App Review: Clear Fear

From the makers of Calm Harm comes yet another fantastic app! Clear Fear was created to help users manage anxiety and understand their thoughts and feelings.

Clear Fear home screen

The app teaches you, “The fear or threat of anxiety is like a strong gust of wind, it drags you in and makes you want to fight it or run away. Instead, face your fear, reduce the threat, and glide…”

When you set up your account, the app cues you to create a “safety net” to remind you skills to use and people to reach out to when you are having a hard time. I love this feature because it can be so difficult to remember in the moment what might help you.

Safety Net Setup

Skills offered to help you “clear your fear” include:

  1. Grit Box: inspirational quotes, both provided by the app and ones you create yourself.
  2. Anxiety Types: education about different forms of anxiety and diagnoses.
  3. Safety Net: safe people you can reach out to when you are having a hard time.
  4. Immediate Help: breathing activities for panic moments.
  5. Information: education about how to use the app, including tips for how to use it.
  6. Self-Monitoring: a journal to track your symptoms and work towards personal goals.
Coping skills options to “clear your fear”

This is a great tool to help with anxiety management, and those avatars are adorable!

What Would You Do Differently?

A couple of weeks ago, I tweeted the question,

If you had known in March 2020 the extent of the pandemic, you couldn’t change the trajectory but you knew for sure what it would be, what would you have done differently?

My answer was, I would have upgraded my home office situation right away instead of waiting until November. I figured it was a waste of money since I was “only working from home temporarily.”

Photo by Tima Miroshnichenko on Pexels.com

Some people were practical like me, saying they would have gotten refunds on trips for that summer before they lost their deposit. Some said they would have purchased stock in things like Zoom or toilet paper.

Some shared that they would have treated the pandemic like a “marathon and not a sprint.” A few mental health professionals pointed out the connection between long-term “survival mode” and burnout, which caused me to reflect on my own relationship with burnout over the past 18 months. If my approach had been, “How do I live with this new normal?” instead of “If I can just make it through a few weeks like this, it will all be over,” I do wonder how my own mental health might have been affected.

Then there were some truly heartbreaking responses. Things like (paraphrased), “I would have begged my grandpa to take lockdown more seriously before he got sick,” and “I wouldn’t have hosted the family gathering that my asymptomatic brother attended.”

Fast forward to the present. How do we shift out of survival mode, grieve what we have lost, and continue to exist in a pandemic?

I don’t have a good answer for this – I’m still working on it for myself! But it is an important discussion to have. How do you grieve something that is still happening? How do we shift into a more sustainable mindset when we have been in crisis for so long?

Obviously none of us can change what we did last March. But what do we want to start doing differently now?

Celebrating 5,000 Followers: Giveaway Alert!

On Monday, something pretty cool happened: my Twitter following hit an arbitrary numerical milestone! Hooray! Can you believe 5,000 people saw what I had to say and thought, “I want more of that in my life”?

Screen shots are forever

I created my Twitter account to promote this blog, and I created this blog to help people. At first, it was to help other therapists struggling to find kid-friendly telehealth interventions, but it has since expanded into mental health education for the general public. There is so much stigma around mental health, and there is so much misinformation in the media. I want to provide accurate, helpful information that you don’t need graduate training to understand. I want people to be able to advocate for themselves and make informed decisions about their own treatment.

Anyone can create a free blog and start posting things. Without readers, I’m just screaming into the void here. You all gave me feedback on what information is helpful, and you shared what I wrote so that more people actually saw that. For all of this, I am so grateful!

How do you express gratitude? By giving away free stuff! I’m going to use an app to randomly choose ten followers. Five will receive a printable copy of It’s About To Get Real Unprofessional, and five will get a personalized Cameo-style video of Armani telling them they are great. Armani will accept requests for custom messages, but he reserves the right to say things at his own discretion.

Since winners will be chosen randomly from my followers, everyone who follows me is automatically entered to win! If I notify you that you won, and that reminds you that you actually never want to hear from me again, I’ll pick new winners until there are 10.

I’m also going to give away one autographed and inscribed copy of Armani Doesn’t Feel Well. Because of shipping and stuff, you have to be in the United States to win this one. Please fill out the submission form below to enter, and I will again choose a winner at random. I will inform the winner via email so that you don’t have to give me your contact information unless you win.

I will select winners the weekend of October 9.

When I started this blog, it was a big day if 10 people wanted to hear what I had to say. A bit over a year later, here we are. Thank you so much!

My Experience with the Therapist Phone Scam

This morning, the San Francisco Chronicle published an article about a phone scam that has been targeting therapists. The article is paywalled, so here are the bullet points:

  • Therapist gets a phone call from someone claiming to be law enforcement
  • Caller states the therapist failed to appear for a subpoena and now has a warrant out for their arrest
  • Caller states that the therapist must pay bail over the phone via gift cards or they will be arrested
Photo by Mikhail Nilov on Pexels.com

Since I received one of these calls over a year ago, I wanted to share my experience so that others know what red flags to look for. Getting a call from someone claiming to be with the police can be terrifying, and it is hard to keep your rational brain going when you are scared.

This scam has been going around for a while. I first heard about it almost two years ago in a Facebook group for therapists – therapists with profiles on Psychology Today were being targeted with these calls.

I am not on Psychology Today, but a few months later, I received a voicemail from a man claiming to be a lieutenant sheriff in a county close to mine. The message stated that he needed to speak to me about an “urgent legal matter” that was “not an emergency.”

First things first: before returning a call from someone claiming to be an authority, Google them. Nothing came up when I searched this man’s name, which was telling. I also searched the phone number, which came up as Kentucky. Why would a sheriff in South Dakota call from a Kentucky number? Short answer: they wouldn’t.

I returned the call because I was suspicious but wanted to cover myself on the tiny chance that this was legitimate. He verified my name, title, and the address of my office (all available online – my Sioux Falls Psychological profile is the top Google result for Amy Marschall, that same information is on this website, and I am listed on several “Find a therapist near you”-type sites).

Then he told me, “On [date], you signed a subpoena to appear at [courthouse] yesterday, and you didn’t show up.” This is when I knew for certain it was a scam because on the date he stated, I had worked from home and not been in the office at all.

He started talking about warrants, and I interrupted him to tell him I had worked from home that day, so it was impossible that I had signed a subpoena. I then asked why he was calling from a Kentucky number, to which he said it was his personal cell phone number.

Me: “Right, because law enforcement officers want people they arrest to have their personal contact information.” (That made him mad.) “Listen, ‘lieutenant,’ since you’re legitimately with the sheriff’s office, I’m sure you know there’s a scam going around targeting therapists and telling us we have warrants out for missing subpoenas that don’t actually exist. I’m going to hang up and call the department directly, and if they can verify your story, I’ll call you back.”

He tried to give me the phone number to his “direct supervisor,” and I told him the phone number was actually available on the sheriff’s department website, which somehow had no mention of him as an employee. To further cover my a**, I did call the sheriff’s department, who confirmed he didn’t exist in their system.

If you are not 100% sure, you can ask other follow up questions, such as “What case is this regarding?” Therapists get subpoenaed to testify about clients. While I would not give a client’s name or information, someone following up about a missed subpoena should know what case they are calling about. Know also that the police typically do not call to give a heads up before arresting someone.

Scammers have a script that they know tends to work. They use fear and your desire to do the right thing to manipulate you into thinking you need to comply with them. Take a breath, remain clam, and trust your gut about the red flags. It will be okay.

Telehealth Activity: Zoom Buddha Board

One thing from my in-person office that I have not been able to replicate in telehealth sessions has been my Buddha Board. (You can see a demonstration of the Buddha Board here.)

Photo by Zaksheuskaya on Pexels.com

When I use art in therapy, I encourage clients to focus on the experience of creating rather than on the final product. The Buddha Board helps them let go of this because the final product disappears before their eyes. Knowing the drawing will disappear also lowers inhibitions – they feel free to draw something that might seem weird or outrageous because it is not permanent.

You can implement something similar with a white board, but something about the drawing vanishing on its own is so freeing for a lot of kids. They don’t have to wipe it away when they are done because it happens on its own.

Recently, Zoom added a “vanishing pen” feature that is the closest I have found to a virtual Buddha Board. Here’s a demonstration of what it looks like:

Vanishing Pen Demonstration

For this to work, the client needs to be on a laptop, and you have to be using Zoom as your telehealth platform. Have the client share the white board screen, select annotate, select spotlight, and select vanishing pen.

Whatever they draw will disappear! Of course, you cannot save the drawing for future review, but a lot of kids really need that added layer of confidentiality when the drawing disappears.

What therapy activities would you like to see developed for telehealth? Tell me, and I will try to make it happen.

The Weekly Mews with Armani

Welcome back, friends! I apologize for the technical issues lately – I usually upload the photos for Armani’s mewsletter using the app on my phone, but that has been glitching on me (it is likely a Code-18 error, unfortunately). So I’m going to try transferring the photos to my laptop and uploading them that way. It’s an extra step that will hopefully Amy-proof the process.

Armani!

Armani has so many updates! First, his pawtograph stamp came, so you can buy a special, signed copy of his book on Etsy, and he will even inscribe it for you! He is so excited to help more kids by sharing his story.

He is so proud of himself!

In other news, our veterinarian quit, so Armani’s care is being transferred to a new provider. He’s nervous about meeting a different vet, but we will make sure they do just as good of a job taking care of him.

His latest blood sample had that clotting issue again, which the new vet reassured us is just bad luck and not a sign that something bigger is wrong. (This is what the last vet said too, and my husband said it checks out.) They aren’t sure about doing another draw, since he hates having them and it has not given us good information. Our choices now are to try the Libre again or just keep him on the low insulin dose and continue to monitor him for symptoms.

Armani and Vera reading together

I’d rather not put him through more invasive procedures that he hates if it is not going to help him, but it makes me nervous to not have the information. He has been doing so well and has been climbing and jumping, still not as high as before he got sick, but he seems happy.

If anyone has the answers, please let me know. We will keep taking care of him the best we can.

Telehealth Activity: 8 Ball Pool

When I interned in a residential setting, a lot of kids bonded and had great therapeutic moments around a pool table. We could play teams with a group or have a casual one-on-one game while talking about a larger issue. A pool table is something that I never thought would be practical for my therapy practice because of space constrictions, but once again, telehealth has shown me that nothing is impossible!

Photo by Tomaz Barcellos on Pexels.com

I use this version of 8 Ball Billiards for telehealth. Pull up the website, choose human versus human, and share your screen. Take turns with screen control to play with your client. They can use any device with a mouse or touch screen for this activity, though I have found that phone screens are challenging due to the small size.

The goal of using pool in the residential program was to give the kids something to do with their bodies while we talked. It gave them the opportunity to relax enough to explore deeper issues. You can get a similar effect with telehealth pool, though there is less body work due to the nature of the virtual game.

Telehealth pool works focus, planning, problem solving, and of course frustration tolerance. It requires taking turns, and since the rules are coded in, following instructions. Sometimes there are no good shots, so you have to decide which option is best when what you really want is not available. Plus, it’s a lot of fun!

Play interventions for telehealth are endless!

Sleep Hygiene: Creating Routines

I wrote last week about the factors that contribute to quality sleep hygiene. Specifically, I talked about creating routines around when you go to sleep and when you wake up – as I mentioned, there is no one-size-fits-all approach to sleep hygiene, and the most important factor is determining what works best for you, the individual.

Photo by Ketut Subiyanto on Pexels.com

There are some general tips to consider, of course, such as:

  1. The light from screens can make your brain think it is daytime, so turning on the blue light filter after about 6pm can help your sleep-wake cycle.
  2. As much as possible, going to bed and waking up around the same time helps your body know when it is time to rest and when it is time to be awake.
  3. Your brain can associate certain things with bed time, so having a routine can help you get restful sleep.

So, what goes into a healthy sleep routine? Again, the specifics need to be whatever works best for you, but general guidelines include:

  1. Light. Do you sleep best in complete darkness, or does that bring up some anxiety? Having a small light in your room can be relaxing. Notice how you feel with different options, and do what works best for you.
  2. Sound. Do you need complete silence? Do you prefer background white noise? Some people have trouble turning their brain off, so a guided meditation or even a familiar television show or podcast distracts their brain enough to get rest. As I mentioned, screens can make your brain think it’s daytime, so turning the device away so you are listening but not watching can aid with sleep. For guided meditations, my personal favorites are from The Honest Guys on YouTube.
  3. Smell. If you are someone who is sensitive to smells, you can use a diffuser or pillow spray. Your brain can tie the scent to your bedtime routine and help you recognize that it is time to rest.
  4. Ritual. A good sleep routine is about 30 minutes of consistent behavior done before going to bed. If you find that bathing relaxes you, bathe at night. This routine can also include reading something relaxing, drinking (un-caffeinated) tea, journaling, meditating, or any activity that brings your heart rate down and makes you feel relaxed.

It can be helpful to deliberately and mindfully document your preferred sleep routine to help you practice. After a few weeks of consistency, you can start to see better quality sleep.

Of course, bring any concerns about your sleep to your primary doctor as well.

App Review: Move Mood

From the awesome people who brought you Calm Harm and Combined Minds comes another amazing mental health app: Move Mood.

“Low mood and depression weigh you down. Instead, engage, initiate, and activate. Build your power to lift this weight.

Move Mood was developed for people with depression or other mood issues, but I think it could be helpful for anyone who has trouble doing The Thing. (The Thing is what I refer to as any activity that is important and helpful, but our brains do not want to let us do it for whatever reason. People with anxiety, ADHD, or many other diagnoses also struggle to do The Thing.)

Helping people get themselves to do The Thing is sometimes referred to as behavioral activation. Basically, this app helps you take steps to trick your brain into doing things that make you healthier and are associated with better mood.

“Now choose a companion to work with you and to help motivate you.”

After you give the app your name, you get to pick an adorable avatar to help you in your journey. There are shapes, characters, and critters to choose from, and you can go back and change it if you want to. After trying some different options out, mine is now a fox.

Setting some tasks

The app prompts you to choose three tasks to work towards. I found it difficult to decide what my top priorities were in each category, but I see the benefit of limiting the number of goals so that the user does not get overwhelmed.

You are prompted to choose a “routine task,” a “necessary task,” and an “enjoyable task.” There is overlap for the different kinds of tasks, so you can decide which things are enjoyable for you versus necessary. Options for tasks are presented based on what you indicate is your priority, with options like “managing my mental health” and “improving my physical well-being.” You can also create your own task, so it is fully customizable.

Customize Task

I told the app that I want to walk a short distance every day to improve my mental and physical well-being. The app prompted me to create a series of very specific steps that go into this task. These kinds of specific steps help if the task seems overwhelming (for example, some people have a hard time showering because the act of bathing has so many smaller steps) or they have trouble knowing where to start.

The app then notifies you at a pre-selected time to cue you to do The Thing.

Although Move Mood markets itself specifically for depression, I think this app is very helpful for someone who wants to form better habits, with a little virtual accountability and planning. It follows a lot of steps I have used with clients in sessions for behavioral activation and does so in a non-threatening and fun way.

Making Therapeutic Moments: Adds

I wrote before about what makes an activity therapeutic, using the premise that an attentive and creative therapist can get therapeutic benefit out of almost anything with the right attitude. In my telehealth and kids training, I say: “It is not my job to do a specific therapeutic activity; rather, my job is to take what happens naturally in the session and make that activity therapeutic.

Although I sometimes want to explore a specific skill or activity with a child, I am constantly surprised by how easy it is to pull a child’s treatment goals into whatever happens in the session.

Something that has been a surprising opportunity for therapeutic moments in telehealth sessions has been adds. Yes, advertisements. Hear me out.

Photo by Negative Space on Pexels.com

Some of the websites I use for telehealth activities have advertisements. Understandable – this blog has advertisements because we all have bills. I use AdBlock to minimize this on my end, but some sites have a workaround for this, and sometimes my client does not have an add blocker.

Most people do not like adds. They make us wait for the thing we actually want and are annoying and frustrating. When an add pops up in a telehealth session, I cue the client to check in with their body and emotions. I validate that feeling and take a moment to practice being patient. Sometimes, we will do a quick breathing exercise or body scan to regulate while we are waiting.

Who would have thought adds would be therapeutic? These opportunities are everywhere in the session, waiting for us to discover them.