by Jennifer Kemp, MPsyc
Striving to better, oft we mar what’s well.
It’s not about perfection. It’s about purpose.
WHAT IS PERFECTIONISM?
Perfectionism is a widespread problem for people struggling with OCD, as well as people who struggle with hoarding, panic disorder, social anxiety, post-traumatic stress disorder, eating disorders, body dysmorphic disorders, and generalised anxiety. Perfectionism is also strongly associated with depression, burnout, and chronic fatigue. As you can see, it is a process that cuts across many disorders; both causing and maintaining problems and interfering with the effectiveness of therapy (Egan, Wade, & Shafran, 2012).
Yet do we know what perfectionism is? Perfectionism is often spoken of as a personality trait (“I’m such a perfectionist!”). It has also been explored using a cognitive behavioral perspective, where perfectionism features thinking errors (shoulds, oughts, musts, all-or-nothing thinking, and so on), and these thoughts lead to problematic behaviors (Shafran, Egan, & Wade, 2018). The idea is that by changing a person’s thinking patterns, you can help change their behavior for the better.
I was in my mid-30s when the penny finally dropped that perfectionism was the underlying cause of the mental health issues I’d been experiencing since my teenage years. At 16, I had gone on a strict diet and developed an eating disorder that persisted into young adulthood. In my 20s, I was diagnosed with generalized anxiety disorder and for about a year I was on antidepressants due to a major depressive episode. I had always struggled with self-criticism and constantly feared making mistakes. Getting feedback of any kind was terrifying.
Since I made that realization, I’ve been exploring my own perfectionism, and through my studies and work as a clinical psychologist, I’ve been lucky to explore the perfectionism of my kind and willing clients. I’ve come to appreciate that there is so much more we can learn about perfectionism when we explore it as behavior that is controlled by certain fears. And I’ve found this approach has given me new strategies to use with my clients and myself.
I’ve never been much of a cognitive therapist, as I’ve always found it difficult to change people’s thinking in a lasting and meaningful way. (If you are a therapist who can do this successfully, I take my hat off to you.) Instead, I’ve been drawn to radical behavioral approaches, where everything a person does is behavior, including their thoughts, feelings, physical sensations, and actions. All these things form a person’s “behavioral stream” and we can analyze any behavior according to what happened before (the trigger, or antecedent) and after (the consequences and reinforcers). The simplicity and practical nature of this makes my work so much easier.
When I work with clients using behavior analysis, I can explore the usefulness (also called the “workability”) of their perfectionistic behaviors within their life (their context). I can also explore the purpose of their perfectionistic behavior (its function), and why the behavior keeps happening (what is reinforcing it). By doing so, I can work out whether certain behaviors are helpful or unhelpful for that person, at that time, and most importantly, can develop specific strategies to change that behavior when it is causing problems. I’ve found that the therapies well-suited to this work are exposure and response prevention (ERP), compassion-focused therapy (CFT), and acceptance and commitment therapy (ACT), and I’m going to give you some examples of how I use these with my clients.
THE CHARACTERISTICS OF PERFECTIONISTIC BEHAVIOR
So, what are perfectionistic behaviors? When we look at all the perfectionistic things people do, we can see patterns that make some perfectionistic behaviors helpful and others unhelpful.
Helpful Perfectionistic Behavior
Helpful perfectionistic behaviors all seem to be motivated toward the things that we want, such as achievement, excellence, and recognition. In behavior analytic language, this is known as behavior under appetitive control — behavior under the control of things we most value. Behavior under appetitive control is flexible and focuses on activities we value. People with helpful perfectionistic behaviors may work extremely hard, but have joy in doing so, and freedom to choose what they do.
Unhelpful Perfectionistic Behavior
Unhelpful perfectionistic behaviors also seem to share characteristics, but vastly different ones to those of helpful perfectionistic behaviors. The most common I seem to notice are:
Unhelpful behaviors that are controlled by fear
Attempting to avoid uncomfortable inner experiences
Setting personal standards just out of reach
Continuous, crushing self-criticism when these standards aren’t met, and
Focusing on short-term relief and not seeing the bigger costs.
Behavior Controlled By Fear
Fear seems to lie at the heart of all unhelpful perfectionistic behaviors. Put simply, unhelpful perfectionistic behaviors are motivated by what we want to get away from. In behavior analysis, this is known as behavior under aversive control. Behavior-driven by fear is rigid and inflexible; it becomes essential to follow the “rules” of what must be avoided.
Phobias are a good example of behavior driven by fear. If you have a fear of spiders, then you are very motivated to avoid spiders. If I was to tell you that there is a venomous spider in the room somewhere with us, it would be very hard for you to do anything except to try to find out where the spider is, or immediately leave the room. Your fear of spiders has controlled your behavior.
Perfectionistic behaviors are much like a phobia of mistakes or judgment. The kinds of fears that drive perfectionistic behaviors seem to include:
Making mistakes or failing
Being judged by others as inadequate, incompetent, or not good enough
Seeing ourselves as inadequate, incompetent, or not good enough and feeling shame
Quite the opposite of helpful perfectionistic behaviors, in unhelpful behaviors there is no freedom to choose or joy in working hard. Your fear of mistakes is your spider in the room. Working hard instead becomes a way of eliminating fear and can itself become a compulsion.
Many types of avoidant behaviors can be under the control of these fears. Passive avoidance strategies include procrastination, postponing tasks, taking the safe option, self-sabotage, and giving up. Active avoidance of these fears includes checking and rechecking work, excessive effort and workaholism, and reassurance/safety-seeking behaviors such as repeatedly checking that people are happy with you. All these fear-driven behaviors can become rigid patterns that then cause many other problems in life.
Just as with phobias, perfectionistic behaviors driven by fear can be the target of exposure. Using ERP, we can learn how to be flexible and take important steps in the face of this fear. Keep in mind, though, that aiming to do perfect exposures will not work. If you attempt this, understand you will need to make a few mistakes too.
Avoiding Uncomfortable Inner Experiences
Our unhelpful perfectionistic behaviors develop as a way of protecting us from inner experiences (thoughts, feelings, images, and physical sensations) that are unpleasant, uncomfortable, and unwanted. (In ACT, this is known as experiential avoidance.) For a start, we might try to avoid uncomfortable thoughts, such as “I am incompetent,” “I am a loser,” or “I can’t do anything right.” These thoughts can come with frightening intrusive images, such as the disappointed faces of our friends, or seeing ourselves as we lose our job, as well as strong emotions, particularly feelings of shame (Fedewa, Burns, & Gomez, 2005).
Shame is not an emotion as such; it is a combination of intense feelings of inadequacy, inferiority, worthlessness, embarrassment or disgust, together with thoughts that we are to blame. Shame is the conclusion that there is something wrong with us. Shame and fear are often associated with specific physical sensations within our bodies. Many people feel the shame related to mistakes in their stomach, such as a sinking or twisting feeling, or feeling nauseous (yep, that’s me). Others feel anxiety, shakiness, restlessness, or tension. All these experiences are uncomfortable, and naturally, we want to get rid of them. Unhelpful perfectionistic behaviors seem to give us a solution to this problem by preventing us from having these thoughts, feelings, images, sensations, and protecting us from what we fear (in the short term). Unfortunately, our efforts to avoid these feelings can then cause us many other problems in our life. Think about how many degrees have been lost due to procrastination.
Using ACT, you can target this experiential avoidance and help people move towards acceptance. Acceptance is not just “putting up with” or “tolerating” this distress. It is being willing to experience difficult and uncomfortable things because by doing so, we can achieve our goals and live our life according to what matters.
Personal Standards Set Just Out of Reach
Many people associate perfectionism with having ambitious standards, and indeed it is a characteristic of both helpful and unhelpful perfectionism. Setting ambitious standards can become a problem when we strive relentlessly to achieve “perfect” standards in a way that becomes rigid and controlling (again, probably because we are motivated to avoid failure or judgment.) It is even more problematic when we continue to raise the bar so that our goal remains just out of reach, and we keep aiming for these targets even though we feel distressed and criticize ourselves for not reaching them.
Even though their standards might be excessive, I never ask my clients to lower them. This is because I don’t believe any of them would actually do so, and I don’t believe in wasting time in therapy. Why argue with an obsession? We need to tackle unreasonable and rigid standards in some other way, and my usual approach involves developing self-compassion using CFT techniques and using ACT to help develop a more flexible perspective on these thoughts.
For most people, their usual response to not meeting their standards is harsh and unrelenting self-criticism. Possibly the most destructive behavior, excessive self-criticism is a hallmark of unhelpful perfectionism. When we don’t meet our standards, we are “not good enough.” When we achieve our objectives, our standards must be “too easy,” and the bar needs to be raised for next time. Many of us base our self-worth on these goals, and the result is never feeling good enough. Over time, this can have a crushing effect on our self-worth.
Using self-compassion helps hugely, and it has been for me personally the biggest breakthrough. Using CFT, we can explore how self-criticism triggers our built-in “threat system” and activates our fight or flight response (Kolts, 2016; Welford, 2016). Self-compassion provides a way of steadying and soothing ourselves in the presence of fear and if we make a mistake. It helps us to accept our difficult feelings, including shame, and be kind to ourselves while we are struggling, as we would likely do for anyone else who was in that situation. We can learn to be our own friends and use support and encouragement rather than criticism and judgment to motivate us to succeed.
Not Seeing the Bigger Costs
It is common for people struggling with unhelpful perfectionistic behavior to be particularly focused on the short-term rewards of their choices. (In behavior analytic terms this is known as responding to short-term contingencies.) I am not saying that people are unaware of the costs of their decisions. After all, the student who is procrastinating on their assignments must know that they risk failing their course. It is just that their intense discomfort when getting started overpowers their longer-term goals and fear of eventually failing. By avoiding their work, they can avoid feeling that discomfort for a little while. As we know, this becomes a trap. Whenever we are stuck in a cycle of responding to short-term consequences we become like a rat in a maze, constantly looking for cheese. The need for short-term relief is never enough.
It can be hard in this situation to see that we have a choice. The student can do the assignment if they are willing to feel the anxiety and fear, nausea, and so on, that comes with that choice. Two ACT strategies often used to address this are the Choice Point (Harris, 2009) and the Matrix (not the movie) (Polk & Schoendorff, 2014). Using these techniques, you learn to slow down and see the choices you have in each moment, acknowledge the pain and difficulty associated with each option, and then make a choice to either move towards your values or keep doing what you have been doing.
A FEW FINAL THOUGHTS…
We don’t need to think of our perfectionism as something fixed in our personality that we can’t change. By looking through a behavioral lens, we can see perfectionism as a set of both helpful and unhelpful behaviors that we can change if we choose. Our task in life becomes maximizing the helpful perfectionistic behaviors, such as healthy striving and working hard to achieve great things and addressing the unhelpful behaviors where they trip us up. ACT, ERP, and CFT can be useful in addressing the unhelpful behaviors that hold us back, and help us to transform these into behaviors where we have the freedom to choose, and that head us in the direction we value in life.
Egan, S., Wade, T., & Shafran, R. (2012). The transdiagnostic process of perfectionism. Revista De Psicopatologia Y Psicologia Clinica, 17(3), 279-294.
Fedewa, B., Burns, L., & Gomez, A. (2005). Positive and negative perfectionism and the shame/guilt distinction: adaptive and maladaptive characteristics. Personality and Individual Differences, Vol. 38(7), 1609-1619.
Harris, R. (2009). ACT made simple. Oakland: New Harbinger Publications.
Kolts, R. (2016). CFT made simple. Oakland: New Harbinger Publications.
Polk, K., & Schoendorff, B. (2014). ACT Matrix: A New Approach to Building Psychological Flexibility Across Settings and Populations. Oakland: New Harbinger.
Shafran, R., Egan, S., & Wade, T. (2018). Overcoming Perfectionism: 2nd Edition. London: Robinson.
Welford, M. (2016). CFT for Dummies. Chichester: John Wiley & Sons.