Thoughts From Our Therapists: Family Sessions

Thoughts From Our Therapists: Family Sessions

By: Katelyn Braatz


Why Are Family Sessions Important When Working with Child or Adolescent Populations?

In my work with children or adolescents, I consider it important to think of family therapy as a component of their treatment plan. When one considers how family members impact one another in regards to emotional and physical developments, it would only make sense to involve family members in a client’s session. Compared to individual therapy, family sessions have several distinct benefits, including but not limited to: increased communication, improved relationships with one another, and deeper understanding of each other (empathy).

As much as I would like all family members to be present, sometimes it simply is not feasible. Therefore, I occasionally work just one legal guardian/parent with the child/adolescent. The goal of these family sessions is to allow for a safe place to exchange emotions and issues with one another. This may be achieved through a series of therapeutic games or simply by talking to one another with myself as the mediator. The family session would focus on the underlying issues that have broken the communication or relationship and hopefully have all family members build each other to be able to work as a team and work together effectively to better handle any issues that lie ahead.

If you or a loved one are interested in family sessions, please contact Exult Healthcare at (469) 714-0006.

Thoughts from our Therapists: Behavior Charts – Do Children Need Them?

Thoughts from our Therapists: Behavior Charts – Do Children Need Them?

By: Katelyn Braatz


What Is A Behavior Chart?

As a therapist working with children who have behavioral issues, whether at home or in school, I encourage the parents to implement a behavior chart. A behavior chart is a simply a method to promote acceptable behavior and decrease/eliminate negative behaviors. Children may not have the same motivations that adults do, and it is in this situation when a behavior chart comes in handy. Children learn at a young age which behaviors are acceptable based on their consequences—a reward is something that may be helpful when it comes to encouraging good behavior. It is important that parents are committed—meaning they have to be consistent and adhere to the rules of the behavior chart as they are the ones who will be delivering the rewards. If done correctly, there should be a decrease in negative behaviors over time.

How To Make One

The first step in making a behavior chart is to identify the goal which must be very specific. For example, if the issue is that the child is having issues getting up on time for school—the goal would be identifying a specific time to be out of bed. (e.g., “Get up at 6:15 AM”). Teaching your child to use an alarm clock to get up on their own may be helpful. It is recommended to start off with one goal at a time as stacking up too many may seem overwhelming or unattainable for the child.

On the behavior chart—you will need to put the day of the week/dates on the chart to track the behavior. It would be helpful if children identify what they want to use to track the behavior, such as a sticker or a simple checkmark. When the child successfully meets all their goals for the day, he or she may be entitled to a small reward.

What Kind Of A Reward Is Good?

To encourage and maintain a healthy strong relationship between parents and children, I would encourage making the chance to spend 30 minutes with mom and dad (perhaps to play a video game or read a book together) one such reward. In order to achieve the “big reward”, I would suggest that it be attainable after the child has successfully met a week’s worth of goals. The big reward could be a trip to the zoo or the day at the park (more time with parents). It is important for the child to identify what would be motivating enough for each day and for the week.

Personally, I like using experiences instead of material items to reward a child. Children often will start valuing materialistic items versus experiences/relationships over time if parents tend to give children toys, etc.


I always educate parents to be always supportive of their child if they do not have a successful day by simply stating “let’s try for tomorrow” and ignoring the negative as the child is already aware of what he or she has done. When one goal is consistently successful, then it may be time to include additional goals. It’s important for parents to stay patient in the process. If you feel like your child cannot follow through with a specific rule pertaining to the chart, it may be helpful to ask their therapist on how it can be modified.

If you feel like your child is having trouble achieving their goals, contact us today to figure out how we can put them on the path to success!

Christelle’s Corner: Staying on the Weight Loss Wagon this Season

Christelle’s Corner: Staying on the Weight Loss Wagon this Season

By: Christelle Leiker


The Holiday season is here!

Everyone is making holiday plans to travel, cook, entertain, and spend time with loved ones. If you have been on a weight-loss journey this year, I am sure you are thinking about how you will survive the holidays without gaining weight or falling off the weight-loss wagon, and how you will stay on course.

Read below to find out how to do just that and celebrate without overindulging!

I want to preface this by clearing up a common misconception about the holidays and weight gain. It has been a highly promoted claim in the world of dieting that most people gain 5-10 pounds during the holidays (from Thanksgiving to New Year). This is NOT true. In a study found in the New England Journal of Medicine (Yanovsky, 2000), 195 men and women were monitored over one year. The average amount of weight they gained from mid-November to January was LESS THAN ONE POUND. However, the study did state that weight gained was not lost the following year.

So, what does this mean?

It means we are getting off track during the holidays and failing to get back on track. The overindulgence and overeating we are participating in during the holidays is not causing huge amounts of weight gain BUT it is breaking the good eating habits we worked so hard to establish over the year.

4-6 weeks of habitually overeating, eating more dessert than usual, or eating food you have avoided the prior 40+ weeks this year WILL thwart your weight-loss efforts!!

How to Avoid the Weight Gain Trap:

  • Stay focused on your goal
  • Always be mindful when you eat
  • Enjoy but avoid overindulging
  • Drink plenty of water
  • Avoid being hungry when you arrive at an event
  • Portion control, portion control, portion control

Start a new Holiday tradition:

If you are the host, you are at liberty to make changes to holiday meals and celebrations that fit into your new healthy lifestyle. If you are not the host, you can make “suggestions”:

  • Serve food on smaller plates
  • Make smaller dishes this year instead of dishes that could serve an army!
  • Use healthier substitutions in old recipes

Everyone can stand to be healthier. You could be doing others in your family a huge favor as well!

Thoughts From Our Therapists: The Intake Assessment

Thoughts From Our Therapists: The Intake Assessment

By: Katelyn Braatz, LPC

The first step of the counseling process is usually the intake assessment. The intake assessment allows for the therapist to ask a potential client questions and listen to them to get a clear understanding of the person and the issues that have brought them in. This process usually takes 45-60 minutes depending on how much detail the client is willing to share with the therapist. The intake assessment is an important part of the therapeutic process because it allows the therapist to decide if they can help the client. To this end, a therapist will use open-ended questions to encourage the client to talk about their current problems and feelings, asking such questions as: “How have you been feeling, What do you think has caused the current problems you are having or How often is this occurring in your life?”

This is then shifted to other questions pertaining to past psychiatric history (“Have you received counseling or been admitted to a mental health hospital before?”); trauma history (“Have you experienced an event that has caused distress in your life?”); family psychiatric history (“Is your mother or father diagnosed with a mental illness?”); medical conditions (“Do you suffer from any medical conditions such as back pain or headaches?”);  current medications (“What current medications are you prescribed and are you taking them as ordered?”); substance use (“Are there any substances you use or in the past”), family and social history (“Who is your primary support system, who is included in your family?”); developmental history (“Were there any delays in speech or in school”); Occupational history (“What is your highest level of education? Do you work?”); legal history (“Were you ever arrested?”); any current suicidal/homicidal/hallucinations (“Do you have thoughts of harming yourself or others or see/hear things that other people cannot hear or see?”).

After the session, the therapist will evaluate how often the client will have to participate in counseling and/or be referred to intensive outpatient program (IOP) which is a program that allows for a group setting with multiple participants. Once the client is given recommendations. They will then need to make a final choice in therapy.

If you are interested in counseling and schedule your assessment, please contact Exult Healthcare today.


Thoughts from our Therapists: The Rising Rates of Suicide

By: Alex Frascino, MS, LMFT

Discussions regarding suicide have become notably more prevalent in recent years. There has been a great concern due to increased suicide rates, especially amongst the younger population. The suicide rate has increased from 11.3 suicides per 100,000 people in 2007 to 12.6 suicides per 100,000 people in 2013 (Singer, J. 2017). But what could be causing this increase?

It is difficult to pinpoint one specific factor that could have caused this increase, but it is still important to understand that it exists and that we can make a difference. In many communities, there still exists a taboo around and a hesitancy to address the issue of suicide. Sometimes we may fear that the very discussion will influence others to develop or act on suicidal thoughts they may already have. It is important to recognize, however, that merely discussing the topic does not influence someone who already has suicidal thoughts to act on them.

When addressing the topic of suicide, it is important to know which factors can increase one’s vulnerability to suicidal ideation. Some of these factors to consider are: emotional distress, exposure to violence, family conflict, relationship issues, lack of social support, drug/alcohol abuse, recurring self-injurious behavior and previous suicide attempts. These factors do not, however, necessarily directly cause a person to commit suicide, and can occur at the same time.

If you have seriously thought about committing suicide or know anyone else who says that they have, contact us today so we can get you in as soon as possible and get you back on the road to living.

Bullying Hurts (Everyone)

By: Nikhil Jaisinghani

October is National Bullying Prevention Awareness Month. Bullying is a serious problem among adolescents, with 28% of American students from grades 6-12 reporting having been bullied (source) and 70% of both students and school staff claiming that they have witnessed bullying activity in schools. 30% have admitted to actually doing the bullying.

On the one hand, most people can probably guess the negative effects that bullying can have on the person being bullied, as those can be quite obvious or, at least, logically-expected: loss of appetite, decreased self-esteem, sickness, depression, difficulty sleeping, anxiety, greater likelihood of drug abuse, and so on (“Bullying Hurts. You Can Help.”).

Surprisingly, perhaps, to most people, being a bully is correlated with negative health outcomes for the bullies themselves. According to the director of the Center for Substance Abuse at SAMHSA, Frances M. Harding, children who engage in bullying behavior are at a higher risk develop problematic habits and behaviors such as illegal drinking and smoking and other forms of drug abuse.

If you think your child is involved in bullying — from either side — or might be at risk for substance use problems, contact us today so they can get screened to determine the best program for them.

Exult Weight Loss Management Info Session- 10/19/17

Exult Weight Loss Management Info Session- 10/19/17

Last night, we held an Information Session to present our new medically-managed Weight Loss Management program to the community. Our Nurse-Practitioner and WLM Program Director, Christelle Leiker, showed visitors around our McKinney location and let them sample our Nestle Optifast products, which are specially-formulated to help clients meet their dietary and nutritional needs.

We also unveiled our Tanita machine for the first time, which, while similar in appearance to a simple scale, is actually a highly complex piece of machinery which analyzes the composition of one’s body and can tell a person various things about it, in addition to their weight, such as fat %, muscle mass, BMI, Total Body Water, and metabolic rate, among other things.

If weight management has always been a struggle for you, then come to Exult or contact us today to set up an appointment to get yourself on the road to a healthier body!

Depression Among Teenagers

By: Katelyn Braatz


Stress. We all experience it, whether in its positive or negative forms. Sometimes, however, we tend to underestimate the amount of stress that teenagers experience. There are numerous stressors specific to teenagers, including: dating, extracurricular activities, money issues, family issues, relationships with friends, expectations from others, tests and homework, owning a car, and so on.

Teenagers may experience feelings such as sadness as a result of these stressors. This is a completely normal response. If, however, the emotions or feelings engendered by this stress are so intense that they tend to last for long periods of time, they can impact the teenager’s functioning in school or other areas of life, and may be a sign of something more serious, such as depression. If you suspect that this might be the case, it may be a sign that it’s time to seek a licensed professional to assess the teenager for possible interventions to address the issue.

Signs of Depression

There are many symptoms of depression, which can be quite different from each other. Here are some to look out for:

  • Withdrawing from family and friends
  • Losing interest in social and extracurricular activities
  • Displaying a lack of energy
  • Feeling tired most of the time
  • Anxiety
  • Irritability
  • Anger
  • Feelings of sadness for much of the time
  • Significant weight fluctuations
  • Sleep pattern changes
  • Physical pains and aches, or sickness, even though there is nothing physically wrong
  • Indifference about the future
  • Uncharacteristic pessimism
  • Guilty feelings
  • Lowering self-esteem
  • Suicidal thoughts
  • Behavioral changes:
  • restlessness
  • tiredness
  • frequent crying
  • withdrawal from friends and family
  • angry outbursts
  • acting-out
  • changes in sleep
  • changes in appetite
  • alcohol or drug use
  • a drop in grades or frequent absences from school
  • self-harm (e.g., cutting or burning)
  • suicide attempt or planning a suicide

It is very important to note, however, that although a person may be exhibiting some of these signs, that does not necessarily indicate that they are experiencing clinical depression. It is very important to seek a licensed professional’s opinion in order to assess the severity of the symptoms to see if it is something that should be addressed clinically.

If you or someone you know has suddenly started exhibiting these symptoms, contact us to set up a consultation with one of our therapists and figure out how we can help.

The Relation Between Weight & Fertility

Our Weight Loss Management Program Director, Christelle Leiker recently shared some studies with the rest of the office about the importance that managing a healthy weight has on various other areas of life. One of these areas is fertility, and in particular, In Vitro Fertilization (IVF). In their 2011 review, Rittenberg et al. looked at over 30 studies, totaling nearly 50,000 independent treatment cycles, which showed that overweight and obese (quantified as having a BMI above 25) were significantly less likely to become pregnant in the first place compared to women who were not above a normal BMI level. They were also significantly less likely to actually carry the child to term and have a live birth. Furthermore, obese and overweight women were also significantly more likely to miscarry.

If you are thinking of becoming pregnant through the means of IVF, come to Exult Healthcare or contact us to see if we can help you maximize your chances of having a happy, healthy pregnancy.


By: Alex Frascino


Discussions regarding suicide have become noticeably more prevalent now than ever before. There has been a great deal of concern due to growing rates of suicide, especially among youth. The suicide rate has increased from 11.3 suicides per 100,000 people (in 2007) to 12.6 suicides per 100,000 people (in 2013) according to Singer (2017). But what could be causing this increase?

It is difficult to pinpoint one specific cause that could be the cause of this increase, but it is still important to understand that it exists and we can make a difference. There is a taboo and hesitancy around suicide that still exists in our society. Sometimes we may fear that the very discussion will influence people to have or even act upon suicidal thoughts. It is important to recognize that the mere discussion alone does not influence people to act upon any possible suicidal ideation. Rather, we should keep this important information about how to address this matter with a friend or family member in mind.

When addressing the topic of suicide, it is important to know and understand factors that can increase risk. Important factors include: emotional distress, exposure to violence, family conflict, relationship issues, lack of social support, drug/alcohol use, recurrent self-injurious behavior and previous attempts of suicide. These factors do not directly cause someone to complete suicide, however, and several of these can occur simultaneously, which can compound their effect.

If you or someone you love is showing signs of suicidal thought or ideation, contact us to get scheduled for a screening and get on the road to living (and loving) life again!