By Mike Magee, MD

In a current survey of fear levels sponsored by Woodbury Commons, over  half the respondents stated that loss of job or income was a major source of distress. Not a surprising result under the currrent circumstances. We've known for some time that there are strong linkages between financial security and mental health. Abundant studies have confirmed that financial insecurity creates panic and anxiety, as well as reinforces feelings of powerlessness and failure. 

One modern-day tool that lives at the crossroads of fear and ecstasy, and finds itself in the middle of our current dilemma is the credit card. For all of their utility and convenience,  these plastic devices, in many hands, encourage people to spend more then they have, and they reinforce extravagance while trapping many in revolving debt. Money supporting late fees and interest is sucked out of the economy with little benefit to society, unless of course you happen to run a credit card company.

Up until recently, this has been a highly profitable sector. With over 1.5 billion cards in circulation in the US, and with the economy essentially flat, borrowing by Americans using credit cards  grew 30% in the first 6 years of this new millenium. In response, company profits jumped 45% between 2003 and 2008. But now the tide has turned and many people - in fact over 7% - are unable to make their minimum monthly payments.

That makes the companies nervous. You see, people who fully pay their monthly credit card bill are not particularly good customers. The company prefers individuals who spend a lot each month but only pay the minimum. Affectionately called "revolvers" by the companies, these customers are perpetually caught up in a revolving door of debt, interest and late fees. And the interest levels they pay, especially in a flat economy with no inflation, are extraordinary. The average credit-card interest rate in the US today is extremely high compared to the prime rate.

What's most amazing is that many caught in the cycle feel they have no options when they actually do. First, they could cut up the card and control spending. Second, for some, they could shift income and be much better off. Let me give you one example: I recently spoke to a young parent who had about $5000 in credit card debt for which she had been making minumum payments for over a year. At the same time, she had continued to contribute about $5000 a year to her 401K plan, which was not matched by her employer any longer. The money was being placed in an insured income fund, where she felt it would be safe from market turmoil, and was making about 2%. Had she done the math, it would be clear that paying off her debt rather then contributing at the moment to her future retirement could give her 18% versus 2% benefits. Relieving oneself of high interest debt in this economy is the best investment you can make.

The point is this: When it comes to finances, fear, and decision making, you need to stay calm, think logically, control urges to spend, and check the numbers. Some times the best solutions are right under our noses.

Today about one in four American adults are living with a diagnosable mental disorder. However, the average American’s understanding of mental illness is minimal at best and often the stigma surrounding individuals with mental illness is almost as harmful to them as their actual disease.

To further complicate matters there is a large sector of the population that does not have a diagnosable mental disorder but still needs some help from time to time dealing with the overwhelming stress of everyday life. While there is certainly no one solution to address these concerns, there is an option that most Americans fail to take advantage of: the phone hotline.

Whether individuals are discouraged from calling because they think it is weird, they are embarrassed of their issue or they think that no one cares what they have to say, they are missing out an opportunity that could potentially make them feel a whole lot better, and it’s free.

Let’s be honest: We could all use a little therapy. Talking just makes you feel better, and talking about yourself to a rapt audience, well who could ask for more? I am a volunteer counselor at a major American University’s peer counseling and crisis intervention hotline and although not all hotlines are alike in their procedure or practice I wanted to highlight some of the little known facts about the phone hotline I work at, in order to better educate the average person about this important resource. Firstly, no issue is too big or too small to talk about and once you take the first step and call, extremely well trained counselors are there to listen with an empathetic ear and unconditional positive regard. In my experience, volunteers usually participate in this type of work because they have had a time in their own life when they needed help as well. While calls are kept confidential and anonymous it is always possible that the person you call for help has been on the other end of the phone before.

Volunteers at my hotline are interviewed and then accepted based on different criteria including their ability to be non-judgmental, their empathy skills, and their passion for helping others. A rigorous training weekend ensues followed by a semester of weekly "on the job" teaching. Trainees receive practice calls from counselors and each call is then scrutinized and strategic listening and counseling skills are discussed. Usually after about two semesters of learning, a trainee will take an oral exam and it will be determined whether or not this new volunteer is ready to answer phones on their own.

My phone hotline has many different listening and helping strategies its volunteers employ, and is prepared to deal with a myriad of potential issues. We practice Rogerian client-centered therapy which means we do our best to let the callers talk about their issue and come to their own conclusions about their feelings and potential courses of action. In general there is a basic flow to a call that includes active listening, empowerments and options. First counselors listen to a client, repeat back to them their thoughts, paraphrase their stories and try to focus in on specific feeling words. By acting as a sounding board, a counselor has allowed a caller to listen to themselves, clarify behaviors, and discover patterns. Counselors also empower callers by determining what the caller deems positive behavior or thoughts and highlighting the good things that are coming from these behaviors or thoughts. If the counselor feels it is appropriate based on the rapport between themselves and the caller, the conversation may turn to options. In this portion of the call the counselor suggests resources and courses of action to address the issue discussed, and asks the caller whether or not they would feel comfortable trying that option, allowing the caller to choose for him or herself what is best. Volunteers never give advice, say "I think" or "you should." We are not licensed psychologists or medical doctors, simply people who want to listen and help people discover their own path to contentment.

The use of phone hotlines is intended for anyone, however if you are looking for a long term solution to a mental illness or chronic problem this is not the correct venue. For individuals living with a mental disorder calling a phone hotline is a great way to supplement other therapy, however it is not a singular remedy. For more intense and specific help, licensed psychologists practicing cognitive behavioral therapy may be a better option. But don’t be discouraged, if talking to a hotline counselor sounds like it may be right for you taking the first step to call is often the hardest part. You can easily search the internet for a hotline that is near you and specific to your needs. Veteran volunteers have heard it all, screamers, heavy breathers, people who need to cry, stories about death, rape, abuse, disease, suicide, and eating disorders; we work here because we want to listen and because we are not going to judge you, no matter what you tell us.

Elizabeth Dillon volunteers at the University of Maryland-College Park Help Center. If you need someone to talk to, please call 301-314-HELP or visit http://www.umdhelpcenter.org/
 
Dr. Allison Conner, Clinical Director of Cognitive Therapy Associates of Manhattan can be reached at 212-258-2577 or at her website. 

Statistics: National Institute of Mental Health. (April 3, 2008). Retrieved June 20, 2008.