The Perfectionistic Therapist: Striving to Help While Being Scared to Fail
The Perfectionistic Therapist: Unwinding Unhelpful Perfectionistic Habits in Our Clients and Ourselves
I’ve been talking, presenting, writing, and training people on the topic of perfectionism for some time now. When I started, I honestly thought that like most of my interests, it might last a year or two then this interest would gradually evolve into something new. What I’ve found instead is that my interest has deepened and broadened. I’ve gone deeper into looking at the behavioural mechanisms that cause and maintain unhelpful perfectionistic habits and expanded into exploring the relationship between perfectionism and specific mental health problems, in particular eating disorders and obsessive-compulsive disorder, and into how perfectionism looks in different groups, such as people with chronic illness and body image problems.
I am particularly fascinated by the experiences of one group of people who seem to struggle with perfectionism so much – therapists. As a psychologist, I can see how our profession almost seems to screen for perfectionism. Therapists with other professional backgrounds seem to struggle with this too.
This makes me wonder how far this issue might go in other professions too. What if other professional groups where the training programs are competitive, there is a focus on exactness and excellence, and a desire to help might struggle and with this too? Medicine, physiotherapy, and dietetics jump to mind.
It is not only our training that creates a context for unhelpful perfectionistic patterns. As therapists, we have a job that is completely uncertain. Every client is unique and client problems are often complex and always ambiguous. We share a deep desire to help and be useful for our clients, creating a very strong internal pressure to succeed that is built upon our values and yet can become rigid and rule-bound. Not wanting to fail our clients or ourselves, we can feel incredible urgency to help every client in every session, always work at our peak level of performance (Deutsch, 1984), and achieve lasting results, all within the limits of Medicare funding. It is so uncomfortable to sit with the uncertainty of whether our clients are getting better that we naturally look for strategies that will give us greater certainty in therapeutic outcomes.
Many of these strategies are of course helpful. Preparing for your sessions, seeking supervision, doing extra training, and writing up your notes in a way that helps you keep track of the client’s next session are all useful strategies. However helpful strategies can become problematic when they are driven by the things that we fear (‘aversives’). In perfectionism, these tend to be two specific things: (1) failure (by this I mean any mistake, rejection, or embarrassment leading to feelings of shame) and (2) the self-criticism that comes with not meeting a standard of perfection that is always just out of reach (Kemp, 2021).
When these ‘aversives’ are controlling your behaviour then you are likely to get hooked into many unhelpful patterns. Active avoidance strategies therapists might use include:
Spending excessive time preparing for sessions
Working much harder than the client in session
Chasing perfect understanding or a perfect formulation of the clients
Delivering perfect ACT therapy (trying to be Russ, Robyn, Kelly, or Steve)
Going over the allocated time to in order finish each session with a meaningful summary and demonstrate your usefulness
Spending too long writing up your notes to capture all details and ensure your notes are perfect if you are ever subpoenaed by the court
Attending more and more training and buying lots of books
While the perfectionistic overachiever is a common stereotype, in fact, many perfectionists struggle to achieve their goals. Passive avoidance strategies that cause problems for therapists include:
Being under-prepared for sessions because you don’t want to think about the difficult client
Procrastination and not finalising reports or letters because you worry that they won’t be good enough
Avoiding complex clients and breathing a sigh of relief when they cancel
Avoiding important yet difficult conversations because you are fearful the client won’t come back if you challenge them
Now of course you might have several of these habits, and they are not causing you any problems. If this is the case, fantastic. Keep doing what you are doing. These habits may be specific to your own work environment. For example, some workplaces require extensive notetaking, and you have the time allowed within your day to do this.
However, for many therapists, these avoidant patterns function as checking or certainty-seeking. By making you feel better in the short term, they are negatively reinforced and therefore are likely to persist unless you make a conscious effort to change them.
You can change unhelpful behaviours by building greater psychological flexibility and self-compassion. If you use an acceptance and commitment therapy (ACT) approach, you can tailor this to the nuances of perfectionism and use these skills to move from feeling stuck to striving for excellence in a flexible, imperfect way. Here are four key components to include in your approach:
Explore your fear of failure. Sometimes called the ‘Big Bad’, this will be the aversive that is controlling your behaviour. Pay close attention to your unwanted and uncomfortable inner experiences when you make a mistake and notice how you respond to your self-criticism. Your avoidant and unhelpful habits are designed to protect you from feeling this way. This is what you are up against because these unwanted experiences are likely to be triggered whenever you risk making a mistake.
Consider the long-term costs of what you are doing. Even if your current habits seem to be aligned with your values, they are also causing you bigger problems. Consider what life would be like if you could strive towards excellence without getting stuck in these unhelpful patterns. Imagine yourself in this future and use this to motivate you to make a change.
Choose just one small habit to change at a time. Perhaps you’d like to start your work a little earlier, rather than leaving it to the last minute. Or perhaps you’d like to send your letters after reading them through just once. Don’t try to change everything at once. Perfectionists often want to make change flawlessly, avoiding mistakes along the way. Instead, pick one small thing and try to increase the frequency of the new behaviour over time. Understand that you are likely to feel uncomfortable at first.
Remember to be kind to yourself. It may feel necessary to be hard on yourself. You may worry that you will be lazy if you aren’t. Yet criticising yourself when you are struggling only amplifies your suffering, making things worse. Soften your attitude towards yourself and treat yourself with the same kindness you would offer a small child who was learning a new skill from scratch. Learning how to offer yourself compassion is the final and most important step toward more helpful perfectionism.
Changing your unhelpful perfectionistic habits takes time and repeated practice. Remember that you cannot be ‘perfectly imperfect’ – there’s only imperfect. You can only start where you are.
Deutsch, C. J. (1984). Self-Reported Sources of Stress among Psychotherapists. Professional Psychology: Research and Practice, 15(6):833-45.
Kemp, J. (2021). The ACT Workbook for Perfectionism: Build Your Best (Imperfect) Life Using Powerful Acceptance and Commitment Therapy and Self-Compassion Skills. Oakland: New Harbinger Publications.
About Jennifer Kemp MPsych(Clinical)
Jennifer is a Clinical Psychologist who works with clients who are struggling with perfectionism and the mental health problems perfectionism facilitates and maintains. Jennifer is the author of The ACT Workbook for Perfectionism. She integrates Acceptance and Commitment Therapy (ACT), behavior analysis, exposure, and Compassion-Focused Therapy approaches in her therapeutic and consultation work. Jennifer presents internationally on the topic of perfectionism and is available for public speaking, conferences, and workshops.