In working with families, a big part of the therapy process is helping each family member find their voice in a healthy and productive manner. In finding your voice, I am referring to the ability to express your thoughts and opinions in a way that is heard and respected.

Unfortunately in many instances, family conflict revolves around finding your voice, or lack thereof. The biggest complaint from kids about parents is they aren't allowed to express themselves, they are either dismissed or ignored. When this issue is brought to the attention of parents, the parent(s) usually has a logical and reasonable explanation. For example, a kid suggests pizza every night for dinner and the parent responds with a “no” without discussion. Many will read this and think what's the problem. The answer is it depends.

If you have a kid that feels heard and validated, then this conversation isn't a problem. If you have a kid that feels ignored or unheard regularly, then this is another example of being dismissed. I'm not suggesting to have pizza night nightly or even every week; the issue here is allowing your kid to speak their mind, to have a say. In this situation, I would suggest for the parents to listen to why it makes sense to have pizza every night, empathize with your kid's excitement at the idea of having pizza nightly, and ultimately explain why this proposal is unrealistic.

Again, many may be thinking why even go through these steps for such a silly proposal. It's less about the proposal and more about having a real, fair conversation with your kid. The more a parent listens to a kid's thoughts and feelings, the more likely the kid is to respect and accept a parent's decision.

I thought it would be helpful to share a few statements that I hear on a regular basis from kids about their parents:

Parents are always right, they are never wrong. This is a big one. What's the point of expressing your feelings to someone who isn't open to another perspective? In these situations, kids distance themselves, the relationship weakens, and kids go elsewhere for care and support.

When it's clear that they are wrong, they never say they are sorry. Apologize when appropriate. I say this all the time to parents and anyone in a mentor role. An apology expresses that you care about the other person and it's perfectly normal to be imperfect.

They don't follow the rules that they make us follow. If your kid makes this type of observation, take a moment and reflect on if they have an accurate impression of what just happened. Even if they don't, ask them why the feel the way that they feel. If they are right, then admit it.

Obviously not all kids feel express these type of parental issues, not even some of the time. However, these are great examples of how kids can feel helpless and unheard. Help your kid find their voice in discussions, it will help with their self-esteem, confidence, and future relationships.


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I get two basic questions when a parent sets up an appointment for their child:

1) What should I say to my child about their appointment?

2) What happens during the first appointment?

Let's go one at a time and assume that we are talking about children under the age of 12. Most kids over the age of 12 actually ask their parents if the can talk to someone. Of course there is a significant difference between a 12 year-old and 5 year-old so you adjust your conversation to an age appropriate level.

What should I say to my child about their first appointment?

This is a question I address during the phone consultation. First, tell your child about the appointment at least a day or two before the appointment. If your child is anxious and you feel that it will exacerbate their anxiety, go with what works. I've found in most instances that kids actually feel relief and curiosity when they learn that they are going to talk with someone about their emotional issues.

Especially for young children, make clear that they aren't seeing a medical doctor, they are seeing a “feelings” doctor. It's okay to be more specific, especially if your child has opened up to you about complex, confusing issues like depression and anxiety. Also make sure that your child knows that there are no shots or medications involved in this appointment, only talking. You would be surprised by how many kids assume a shot or medicine is involved when they hear “doctor appointment.”

Lastly, frame the appointment with concern and care. It's okay to say that the school or family has concerns and this appointment is to help. In many cases, the child has raised the concern and the desire to see a therapist, so it might be welcomed with open arms. You can also add that it's up to the child if they want to meet alone or would feel more comfortable with a parent in the room. The choice is theirs to make.

What happens during the first appointment?

The first appointment is an opportunity for the child psychologist to help the child feel comfortable with the idea of therapy. I usually spend the first part of the session reviewing patients' rights, my responsibilities, office rules, and other details like the length of sessions and who I am. I also try to mix in some humor or silliness to help the child feel more relaxed and playful.

How the first session progresses is up to the child. Especially in play therapy, the goal is for the child to feel like they have a safe, nonjudgmental space. Sometimes a child will want a parent or caregiver to accompany them for the entirety of the session. In other instances, a child might walk in and say “see you whenever we're done” and leave their parent(s) in the waiting room. It depends on the child and neither approach is wrong. The goal is to make sure the child feels that therapy is a safe space where they are respected and valued. That's the foundation of any healthy relationship.

Certainly there are exceptions to the rule, but this is a fairly accurate impression of how I encourage informing a child about an upcoming therapy session and how most first sessions go in my office.


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There is an underlying belief that the legalization of marijuana is harmful because marijuana is a gateway drug. I always ask law enforcement about marijuana being a gateway drug and the answer is almost always a unanimous yes.

However, research tells a different story. I'm not about to argue for the legalization of marijuana, that isn't the message I'm attempting to convey. Rather, I'd like to illustrate how alcohol is actually the gateway drug, and how we as a society seem to be okay with alcohol's harmful and often deadly consequences.

A recent study found that teens who abused alcohol are twice as likely to abuse prescription opiate drugs than those who only used marijuana. This is an important statistic because prescription drug abuse and overdoses are skyrocketing across the country. Opiate drug overdoses kill more Americans yearly than cocaine and heroin overdoses combined.

Alcohol research tends to focus on underage/teen use. In a recent survey by the Centers for Disease Control (CDC), 25% of 8th graders, 40% of 10th graders, and 53% of 12th graders reported drinking alcohol in the last month. If this isn't alarming enough, the study dug deeper and found that 79% of teens drank because it felt good, 67% to forget their problems, and 66% because of peer pressure. For me, these responses allude to underlying mental health concerns like poor self-esteem, deficits in coping skills, depression, anxiety, and loneliness.

Makes sense, right? Adolescence is tough for teens and parents. Teens are dealing with social and academic pressures, identity issues, and navigating the world of independence. So what's the excuse for adults? Over 35,000 adults die each year from dependent and non-dependent use of alcohol (CDC). When including unintentional deaths, homicides, and other indirectly related deaths, the 35,000 number more than doubles. According to the National Council on Alcohol and Drug Dependence (NCADD), alcohol plays a role in approximately 40% of all violent crimes in a given year. That equates to almost 4,000 violent crimes per day.

Most feedback from adults for reasons to drink ironically sound very similar to teen responses: for fun, to relax and forget about problems/stress, and because of social expectations. The problem here is the more you drink, the worse you think. Over time, social drinking can evolve into an addiction and into your preferred coping mechanism for stress or any issue.

So what is really being said when a teen is told that they can't drink until the arbitrary age of 21? You aren't old enough to handle the responsibility of drinking at this time, wait a few years. The problem is that millions of adults show time and again that they can't handle the responsibility either. Research repeatedly shows that most people use alcohol as a coping mechanism, as a way to avoid real life issues.

At a societal level, it seems there is a hint of “oh, he's been drinking, that explains it,” to justify behavior. It is almost as if alcohol is being blamed, taking away the responsibility from the individual.

There needs to be a shift in the alcohol dialogue. There needs to be more honesty and courage. Alcohol needs to be talked about for what it is, an unhealthy coping mechanism for many that kills tens of thousands every year. The statistics don't lie. Maybe “happy hour” should be renamed “ignore your problems hour".


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Ten years ago my brother and I went on a cross-country road trip. Five years later, he mentioned that trip in a speech at my wedding. The memorable part for him wasn't getting to the Pacific Ocean, it was the small experiences along the way: the landmarks, hours in the car, small-town diners, and random social encounters. The journey of being together.

In much the same way, therapy is a journey. A person walks into the first appointment (intake) struggling in some life facet, seeking answers. The person has usually sought answers prior to coming to therapy whether through self-reflection, friends, family, self-help books, or the internet. Therapy, if successful, helps the person realize that personal growth is finding comfort and strength in the struggle. A dear colleague once said, “Patients are struggling in the search of answers, our job is to help them be okay with the struggle of the question.”

If someone comes to an appointment asking why bad things always happen to them, I'm probably not going to be effective if I respond with answers for their questions. After all, the question has probably been asked numerous times to friends and friends. I would be just another opinion. My impact is helping that person in becoming more comfortable with the emotional discomfort of feeling like bad things always happen. The more comfortable a person becomes, the better able they are to challenge rigid ideas and thoughts and manage their emotions and stress.

A mentor repeatedly would say to me, “Salmaan, it's about the process, not the content.” It took me years to understand the essence of this statement. The content of a relationship is the back and forth storytelling. The process of therapy is the actual sharing and connecting in the experience, allowing yourself to be vulnerable and radically honest with another person. At some level, what is being shared (content) is minor, the actual sharing (process) is significant.

Let's take a patient with anxiety to illustrate the content and process of therapy. The content is when a person talks about their anxious symptoms. It's helpful but it's distant, it's what has happened “out there” in the world. When the focus moves into the room, on how the anxiety is impacting the therapeutic relationship, this is the process. Exploring the anxiety happening right then and there, how to manage it, and how to recognize that it is manageable. It''s much easier written than done. It takes time and that's perfectly normal.

Recently, I posted and wrote about a great experiment on gratitude. This was a fantastic example of the power of process, how even the smallest moment could have a significant impact on overall life satisfaction and relationships. The content is what is shared, the process is how you shared.

I hope the difference between content and process is clear. If not, I'll try one more time. Occasionally, you may see a facebook status where one person will proclaim their love for another person. What you read is an example of the content. The process would be the person sitting down, thinking about the loved one, writing a status, and sharing it for everyone to see.

This may seem like a random topic, but I feel that it underlies not only therapy but any relationship that you wish to be meaningful. At some level, it's also to remind myself, "Salmaan, it's about the process, not the content."


As usual, feel free to share this post via facebook, twitter, etc. Comments are welcomed!

If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville facebook group by clicking here. You can also follow me on twitter here. Thanks for your support!