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.


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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.


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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.

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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.

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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.

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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.

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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! 

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).

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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.

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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.

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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.

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