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How do you know when you should focus on perfectionism in therapy?

Martin Antony · Accepted Answer

I generally recommend focusing on perfectionism when it is causing problems in a person’s life and when it appears to be the individual’s main problem (versus just a feature of some other problem, like depression or an anxiety disorder). I also recommend focusing on perfectionism when the case formulation suggests that perfectionism may be driving one or more other problems. For example, I saw a client with body dysmorphic disorder, depression, and social anxiety disorder, with whom it became clear that problems with perfectionism were the main underlying explanation for all three of these other issues (e.g., anxiety over not looking perfect and being judged by others for his imperfections, as well as low mood focused on not being able to meet his standards).

Question 4

What are the best techniques to help the patient being more flexible?

Martin Antony · Accepted Answer

The most studied treatment for perfectionism is Cognitive-Behavioral Therapy (CBT). It includes teaching people strategies for identifying and challenging perfectionism-related thinking and for changing behaviors that maintain perfectionism over time. My self-help book, When Perfect Isn't Good Enough (https://www.amazon.com/When-Perfect-Isnt-Good-Enough/dp/157224559X), describes these strategies in detail, as does my book for therapists, Cognitive Behavioral Therapy for Perfectionism (https://www.amazon.com/Cognitive-Behavioral-Treatment-Perfectionism-Sarah-Egan/dp/1462527647). There is also emerging evidence supporting mindfulness and acceptance-based strategies (e.g., https://www.amazon.com/Anxious-Perfectionist-Perfectionism-Driven-Acceptance-Commitment/dp/1684038456) and relational therapy approaches (e.g., https://www.amazon.com/Perfectionism-Relational-Conceptualization-Assessment-Treatment/dp/1462528724).

Question 5

Is CBT effective for perfectionism aimed at others? In other words, can it be used to alter the behavior of a person with unreasonable expectations of those around them?

Martin Antony · Accepted Answer

Most of the research on CBT for perfectionism has focused on unreasonably high standards that people hold for themselves. Although there are reasons to assume that psychotherapy (e.g., CBT) may be useful for people with “other-oriented perfectionism,” there are also reasons to believe that it may be less effective. Perfectionism aimed at others is associated with perfectionistic thoughts and behaviors that can be targeted by CBT. However, it is possible that individuals with unreasonably high standards for others may respond less well to therapy compared to those with unreasonably high standards for themselves, especially if they are not distressed by their perfectionism or if they lack insight into the impact that perfectionism has on their lives.  More research is needed in the area of other-oriented perfectionism and its treatment.

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Should we be looking for perfectionism when someone presents with depression?

Martin Antony · Accepted Answer

Perfectionism is common in individuals with depression, so I generally recommend asking questions to assess perfectionistic thinking in individuals presenting with low mood. For example, I might ask the client about the extent to which their low mood is triggered by not being able to meet their high standards, and the extent to which their self worth is determined by whether they meet their standards.

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