essays/psychology/psychoanalytic-theory-theories-of-counseling-and psychotherapy-psychology-essay.php#ixzz2cmqlANAb http://www.minddisorders.com/Ob-Ps/Person-centered-therapy.html#b#ixzz2dzABrENS B. Books Corey, G. (2012). Counseling and Psychotherapy: Theory and Practice Second Edition. Cengage Learning, Philippines.

Crime And Punishment In Wuthering Heights Essay -- essays research pap

The complex and furious creation of Emily Brontà «, Wuthering Heights is a powerful novel that fiercely combines many of the greatest themes in literature, such as love and its intricacies, revenge and the its terrible effects, and the contrasts between nature and society. One of the most prevalent themes in this celebrated work is that of crime and punishment, or sin and retribution. One character in particular, Heathcliff, stands apart as a conduit for both of these, es-pecially his sins. His past crimes, both worldly and metaphysical, coincide with his punishments.   Ã‚  Ã‚  Ã‚  Ã‚  Heathcliff, to some, began life as a crime. His foster brother Hindley shunned him as a reject from society while viewing Heathcliff’s very existence a grievous crime, particularly because Mr. Earnshaw’s love and affection were displaced towards Heathcliff instead of himself. Far later in the novel, this terrible attitude backfires upon Hindley, who is misused and cheated out of ownership of Wuthering Heights by Heathcliff. This crime parallels another: Heathcliff’s abhorrent abuse of both Hindley in his weakened state and Hindley’s son Hareton, who is made the stablehand instead of the rightful owner of the Heights. Heathcliff also trespassed when he imprisoned Catherine upon her visits to his son Linton. He coerced her into marrying Linton while her own father was dying, and so gained ownership of Thrushcross Grange as well as the Heights. &...

Paradoxical Thinking of Google

Paradoxical Thinking of Google Abstract Paradoxical thinking is looking at a problem from opposite perspectives. We live in a complex world which is full of paradoxes. Paradoxical thinking has contributed to many companies success. It is important for us to know about paradoxical thinking. This article analyzed that how Google applies paradoxical thinking in their interface, products and '20 percent program'. Then the article indicated that the key to learn paradoxical thinking is open in mind. Paradoxical Thinking Introduction Before we get started, we need to know what is paradoxical thinking.A paradox is a group of statements that are contradictory. And paradoxical thinking is looking at a problem or a situation from different or even opposite perspectives, and finding the same thing which is deep down in two opposite perspectives. (Westenholz, 1993) For example, in the 1830's, Faraday had observed that a current of electricity passing through a wire could cause the magnetized nee dle, which was located close to the wire, to move in a rotational direction. This was the basis of his electric motor. But he didn't stop with this.He twist his mind and found that moving magnets can cause electricity to flow. This is one of the most brilliant application of paradoxical thinking. Paradoxical thinking has helped plenty of companies to be successful. The following research on Google is trying to find out how they practice paradoxical thinking. Research on Google Company History Google Inc. is an American corporation which provides internet-related products and services. It has the dominant position in this field. Google Inc. was founded in 1998 and set up the workspace in a garage.At the end of 1998, Google was recognized as the search engine of choice by â€Å"PC Magazine†. In 1999, Google received 25 million dollars investment and started its rapid growth. In 2000, Google started to release multiple language versions of Google. com and became the world's larg est search engine by acquiring the first billion-URL index. (Schonfeld, 2008)Google's initial public offering of 19,605,052 shares stock took place on Wall Street on August 18, 2004. Opening price: $ 85 per share. And the price is around $700 per share. Recently, Google. om is listed as the internet's first most visited website, and numerous international Google sites are in the top hundred, as well as several other Google-owned sites such as YouTube and Blogger. (â€Å"Our History in Depth† . Google Inc, 2012) Interface At the end of 20th century, countless search engines were published. What makes Google. com outstanding? I think the interface is a very important factor. As we can see in the pictures, many search engines, such as HotBot, Excite, DogPile, used very complex and colorful homepage in order to attract visitors and indicate their websites' powerful functions.While Google. com used a very simple homepage. It only got a logo, a textbox and two buttons on the websit e. At first, the complex homepages maybe more attractive because of their colors and structures. But visitors more concern about the result pages than the search engine page. Then the convenient Google. com became popular. This is a good example of paradoxical thinking. Complexity cannot always be good. Simplicity can be a better choice. Besides the simple homepage, the â€Å"Google doodles† is also a determine difference. The doodles are not just comics, they also include mini games and short animations.Visitors will have fun and learn some knowledge through these doodles. The doodles are great mixed with Google's logo. It will connect visitors good feelings with Google. com and make them more willing to re-visit it again. Sometimes people come back not because the functions, but for the little funny tricks. (Gube, 2009) Products and Services Google provide a variety of services for people and businesses, not just search for the word you typed. The CEO, Larry Page, described the â€Å"perfect search engine† is something that â€Å"understands exactly what you mean and gives you back exactly what you want. This means making search smarter and faster. You can save time when searching information and have more time on the stuff you are good at. Advertising covers more than 90% of Google's revenue. Google has implemented various innovations in this market. Traditional way of advertising is that showing a product or a service and then trying to raise your interests about it or persuading you to pay it. While Google uses a different way. It takes full advantage of its search engine. The ads show up in the result you found and are related to what you are looking at. Helft, 2009) Ads are presented to you, according your interests. Only a few sentences can be more effectively than traditional ads. And people are more willing to see the ads that are related to what they are looking at. Google search is Google's core product. Now it is far more than a web search engine. You can get access to all the Google's products and services through it. Google's mission is to organize the world's information and make it universally accessible and useful. They want to build a worldwide information centre. For example, the Google map.You can see almost everywhere all over the world. And you can get various information, such as traffic information, geography information, even the street view. Google also developed Chrome and Android to make it simpler and faster for people to do what they want to online. All the Google products and services are trying to make the complex web and information simpler and easier to access or use. 20 percent time Theories of workplace control don't talk much about freedom. The workplace is often understood as a totalizing environment, saturated with obvious and subtle forms of coercion.It is kind of like a prison camp. While, companies like Google have created environment that resembles a playground more than a prison camp. They use a innovative time off program called â€Å"20 percent time†. This program allows the staff devote 20% of the working time to independent projects of their own choosing. (Walker, 2011) Although, not all the independent projects can be applied, Google have got many innovative products, such as Gmail, Chrome, Google Earth and so on. This program is contra to the theories of workplace control, but it keeps Google's creativity.Culture Google is known for having an informal corporate culture. Unlike other big company, Google has a casual culture. Google has some philosophy like â€Å"you can be serious without a suit†, â€Å"work should be challenging and the challenge should be fun. † (Stross, 2008)They believe that great, creative thing are more likely to happen with the right company culture. It does not just mean lava lamps and rubber balls. The culture put an emphasis on team achievements and pride in individual accomplishments has contribute to t heir success.They have built wonderful offices to make employees feel comfortable and fun, and made the company attractive and creative. Learn Paradoxical Thinking Paradoxical thinking is not a talent. It is a skill that you can learn and practice. Paradoxical thinking is looking at a problem or a situation from different or even opposite perspectives. The core is â€Å"outside the box†, which means be open in the mind. We need openness, courage and curiosity to think paradoxically. Openness means that we need to pay attention on our ideas that seem to be ridiculous and be open to learning new subjects.Be brave to try a totally different approach to what you are doing. Be curious about everything, especially that you have been ignoring for granted. Always ask yourself â€Å"Can I change this into the exact opposite? † Being a paradox thinker need to be skeptical. The more skeptical you are the better a paradox thinker you will be. Do not take for granted what others ac cept as a routine (K. R. Ravi). The eight skills related to intelligence are memory, logic, judgment, perception, intuition, reason, imagination and paradoxical thinking.Paradoxical thinking is often regarded as the least used of these skills. This is because that companies that survive hold rational views. While paradoxical thinking involves the ability to reverse, manipulate, combine, synthesize opposites (K. R. Ravi). It is hard to accept paradox for people that cannot live with two seemingly contradictory forces at the same time. Summary We live in a complex world which is full of paradox. It is very important for us to learn paradoxical thinking. (T. Belasen) By thinking paradoxically, we can find new opportunities, improve our performance.For management and leadership, paradoxical thinking means try opposite ways, and find the expectation in these ways. For example, the Greyhound bus line have gone through a very tough time because of the Green Tortoise. The Green Tortoise lin e's price is half of that of Greyhound. It is hard for Greyhound to compete with Green Tortoise on price. Instead of reducing the journey time and cost, the owner of Greyhound increased the journey time from four days to six days. This is trying a opposite way. Since he is more familiar about this place than the Green Tortoise does, he added more ‘fun' into the six days trip.His fun trip strategy gave him a new opportunity and changed travel into a pleasure industry. References â€Å"Our History in Depth† . Google Inc. (2012, October 21). Retrieved from http://www. google. com/about/company/history Gube, J. (2009, September 12). Popular Search Engines in the 90's:Then and Now. Retrieved from http://sixrevisions. com/web_design/popular-search-engines-in-the-90s-then-and-now/ Helft, M. (2009, March 11). Google to Offer Ads Based on Interests. The New York Times. K. R. Ravi. (n. d. ). Paradoxical Thinking. Retrieved from http://www. krravi. com/PARADOXICALTHINKING. df Scho nfeld, E. (2008, January 9). â€Å"Google Processing 20,000 Terabytes a day, and Growing†. Retrieved from TechCrunch. Stross, R. (2008). Planet Google: One Company's Audacious Plan to Organize Everything We Know. New York: Free Press. T. Belasen, A. (n. d. ). Paradoxes and Leadership Roles. Walker, A. (2011, November). ‘Creativity loves constraints': The paradox of Googles twenty percent time. Ephemera: Theory & Politics in Organization, pp. 369-386. Westenholz, A. (1993). Paradoxical Thinking and Change in the Frames of Reference. Organization Studies, pp. 37-58.

Physician and Nursing Shortages Essay

Healthcare reforms including Obama Care, formally named the Patient Protection and Affordable Care Act greatly impacts physicians and nursing shortages. There are several provisions which could direct impact physicians and nurses through incentives for potential recruitment, grants, training and retention. Through potential initiatives, the act may indirect effects that may question or present new reimbursement alternatives and models of health care delivery options. Healthcare reforms will allow millions of additional working as well as no working Americans to obtain healthcare coverage and this may challenge and highly impact physicians and nurses workforces across the United States. Many healthcare facilities have already reported high vacancy rates for technicians, pharmacists, maintenance staff, housekeeping staff and radiology technicians and laboratory technologists. Today, fair percentage of the American population, roughly 20%, lack proper access to needed primary care becau se there is an ongoing shortage of physicians. Some doctors, almost 30% are declining to accept new patients whom are insured with Medicaid. The changing demographics of the United States today and perverse reimbursements are direct impacts from the physician shortage. The looming physician and nursing shortages will inevitably hinder the health care system that is already being tax as well as alter the way patients and their physicians interact because the doctor-to-patient ratio will continue to be raised which will hurt patient outcomes. All workers within the healthcare arena play a vital part in making the healthcare system successful. Physicians and nursing shortages definitely create problems for every department and for all other workers within their system. Worldwide shortages that the United States are currently experiencing may create dangerous and unacceptable care to patients. Shortages additional enable work environments that do the foster retention of highly experienced and  qualified healthcare professionals, resulting in high turnover and revolving worker pool. Physicians and nursing shortages present c hallenges that do not help the workforce in healthcare organizations worldwide. These challenges include inadequate incentives which may attract students to join the profession, understaffing in various medical professions, as well as inadequate training facilities, and primary care being undervalued. Obama Care relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes. â€Å"If the population growth, aging and demand for care created by the newly insured, it is estimated that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under Obama Care.† (Howard, 2013) The health care system involves a network that is a combination of hospitals, employers, insurers, physicians, patients and various other stakeholders. A significant change impacting one component will reshape the entire system. Stakeholders are greatly concerned because the qualities of health care as well as the cost of care. Health care reforms will need to a ddress changes that are missing in policy outlines which should make primary health care more rewarding and appealing to potential new nursing and physician staff and which will also help to maintain the nursing and physicians that are already practicing. Additional the current supply of primary health care physicians will continue to fall behind the increasing patient demands. This will also result in stakeholders presented with the problems of increasing shortfall during the next decade within the primary care physicians. The availability of primary care is consistently and positively targeted to continued improvement with patient outcomes, raising health costs, lower utilization of health and reduced mortality rates. The Affordable Care Act set forth millions of dollars to address the problems and concerns that are associated with existing physicians shortages. The Affordable Care Act also has provisions that are aimed to improve the education, ongoing training as well as to help with the recruitment of nursing, physicians, doctors as well as other health care personnel. In addition, there are provisions in place that help to increase workforces’ cultural competency, enhance faculty training of healthcare professionals, and diversity. The provisions also play a vital role because of the fact they are put into place to examine innovative  reimbursement and care delivery models that highlight primary care services value and offer in improvement in the patient care coordination. On an average, primary physician groups may see about four or five patients within an hour, probably about one patient every fifteen minutes. Because of increase productivity and cost restraints and pressures, this number could increase dramatically. This trend, unfortunately, will be matching the burden of physicians declining incomes and job market. A lessor number of physicians earn what physicians earned many years ago. Primary health has been affected more as compared to services rendered. Additionally, the shift to a bundled fee for performance from the fee for service reimbursement system for force solo practicing physicians and small group practices into forming or partnering into larger practices. Physicians and nursing staff are not surprised by many of the findings. The Doctors Company, the largest physician-owned medical malpractice insurer in the nation in 2012, released results from a survey in which more than 5,000 physicians participated in across the nation commented on the future of health care reform. A result of the survey concluded that 60% of the respondents concluded that the pressures of trying to increase patient numbers will probably have a negative effect on the level of care physicians whom have the opportunity to provide services. The study concluded that 51% of the physicians thought that their ability to successfully keep positive relationships with their patients and grow patient relationships would be negatively affected. Lastly, the study concluded that out of 10 physicians, nine are disillusioned by the concerns with the shortages so that several of the physicians actively discourage family and friends from pursuing careers in medicine. Unfortunately, this is a shocking reality of what many of us already know, and statistics presented from the study would be even higher if the exact survey questionnaire was conducted today. While the many projected newly insured patients that will enter the health care system may obtain their insurance coverage through available st ate ran exchanges, many new patients may still find themselves unable to afford potential discounted policies. This will cause many to look for coverage from Medicaid out of urgency and because they may feel as though they have no choice. Primary care physician payments have been reduced in the past and we can look for them to be continually reduced maybe even more in the future. Many  physicians are unhappy with the fact that they may owe over 160,000 when they finish medical school. Many potential physicians do not find this attractive because many will have salaries that are likely to be less than the cost of their education. Many physicians in this case will find it more attractive and enticing to become specials which again will attribute to the physicians and nursing shortages. Physician assistants and nurse practitioners may have to step up in fill in. Physician assistants are qualified personnel that have been license and qualified to provide needed preventive care options. Physician assistants have an important role in the management of chronic disease prevention and management, administering blood sugars testing and interpreting blood sugar levels. When physicians have only a short time, less than 10 minutes or so to see a patient, sometimes they encounter issues which may leave no choice but to pass responsibilities to their , who are able, to practice with the supervision of the physician in most states. â€Å"Under the proposals, issued with a view to impending physician shortages, it would be easier for hospitals to use advanced practice nurse practitioners and physician assistants in lieu of higher-paid physicians.†(Pear, 2011) Because these change, hospitals could benefit by seeing savings which would be immediate. Legislation within several states at this time is seeking to extend the physician assistant’s autonomy by enabling the assistance to independently practice without of physicians, but under certain guidelines and protocol s. Many Americans may find this legislation to be filled with controversy, but many may feel that the legislation is needed to increase productivity of physician assistants, nurse practitioners and primary-care physicians whom will ultimately have responsibilities because of the growing shortages. Doctor-patient relationship will definitely change because of the shortages. In the past, patients were granted appointment times that could last up to 60 minutes, these days are gone because patients are rushed out because of people waiting to be seen in addition. This doesn’t mean service will go down or the quality of medical care will not be like it was. Even though many people have doubts and are not optimistic, I feel the quality of medical care and health service will improve. Research also indicates the quality of patient care will improve performance measurements will prove this in the future. The Patient Protection and Affordable Care Act will impose  changes that may be dis ruptive in the delivery of primary care. The act allows expansion of primary care access to physicians, millions of new patients, and policymakers will be faced with increase pressure to resolve primary care practitioner’s shortages. Even though controversy surrounds the Affordable Care Act enactment, the government should do more to drive motivation among physicians, nurses and professional medical associations. They can also embrace medical societies that may offer strategy initiatives suggestions that will help to meet the nation’s primary care needs. Physicians have experience some success to this date with embracing the changes to primary care, such as supporting laws that allows primary care practice to be perform by non-physician practitioners including assistants and nurse practitioners. Some physicians have realized that they may benefit from the integration of primary care practice from population health needs. Many physicians have realized that the environment now created is beneficial, it helps the m. Many physicians have chosen to stop being against non-physician practitioners and are welcoming them to work with them. Physicians can also offer problem solving and physicians should take initiatives to foster policies and develop solutions which addresses primary care shortages. Initiatives can involve no more opposition of non-physician practitioners with primary care providers (in the past medical organizations as well as physicians did show opposition to this). Additionally, physicians should embrace changes with the delivery of primary health care including the shifting of some responsibilities to the practitioners. Lastly, because of the Affordable Care Act focuses with prevention and wellness, physicians should realize that opportunities exist to the integration of the primary care practice with population health. Many Americans will have coverage with the expansion of health insurance coverage. With the nation’s continued growth and new covered Americans the drive the demand for primary care to levels will definitely exceed existing capacity levels. The millions of newly insured Americans who may not had access to primary care will definitely be looking for primary care now with the enactment of the act. Because of this, there will more than likely be disruptive and unwelcome changes in the delivery of primary care. Important ethical issues are presented with health care reform. The recently 2010 enacted Patient Protection and Affordable Care Act have  ignited ethical debates over some minor and major controversial topics. Why do many feel as though reform within the health care system such a controversial issue? Politicians seek to gain advantages over their worthy opponents which fuel the policy debate. Differences which are important to us all, with values and moral beliefs are the underlying issues of political differences. To help comprehend the moral paramete rs of debate within health care reform, it may be beneficial to start by analyzing the primary goals of the nation’s health care system. Individuals and as the society want and have high expectations with our health care system. The United States health care system has been shaped by fundamental desires and goals. The American people will accept nothing less those exceptional, high levels of quality care which provides excellent health benefits. Americans expects the United States to continue being the frontiers of medicine and expects the United States to continue improving the quality of health care. The American people also want and welcome having a freedom of choice which means they make their own decisions about their care. These decisions can include deciding where to receive care, if and when they do, what kind of care they get, and from which health care provider in which they seek care. Basically, Americans including myself would like to maintain our on control over our health care needs, choices and providers. We also want affordability with healthcare, we don’t want to spend all our hard earned money on health care costs and not have enough money to cover our other needs. In addition, most Americans feel as though our fellow Americans can share in the costs of providing health care benefits to us all and Americans Americans as well as the government wants to make sure that medical care costs are controlled. This is an important attribute of the cost of medical care and it’s a vital element of the health care reform enactment. Extending care access to everyone without appropriate cost control measures will be unsustainable. â€Å"The number of emergency room visits continues to rise at a rate greater than that of population growth, exemplified by an increase in emergency room visit rates from 352.8 to 390.5 per 1000 persons from 1997-2007.† (Tang, 2010) Today, the United States spends the most on health care per capita, more than any other country. Americans generally would prefer cost containment that does not reduce quality or services. Cost containment approaches are not design to interfere with the  value of health care. The PPACA have address cost containment strategies which include patient care that is accountable, patient-centered medical homes, and programs to reduce patients being readmitted and patients acquiring new conditions while admitted as well as bundled payments. The Patient Protection and Affordable Care Act have some provisions that may be negative for doctors, however in some instances patients can suffer more. However examining the positives, On a positive side, provisions as well programs can help many of us. The Affordable Care Act seeks to provide additional access to coverage, lowering health care spending and improving the quality of health care delivered services. Initiatives of the ACA aid health care organizations; doctors and providers work together to coordinate health care of patient’s beneficiaries to ensure the quality of health care continues to improve while spending and costs are lowered. Many of the elderly have begun receiving the benefits of the provisions of the law. Some of these benefits include lower payments and preventive service care. They also are seeing the benefits of Medicare prescriptions at lower drug cost. The Affordable Care Act is helping seniors by allowing annual wellness visits and preventive services in which they have no upfront or out of pocket costs, offering coverage to individuals that may have pre-existing conditions and it allows for no one to be denied coverage because of pre-existing condition and huge savings on prescription drug costs. Though the health reform law includes measurement which may address the presented and growing shortage, other provisions in the law most likely will raise the demand of primary care. For example, the law is expected to extend coverage to millions of uninsured people by 2019, which will definitely increase the demand for primary care services. â€Å"The PPACA coverage expansions are predicted to increas e the shortage of primary care physicians from approximately 25,000 to 45,000 by 2020.† (Carrier, 2012) There are several measurements that can be implemented to help improve access to primary care providers and services. Because the U.S. has a high percentage of Americans without adequate healthcare a Mobile Health Clinic or a Nursed Managed Centers can be used to attract a lot of people such as the homeless people who do not have the means to be able to go to the doctor (Whelan, et al, 2010). This will allow them to be able to see a doctor and get the proper medical attention they need to have healthier lives. One possible  approach to alleviating pressures on the primary care workforce is greater use of nurse practitioners, which could both increase the number of primary care providers and potentially free up physicians to care for more complex patients. Improving access to primary care services and having more effective public health measures are critical to ensuring that individuals have access to high-quality services at the place and time that best meets their needs. Physician assistants can we be a part of the answer as well. They are well trained, have the clinical skills, with a high level knowledge base, and be a part of the solution. The skills they bring to the table can help address the impending avalanche of patients. Not only are they cost effective with overall labor costs less than a physician, but can take the stress off of a physician needing to see a certain amount of patients per day, as to keep the productive practice (Bahrych 2011). Finally, a scholarship program for students committed to providing primary care in communities with doctor shortages should be implemented; the program can allow open residency slots to be utilized in areas with shortages. Grants and incentives should be established. Also initiatives should be in place to forgive student loan debt. I would also make the following recommendations for improvements that will increase the availability of specialty care through tele-health, bringing specialists to primary care sites, and using physician assistants to deliver specialty services; and also expand the role of primary care providers, physicians and nurse practitioners to handle more specialized health issues through consultations and ongoing training. References: Howard, Paul. (2013, July). Get Obama Care While Supplies Last. Retrieved from http://www.usatoday.com/story/opinion/2013/07/11/obamacare-doctors-medicaid-primary-care-column/2510199/ Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007. JAMA 2010; 304: 664-670 Pear, Robert. US Moves to Cut Back Regulations on Hospitals, October 2011. Retrieved from http://www.nytimes.com/2011/10/19/health/policy/19health.html?_r=0 Bahrych, Sharon. Let Physician Assistances be Part of the Primary Care Answer, December 2011, Retrieved from