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,

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

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.

Sunday, December 14, 2014

How Do You Define Friendship? Results From My Friendship Survey

Friendship is kind of like love. You know it when you see it but trying to come up with a clear and universal definition can make your head ache. As a psychotherapist, I hear people talk about relationships all the time, but I found myself wanting a broader understanding of people’s views on friendship. So, I put together an online survey about it. It’s clearly a topic near and dear to our hearts because over 600 people responded. I asked a lot of different questions about friendship and got hundreds of detailed responses. People shared their most interesting and poignant perspectives when I asked them to write about how they defined friendship.

photo courtesy of Robin Smirnov

Some noteworthy comments about how hard it is to pin down a good definition include:

'Friendship' is a weird, nebulous concept. I wish I had some good theory of friendship, but I mostly just know it when I see it.

I don't have a great definition, but I know it's critical to my life.
Friendship comes in so many forms today it is difficult to define.

Trust and authenticity came up over and over:

Friendship is having someone you like, respect, and trust who likes, respects, and trusts you.

Friends are the people you trust enough to be yourself with
Friends should be trustworthy, honest and supportive.
A friend should be authentic, available, committed to my spiritual, mental and emotional growth.
A friend is someone who trusts me, and is trustworthy.
The level of trust changes and the conversations become deeper, a great need to keep in contact. Levels of intimacy in sharing, confiding, being there.

Connection and acceptance were considered crucial for close friendships:

Friends accept and acknowledge each other's differences as a part of who they are, and only try to change them if they actually want to change.
Friendship is about accepting, I think. It's about sharing some value or interest or goal and seeing that shared piece and treasuring it.
I define friendship as enduring and non-judgmental but I'll tell you the truth, it’s about connection.
Friendship is a bond between two people that fosters intimacy and connectedness.
I know I have a friend when I can be myself 100%.
Those that accept and embrace weird personality quirks and don't shame each other for them.
I would hope that unconditional affection and love, caring and compassion are all part of it.

Comfort and joy in each other’s company, doing things together, and having shared interests were also highly endorsed:

Friendship is someone you do things with like going to dinner, lunch, or shopping in your free time. I find it easier to maintain a friendship with someone who lives close by, has the same relationship status, has children similar in ages to yours, and has similar interests.
You should be able to relax around a friend and they should make you feel positive about yourself.
My friends share my interests, values and goals. They are responsive, respectful, and keep their judgments to themselves.
Friendship is when two or more people mutually enjoy the presence of one another. It is something that happens naturally. You cannot force it. Traits that I prefer include being a good listener, great with advice, emotional support, as well as being able to open up to me in return. I know I have a friend when I can be myself 100%.
Loyalty, honesty, sense of humour, ability to listen as well as converse, warmth, ability to give feedback in a kind manner.
Feeling comfortable and enjoying another's company. Trust, honesty and integrity. When you feel truly comfortable spending time together.
A friend is someone who is non-judgmental towards me, shares some interests, is interested in me as a person and someone I enjoy spending time with.
Friendship is enjoying the other person's company, bonding with each other and being there emotionally.

Loving and having affection for one another was also a common component:

I would hope that unconditional affection and love, caring and compassion are all part of it.
What I look for in a friend is someone who likes me, of course. Someone that's easy to talk to and who I can get along with really well.
The comfort, enjoyment and ease of being in anothers' company. Joyful anticipation of meeting/talking, taking a genuine and heartfelt interest in the other person.
A friend cares.
A friend is someone that you go out of your way to make time for, do things for, and care for. It is born out of love and care, generally through time/experiences/circumstances. It is work to be a good friend, and the rewards are similar to completing any difficult project/goal.
Friendship is having someone you like, respect, and trust who likes, respects, and trusts you. Trust, love, kindness, patience, sharing, related interests, support.
Trust, love, kindness, patience, sharing, related interests, support.
In our friendship, we have each other's backs, trust each other and love each other.
We are friends if we love each other. We are best friends when I love them more than myself, and vice versa.

Knowing each other well, being able to count on one another and supporting each other during the hard times were frequently cited:.

Friends support each other in hard times and celebrate together in good times.
Friendship is the ability to count on someone for both practical and emotional needs.
Friends hold you up when you can't hold yourself up. They have your back at all times but also hold you accountable. They're loving, compassionate, firm, and constant
Remembering what/who is important for them.
Friendship is being available to someone when they need you no matter how long it has been since you have seen or spoken to them.
Once you feel like you can call someone if you need help without feeling as though you are a burden, that's when someone becomes a friend.
Friendship is helping each other out, just because you want to. It's taking an interest in another's life.
A friend is someone who can be counted on to be there when the chips are down.
Friends are close. They know me. They understand.

People also made some interesting points about those who seemed like friends but weren’t. The popular term for this type of person is a frenemy. It’s clear from some of the responses that frenemies have caused considerable pain to those who thought they were really their friends.

I've had friends where we constantly bump heads and it's almost as if the friendship was a competition and I don't think that's healthy.

Someone I thought was my very best friend told me after my divorce that my depression made her depressed and she didn't want to be around me.
People have become selfish and have misplaced values.
It is hard to see that long-term friendships can still end. I thought that after age 50, our friendships were cemented for life, but was recently dropped by two women I thought of as good friends.
Compassion, empathy, open-mindedness are important but often lacking in society.
By my own definition, trust is the key variable in friendship, so I'm not certain anyone I don't trust can possibly be a friend. I'm a bit sad to reach that conclusion, especially since my own struggles to trust those around me may prevent close relationships.
A friend is someone you can share secrets with and know you won't be judged by labels, but just by your character. A friend is someone who is there for you through successes and failures but doesn't use it as gossip material.
Because of social media, friends of friends are more able to cause trouble with other friends, causing an uprising in cynical activities.
Some of the characteristics of a true friend include trustworthy, kind, considerate, caring, not controlling, secure personality, available, patient, encouraging, rejoices in your success- not jealous.

I want to express my most sincere gratitude to those who shared their opinions and stories about friendship with me. Check back for future blogs where I will be exploring the topic of friendship further and sharing more results from my survey.

Here is the link if you would like to respond to my friendship survey: