Helping Clients with Perfectionism
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When counselors think of perfectionism, it is important to view it on a continuum. In some instances, perfectionism can help achieve high standards and goals, while in other occurrences, it can cause distress or impairment to your client’s life or to those around your client.
A tendency towards perfectionism can feel good when it is coupled with a job well done. Those who suffer from clinical perfectionism fear negative evaluation or failure. Some clients procrastinate, over-prepare for meetings, and seek over-reassurance from others because they fear the task they complete will not be exactly right.
Assessing Clinical Perfectionism
As a counselor, it is important to complete a full assessment of all symptoms, including any misuse of alcohol or other substances in your initial evaluation with the client. It is not unusual for a client to have comorbidities, meaning two or more mental health disorders at once. For some, their tendency towards perfectionism can lead to anxiety, depression, or other mental health disorders.
The Journal of Obsessive-Compulsive and Related Disorders reports,
Clinical perfectionism is characterized by imposing excessively high standards on oneself and experiencing severe distress when standards are not met. It has been found to contribute to the development and maintenance of various clinical presentations, including anxiety, obsessive-compulsive, and eating disorders.
When assessing young adults, keep in mind that research indicates a rise in perfectionism within this age group. This may be revealed through their social media usage and postings. Ask young adults about their social media usage and how it is affecting their mental health. Curran & Hill (2017) studied multidimensional perfectionism measurements from 164 samples of 41,641 American, Canadian, and British college students between 1989 and 2016: “In line with expectations, college students’ mean self-oriented perfectionism, socially prescribed perfectionism, and other-oriented perfectionism scores displayed linear increases.”
Obsessive-Compulsive Personality Disorder
When a client presents with perfectionism that is clinically distressing, evaluate for obsessive-compulsive personality disorder (OCPD). Symptoms for clients often start in early adulthood, developing a pattern of preoccupation with orderliness; perfectionism; and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. Those with perfectionism have high standards for themselves and other people, which can cause relational issues.
Obsessive-compulsive personality disorder (OCPD) is not to be confused with obsessive-compulsive disorder (OCD), which features obsessions, compulsions, or both of these.
When gathering information for a diagnosis, it is helpful to reach out to other sources in the client’s life, such as friends, significant others, and family. This is done to obtain a complete picture of the persistent behaviors. Often, clients with OCPD do not see their perfectionism as a problem, but it can cause distress to those around them. All information from other sources would be gathered with the client’s permission and obtaining proper releases of information.
A person with OCPD often performs well in environments requiring a structured or detailed approach. Their over attention to detail can cause people to miss work deadlines or ask for more time with the intention of perfecting their work. Others may want to micromanage or take over the entire project at work in order to control the finished product and make it just right. These behaviors can cause difficulties regarding a person’s occupation or relationships.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, DSM-5-TR defines OCPD:
The diagnostic criteria is indicated by four (or more) of the following, in a variety of contexts, for example, work, school, social, and/or leisure domains
Preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
Shows perfectionism that interferes with task completion
Excessive devotion to work and productivity resulting in neglect of leisure activities and friendships (not accounted for by obvious economic necessity)
Overly conscientious, scrupulous and inflexible about matters of morality, ethics, or values (not accounted by cultural or religious identification)
Unable to discard worn-out or worthless objects, even when they have no sentimental value
Reluctant to delegate tasks or work with others unless they submit to exactly his or her way of doing things
Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
Rigidity and stubbornness
Comparisons
Those who are perfectionistic tend to view themselves with upward comparisons, meaning they compare themselves to others who have more advanced skills than themselves. This results in the person feeling worse about themselves because they set up a situation in which they cannot live up to the standard. When perfectionists compare themselves to other perfectionists, it often turns into a competition. Either way of thinking does not foster a healthy level of self-esteem or self-worth. In counseling, it is good practice to monitor the comparisons perfectionists make and redirect them to compare themselves to themselves.
Social media encourages users to create a carefully cultivated image of themselves, which can encourage perfectionistic strivings or clinical perfectionism through the use of comparison. A research study of adolescents performed by Molnar et al., 2023 found:
Social comparison seemed to play a central role in many adolescents’ understandings of perfectionism. For some, this manifested as upward social comparisons that were inspiring. However, in most cases, these upward social comparisons resulted in feeling worse about themselves and fueled further perfectionistic behavior. Interestingly, it was common for adolescents to choose other perfectionists as objects for comparison. Specifically, adolescents made downward comparisons such that they would compare their perfectionistic behavior to similar others to ensure that they were the most perfectionistic, illustrating how social comparisons frequently morphed into a form of hyper-competitiveness.
Cognitive Behavioral Treatment
Challenging the thoughts of the client can help develop a new perspective on perfectionistic thinking and behaving. Some ways to decrease unhealthy perfectionism is to challenge the client’s all-or-nothing thinking or expose the client to make small mistakes on purpose. Exposing clients to small mistakes will help them tolerate the consequences of imperfection and view their thinking as an overestimation of making a mistake. No matter which type of treatment is chosen, a collaborative approach works best when the counselor and the client develop treatment goals together.
Reassure the client when restructuring thoughts that this type of treatment is not attempting to change the personality or who the core of the person is. Cognitive behavioral treatment helps ease the pressure of perfectionism. The counselor can do this by examining the rigid rules the client believes in and helping to establish more balanced and flexible thinking.
Behaviorally, helping clients focus on smaller goals can help them break down a larger project, easing overwhelm and stress. Another area of perfectionism that causes distress is harsh self-criticism, which can be replaced with self-compassion.
Mindfulness-based Treatments
Mindfulness can help those who struggle with perfectionistic thinking be more in the present moment. Many of these clients have difficulty identifying what they feel because their minds are focused on details and tasks. Mindfulness helps clients focus on their thoughts and feelings without trying to judge or control them. By noticing and labeling distressing thoughts without attaching meaning to them, a form of acceptance takes place. From this position, clients can more willingly choose to change those thoughts.
Simple exercises can be taught with the client in session, such as focusing on the five senses at this moment. Ask the client what they see, hear, smell, taste, and touch while in the office with you. Another exercise is mindful eating. Mindful eating can be held as a group activity or in an individual session. Have the client describe each sense using a piece of fruit or chocolate. For example, the client can describe what the food looks like, the taste, the feel of the food, the smell, and the sound of the jaw chewing. Slowing down and focusing on each sensation of eating, without judgment, can bring relaxation to body, mind, and spirit.
The use of mindfulness was applied to perfectionism with athletes. A 2023 study by Li et al. reports, “Mindfulness can impact competitive state anxiety through its mediation of self-efficacy and perfectionism. Mindfulness training plays a positive role in reducing perfectionism, enhancing self-efficacy, and decreasing anxiety levels among athletes.”
Mindfulness can also increase self-compassion, which decreases the distress of perfectionistic thinking. In session, teach your client to become aware of distressing thoughts through observation. Next, practice various self-soothing techniques and encourage them to respond in healthy ways. Some self-soothing methods are distraction, deep breathing, or positive self-talk. When clients learn to care for themselves despite being imperfect or failing, this increases their self-compassion.
Remember, stress can increase perfectionistic behaviors. Evaluate the stressors in your client’s life. When your client experiences multiple stressors, monitor their perfectionistic behaviors and thoughts. As clients feel emotionally out of control, they may search for ways to control tasks or their environment. Mindfulness will increase their awareness and help clients learn relaxation, decreasing the stress response.
Lisa Hutchison, LMHC
Writer & Contributing ExpertLisa Hutchison, LMHC, is a licensed mental health counselor for the Commonwealth of Massachusetts. She works for professionals who want to treat and prevent compassion fatigue. With over 20 years of psychotherapy experience, she helps her clients assert themselves, set boundaries, and increase their coping skills. Her specialty is decreasing stress, anxiety, and depression while increasing realistic methods of self-care for those who help others. Ms. Hutchison’s psychological advice has been featured in Reader’s Digest and the Huffington Post. Her articles have been published in numerous magazines, including Grief Digest and Today’s Caregiver.
Lisa is the bestselling author of I Fill My Cup: A Journal for Compassionate Helpers and a faculty member writer for NetCE. Her latest continuing education unit publication is “Setting Ethical Limits for Caring and Competent Professionals.” She has taught creative writing in colleges and presented on boundaries for the compassionate helper; the use of expressive art to heal grief, anxiety, and depression; inspirational and motivational topics; and creative writing techniques.