Clients Struggling With Perfectionism

Perfectionism, or the tendency to demand or require perfection for oneself or others can be seen as an attempt to gain acceptance and avoid rejection or abandonment. Simultaneously, however, perfectionism can interfere with the establishment and maintenance of interpersonal connections and close relationships.

Although perfectionism develops in a relational context, the impact it has on other behaviors can result in the fear of being criticized or judged. Effective therapists must acknowledge these nuances and work with the client to explore components of the client's perfectionism, while effecting changes so that the client can meet his or her own needs without feeling the need to be perfect.

In this video program, Dr. Paul L. Hewitt demonstrates his approach to helping clients who struggle with perfectionism, an integration of psychodynamic psychotherapy and interpersonal theory framework that emphasizes the importance of clinical formulation and the establishment of an effective therapeutic relationship.

The dynamic relational treatment model for perfectionism integrates psychodynamic and interpersonal principles (see Hewitt, Flett, & Mikail, 2017; Hewitt et al., 2015) and emphasizes the relational basis of human behavior including relationships with others and with self.

In particular the approach focuses on underlying needs for belonging and self-esteem, focusing on how perfectionistic behavior offers a false promise to securing these needs. While individuals with perfectionism may recognize their perfectionistic behavior, they may not have insight into the contingent nature of perfection with relatedness and self-esteem, how it developed, nor how perfectionistic behaviors actually thwart these needs.

Thus, treatment aims to first develop awareness regarding the relational dynamics and unique interpersonal patterns underlying their need for perfection. The clinician can then help the patient move toward more adaptive and flexible ways of securing these needs of belonging and self-esteem.

Paul L. Hewitt, PhD, RPsych, is a professor of psychology at the University of British Columbia and a registered clinical psychologist whose research interest focuses primarily on personality vulnerabilities and their implications for psychological difficulties among adults, adolescents, and children.

• Hewitt, P. L., Flett, G. L., & Mikail, S. F. (2017). Perfectionism: A relational approach to conceptualization, assessment, and treatment. New York: The Guilford Press.
• Hewitt, P. L., Mikail, S. F., Flett, G. L., & Dang, S. (2017). Specific Formulation Feedback in Dynamic-Relational Group Psychotherapy of Perfectionism. Psychotherapy, 55, 179–185
• Hewitt, P. L., Mikail, S. F., Flett, G. L., Tasca, G., Flynn, C. A., Deng, X., Kaldas, J., Chen, C. (2015). Psychodynamic/Interpersonal group psychotherapy of perfectionism: Evaluating a short term treatment. Psychotherapy, 52(2), 205–217.

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