Tuesday, December 18, 2018

Keeping the Happy in Happy Holidays

Whatever holidays you celebrate this season, I hope they are happy. For many people, this is the best time of the year. Parties, gifts, decorating, baking, festivities and seeing friends and family bring considerable joy and delight. However, for those struggling with mental illness, loss or family dysfunction, December can be stressful and depressing. If you’re grieving and this is your first holiday without your loved one, things that have brought joy in the past may trigger sadness and tears. If you’ve had a big life change such as a divorce or all the children have left home and they won’t be with you for the holidays, the empty nest can hit very hard especially when it seems like everyone else is focusing on their kids or grandkids.

If you just haven’t been feeling in the holiday spirit this year, be easy on yourself. In my psychotherapy practice lately, I’ve been seeing significantly higher levels of stress, anxiety and depression than in previous years. So unfortunately, you may in much better company than you probably expect. You don’t have to go all out celebrating; in fact, you don’t really have to do anything about the holidays at all. The week between Christmas and New Years can be a time of self-care and peace if that’s what works for you. Keep it simple, positive and calm. You don’t have to attend a single party, buy elaborate gifts, bake or send Christmas cards. Think about what is meaningful to you and do as much of that as possible. For many of us here in the Vail valley, the start of ski season is a highly anticipated time of adventure and fun. Don’t let holiday obligations keep you off the hill or out of the snow. 

Be careful about spending, overeating and too much alcohol. Hopefully you didn’t go beyond your budget when buying gifts. Research shows that in the long run, we remember and value positive activities and quality time with loved ones more than material objects. Stick to your fitness schedule and a healthy diet. Be sure to get enough sleep. People really underestimate how important quality sleep is in managing stress and keeping your mood bright. 

Social media can be a source of pleasure and amusement or it can be a real downer. Remember most people only post the good stuff that’s happening in their lives. Don’t overgeneralize and conclude that everyone but you has a great life and is having perfect holidays. It’s fun to share your best, most joyful or entertaining moments on your social media feed so don’t hesitate to do so. Using social media to feel closer and more connected to the people you care about can be a cherished source of happiness, validation and emotional support.

If you are introverted and find socializing exhausting, be attentive to your self-care needs. Consider attending only those events that are most meaningful or comfortable for you. It’s fine to leave a holiday celebration after only an hour instead of staying for an entire evening. If you have guests staying with you or you are staying in someone else’s home, make sure you carve out some quiet time for yourself without apology. Excuse yourself to lie down or take a walk. Offer to help in the kitchen so you have something to do if you find small talk difficult. It’s perfectly fine to decline events that are too loud or overwhelming for you. Instead, schedule small get-togethers that help you feel comfortable and relaxed instead of stressed and pressured. 

Many people feel alone and isolated this time of year. For members of our community who’ve moved here from other places, this can be an especially lonely time. If you have to work long hours during the holiday season, you may feel stressed, grouchy and disgruntled. If you work or live near someone who has no local family, the greatest gift you can give them may be to invite them to share in your own festivities. If they decline to attend, drop off some treats from your holiday table. Be flexible about when guests can arrive or leave to accommodate the schedules of those who have to work on Christmas or New Years. 

Practicing tolerance, acceptance, kindness and generosity of spirit are some of the greatest gifts we have to give, and they don’t cost a thing. Remember the reason for the season. Hint, it’s not about glamour, extravagance and exhaustion. Do what makes you feel relaxed, connected, and joyful and brings meaning to your life. That will be your best recipe for happy holidays. 

Friday, September 28, 2018

Dealing with Brett Kavanaugh's Supreme Court confirmation hearing if you've been a victim of sexual trauma

This past week’s Supreme Court Confirmation hearings and Dr. Christine Blasey Ford’s testimony are affecting just about everyone who’s paying attention. However, survivors of sexual abuse, assault or harassment are likely to be affected in a way that those who’ve never been through it may have a hard time comprehending. While the actual statistics about sexual victimization vary, there seems to be a consensus that at least 1 in 4 women have been affected. This means that all of us are regularly interacting with women who may be profoundly distressed by what’s happening. While some survivors may feel validated and empowered because people are finally talking about this, others are feeling triggered and overwhelmed. As they see news coverage and social media posts confirming their worst fears about shaming and disbelief, their trauma symptoms escalate.

If you or someone you care about is struggling, encourage them to seek help. Feeling isolated and alienated only makes things worse. Psychotherapy, support groups or online forums can provide a sense of community and teach valuable coping skills. Recovery from trauma is possible and no one should feel like they need to suffer alone in silence. Setting boundaries on news exposure is critically important. Avoid the news if it’s highly disturbing to you. Reading articles or short summaries may be easier to handle than watching live coverage or video updates. Take care with your social media exposure. You may want to pare down your friends list. If someone on your feed is sharing posts that are upsetting, consider clicking the unfriend button. Alternatively, you can block their posts without actually blocking them. Establish a rule on your own feed that negative or incendiary comments will be deleted as soon as you see them. It’s your page and realizing you have control over what populates it can be powerful. 

If you are struggling, be compassionate towards yourself. Feeling badly about bad things that have happened to you is actually reasonable and healthy. It’s not a sign of weakness. Feeling triggered means that you are hijacked by a flood of fear and panic, intense negative emotions and a loss of the sense of your current time and place. While you may not experience a full-on flashback, the sense of feeling overwhelmed and out-of-control can be hard to manage. If this happens to you, bring yourself back to the present moment. Take deep breaths, focus on something in the physical world, feel your feet against the floor or the wind in your hair, observe the leaves on the trees or play with your pet. Hop on your bike or go for a hike. Listen to uplifting or inspiring music. Use as many of your senses as you can to ground yourself. Deep breaths and a mindful focus on the world outside your head can stop the cascade of fear and panic and help you reset. Your goal is to remind yourself that you are not stuck in the past and that you are safe. Reach out to compassionate friends and family. Don’t turn to alcohol and drugs to manage your reactions. While they may seem like a good short-term fix, they make things worse in the long run.

Reading #metoo posts can create internal pressure to disclose your abuse or harassment history. While there is comfort and strength in community, don’t feel compelled to share your story if doing so makes you uncomfortable. It’s OK to let other’s take the lead if you’re not ready to participate. On the other hand, hearing other’s #metoo stories or experiencing outrage about what you’re seeing onscreen can be a galvanizing force that motivates you to disclose your story. Do whatever feels right to you and be OK with it. Whatever you choose, don’t let guilt and shame define you. You are so much more than your worst experiences.

Whether you have been a victim of sexual harassment or assault, or love someone who has been victimized, take this opportunity to think long and hard about what we want from our relationships, our country and our leaders. Any positive or constructive effort you make is a step in the right direction.  Don’t sit back waiting for someone else to be the change you want to see in the world. And if you only do one thing, remember that your vote counts, so get out and cast your ballot on election day. 

Tuesday, November 8, 2016

Recovering From Post-Election Traumatic Stress Disorder

As the divisive 2016 presidential election finally draws to a close, let’s all agree to breathe a collective sigh of relief as we bid farewell to the most hostile and vicious campaigning many of us have ever had the displeasure to experience. The constant negativity associated with this election cycle has permeated our homes, workplaces, neighborhoods and communities. It’s damaged marriages, families and friendships. I’ve witnessed its toxic effects on the clients I see in my practice. I’ve been deeply dismayed by the frustration, worry, outrage and hopelessness expressed by so many of the people I’ve come in contact with recently, both personally and professionally.

There are many reasons why the 2016 presidential contest will go down in history as the most stressful election of our lives to date. Aside from the pre-existing deep divide in the views of liberal and conservative Americans, the 24-hour news cycle, endless exposure to intrusive and disturbing commercials and constant derisive commentary on Facebook and other social media have kept most people stirred up to a fever pitch with little respite.

As both a psychologist and member of my community, I am gravely concerned about the adverse impact this election has had on people’s emotional well-being and relationships. The negative fall-out from conflicting political beliefs has caused serious distress within couples and families and threatened friendships, collegiality in the workplace and community cohesiveness. Campaign messages have highlighted threats and security issues, mistrust, economic decline, gender, racial and class divides, and narcissism and nastiness in people we are supposed to look up to as our leaders. Many voters have experienced intense feelings of anger, fear and discouragement compounded by the bitter arguments that have ensued among people who usually care about and respect one another.

So, how do we recover from Post-Election Traumatic Stress Disorder? First and foremost, avoid thinking the worst and expecting imminent catastrophe. The peaceful transition of power, which happens after every election, assures a comforting degree of stability. The constitution and three branches of government limit political power, so regardless of campaign promises, the wheels of government move ponderously, as every newly minted president with lofty predictions for the first 100 days has discovered the hard way. And if you don’t like who won, you can take some comfort in term limits. Whether your candidate was the winner or loser, it is a privilege to participate in a process that people have fought, sacrificed and died for. I hope you exercised your right to vote and that you wore your “I Voted” sticker with pride after you did so. If you are unhappy with the outcome of the presidential election, focus instead on state and local results and initiatives that went your way. Your vote DID matter. Limit your media consumption if watching or reading about politics and the election is disturbing to you. Exercise your power to change channels or push the “off button.” Refuse to participate in contentious political exchanges with friends, family, coworkers and neighbors, especially as the holidays approach. You can always step away, change the subject or simply state that it’s not something you want to talk about right now. Remember that nobody ever changed anyone else’s mind with a Facebook post so declare your wall a politics-free zone. Share good news, happy photos and cat videos to bring smiles to the faces of everyone who reads your posts. If someone puts something rancorous on your Facebook page, simply delete it. It’s your wall after all!

Political beliefs and voting choices are only a part of who we are. Now that the election is over, reconnect with those you care about who have disparate beliefs and voting habits by focusing on your similarities and shared joys instead of your differences. And remember, variety is the spice of life! Being married to or best friends with your clone would be awfully dull. Relax, be playful and enjoy activities that have absolutely nothing to do with politics. Watch a good movie or non-political comedy show so you can laugh together. Life goes on, and there is so much to celebrate, appreciate and look forward to, regardless of the outcome of this election.

Sunday, October 4, 2015

Psychotherapy Practice Finance: Credit Card Worries?

October 1 2015 was an auspicious day for mental health professionals in private practice for two important reasons. As health care providers, we had to switch to ICD-10 for our diagnostic coding. And as small business owners, we got worried about whether we needed to change the way we processed our credit card payments. 

So what was so special about October 1, 2015 in the world of credit card processing?  That’s the day liability for transactions resulting from fraudulent EMV chip credit cards shifted from the bank issuing the credit card to the business owner running the transaction. In terms relevant to our profession, if a client payment using a fraudulent EMV chip card goes through AND we don’t have an EMV Chip Reader terminal to run the sale, the bank will charge back the cost of the service and we will be stuck unpaid. The good news is, no additional penalties or fees are incurred beyond the charge back. It’s also good to know that nothing has changed for transactions using cards without the EMV chip. So, if your usual method of processing credit cards is using a magnetic swiper (either a free standing terminal or one attached to your computer or smartphone), hand entry from a client’s form authorizing repeated automatic card payments, or client entry using a payment portal web site AND the client uses a fraudulent magnetic strip card, the bank will still be the liable party. The bank also still incurs the liability if we run the card in a way that wouldn’t customarily use an EMV Chip Reader, such a remote entry when the customer and card are not physically present while the transaction is being run.

So what’s the big deal and why all the fuss? Well, apparently just under half of all the world’s credit card fraud occurs here in the USA, even though only one quarter of all credit card transactions occur within our borders. A key reason for these disheartening statistics is that America’s love affair with cheap and easy to use magnetic strip credit cards has lingered way past its prime. Magnetic strip cards are simply too easy to counterfeit. EMV (which stands for Eurocard/Mastercard/Visa) technology has been in use in other parts of the world for years. The inclusion of an electronic chip embedded within the credit card makes it significantly more difficult to create usable counterfeit cards. It is currently estimated that here in the US, only one third of all transactions are processed using chip enabled cards, but that number is expected to rise rapidly. All chip-enabled cards will still have a magnetic strip and will work in magnetic strip readers, but the liability for fraudulent transactions processed in this way has shifted from the bank to the merchant. For the time being, there are no plans to charge merchants differential rates for running EMV chip-enabled cards vs. magnetic strip only cards.

Switching to a new card reader that will do magnetic strip cards, EMV cards and NFC (Near Field Communication) devices such as Apple Pay will eventually be a worthy endeavor and is likely to incur only minimal costs and inconvenience. Given (1) the volume of business we private practitioners generally do, (2) the fact that we hand-enter many transactions based on credit card information we keep on file, and (3) the ongoing professional relationship we have with most of our clients, our actual risk of getting stuck because someone paid us with a fraudulent chip card AND we didn’t have a chip reader is, in fact, pretty low.

I use Transfirst for running my credit card sales and when I called to ask, they freely advised me that they consider my current risk extremely low. Their advice was to plan to get a chip reader at some point but not to worry about it for now. They don’t currently have a chip or NFC based system to use with the iPhone/iPad but they anticipate having something on offer in the near future. I haven’t yet done any diligent research on the new “Chip and Dip and NFC” card reader systems but it seems like options are still pretty limited. I did review Squares’ site and if you use a Square reader plugged into your phone or an iPad to process your credit cards, you can purchase one from them $49. Free-standing machines seem to be running in the $200-$300 range. Remember, if you purchase a free-standing machine, you need to check with your credit card processor first to make sure it will work with their system. I couldn’t find any good peripherals currently available that connect directly to a computer via USB cable. It seems like you will need to hold tight for the time being if you routinely run your transactions through a swiper peripheral connected via USB cable to the computer running your practice management system, as I currently do. Again, check with your credit card processor before buying anything to make sure it will work with their system.

I am all in favor of easy to use, inexpensive systems that reduce fraud. Whether we eat the cost or the bank eats the cost, it is still theft and it is wrong. Updating our equipment as more affordable user-friendly options come available is something we can do to help curb the use of fraudulent cards here in the US. When I have some good affordable options to choose from, I will definitely get an EMV/NFC card reading system. For now, I will stick with what I’ve got, and cross this off my “Things to Worry about List.”

Tuesday, September 8, 2015

Preventing Suicide in Eagle County

Living in a place as magnificent as the Vail Valley brings many wonderful things to our lives, however, it does not protect us from the tragedy of suicide. On December 25th 2014, Scotty Lamothe, the brother of local realtor and SpeakUp ReachOut Board Member Corey Lamothe, committed suicide after a 14-year struggle with depression, addiction and suicidal thoughts. On September 12th we will remember Scotty and many others who have been lost to suicide at the SpeakUp ReachOut Community Walk and Heartbeat Memorial Balloon Launch in Eagle and the First Annual Scotty Lamothe Memorial Golf Tournament in Vail. 

According to the most recent statistics available, Colorado ranks seventh in the nation for completed suicides and Eagle County has one of the highest rates of suicide in the state of Colorado. While we don’t have the data to explain exactly why these elevated rates of self-harm occur here, we do know that the group at highest risk for suicide is white men between the ages of 25 and 54, a demographic well represented here in our mountain community. Other risk factors include unemployment, which can be a significant problem in our area where good jobs can be hard to find and are often seasonal, relationship loss, financial problems, depression or other mental illnesses, substance abuse, owning a gun, aggressive or impulsive tendencies, lack of access to mental health resources and perceived stigma about talking about suicide or reaching out for help.  While many people, establish permanent homes in the Vail Valley and become involved and connected members of our community, others may be at risk due to the isolation and lack of social support that can come from second home ownership, transience, and being distant from family and lifelong friends.

SpeakUp ReachOut was founded in 2009 to provide suicide prevention education and resources for Eagle County. We meet at the Avon Municipal building on the third Thursday of every month at 4pm. If you’re interested in getting involved, you are welcome to join us. Find out more by checking out our website, www.speakupreachout.org.

It is unsettling to realize that most suicidal individuals do not actually want to die. They just want to end their pain and they feel they have run out of options. The good news is that suicidal crises tend to be short-lived and that suicidal intent or risk can be detected early and lives can be saved. When suicidal people survive an attempt, they are usually relieved and grateful for their rescue. Services available in our community for the assessment and treatment of suicidal behaviors and their underlying causes include private practice psychologists, psychiatrists, social workers, and psychotherapists, as well as school counselors and clinics. Mental heath services are covered by health insurance and some practitioners and clinics provide sliding scale fees based on ability to pay. If you would like help but aren’t sure where to begin, talking to your physician is a good first stop. If you or someone you care about is in immediate danger, call 911, the National Suicide Prevention Hotline, 1-800-273-TALK or Colorado Crisis Services at 1-844-493-TALK.

Sadly, talking about suicide still carries a stigma. People used to avoid talking about other serious health problems, like cancer, and this veil of secrecy only compounded the suffering of affected individuals and their families. Open dialog leads to solutions, support and constructive conversations. It’s time for open dialog about this serious, preventable, public health crisis. Talking about suicide will not encourage people to consider suicide. Instead, it can save their lives.

This week is National Suicide Prevention Week. This year’s theme is “Preventing Suicide: Reaching Out and Saving Lives.” Please join your friends, colleagues, neighbors and SpeakUp ReachOut in drawing attention to suicide prevention and reducing the number of lives shaken by needless, tragic and preventable deaths. You can make a difference. Come walk with us on September 12 as we remember, reflect and revitalize hope. You can register online or just come by the Dusty Boot at 8:30 am to register onsite.

If you or someone you care about is in immediate danger, call 911, the National Suicide Prevention Hotline, 1-800-273-TALK

Jill Squyres, PhD is a clinical psychologist in private practice in Eagle. She is also on the Board of SpeakUp ReachOut. She can be reached at 970-306-6986 or drjsquyres@mac.com

Tuesday, May 19, 2015

Why can’t we be friends? | Dr. Jill Squyres | TEDxVail

I'm Blogging For Mental Health 2015: Want To Know Who Your Friends Really Are? Design Your Dream "Friendship House"

How do you know if someone is your friend? For that matter, how do you know when someone who you think is your friend really isn’t? How do you decide when an acquaintance has become a friend? When is someone who was once your friend officially a friend no longer? How can you keep frenemies out of your life? As a psychotherapist, I’ve explored these questions with many clients. I’ve considered them from a personal perspective as well. In January, I gave a talk called "Why Can't We Be Friends" at TEDxVail discussing some of my thoughts on friendship: 

In my talk, I explain how I developed the idea that each of us needs to design a “Friendship House” to help us answer important questions about friendship.  The friendship house is a practical metaphor for defining and understanding what you want and need from your friends.

Whenever you build a house you have to start off with a solid foundation or the structure will not stand. The foundation of your friendship house will be constructed of those qualities that you decide MUST be present for someone to be your friend. For example, the building blocks that make up the foundation of my personal friendship house include common interests, integrity, respect, kindness, trust, being there when I need them, reciprocity, and emotional stability.

Once the foundation is set, it’s time to think about what you want from your friends, but don’t necessarily need from every friend. Do you want a good listener? A cheerleader? Emotional support? Soup when you’re sick? Someone to share a meal or go to the movies with? People to chat with in the evening or provide practical advice when you need it? Someone to help you move your furniture? Someone to discuss books with? Someone who knows your history? Someone who encourages you? A pragmatist who can get your head out of the clouds when you need it? A travel buddy? A nightly gaming companion?

Your friendship house should be designed with multiple rooms because different friends who meet different needs will find their place in different rooms. When you meet new people and get to know them well enough to grow from acquaintances to friends, you can welcome them in to your house because you can be confident the foundation will support them. New friends may stay in the entry hall while you get to know them better and figure out which room they belong in or even if they will be allowed further into the house. 

My personal friendship house currently has a kitchen, hall, living room, family room, office, library, computer room and game room. Friends who are also members of my family find their place in the family room. Those I like to hang out and watch movies with belong in the living room. Since I’m a compulsive reader, the library is a particularly special place in my friendship house. It’s not where I keep my books, it’s where I keep my literary friends who support me in my writing and love to read and discuss books with me. My online friends, who I deeply cherish, find their home in my computer room. My game room is filled with the people I like to play and have fun with. From childhood, my kitchen has always been the heart of my home and my kitchen table has always been my favorite place to settle in for great conversation. So, the friends I feel closest to gather around the table in my kitchen. My friendship house has a home office. The professional contacts I consider to be friends may not belong around my kitchen table, but they do have a place in my friendship house, in the office.

There is a gate to enter the yard and a porch. Acquaintances start out in the yard. If they seem nice enough, they progress to the porch. When I get to know them better, they may be invited in through the front door. Or I am likely to learn that some of these people are not right for me because they don’t value the things that are important to me, in which case they will be escorted back out the gate. My roof is strong and sturdy to keep acid words or bombshells from finding their way in to my house. I’ve built stout walls with big windows, that allow me to see what’s going on outside but don’t allow just anyone to mosey on in. The roof, walls, doors and windows represent the healthy boundaries that are fundamental to all good relationships.

What is not in my friendship house is as important as what is in it. There is no toxic waste. There are no black holes. There are no snakes, back-stabbers, vampires, psychopaths or queen bees allowed in my house.  Someone new may get as far as the porch and show me they don’t value honesty, trust and reciprocity; in which case, they will be escorted out.

I know someone who’s already ensconced in my house needs to leave when they no longer fulfill the minimum expectations that serve as my house’s foundation. I may also come to realize that we’ve changed so much there are no longer any rooms they fit into. It’s definitely time to clean house when the only place it feels like someone belongs is in the toxic waste dump or one of the black holes that are outside my protective walls and fence.

Like my physical house, my friendship house has grown over time to reflect my ever-changing needs, values and tastes. The design was much simpler when I was younger. The foundation was not yet strong because I didn’t yet know how to build it properly. There weren’t many rooms because my life was less complicated and my needs weren’t as clear. The front door was too flimsy which made me vulnerable to letting the wrong people in. There was no garden gate and no porch. There were some rooms in my friendship house that may not have belonged there. My friendship house remains a work in progress. So long as I am alive, I will be remodeling, changing, adding more of what I cherish and clearing out the clutter that drags me down and doesn’t belong in my life.

If I feel lonely I can take a look at my friendship house and see all the ways I can feel connected again. I can also think about which rooms need more people in them or whether I might need to do a little renovation or even build an addition. Or maybe it’s time for spring-cleaning because I’m not happy with some of the people in my friendship house and I realize that my needs are no longer being met in these relationships.

So what about your friendship house? What do you need to build a strong foundation? What rooms belong in your floor plan? Be sure to construct good boundaries in the form of solid doors, stout walls and a sturdy roof. Remember to keep your house clear of clutter and to regularly take out the trash. Make sure there are no toxic people in your house poisoning the air you breath and draining your life away. Fill all of your rooms with people who make your heart sing and make your life better because they are a part of it. Building and maintaining your dream “friendship” house brings you one giant step closer to enjoying a happy life rich with healthy, fulfilling and supportive relationships.