Ask someone about what makes a relationship strong, and you'll get responses that include trust, honesty, communication or a mix of all three. Trust is a requirement for a healthy relationship. But what happens when that trust is broken? Here are some tips to consider to rebuild the trust in your relationship,

Acknowledge the process will be difficult. Rebuilding trust is a complex and difficult task. Accept that there will be progress and setbacks, it will be time-consuming, and that the relationship may not survive. 
 
Reflect on how trust was broken. In order to fix something, you have to know why and how it broke. Every relationship is different, but usually there are signs of trouble in the relationship. 

What was each person's role? It takes two to tango. It's important to be accountable for your behavior, however, it's equally important to understand how the distrusting behavior came about. I've written more about this process in a post about infidelity. 

Express your pain and uncertainty. People aren't computers. You can't just reboot and wipe out a virus from your system. Share your feelings with the person. Acknowledge that there is pain, confusion, anger, and sadness. You have to purge your emotional world. 

Let go. Letting go is not about forgiving the other person, it's about forgiving yourself and moving forward. In order to move forward in a relationship, you have to come to peace with the past. Letting go can be difficult but it doesn't have to hold you back from happiness. 

Mutual recommitment. Both people have to recommit to the relationship. If there has been infidelity, all communication has to be severed with the person, all communication. You can't recommit when your mind and emotions are somewhere else. 

Communicate. Start from the basics. Seek counseling. If trust was violated, it almost always means the communication was lacking or artificial. Learn how to communicate respectfully and effectively. 

Express what you need from one another. Part of the recommitment process is being clear and direct about not only what was lacking, but also what each person needs moving forward. 

Set goals together. A therapist may be helpful here to provide balance and a realistic expectation. Setting goals together provides two things: 1) both people are on the same page about the direction of the relationship, 2) it's a healthy exercise of communication and connection, which was probably lacking in the relationship. 

Check in regularly. Again, weekly therapy sessions can be helpful here. Or set aside time each week to check in and reflect on progress, difficulties, or changes in the trust rebuilding process. Weekly discussions also keep you invested and mindful of your relationship. Another thing that was lacking that lead to the trust fissure. 

Praise and show gratitude. Praise one another for effort and positive growth, even if it's minuscule. Just like letting go, the process of praising can be beneficial not only for the other person, but also for you. 


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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 family member was recently diagnosed with a mental illness. I want to help but I don't know what to do. What can I do for this person?

-- Anonymous August 2014

It's almost a certainty that every person will find themselves asking this question as approximately 1 in 4 people will experience a mental illness during their lifetime. For a comparison, do you know anyone that is left handed? Approximately 10% of the population is a lefty. So you're 2.5 times more likely to know someone with a mental illness than a lefty. 

Mental illness is a condition like no other. An individual's mental illness is unique. Universally effective interventions don't exist in the way that a medical doctor might treat a broken bone. Here are 10 tips for what to do if a family member has a mental illness:

Accept the Illness. Accept that the person has a mental illness. Understand that the symptoms you see are rooted in the mental illness, not the person. 

Educate yourself. What's the first thing someone does when they are diagnosed with a medical condition? Immediate Google search. Do the same with depression, anxiety, or the diagnosed condition. Research not only the health condition but also ways to intervene in positive and healthy ways. 

Attend health professional appointments with your family member. Ask questions at appointments about symptoms, warning signs, and coping strategies. 

Combine your Google education with your family experience. I tell patients and families that they are the expert on themselves and their family. With your newly found education from researching the illness, see how that education fits with your family. Not all individuals have the same family dynamic and symptom presentation.

Respect. Treat each member of the family with respect. A mental illness does not make anyone less valuable or worthy. Although this previous post is about addiction, many of the tips can be generally applied in how to communicate in a respectful and empathic way. 

Keep your family intact. Yes, a mental illness calls for an increase in attention, time, and energy for that individual, but don't lose focus on the other members of the family. Continue family activities to the extent that you can.

Be realistic. One of the first questions I hear is, "How long does this last and when is it cured?" There isn't an easy answer. Have a major goal in mind but break the big goal down into smaller goals. In developing these goals, include all appropriate members of the family, including the person with the mental illness. 

Stay connected. It's not uncommon for families to experience shame, confusion, and embarrassment. Part of your education is accepting that one person isn't to blame, and it's vital to stay connected to others. Continue relationships with friends and other families. Reach out to support groups through organizations like NAMI.

Be a clear and consistent presence. It can be difficult but be a consistent and healthy support for your family member. Find that healthy balance and stay away from contributing to unhealthy behavior. Sometimes your love can enable unhealthy behaviors and decisions. When you find that line, have a discussion with your family member about how you see your role in their life and the possible limitations of your role. 

Stay healthy. Make sure that you continue to make healthy decisions for yourself. Be aware that you aren't significantly sacrificing your mental health in trying to fix a loved one. You can only help when you are at your best, or at least in a mentally strong state. Whatever activities help you manage stress, continue them. 

I often recommend family members to participate in their own therapy as it can be incredibly stressful when dealing with another family member's mental illness.

Remain hopeful, realistic, but hopeful. Hope doesn't fix a mental illness, but it provides an atmosphere to remain motivated to overcome a mental illness. Hope doesn't have to be the notion that this mental illness will be gone by the end of the week, it can be that we are going to have a good day. 

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 negativistic style of thinking usually doesn't happen overnight. However, once your default setting is to think negatively, it feels automatic and almost natural to think the worst. 

Things get complicated when depression enters the equation. Depression exacerbates negative thinking, and the result is a self-sustaining cycle of negative feelings sharpening negative thoughts which intensifies the depression. I mention depression because those who struggle with negative thinking tend to exhibit symptoms of clinical depression. Something to consider if you haven't already. 

It's important to know that negative thoughts are completely normal. No one is perfect and it's healthy to reflect on personal weaknesses and areas of improvement. What is not normal is to allow these thoughts to control your life and relationships. 

10 Tips For Overcoming Negative Thoughts

Stop extreme thinking. Life isn't black or white. There is gray and context to everything. Be aware if you use words like "always" or "never" and if you make generalized statements about "everyone" and "everything."

Reality test. If you are unaware of your negativity, then how can you change? Easy. Try a reality check with friends, family, or someone that you trust. Sometimes negative thoughts can be corrected with a conversation. 

You aren't a mind reader, stop assuming. In sessions, I find myself regularly saying, "So what did you say in reply?" I get a quizzical glance and usually a, "Well, they didn't actually say that, but I'm sure they were thinking that." So did the person actually say it, or are you projecting what you believe they are thinking?

Value the positive. Don't dismiss or explain away the positive. If you have overwhelming negative thoughts, you are probably focusing too much on negative things and ignoring the positives in your life. Take a moment and value your positive experiences. 

Fully accept compliments. If someone gives you a compliment, stop for a moment, let the feeling sink in, and say "thank you." Sounds weird? If yes, then that's a sign you need to practice accepting compliments. 

Express gratitude. Not in your mind. On paper and then out loud and to the person. Sounds weird? See the last tip. You might be surprised how expressing gratitude actually makes you feel better. There is a great Upworthy.com video about gratitude. You can read and see more about that in a previous post. 

Set realistic goals. Accomplished goals make you feel good. Be realistic. Don't set the bar too low, but be realistic. Try to change one thing daily, weekly, or monthly. Be specific and clear in your goal-setting. 

Practice mindfulness, Mindfulness is the process of being aware of the present. When negative thoughts enter your consciousness, you are no longer in the present. You are on a cognitive tangent. Your attention is no longer on what is happening in the present, it's on beating yourself up. Mindfulness can be very effective in stopping negative thinking and helping you focus on the here and now. 

Do positive things. Volunteer, practice good manners, serve as a mentor. Again, be reasonable as you don't want to set yourself up to wonder why people aren't reciprocating your positive acts. Keep it simple. 
 
Recognize that change is a process. This idea is forgotten by many very quickly. If you expect a quick fix, it's just not going to happen. Accept that real change takes time, but it will be worth it. Value the progress that you are making. 


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!

Let's skip over the moral debate, just bypass that altogether. In fact, let's work from the perspective that pornography is just like any other activity or hobby. 

Pornography's accessibility is incredibly easy. Statistics show that the average age of exposure is 11, and the largest and fastest growing consumer of internet pornography are kids aged 12-17. That's alarming, especially considering this is the developmental period when kids learn about and experience relationships. 

There is a natural process of learning about romance: the innocence of sliding a note to someone, asking a friend to ask for you, actually saying "i like you." Pornography bypasses this maturation process and pushes people into a completely different world. Kids and even young adults aren't psychologically and neurologically mature, so pornographic content becomes a part of their maturation and personal belief system. 

A relationship is an emotional connection with another; pornography is a lonely attempt to satisfy your needs.
There is a must-watch TEDxGlasgow talk about how the brain is affected by pornography, I really recommend it. In that video, the presenter speaks about dopamine, a neurotransmitter involved in the reward system. The reward system is linked to the prefrontal cortex, a brain area that develops well into a person's late 20s. Internet pornography gives you perceived satisfaction with the click of a button, something that is impossible in real life.

Imagine the idea that you could feel satisfied with one click of a button, you believed that satisfaction and happiness were that easy. That's an unrealistic goal and unrealistic goals can lead to relationship issues, personal disappointments, and psychological disorders.

In working with couples where one or both are addicted to porn, there are usually expressions of marital emptiness and dissatisfaction. Over 50% of divorces involve one or both persons having an obsessive interest in pornography. Pornography was sought to fill a void or provide novelty. In reality, it isolates and distances people. Part of the work is understanding the personal void and helping couples reconnect in a healthy, meaningful way. 

Individuals with an addiction to pornography talk about a chase of making a fleeting moment of satisfaction more permanent. It warps your mind and belief system much in the same way that Hollywood movies do. The work here involves increasing awareness that this is an unhealthy chase that can't be won, and permanent satisfaction is based in actual relationships, not internet content. 

Most assume that pornography addiction is almost exclusively a problem for boys and men. That's simply not the case as about 1/3 of the visitors to pornographic websites are women. So it's a problem that's faced by both boys and girls and men and women.

Pornography and other addictions can literally change the neural circuitry of your brain. It can alter your emotions and belief system. However, it's never too late to better and work on yourself. 


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Let's skip the conversation about our mental health being a mixture of biological, cultural, individual and environmental factors. People are a mixture of all those factors. Let's focus on the factors that can be addressed and even improved. 

Stress. Stress has a negative connotation almost exclusively (e.g., "I'm stressed out!"). Stress can actually be a good thing, when it's at a moderate level. Studies have shown that stress not only affects your physical health, but also your mental health. Chronic stress has been linked to depression, anxiety, and other psychological issues. 

Relationships. It's rare to find a psychologically healthy and well-rounded individual who lives in social isolation. People are naturally social and connecting with others is healthy. Relationships provide support and safety. When we feel safe, we tend to feel happier. When we isolate we tend to feel confused and lost. 

Coping Skills. I am a firm believer that our mental health is a fairly simple equation: 

Stress - Coping Skills = Mental Health

Our mental health is directly related to the stress-coping relationship. There will always be stress. Many people who have the most stressful lives never suffer from a mental illness. I believe this is mostly due to their ability to manage stress with coping skills and resources. The more healthy coping skills you have, the better you are able to manage stress, and subsequently decrease your risk of experiencing a mental illness. The opposite applies if you have limited and unhealthy coping strategies; your chance of having a mental illness increases. 

Nutrition. I am also a believer that our diet impacts our mental health. Obesity is highly correlated with depression. Obesity is also a sign of an unhealthy coping skill: excess eating. 

Your diet in general affects your mood and mental health. Ever "splurge" on a meal that your body isn't used to? If you have, then you know that unpleasant feeling and mood you have after the meal. Research indicates people who report some level of psychological distress report eating less fruits and vegetables. Those who eat more fruits and vegetables report less mental health issues. 

Optimism. I spent years researching optimism (if you are bored, you can read my dissertation here). Optimism's impact on mental health is undeniable. Optimistic individuals have healthier, more positive attitudes, are more resilient to stress, and use healthier coping strategies. Some may say that being optimistic doesn't change the circumstance, but it impacts your mood which changes your confidence and commitment. 

I wrote about these 5 factors instead of genetics, environment, or culture because you can actively change each of the 5 factors at an individual level. It takes time and there will be ups and downs, but it can happen.


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It's a topic that many don't want to talk about but it's a problem here and across the globe. I keep not wanting to write about this, but time and time again I am reminded that it is needed. About 10% of children are sexually abused (National Center for Victims of Crime). That number breaks down to approximately 20% of girls and 5% of boys. Approximately 60% of victims are abused by someone in their social circle.

What Do I Do? 

Remain calm. Yes, it is easier said than done, but it's very important to try to remain calm because it helps your child remain calm.

Find a safe place to talk. Children are usually confused, scared, and anxious. Provide a comfortable environment. 

Listen to your child. Your child may have difficulty putting their experience into words. That's okay, just listen.

Seek medical attention. Seek medical attention if appropriate. Sometimes there can be internal injuries that aren't visible. Ask if their body hurts and where. 

Stay connected. Your child needs you the day they talk and the days and weeks following. Observe your child and look for signs that they are having difficulty coping. Children who have been abused often isolate themselves, are vigilant, use inappropriate sexual language, are easily upset, and can experience separation anxiety. 

Praise your child. Praise them for their bravery to speak up. Praise them for their honesty. 

Seek outside support. If you feel it is necessary, seek outside support to help your child cope. 

What Not To Do

Do not confront the alleged perpetrator with the victim. Almost everyone experiences the thought of confronting the perpetrator. Do not do that with the victim. 

Do not ignore what happened. Don't sweep it under the rug. Don't "protect the family" or the "reputation" of the alleged perpetrator. 

When you ignore what happened (even if you have doubts), then you are condoning the actions of the perpetrator and disbelieving the victim. I've had many people share that they feel this way, and that can cause irreparable psychological damage.

Do not blame your child, directly or indirectly. Many kids feel like they made a mistake, or did something bad. Make sure your child knows that they aren't to blame and that the other person needs help. 

Child abuse (any type) is a challenging and heartbreaking situation. However, research shows the most important thing you can do for a child is provide a loving and supportive environment. If your child knows you are on their side and you believe and love them, that can be all the child needs to recover and even thrive. 


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Last week's post focused more on the psychology and origins of anger. Two of the central points from that post were 1) recognize that usually where there is anger, there was sadness and 2) your body sends signals that you are angry, but are you aware?

How to control your anger

Before reading further, go back and read last week's post if you haven't (linked above). It's important to be aware of the body signals that suggest you are angry. Take a moment and think about your body's reactions to anger, what thoughts come to mind when angry, and how anger impacts how you relate to others. Without that knowledge it will be even more difficult to manage your anger. 

Anger management tips

Take a step back. When overwhelmed with anger, your decision-making skills are compromised. Remove yourself from the environment and regroup.

Relaxation techniques. This is a funny one as everyone knows they should relax. The problem is many people go through the techniques in a hurried manner. So counting to 10 won't be effective if it is a 5 second process. Same with deep breathing. Slow down the process. Count slowly, breathe slowly, move slowly. The slowness will calm your mind and body. 

Make healthy choices. If something or someone makes you angry and you can avoid it, then avoid it. What's it say about you if you keep putting yourself in negative situations when you don't have to?

Maintain healthy boundaries. It seems like a common conversation topic for many is complaining about others. Maintain healthy boundaries with individuals that tend to be the root of your anger. If you limit your availability, you'll limit anger. 

Think solutions. A component of anger is feeling helpless to change the situation. Be thoughtful. Is there something you can do to correct the problem? For example, if you are late for work every morning, try completing some of your morning tasks before you go to bed. 

Humor. If you know me, you know this is one of my favorites. This doesn't mean make fun of others or to be sarcastic, but if you can inject humor into an angry moment, it can really lighten the mood. Research has found that laughter reduces the release of stress hormones and increases the release of endorphins (feel-good hormones). 

Let go and forgive. Ask yourself, what purpose is my anger serving? It certainly can be a way to communicate your disapproval or hurt, but at some point the anger has more of an impact on you than the other person. Letting go and forgiving doesn't mean you are weak or submissive, it means you value your well-being. 

Get the anger out. Talk to a friend, write in a journal, exercise. Find activities that you enjoy and that are stress relievers. Do NOT punch a pillow. Research shows that punching a pillow actually increases rumination and aggression. Not what you want.


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Everyone gets angry. I've written previously about the psychology of grudges, aggression in kids, and other topics related to anger. Anger plays a large role in daily life, and sometimes it's uncontrollable. Before we delve into how to control anger, let's briefly talk about the origins of anger. 

Before anger, there was sadness

In my clinical experience, anger is almost always a secondary emotion. The primary emotion is the feeling of sadness or hurt. For some this may seem counter intuitive or flat-out wrong, but consider depression, especially in men. One of the criteria for a diagnosis of depression can be irritability. For kids, depression can be masked by acting out in an hostile or angry manner. The image of a depressed person is usually someone sitting alone and crying. However, depression can present in an aggressive manner, such as yelling or fighting. 

In my post, The Psychology of an Extremist, I lay out the idea that before we see the rage, there is a pattern of sadness (e.g., rejection, isolation, alienation, worthlessness). The same applies to moments of uncontrollable anger. 

How to understand your anger

Get to the real source of your anger. You might be wondering why I'm talking about sadness in a post about anger. There is a reason. In order to control your anger, you first have to figure out why you are angry. If your friend is late for dinner, are you angry that your friend is late or are you hurt that your friend doesn't value your time and that is what makes you angry?

Listen to your body. I wrote a general piece about how your body is constantly sending your mind feedback about your emotional state. For anger, reflect and be thoughtful about what is happening with your body when you are feeling angry. Are you shaking, sweating? Is your heart pounding, hands balled in a fist, jaw clenched?

Get in your head. Be aware of what you are thinking. Are you having thoughts of hurting someone, yourself? Are you fantasizing about yelling or other aggressive acts? When experiencing uncontrollable anger, you are probably experiencing thoughts that are out of your character. Along the lines of depression, it's common for angry feelings to turn into self-deprecating thoughts of inadequacy and worthlessness.

How to control your anger

In the next post, I'm going to write more about strategies to utilize to manage and control your anger. Some techniques will work for you while others will not. Like anything, you have to try something to determine if it is right for you.


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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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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!