I’ve been asked this question by friends, strangers, aspiring mental health professionals, and even patients. It’s an interesting question, but I always find myself surprised when it is asked.

I also give the same response every time. In my years of being a clinical psychologist, I’ve never come across the same type of person twice. I have worked with many people who have presented with depression, anxiety, family conflict, etc., but each person had their own unique background and story.

Yes, common themes do arise in therapy: grief from losing a loved one, anxiety related to control, reoccurring relational problems, poor self-esteem due to a chaotic, neglectful home life. However, each person has their own experience, and the same experience can have a different impact from person to person.

Even the loss of a loved one can impact people differently. One person could be grief-stricken for months or years, while another may process the loss by becoming more active in personal pursuits as life isn't limitless.

People are complex, and it’s immensely rewarding and actually energizing to be able to work with people from different backgrounds. It’s a privilege to be allowed access to others’ experiences.

To be completely honest, sometimes there are moments of feeling disconnected during a session. Some might describe this moment as boredom or disinterest, but it's different. It's more about the interaction being superficial versus meaningful. It's getting caught up in the minor details instead of focusing on the central issue.

The disconnect during a session refers to the emotional connection between the patient and therapist. The patient or therapist can feel disconnected in a moment, the feeling isn't exclusive to either. Part of the therapy work is verbalizing and exploring this emotional distance, and recognizing if and when the same disconnect occurs in other relationships.

So for those who have that friend who only wants to talk when there is a problem, or only shares their own successes, take a moment and reflect on the relationship. Consider your perspective, but also connect with the perspective of others.

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. Thanks for your support!

According to Seligman, Steen & Peterman (2005), the secret to happiness isn’t money, adventure, or love; it’s expression of gratitude. If you want to read the study or view a creative summary and twist to the study, check out this Upworthy.com video by clicking here.

If you don’t want to read or watch, I’ll do a quick summary. Basically, it was found that people are happier when they express gratitude, and even happier if they are able to express gratitude directly to the person. The largest increases in happiness were found in those who initially reported the lowest levels of happiness.

This makes sense, right? Expressing gratitude means that you are polite, thoughtful, and respectful. Anyone would think these are characteristics of a well-adjusted, happy person. The catch is that there were people who initially expressed low levels of happiness, but their happiness increased significantly after expressing gratitude verbally and directly to another. Why?

Well, I think the answer lies in the process of expressing gratitude. One of my mentors always said, “It’s the process, not the content,” during our supervision sessions. It took me a while to understand what he meant, and I think it applies here (Thanks, Jeff). I’ll write about “the process” more in the coming weeks.

The process of expressing gratitude is powerful and intimate, more so than most people realize. It’s one thing to say “thanks”, it’s another thing to expound on that “thanks” and express how someone has really helped you as a person. Expressing gratitude opens your emotional world to another. That can make anyone feel vulnerable.

Why would someone feel vulnerable?

Two reasons why someone might feel vulnerable are: 1) the possibility of being hurt/exploited/criticized and 2) the possibility of actually emotionally connecting with another person in a healthy way. The latter is what happens with gratitude. When you express gratitude, you are saying, “I really appreciate you and the positive impact you have had on my life.” It may feel uncomfortable, but it feels good to make another person feel good, at least according to this study.

Why does any of this matter?

Well it matters quite a bit, certainly in therapy. My standard approach to working with a depressed individual is maintaining and increasing positive experiences (click here to read more about my approach). However, “positive experiences” are usually defined by actions that bring you joy: a hobby, lunch with a friend, something that makes you feel good. This study adds the twist of making someone else feel good by expressing gratitude. It will certainly add to my approach and hopefully yours.

If you are having a down day (or even a great day), express gratitude to someone. Test the idea out. See what it's like to send an email versus a phone call. If you're really brave, share your gratitude in person. You might be pleasantly surprised by how good it feels.

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. Thanks for your support!

This post isn’t going to focus on the health, economic, and social risks of smoking cigarettes. It’s not going to focus on interventions like nicotine gum, the patch, or going "cold turkey". I want to talk about the psychology of smoking within the framework of Sigmund Freud’s developmental stages.

I won’t write in depth regarding Freud, mainly for the sake of brevity and because his theories are widely considered to be inefficient and inaccurate. However, there is merit to the oral phase of his developmental theory in relation to cigarette smoking.

Freud's oral phase occurs in the first year of life where the baby’s existence is largely centered on instant gratification. Babies are oral, whether it’s nursing, eating, tasting a new toy, biting, crying, babbling, etc. Freud posited that if you didn’t mature and develop healthily, you would be stuck in certain developmental stages and riddled with anxiety (read more about anxiety here).

So the oral phase of Freud’s developmental theory emphasizes the need for oral gratification at any cost. An underlying aspect of the oral phase is the inability to tolerate frustration or cope with stress. A baby in the oral phase doesn’t have the capacity to cope with frustration, anxiety, and emotions. All they know is get comfort orally (e.g., mother’s breast, pacifier, biting, eating).

For a baby, nursing on the mother’s breast is the greatest comfort. Healthy development is the progression of receiving comfort from the mother (e.g., nursing), to self-comfort (e.g., pacifier, thumb-sucking), and to more advance mechanisms (e.g., crying and soothing self, verbally expressing feelings, etc.). As you progress, you become more independent and psychologically strong.

With that in mind, it doesn’t take much imagination to understand the gratification received from smoking a cigarette. A smoker literally takes a puff and receives gratification. However, the gratification received is short-lived and, more importantly, unhealthy. I'm not comparing smokers to babies, but smoking is infantile within the context of Freud's theory.

Think about it, the vast majority of smokers use cigarettes when increased stress levels are combined with an inability to cope in a healthy manner. In these moments, gratification is a decrease in stress/anxiety/emotionality. For some, a cigarette provides that instantly. The same logic can be applied to overeaters, alcoholics, or any other population struggling with addiction.   

So if you want to stop smoking, it’s not about avoiding cigarettes. It’s about delaying instant gratification, recognizing the frustration of delayed gratification, finding effective coping strategies to manage frustration and anxiety, and then being consistent. When effective coping strategies are in place, you will get gratification in a healthy way.

If that sounds impossible, trying sucking your thumb instead of smoking that cigarette the next time you feel the urge. Just might work :)

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. Thanks for your support!

Enabling is a term that has become more mainstream in the last decade or so, especially with the popularity of 12-step programs (and reality TV) for those with addiction issues. However, enabling behavior isn’t new, and it’s not limited to addiction.

What is that fine line between love and enabling? Love is however you define it. More than likely some part of that definition includes unconditional acceptance. The notion that you are loved exactly the way you are.

Enabling grows out of and is driven by love. Enabling is loving someone to the extent that you excuse and then assume their responsibilities. The more you take over their responsibilities, the more they depend on you. The cycle continues, around and around it goes.  

With addiction, the addict might be in excruciating pain and the only thing that will help is another fix. Out of love, they are given a few dollars for that one fix. The mind rationalizes the behavior in a number of ways, including that if they are given the money they’ll see that they are loved, or that it’s better to get the money from a loved one than to do something harmful or even criminal.  

With children, enabling might be in the form of eating. Your little one takes two bites of dinner, says they are full, and then comes back an hour later complaining of starvation. As a parent you don’t want your child to go hungry; at the same time, you don’t want to set the example that it’s okay to avoid dinner and finagle your way into a delicious dessert (preferably something with peanut butter).  

With teenagers, it could be allowing your teen to stay up late and then they don’t want to go to school because they feel tired. You think to yourself they do look really tired so maybe this one time. Even something this minor could be the start of a major case of enabling.

Seemingly healthy relationships aren’t immune to enabling. One person works a stressful job and then doesn’t take care of their responsibilities at home. The other compensates and takes over all of their responsibilities. You can see how this might become problematic over time.

Enabling happens with emotions as well. If you withhold your feelings because your partner doesn’t handle emotional conversations well, then you may be enabling their inability to connect and empathize with you and your needs. Resentment, confusion, and loneliness can grow and suddenly a relationship is in trouble.

You might be thinking sometimes you have to pick up the slack. People have bad days, weeks, even months. That’s absolutely correct. Sometimes it’s not enabling. It’s being there for the other person when they need extra support. A sign of enabling is if you find yourself taking over the other person’s responsibilities, things that have been discussed many times in the past. There are certain behaviors that a child/teen/adult should be able to do.

The other component, and a discussion for another time, is what is happening that you allow yourself to be the enabler. Is it that you are an amazingly compassionate person, or maybe it’s difficult to advocate for yourself and express troubling feelings to someone you love? Enabling is a two-person process. Both have a responsibility.

Identifying enabling behavior can be difficult, because the motivation is grounded in love. However, if you regularly ask yourself why someone continues to behave a certain way (especially if the behavior is harmful), it is worthwhile to look at each person’s responsibility in the behavior. Sometimes love is confronting the other on their issues or shortcomings, as long as the approach is fueled with compassion and sensitivity.


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

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

I don't know if there is a right way to die, but Jo went out in a great way. In this past year, I have met with a number of Knoxvillians who work with the child/adolescent population. Jo was as vibrant and energetic as any. That's quite the feat considering she was living with two, rare autoimmune disorders that impacted her physical health and daily life.

News of her death last month was a shock. I had just met with her weeks earlier and she was as energetic as ever. As details became known, it became very clear that Jo had a sense all along. She developed plans for her "work" kids to help them cope with her death. These preparations were made months in advance and were incredibly thoughtful. Imagine writing letters to those you care about, knowing the end is near, and still being as dedicated to living as ever. Incredible courage and vitality.

I thought, "Wow, Jo was making new friendships as she was dying." This certainly isn't a rare phenomenon, but it is phenomenal. It's an incredible life lesson: Live life for you, stay in the moment. That's exactly what Jo did, she faced death and kept going. She easily could have retired or isolated herself. She continued living life, for herself and those she cared about. She valued herself.

Jo was the poster child for living in the moment. She blocked out outside and internal distractions, and was able to enjoy the moment for what it was. She could have had a tasty dinner and wondered if this would be her last great meal. Instead she chose to enjoy the meal for what it was, a great meal.

To be honest, I was confused and upset as to why Jo didn't confide in me, I am a psychologist after all. In a way it was shameful and egotistical, but it's how I felt at the time. Then it hit me: it wasn't about me, it wasn't about her, it was about living. Jo didn't let death take control, she lived on her terms. Talking about life expectancies, cell counts, immune systems, would have taken away from her essence of living. She was a genuinely open person, she accepted her fate.

I'm not doing Jo justice, she was more remarkable than words can capture. However, I hope you gained a sense of her spirit and love for life and others. I hope when adversity presents itself and you are feeling hopeless, defeated, and overwhelmed that you find your way and thrive. Regardless of the situation, you can have some sense of control. You have options, just like Jo.

You will certainly be missed. Rest in peace, Jo.


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. Thanks for your support!

One billion dollars is spent every year on dieting. Billion. Think of what you could do with that type of money. Ok, I just lied. It’s not one billion, it’s 60 billion. Sixty billion dollars on dieting, books, dieting drugs, and surgeries.

Weight gain is a numbers game. If you consume more calories than you burn, you will gain weight. Weight gain is your body saying, “I have no idea what to do with these extra calories so I’m going to store it in this love handle.” Remember that previous post about your body constantly talking to you (read it here if you missed it)? The same concept applies to eating.

Diets give you a framework for how to lose and maintain weight. In the end, it doesn’t matter what diet fad you adhere to, what matters is you. What are you doing fundamentally to change the way you view your relationship with food? Why are the diets not working?

Be realistic. Have realistic goals. Don't set yourself up for failure. Instead of cutting out all unhealthy foods, start by removing one food from your diet. If you eat out for lunch 5 times a week, set a goal to eat out 4 times a week.

Slow down. Take your time when eating. The faster you eat, the more you eat. Your body hardly has time to send you the “I’m satisfied” signal before another bite. Remember when you were young and everyone said chew your food 20 times? Well, chew your food 20 times.

Be mindful. Don’t just eat. Notice the flavor, texture, and other features of what you are eating. Being mindful changes your eating experience and helps you determine when you are satisfied before you are stuffed.

Recognize if you are actually hungry. Many people eat because they are bored, stressed, upset, it’s the typical eating time, or the opportunity simply presents itself. Ask yourself, “Am I hungry or am I just eating to eat?”

It’s okay to make a mistake. No one is perfect. If you gain weight or “cheat” on your diet, it’s okay. Reflect on what happened and learn from it.

Drink water. Your body is 60% water. It needs water. Water flushes toxins, transports nutrients, and can speed up metabolism. Most professionals recommend 12 glasses of water for men and 9 for women (8oz glass).

Water is also an appetite suppressant. For babies, the more food they eat, the less milk they drink. The more milk a baby drinks, the less food they eat. So, the more water you drink (which you need anyway), the less food (and calories) you will consume.

Avoid temptations. Alcoholics are taught to stay away from places where alcohol is readily available. Stay away from snacks and foods that are your weakness. Don’t peruse the snack aisle at the grocery store, and keep certain foods out of your home.

Adhere to your guidelines and be patient. Give your dietary change a chance. Your body needs time to adjust. If you don’t see instant results, stay positive.

Support. Changing your food lifestyle is hard. If you need support, get it. Whether that means a support group, dieting partner, therapy, or whatever is helpful for you.

The statistics are there: 95% of folks regain the lost weight within 5 years. Over 100 million Americans are dieting. Diets are short-term and superficial. Instead, change how you think about food and eating at the core (no pun intended), and you can change your life.

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. Thanks for your support!

Bad things happen in life, they just do. If they keep happening, it might be worthwhile to ask yourself, “Why does this keep happening to me?” “What is my role?” It’s one thing to be dealt a bad hand or have bad luck, it’s another to actively play a part in your own demise.

Self-destructive behavior can be a conscious effort, but in many instances it’s driven by unconscious forces. Why would someone actively sabotage their life? Why would someone seek out unhealthy relationships? Why are you chronically late to work or short-tempered? There are actually quite a few explanations for self-sabotage.

Self-destructive behavior is seen as normal. For some people, self-destructive behavior has been happening for so long it feels normal. A common theme in therapy is assisting an individual in realizing how their way of living might be maladaptive. It’s not easy to change unhealthy behavioral or cognitive patterns, especially if there is some degree of benefit. Part of the therapeutic process is gaining awareness of the beneficial and/or harmful aspects of behavior. 

Self-destructive behavior is beneficial. This might be a head scratcher, but sometimes there is a benefit to self-destructive behavior. Whether it is to elicit compassion, pity, or sympathy, self-destructive behavior can serve as a way to gain attention from others or a connection to someone. For some, any attention (even negative) is better than no attention, and there are plenty of people who are drawn to the emotionally wounded.

The fear of change. Change is uncomfortable and scary. Even if your behavior is self-destructive and unhealthy, if it has been your standard behavior, it’s comfortable and predictable. Comfort and predictability are highly valued, and in many cases, well-being and quality of life are compromised for comfort and control. Many people in unhealthy relationships are caught in a common conundrum: stay in a harmful, yet predictable, relationship or leave and be left with the unknown.

The fear of success. Self-destructive behaviors are typically associated with maladaptive, unhealthy experiences. After enough time, individuals can embrace a self-view of being inadequate and worthless. When failure is perceived as inevitable, even the idea of being successful is anxiety provoking. Shifting from a negativistic to an optimistic mindset is a challenge. Part of that challenge is letting go of a current identity and opening yourself to a new way of living. It can be an intimidating proposition but it's certainly doable.

Self-destructive behavior is common. If you find yourself wondering why the same bad thing continues to happen to you, partake in self-reflection and see if you can recognize patterns in your behaviors, relationships, and experiences.

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. Thanks for your support!

In a previous post titled "Letting Go",  I briefly commented on grudges within the process of moving on from relationships. You can read that post here. In this post, I want to say more about the idea of a grudge and how it may speak more about your coping and communication style than anything someone has done or said to you.

What is a grudge? A grudge is the resentment of another for a past harm. Psychologically, a grudge is what remains when an emotional injury hasn't healed properly or completely; essentially, an emotional wound or scar.

A few weeks ago, I wrote about how your body sends your mind signals when you are feeling specific emotions (to review that article, click here.). A grudge is your mind sending the following signal to your consciousness:

I continue to have thoughts about that person because of what happened, and because I still have unresolved feelings about the person and experience.

If you find yourself preoccupied with resentful feelings toward another person, you are holding a grudge. You have three options: continue to hold the grudge, address your feelings with the appropriate person, or decide to actively move on with your life. You could also do some sort of combination of the three.

Option #1: Hold on to the grudge. The benefit of this is you get to focus all your anger and resentment at this person inside of your head. The downside is chronic angry and resentful feelings puts your mental and physical health at risk. The other downside is you learn (or continue) to suppress your feelings, which will feed the cycle of being hurt and not advocating for yourself.

Option #2: Address your feelings. The purpose of sharing your feelings with the appropriate person (the perpertrator) is not to get that apology or for the person to grovel for forgiveness (though that would be nice), the purpose is to find your voice, to advocate for yourself. This value is sometimes lost in the process. Advocating for yourself is taking ownership of your life, it's saying that I can't control what other people do but I have power over my actions and how the actions of others affect me.

Option #3: Move on with your life. Many choose this option, but be careful. At face value, moving on and even learning from your experience sounds like a healthy, well-adjusted way to live. This option may very well work, but be aware that for some, continuing to be the "bigger person" may result in emotional and relationship issues later in life.

Why do some experiences result in grudges while others are resolved and released? That's a great question to reflect on. Is it simply because you have fully expressed your feelings and have complete understanding of the situation or are there other factors?

Many hold grudges because of the fear of what may happen if their true feelings of anger, sadness, and resentment are expressed. Expressing your feelings in a healthy way usually won't result in the catastrophic damage you imagine. It will result in a personal sense of accomplishment and mastery of one's environment.

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 facebook group by clicking here. Thanks for your support!

You might be confused by the title, especially if you are familiar with the terms “narcissist” or “narcissistic personality disorder”. These terms tend to carry a negative connotation and most imagine a narcissistic individual as self-centered, conceited, and even delusional in their own self-worth. Other characteristics of a narcissist can include lack of empathy, relational exploitation, and entitlement. With all this said, narcissism can be a good thing…as long as it is in moderation.

What is narcissism in moderation? Basically, taking the good narcissistic tendencies and rejecting the bad. Many psychologists refer to two types of narcissism: healthy and unhealthy. The fundamental difference between these two types is the person's sense of self. Unhealthy narcissists lack a stable, healthy self-esteem. To compensate for feelings of inadequacy, the unhealthy narcissist exaggerates self-worth and importance.

The healthy narcissist has a stable and sound self-esteem, so there is little need for grandiosity and power-grabbing. The healthy narcissist is still confident and ambitious, but these feelings are grounded in a realistic view of personal strengths and talents.

How do you cultivate healthy narcissism?

It comes back to moderation and hopefully it starts from an early age. You certainly want your children to be confident, ambitious, and successful. At the same time, kids should be kind, considerate, and thoughtful. Instead of teaching kids to “win at all costs”, the focus should be on giving a great effort. This doesn’t mean kids shouldn’t want to win, it means their self-esteem should include both the outcome and their effort. The same goes for academics. If your child tries their best, be happy with the effort regardless of the outcome.

As for adolescence into adulthood and beyond, reflect on your successes. Did you reach milestones on your own merit or through exploitation and deceit? Did you consider the feelings of others or only focus on what was important to you? There is no easy answer, but most people have a sense of whether their successes are their own, someone else's or a combination.  

What are everyday signs of unhealthy narcissism?

Unfortunately there are unhealthy narcissists everywhere. Here are a few signs that someone might be a narcissist:

Showing compassion for a friend, but taking pleasure at their failures/difficulties.

Someone who can't see their faults or take any responsibility for a mistake.

The inability to apologize; it's always the other person's fault.

Someone who only talks about themselves or takes your successes and makes them their own.

Taking someone's concern as criticism, and responding defensively and critically.

The inability to empathize; lacking the ability to see the world from a perspective different from their own.

These are just a few of the many types of interactions with unhealthy narcissists. For me, when I find myself wanting to roll my eyes during a conversation, that's a signal that someone might be a narcissist, the unhealthy type.

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 facebook group by clicking here. Thanks for your support!