General Banking Perspectives: Dhaka Bank Ltd

1. Introduction Commercial Bank implies that banks devote most of their resources to meeting the financial needs of business firms. This institution offers the public both deposit and credit services as well as a growing list of newer and more innovating services, such as investment advice, security underwriting, and financial planning. In recent years financial institutions have diversified themselves to satisfy consumers and units of government around the world.The result is the emergence of a financial institution that has been called a financial department store because it satisfies the broadest range of financial services needs in the global economy. The importance to commercial banks may be measured in a number of ways. Banks are still the principal means of making payments, through the checking accounts, credit cards, and electronic funds transfer services they offer. Banks are important because of their ability to create money from excess reserves made available from the publ ic's deposits.The banking system can take a given volume of excess cash reserves and, by making loans and investment, generate a multiple amount of credit. Bangladesh is developing country. After liberalization, we achieve a poor economic growth in last three decades. This is because of number of micro and macro factors as density of people. Bangladesh is a place where we see lack of proper education and poor political stability. Political instability is the major factor in Bangladesh that makes a vital hazard to achieve the economic growth.All of above, banking industry brings a little bit hope that can be a better flavor to accelerate the economic growth in our country. This is the only sector (especially private banking) that getting a continuous develops from last two decades. One of the aims of this study involves the focus on ‘The General Banking Practice of Dhaka Bank Ltd, Halishahar Branch’. Another aim of this paper is to point out how management of the bank ca n perform better and provide better service to the clients. 2. Methodology Different data and information are required to meet the goal of this report.Those data and information were collected from various sources, such as, primary and secondary which is showed below: Primary data were collected from: ? Face to face conversations with the employees at various fields. ? Personal interviewing and interacting customers. ? Observing various organizational procedures. ? Customer’s response from questions. Secondary data were collected from: ? Internet and Annual report of Dhaka Bank Limited. ? Progress report/ Statement affairs and Bank Rate sheet of the Bank. ? Several kinds of Academic test-book and training sheet. Different publications regarding banking functions and foreign-exchange operation. ? Prior research report on this Bank. 3. Scope The scope of the research covers the General Banking practices of Dhaka Bank Limited. The report focuses on the general banking practices in general, how it is implemented in Dhaka Bank Limited. 4. Limitation of the study The present study was not out of limitations. From the beginning to end, the study has been completed sincerely and carefully. But some problem arises from conducting the study.During the study it was not possible to visit the whole area covered by the banks although the financial statements and other information regarding the study have been covered. Some limitation are given stated below- 1. The main constraint of the study is insufficiency of information, which was required for the study. There are various information that the bank employee can't provide due to security and other corporate obligations. 2. Due to time limitations many of the aspects could not be discussed in the present report. 3.Every organization has their own secrecy that is not revealed to others. While collecting data through interviewing the employees, they did not disclose much information for the sake of the confidentiality of the organization. 5. Background of Dhaka Bank: Dhaka Bank Limited is one of the premier and top ranked private banks in Bangladesh. The bank was established in the year 1995 as some veteran and well established businessmen grouped together and worked sincerely to establish this bank. The bank was incorporated as a public limited company under the companies act 1994.The founder of the bank was Mr. Mirza Abbas Uddin Ahmed who was also the former advisor of the bank. The Head Office of the bank is located at Biman Bhaban 1st floor, 100 Motijheel C/A, Dhaka 1000, Bangladesh. The bank started its very first journey on July 5th 1995 with an authorized capital of Tk. 1000 million and a paid up capital of Tk. 100 million. Since the inception of the bank the bank made phenomenal growth in terms of operation, business and goodwill. As of March 31st 2010 the bank’s paid up capital stood at Tk. ,659,597,800 and the total equity (capital and reserves) stood up at Tk. 6,036,368,754. Th e bank currently has 62 fully operational branches all over the country, 3 SME Service Centers, 6 CMS Units, 2 Offshore Units, and one CPZ (central processing office) which is situated in BGMEA building Karwan Bazar , Dhaka Bangladesh As an integral part of their commitment to Excellence in Banking, Dhaka Bank now offers the full range of real-time online banking service through its all branches, ATMs and Internet Banking Channels.Dhaka Bank Ltd is the preferred choice in banking for friendly and personalized services, cutting edge technology, tailored solutions for business need, global reach in trade and commerce and high yield on investments. 5. 1. The Mission of Dhaka Bank Limited- To be the premier financial institution in the country providing high quality products and services backed by latest technology and a highly motivated team of personnel to deliver Excellence In Banking. 5. 2. The Vision of Dhaka Bank Limited- At Dhaka Bank, we draw our inspiration from the distant sta rs.Our team is committed to assure a standard that makes every banking transaction a pleasurable experience. Our endeavour is to offer you razor sharp sparkle through accuracy , reliability , timely delivery , cutting edge technology and tailored solution for business needs, global reach in trade and commerce and high yield on your investment . 5. 3 The Goal of Dhaka Bank Limited- Our people, products and processes are aligned to meet the demand of our discerning customers. Our goal is to achieve a distinction like the luminaries in the sky.Our Dhaka Objective is to deliver a quality that demonstrates a true reflection of our vision – Excellence in Banking. 6 General Banking General banking creates a vital link between customers and bank. It’s really a classic as crucial department for the bank. It is the introductory department of the bank to its customers. The Dhaka Bank Ltd, Halishahar branch has all the required sections of general banking. Every day it receives de posits from customers and meets their demands for cash by honoring instruments. General banking department is that department which is mostly exposed to the maximum number of bank customer. . 1 Different Departments of General Banking It has five major parts in the branch to perform. The sections are: i. Account opening section ii. Cheque clearing iii. Cash iv. Remittance v. Accounts section 6. 2 Different Types of Customers/ Account Holder: Any one can open an account in Dhaka Bank Ltd. if he is capable of entering a valid contract and a banker is satisfied his confide and willing to inter into the necessary business relation with him. So any one of the following types of customers can open account:- i. Individual ( personal ) ii. Joint iii. Proprietorship ( sole traders / registered or unregistered ) v. Joint stock companies ( private/ public ltd. companies) 6. 3 Account Opening and Dispatch Department: Account opening is the gateway to the bank. The relationship between a banker and its customer begins with the opening of an account by the customer. For this, account opening is considered the most important function of a commercial bank. All banks generally maintain a separate department to open accounts. The function of accounts opening department can be classified into the following three categories: 1. Supplying various accounts related information to the customers. 2. Opening of account and . Issuing cheque books and ATM Card. Supplying various accounts related information to the customers: When a customer comes to open an account with a bank, s/he needs to be informed about various information relating to account opening. Account opening department enthusiastically provides necessary information to the customer. Following information is supplied to the customer depending on their requirements: †¢ Type of accounts maintained by the bank †¢ Requirements/Necessary formalities for opening each type of accounts †¢ Eligibility to open an accou nt etc. Types of accounts maintained by DBLAccounts based on operations as under: †¢ Current Account (CD A/C) †¢ Short Term Deposit Account (STD A/C) †¢ Savings Bank Account (SB A/C) †¢ Fixed Deposit Receipt Account (FDR A/C) Accounts based on Nature of Customers as under: †¢ Single/Individual Account †¢ Joint individual Account †¢ Sole Trader/ Proprietorship Account †¢ Partnership Account †¢ Company Account etc. Savings accounts are opened for single/individual and joint individual customer. Business organizations/enterprises are not allowed to open savings account. 6. 4 Requirements/Necessary formalities for opening each type of accounts: ? Single/Individual Savings Bank Accounts: Introduction of customer (Must be either by an account holder (SB/CD A/C) or an employee of the bank. †¢ Photographs-Two copies (attested by the Introducer) †¢ Photocopy of valid passport/Citizenship Certificate from Chairman or Ward commissioner/Cer tificate from the employee of the bank. Add: †¢ Transaction Profile †¢ Signature on Money laundering Circular ? Joint Individual Account: No additional requirements/formalities other than the Single/Individual Savings Bank Accounts. ? Single Individual/Joint Individual CD A/C Requirements/Formalities as like as SB A/C, except here introducer must be a CD A/C holder of the bank. Proprietorship CD A/C †¢ Introduction of the customer (Must be by a CD A/C account holder or an employee of the bank. †¢ Photographs- (Two Copies) of the proprietor. †¢ Valid Trade License. †¢ Company Seal. †¢ Photocopy of valid passport of the proprietor/Citizenship/ Certificate from Chairman or Ward commissioner/Certificate from the employee of the bank. Add: †¢ Transaction Profile †¢ Signature on Money laundering Circular †¢ Signature on KYC form ? Partnership CD A/C †¢ Introduction of the partners (Must be by a CD A/C account holder or an employee of the bank. Photographs- (Two Copies) of every partner. †¢ Valid Trade License. †¢ Seal. †¢ Date of incorporation. †¢ Photocopy of valid passport of the proprietor/Citizenship Certificate or Identity Certificate from Chairman or Ward commissioner/Certificate from the employee of the bank. †¢ Partnership Letter. Add: †¢ Transaction Profile †¢ Each partner’s Signature on Money laundering Circular †¢ Each partner’s Signature on KYC form ? Limited Company A/C †¢ Introduction (Must be by a CD A/C account holder or an employee of the bank †¢ Photographs- (Two Copies) †¢ Valid Trade License Company Seal †¢ Resolution of the Company on company’s letterhead †¢ Certified and attested copy (attested by MD or Chairman) of Memorandum of Association and Articles of Association †¢ Certified and attested copy of Certificate of incorporation †¢ List of Directors †¢ Photocopy of valid passport/Citizensh ip Certificate or Identity Certificate from Chairman or Ward commissioner/Certificate from the employee of the bank. Add: †¢ Annexure E: Identification of Directors and Authorized Signatories †¢ Annexure D: Director’s Signature on KYC form †¢ Transaction Profile 6. Eligibility to open an account: Anyone capable of entering into a valid contract can open an account with the bank. A minor can also open an account under guardianship or alone if s/he is at least 12 years old. But a minor is not allowed to open a current account. Lunatic, Insolvent person/Drunker/Liquidator/Any other individual or organization by law cannot open an account with bank. 6. 6 Accounts Opening of Customers with the Bank Opening of an account involves certain formalities, which varies according to different types of accounts as well as various categories of customers.The bank supplies following printed forms during opening an account of a customer: o Account opening Form o Specimen Signat ure Card o Deposit Slip o Cheque Book Requisition Slip o KYC Profile Form o Transaction Profile Form Customers are requested to read all the instructions carefully and then fill up the forms properly. Account opening officer must have to check all the forms or documents i. e. whether the customer duly signs them where necessary as well as introducer must introduce the customer by putting signature in the space provided on the account opening form.After completion of all the formalities by the customer, Dhaka bank officials have to perform the following functions chronologically: |Scrutinizing account opening form and Specimen signature card | |Getting the approval of accounts by authorized officer | |Putting account number on the form | |Putting entry in the account opening register | |Posting all the account information in the computer | Issuing a cheque book | |Maintaining all relevant papers/documents in separate file in the name of the | |every account holder | |Sending the sp ecimen signature card to the cash department | |Sending a thanks giving letter to the New account opener’s address | |Maintaining all relevant papers/documents in separate file in the name of the every | |account holder | 6. 7 Issuing of a Cheque BookA cheque book is issued to the customer at the time of the account opening or may by issued after 2-3 days from account opening. And additional cheque book is issued at the request of the customer according to his/her necessity. Followings are the formalities during issuing a cheque book: Getting the cheque book requisition slip signed by the account holder By verifying the signature, issuing the cheque book Writing down the account number on each leaf of the cheque book Making entry to the cheque issue register Supplying the cheque book to the account holder after getting proper acknowledgement from the account holderInland Remittance Department Remittance Department: This department deals with transfer of money from one place to another place. Remittance can be classified as inland remittance and foreign remittance; however, remittance department mainly deals with inland remittance rather than foreign remittance. Instruments used for inland remittance as under: o Pay Order (P. O) o Demand Draft (DD) o Telegraphic Transfer (TT) Pay Order: A Pay Order is a written order on a specific instrument i. e. generally called â€Å"Block† issued by a bank to pay a certain sum of money to specific person, Organization or a bank.It is called banker’s cheque, as it is issued by a bank as well as drawn upon on a bank. Issuance of Pay Order: issuance of pay order involves following steps: ? Upon requests of customer, bank supplies prescribed application form ? Applicant has to provide detailed particulars of him/herself as well as beneficiary or receiver of the Pay Order ? Total amount of the P. O must be written both in words and in figures in the space provided ? Credit vouchers are prepared; one for com mission and another for VAT ? Now customer is requested to deposit the P.O amount along with VAT and Commission charges to the cash department ? Cash department releases the application form with authorized signature and cash received seal ? Now Pay Order is written on block which has three parts: First part is retained by the issuing bank, Second part is for customer and Third part is for the beneficiary of the Pay Order ? In this stage all the information is entered into the P. O register Payment or Encashment of Pay Order: Issuing bank makes payment of Pay Order upon presentation through clearing house. When the P.O does not consist of discrepancies, necessarily the proceeds of Pay Order is credited to the account of payee/beneficiary. However, before making payment of P. O, the signature of issuing officer is verified and date of payment is recorded in the Pay Order issue register. Demand Draft A Demand Draft, which is traditionally called DD. A DD is a written order on a specif ic instrument of one branch of a bank upon another branch of the same bank to pay a certain sum of money to or to the order of a specified person or of a specified organization. In practice DD is not issued between two branches within the same city.Issuance of Demand Draft: Issuance of DD involves following steps: ? Customer is asked to fill up a form in specific form provided by bank which is also treated as a voucher ? Commission and Charges are also mentioned in the form ? Two credit vouchers; one for commission and another for VAT is stapled with the form ? Customer pays cash in the cash department with relevant vouchers ? Cash dept. receives cash and delivers vouchers after completing necessary formalities ? Now DD is prepared in a block Branch-wise serial number is given on the draft ? The draft number is written on the voucher ? Draft block and voucher along with the register are sent to the officer in charge for checking and then sent to manager/Second in charge of the branc h for authorization ? The draft may be crossed if customer desires and finally delivered to him/her against initial or acknowledgement on the voucher Payment of Demand Draft: After receiving the DD, the drawer branch checks the date, amount both in words and figures and signature. In case of Test DD, Test number must be reconciled before payment.And then DD is cancelled and payment date is noted in the register. If the DD is crossed, the payment is made through clearing house. Telegraphic Transfer In case of Telegraphic Transfer, which in brief is called TT, an applicant has to fill up prescribed form supplied by bank to inform all the particulars about the sender as well as the receiver/beneficiary of the TT. Besides, following points should be checked in this regard: ? Full name of the beneficiary and his account number if the instruction here is â€Å"credit to beneficiary’s account†, or full address if instruction is there to advise & pay ?Commission and Telegram c harge are recovered from customer ? A cost memo has to prepare for customer in this regard; containing the amount of TT, commission and Telegram charges ? Customer has to deposit cash in the cash department along with voucher and application ? Remittance depart finally checks all the particulars viz. name of the beneficiary, account number of the beneficiary, name of the bank, name of the branch and mode of payment etc. ? Each and every TT must be Tested whatever the amount of TT ?Authorized officer then send the TT message through Telex/Telephone ? The issuing branch also sends a TT confirmation advice to the drawer branch and one copy is retained by the branch Payment of Telegraphic Transfer (TT): The payment of TT is paid only when TT test numbers reconcile. TT receiving branch maintains TT message receiving memo. On agreement of Test, the serial number of TT is entered in the TT payable register. The issuing branch informs if any number is mismatched or omitted. Two vouchers are prepared in this regard as under:DBL General A/C†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦****** Branch———-Dr. Bills Payable A/C†¦Ã¢â‚¬ ¦.. (TT payable)————-Cr. The TT amount is then credited to the beneficiary’s account if the beneficiary/receiver of the TT is an account holder of the branch; otherwise a Pay Order is issued if the beneficiary/receiver of TT is an account holder of another bank. 6. 8 Clearing Section: According to the Article 37(2) of Bangladesh Bank Order, 1972, the banks, which are the member of the clearinghouse, are called as Scheduled Banks. The scheduled banks clear the cheque drawn upon one another through the clearinghouse.This is an arrangement by the central bank where everyday the representative of the member banks gathers to clear the cheque. Banks for credit of the proceeds to the customers’ accounts accept Cheque and other similar instruments. The bank receives many such instruments during the day from ac count holders. Many of these instruments are drawn payable at other banks. If they were to be presented at the drawer banks to collect the proceeds, it would be necessary to employ many messengers for the purpose. Similarly, there would be many cheque drawn on this the messengers of other banks would present bank and them at the counter.The whole process of collection and payment would involve considerable labor, delay, risk and expenditure. All the labor, Risk, delay and expenditure are substantially reduced, by the representatives of all the banks meeting at a specified time, for exchanging the instruments and arriving at the net position regarding receipt or payment. The place where the banks meet and settle their dues is called the Clearinghouse. Activities of the Section: (a) Preparation of Clearing Outward and Inward Lodgment and record maintenance of the same. (b) Batch posting as and when required. On receipt of instruments, the same is endorsed here.Then clearing section wi ll sent IBDA to head Office for clearing purpose and on receipt of IBCA from Head Office amount is credited to customers account and vice versa. If the instrument is return then the same is given back to the customer. 6. 9 Collection Section: Checks, drafts etc. are drown on bank located outside clearing house are sent for collection. Motijheel Branch collects its client’s above-mentioned instruments from other branches of DBL and branches other than DBL. In case of out ward bills for collection customers account is credited after finishing the collection processor.And in case of in ward bills customers account is debited for this purpose. So it places dual role as follows: i) Collecting Banker ii) Paying Banker. Activities of the Section: Collection is done when (i) Paying Bank is located out side Dhaka City. (ii) Paying Bank is other branches of DBL situated inside Dhaka City. i) Paying Bank is outside Dhaka City: Collection department of Motijheel Branch (Principal Branch) , DBL sends outward bills for collection (OBC) to the concerned paying bank to get inter Bank Credit Advice (IBCA) from paying Bank.If the paying bank dishonors the instrument, the same is returned to principal Branch. ii) The Paying Bank of their own branches inside Dhaka City: Collection Department sends transfer delivery item to other branches of same bank situated inside Dhaka City. Upon receiving IBCA customer’s a/c is credited. Procedures for Outward Bills for Collection: 6. 10 Accounts Section: In banking business transactions are done every day and these transactions are to be recorded properly and systematically as the banks deal with the depositors’ money.Any deviation in proper recording may hamper public confidence and the bank has to suffer a lot. Improper recording of transactions will lead to the mismatch in the debit side and credit side. To avoid these mishaps, the bank provides a separate department whose function is to check the mistakes in passing v ouchers or wrong entries or fraud or forgery. This department is called Accounts Department. Besides these, the branch has to prepare some internal statements as well as some statutory statements, which are to be submitted to the Central Bank and the Head Office.This department prepares all these statements. Functions of Accounting Department: We can divide the functions of accounting department into two categories. One is day-to-day task and another is periodical task. a. Day to day functions: Here day-to-day function refers to the every day tasks. Accounting department of DBL performs the following day to day functions: b. Periodical functions: Periodical functions of accounts department include the preparation of different weekly, fortnightly, monthly, quarterly and annual statement.The accounts department prepares the following statements: etc. 6. 11 Cash Section: Cash section is a very sensitive organ of the branch and handle with extra care. Operation of this section begins at the start of the banking hour. Cash officer begins his/her transaction with taking money from the vault, known as the opening cash balance. Vault is kept in a much secured room. Keys to the room are kept under control of cash officer and branch in charge. The amount of opening cash balance is entered into a register.After whole days’ transaction, the surplus money remain in the cash counter is put back in the vault and known as the closing balance. Money is received and paid in this section. 6. 11. 1 Cash Receipt: 6. 11. 2. Cash Payment: 6. 12 Conclusion: Bank is the largest organization of mobilizing surplus domestic savings. Attractive Savings Schemes are offered by DBL such as Contributory Savings Scheme, Monthly Benefit Deposit Scheme, Special Deposit Scheme, Education Savings Scheme, Fixed Deposit Scheme, Dhaka Bank Money Scheme, Dhaka Bank Insured Fixed Deposit Scheme as well as different accounts to save money.Schemes are designed concentrating in different purposes t o help the fixed income group people to help in need. Bank-Officials are also whole-hearted and dedicated to serve their customer with utmost care. 7. Online Branch Banking The Bank has set up a Wide Area Network (WAN) across the country to provide online branch banking facility to its valued clients. Under the Scheme,  clients of any branch shall be able to do banking transaction at other branches of the bank. Under this system a client will to be able to o following type of transactions # Cash withdrawal from his/her account at  any  branch  of the Bank irrespective of location. # Cash deposit in his/her account at any branch of the Bank irrespective of location. # Cash deposit in other's account at any branch of the Bank irrespective of location. # Transfer of money from his/her account with any branch of the Bank. Any amount can be deposited or transferred under Dhaka Line.In the system, however, at present there is a limit for cash withdrawal through bearer or by accou nt holder himself. Terms & Conditions of Online Branch Banking Service ONLINE BRANCH BANKING SERVICE is designed to serve its valued clients. Under this system, you shall be able to do the following type of transactions:    †¢ Cash withdrawal from your account at any   branch of the Bank †¢ Deposit in your account at any Branch of the Bank. †¢ Transfer of money from your account to any other account with any Branch of the Bank Transaction Limit Maximum ceiling of cash withdrawal by self is Tk. 10,00,000/- (ten lac) only per transaction †¢ Maximum ceiling of cash withdrawal by third party (bearer) per transaction is below Tk†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Only (please mention the limit you wand to place). †¢ Cash deposit/transfer  by online transaction is unlimited Online Transaction Membership Fee Membership fee is  Tk. 50/- per month for the Online Branch Banking Service. Charges for Online Transaction †¢ There will be no charge for transac tion within the city where the account is domiciled †¢ Fee Tk. 7/- will be realized from the customer’s account for each remote transaction (inter-city)  for amount up to Tk. 1, 00,000 (one lac). †¢ Fee at the rate of   0. 075% will be realized from the customer’s account for each remote transaction of amount more than Tk. 1,00,000 (one lac). Who can get this service The Clients who has account in Dhaka bank or who will open account in Dhaka bank and would be interested to maintain substantial deposits in Savings, Current or STD accounts, will be eligible to get Dhaka Line Service.How one can get this service Intending and eligible clients have to apply in prescribed application form to their branch (where account is maintained) to get the online service from the bank. The client should submit two copies photographs and signature cards alongwith the application form. To avail the Dhaka Line service, no charge should be paid for online transaction within a locality where the account is domiciled. But charges should be paid by the customer for inter city online transaction When a account will be activated for onlineWithin 15 days from the date of submission application a account will be activated for online service Dhaka Bank Limited obtained Principal Membership of Master-Card International in the month of May 1999. Within a period of 6 months, the bank successfully launched Master Card-Credit Card which created a new dimension in its customer service and consumer financing. The Special feature of the Dhaka Bank Master Card is that its bears the card holder’s photo on the card, which is the first of its kind in Bangladesh and adds security against misuse.Dhaka Bank Limited issues 4 types of cards. These are Gold Local & International and Silver Local & International. Local cards can be used in Bangladesh only. 7. 1 Followings are the main feature of MasterCard Credit – †¢ Dhaka Bank Ensure High Level of Security  by inserting your Photograph on the Card. †¢ 20 to 50 days credit form the date of transaction. When you receive your monthly statement, you can either choose to pay in full or just minimum due amount shown on the statement. No interest is charged if you pay in full within payment due date. 24 hours a day, 365 days worldwide service. †¢ No joining/administrative fees. †¢ waiver of annual fees for International Card: If you accumulate 20,000 Dhaka Bank Bonus Point for your Gold Card or, 10,000 Bonus Point for your Silver Card in a year then you enjoy our Card without fees( $ 1 purchase: 1 Bonus). †¢ Waiver of annual fee for Local Card:   If you accumulate 10,000 Dhaka Bank Bonus Point for your Gold Card or 8,000 Bonus Point for your Silver Card in a year then you enjoy our Card without fees( Tk. 50/- purchase : 1 Bonus point). The Highest Dhaka Bank Bonus Point holder can enjoy free air ticket Dhaka-Bangkok-Dhaka. (Business Class). †¢ Cash advance faciliti es. †¢ 1,39,00,000 locations accept MasterCard worldwide Facilities Available with the Card : The Card can be used for: 01. Making payments to Merchants against purchase of all goods and services by the Cardholder form Marchant(s); and 02. Availing Cash Advances: ? 2. 1 From any of DBL Branches or any member of MasterCard of any Merchant authorized to make Cash Advances; as may be agreed upon by DBL or ?By the use of the Card on any ATM of DBL or of MasterCard. Subject to these terms and conditions and in compliance with such requirements, limitations and procedures as may be imposed by DBL, any Merchant or MasterCard from time to time. 7. 2 SWIFT Dhaka Bank Limited is one of the first few Bangladeshi Banks who have become member of SWIFT (Society for Worldwide Inter-bank Financial Telecommunication) in 1999. SWIFT is members owned co-operative, which provides a fast and accurate communication network for financial transactions such as Letters of Credit, Fund transfer etc.By be coming a member of SWIFT, the bank has opened up possibilities for uninterrupted connectivity with over 5,700 user institutions in 150 countries around the world. SWIFT No. : PRBLBDDH Deposit Schemes of Dhaka Bank Limited: Bank is the largest mobilizer of surplus domestic savings. For poverty alleviation, we need self employment, for self-employment we need investment and for investment we need savings. In the other words, savings help capital formations and the capital formations help investments in the country.The investment in its turn helps industrialization leading towards creation of wealth of the country. And the wealth finally takes the country on road to progress and prosperity. As such, savings is considered the very basis of prosperity of the country. The more the growth of savings, the more will be the prosperity of the nation. The  savings rate in Bangladesh is one of the lowest in the world. In order to improve the savings rate, Financial Institutions responsible for mobilization of savings should offer attractive Savings Schemes so that the marginal propensity to save increases.The savings do not, of course, depend only on the quantum of income but largely depend on the habit of savings of the people. Contributory Savings Scheme: This is a Savings Scheme in which a person gets the opportunity to build up savings by contributing monthly installments and receives an attractive fixed amount at the end of a specified term. The Scheme is designed to help the fixed income group to save money and build up a sizable funds with which they can go for some income generating venture to improve the quality of their life and/or meet any future financial obligationsThe salient features of the Scheme are given below: > Minimum size of monthly installment shall be Tk. 500/- and multiplies of Tk. 1000/-. Maximum installment size shall be Tk. 25,000/- > The Deposit shall be for a period of 5 years. Lump sum amount shall be paid after maturity or monthly Pension shall be paid for the next 5 years according to the size of deposit. A brief chart of lump sum amount and monthly pension installments payable are shown below: Size of monthly deposit (Taka) |Terminal value after 5 years (Taka) |Pension for next 5 years (Taka) | |500/- |40,000/- |870/- | |1,000/- |80,000/- |1,739/- | |2,000/- |1,60,000/- |3,478/- | |3,000/- |2,40,000/- |5,217/- | |4,000/- |3,20,000/- |6,956/- | |5,000/- |4,00,000/- |8,695/- | |6,000/- |4,80,000/- |10,434/- | |7,000/- |5,60,000/- |12,173/- | |8,000/- |6,40,000/- |13,912/- | |9,000/- |7,20,000/- |15,651/- | |10,000/- |8,00,000/- |17,390/- | |11,000/- |8,80,000/- |19,129/- | |12,000/- |9,60,000/- |20,868/- | |13,000/- |10,40,000/- |22,607/- | |14,000/- |11,20,000/- |24,346/- | |15,000/- |12,00,000/- |26,085/- | |16,000/- |12,80,000/- |27,824/- | |17,000/- 13,60,000/- |29,563/- | |18,000/- |14,40,000/- |31,302/- | |19,000/- |15,20,000/- |33,041/- | |20,000/- |16,00,000/- |34,780/- | |21,000/- |16,80,000/- |36,519/- | |2 2,000/- |17,60,000/- |38,258/- | |23,000/- |18,40,000/- |39,997/- | |24,000/- |19,20,000/- |41,736/- | |25,000/- |20,00,000/- |43,475/- |Short Term Deposit ? A short term deposit (STD) account is a running account with amounts being paid into and drawn out of the account continuously. ? These accounts are called Demand Deposits or Demand Liabilities since the banker is under obligation to pay the money in such deposits on demand. ? These accounts are generally opened by Business Organization, Public Institution, and Corporate Bodies. ? An STD account may be opened by an individual person. ? It is an interest bearing deposit. Interest is calculated on daily basis as per Banks Prescribed Rate and is credited to account on half yearly basis. Current interest rate on STD account  is 6 Percent.Education Savings Scheme The educational expenses particularly the expenses for higher education are sharply increasing day by day in our country. Sometimes, the children are deprived of getting the desired level of education because of the inability of the parents to meet their educational expenses. But the parents would not feel any difficulty to defray such expenses if a proper financial planning is made much ahead of time. Moreover, we are receiving demands from the Islamic minded people of our country for an attractive Savings Scheme on the basis of Islamic Sariah so as to encourage them to save in Islamic way for education of their children.With this end in view, Dhaka Bank Limited has introduced a Savings Scheme entitled â€Å"Education Savings Scheme† in accordance with the principles of Islamic Sariah i. e. , on the basis of profit and loss sharing. The scheme provides a unique opportunity to the parents to make a future provision for the educational expenses of their children when they enter into Schools, Colleges and Universities out of the benefit of a small amount of savings with the Bank at an opportune moment The salient features of the Scheme are give n below: ? The Scheme shall be implemented through all Dhaka branches, though it is specially designed for Islamic Banking branches. ? Deposit of Tk. 50,000/- and multiples thereof but maximum limit of Tk. , 00,000/- at a time will be acceptable under the Scheme. ? A specially designed Receipt shall be issued for the deposit under the Scheme in the same manner as issued in case of FDR. Branches shall use the ESS receipts that used for existing scheme. ? The instrument shall be issued for a period of 5 years term. ? On maturity a lump sum amount of Tk. 85,382/- shall be payable or education allowance @ Tk. 1,854/- per month per Tk. 50,000/- shall be payable on the basis of deposit amount for next 5 years starting from the completion of the term as per following table. Income Tax @10% on interest may be deducted at source at the time of payment of lump sum amount. Initial Deposit (Taka)    |Lump sum amount payable at maturity (Taka)    |Amount of Education allowance per month | | | |  (Taka) | |50,000/- |85,382/- |1,854/- | |1,00,000/- |1,70,763/- |3,705/- | |1,50,000/- |2,56,145/- |5,558/- | |2,00,000/- 3,41,526/- |7,410/- | |2,50,000/- |4,26,908/- |9,263/- | |3,00,000/- |4,69,704/- |11,115/- | |3,50,000/- |5,47,988/- |12,968/- | |4,00,000/- |6,26,272/- |14,820/- | |4,50,000/- |7,04,556/- |16,673/- | |5,00,000/- |7,82,840/- |18,525/- | Double Benefit Deposit Scheme ? The Scheme shall be implemented through all the branches of Dhaka Bank Limited. ? Deposit of Tk. 25,000/- (Taka twenty five thousand) and multiplies thereof but maximum limit of Tk. 25, 00,000/- (Taka twenty five lac) at a time will be acceptable under the scheme. ? The instrument shall be issued for 5 years 4 months term. ? At maturity after 5 years 4 months double the amount of deposit will be paid to the depositor. Photograph of Nominee, duly attested by the depositor, shall be obtained at the time of opening the account. ? Normally no withdrawal will be allowed before maturity. But if any depositor intends to withdraw his deposit before maturity, the following rules will apply: ? (a) No benefit including interest/profit shall be allowed for pre-mature encashment within one year. (b) If the accounts / deposits are closed / encashed after one year of its opening, benefit shall be allowed on the deposit at normal Savings Deposit rate ? The instrument will be acceptable as collateral security against any investment subject to registering lien with the issuing branch. In case of death of a depositor, the amount of instrument will be paid to the nominee, to the legal heirs of the depositor on production of succession certificate. ? In case of instrument is lost the procedure for the issuance of a duplicate receipt will be the same as applicable in case of loss of FDR. ? Under the scheme depositor can get free insurance facility. ? Insurance coverage is only applicable to personal accident and serious illness related insurance policy. ? Depositor can take loan against his/ her deposit under this scheme ? At present no income tax will be deducted from the interest earned. But in future for any change in the government policy Bank reserves the right to deduct income tax.Fixed Deposit Scheme This type of deposit should be kept for a fixed term or period. Dhaka Bank Limited deals with the following terms deposit. Particulars Interest Rate 1(One) month 9. 00% 3(Three) month 12. 00% 6(Six) month 11. 50% 1(One) year 11. 00% Lakhopati Deposit Scheme (a)Monthly Installment size, tenure and terminal value of the scheme will be as follows: Monthly Installment Size (Taka) |Tenure |Amount to be paid after maturity (Taka) | |250/- |15 years |1,00,000/- | |500/- |10 years |1,00,000/- | |1,285/- |5 years |1,00,000/- | |2,400/- |3 years |1,00,000/- | Dhaka Millionaire   Scheme Monthly installment shall be Tk. 12,465. 00 /Tk. 7,890. 00 /Tk. 4,570. 0 for the tenor of 5/7/10 years respectively |Size of monthly deposit   (in |Investment Tenor (in |After the investm ent Tenor the terminal |Pension size of installment | |Taka)   |Year) |value of the Scheme (in Taka) |according to the years Invested | | | | |(in Taka ) | |12,465/- |5 |1,000,000/- |21,748/- | |7,890/- |7 |1,000,000/- |17,137/- | |4,570/- |10 |1,000,000/- |13,786/- | House Building Deposit   Scheme # The tenor of the House Building Deposit Scheme will be 5/7/10 years. # Minimum Equity building amount shall be Tk. 10. 00 lac. |Size of monthly |Size of monthly deposit in|Investment Tenor (in|Age Limit |After the   investment Tenor | |deposit in Tk. |Tk. Year) |(in Year)* |the terminal value of the | |(without |(with Insurance) | | |Scheme | |Insurance) | | | |(in Taka)** | |7,890/- |8,045/- |7 |18 to 38 |1,000,000/- | |12,465/- |12,640/- |5 |18 to 40 |1,000,000/- | |9,135/- |N/A |10 |18 to 35 |2,000,000/- | |15,770/- |N/A |7 |18 to 38 |2,000,000/- | |24,925/- |N/A |5 |18 to 40 |2,000,000/- | * Age upper limit will be applicable for HBL facilities only # Insurance Coverage will be restricted to terminal amount of Tk. ,000,000/-(Taka Ten Lac) only, here the age limit will be from 18 years to 60 years # A person can open more than one account but House Building Loan facility shall be on one account only. # Account in the name of minors can be opened too under the Scheme but without insurance coverage. # The installment shall be payable by the 8th day (in case of holiday the next working day) of every month. Advance payment of any number of installments  is acceptable. 8. CAMEL Rating of 48 Banks: The capital adequacy, Asset quality, Management standard, Earning and Liquidity rating (CAMEL) of all commercial banks on the basis of credit management performance till December 2007 have been rated by Bangladesh Bank (BB). It is mentionable that Dhaka Bank Ltd. got the top position in â€Å"A† class banks. CAMEL Rating:Analyzing the overall operational activities of all commercial and specialized banks; central bank, the regulatory authority of countryâ €™s banking sector has ranked 6 ‘A-class’, 27 ‘B-class’, 8 ‘C-class’,5 ‘D-class’ and 2 ‘E-class’ banks by the end of 2007, which was completed recently. A- Class Banks: 1. Dhaka Bank Ltd. 2. Shahjalal Islami Bank Ltd. 3. Commercial Bank of Ceylon. 4. Citibank N. A. 5. State Bank of India 6. Standard chartered Bank B – Class Banks: 1. Eastern Bank Ltd. 2. Premier Bank Ltd. 3. The Trust Bank Ltd. 4. BRAC Bank Ltd. 5. Southeast Bank Ltd. 6. NCC Bank Ltd. 7. One Bank Ltd. 8. Standard Bank Ltd. 9. Woori Bank 10. Bank Alfalah Ltd. 11. National Bank of Pakistan. 12. Dutch Bangla Bank Ltd. 13. Exim Bank Ltd. 14. Mutual Trust Bank Ltd. 15. Jamuna Bank Ltd. 16. Bank Asia 17. Islami Bank Bangladesh Ltd. 18. Uttara Bank Ltd. 19.National Bank Ltd 20. The City Bank Ltd 21. Basic Bank Ltd. 22. Habib Bank Ltd. 23. HSBC 24. Pubali Bank Ltd. 25. Mercantile Bank Ltd. 26. Social Investment Bank Ltd. 27. Dhaka Bank. C- Class Ban ks: 1. First Security Bank Ltd. 2. UCBL 3. Al-Arafa Islami Bank 4. Bangladesh Shilpa Rin Sangstha 5. IFIC Bank Ltd. 6. AB Bank Ltd. 7. Agrani Bank Ltd. 8. Rupali Bank Ltd. D- Class Banks: 1. Sonali Bank Ltd. 2. Bangladesh Krishi Bank 3. Bangladesh Shilpa Bank 4. Janata Bank Ltd. 5. RAKUB E-Class Bank: 1. Bangladesh Commerce Bank Ltd. 2. Oriental Bank Ltd. 9. Recommendation After observing the operation procedure of DBL, I recommended the following: ATM:Dhaka Bank has few ATM booths in the Dhaka city, but these are not sufficient to give service to the customer’s . So Dhaka Bank has arranged an agreement with Dutch Bangla Bank limited so that the customers of the Dhaka Bank can use its booth. To give smooth service to the customers Dhaka Bank should increase its own ATM Booth. Branch: Dhaka Bank should open branches in the all district towns besides Dhaka & Chittagong city for expansion its business area. Interest Rate: Dhaka Bank should Increase interest rate on FDR and other deposit scheme. Islamic Banking Branch: Bangladesh is a Muslim majority country, so Dhaka Bank should increase their Islamic Banking Branch in Bangladesh. 10. ConclusionIn Halishahar branch I have been working for 3 months, by this time I have found some good strengths and opportunities, Dhaka Bank Halishahar Branch has a strong opportunity to achieve strong market in Halishahar area because it is situated in a appropriate and attractive place. In short time Halishahar Branch gathered 30 core deposits; this is a great achievement for Halishahar branch and also achieving healthy profit as a new branch. From my view, this branch has some Strength these are: ? Dhaka Bank has well reputation in the market. It is number one Private commercial Bank in Bangladesh. ? In Halishahar branch efficient management practice. ? Halishahar branch is Well-furnished and Air-conditioned Bank. Dhaka Bank’s Officers are highly educated. ? Dhaka Bank’s Executives are highly qualified and ex perienced. ? Credit Department of Halishahar branch is strong prospective department. ? Dhaka Bank gathered maximum market share in banking business. ? Dhaka Bank not engaged in unfair business practice. ? Dhaka Bank has many attractive deposit schemes. ? Dhaka Bank becomes more reliable to the all kind of people. References 1. Kenova, V. & Jonasson P. 2006. Quality Online Banking Service. Jonkoping university. 2. Pallent, Julie. 2007. SPSS Survival Manual: A Step by Step Guide to Data Analysis usingSPSS for Windows. England: McGraw. 3. Cooper, D. R. , & Schindler, P. S. (2003).Business research methods (9th Ed. ). Mc GrawHill. 4. Cooper and Schindler (2006) 5. Malhotra 2003 6. http://www. htm. uoguelph. ca, 7. â€Å"Marketing Professional Services† By Philip Kotler, Thomas Hayes, Paul Bloom. 8. Mr. Alan Lau, Head of Consumer Banking, Maybank Singapore 9. October 20011 Mr. Laksham Silva, CEO, DFCC Vardhana Bank (07/03/2012 ADRIANA REYNERI), (Tanbir Ahmed Chowdhury-2009). â₠¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€œ Deposit-slip depositing the cheque along with Crossing of the cheque are done indicating the Branch as collecting bank Entries are given in the Outward Clearing Register Endorsement â€Å"Payee’s A/C will be credited on realization† is given

Introduction to Sociology: The Concept of Deviance Essay

Understanding that society has unavoidably primary influences on what is deemed deviant or not significantly reduces the confusion that abound concerning the subject. This paper presents this assumption and emphasizes the pertinent works of several experts in the field. Ahmad and Rosenhan in their separate treatises try to put forth convincing proofs and arguments as to their respective positions. In essence, this paper explains the stand of Ahmad and the discoveries and conclusions drawn by the experiment performed by Rosenhan. Culture, creed or religious persuasions unavoidably are crucial to the behavior of people which may be the benchmarks with which people base their actions, decision making and choices (Navada, 2009). II. CHAPTER 2 SUMMARY AND ANALYSIS The following questions will help the reader and student to make objective judgments on several key issues regarding their outlook on issues. The idea is that deviance according to society’s dictates can and will make or break certain ways of living, probably leading even to the annihilation of a number of people as the perpetrators might perceive their victims. Ahmad appears brilliant as to how he pursued the arguments concerning the validity of the West’s allegations about who are terrorists. The gist of his article was that the problem with society is that it has no permanent definition of a concept in particular. In the issue of terrorism, when it happened that a group of people or a country deemed another one lesser influential in terms of politicking, then the more influential or powerful a person is, the more he or his group sets the tone of morality and ethics: what is moral and ethical hinge on the degree of greed and selfishness of individuals. Rosenhan shows that being insane cannot be actually determined by whatever instrument or tool, or by what is dictated as the â€Å"normal curve. † The kind of study he made was an in-depth one and brings reality check to the people seriously involved in mental illness and restoring health. There were many observations that indeed were valid including the fact that grave responsibility lies with the head of these hospitals or organizations whose modelling or example mean death or life, recovery or real insanity for the individual patient. 1. Ahmad’s Article The point of view of Ahmad (1998) succinctly described in his article Terrorism: Theirs and Ours` must be read with as much as the removal of colored â€Å"glasses† which may be a hindrance as to getting this author’s point of view. It means that filtering his ideas through one’s personal biases and perspective may not be a very good idea at all. Rather, a Jewish person with his own arguments should probably pretend first that he is at the side of the writer and later take on his identity and worldviews (Ahmad, 1998). What is the author’s point in writing the paper? Ahmad simply states that terrorism depends entirely on who’s benefited by the action especially in grand scale (Ahmad, 1998). In the case of Palestine and Israel, and on the world’s stage, terrorism cannot be ascribed as such for as long as the West such as the United States remains in such a lofty position as a superpower. Their might and clout spell dominion and their own definition of what terrorism. Contemporary milieu shows that since the Palestinian people are not on the American side according to Ahmad, then this particular group of people has no say; and whenever they take up arms, it is not termed as a nationalistic campaign. Rather, it is terrorism. Ahmad also meant that America and its relationship to influential nations can be considered farce and the display of concern as charade (Ahmad, 1998). How does the author prove his point? The use of logic and/or deductive reasoning was how the author Ahmad tried to persuade his audience (Ahmad, 1998). What evidence do they use to prove their point? Ahmad saw to it that archival evidence supports his arguments well. He utilized the news and editorial clips and other sources to put forth the allegations that during the times that Israel was not yet a State, Jewish uprisings were acceptably known as terrorism. Evidences from print communications then turned around which made Palestinian revolts as works of terrorists (Ahmad, 1998). What do their findings say about deviance and society in general? Ahmad’s arguments simply posited that deviance is dictated by politics and power (Navada, 2009; Ahmad, 1998). It is the fact that in any given society, the ideology that permeates is one that is held by those in positions of authority, wealth and power. In the case of the existence of the Jewish State or that of the Palestinian identity, he argues that in their respective â€Å"reigns† these two races the emergence of the term terrorism is defined by the point of view of each. When the Palestinians were occupying the place, Jewish reformers or the Jewish desire for a country represented a threat and was described as terrorism; their leaders, called terrorists. Deviance, normality, or abnormality are terms inherently critical to society as the definition of the terms rests on the people governing a particularly society or institution. It is probably correct to think and draw conclusions that Mr. Ahmad is right concerning this point of view (Ahmad, 1998). However, it is entirely another thing when terror continues to be wrought in various places of the world by the vast network established by people of similar persuasions. It would be entirely simplistic to think along strictly along the line of thought that Mr. Ahmad was thinking (Ahmad, 1998). The world of humans is oftentimes unpredictable, changing and wondrously exciting. However, when these attributes become extremely bizarre and painfully detrimental, humans become sick and worried about to what extent can other humans afford to inflict harm against them. Suicide bombing is, if not the most, one of the most gruesome acts anybody can commit. It is outright crazy and stupid. One must be beside the normal to be entertaining such a thought in mind. Ironically, fanatics who have committed and attempted suicide bombings in the past, were deemed normal until the day when the execution of their ultimate plans were made public whether foiled or completed. People who are afflicted with mental disorder may, as other people, travel for the same reasons – vacation, visiting friends or relatives, business, recreation, and sometimes for religious or spiritual focus (Miller & Zarcone, 1968). Others indeed may travel for reasons other than the normal – for reasons triggered by malformed mental state such as the men who carried out the 911 attack of the Twin Towers in New York. Along the 911 attack, suicide bombing through aircraft came to prominence resulting in the stirring of the awareness among the international public of the fact that the regular traveller might not be that â€Å"regular† anyway. It is probable that some of them are driven by excessive anger or motivated by utopic hope as taught in the communities wherein they have pledged their life allegiance (Silke, 2003). 2. Rosenhan research What is the author’s point in writing the paper? Rosenhan’s breakthrough (1973) in mental institutions was a very interesting and inexplicably raw to the minds of figures or people who are in helping profession (Rosenhan, 1973). It is critical and contributes a sensitive fibre to a huge institution that caters to mental illness. There may be loopholes as to how the experiment was carried out including ethical issues to human participation but the results and the procedures were â€Å"loudspeakers† and are considered significant to the idea of labelling and the diagnosis of the mental illness (Rosenhan, 1973). How does the author prove his point? Rosenhan proved his point by direct and firsthand experiences of people who were participants in the study (Rosenhan, 1973). What evidence do they use to prove their point? With the thorough handling of data derived from these individual participant’s observations, he made generalizations and conclusions as to the state or condition of the Mental Institutions, the capabilities and efficiency of Mental Health Professionals were in question. His findings which were consistent to a large extent with many of his volunteers’ observations push the issue of proper diagnosis and labelling, use of diagnostic criteria, the abilities and qualifications and work ethics of people practicing in the mental health field to the fore and pose as challenge to the kind of profession being handled here (Rosenhan, 1973). What do their findings say about deviance and society in general? Specific items observed especially important to making generalizations in the discipline include the length of time that nurses, attendants and most importantly, the psychiatrists and psychologists spend with patients. By empirical evidence criterion alone, the practice drastically falls short on this aspect. In the area of diagnosis and subsequent intervention measures, the initial assessments, description aspect play a major role hence can never be relegated to a minor place in the practice. Mental illness then or deviance for that matter hinges on many issues brought out in the experiment (Rosenhan, 1973; Navada, 2009). III. REFERENCE PAGE Ahmad, Eqbal (1998). `Terrorism:Theirs and Ours. ` Accessed June 13, 2009 online at http://www. sangam. org/ANALYSIS/Ahmad. htm Gordon, Harvey, Mike Kingham, Tony Goodwin (2004).. Air travel by passengers with mental disorder. Psychiatric Bulletin 28:295-297. The Royal College of Psychiatrists. Jourad, Sydney (1963). Personal Adjustment. 2nd Ed. New York: MacMillan Company. Navada, Marianne Ryan-Go (2009). Principles of Sociology; Chapter 8, pp. 1-4. Accessed June 13, 2009 online at http://book. gonavada. com/html/Chapter8. html Rosenhan, David (1973). `On Being Sane in Insane Places. ` Accessed June 13, 2009 online at http://www. walnet. org/llf/ROSENHAN-BEINGSANE. PDF Silke, A. (2003). The psychology of suicide terrorism. In Terrorists, Victims and Society (ed. A. Silke), pp. 93 -108. Chichester: Wiley. Tiffin, Joseph and Ernest McCormick J. (1958). Industrial psychology. Englewood Cliffs, New Jersey: Prentice Hall, Inc.

Cbt Case Study

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

A topic from one of the four articles Annotated Bibliography

A topic from one of the four articles - Annotated Bibliography Example Anna Lappà © looks into the past of corporate renaming operations to realize the clear use of approaches that confound the community and immunize the industries at the start of legal attacks. Within the article, Anna Lappà © refers to Philip Morris, a legal activist who was not simply exhausted with the old title of the corn syrup processing company the moment it spent millions of dollars attempting to retrofit its stand. Even though the company has been constantly associated with unselfishness, the company ought to process such foods under amplifying pressure from its rivals. Habitual products have been compared with the operations of the organization. Anna Lappà © uses tobacco to show the extent at which civic heath lawyers can go to tarnish the names of the companies. Another basis of the writer’s argument is behind the cause for the trade alliance pooling millions worth of funds into its messaging with the support of legal health publicists. Through the public advocates , Anna Lappà © has managed to make the society question the fast foods addiction rate (Lappà ©, 2010). The summer of 2002 saw the fling of three lawsuits against the QSR (Quick Service Restaurants), asserting that a variety of criteria of petitioners had suffered injuries caused by consuming â€Å"fast foods† (Davis, Driscoll and Schwartz 121). Plaintiff’s advocate and the concealed consumer counsel holding him up, and stated publicly that the lawsuits emerged from numerous similar tobacco proceedings strategies from the tobacco industry’s plaintiff. These lawsuits reflected suing strategies that were previously used by other counsels against cigarette manufacturing corporations. The tobacco plaintiff’s bar has consistently attempted using such strategies to their advantage. Such a situation would be very difficult to come around. Advocate counsels trying to provide