I'm continuing to write about relationships for a couple of reasons: 1) this topic has been the most requested by readers, and 2) I am contributing to a public forum this coming weekend focusing on advice for a healthy and happy marriage. My hope is writing this will help you as well as help me get my thoughts in order. 

Is love enough? Unfortunately, we know the statistics. Divorce rates vary, but most have the rate in the low 40% range. Not quite the 50% that everyone talks about, but still an alarmingly high rate. So it seems like love alone is not enough, at least 40% of the time. Sorry, don't shoot the messenger.

Love may not be enough on its own, but it's a good start. When you are considering a serious commitment like marriage, you want to be thoughtful and honest about your relationship. The questions that are usually pondered are: Do I love this person? Can I see myself with this person for the rest of my life? Am I getting married for the right reasons?

How do you answer these questions? What's the right answer? Is there a right answer? Whether it's mutual love, similar interests, or "chemistry", you have to dig deeper into your relationship for the answers. This is my advice. If you ever find yourself thinking that things will get better after marriage, take a step back, a big step back.

How do you dig deeper? One option is premarital counseling. Studies show that premarital counseling reduces the risk of divorce by 30%. The goal of premarital counseling is not to find flaws in one another and point out what issues are going to be a problem. Instead, premarital counseling provides an opportunity to have a meaningful dialogue about what works in your relationship, what areas you can improve on, and what to be aware of if you choose to move forward together.

For many couples, premarital counseling is a welcomed relief. There may be life issues that have been avoided such as children, religion, family dynamics, living situation, and finances. At a deeper level, issues like communication style, stress management techniques, and personality characteristics can be openly explored and better understood by each partner. Conflict will happen, but the resolution can be easier if you truly know your partner. Part of knowing your partner is having open conversations about similarities-differences, strengths-weaknesses, and tendencies-aversions.

One potential issue for couples is misinterpreting your partner. That is, misinterpreting your partner's intentions. If your partner walks away from a conversation to think or gather their thoughts, you might misconstrue the walking away as not caring about the conversation (or relationship). If you are confused by a statement, action, or response then ask for clarification. Many potential blow-ups are avoided by simply stating, "I'm a little confused, can you say more about what you just said."

Communication style can be another major obstacle for couples. Some people like to talk immediately about a problem, while others like to have time to gather their thoughts and then come back to the issue. Generally speaking, men typically want to fix the problem, whereas women want to "talk it out." Counseling can help a couple achieve balance between these approaches or at least help the couple communicate more effectively.

Premarital counseling provides an opportunity to practice how to communicate with one another about serious issues. Confronting conflict may feel scary, but it can actually build confidence in yourself, your partner, and your relationship. The more you practice, the less anxiety, stress, and fear you will experience in the future when a difficult topic arises. You and your partner will be more aware of each other's communication styles, stress management skills, and nonverbal cues (e.g., eye-rolling, head-scratching, etc.)

Take a moment and try this exercise. Reflect on how you felt reading this post, maybe read it again. Which emotions and thoughts did you experience? Now imagine what it would be like to read this with your partner sitting beside you. Would there be tension, discomfort, fear? If the idea of reading this with your partner makes you anxious or brings to consciousness a serious but ignored issue in your relationship, then maybe this post will help open dialogue between the two of you.

I've talked exclusively about premarital counseling, but these same concepts apply to any relationship. It's never too late to improve yourself or your relationship.


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

Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support! 

If someone steps into my office, it's because there is a problem, usually a serious one. I'm still waiting for the day that someone walks in and says, "I'm doing great in all areas of my life and wanted to share that with you." Not sure what I would do. So instead of only focusing solely on how to solve particular problems, I also want to highlight the positive in everyday life. 

So why do relationships succeed? If you read my post on relationship failure (if not, you can here), then the concepts in this post should be somewhat familiar. Again, the major themes are communication, trust, and empathy. 

Before addressing the relationship themes, it may be worthwhile to stop and think about what success means to you in the context of a relationship. A successful relationship must have genuine communication, unconditional trust, and mutual empathy.

Communication. What is healthy communication? Most of you will say being open, honest, and sincere with your partner. All of that is true. Healthy communication involves each person being heard and respected. Being heard is more than someone looking at you when you are talking. It is the active participation of the other in attending to you. It includes both communicative (i.e., verbal acknowledgement, response) and non-communicative gestures (eye-contact, body language). 

The more attentive you are to the other person, the more genuine the connection. So put down the smart phone and make eye contact (don't worry, your facebook page will still be there). If the other person does not have your undivided attention, then the other will be less invested in the conversation. For that moment, the other person will be less invested in you. How do you feel if you are talking to someone and they are multi-tasking? People in successful relationships emphasize the importance of genuine communication between partners. 

Trusting your partner and the relationship. Trust is following through on what you say you are going to do. This includes major commitments (i.e., honesty, faithfulness, integrity) as well as the smaller details (i.e., daily responsibilities, punctuality, etc). It may seem silly to have your relationship impacted by forgetting to do the dishes. However, I've had many couple sessions where people express that the lack of commitment to the small things becomes a big issue over time. No one is perfect, everyone makes mistakes. You can either acknowledge your limitations and work to improve or make excuses. One builds the relationship, the other hurts it.

Trust is knowing that something is important to your partner without your partner having to tell you repeatedly. I’m not saying you should be a mind-reader. However, you should be attuned to what matters to your partner. By being proactive or even active, your partner will notice that you are trying to meet their needs. This goes a long way in the process of building trust. 

Trust is strengthened by being honest with each other. Being honest does not mean you are an open diary all of the time; it can include saying, “I’d rather not talk about it now, maybe later?” This type of statement sends two messages: "I’m not in a good place right now, but I do want to talk about it with you at some point." At a deeper, relational level, this statement also says, "I can be vulnerable with you and I trust that you won't use my vulnerability against me." This is a subtle but very powerful component of a relationship (I'll write more about that in a future post titled "It's about the process"). When you feel weak and need support, a good partner will be there for you. These moments strengthen the relationship and builds trust.

Empathy. The concept of empathy is known by many, but the application can be a challenge. Empathy is the awareness of another person's feelings. The common metaphor is "put yourself in the other person's shoes." Training yourself to be empathic is a great skill to have for any relationship. A question to ask yourself is "How might the other person be feeling right now?" It's that simple. Empathizing with your partner does not mean you are wrong, or they are right. It means you are trying to understand and connect with your partner's emotional world and actions. Empathy involves setting aside your feelings (no, not dismissing them) for a moment and connecting with your partner's feelings. This may not solve the issue, but it can strengthen your relationship. 

Reflect on your current relationship and even past relationships. What went wrong? What went right? What can I change? I imagine that the answers to these questions will involve one, two, or all three of the relational themes. 

Healthy relationships are a combination of minimizing the unhealthy and maximizing the healthy. It's not an either-or scenario: you can't just avoid the negative or just emphasize the positive. If you want to be a physically healthy person, you have to minimize junk foods AND have a healthy diet. A relationship is work, but I can't help but reflect on something my dad says to me (all the time, I mean, all. the. time.): If something brings you happiness and success, is it really work?


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

Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support! 

Why do relationships fail? On the surface, I am sure you can think of many reasons. Ultimately though, failed relationships are due to problems in communication, trust, and empathy. More specifically, relationships fail because of an inability to communicate between one another, a lack of trust with the other and the relationship, and a disconnect with the emotional world of your partner. All three interact in a systemic way, each impacting the other two.

Inability to communicate with one another. Talking sounds simple enough. However, this is where quality is more important than quantity. Talking isn't difficult, we talk to our partners everyday (I hope). It's the depth and richness of what we communicate that strengthens a relationship. In failed relationships, the majority of the communication that exists falls into two categories: superficial or lacking. Superficial communication is mostly noise; conversations that are unrelated to your relationship or your partner. Even worse is when communication is lacking. In these situations, you can feel the distance growing between you and your partner, the relationship slipping away slowly but steadily. The more the communication deteriorates, the harder it becomes to talk about meaningful issues.

Problems trusting the other and the relationship. Trust is always a part of any discussion about relationships. You trust your partner to be open, honest, and respectful with you. You trust your partner to invest in the relationship as much as you do, to be committed to growing together. Trust is undermined when the same problem repeats itself. Deception and lying is a common trust issue. A person lies, the lie is discovered, a promise is made to not lie again, and then another lie follows. Over time, trust is lost and the relationship is in serious trouble. If you can't trust your partner, reevaluate your relationship.

Related to trusting the other is trusting the relationship. Trusting the relationship means believing that your relationship is strong enough to open a dialogue about uncomfortable and even painful topics. It's believing that your relationship can endure a conversation that may lead to conflict, an argument, or even a breakup. Some relationships fail because both people are worried if they bring up a difficult conversation, then the relationship won't survive. The irony is by not bringing up potentially difficult conversations, the relationship can not thrive. If you find yourself wanting to express something to your partner but you can't, it might be worthwhile to examine how you feel about the other person and the relationship. Conflict is a part of any relationship, but it doesn't have to be the beginning of the end.

Disconnect with the emotional world of your partner. In one word, this refers to empathy. Unfortunately, it's a lack in empathy. Empathy is a necessity of any relationship. Empathy does not mean radical forgiveness, acceptance, or submission. It does not mean that you allow your partner to do whatever he/she wants and you accept any and all behavior unconditionally. Empathy refers to understanding how your partner feels at any given moment. Many relationships end because of the inability to understand the perspective of the other person. In many instances, one person feels so strongly that it blinds his/her ability to even consider the other person's feelings. Sometimes an attempt is made to empathize with the other, but the feeling seems so foreign or wrong that it is hard to process the experience from an opposing point of view. Trying to empathize and understand the other person's experience is sometimes seen as a weakness. When empathy is perceived as a weakness, the relationship will fail.

In couples therapy, most sessions involve a discussion of communication, trust and empathy. What is your communicative style? What does trust mean to you, your partner, and your relationship? What role does empathy play in your life and relationship? Many sessions often reflect back on previous relationships, and even childhood, to gain insight into what communication, trust, and empathy looked like throughout your development. In session, a therapist is able to see the live relationship between the two individuals; how each empathizes (or doesn't) with the other, how trust (and distrust) affects the ability to listen, communicate, and connect with each other. I often ask one partner how the other partner is feeling in different moments, which allows for a conversation about how they are on the same or different emotional wavelength. If your relationship is in trouble, seek couples therapy before there is irreparable damage.

There are many reasons why relationships fail, but difficulties in communication, trust, and empathy are always involved. I must say that sometimes relationships are just not meant to be. It's no one's fault, some relationships simply aren't a good match (like oil and water, or my wife and smartphones).


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

Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support! 

Anxiety disorders are the most common mental illness in the U.S. Approximately 20% of adults suffer from clinical levels of anxiety. The numbers are in the 10-15% range for those under the age of 18.  Approximately 1/3 of all people suffering from anxiety disorders seek treatment. The rest do not.

Anxiety is a normal part of life. In fact, studies have found that a moderate level of anxiety, compared to low and high levels, results in greater performance on a number of tasks. So anxiety is healthy. It only becomes a problem when it interferes with your daily functioning.

Most people think of an anxious person as looking nervous, always worrying, or acting impulsively. But anxiety can manifest itself in ways that seem to have little to do with anxiety. Irritability and anger can be a byproduct of anxiety. Taking more than an hour to fall asleep may be a sign of underlying anxiety. Daydreaming and being preoccupied with your thoughts can be signs of anxiety. Anxiety has many shades. 

Anxiety is usually associated with depression, and vice versa. I would estimate that over 90% of the people that come to my office are struggling with anxiety and/or depression. Anxiety can manifest in a number ways: physically (e.g., excessive sweating, difficultly breathing, trembling), physiologically (e.g., abdominal pain, heart palpitations, and chest pain), and cognitively (e.g., inability to concentrate, excessive worrying, and memory problems). These are a handful of the many symptoms experienced by individuals suffering from anxiety.

My therapeutic approach (for anxiety and most disorders) is to understand the root causes of your anxiety. When did it begin, how was your anxiety managed at a young age, what is anxiety like for you, what happens when you become anxious, how have you tried to cope with anxiety? These questions require analysis of the present and the past, to gain insight into life experiences that may reveal pieces of the anxiety puzzle.

In many cases, anxiety is related to a fear or avoidance of 3 things: the unknown, the unpredictable, and the uncontrollable. It is common for someone suffering from anxiety to have had an unpredictable, negative life experience (e.g., sudden move, loss of a loved one, betrayal/violation of trust, instability in early life, accident with major injury, etc.). In almost all instances, the person describes the experience with a sense of feeling out of control, helplessness, and fear. These feelings begin to drive your behavior, in an attempt to avoid the unknown, unpredictable, and uncontrollable.

The result is you try to control too much of what is happening to and around you. At some level of consciousness, there is a drive to avoid the negative emotions of feeling out of control, powerless, afraid. If you believe you are in control, then you can limit the probability of an unpredictable, fearful event. You can avoid those experiences of helplessness and uncertainty. Unfortunately, this type of strategy can only be maintained for so long before our mind falters, and anxiety starts to spiral out of control. Perspective is lost, and the ability to manage anxiety has been replaced by the crippling feeling that nothing can help.

Anxiety is like a leaky faucet. Initially, it doesn't seem like a problem. Maybe ignore the dripping or try to tighten a nut. If it still drips, it's okay because it is dripping slowly. Over time that slow drip quickens. All of a sudden, the water is flowing and it can't be stopped. At this point, control has been lost and the anxiety takes over. Anxiety feels overwhelming, paralyzing. I have had patients describe anxiety as a "recurring tsunami" and "chains that tighten as you try to escape." If you can relate, there are ways to get help.

There are a number of resources available to overcome severe anxiety. Therapy can be very helpful. Simply talking about your anxiety can alleviate symptoms. By addressing personal experiences (past and present) associated with your anxiety, you are confronting distressful thoughts and feelings that were once seen as unapproachable. You will become more aware of your tendencies in anxious situations, which will better prepare you for the next anxious experience. You will gain clarity on how to effectively cope with anxiety; which strategies are effective and ineffective. Anxiety will no longer be as daunting as you thought; instead, it will become approachable and ultimately manageable. 

The first step is always the hardest, but it can be the simplest. Talking about your anxiety can seem impossible, but when you find the strength to do it, you will find relief. 


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

Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support! 

Glass half-full or half-empty?  Based on your response, your worldview could tend to be more optimistic or pessimistic.  We are all familiar with the expression.  So I chose to mention it for a couple of reasons: 1) it's familiar 2) I'd like to use a similar analogy to explain depression.

There are a number of theories that explain depression from a genetic cause to environmental factors to an imbalance in specific neurotransmitters.  There are a number of ways to conceptualize and work with depression.  I will describe one approach here, the glass of water approach.  I was first introduced to this approach by my supervisor during internship, a very skilled therapist.  Before I go further, I have to emphasize that depression is complex, not every depressed person fits into what I describe below.  Each person is unique.

Think of yourself as a glass of water, neither half-full nor half-empty.  Now let's take a moment and focus on the actual water in the glass.  The water is the accumulation of single drops of water.  Think of each drop of water as a life experience.  It doesn't have to be a major experience, it could be any experience.  Anything from your first day of school to what you had for lunch. Both positive and negative experiences, they all accumulate in the glass.  As you have more experiences, the water level rises, drop by drop. 

For someone struggling with depression, the water in their glass has more drops of negative experiences than positive ones, or the impact of the negative experiences is greater than the impact of the positive.  Sometimes that is actually the case and sometimes that is the perception.  Part of therapy is determining whether the individual's perception is accurate or distorted.  Let's assume accuracy, the depressed individual has more negative experiences than positive.  So what can be done?

My approach is not to sugarcoat what has happened. Bad things happen in life, there is no getting around that. It's a part of life.  For depressed individuals, It is often suggested to focus on the positive or to look at how the negative might be a positive.  Sometimes this approach is effective, many times it is not.  The glass of water approach acknowledges the negative experiences and focuses on how "drops" of positive experience can be added to the water in glass.  The belief is that your experiences are real, they have shaped who you are. The negative experiences were painful.  Let's focus on figuring out how positive experiences can be added to your glass.  

A new positive experience does not replace a negative experience, but it may neutralize the impact of the negative experience.  The more drops of positive experience into the glass of water, the less likely that the negative experience will have a profound, lasting impact. 

For example, if you have a bad morning followed by a bad afternoon, you'll probably be in a bad mood that night. However, if you have a bad morning followed by a pleasant afternoon, you will probably be in a better mood than the previous example.

What is a positive experience?  Simply, an experience that brings you happiness or joy.  A potential hurdle, especially with depressed individuals, is they can truly feel there is no positive or pleasurable aspect of life.  It's a huge challenge to even think about something positive.  
A positive experience may be a non-negative experience. In that case, simply providing support and care may be the main focus of therapy, with occasional analysis of the depressive episode.  One strategy is to explore what brought you pleasure before the depression arose (e.g., spending time with family and friends, alone time, exercising, music, reading, being outside, etc.). Talking about these experiences can ease the depression and bring about hope and some level of optimism.    

So if you are struggling with depression, ask yourself what brings you joy, what eases the pain.  If you are able to come up with a list or ideas, follow through with them.  

This has been a simple description to a complex issue.  For the sake of brevity, I kept this short.  I hope no one was offended or thought that overcoming depression is always easy.  That certainly was not my intent.


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

Salmaan Toor is a licensed clinical psychologist practicing in Knoxville, TN. If you are interested in being notified of future posts, you can “like” The Family Center of Knoxville on facebook here or can follow me on Twitter here. Thanks for your support!