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Welcome Dr. Elizabeth Ault, Psychiatrist

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Family Focus is so excited to welcome Elizabeth Ault, MD, Psychiatrist, to our wonderful team of providers!  Dr. Ault is well-trained and enthusiastic.  She has a wonderful personality, and she will be such a great addition as we continue to try to serve the mental health needs of families in the Baton Rouge area!

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WHY WE NEED TO PAY ATTENTION TO 13 REASONS WHY

WHY WE NEED TO PAY ATTENTION TO 13 REASONS WHY

 by Suzanne Jones, May 10, 2017
13 reasons why

The raw, powerful Netflix series, 13 Reasons Why, has generated a fair bit of discussion and controversy. Based on a novel with the same title, the series tells the story of a girl, Hannah, who leaves behind tapes explaining the 13 reasons why she committed suicide. The experiences of Hannah and other students at Liberty High School include bullying, cyber-bullying, sexual harassment and assault, depression and suicide.

WHY SHOULD WE PAY ATTENTION?

The author of 13 Reasons Why, Jay Asher, wanted to spark a discussion about suicide, which is important  given that suicide is one of the leading causes of death among teenagers. Many scenes, including rape and suicide, are intentionally graphic and disturbing to paint an honest picture. Parents may object to these scenes as well as those with strong language, underage drinking, and drug use, but it would be a mistake to get stuck there.
Like it or not, our young people are watching this series; it speaks to them in powerful ways. They need to be able to process what they are seeing with adults who are prepared to engage in the discussion. However, be warned that this series could be very triggering for those with a trauma history, or those who know someone who committed suicide.
The documentary at the end of the series makes several important points. For example, many adults will find it difficult to relate because we did not have internet and social media.
Hannah’s downward spiral starts with a compromising photo that was passed around the school as a “joke.” In a nanosecond, her reputation was ruined. She became an object of scorn and was “slut-shamed” even though the picture was taken out of context. From there, many of the boys in the school felt free to treat her and talk to her in sexually demeaning ways.
Another point is that Hannah’s reactions were classic for someone who has experienced trauma. She often froze, becoming numb and disconnected, engaging in behavior that could be mistaken for tacit compliance. Hannah eventually becomes so wounded and guarded that even when good people try to reach out to her, she remains closed to their efforts. In the end, feeling hopeless and alone, she takes her own life.

HOW DOES THE SHOW RELATE TO OUR CHILDREN?

Cyber-bullying is a 24/7 possibility for today’s students, with no place to escape for safety. Sexual harassment is depressingly common. One teenager I spoke with said she thought the story was realistic, and represented what many high school students are exposed to, even if they don’t experience it directly.
The issues raised in 13 Reasons Why are disturbing and difficult to talk about: sexual objectification and harassment, victim-blaming, and the “guy-code” that makes good guys look the other way and say nothing. Many of the scenes were eerily similar to the stories I’ve heard from clients.
It’s important to understand the mind of a teenager while discussing 13 Reasons Why. Adolescent brains are still developing; logical adult insight and foresight is not yet available to them. Teenagers are often impulsive and emotionally driven. For them, misery feels like it will go on forever.
It was maddening to watch the teens in the show try to solve their dilemmas on their own, without adult input. More than once I found myself exasperated and yelling, “Tell your parents! Let them help you!”
Sometimes our kids won’t talk to us because they want to avoid lectures and judgment, but often they just don’t know how to put what they are experiencing into words. They feel like they “should” be able to figure things out, and often the only thing we adults see is the push-pull of ‘leave me alone but please help me’! We need to let them know their pain matters and that it is ok to need help, even if they are not sure how to explain what is going on. We need to get our kids talking to us.

START A DIALOGUE 

To that end, I have created some questions, with input from social workers, teachers, therapists, and teens, to get the discussion started. Don’t feel the need to ask everything. Just keep things open-ended and listen.
  • What did you think of 13 Reasons Why? Was it realistic?
  • What do you think of Hannah’s decision to tell her story?
  • What would you do if you were in Hannah’s shoes?
  • What do you think of Hannah’s 13 reasons?
  • How is it that people kept missing her hints?
  • Who do you think was hurt by Hannah’s suicide? Do you think Hannah intended to hurt those people?
  • Some people think 13 Reasons Why glorifies suicide. What do you think?
  • Who were the people who cared about Hannah? Why do you think she wasn’t able to receive that love?
  • What could Hannah have done differently to get people to see how badly hurt she was? How can kids talk about their pain and need for help?
  • What makes it hard to tell adults?
  • What could the adults have done differently that would have been more helpful?
  • How would you know if a friend was in trouble?
  • Would you know where to get help if something like what happened to Hannah happened to you or someone you knew ? (Parents, teachers, counselors, hotlines, etc.)
  • Who are the Hannahs in your school?
  • How would you describe Bryce? How did he justify raping the two girls? What made it possible for him to get away with it?
  • What do you think Bryce would have done if Hannah hadn’t told about the rape and Clay hadn’t forced a confession? (Unfortunately, predators often have many victims and don’t stop until they have consequences.)
  • Do you think it is OK to have sex with someone who is passed out/drunk?
  • What does it mean to get consent? How should someone make sure they have consent?
  • If you could re-write the ending, what would be different?
As uncomfortable as it is, we need to talk about this. There’s a saying in therapy circles that if we don’t talk it out, we will act it out.
Over and over the story drives home the point that the smallest gesture can have a profound and wide-reaching impact, either for good or bad.  Zach, the school’s star basketball player muses, “One thing. If one thing had gone differently somewhere along the line, maybe none of this would have happened.”
Maybe an honest conversation is the place to start.
It has to get better. The way we treat each other and look out for each other. It has to get better somehow. (~Clay from 13 Reasons Why)
 
**If you are in an emergency and need immediate help, call 911 or go to your local emergency room. If you are struggling with depression and want help, we would be happy to set up a counseling appointment with you by calling 225-341-4147. 

 

Things Narcissists Do

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Things Narcissists Do
1. THEY REFUSE RESPONSIBILITY.
It’s not their fault. Not EVER. It’s always your fault. His fault. Her fault. To a narcissist, it’s not their fault they hurt you, it’s your fault for being hurt-able. If your feelings are hurt, it’s not their fault; it’s your fault – for having feelings. (You may be told that you’re “choosing” to feel bad about the hurtful things they’ve done, and that it’s the wrong “choice”.) If caught doing something insensitive or selfish, they will tell you they “had to” do it because of someone or something else. If you imply that anything is their responsibility, they give you excuses and lies, and often, if those fail to work, they will finally make it clear that the bottom line is they simply don’t care because they don’t have to, and the fact that you care is just unnecessary or wrong. From their perspective, you shouldn’t care — you should get it right like they do, and be more like they are. Uncaring.
2. THEY LIE.
Narcissists lie to make themselves look good. They lie to get out of emotional responsibility. They lie to manipulate. They lie to gain influence. They lie out of habit. Life is a game to narcissists – a game they have to think they’re winning – and truth is one casualty in their game plan. The only time a narcissist has any interest in telling the truth is when it will serve them or cost them nothing to do so. The rest of the time, they don’t consider it necessary or important to be all that honest. Honesty can impede their self-gratification and compromise their powerful persona, and they don’t like that. To narcissists the truth is frequently “flexible” and optional. There’s no such thing as an honest narcissist.
3. THEY LOOK DOWN ON YOU.
Narcissists have to make themselves feel bigger by convincing themselves others are smaller by comparison. They’re no strangers to being condescending, snobby, clique-ish, elitist and superior; however, they may be very good at hiding their disdain to prevent a loss of popularity, which narcissists know brings them power. Narcissists with money look down on the working class. Narcissists in the working class look down on those with more money. Educated narcissists dismiss the opinions of those who have no degree. Narcissists with no degree claim educated people don’t actually know anything. Whatever narcissists HAVE (or think they have) is what they use to look down on others WITH. No-one else’s background, appearance, values, political persuasion, school, preferences, religion, way of life, profession or opinions are ever any good or worthy of their respect unless they themselves value and/or possess the same. If you think or choose differently from a narcissist, you’re “wrong”, and they’re “right”.
4. THEY’RE TWO-FACED.
Narcissists literally have two faces — their real face and their stage face. And neither is anything like the other. Which one you see will depend on how long you’ve known them. Narcissists can be very charming and know how to gain favor. Anyone who doesn’t know a narcissist well will tell you the narcissist is one of the greatest people they’ve ever met! They believe this is one of the most intelligent, kindest, most interesting, funny, agreeable, most attractive, talented or accomplished people ever. They may wish they themselves had it so “together” or were so popular. However, anyone who knows that same narcissist better (family members, longtime coworkers, etc) will tell you the narcissist is one of the most horribly frustrating and toxic people they know, and the mere mention of their name makes them feel uneasy, angry, frustrated or otherwise unhappy. Being the only one who is experiencing a narcissist’s real face, while all other family members or coworkers can still only see the narcissist’s stage face is a very lonely, painful and frustrating place to be. Thankfully, the number of people who can see through the facade tends to increase with time.
5. THEY’RE VINDICTIVE.
If you dare to question a narcissist or request things like healthy boundaries and honesty, you’re going to become public enemy number one. The “Mr. or Ms. Wonderful” mask immediately comes off, and there is no level they will not stoop to in order to “punish” you. They have myriad ways of attempting this; some are covert, and some are open and obvious. The narcissist has a seemingly inexhaustible obsession for making people who cross them “pay”. Once they set their sights on you, you’re a permanent enemy, and their seething spite will feel as intense years down the road as it did when it first began. The length of time they can keep up the full intensity of their hatred for you and their campaign to exact revenge is absolutely dumbfounding to non-narcissistic people.
6.THEY PROJECT PSYCHOLOGICALLY.
Many mentally disordered individuals project frequently. Narcissists, however, are some of the most actively and severely projecting people encountered. Ever full of accusations and criticisms, the most crazy-making thing about most of the narcissist’s claims is that YOU are doing exactly what THEY are doing. (Projection.) Have they just lied to you? Well, you’re about to be called dishonest. Are they cheating you out of an opportunity? You’re going to get the finger pointed at you for being sneaky. And you can’t say a word to them about something hurtful they have done, because that makes you an abuser – of them. You can’t give them anything but glowing feedback without their raging at you, but you’ll be the one constantly criticized severely and then called freakishly oversensitive if you show any feelings about it. And if they say so, it’s law — you don’t know what you’re talking about.
7. THEY SMEAR PEOPLE WHO OPPOSE THEM.
Narcissists are allergic to healthy boundaries and fairness. If you question the insensitive things they do or put any limits whatsoever on their bad behavior, you will be targeted for social, professional, or personal obliteration. Whatever narcissists perceive to be your psychological or situational “weak spots” will be their prime targets. For instance, if the narcissist knows that your greatest fear is social ridicule, that will be the main focus of the smear campaign. If he or she knows that recently, you made a mistake for which you feel guilty, that will be used against you. Narcissists know that the more effectively they can pinpoint your insecurities or flaws, the more successful they will be in eroding your confidence and your influence. And if they manage to do that, they stand a good chance of getting back the power they planned to do whatever they pleased with before you “got in their way”.

 

 

Childhood OCD

All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can't stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again.
About OCD

OCD is a type of anxiety disorder. Kids with OCD become preoccupied with whether something could be harmful, dangerous, wrong, or dirty — or with thoughts that bad stuff could happen.

With OCD, upsetting or scary thoughts or images, called obsessions, pop into a person's mind and are hard to shake. Kids with OCD also might worry about things not being "in order" or "just right." They may worry about losing things, sometimes feeling the need to collect these items, even though they may seem useless to other people.

Someone with OCD feels strong urges to do certain things repeatedly — called rituals or compulsions — in order to banish the scary thoughts, ward off something dreaded, or make extra sure that things are safe, clean, or right in some way.

Children may have a difficult time explaining a reason for their rituals and say they do them "just because." But in general, by doing a ritual, someone with OCD is trying to relieve anxiety. They may want to feel absolutely certain that something bad won't happen or to feel "just right."

Think of OCD as an "overactive alarm system." The rise in anxiety or worry is so strong that a child feels like he or she must perform the task or dwell on the thought, over and over again, to the point where it interferes with everyday life.

Most kids with OCD realize that they really don't have to repeat the behaviors over and over again, but the anxiety can be so great that they feel that repetition is "required" to neutralize the uncomfortable feeling. And often the behavior does decrease the anxiety — but only temporarily. In the long run, the rituals may worsen OCD severity and prompt the obsessions to return.

Causes:

Doctors and scientists don't know exactly what causes OCD, although recent research has led to a better understanding of it and its potential causes. Experts believe OCD is related to levels of a neurotransmitter called serotonin. Neurotransmitters are chemicals that carry signals in the brain.

When the flow of serotonin is blocked, the brain's "alarm system" overreacts and misinterprets information. These "false alarms" mistakenly trigger danger messages. Instead of the brain filtering out these messages, the mind dwells on them — and the person experiences unrealistic fear and doubt.

Evidence is strong that OCD tends to run in families. Many people with OCD have one or more family members who also have it or other anxiety disorders influenced by the brain's serotonin levels. Because of this, scientists have come to believe that the tendency (or predisposition) for someone to develop a serotonin imbalance that causes OCD can be inherited.

Having the genetic tendency for OCD doesn't mean that someonewill develop OCD, but it does mean there's a stronger chance that he or she might. Sometimes an illness or some other stress-causing event may trigger the symptoms of OCD in a person who is genetically prone to develop it.

It's important to understand that the obsessive-compulsive behavior is not something that a child can stop by trying harder. OCD is a disorder, just like any physical disorder such as diabetes or asthma, and is not something kids can control or have caused themselves.

OCD is also not something that parents have caused, although life events (such as starting school or the death of a loved one) might worsen or trigger the onset of OCD in kids who are prone to develop it.

Common OCD Behaviors in Kids:

OCD can make daily life difficult for the kids that it affects and their families. The behaviors often take up a great deal of time and energy, making it more difficult to complete tasks, such as homework or chores, or to enjoy life.

In addition to feeling frustrated or guilty for not being able to control their own thoughts or actions, kids with OCD also may suffer from low self-esteem or from shame or embarrassment about what they're thinking or feeling (since they often realize that their fears are unrealistic, or that their rituals are not realistically going to prevent their feared events).

They also may feel pressured because they don't have enough time to do everything. A child might become irritable because he or she feels compelled to stay awake late into the night or miss an activity or outing to complete the compulsive rituals. Kids might have difficulties with attention or concentration because of the intrusive thoughts.

Among kids and teens with OCD, the most common obsessionsinclude:

fear of dirt or germs
fear of contamination
a need for symmetry, order, and precision
religious obsessions
preoccupation with body wastes
lucky and unlucky numbers
sexual or aggressive thoughts
fear of illness or harm coming to oneself or relatives
preoccupation with household items
intrusive sounds or words
These compulsions are the most common among kids and teens:
grooming rituals, including hand washing, showering, and teeth brushing
repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, or rereading, erasing, and rewriting
checking rituals to make sure that an appliance is off or a door is locked, and repeatedly checking homework
rituals to undo contact with a "contaminated" person or object
touching rituals
rituals to prevent harming self or others
ordering or arranging objects
counting rituals
hoarding and collecting things of no apparent value
cleaning rituals related to the house or other items

Signs and Symptoms of OCD:

Recognizing OCD is often difficult because kids can become adept at hiding the behaviors. It's not uncommon for a child to engage in ritualistic behavior for months, or even years, before parents know about it. Also, a child may not engage in the ritual at school, so parents might think it's just a phase.

When a child with OCD tries to contain these thoughts or behaviors, this creates anxiety. Kids who feel embarrassed or as if they're "going crazy" may try to blend the OCD into the normal daily routine until they can't control it anymore.

It's common for kids to ask a parent to join in the ritualistic behavior: First the child has to do something and then the parent has to do something else. If a child says, "I didn't touch something with germs, did I?" the parent might have to respond, "No, you're OK," and the ritual will begin again for a certain number of times. Initially, the parent might not notice what is happening.

Tantrums, overt signs of worry, and difficult behaviors are common when parents fail to participate in their child's rituals. It is often this behavior, as much as the OCD itself, which brings families into treatment.

Parents can look for the following possible signs of OCD:

raw, chapped hands from constant washing
unusually high rate of soap or paper towel usage
high, unexplained utility bills
a sudden drop in test grades
unproductive hours spent doing homework
holes erased through test papers and homework
requests for family members to repeat strange phrases or keep answering the same question
a persistent fear of illness
a dramatic increase in laundry
an exceptionally long amount of time spent getting ready for bed
a continual fear that something terrible will happen to someone
constant checks of the health of family members
reluctance to leave the house at the same time as other family members

Diagnosing OCD:

OCD is more common than many other childhood disorders or illnesses, but it often remains undiagnosed. Kids might keep the symptoms hidden from their families, friends, and teachers because they're embarrassed.
Even when symptoms are present, a parent or health care provider might not recognize that they are part of a mental health disorder and may attribute them to a child's quirkiness or even bad behavior.
Doctors consider OCD to be a pattern of obsessive thinking and rituals that does one or more of the following:
takes up more than an hour each day
causes distress
interferes with daily activities
OCD in kids is usually diagnosed between the ages of 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone.
If your child shows signs of OCD, talk to your doctor. In screening for OCD, the doctor or a mental health professional will ask your child about obsessions and compulsions in language that kids will understand, such as:
Do you have worries, thoughts, images, feelings, or ideas that bother you?
Do you have to check things over and over again?
Do you have to wash your hands a lot, more than most kids?
Do you count to a certain number or do things a certain number of times?
Do you collect things that others might throw away (like hair or fingernail clippings)?
Do things have to be "just so"?
Are there things you have to do before you go to bed?

Because it might be normal for a child who doesn't have OCD to answer yes to any of these questions, the doctor also will ask about how often and how severe the behaviors are, about your family's history of OCD, Tourette syndrome and other motor or vocal tic disorders, or other problems that sometimes occur with OCD. OCD is common in people with Tourette syndrome.

Other disorders that often occur with OCD include other anxiety disorders, depression, disruptive behavior disorders, attention deficit hyperactivity disorder (ADHD), learning disorders, and trichotillomania (compulsive hair pulling). PANS, a rare condition that stands for Pediatric Acute-onset Neuropsychiatric Syndrome, also has been associated with having OCD. 
Treating OCD

The most successful treatments for kids with OCD are behavioral therapy and medication. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT), helps kids learn to change thoughts and feelings by first changing behavior.

Behavioral therapy involves gradually exposing kids to their fears, with the agreement that they will not perform rituals, to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur. For example, kids who are afraid of dirt might be exposed to something dirty, starting with something mildly bothersome and ending with something that might be really dirty.

For exposure to be successful, it must be combined with response prevention, in which the child's rituals or avoidance behaviors are blocked. For example, a child who fears dirt must not only stay in contact with the dirty object, but also must not be allowed to wash repeatedly.

Some treatment plans involve having the child "bossing back" the OCD, giving it a nasty nickname, and visualizing it as something he or she can control. Over time, the anxiety provoked by dirt and the urge to perform washing rituals gradually disappear. The child also gains confidence that he or she can "fight" OCD.

OCD can sometimes worsen if it's not treated in a consistent, logical, and supportive manner. So it's important to find a therapist who has training and experience in treating OCD.

Just talking about the rituals and fears have not been shown to help OCD, and may actually make it worse by reinforcing the fears and prompting extra rituals. Family support and cooperation also go a long way toward helping a child cope with OCD.

Many kids can do well with behavioral therapy alone while others will need a combination of behavioral therapy and medication. Therapy can help your child and family learn strategies to manage the ebb and flow of OCD symptoms, while medication, such as selective serotonin reuptake inhibitors (SSRIs), often can reduce the impulse to perform rituals.

Helping Kids With OCD:

It's important to understand that OCD is never a child's fault. Once a child is in treatment, it's important for parents to participate, to learn more about OCD, and to modify expectations and be supportive.

Kids with OCD get better at different rates, so try to avoid any day-to-day comparisons and recognize and praise any small improvements. Keep in mind that it's the OCD that is causing the problem, not the child. The more that personal criticism can be avoided, the better.

It can be helpful to keep family routines as normal as possible, and for all family members to learn strategies to help the child with OCD. It's also important to not let OCD be the "boss" of the house and regular family activities. Giving in to OCD worries does not make them go away.

Article from Kidshealth.org
Reviewed by: Elana Pearl Ben-Joseph, MD

Welcome Dr. Elizabeth Ault, Psychiatrist

  Family Focus is so excited to welcome Elizabeth Ault, MD, Psychiatrist, to our wonderful team of providers!  Dr. …

Jones Suzanne headshot 2017 (2)-1

WHY WE NEED TO PAY ATTENTION TO 13 REASONS WHY

WHY WE NEED TO PAY ATTENTION TO 13 REASONS WHY  by Suzanne Jones, May 10, 2017 The raw, powerful Netflix series, 13 Reasons …