Hey Salmaan, I wanted your opinion regarding conversion therapy considering you are in the field. Particularly because you are a Muslim, what's your opinion about conversion therapy and what role do your religious beliefs play in working with someone who is gay.

-- Anonymous, August 2013

I openly admit I do not have first-hand experience with conversion therapy, I have only heard stories from those who were willing and unwilling participants. The stories I have heard have been negative; however, I know there are positive stories out there.  I am not sure if a “conversion” to heterosexuality makes the therapy a success, or if the goal of conversion therapy is to manage homosexual desires in a heterosexual manner. It's certainly controversial, and therapy in general is usually a failure if the participant has been coerced into therapy.

In my professional work, when someone who is confused or struggling with their sexuality enters my office, I focus on the struggle and confusion. I never have and never will push someone to one orientation or another. That's me speaking as a psychologist and a Muslim. Maybe I'm doing my faith a disservice, but I don't think so. In my life and work, I believe it’s not my place to judge; my role is to increase understanding and awareness in your life.

Part of therapy with me is having a conversation about what would it be like to be straight and what it would be like to be gay. This allows for a genuine analysis of how the person feels and may bring clarity regarding their sexual orientation. If someone wants to talk about the role of their faith, that conversation is certainly explored. Many do struggle with balancing their religious beliefs and their orientation.

In my experience, people know their sexual orientation upon entering therapy. Therapy is usually more confirmation and supportive than analytical. A major part of the therapy is how to manage current relationships, especially family relationships. For many, the major stress is how to tell family, especially if the family is opposed to the lifestyle. The fear of being ostracized and disowned from their family is very real for many.

For those who have been adamant that homosexuality is a choice, I always say your political/religious affiliation is a choice, so spend the next 5 years genuinely being of a different political mindset or different religion. That might provide perspective into what it is like to pretend to be something that you are not. That’s my personal belief.

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! 

In case you missed it, there was an entertaining dialogue between Tina Fey and David Letterman on his show the other night. You can watch the clip here.

To paraphrase, Fey pondered aloud whether her 2 year-old might be a sociopath because of a few incidents, including an end-of-bath-time choking episode. All of this was in a humorous way but it's an interesting observation.

Most are familiar with the term "sociopath", but for clarity I will highlight some characteristics of a sociopath. Sociopaths tend to lack remorse, shape their sense of morality for personal benefit, manipulate and exploit relationships, are intelligent, have violent tendencies (especially against the defenseless or weak), and can seemingly respond unemotionally to an emotionally-charged situation. 

I imagine your child has exhibited these traits at some time in their short lives. I hope so, because it is largely normal and part of the developmental process. Think about it, your toddler disturbs your sleep and functions on their schedule, your child might lie to get something or hurt someone's feelings without showing care/concern, and your teen may have behaved in a self-centered, selfish manner. These are all sociopathic behaviors, not traits, just behaviors.

So what can Tina Fey and other parents do to nurture these sociopaths into emotionally well-adjusted adults? 

Teach your child about emotions and relationships. When they act, help them understand why their friend (or you) felt happy, sad, or any emotion. There is a big difference between saying "Don't do that!" and explaining why something should (not) be done.

Explain to them why sometimes it's appropriate to say, "I'm sorry". Learning to apologize will help your child gain empathy and insight into other's thoughts and feelings. Apologizing is uncomfortable for some, so it's good to normalize the process.

Role play. With kids, simple is best. Any lecture on empathy, respect, or trust will probably be too overwhelming. If your child calls someone a name (e.g., stupid), you can ask your child how it would feel to be called stupid. The message can really sink in by acting out each role so your child can see what they are like and what it feels like to be the other.

Model appropriate behaviors and emotional expressions. A child's main reference for learning is their caregiver(s). Show your child how to express emotions appropriately and how to engage in healthy conversations. No one is perfect, so when you make a mistake or say something you shouldn't say, own it. This will teach your child that it's perfectly okay and normal to make mistakes.

If you are having trouble managing your emotions and relationships, find someone to help. It doesn't have to be a professional. It can be a family member, friend, or anyone who would be a positive, healthy person in your child's life.

It's important to always remember that kids make mistakes. With your guidance, your child will develop a sense of empathy and respect for others. It will take time and is a long-term project. I encourage you to work on empathy as early as reasonably possible, but know that their behavior won't consistently change until early to middle childhood (5-10 years of age).

As usual, feel free to share via facebook, twitter, etc. Comments are welcomed. If you are interested in being notified of future blog posts, you can “like” The Family Center of Knoxville page by clicking here.

Suicide is a mostly avoided topic, but there is a good chance you will be impacted by a suicide in your lifetime. More than likely, you will personally know someone or know of someone who has taken their life. Here are some sobering statistics (courtesy of the National Center of Health Statistics, 2010):

Suicide represents 1.6% of all deaths in America.

Suicide is the 2nd leading cause of death among teens.

Suicide ranks 10th in causes of death in America. Homicide is 16th.

Men are 4 times more likely to carry out a successful attempt than women.

Women attempt suicide 3 times as much as men.

There are approximately 1 million suicide attempts/year.

So what do you do if feeling suicidal? It’s important to know that as lonely and hopeless as you feel, many people from all walks of life have suicidal thoughts. Feeling suicidal is scary, but it’s not uncommon. Suicidal thoughts are the result of being overwhelmed with feelings of sadness and pain. You feel like you can’t cope and there is no other option. What’s important to know is with time and healthy choices, suicidal feelings can pass and you can regain control of your life. Here are some things that help if feeling suicidal:

Talk to someone.  Don’t keep suicidal feelings to yourself. Talk to someone. Feeling understood will decrease the loneliness and hopelessness.

Avoid drugs and alcohol.  Some feel that drugs and alcohol numb the pain; however, drugs and alcohol can actually exacerbate suicidal thoughts and feelings.

Make your home safe. If you have thoughts or a specific plan of how to hurt yourself, remove household items, weapons, and/or medications from your home. If you can’t, then go to a safe place or have someone remove the items for you.

Exercise and get outside.  Try to exercise for 30 minutes. Go for a walk outside. Even 10 minutes of activity can result in an improvement in mood.

Keep yourself busy.  Staying busy keeps you from thinking about suicide and keeps you productive. It also gives you time to gain perspective on your situation.

Focus on what keeps you from attempting suicide.  You are alive and that is for a reason. Focus on what keeps you alive (faith, family, friend, hobby, anything that helps).

You may be thinking that everyone will be better off, or even happier, if you aren't around. That is never the case. A suicide leaves a path of pain and sadness behind for those left to deal with the aftermath.

If you are feeling suicidal, there is always someone to talk to. In the U.S., you can call:

The National Suicide Prevention Lifeline at 1-800-273-TALK (8255)

The National Hopeline Network at 1-800-SUICIDE (1-800-784-2433)

Outside the U.S., you can search for a resource in your country by visiting the website below:

http://www.befrienders.org/directory

If you know of someone who is suicidal, you can call 911 or take the person to the nearest emergency room.


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! 

A major part of therapy is increasing your awareness, not just of your surroundings and other people, but also of yourself. Self-awareness is a process centered on gaining insight into how your thoughts and feelings impact you, others, and relationships. In this post I want to take a tangible turn and focus on listening to your body, literally.

The idea of becoming more aware of your physical experience and signals is grounded in the mindfulness process. I’ll write more about that at a later time but if you are interested, just do a quick search of mindfulness.

It’s my belief that the majority of mental health issues come down to a combination of feeling depressed, anxious, or both and struggling with how to cope with these feelings. This is a gross simplification, but in the end most conditions have an anxious or depressed underpinning. I often ask patients how you know you are depressed, anxious, or both. How do you know? Most describe an event (or many) that explains a change in their emotions and behaviors. This is an appropriate response, but it usually doesn't include a description of how their body is reacting during times of duress.

About those body signals. I start with fairly easy, straightforward questions. How do you know you are hungry or thirsty? How do you know you are hot? The answers are obvious: stomach growls, throat is dry, you sweat or feel warm. The same rationale applies to depression and anxiety or any emotion for that matter. Your body almost always tells you when you are happy, sad, angry, etc.

Even when feeling depressed your body sends you signals. Common symptoms include but are not limited to lack of energy, somatic complaints (aches and pains), decreased appetite, and tears from eyes (also known as crying). As for cognitive issues, symptoms include poor concentration, negativistic thinking, and memory problems.

For anxiety, common cognitive symptoms include but are not limited to excessive worrying, difficulty concentrating, and attention issues. Physical symptoms include sweating, tremors and shakes, chest pain, fatigue, and nausea.

Increase your body awareness when in an emotional state. Specifically, ask yourself what is physically happening when you are happy, sad, etc. Making connections between bodily cues and emotions will lead to an improved quality of life. For example, if you know you have trouble paying attention when anxious, by identifying the anxiety you can then intervene with relaxation techniques before the anxiety impacts your thinking. If you have unhealthy conversations when feeling hurt, recognizing your emotions will assist you in coping with your hurt feelings until you are in a psychological state where you can have a healthy conversation.

A good exercise is to reflect on the lowest and highest moments of your day (or any memorable experience), how you felt, and what if anything was happening with your body. As you do this more often, you will become efficient in identifying the body-emotion connections. Soon you’ll be able to recognize how you feel during that emotional experience instead of afterwards. I’ll write much more about how to become more mindful of your body and experience in the coming weeks.

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

In a relationship, how do you tell your partner hard things they don't want
to hear? 

-- Anonymous August 2013

So this question not only comes up in most therapy experiences, but also on a daily basis for most people. If someone is complaining or expressing frustration about a relationship, there is probably a conversation that hasn't been had, that needs to be had.

Relationships are work. Relationships are fun when things are going well. Maybe that’s why it’s difficult to have a conversation that may lead to a disagreement, argument, or even a breakup. At some level, there is fear and anxiety about what might happen if avoided issues are brought to attention. When a relationship seems to be going well, it takes a lot of courage to discuss an issue that may lead to conflict.

So how do you have a difficult conversation with a loved one? Here are a few things to consider.

Imagine your partner’s emotional reaction. Recognize why you feel the conversation will be difficult. Try to imagine how your partner might react. If you think they will respond with anger and defensiveness, then try to start the conversation by saying you are not trying to cause hurt or anger (or any negative emotion). If your partner expresses hurt or anger, then apologize and repeat that your intent is not to hurt but to better a situation.

Emphasize care and concern. Clarify that you are bringing this issue to attention because you care about the other person, and how certain actions impact your partner and you. Reiterate that you are initiating this conversation out of care and love, and that the conversation is needed for change; change that would benefit your partner and the relationship.

Find a moment of empathy. Recognize how you feel. Then find an experience where your partner felt the same way. Make a connection between the two. Let’s say you are frustrated by your partner’s pattern of starting but not finishing a task. With that, let’s say your kids have a tendency to not put their toys away after playing and it’s very frustrating for your partner. Then you could say, “You know how you feel when the kids leave a mess of toys, that’s how I feel when you start something and then don’t finish it.” Connecting an emotion with your message increases the impact of your message.

Context and comfort. Understand your partner. If your partner prefers to talk privately, then have a private conversation. If they are more comfortable knowing ahead of time that a serious conversation is needed, then give them a heads up. Providing a familiar environment is a great way to give your partner a sense of control and to show that you are attune to their feelings.

I usually do not recommend this, but if they are more comfortable communicating via email, then try initiating the conversation via email. Again, I don’t recommend having an email conversation instead of a face-to-face conversation, but for some it’s an easier, more comfortable way to express thoughts and absorb information. You have a better chance of a productive conversation if both people are in a relaxed mindset.

Praise. Lastly, appreciate your partner for being open to a difficult conversation. Even if an issue isn't resolved, praising your partner's effort of being attentive and listening to your feelings will make future conversations smoother and hopefully productive. A simple “thanks for listening” can go a long way.

Although scary, these are the type of conversations that can strengthen your relationship. Openness about one’s feelings in a relationship sets clear and healthy boundaries for you and your partner. You can read more about boundaries here.

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

First of all, it’s not common for patients to add me on facebook. However, it happens enough that I feel a need to comment on it. There is nothing special about me, and it’s actually natural and sensible to add someone that you are associated with, even if it is only for correspondence.

With that said, I can’t be your facebook friend for primarily one reason: it’s a boundary issue. Some might be thinking, “Calm down, it’s only facebook, it’s not a big deal.” This isn’t about being a clinical psychologist and not sharing personal things with the patient. This isn’t about me wanting to keep patients from seeing that I’m a passionate Tennessee alum (go Vols!). It’s about you, and why you are seeking out therapy. Let me say more.

The vast majority of patients seek my services because there have been boundary issues in their lives, past and present. What’s a boundary issue? It can be many things: from being in an abusive relationship to always doing whatever your partner/friends want to do on a night out. It can be parents treating you like a child when you are in your 30s and beyond. It can be your boss putting inappropriate work demands on you. Lastly, it can be boundaries within you; whether it’s poor eating habits or making the same unhealthy life decisions time and time again. Poor boundaries lead to mental health issues like depression and anxiety.

Therapy is your space to improve yourself. One of the ways to work on yourself is to have an appropriate, healthy relationship with your therapist. This type of relationship is defined by mutual respect and honesty. A hallmark of respect and honesty is to have potentially uncomfortable conversations and still know the other cares and wants what’s best for you.

So yes, it’s uncomfortable to sit with someone and say that we can’t be facebook friends. The degree of discomfort increases when you follow the facebook conversation with the continuation of your session. However, by openly talking about the friend invitation, you learn how to have a difficult conversation and still maintain a strong connection with the person. These conversations strengthen the relationship. You will realize a relationship isn't defined by agreeing all the time.  A healthy relationship is defined by how you connect with one another, not necessarily what connects you.

This all applies to your relationships outside of the therapy room. That uncomfortable conversation actually gives you confidence and strength going into other relationships. If you can have an uncomfortable conversation with your therapist (and survive), then maybe you can have that conversation that you've been meaning to have in other relationships (and survive). Feeling comfortable with uncomfortable conversations will help you define and maintain boundaries in your relationships. Those boundaries are ways of taking care of your needs. In any relationship it’s important to find balance between the needs of each individual.

I can see myself having friendships with the vast majority of my patients. At times, the session has a friendly feel. I am fortunate to have the opportunity to work with unique individuals. Part of my responsibility is taking care of the needs of my patients, even if it means a friendship is confined to moments in my office.

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

When it comes to parenting, I certainly do not have all the answers, but I've learned a few things I wish I knew when expecting our first child. Most everyone congratulates you and says, “You’ll love it!” I had one friend that gave it to me straight, “It’s awesome and amazing, but being a parent is the most challenging thing you’ll ever do.” That conversation helped immensely. Let’s get on with the tips:

1) Read books if you want, but they won’t fully prepare you to be a parent. Go ahead and read books, it’ll help with the anxiety. When it comes down to it, something from within you comes out (no, not the baby) and your natural parenting skills kick in. Books prepare you intellectually, but the parenting experience is a largely emotional one.

2) You are entering the most rewarding and challenging job you’ll ever have. It’s that simple, within minutes you can go from tears of joy to tears of frustration. Parents who previously considered themselves unemotional find themselves wiping away tears when asked about the birth of their child. For the challenging moments, take a step back, get perspective, and get back in there.

3) Accept that you’re going to make mistakes, a lot of mistakes. Parenting definitely fits the “learn on the job” description. No parent is perfect. When you make a mistake, learn from it. When you make that same mistake for the hundredth time, keep learning.

4) The first few months are a blur, just survive and advance. For sports fans, I compare the first few months to March Madness. It doesn't matter if you win by 1 or 30; just make it to the next day. Keep advancing. If you are fortunate enough to have a child that sleeps through the night just weeks after birth, just be happy. Most parents experience sleep deprivation the first few months. It’s part of the game.

You will hear the funniest stories from the first few months. In our case, one morning the alarm went off and I cradled the alarm clock like a baby. My wife appropriately asked what I was doing and I responded with, “Ssshhhh, I think she’ll go back to sleep.”

5) Sleep when your little one sleeps. I can’t emphasize this enough. Your sleep pattern will already be screwy. If you are sleep deprived and your little one takes a nap, take a nap as well. Yes, there are things to do around the house. You will have to decide what's more important, sleep or household chores.

6) Taking a break from your infant doesn’t make you a bad parent. It’s okay to take a break; everyone needs a little time for themselves. As a matter of fact, if you acknowledge that you might need a break, it will make you a better parent in the long run.

7) Welcome help and support from family and friends with open arms. Don’t be a hero. If someone offers to cook a meal or clean the house, take them up on it if you feel you need the support. If family/friends offer to change a diaper, get them to sign a written contract. Then present it to them if they say they were only joking when the time comes for a diaper change. Having legal counsel present at that moment is optional.

8) You’re going to be one of those parents that put up pictures of your baby on facebook all the time. We all do it. Your kid is undoubtedly the cutest baby to ever wear a onesie with a funny message.

9) It’s okay if your child doesn’t eat, they’ll eat later. The baby’s weight will be the focus of many conversations. Just like adults, babies will tell you when they are hungry. It’s okay if he hasn’t fed for a couple of hours, he won’t shrink.

10) Comparisons to other babies are inevitable. Almost all conversations with other parents will start with two questions: 1) What is your baby’s name? 2) How many weeks/months old is he? You will then privately compare your baby to the other. This will happen for about a year, maybe thirty. Try to let that go; all kids mature at their own pace.

11) Once you have a rhythm and schedule, something will happen that will flip your schedule upside down. Just accept it. Learn to go with the flow or your head will explode.

As usual, feel free to share via facebook, twitter, etc. Comments welcomed and thanks for reading!