Therapy for Perfectionism

Perfectionism is one of the greatest contributors to stress and anxiety in our society...and it isn't difficult to understand why. Perfectionistic tendencies usually receive a great deal of social support.

As an example, parents rarely say to their kids, "Please don't try to do such a great job with your schoolwork!" Employers rarely say, "Don't strive for such excellence in your work all the time!" On the contrary, perfectionism is usually encouraged. Because of this, perfectionistic people are often conditioned to become even more perfectionistic.

However, perfectionism can take an enormous emotional toll. People who are perfectionistic are often highly self-critical, chronically stressed, and prone to burn-out in their work. In addition, their relationships are often strained by the pressure they put on themselves (and, at times, on the people around them.) Their perfectionistic tendencies may leave them feeling like mice running on a wheel in a cage — running ever-faster, but never finding lasting satisfaction. Changing this pattern can be an important goal in therapy.

Before describing my therapeutic approach to working with perfectionism, I want to clarify one common misperception: I never encourage people to give up their desire for excellence and simply settle for careless, lackluster efforts. Instead, I work with my clients to replace self-critical attitudes and self-defeating behaviors with replacements that lead to a peaceful, self-supportive mindset.

I find that instead of leading to mediocrity, this often leads to higher quality results at work, with creative projects, and in relationships. In the long run, it's a win-win solution for everyone involved. (Though in the short run, it certainly takes work to change the patterns!)

To begin the process of cognitive therapy for perfectionism, I often begin by exploring the various "flavors" of perfectionism.

Different Types of Perfectionism

It's always fascinating for me (and often, for my clients) to see how perfectionistic tendencies show up so uniquely. Some people are perfectionistic at work, but not at home. Others are perfectionistic about their relationships, but not about their jobs.

To get a better sense of a person's tendencies, I often give my clients an informal "perfectionism attitudes survey." This survey allows people to clarify where their perfectionistic tendencies emerge.

For example, someone who has classic work-related or school-related perfectionism (what I call "performance perfectionism") might have attitudes like the following:

  • "You should always do your very best at your assignments."
  • "It's unacceptable to slack off or to give less than 100%."

The person with these beliefs may experience a significant amount of pressure and stress whenever she is at work or school. However, outside of work or school environments, she might be surprisingly non-perfectionistic!

As another example, someone who has what I call "presentation perfectionism" might have the following beliefs:

  • "It's really important to always look your best."
  • "Impressions are important, and it's tough to undo them."

This person might become overwhelmed with a sense of pressure when interacting socially. However, he might have few perfectionistic tendencies in other areas.

There are many, many different ways that perfectionism shows up. In therapy, we often unmask many types, including relationship perfectionism, appearance perfectionism, spiritual perfectionism, decorum perfectionism, and more. It becomes obvious, in fact, that most of us have perfectionistic tendencies in one area of life or another.

Identifying our various flavors of perfectionism — and taking an honest look at how they show up in our lives — is one of the first steps toward changing these tendencies.

Altering Thought Patterns

As a cognitive therapist, my primary goal is to help my clients change their Thoughts, Emotions, and Actions — what I call the "TEA cycle."

When working with perfectionism, I find that it's often easiest to begin with the thoughts part of this cycle. Because of this, I begin my work by helping clients to unmask any self-defeatingly perfectionistic thoughts that they may be generating. We then work to replace these habitual "automatic thoughts" with self-supportive alternatives. In this work, I draw on an approach from Rational Emotive Behavior Therapy, a particular type of cognitive therapy.

A primary strategy in REBT is to help clients develop new attitudes based on Unconditional Self-Acceptance — USA for short. The idea is that self-critical, perfectionistic attitudes sap our energy, inspiration, and clarity; whereas self-accepting attitudes can free us up to peacefully accomplish many wonderful things.

Virtually everyone who has perfectionistic tendencies has a habit of self-critical thinking. For example, I often find the following types of thoughts in my clients:

  • "I'm so bad at this; this shows that I'm a screw-up."
  • "I really should be doing a lot better job at this. I better work harder."
  • "What's my problem? How could I mess this up? I should be more skilled at this."

In therapy, we look for "should" statements, "have to" beliefs, "better do" admonitions and other type of self-defeating self-talk. We then replace these with more self-supportive new statements.

In addition, we also uncover and modify deeper beliefs that say things such as:

  • "If I do a good job at this, it means I'm a good person."
  • "I need to make this work to show people that I am capable."
  • "If I'm successful at this, it will show that I'm a success in general."

These types of beliefs tie our worth to our work (or relationships, or appearance, or whatever), and place enormous pressure on us to chase perfect results.

Finding these types of beliefs and replacing them with USA — Unconditionally Self-Accepting — alternatives is an important part of the "cognitive" part of cognitive-behavioral therapy.

Anti-Perfectionism Practices

In addition to this thought-changing work, I also encourage my clients to make gentle but steady modifications to their actions. One of the most challenging (though sometimes fun!) ways to do this is to engage in anti-perfectionism practices.

In these practices, clients intentionally act in non-perfectionistic ways. For example, someone who is a communications perfectionist might intentionally flub a word or two. An appearance perfectionist might intentionally leave her shoes untied. A punctuality perfectionist might intentionally show up late for a meeting. A decorum perfectionist might simply act in silly, unusual ways.

The goal is to make these practices gentle and fun. As we engage in them, we demonstrate to our minds that mistakes are ordinary and acceptable, and that our worth is not really on the line. We also begin to break up any relational patterns that might be holding the perfectionism in place. (For example, our spouse might not be happy if we're two minutes late. Too bad! He or she will need to adjust.)

In addition to these anti-perfectionism practices, I also work with my clients to develop general stress-reducing and anxiety-reducing habits. These might include a commitment to a relaxation or exercise practice, an increase in assertiveness and boundary-setting activities, and improvement of conflict-resolution skills.

There are many other tools and strategies from the cognitive-behavioral therapy tradition that can help to reduce perfectionism, including locus-of-responsibility and perceived self-efficacy work. I try to take a very comprehensive approach in my counseling work for perfectionism.

Please contact me if I can answer any questions about cognitive-behavioral therapy for perfectionism.

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