Hacking Social Isolation, published on

25 Jun

Hacking Social Isolation, published on

This article was written for‘s #Love column, which is a special column focused on digital matters of the heart.  Thank you Jordan Crook, TechCrunch tech journalist for the opportunity to contribute my writing.

Tech in dating: decoding the social rules of text, online dating & social media

1 Jun

Let’s face it: flirting, finding love and managing relationships have always been complicated, but with the involvement of countless forms of technology now impacting every little step of the way, the social rules of love and sex have only gotten more confusing. The role of tech in dating is a primary topic in psychotherapy sessions I conduct with young singles in the Bay Area of California- the world’s hub and backbone of tech culture. Part of my role as their clinical psychologist is to help them decode and navigate the emerging social rules of text, online dating and social media to help them achieve fulfilling relationships. I recently spoke withTech Crunch journalist Sara Buhr, who was investigating dating trends among people immersed in the tech industry. Some of the questioned she asked of me were: How are the norms and expectations different? Are young men in tech less likely to follow traditional social rules of dating? How has the proclivity toward using dating websites changed the dating game? This article was born from that conversation, and aims to illuminate the challenges of social connection in the 21st century.

So what do we already know? If you want to communicate personally with anyone these days, you’ve got to text them. Casual, easy and non-threatening, text messaging is upending today’s dating culture. The cellphone is the gateway: swiftly and radically changing the way people interact, meet and move forward (or not) in a relationship. According to a report released in 2013 by Nielsen based on actual phone bills of mobile contract subscribers, about 764 text messages per person were sent/received each month in the USA in 2012, compared with about 165 mobile calls per month. A new survey of 1,500 daters provided to USA TODAY reveals how deeply mobile technology has rocked the dating world. The daters, ages 21 to 50, give even greater insight into mobile behaviors and a new range of dating questions: Do you check your phone during a date? How soon must you reply to a text? Should a friend call or text you to see how the date is going?

Among the findings:

•Approximately one-third of men (31%) and women (33%) agree it’s less intimidating to ask for a date via text vs. a phone call.

•More men (44%) than women (37%) say mobile devices make it easier to flirt and get acquainted.

Texting is kind of an ongoing conversation. It does make it easier to flirt. Maybe you’re talking every day,” says Alex Pulda, 27, who works in product research in San Francisco. “It’s not like text conveys a ton of emotion, but you are getting a little more comfortable with each other.” Pulda says he texts for everything, including dates. “I don’t love phone calls,” he says. “They have all the downsides and don’t have the benefit of face-to-face communication. It’s kind of this in-between. And part of it is, it’s a lot more work than a text.”

Millennials’ love of texting is rubbing off on other generations, suggests Naomi Baron, a linguistics professor at American University in Washington who has studied electronically mediated communication in five nations, including the USA. She says telephone calls are often thought of as an intrusion, while texting affords a way of “controlling the volume,” a term she uses to describe the sense of control that text gives users that they can’t get with a voice conversation. “We tell ourselves we don’t want to disturb someone. Sometimes it’s true, but more often, it’s because we can’t get them off the phone,” she says. In texting, “we don’t have to talk to people or listen to what another person has to say. We decide how we want to encounter or whether we want to encounter other people. Technology gives us tools for controlling our relationships.” In the modern world of dating, it’s becoming increasingly difficult to know how our electronic messages are being perceived and paced by others.

It’s not uncommon (and quite the norm) for my patients to save texts, tweetsstatus updates and Gchats to discuss and analyze during our psychotherapy sessions. These digital exchanges are often at the root of their increased anxiety and worry, social tension, and depressive symptoms such as decreased concentration and irritability at work and other important areas of functioning. Life coach Debra Smouse explains “when a response [from others] doesn’t come, we begin to worry. When we don’t hear back, our minds start to spiral, creating crazy scenarios and we begin to believe that something is wrong. We know logically that a friend may have left his or her desk or a colleague may be on a call, but when we’re on the other end and stress hits, an unanswered chat box is discomforting, and logic goes out the window.” [Technologies like Gchat] “make us think that because the technology is ‘instant’ and free, people should respond instantly — and there’s something wrong when they don’t,” adds Alex Soojung-Kim Pang, author of “The Distraction Addiction.”

It’s not just the frequency and pace of our electronic messages that are difficult to decipher. The content of these exchanges can also be equally confusing in the context of modern dating (a.k.a ‘hanging out‘), getting to know each other, (a.k.a ‘internet stalking‘) and sex (a.k.a ‘hooking up‘.) Ambiguous, common messages like “what’re you up tonight, anything fun going on?”, “I’m out drinking with some friends if you’re around”, and “hey” are all commonplace in the current dating marketplace, can make it difficult for people to gain traction towards building a committed relationship. The normalization and proclivity toward using dating websites in recent years contributes to a pattern of non-comittal social ties. Mobile apps like Tinderokcupid and plenty of fish supply people with a never-ending source of new social opportunities. The problem is that “young people today don’t know how to get out of hookup culture” Donna Freitas explains, author of the forthcoming book, “The End of Sex: How Hookup Culture is Leaving a Generation Unhappy, Sexually Unfulfilled, and Confused About Intimacy.” “Dodging vulnerability cheats us of the chance to not just create intimacy but also to make relationships work”states Brené Brown, a University of Houston researcher whose work focuses on the need for vulnerability and what happens when we desensitize ourselves to it.

In this light, people can utilize psychotherapy as a way to build social skills to help them find, evolve and navigate romantic relationships. Dean, a Millennial who writes about her generation (generally born 1982 to 2000) says, “We really see this generation as having a huge handicap in communication. We have our heads down in our smartphones a lot. We don’t know how to express our emotions, and we tend to hide behind technology, computers and social media.” she says. With diminished opportunity for healthy social relationships, this generation is at increased risk for anxiety, depression and isolation.

As a mental health professional, I help people identify the relationship between their thoughts, feelings and behaviors that are leading them to feel ‘stuck’ in unfulfilling social patterns. It’s a slow process- teaching pacing and managing expectations are key to lasting progress. Participating in psychotherapy can help people increase their ability to establish and maintain fulfilling relationships. With these relationships come the superior health benefits of physical contact and emotional intimacy, love, trust and not-so-cyber sex.

Cohabitation: a generational trend that’s here to stay, but does it work?

30 Apr


Once in a while a treatment issue pops up so frequently among young adult patients in my psychotherapy practice, I begin to feel like it’s a generational trend, or perhaps specific to living in the Bay Area.  More and more people are struggling to make their romantic relationship work while cohabiting.  Like many desirable urban areas, Bay Area rent prices continue to soar with no end in sight.  In spite of having well-paying jobs, many young adults are weighed down with hefty student loans, and have learned to enjoy an expensive lifestyle where smartphone bills, an expectation of recreational travel, eating out, and ‘networking over drinks’ are the norm.  Many couples start moving in together in their mid-twenties, reasoning “it’s too early to get married, I need the freedom to make life decisions and consider what’s best for me before settling down” or “we were staying at each other’s places all the time anyway, it made sense to save money on rent and get a place together- living together will give us a chance to see if our relationship will work before making bigger decisions about engagement or marriage.”  Cohabitation among young adults appears to be here to stay, but does it work?

Cohabitation in the United States has increased by more than 1,500 percent in the past half century. In 1960, about 450,000 unmarried couples lived together. Now the number is more than 7.5 million. The majority of young adults in their 20s will live with a romantic partner at least once, and more than half of all marriages will be preceded by cohabitation. This shift has been attributed to the sexual revolution, the availability of birth control, and in our current economy, sharing the bills makes cohabiting appealing.  In a nationwide survey conducted in 2001 by the National Marriage Project, nearly half of 20-somethings agreed with the statement, “You would only marry someone if he or she agreed to live together with you first, so that you could find out whether you really get along.” About two-thirds said they believed that moving in together before marriage was a good way to avoid divorce.  Premarital cohabitation allows couples to experience a “trial run” before making the real commitment of marriage.  Following this logic, those who cohabit before marriage are more prepared for marriage having already lived together, and reducing their risk of divorce.  Research studies have shown however that premarital cohabitation should be considered with caution if marriage is the desired outcome, particularly for serial cohabiters.  “People who live with multiple partners have higher divorce rates. If you’ve only lived with the person you are going to marry, you have no greater chance of getting divorced than a couple who hasn’t lived together” says Sharon Sassler, a professor of policy analysis and management at Cornell University who has extensively studied cohabiters.

Couples who opt to live together before marriage, engagement or otherwise clearcut commitment, tend to be less satisfied with their marriages and more likely to divorce than couples who do not. These negative outcomes are called the cohabitation effect.  Researchers originally attributed the cohabitation effect to selection, or the idea that cohabiters were less conventional about marriage, and therefore more open to divorce. As cohabitation has become a norm, however, studies have shown that the effect is not entirely explained by individual characteristics like religion, education or politics. 

What contributes to the cohabitation effect? 

Relationship inertia.  Some couples who would not (and likely should not) have gotten married do so because they were already living together. The threat of having to separate complicated living arrangements and shared belongings may be enough to keep some couples together.  Some couples may find themselves on a path toward marriage because it seems more palatable than the alternative.

Conflicting agendas.  Researchers discovered that in heterosexual relationships women were more likely to view cohabitation as a step toward marriage, while men were more likely to see it as a way to test a relationship or postpone further commitment.  This gender asymmetry was associated with negative interactions and lower levels of commitment even after the relationship progressed to marriage.  There is a dearth of information on same-sex couples who choose to cohabit; their circumstances should be distinguished from heterosexual couples since same-sex relationships continue to be impacted by discriminatory laws prohibiting same-sex marriage in the United States.

Sunk costs and cognitive dissonance.  How do these concepts apply?  The more time and energy people invest into a relationship the harder it becomes to end the relationship, even if cutting their losses will save them more heartache in the future.  Further, people tend to strive for consistency between their feelings, behaviors and circumstances.  Even if there are plain signs a relationship is no longer rewarding or even functional, living together can lead people to adjust their views so that their current living arrangements continue to ‘make sense’.  

Decreased opportunity to meet other (potentially better suited) partners.  Couples who live together are likely spending more time together, narrowing their exposure to other people who frankly might be a better match, romantically.  Some people end up investing years of their 20’s and 30’s into relationships that might have lasted only months had they not been living together.  


One thing men and women do agree on, however, is that relationship standards for a live-in partner are lower than they are for a spouse.

Young adults in psychotherapy treatment illuminate the dilemma of cohabitation:

“It’s true, I make about 30 thousand dollars more annually than my girlfriend does. But I don’t think I’d be ready to pay more of our bills than she does, unless we were married…but we’re not, we’re living together.”  James, age 29

“My [live-in] boyfriend doesn’t like that I go out and stay out so late drinking with my friends.  It’s like he expects me to stay in, just because he’s tired from working all the time.  Why shouldn’t I go out and have fun with my friends? I think once I’m actually married to him things will be different, I’ll want to do different things when I’m married. I’ll be thinking about having kids, and my friends will be married too.”  Audrey, age 27

“Everything is going really well with my girlfriend, we’ve been living together for almost a year now.  Except she has made it very clear she wants to move back East to be close to her family once she’s married and ready to have kids. Her mind is made up. But my career in tech is growing here, the company I founded is based here in Silicon Valley and my family is here too.  So what should I do doc?  Enjoy our relationship for now since we’re so young? Or break it off now rather than avoid the inevitable?”  Mark, age 26

What is the impact of the cohabitation effect on one’s mental health?  Dr. Lloyd Stockey, a board certified primary care physician at Kaiser Hospital’s flagship medical center in Oakland, California weighs in on the topic. “[Cohabitation] is like a lease or practicing to see if you really want to commit. Unfortunately, it sets the bar low. There’s no real commitment with living together. It’s an opt out clause, and it’s never equal. It’s a roommate situation after 2 years.  Everyone ‘goes for self’ when cohabiting. Career, freedom, and personal success comes before commitment and family. The younger generation thinks it’s commonplace to upgrade partners, and is satisfied being single parents.  The landscape has changed. There’s blurring in gender roles, household leaders, finances, and expectations. Playing house is exactly what it is. It’s monopoly money. Looks good on paper and everyone is playing, but not worth anything when the game is over.  Codependency and living arrangements cause a majority of adjustment disorders and depression in family medicine. It’s messy in a lot of ways. It’s just like Facebook says–single, married, or it’s complicated.”

The bottom line: cohabitation is here to stay, and there are things young adults can do to protect their relationships from the cohabitation effect. Meg Jay is a clinical psychologist at the University of Virginia and author of “The Defining Decade: Why Your Twenties Matter — and How to Make the Most of Them Now advises – it’s important to discuss each person’s motivation and commitment level before opting to move in together, and view it as an intentional step toward, rather than a convenient test for marriage or partnership. It also makes sense to anticipate and regularly evaluate constraints that may keep people from leaving the relationship.  Couples who communicate openly and regularly will likely reduce ambiguity about their partner’s commitment, and have realistic expectations about the future of their relationship.  Sassler says the takeaway from her research at Cornell is that couples need to talk about situations such as the possibility of pregnancy, whether they’ll split household expenses evenly, and general expectations about gender roles. 

Understanding the role of cohabitation in the success and failure of relationships has far-reaching implications for generations to come.  Recent estimates suggest that about 33% of all children of unwed parents are born to parents in a heterosexual cohabiting relationship, and more than 50% of all children born in the United States will live in a house headed by at least one unwed parent.  Those who contemplate cohabiting can benefit from educating themselves about the benefits and risks, and utilize resources on how to make a smooth and successful transition to cohabitation (couples workshops, relationship books, working with a family/couples therapist).  Whether or not people subscribe to traditional societal expectations for marriage, choose to cohabit or not, my aim for the individuals in my psychotherapy practice is that they become better equipped at participating in happy, functional and rewarding romantic relationships.

Dr. Christina Villarreal is a licensed clinical psychologist in the Bay Area, CA.  She has a private psychotherapy and forensic assessment practice with office locations in Rockridge and San Francisco.



Dr. Villarreal has added a second office location in San Francisco’s Financial District

6 Feb


I will be opening up a new psychotherapy office in the financial district of San Francisco beginning March 1st, 2014! This office will be a second location for me, as I will continue to see patients in Market Hall, located in the Rockridge area of Oakland. My new office address is at 220 Montgomery, located in the historical landmark Mills Tower Building, regarded as the city’s second skyscraper after the Chronicle Building and home to several major financial firms including the New York Stock Exchange. Please pass this update to anyone who might be interested in psychological services, including psychotherapy and forensic assessment.

Freshman year college survival guide: 20 tips for success

17 Oct

The autumn season for many young people is an exciting time of year. Seniors in high school are excitedly anticipating next steps in their educational paths, contemplating their college selection and admission possibilities. Freshman in college are in the throes of their first term/semester, scrambling to survive and balance their newfound independence, educational demands, and social development. In my practice as a clinical psychologist I treat young people as they learn to navigate these important life transitions.

One of the questions I am asked most often by young people is “How did you make it through college successfully and get in to graduate school? How did you become a clinical psychologist with your own private practice? I also receive emails from young people all over the country hoping I might share with them helpful advice on building a prosperous career in psychology. Many of them do not have role models to approach for guidance, particularly young people of color and/or those who may be the first generation to attend college in their family or community.

An excerpt from a message I recently received:

Dear Dr. Villarreal,
I am a senior in high school in Utah. Since I was in 8th grade I was interested and fascinated with psychology. I am still interested now that I’m a senior. I want to be a clinical psychologist and I came upon an interview that you did on YouTube and you really stood out to me. I am also a Hispanic female, therefore you were really inspirational to me! I had some questions about how you chose your undergraduate school. This seems to be the only thing I am worried about and I don’t exactly know what I should be looking for. Also, I know that I want to open my own private practice in the future and I wanted to know how you started yours. Thank you so much for you time.

At every step along my journey through college and graduate school I benefited from peers, teachers, and supervisors who helped guide me towards success and taught me to tap into the essential motivation and stamina it takes to overcome the inevitable challenges, setbacks and failures along the way. According to American College Testing (ACT), one in every four college students leaves before completing their sophomore year and nearly half of all freshmen will either drop out before obtaining a degree or complete their college education elsewhere. The tips in this article serve as a guide to surviving your first year of college with improved odds for success. Developing the right tools, skills, and habits early on can help you not only succeed in college and your future career, but in managing a well-balanced life.

  1. Attend freshman and campus orientations. It is extremely tempting to skip some of the long-winded freshman year orientations that take place at the beginning of the school year. Even if you don’t hear any new information, these gatherings are an excellent opportunity to ask questions, meet other like-minded peers, and commit newly learned information to memory.
  2. Make an effort to befriend roommates and others in your residence hall. The people you live with your freshman year are all likely going through similar transitions and emotions as you, and can be huge source of support as you adjust. This built in network of people serves not only as a team to problem solve day-to-day challenges, but will open up continued opportunities for social support.
  3. Stay on campus as much as possible your first year. Frequent trips home to eat or do laundry, off campus jobs, or maintaining romantic partners from home can stand in the way of fully adjusting to college. The more time you spend acclimating to your campus and new peers, the more comfortable you’ll be in your new environment and the more likely you are to thrive there.
  4. Get organized. In high school, teachers typically lead you through all the homework and due dates. In college, professors hand out a course syllabus and/or post the assignments online for the entire term/semester and expect you to prepare independently. While digital devices are a great way to get organized, maintaining a hard copy calendar is also extremely helpful for mapping out a ‘master timeline’ for completing all your readings, assignments, tests, and other important events. While good grades might have come naturally to you in high school, you will have to develop a new set of organization and study habits to survive your new educational setting.
  5. Become an expert on course requirements and due dates. Professors spend hours preparing course syllabi and calendars so that you will know exactly what is expected of you, and when. One of my most memorable failures (that thankfully I can laugh about now) is when I didn’t realize that a freshman course final exam was only ‘optional’ for those people who’d earned a certain number of points by the end of the semester. Don’t get burned by finding some things out too late!
  6. Commit to a study area and time schedule. With a never-ending calendar of social opportunities, campus events and parties it’s very easy for unstructured ‘study time’ to fall by the wayside. As early as possible, carve out specific times in your schedule to complete your readings and studying. Set realistic deadlines for yourself and stick to them. Choose a place with as few distractions as possible and make a commitment to going regularly. Selecting study partners is also important- decide early on which of your peers are better as study partners and which are better reserved for socializing only.
  7. Seek a balanced life. College life is an ever-changing mix of social opportunities, academic demands, and self-care. Try to prioritize what’s most important to you in advance and then make your choices accordingly. Peers can be extremely influential in your daily habits so try to surround yourself with like-minded people who will help you maintain a balance that’s well-suited to your personality and abilities.
  8. Attend class regularly. Avoid the temptation to sleep in or go late to that 8 am class. Without parents or attendance requirements to keep you on track, it’s a slippery slope when you start giving yourself permission to skip classes. Even if your professor is simply reviewing a powerpoint presentation that is available online, you’ll miss the exposure to auditory learning which will help you perform better on exams and assignments. You also risk missing vital information from professors about what to expect on exams, changes in due dates, etc.
  9. Connect with students in your classes. Aim to meet at least one new person in each of your classes and exchange contact information with them. Everyone appreciates someone else making an effort to say hello, so try to overcome feelings of shyness. These connections will serve as an important resource when you have to miss a class or need to build or join a study group down the road.
  10. Visit your professors during their office hours. Speaking as a professor, I can assure you there are only benefits to getting to know your professors, especially if later in the semester you run into some problems and need to ask for extensions or planned absences. Professors maintain office hours for the sole purpose of meeting with students to help them troubleshoot and succeed in their course.
  11. Meet with your academic adviser at least twice a year. This is the person who will help you with course conflicts, adding and dropping courses, planning out your terms/semesters, and selecting majors and minors and their requirements. Your academic adviser can play an integral role in leading you towards a timely graduation. Don’t be afraid to request another adviser if you don’t click with the one assigned to you.
  12. Don’t feel pressured to decide on a career right away. Even if it seems like everyone else knows what they’re doing with their lives, try to resist committing prematurely to a specific career path if you feel undecided. College is a time for you to explore what you enjoy learning in greater depth. It may take a few different directions before you have a greater sense of how you’d like to spend your time once you graduate. Further, just because it feels like a struggle to succeed in a given area, don’t give up easily. Trust your attraction to a particular area of study. Passion is the fuel for hard work and determination, which will allow you to succeed over time.
  13. Consider joining student organizations. A big hurdle for a lot of new students is the combination of homesickness and a feeling of not belonging, particularly for students of color, sexual minorities and those living far from their regional home. Look into joining student organizations, clubs, sororities or fraternities, or sports teams. You’ll benefit from much needed social support, learn new skills, and feel more connected to your school.
  14. Don’t be afraid to enlist extra help. One of the biggest mistakes students can make is not securing extra help early on, before becoming overwhelmed and lost. Take advantage of the study resources on campus- most have learning labs and tutors available, or consider joining/forming a study group. Don’t feel ashamed for needing extra resources or support. Every successful professional (including myself) got there by adopting a ‘do whatever it takes’ approach to achievement. College is a humbling time for just about everyone at one point or another. Make an effort to shift your focus away from evaluating yourself by the grades you earn. Instead, look for upward growth as a marker of success. My own college transcripts definitely reveal a slow and humble start, with steady improvements along the way.
  15. Stop comparing yourself to everyone else. Everyone learns in different ways, and at different paces. Everyone comes from different backgrounds with a wide range of life experiences, making college easier or harder, depending on their origins. If I’d given up after realizing other people were learning faster than me, or earning higher grades than me, I definitely would NOT have succeeded in earning a Ph.D. I wasn’t the smart kid who earned straight A’s, and I had to work much harder and longer than many of my peers to achieve passing grades. I made a lot of mistakes and faced a fair amount of setbacks along the way. Eventually college got easier, even though the courses got harder because I became more familiar with what study habits worked best for me. In spite of those challenges and setbacks, I continued to pursue my long term goal of becoming a licensed clinical psychologist. Accept early on that it may take you longer than expected to reach your goals, and the path you take to get there may be different from those around you. Keep asking for help, but be prepared to work harder than others around you if you expect to see successful, competitive results.
  16. Take responsibility for yourself and your actions. Try not to waste time placing blame on others for problems you face along the way. Move on and take the attitude that no one else is worth losing sight of your goals. Part of being an adult means taking responsibility for what happens to you, regardless of how you got there.
  17. It’s normal to feel overwhelmed. College is a time of tremendous change and ongoing challenges. Expect to have moments when everything seems too difficult to continue, or feeling like everyone else seems to be getting along better than you. Take a break and wait for those moments to pass; they will. Just keep moving forward and take one day, one week at a time.
  18. Make time for self care. Be sure to set aside time and activities that help you relax and take the stress out of your day or week. Whether it’s spending time with friends or communicating with family for support, engaging in your favorite type of exercise or hobby, or having downtime watching your favorite television shows or movies, be good to yourself. It will feel like you don’t have time to relax! But by doing so you will recharge and have better focus when you return to your studies.
  19. Maintain healthy eating and sleeping habits. Adequate sleep and nourishment are essential for maintaining your mood and energy level. While college dorms and apartment settings are great places to socialize with your peers, they aren’t always conducive to maintaining good health habits. Make a concerted effort to develop and maintain realistically healthy dietary and sleep habits. Freshman are especially vulnerable to gaining weight from unrestricted junk food and alcohol consumption. Aside from taking a negative toll on your physical health, don’t underestimate how these bad habits can affect your mental health as well. Even if you are the envy of your friends because you’re less prone to alcohol hang-overs or weight gain, poor health habits will eventually take a toll on your mental functioning and consequently your ability to thrive at your highest potential.
  20. Seek professional help when you need it. Familiarize yourself with your college’s health resources and counseling centers. If you become sick, or notice ongoing feelings of isolation, anxiety or depression, don’t wait for things to worsen before taking advantage of the many services these offices provide for students. You don’t have to face these issues on your own. Consider asking a friend to go with you if you feel reluctant to go alone or offer to go with a peer who may be struggling. Keep a list of emergency hotlines for handling crises such as experiencing suicidal thoughts, sexual violations or violence.

BONUS TIP: Keep track of your spending habits. While a fortunate few of you will have adequate financial support during your college years, many of you will need to learn how to budget your money and spending habits early on. Regardless of your financial resources, it’s important to develop responsible skills in money management- the earlier the better. Avoid succumbing to credit card solicitations on campus or in the mail. The average credit card debt of college graduates is shocking, and can take a staggering number of years to pay off. Familiarize yourself with what options you have in your college’s financial aid center, and plan accordingly.

Final Words of Advice for College Students~ Your college years will fly by before you know it.  Try to hold on to the positive experiences and let go the hardships. Invest in healthy relationships and avoid negative people that can drain you, stress you out, pressure you, or demand more of you than you can afford to give. Don’t be afraid to try new things, go new places, or take new risks! Some of the best experiences I had were the result of taking a leap of faith in myself and my ability to figure something out after the decision/commitment was already made. Roll the dice and bet on yourself to succeed, even if the odds are seemingly stacked against you. Remember that setbacks are NOT failures, they are extended opportunities to learn and grow in new ways. Furthermore, what you learn from those setbacks will prove to be the backbone of your strength and abilities later in life. Forgive yourself for making mistakes. No one else is keeping track like you are; as soon as you get back on the right path, those incidents will fade away as you continue to accrue new achievements. I look forward to hearing your success stories!

Dr. Christina Villarreal is a licensed clinical psychologist and maintains a private psychotherapy and forensic assessment practice in Oakland, CA.


CBT for Treating Mood Disorders

9 Oct

CBT for Treating Mood Disorders

Among the various psychotherapeutic “talk therapies,” cognitive-behavioral therapy (CBT) appears to be the most effective approach.  CBT is the modality of treatment I use within my psychotherapy practice in the Bay Area, CA.  Like all psychotherapies, much of the success depends on the skill of the therapist as well as the connection one develops with their therapist over time.  What can you expect in a typical session of CBT?

Approach.  CBT focuses on identifying distorted perceptions that people have developed of the world and themselves, revealing how these maladaptive perceptions influence feelings and behavioral choices.  CBT strategies help people adjust these perceptions, and discover new, healthier patterns of thinking. These perceptions, known as schemas, are negative assumptions developed in childhood that can precipitate and prolong mood disturbances.  CBT works on the principle that these schemas can be recognized and altered, thereby changing the response and eliminating disturbance in mood.

  • First, you will learn to recognize depressive and/or anxious reactions and thoughts as they occur, usually by keeping a journal of thoughts, feelings and reactions to daily events.
  • “Homework” may be given in order to practice testing old, negative assumptions against reality, illuminating what may have been previously ignored or overlooked
  • In conjunction with your therapist, you will learn to examine and challenge these maladaptive automatic thoughts and reactions.
  • You will learn to identify how your particular style of thinking has led to patterns of low moods as well as patterns in interpersonal conflicts.  You will learn how to employ new, healthy coping strategies tailored to your special needs.

Over time, CBT can help to rebuild the confidence necessary for you to sustain healthier patterns of functioning.


Shootings Advice from Oakland Clinical Psychologists

2 Feb

Dr. Villarreal, along with her colleague Dr. Frank Davis, was interviewed by journalist/blogger Zennie Abraham of regarding the Newtown Shootings.

sandyhook students, of Newton, CT

[from article produced by Zennie Abraham] “In the wake of the Newton Shootings, many people have a lot of questions. But perhaps the most well-considered one concerns how do we spot a person who might commit such an act before they do it?

To get to that answer, I turned to Oakland and Berkeley-based clinical psychologists Christina Villarreal and Frank Davis, respectively for a talk.

The main reason for Adam Lanza’s murder of 26 people, 18 of them kids, was simple: “access to guns,” is the comment both Dr. Villarreal and Dr. Davis pointed to in our conversation. “There may have been some mental health issues,” speculated Davis. “We have to speculate that there were mental health issues, but as of this time no report has been made (explaining that), Villarreal said.

What To Do If You Think Someone Has A Problem

If you think you know someone who has a mental illness problem that could lead to gun violence, Christina Villarreal and Frank Davis recommend that you talk to the person and also talk to a mental health professional for advice, too.

What About Internet Threats?

Some post threats of life to others on the Internet, but does that count as a issue of concern? Dr. Davis says it does. “I would take the threat seriously,” he said. And Davis also explained that it’s better not to consider such an act as benign. Dr. Villarreal said that it’s also important to make sure parents of children know what they’re accessing online, in order to keep them both from threats and from the possibility that they may be issuing threats via the Internet.

The watchword is to watch. Watch people around you and what they do. Be ready to ask questions of the person you think has the problem.

I would add this: support gun control. We have too many guns in our society, and that has to end.

Stay tuned, Zennie Abraham

2012 in review

2 Jan

The stats folks prepared a 2012 annual report for my blog.  It received 20,000 views in 2012 from 140 different countries!  I hope to continue writing pieces that inform the public on issues in clinical psychology as they relate to their world…please feel free to submit requests for topics in clinical psychology you’d like to see written about in my blog.  Happy New Year!

Here’s an excerpt:

4,329 films were submitted to the 2012 Cannes Film Festival. This blog had 20,000 views in 2012. If each view were a film, this blog would power 5 Film Festivals

Click here to see the complete report.

Adam Lanza, mental illness and violence: Is there a connection? Get the facts.

26 Dec

Adam Lanza, the man the Associated Press has identified as the gunman in New Haven, CT’s mass shooting is reported to be responsible for the second worst mass shooting in U.S. history, exceeded only by the Virginia Tech massacre. Like the 1999 Columbine High School massacre, all of the individuals responsible for these tragedies were reported to have documented histories of mental illness. William Spengler, the gunman who ambushed firefighters in N.Y. killing two and injuring two others before killing himself had a criminal history of violence. Horrific events such as these draw widespread criticism of U.S. gun laws and spark intense debate about gaps in mental health care language and practices, privacy laws and loopholes that allow individuals adjudicated as mentally unsound to purchase and carry handguns without detection by the National Instant Criminal Background Check System (NICS). While the vast majority of individuals with mental illness are not prone to violence or anti-social behaviors, mental health professionals are aware that some psychiatric disorders are believed to be risk factors for violence. How can we know if and when there is a connection between mental illness and violence? This article serves to provide facts about relevant mental disorders in the case of Adam Lanza’s murder/suicide spree.

Did mental illness and/or a developmental disorder contribute to Adam Lanza’s violent behavior and callous disregard for human lives?

Adam Lanza’s brother, Ryan Lanza, told ABC news that Adam “is autistic, or has Asperger syndrome and a ‘personality disorder.'” Greater diagnostic clarity will likely emerge in the coming weeks as individuals familiar with Adam’s medical/mental health history come forward to aid law enforcement in their investigation. In the meantime, this article serves to clarify symptoms of the diagnoses that have been named in the case:

Personality Disorder: The Diagnostic and Statistical Manual (DSM-IV), psychiatry’s classification guide states “a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.” This pattern must appear inflexible and pervasive across a wide range of situations, and lead to clinically significant distress or impairment in important areas of functioning. While Adam Lanza’s particular diagnostic picture is currently unclear, some personality disorders appear to reflect symptoms consistent with Adam Lanza’s violent behavior and callous disregard for human life.

Antisocial Personality Disorder (ASPD): The DSM-IV‘s term for what is commonly known as psychopathy. Although there are behavioral similarities, ASPD and psychopathy are not synonymous. A diagnosis of ASPD using the DSM criteria is based on behavioral patterns, whereas psychopathy measurements also include more indirect personality characteristics. The psycho-diagnostic tool most commonly used to assess psychopathy is the Hare Psychopathy Checklist, which measures the following symptoms:

  • Aggressive narcissism (which may include) glibness/superficial charm, grandiose sense of self-worth, pathological lying, manipulation of others, lack of remorse/guilt, shallow affect (genuine emotion is short-lived and egocentric), callousness/lack of empathy, failure to accept responsibility for own actions
  • Socially deviant lifestyle (which may include) need for stimulation/proneness to boredom, parasitic lifestyle, poor behavioral control, lack of realistic long-term goals, impulsivity, irresponsibility, juvenile delinquency, early behavior problems, revocation of conditional release

Research studies report these symptoms are associated with reactive anger, impulsive and premeditated violence, and criminality. While the exact cause of personality disorders remains under debate, research studies point to both genetic and environmental contributions. Assessment and treatment of personality disorders are generally time consuming and challenging, and exacerbated by cutbacks in managed healthcare. Doctors and other health care professionals are seldom afforded adequate time to collect the detailed information necessary to diagnosis and treat someone with a personality disorder. Effective treatment includes long-term theraputic strategies that are firm yet fair, and teach individuals skills that can be used to live independently and productively within the rules and limits of society.

According to Dr. Janella Street, a clinical and forensic psychologist who works with individuals who’ve been accused of or convicted of criminal activity “One of the biggest challenges in providing preventive mental health care is overcoming the stigma attached to being diagnosed with a mental disorder. We have to make more effort to educate the public about various types of mental disorders, and remind them that only a very small percentage of individuals with a mental disorder act out violently.”

Schizoid Personality Disorder: These individuals avoid social intimacy, have little interest in relationships, and have limited emotional range – often manifest as blunted affect. Russ Hanoman, a friend of Lanza’s mother, earlier reported to CNN that Lanza was “very withdrawn emotionally.” Schizoid Personality Disorder is not the same as schizophrenia, although there is a familial association between the two. There is also a familial association between schizophrenia and insensitivity to pain, which Lanza reportedly experienced. Richard Novia served as an advisor to Newtown High School’s technology club, an organization to which Lanza belonged. Novia says he had meetings with Lanza’s mother, Nancy, and school administers about ensuring Lanza’s safety, considering his apparent inability to feel pain. “If that boy would’ve burned himself, he would not have known it or felt it physically.” It is currently still unknown if Adam Lanza was officially diagnosed with congenital insensitivity to pain, a rare neuropathic disorder that makes people unable to register painful stimuli and can lead to empathy problems.

Avoidant Personality Disorder: These individuals are socially inhibited, feel inadequate, avoid social interaction, and are hypersensitive to criticism. Many who’ve come forward to offer their accounts of Lanza in his youth describe him as socially withdrawn and awkward. Alan Diaz who reportedly knew Lanza several years ago said “He was a shy kid, quiet. He would sometimes stand in the corner. We knew he was socially awkward and we just accepted it. But he was never threatening.” Marsha Moskowitz, 52, drove Lanza to school for three years and said about Lanza “He didn’t sit with the other kids and didn’t seem to have any friends.”

Autism: Autism is a disorder characterized by difficulty with social interaction and communication, as well as repetitive and restrictive behaviors and interests. It is currently estimated to affect 1 in 88 children born in America. Diagnosis is usually made between ages 2 and 6. While children with severe autism can have violent outbursts, there is no known link between autism and premeditated violence. According to UCLA psychologist Elizabeth Laugeson, autism spectrum disorders can sometimes correspond with a reduced sensitivity to pain. Lanza’s classmates claim to have been told that he had Asperger’s.

Asperger’s Syndrome is considered a type of autism (with anticipated change in nomenclature in the DSM-V in 2013). In this disorder, individuals have difficulty with social interaction and judgement, lack non-verbal communication skills, demonstrate repetitive and restrictive behaviors. Odd speech patterns and physical clumisness can also be common traits. People with Asperger’s may lack interest in sharing experiences with others, or developing relationships. Asperger’s is also associated with an insensitivity to pain as well as social deficits such as impoverished ability for empathy. Individuals with Asperger’s tend to have a theoretical understanding of people’s emotions, but often struggle with acting socially appropriate in real-life situations. The cause of Asperger’s Syndrome appears to result from developmental factors that affect many or all functional brain systems. The mainstay of treatment for Asperger’s is behavioral therapy, focusing on specific deficits to address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Most children improve as they mature to adulthood, but social and communication difficulties may persist.

News source CNN has been unable to independently confirm whether Lanza was diagnosed with autism or Asperger’s. Both are developmental disorders, not mental illnesses. The Autism Society has released the following statement “There is absolutely no evidence or any reliable research that suggests a linkage between autism and planned violence. To imply or suggest that some linkage exists is wrong and is harmful to more than 1.5 million law-abiding, nonviolent and wonderful individuals who live with autism each day.”

Judith Warner, a health journalist of Time Magazine writes “We don’t know that Lanza’s crime represents a failure of our “system” of mental health care in America, as has been said countless times this week, because we don’t know what, if any, mental health care he was receiving in recent years at all. We don’t know what the Lanzas’ attitude toward mental health care was. Did Nancy, who home schooled Adam for years, reject the mainstream beliefs of child psychiatry, as many in the home-schooling community do?”

In the aftermath of the New Haven, CT shooting, The Interdisciplinary Group on Preventing School and Community Violence has asked for “a renewed nationwide effort to address the problem of mass shootings that have occurred repeatedly in our schools and communities. Now is the time for our political leaders to take meaningful action to address the need for improved mental health services and protection from gun violence. At the same time, concerned citizens in every community should engage in comprehensive planning and coordination to prevent violence in our schools and communities. These plans should include access to mental health services for youth and adults who are showing signs of psychological distress, including depression, anxiety, withdrawal, anger, and aggression as well as assistance for the families that support them. The bottom line is that we must all work together toward the common goal of keeping our schools and communities safe.”

The complete position paper and a list of endorsing organizations is available at

Read more at:

The complete position paper and a list of endorsing organizations is available at

Read more at:

The complete position paper and a list of endorsing organizations is available at

Read more at:

The complete position paper and a list of endorsing organizations is available at

Read more at:

The complete position paper can be reached at

Dr. Christina Villarreal is a clinical and forensic psychologist in private practice in Oakland, CA. Professional inquiries please direct to


Fifty shades of grey: 7 ways to promote change in your partner

23 Oct


Since writing the article Fifty shades of grey: awakening women’s sexual identities many readers have asked me to elaborate on a variety of topics related to the best-selling book series Fifty Shades of Grey, by E.L. James.  One question that has repeatedly come up is ‘How can I promote change in my partner, the way Ana did in Fifty Shades?’  As a clinical psychologist in private practice, I often help people improve their romantic relationships by helping them build communication skills, gain insights to their own perceptions about dating and marriage, and develop existing social skills so that their relationships are more fulfilling and enjoyable.  It’s not uncommon for people to want their partners to change as a way to improve their relationship, much like the characters in the book Fifty Shades of Grey.  This article serves to offer professional advice from a clinical psychologist on how to get what you want from your partner, and improve your relationship for the better.

1. In order to get what you want out of a relationship, you have to ask for it. 

  • It sounds simple, but a lot of women assume that their partner should know what they want.  Girls are often socially reinforced to be more socially subtle and indirect, while boys are often socially reinforced to be more direct and straightforward in their communication style.  So when women expect men to pick up on subtle clues about their needs in a relationship, and then get angry when their partner doesn’t “get it” this only leads to further miscommunication and fights—not change.  Ask for what you want, and explain your reasoning (using both logical and emotional sources).  Then give your partner a chance to share their perspective, and give them the attention/consideration you’d like to receive.

In Fifty Shades of Grey, Ana was initially reluctant to share with Christian her desire for a deeper emotional connection with him.  Like many women, she was afraid of wanting ‘more from the relationship’ than her partner, so she chose to wait for him to take these steps on his own.  She tried to engage in the relationship on Christian’s terms, in spite of her obvious discomfort with some of his sexual preferences/habits, and his inclination to keep her at arms length, emotionally.  Ana eventually came to realize she couldn’t be happy with what he was offering her, and chose to walk away when he struggled to meet her needs in their relationship.  When Ana finally made it clear what she needed from the relationship in order for it to work, Christian began the process of challenging himself to compromise and change himself in order to meet her needs. 

2.  Timing is everything (when it comes to communication!)

  • When initiating some conversations, especially ones that are likely to be emotional in nature, timing is essential.  Men are generally more comfortable and willing to open up to the possibility of change when they don’t feel pressured and put on the spot.  A lot of guys need time to think and analyze the situation before they are ready to respond, let alone agree to change immediately.  By giving your partner time to think over your concern without pressure, you’re more likely to get a positive response.  It can also be helpful to raise certain topics during an activity, like a long walk, drive or other simple task, rather than saying “we need to talk” and then expecting them to engage in long, emotion-filled, face-to-face conversation.  While women are often accustomed to simply chatting with their girlfriends, men are often more comfortable having conversations with their friends while doing a mutually engaging activity.

In Fifty Shades of Grey, Christian demonstrates to Ana he needs time to absorb and consider the changes she needs in order for their relationship to work.  Initially, his reaction to her is “this is who I am, and I can’t change.”  Further, Ana and Christian attempt to resolve their conflicts when both of them are already emotionally and/or physically charged, which proves to be unsuccessful in several scenes.  Both of them often needed time to cool off after an argument, and re-assess where they were willing to make compromises for each other.  The author made a point of allowing their relationship to develop and overcome obstacles in small, realistic steps.   

 3.  Lead by example.

  • It’s often very helpful to take initiative in a relationship, and lead by example.  Be willing to find out if there are things your partner would like to see you change, and take them into serious consideration.  Take the approach that you want the relationship to grow in a positive direction for BOTH of you.  If your partner sees that you are willing to meet his needs in a way that might be initially challenging for you, he will be much more willing to change for the sake of the relationship too.  Try to resist the urge to keep score.  No one wants to feel like they’re in a relationship with the relationship police!  As long as both people are working on change, this is positive growth.  It’s not a competition and there is no finish line.  Aim to use positive reinforcement and support, and express appreciation.  You’ll likely receive it in return.  Both men and women are naturally attracted to people with ‘good energy’ versus, nagging, critical energy.

Ana was willing to demonstrate to Christian that she could change her ideas of what sex ought to be like- instead of ‘vanilla sex’ she was willing to experiment with his preference for BDSM-style sex.  With time, Ana was also willing to accept Christian’s gifts and lavish lifestyle, in spite of her discomfort with wealth, and all that it represented to her.  I believe her willingness to change for the sake of the relationship and positive encouragement allowed Christian to open up to the idea of change in himself.  For example, he became increasingly willing to allow her to physically touch him in ways he’d never allowed himself to be touched before.  She was also sensitive to moving forward at a pace that was comfortable to him.  The author writes about this dynamic of their relationship very realistically, which is why I believe the book captivates such a large audience.

4.  Understand that a man shouldn’t be expected to ‘change for you’ he should ‘change for himself’. 

  • A lot of men develop habits in their life because it suits them during certain phases in their life.  These habits aren’t necessarily indicative that he’s ‘not ready for a serious relationship’ it just means he hasn’t found reason to behave differently.  This does NOT mean however, that a man should be expected to ‘change for you’.  If a guy sees that certain behaviors aren’t going to fly with you, he’ll figure that out, and decide on his own to internally motivate and take a new direction if he believes he’ll be a happier version of himself as a result of what this change can offer him.  

In the past, Christian was involved with many women in various capacities.  However, he’d never been inspired to relinquish his rigid sexual and relationship preferences.  When Christian fell for Ana, he realized he wanted to experience more with her, both emotionally and physically.  The author captures the tremendous challenges he experiences as he attempts to hold onto a woman who wants things he’d never thought possible to give someone.  When Ana questions his ability to be fully satisfied with her (as someone who doesn’t share his affinity for strictly BDSM-style sex), he explains that he no longer needs to maintain that lifestyle because he is happier with her than he’d ever been before.

5.  Don’t fight your differences, appreciate them.

  • We’ve all seen that great couple in action- they seem to compliment each other and because of that, their lives are happier, healthier and less stressed.  Each of us have strengths and weaknesses in our personalities.  As much as we’d like to think we’re pretty close to perfect, we can often benefit from partnering with people who help ease us out of our rigid habits.  People who are planners and highly organized can often benefit from being partnered with people who are spontaneous and make do with completing things ‘at the last minute’.  Just because two people think/behave differently, doesn’t mean they need to try to change the other person.  In fact, these differences actually result in a couple that is capable of both planning AND living with spontaneity and flexibility- all skills that are equally important for a well-balanced life. 

Ana and Christian’s relationship is a great example of how two people can benefit from their personality differences.  Christian successfully introduces Ana to a sexual lifestyle that is highly fulfilling to her, and one that she might not have ever enjoyed had she not become involved with him.  Ana successfully introduces Christian to emotional intimacy, and helps him to trust and let go of his rigid need to control others- skills he might not have developed without a relationship with Ana.  Together, their qualities create a relationship that captivates readers because it is so obviously fulfilling and enticing to them both physically and emotionally. 

6.  Learn to get your needs met in a variety of ways, rather than looking for your partner to ‘be everything’ for you.

  • Everyone should aim to develop and utilize a variety of ‘self-care’ habits, tools, and social support as a way to cope with the stressors in their lives.  Our partners can’t possibly be held responsible for changing in every way we’d like them to, and even if they were willing to try, it wouldn’t be possible.  Be aware that when you are stressed, you become more irritable and more likely to focus your attention on the shortcomings of your partner.  Don’t let stress accumulate and destroy your mood, leading you to believe your relationship is inadequate at making you happy.  No relationship should be held responsible for your happiness.  Only YOU can put to use a variety of resources that are effective in helping you distress.  Then you can go back to enjoying your partner, who hopefully is also working hard to do the same.

In this example, Christian is the one in the relationship that has to grow to accept that Ana needs to maintain parts of her life separate from him (working and developing her career, spending time with old friends, etc.) and can’t be available to him all the time to meet his needs.  Ana helps him realize that they can remain close and intimate without sacrificing their respective need for independence.

7.  Recognize that some urges to ‘change others’ have origins in your past. 

  • Each of us can benefit from looking at our familial upbringing and preconceived perceptions about intimate relationships as a way of better understanding what we expect from our relationships.  When necessary, be ready to seek the expertise of a mental health professional to help you gain insight, understanding, and coping strategies when your past is keeping you from enjoying your intimate relationship.  If you feel that your partner’s past seems to be getting in the way of his ability to enjoy the relationship, support and encourage him to figure out ways to work through these issues, and also consider seeking professional help when necessary.

Fifty Shades of Grey illuminates the various ways in which Christian’s dysfunctional childhood shaped his overall outlook on interpersonal relationships, limiting his ability to trust and connect with others.  In the past, Christian’s only way of engaging in physical intimacy was through domination and control.  While Christian is able to successfully engage with Ana in the creative fantasy world of BDSM, he is also forced to examine his upbringing as a root cause for his rigid need control others, lack of trust, and need to keep people at a safe distance.  Through the use of effective, ongoing psychotherapy and support from loved ones, Christian is able to challenge himself and change in ways that allow him to reap the benefits of a loving, romantic relationship.  

Dr. Christina Villarreal is a licensed clinical psychologist in private practice in Oakland, CA.  For professional inquiries contact her at



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